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631- 589 -8100
24. -1 -98
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ev. 3/86. PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide
l�) P.C.H.D. Permit
OF
Name
MailingRddtesa old
Separate Sewerage System t by
Consisting of
FOR SEWAGE DISPOSAL SYSTEM
Gallon Septic Tank and
A / o4;'o
Water Supply: Public Supply From Address
or:— Private Supply DrWed.by%7 8 fIOS • Address 162 �a�'eY �e� + � • Q�,2 ��
Building Type Acs ei de.44 Tie,1 Has Erosion Control Been Completed?
A`
Number of Bedrooms )C :B u Y Has Garbage Grinder Been Installed? , Y
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown n the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and r4go-&-l-N tions, in accords a wit t Ift d plan and the permit issued by the
Putnam County Department Of Health.
Date �� �� s �l Certified by ...
Address a'ylbra & License No. 1
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsenita'
conditions resulting from such usage. Approval of the separate sewera em shall become null and void as soon as a publi: sanitary sewer becomi \/
available and the approval of the private water supply shall become null a v when a p Ic water wpply becomes available. Such: approvals a, , ((
subject to mod fication or change when, in the judgment of the Com r of Health ch revocation, modification or change Is neces ry.
�� ... \
Date �Z ` By Title
ti
Tax Map 24 °
Town or V e
Bla _ Lot 1 0
Subdivision Name m Sabdv. Lot # 17
Date Permit issued
�Z —12-94
A / o4;'o
Water Supply: Public Supply From Address
or:— Private Supply DrWed.by%7 8 fIOS • Address 162 �a�'eY �e� + � • Q�,2 ��
Building Type Acs ei de.44 Tie,1 Has Erosion Control Been Completed?
A`
Number of Bedrooms )C :B u Y Has Garbage Grinder Been Installed? , Y
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown n the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and r4go-&-l-N tions, in accords a wit t Ift d plan and the permit issued by the
Putnam County Department Of Health.
Date �� �� s �l Certified by ...
Address a'ylbra & License No. 1
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsenita'
conditions resulting from such usage. Approval of the separate sewera em shall become null and void as soon as a publi: sanitary sewer becomi \/
available and the approval of the private water supply shall become null a v when a p Ic water wpply becomes available. Such: approvals a, , ((
subject to mod fication or change when, in the judgment of the Com r of Health ch revocation, modification or change Is neces ry.
�� ... \
Date �Z ` By Title
ti
IV
x�
CERTIFICATE OF LABORATORY ANALYSIS
LAB ID NUMBER: 97 -5299
CLIENT:
SAMPLING LOCATION:
COLLECTED BY:
DATE COLLECTED:
DATE RECEIVED:
DATE OF REPORT:
M. Dottavio
11 Farm to Market Rd
Brewster NY 10509
Kitchen tap: 17 Big Elm, Patterson NY
M. Dottavio
08/27/97 TIME COLLECTED: 10:30 AM
08/27/97
09/02/97
ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED
Total Coliform Absent Must be "Absent" SM18(9223) 08/27/97
E. Coli Absent Must be "Absent" SM18(9223) 08/27/97
This'sample, as submitted- to -the-laboratory, and as -compared to the New York State limits for drinking
water quality for the tests performed, was:
✓ ACCEPTABLE. NOT ACCEPTABLE.
Richard W. Emerich, Laboratory Director
NYS ELAP #11218
CT Lab Approval #PH -0171
* Underlined results are unacceptable according to health department and /or US EPA codes.
** Maximum Contaminant Level (maximum permissible concentration allowed by health department and/or US EPA codes).
618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 - 278 -7600 / Fax 914 - 278 -7754 / E -mail: NoAmLab@aol.com
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
A
Owner or Purchas of Building
AM
Building Constructed by
Location - Street
Building Type
Tax Map Block Lot .
TownlVillage
R'l CA C
Subdiv' on Name
1
Subdivision Lot #
I represent that I am wholly, and completely responsible for the location, workmanship; material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with-the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee'to the owner, his successors, heirs or assigns, to place in good operating condition
any -part of ' said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system. -
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month �_ Day i Year
._ n .11
General Contractor (Owner)) n- Signature
om-��
T'�,&o
1
�L
Corporation Na e (if corporation)
Address: Rg
� 4�9g&
State wQ j' t�eA W 4 Zip ADTDI
Signature:
Title:..9sQ>S ,�2� /oy�C -�''z 41127d;l
Corporation Name (if corporation).
Address:
State Zip Zr I'z I
Form GS -97
�� a
0., ►�
�W YO4
WhLL UUMrLt;"11U1.v r%Zrvtcl
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOURESS: AWNIVILLAGLIC11Y TAX GRID NUMSE .
G- C(.,,i
WELL OWNER
NAME;
g(� 04IF,,%�c. 001J0,1�)OS-4
ADDRESS:
ANA"
PgIVATE
O PUBLIC
USE OF WELL
primary
2 - secondary
RESIDENTIAL O PUBIC PPLY O AIR /COND. /HEAT PUMP 0 ABANO NED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER .(specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO..PEOPLE SERVED '2! / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
E] PLACE EXISTING SUPPLY _ ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
W SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
' WELL'DEPTH ft.
oe
STATIC WATER LEVEL �f. ft.
GATE MEASURED /
DRILLING
EQUIPMENT
IdROTARY COMPRESSED AIR PERCUSSION ❑ DUG
O WELL POINT ❑ C 2 LE PERCUSSION O OTHER (specify):
WELL TYPE
O SCREENED . OPEN END CASING ❑ OPEN HOLE IN BEDRO K O OTHER
CASING
DETAILS
TOTAL LENGTH — fL
MATERIALS: STEEL 9 PLASTIC% O OTHER
LENGTH BELOW GRADE ft.
JOINTS: O WELDED THREADED ❑ OTHER
_ ..
DIAMETER __!k_ -_.— in.
_ _ _
SEAL: CEMENT ROUT ❑ BENTONITE ❑ OTHER
WEIGHT PER FOOT �I� Ib. /ft.
DRIVE SHOE, C] NO
UNEA: CJ YES ❑ NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
OYES ONO
HOURS
SECOND . _
. , ._. __.......
GRAVEL PACK
° �Y S
f3NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST It detailed pumping
M O PUMPED I tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER ; O YES ❑ NO
'WELL LOG if more detailed formation descriptions or sieve analyses
are available,, please attach.
DEPTH FRaM
SURFACE
water
Bear.
In9
well
Dia'
peter
FORMATION DESCRIPTION
CODE
tt.
tt
WELL DEPTH
ft.
DURATION
hr. min.
ORAWOOWN
It.
YIELD
gpm.
Surface
S(S t
' Li
�--
5
WATER IYCLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? OYES ONO
°
STORAGE TANK : TYPE
CAPACITY GAS. go G
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME`�`J DATE .
ADDRESS f� slGfntTURE
4/no v v
'V
PUTNAM COUNTY DEPARTMENT OF HEALTH
\� DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CER IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # PH-4 - 97
Located at a$ (44afDowm4")Fow,,,vi}lsge- o N & %P� w n
Owner /Applicant Name �,i a l 4 Dana tte- Tax Map 2 6 Block Lot
SLt't tr t
Formerly DO W ilu- Subdivision Name � 9,4a 6A _
Subd. Lot # 4-
Mailing Address
L o. Zip l ors 6 6
Date Construction Permit Issued by PCHD - 2 -9c
Separate Sewerage System built by � i p� a4lur5 Address fleoock
Consisting of 00 Gallon Septic Tank and 4 oo l., �' 2.4! I `Q"t w/
Other Requirements:
Water Supply: Public Supply From Address
or: /Private Supply Drilled by �'' ll, Address a Dl�
"
4
-Building Type 2vt At4vslc" Has erosion control -been completed?
Number of Bedrooms 4 Has garbage grinder been installed? O
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulation f the Putnam County Department of Health.
Certified by P.E. / R.A.
Date: 10-?-0-.97
n (Design �ro`fes�siopal)
Address e z , a0v- 220 , "&'C U5o h , IJ 4 Y ' 10 S z+ License # 0-79 r% 9
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modification or change is necessary.
By :G�3/ `Z% Title: 14 6Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
DEPARTMENT OF HEALTH
UIR', WELL COMYLETIUN Kbrur%l
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET AOURESS: Wror I �" Jn aUl y) TAX GRID NUMBER
Ba s --
WELL OWNER
NAME: ADDRESS: a
& _ ._ - Ba IS1 L. AA a' CO Id S
drPqIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
17 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO.IHEAT PUMP O A NOONED
O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT _-5— gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE 00 gal.
REASON FOR
DRILLING
(]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
STEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH r ft.
STATIC WATER LEVEL 49— ft.
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: 9STEEL O PLASTIC ❑ OTHER
LENGTH BELOW GRADE ft.
JOINTS: O WELDED ❑ THREADED ❑ OTHER
DIAMETER —2— in.
SEAL: CEMENT GROUT O BENTONITE ❑OTH
WEIGHT PER FOOT 17_ Ib. /ft.
I DRIVE SHOE eYES O NO I LINER: ❑YES GAO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
O YES ONO
HOURS .-•- ...___ ..
SECOND
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST If detailed pumping
MEJH00: ❑ PUMPED i tests Were done is in-
COMPRESSED AIR , ! ormation attached?
❑ BAILED ❑OTHER YES O NO
WELL LOG If more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
inq
Well
Dia-
letcr
FORMATION DESCRIPTION
coal
ft.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
9Cm.
Surface
C!
hirt
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ❑ NO
ANALYSIS ATTACHED? O YES ❑ NO
STORAGE TANK: TYPE
CAPACITY GAIL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME DATE (,
ALBERT M. HYATT & SONS, INC. .
ADDRESS Well Drilling SIGNATURE
Rte. 311 R.R. 2 Box 171A
PATTE °SON, NEW YORK 12563
3/89 ,/
McCORMACK SMITH ENGINEERS
UPPER STATION ROAD -
RR 2, BOX 2 2 0
GARRISON, NEW YORK 10524
(914) 424 -3848
Fax: (914) 424 -4067
October 31, 1997
Mr. William Hedges
Putnam County Dept. of Health
Division of Environmental Services
4 Geneva Road
Brewster, NY 10509
Re: Request for. a Putnam County Department of
Health Permit Jeremiah Estates Subdivision
Philipstown Cold Spring
S. D. Lot 4 Tax Map 28 Block 1 Lot 1
Dear Mr. Hedges:
By copy of this letter I am requesting a Certificate of Construction Compliance for
sewage disposal system for the subject property. I am attaching for your information
and use:
Certificate of Construction Compliance
3 Copies of a 2 year guarantee, signed by the installer
Water Analysis
Well Completion Report
3 Sets of as -built plans
Postal -. Money Order_ or Certified Check _ in .. the . amount-- of..$200..00 ..
You have inspected the subject property.
If you have any questions or comments, please do not hesitate to call.
Very truly yours,
Patti McCormack Smith, P.E.
PMS:ksm
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
046 �- �L'tvlib 2 . .....
Owner or Purchaser of Building Tax Map Block Lot
Building Co structed by G A
*& A
(L
Location - Suet
'-R&I cj,�:K-ul n
TownfVilla e
Qkftyu I JL
Subdivision Name
Building Type ',� I Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or. assigns, to place in good operating condition
any part of said _system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month = - - - -� Day,_ Year Signature:
General Con•ttMdr (Owner) = Signature
Corporation Name (if corporation)
Title: oxw�
Corporation Name (if corporation)
Address: Address:
State Zip State Zip
Form GS -97
YML-ENVIRONMENTAL SERVICES '
321 Kear Street
Yorktown Heights, N..Y. _10598
(914) 245-2800
Albert H. Padovani, Director
. , ~�r
LAB #: 87.305056 CLIENT #: 27 NON STAT PROC PAGE 1
DOWNEY OIL CORP. DATE/TIME TAKEN: 10/24/97 10:45A
442 LANE GATE RD ' DATE/TIME REC'D: 10/24/97 11:10A
COLD SPRING, NY 10516 REPORT DATE: 10/2B/97
- ` PHONE: (914)-265-3663
SAMPLING SITE: RR2 BOX 159 EAST MOUNTAIN RD SOUTH SAMPLE TYPE..:'POTABLE
: COLD SPRING NY 10516 PRESERVATIVES: NONE
COL'D BY: LINDA-BOLT TEMPERATURE..: < 4C
NOTES...: KITCHEN TAP COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
10/24/97 MF T. COLI� RM ABSENT /160 ML, ABSENT
/
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDI THE NEW YORK STATE
. AND EPA FEDERAL DRINKING WATER STANDARDS., FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
/
SUBMITTED BY:
- Hl � t . M. radovani, M.T.(ASCP) .
. -~�-
Di. tor ELAP# 10323
17
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Rev 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide C s.
P.C.H.D. Permlf q— ^ ,�
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM G,. i�/QIk Q�
Xa-
Cie r V
at �� SGd'7� � A�i t Tat; Map�°2'- -Block Lot �
Own pllcant NNameVbN W.,0 uf Formerly Subdivision Nair 426 Sufidv. Lot q-, _
Melling Address r o, �X �d ��� eL� zip Date Permit Issued
Separate Sewerage System built by ! k� W D x14 L Address
!Q
Consisting of � JrG Galion Septic Tank and
Water Supply: Public Supply From Address
P or:— Private Supply Drilled by A` Address -Ae�w :!! 7'� y °l
Building Type S� N . � � Has Erosion'Control Been Completed?
Number of Bedrooms • Has Garbage Grinder Been Installed? o
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work f copies
of which are attached),', and in accordance with the standards, rules and regulatio in accord an with the filed plan, and the permit issued by the
Putnam County Department Of Health.
�✓
Date toy Certified by P. E. R.A.
Address Gir'� l A` License No.
Any person- occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the` separate sewerage' stem shall become null and void as soon as a pubic: sanitary sewer becomes
available and the approval of the p►ivate'water supply shall become null a d k! when ter supply becomes available. Such approvals are
subject to /mmoodl catio/7 or change when, in the judgment of the Com, 1 of I oation, modification or change Is necessary.
Date �I BY' Title
PUTNAM COUNTY DEPAR'iM M OF HEALTH
DIVISION OF ENVIR01NMMAL HEALTH SERVICES .
�G i ✓-� /�/1 -4e-
Owner or Purchaser of Building
Building Constructed by
Location - Street
Municipality
Building Type
Section Block Lot
Subdivision Name
_ /2
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the. approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system. constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
"Certificate of . Construction _Compliance "_ for the sewage disposal .system,, or,any
repairs made by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this day of 19 Signature .10m
Title
General Contractor (Own ) - Signature
Corporation Name (if Corp.)
Corporation Name (if Corp.) P4), P,6k �i'u.� �''1��Aot 'l M)-)
Address
Addres
rev. 9/85
mk
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT C
Well Location
Street Address:
Berndora Estates
Town/Village:
Mahopac
Tax Grid #
Map Block Lot(s) 12
Well Owner:
Name: Address:
Donald Hill, P.O. Box 402, Mahopac Falls, NY 10542
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 42 ft.
Length below grade 41 ft.
Diameter , 6 in.
Weight per foot 19 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: Welded X Threaded Other
Seal: X Cement grout Bentonite Other
Drive shoe: X Yes No
_
Liner Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed X Pumped X Compressed Air
Hours 6
Yield 5 gpm
Depth Data
Measure from land surface- static (specify ft)
40'
During yield test(ft)
440'
Depth of completed well in feet
505'
Well Log
If more detailed
information
descriptions or
sieve analyses.,,.,. . _:..
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
20
Drillin
in overburden
clay and boulders
20
Hit rock
at 20'
20
42
Drillin
in rock
set . casin ,. , grouted
42
505
Drilling
in rock
granite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type Sub • Capacity 5=m
Depth 460' Model 5GS07412
Voltage 230 HP 3/4.
Tank Type WX #251 Volume 6_22c a ns
Date Well Completed
8/13/97
Putnam County Certi nation No.
Date of Report
10/14/97
Wei it si to
T. Beal, Jr.
1VV1 E: txact location of well wan distances to at least two permanent lancimarKs to be provraea on a separate sneevpian.
Well DrilleesNa;ng, P -F B 1 & n , Inc. Address: 4 Putnam Ave., Brewster, NY
Signature: Date: 10/14/97 10509
lcolln T. a , Jr.
While copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
I
� NORTH AMERICAN
� LABORATORIES, INC.
CERTIFICATE OF LABORATORY ANALYSIS
LAB ID NUMBER: 97 -6332
CLIENT: P F Beal & Sons
4 Putnam Ave
Brewster NY 10509
SAMPLING LOCATION: Donald Hill, Lot #12, Craescot Way
COLLECTED BY: C. Beal
DATE COLLECTED: 10/15/97
DATE RECEIVED: 10/15/97
DATE OF REPORT: 10/20/97
ANALYTE RESULT* UNITS
Total Coliform Absent
E. Coli Absent
TIME COLLECTED: 8:20 AM
MAX CNTMT LEVEL ** METHOD ANALYZED
Must be "Absent' SM18(9223) 10/15/97
Must be "Absent' SM18(9223) 10/15/97
This sample,._as submitted to the laboratory, and as compared to the New.York_S.tate limits for drinking
water quality for the tests performed, was:
ACCEPTABLE. NOT ACCEPTABLE.
NYS ELAP #11218
Richard W. Emerich, Labors ory Director CT Lab Approval #PH -0171
* Underlined results are unacceptable according to health department and /or US EPA codes.
** Maximum Contaminant Level (maximum permissible concentration allowed by health department and/or US EPA codes).
618 Clock Tower Commons, Brewster, NY 10509-9241/914-278-7600/ Fax 914 - 218.7754 / E -mail: NoAmLab @aol.com
RAESCOT
( ospholt pavement J
LOT
`;
�C\4
lh
0
�O
cross cut found
drill hole set 77; ,''�
ly 97 -, j '30 "
SEWAGE DISPOSAL TIE-INS (BY TAPE
+--- -- --- ------- - +- ---------------+
UNIT
O
B
WA.
Y
0= 61008'55
y)
o l�
147
0,° 11
L = 58.70'
154
utility boxes
�N o
160
concrete monument
;.3
ono
1,
cJ
cpncrete`
droin s10
71
1 #6
179
75
JEnd of Trench
electric meter I
48 1
1
t
sk
1
#9 165
36
3
\OS
30.5 1
O i
#1163
`;
�C\4
lh
0
�O
cross cut found
drill hole set 77; ,''�
ly 97 -, j '30 "
SEWAGE DISPOSAL TIE-INS (BY TAPE
+--- -- --- ------- - +- ---------------+
UNIT
O
B
ASEPTIC TANK
(O O i
0= 61008'55
J.B. #1
147
0,° 11
L = 58.70'
154
53 1
0
160
59 1
1 #4
o �
66
1 #5
173
71
1 #6
179
75
JEnd of Trench
#7 174
48 1
1
#8 169
sk
1
#9 165
36
3
Pt jl(
30.5 1
O i
#1163
SOGP va�ch 10ti
1 Opel, 0 r )
#1268
89
01
#13178
99
1
104
,a
A
j
#16196
111
.c t
6
oR�sE
N
N�
MSS
'9" '�
driveway
4?
well
`;
�C\4
lh
0
�O
cross cut found
drill hole set 77; ,''�
ly 97 -, j '30 "
SEWAGE DISPOSAL TIE-INS (BY TAPE
+--- -- --- ------- - +- ---------------+
UNIT
IA
B
ASEPTIC TANK
131
31
J.B. #1
147
49 -1
1 #2
154
53 1
1 #3
160
59 1
1 #4
167
66
1 #5
173
71
1 #6
179
75
JEnd of Trench
#7 174
48 1
1
#8 169
42 1
1
#9 165
36
1
#10162
30.5 1
1
#1163
87
#1268
89
#13178
99
#1486
104
#1591
107
j
#16196
111
w
v
N
r -iron found wall general/.
S 16 °33'00"
2X8
Oc
olonq
r
acs
/' llltnAm County Department
�`� of Heaitfi
t�lvision of Enviro=ental Health Servioes
� �n
o , Approved as noted for oonformanoe with
app able Rules and Regulations of the
r Ce p artme
J -i
Signature � Title ate
AS BUILT PLAN
SEWAGE DISPOSAL SYSTEM
LOT #12 BEPNDORA VALLEY SECTION 2
DONALD HILL
CARMEL (T)
BY: DANIEL J. DONAHUE, P.E.
DATE: OCTOBER 15, 1997
saB'E /II ='Id I
THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS
CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SEWAGE
DISPOSAL SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED
OVER. THE SYSTEM WAS CONSTRUCTED SUBSTANTIALLY IN ACCORDANCE
WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY
DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF
LAURENT ENGINEERING
ASSOCIATES, P.C.
MILLBROOKE OFFICE CENTRE
Route 22 8 Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
December 9, 1996
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS
Lot 17 Big Elm Subdivision
Courtney Lane
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of SS -17 "Proposed SSDS -Lot 17 ", dated 12 -9 -96.
2. "Application For Approval of Plans For a Wastewater Disposal System ".
3. "Construction Permit of Sewage Disposal System ", dated 12 -9 -96.
4. "Application to Construct a Water Well ", dated 12 =9 -96.
5. "Design Data Sheet ".
6. "Letter of Authorization ", dated 12 -9 -96.
7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only
8. Money order in the.amount of $300.00, review fee.
We would appreciate your review, approval and issuance of the Construction Permit at your
earliest convenience:
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
1 .
Harry W. Nic s, Jr., P.E. 0C C `HJ C-- 330 9G
HWN:bd
96069 J!ii;, `..w l ,i -1 1H, AN,1
cc: ' Mr. S. Satyanarayana A .1 i °i? "I >.% 1' � l 11 cl
a 21 %I]110�.'_d
DEPARTMENT'OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
0 /�- 14
WELL LOCATION
Street Address CTS Village City
L.�4
Tax Grid Number
WELL OWNER
Name
Mailing Address
5.
-T�Gey�msy�V Private
'Vylo2ZI O Public
USE OF WELL
- primary
2- secondary
RESIDENTIAL
9BUSINESS
0 INDUSTRIAL
D PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP D ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT $ gpm /# PEOPLE SERVED 3 S /EST.
C] REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION
13NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL
OF DAILY USAGE 606 gal
M ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
/
WELL TYPE
- DRILLED
DRIVEN ®DUG GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: aid �f��
Lot No. ��►
__.._.WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _)O_NO
NAME OF PUBLIC WATER SUPPLY: )y TOWN /VIL /CITY
DISTANCE TO PROPERTY.FROM NEAREST WATER MAIN:
i
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
Z c ti
(dat ) nature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt3- (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in s. anner as not to degrade or otherwise ntamriate —a ace or groundwater.
G jZ 19
ate of Issue:
ate of Expiration 19 Permit Issuing Official
is Non - Transferrable White copy: HD File Pink copy: Owner
Yellow copy: Bldg. Insp. Orange copy: Well Driller
1
Pr",M CaJN=.DEPARM%ff = OF HEALTH
DIV]fg-- .-OF- RMUCumqML FMLTH SEEM
DESIGN DATA. S=-SUBSUFACE SEWAGE DISPOSAL SYSTEM FIZE NO:
Owner Address /y
eV1 IC'5,91 - qTcrl
Located at (Street) 65yltlyry Z-41VAC Sec. Block Tot 1?7
(indicate nearest cross street)
Municipality xz Watershed
CIP6 7-0 A/
SOIL PERCOLATION TEST DATA REQUIRED M BE SUBMT= WITH APPLICATIONS
Date of ,Pre- Soaking 18 C7 Date of Percolation Test
Sld,61-M
HOLE
NUMBER CLOCK TIME PERCOLATION PERODLATION
Run Elapse Depth to Water Frcm Water Level
No. Time Ground Surface In Inches Soil Rate
6p�/7 Start-Stop Min. Start stop Drop In Min/In Drop
Inches Inches Inches
i /;/./ - 1",V
" /&
2 ¢
27
'? if
6. D
3
A
5
-Z 71
—2
5
2
3
4
5
N=: 1. Tests to be repeated at same depth until approximately equal 'soil rates
are obtained at each percolation test hole. A-U data' to* be submitt?2d
for review.
2. Depth measureients to be made from top of hole.
retv 9/8-5
DEPTH
G.L.
21
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
TEST PIT DATr REQUIRED TO BE SUBMITTED WITH e` x)LICATION
DESCRL )N OF SOILS ENCOUN'T'ERED IN 7F ' ..COLE'S
HOLE NO. A HOLE NO.' HOLE NO.
Topsv/G
s4A/o
/hoc /C
14/4-
To ASoIG
INDICATE LEVEL AT WHICH GROONDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED IV 14
DEEP HOLE OBSERVATIONS MADE BY: il,= r. / / /T� /I �� ci1 DATE:.
DESIGN
Soil Rate Used G - 7 Min/1" Drop: S.D. Usable Area Provided Sv o
No. of Bedroccns Septic Tank Capacity /2S-b /,/C- Type C�
Absorption Area Provided By 400 L.F. x 24" width.trench
Other
4 Signature
WAddress 41a&lPr,ylf� SEAL Cl)
iVo. 561 +4 /4` %r
THIS SPACE E% US t ' TH DEPAI` ONLY: ZPI
Soil Rate Approv' 4' !; ^� � lid sq -ft /coal. Checked by Date
ri �a
)�'T , Z__� _ ._ C C X T-Y I- r 'SZ" _ . )U ]E X�>
APPLICATION. FOR APPROVAL OF P,LA11S FOR A _WASTEWATER DISP.OSAG SYSTEM
i . Name and Address bf. Applicant: 5fl -.-=max 94
2 dame of Proje'ct: ko�' Sv 1>s' 3.•_,_Location �V /C: ��
4 • Project Engineer: � V %✓� ��.t%t -S a2�_
5. Address: Millbrooke Office Cent
. ... . .. .. .
Brewster, NY 1Q509
License f
ense Nuriber: S'vI -z" %. Phone: (914) 278-61.03........,
Pro.iect:.
Private/Residential Food.Ser.vice ....Commercial ,
Apartments Institutional :H6b.i,le .Home_ Park
Off ic`e Building.;::.'.. Realty: Subdivision Other .(specify)
i Is this -project subject' to State Environmental -Quality Review (SEQR)?
T'vDe Status (Check One) Type I.. Exempt
Type II. Unhisted. ;�,Q_
8. Is a Draft Environmental Impact Statement (DEIS) required? .. .....
IV le
g.,Has DEIS been completed 'and found acceptable by Lead Agency ?,
10. Rame of Lead Agency
'S
. Is this project in an area under•'the control of •local planning., zoning,
.
or other officials, ordinances? .......................................... r 90
2 If so, have plans been .suL;-nitted to such :author.ities ?. . . . . ... :.......... _ >'/'4i____
3., has prel in, inary approval beep granted by '.such authorities ? Date Granted:��_,
Type of Sewage Disposal: System Discharge....... Surface water _Ground waters
surface water discharge, what is the stream class designation ?........
Waters index number (surface)(,1V
's project located near. a public water supply system? .................. — Q- -_.� —•
'f yes, nave of eater supply Distance to water supply •..��%�.._._
Is project site near a public sewage collection or 'disposal syst,:-1 ? .....
_,__,___..__�_...
NaJ e of sewage system ,� Distance to sewage system
Date observed: 23. Fare of Health Inspector: ___....____ -
'roiect desisn flo•: (gal Ions per day) ...... ............................... _...._......_...
I
25. Is State Pollutant Discharge Elimination System (SPDES) :Permit required ?.._
26. Has SPDES Application been submitted to local DEC Office?
27. Is any portion of this project located within a des ign'ated:Town or State
wetland? ................................... ...............................
23. .Wetland ID Number ........................ ...............................
29. -Is Wetland Permit required? . ............................... ...... /Vo
Has applicatioo been made to Town or Local DEC Office ?• ...............
30. Does project require.a DEC Stream Disturbance Permit? .....................
31. Is or was project site used for-agr- icultural activity involving application
OT" pesticide$ to orchards or other crops, solid or hazardous waste disposal
landfilling, sludge application or industrial activity? ... YES'or.h0._ A%i
32. Is project located 41 thin 1;000 -feet oi= existence of abandoned. landfill;.._`':.
hazardous waste site, salt stockpile',landfill, sludge -.disposal site or'
any other potential known source of contamination? .....:_ .. .....YES or NO �d
DESCRIBE:
33. Is there 'a local master plan or file with the Town or Vi.11a'ge? ......
3:. Are co :unity water, sewer facilities planned to be developed within 15 years?..�
35. Are any*sewage.disposal areas in excess of 15% slope? _
36. Tax Vap ID t;ur,-,ber ....... ............................... ................
37. Approved Plans are' to''be: returned to: ................. Applicant _ Engineer
'I"' the application!is signed by a person ocher than the applicant shown in It .1, the
°pplication must be-accompanied by y-a Letter of Authorization: Failure to comply with t h'i's
Drovision.may be grounds for the rejection ;of any sub,-,lission.
I hereby affirm, under penalty of p,_rqury,- that information provided on this
fora is true to the best -of nmy PnoulEbye and bpl ief. False sta'te., ents 'made
herein are punishable as a Class A Hisdemeeanor pursuant to Section 210 -45 of
the Pena 1 Law.
:GiATURES & OFFICIAL TITLES:
MillbH oke Office Centre
s:LING ADDRESS: Brewster, NY 10509
PVINAM COUNTY DiIOAnM6 f OF HEALTH
OWNAl ►a!dalHeiftSeevkoa.Car":N.Y 10612 - -�
CSiCIiPICATB OF CO
. ,
GO
00 N POW FOR =WAG
Ltisbd f •
:rI ±
Meft Afiieaa.Ly l•�p•��ti G A//�lR/l �'%� .�Tc�Sl7 Town 2249yf3?wW zip
ja@ Subdivision Approved Fee Enclosed M Amn„ntTSOW �r
Typo 1 5 �.�, A��� e� – cot Are.; 0& �f -� Fm S«11o0 Ong Deptli—Vahme . .
Ntmber of Belhann Delp Flow G P D `S�. PCHD NoMmtim Is Repotted Wism FM' IS conobted
Sgwnm Sewage Sites b eaoabt at l GaOse SRI& Tack „x_ 07_- - f_1 ys Z�ft -es::
To be oeesftnabd by Addres
W*IW'Sttp*s PdWk Sqq* Fram—
an :k=, __ dvaft Std DrMad by
Otbar ReQahemenb _
1 represent that 1 am wholly and Completely responsible for the design and location of the proposed system(:); 1) that the separate saw di sal s bm
above described will be eonstruefed as shown on theipp►ovaf amendment theie�,to and ih.accordance' with the standards. rules a regu ns o nam
County Department of HeA th, .aml�that on conipletion thereof a "Certificate, of Construction Compliance'.' satisfactory to the Commissioner of Health will
be submilted to •the, Department, and a written guarantee -will .be •furnishW the owner, his successors, heirs or assigns by the bulkier, that said bulkier will
piA of ep sting condition any part .of `said sewage disposal system tluri�p thq,pS►bd of two (2 yeah Immediately followliq tIN'date of the Issu-
ppr of ,the Certifkate Of Construction Compliance oft • original. system o► any re s thereto; 2) that the drilled well described allow
will M located a shown on the approved plan and that said well will be inst 'in accordance In the nW►d ' i ins and rpu ai lions of the Putnam
County Oepartmentgol" knith. 1
Date RE R.A.
r �
APPROVED FOR CONSTRUCTION: This approval expires two years from the
revocable for cause or may be amended or'modified when Considered necesser
requires a new permit. Approved for disposal of domestic sanitary e
xev. at. �-ec. lam',96.8
10%88 -
C. —License No 5
due ess construction of the building .has been undertaken and is
the��lmis r of Himith. Any change or alteration of construction
91-01 �`
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
•- ,
Located at
(T) Section may_ Block /• Lot 9R'
Subdivision of
Subdv. Lot __L7 Filed Map ,h 2�6� - Date.
Gentlemen:
This letter is to authorized /jG�,�-� ,
a duly licensed -professional engineer or registered architect
(I 'ndica e
to apply for a Construction Permit for a separate sewage-system, to
serve the ab,pve noted property in accordance with the standards, rules
or regulations as promu1agated by the Commissioner of. the Putnam County
Department of Health,.and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity w:Lth the provisions of Article 145 'or
147, Education Law, blic Health Law, and the Putnam County Sani-
`3� NE4 °✓ y t
tary Code. Q� ,q� NNlCHOC9s�\
CO
-1 GNI
u Very truly yours,
Z, ° �'��'
Si ed
"Owner of Property
Telephone
•..
,° � .� /:.►illy . � •
Telephone
AP? E*D I X C FINAL S I t I NSPECT I CN DATE: 7 `� 3 -;F?
Inspected by:-�
STREET LOCATION L-d ._. " " "yam c�wr�r� S�' ^J �+ ��s N Sa ,— YA,�A�PaY,�
PERMIT # �� - TM # OR SJBD I V I S I ON LOT #
I. SE3oGE DISPOSAL AREA
a. SOS area located as per approved plans
b. Fill section - date of placsnent
2:1 barrier LGTH WIDT'ri
c. Natural soil not stripped
c. Stone brush etc..greater than 15' from
e. 100 ft from water course /wetlands
11 .SEWAGE DISPOSAL SYSTEM
a. Seotic tank size
b. Seotic tank instal evel
c. 10' minim.m from foundation
C., DISTRIBUTION BOX
1
1. A1; outlets at same eievat'on - water -emot
2. Protected below frost
,,. Minimum 2 ft oricinal sc' 1 betwe-en bcz _.
e . JUNCT I CN BOX - crooer 1 v _set
TRIENC.'ncth rGcuired - Yoa i
2. C4 _-dance to watercourse measured
►rstalied acwrdina to cian
Slcce of -reach acceptable 1/16 - ?` =2
5. 10 feet =ran oroperty 1;r.e - 20 feet
6. De-th of trench < 30 in &es from s.:rfa_e
T. Roan allowed for expansicr:. 100%
$. Size of cravel 3/4 - 1," diameter cie ^
Decth of cravel in try. 12" minimum
P i ce ends capped
c . Pl W OR DOSE SYSTEMS
1. Size of arno chamber
2. Overflew tank
3. Alarm, visual /audio
4. Pump easily accessible marMle to crac=_
5. First box baffled
6. Cycte witnessed by Health Department
estimated flow per cycle
I 1 . HOUSE
a. House located per amroved plans
b. Numcer of bedroans
r
V. WELL
a. Well located as per anoroved plans
b. Distance fran SDS area measured
Casing 18" above grade
d. Surface drainage around well acceotable
OVERALL WOWAANSH 1 P
a. Boxes procerly grouted
b. All pipes partially backfilled
;6.- A.11- oiges. flush -with inside of box
d. Backfill, material contains stones < 4" d�
e. Curtain drain installed according to oi:.
f. Curtain drain outfall protected & dir tc
g. Footing drains discharge array from SOS
h, Surface water protection adecuate
,.,.._. i b /: F.�, ^S�l;EG1`.•C`r1fi' ^�i ;� army i raar� _.
al
A
i r+sta l l
i
YES -NO I CO"-LENTS
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FLOW AN. GRADE 1 '
4" VERTICAL FACE i
a �
EMBEDDING DETAIL
STAKE TOWARD
3 L LAID 8
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