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00835
TOTE CHANGE OF OWNERSHIP,` P�
PUTNAM GOUT
Division of Environme
1 CERTIFICATE' "OF; CONSTRUCTION COMPLIANCE ;F.I
- � n
Located at = } Skv Lane
Owner Forrester Builders w
Arthur :Burdick_
Separate, sewerage System built by
1200` P ��: t -t
consisting jof LGaL= Septic Tank j r,
Other regwrements a
` *Water SupPIY r ,t �`'" °Public:9uPPlyr From ° •- T
X :Prrvate'.Supply.,Drilled, By
Address u
ng, ^Type ,
sid
Buildi Re ence
Nas Erosion ControrBeeri Completed?
dept k� -' -run, sand and g
,I certify that the system(s) .,as listed serving the above premises were
attached);, and in -,accordance yyrr��th the staripa its Lyles and regula'
..min rennal.�nr SdAJECr 'la Kf►LEA9E. b'( �Me� .1COr�f;KFSf�
TISSUED IN, NAME OF `ARTHUR DESIERVI
DEPARTMENT` OF HE vie. T H
Heath Seraces Carmel N Y 10512
SEWAGE D- ISP0SA'L4ST_�EM _ Patterson
3
Town or Village -
:1.4A `'ace spring ea ows
Job.
r
k
,Ad Brewster,
New. York .
238 f t ri
4 lineal Feet X 36 : width* trench
u `
w
No: of Bedrooms ''- 4 Date". Permit • Issued
el
'trucfed essential �s [bialth8 r hey; completed viork(copies of which are
Plans fUed, a it issu d the utpam County Department 'of Health,
:
Address r�
• - a2 �
� �r
License No. vV,Qa.r2 L'
Any +person occuPYing premises served by the above systems) shall prompt take su n as may, a secure the corr"ecfion. ,of any unsanitary..
Y
s _ sb.
conditions resulting from•rsuch `,usage Approval -of the ♦separate; sewerage aystem sfi �pu1k8J(
, _
oh as sanitary ibecomes
',;available )and he approval of the_prwate water supply shalI_become null and void :whe
in the.:judgment
:,public- .sewer
ecbrner available.; Such approvals. are
subject. to modification _or change, when,. of the Commissioner of,HealrfQ
edification change, :Is necessary: '
,
C aty
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Date,i�c'°�D B Yr
Title
r'
Mika;
WELL COMPLETION REPORT f'' PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of. Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is 'to be completed by well driller and submitted to County Health Department together with laboratory report* of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
CQ I
NAME
ADDRESS
OWNER
D
ui
LOCATION
(No. 8 trees ) (Town)
(Lot Number)
OF WELL
JC'
l
PROPOSED
DOMESTIC
BUSINESS
❑ ESTABLISHMENT ❑ FARM
❑ TEST WELL
USE OF
WELL
11 SUPP Y
El INDUSTRIAL El CONDITIONING
❑ OPeif )
DRILLING
EQUIPMENT
El ROTARY
COMPRESSED ❑ CABLE
AIR PERCUSSION PERCUSSION
❑ OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
3 THREADED' ❑ WELDED
(DR�IVVEE SHOE
LJ ❑
NO
WAS CASING 9OU D7
I YES J NO
Li
YIELD
TEST
❑ BAILED
j HOURS
1:1 y PUMPED [. COMPRESSED AIR
G.P.M.
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST fleet)
710
Depth of Completed Well
in feet below Land surface: u! a
MAKE
LENGTH OPEN TO AQUIFER (leet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (inches)
FROM (feet)
TO (feet)
PACKED:
gravel pack (Inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with
two permanent landmarks.
distances, to at least
FEET to FEET
��
/IAiCGr
C�/
I
i
-
.' 0 -g r, LOJN
T
i
I
i
I
I
T1
i
BOYD. ARTESIAN WELL
cpt
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE:.
3
Rr• D 3
DATE ELL C MPLETED
DAT OF
EPORT
WELL DRILLER (Signature)
ROUTE 52
3
CARMEL, N.Y.
CQ I
0 er or PurchAser of Building
%dpi
i, • ing Constrileted by
`2l
Street cat
9 . . j.
Muni c •
Block
Lot
GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his succes-
sors, 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 initial use of the sewage disposal
system, or any repairs :Wade by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices 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 1972- ,Signature
Title
If corporation, give name
F� and address
- - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 2699
sotnicE:
Forrester Bu i ders $ I ne .
RF, , 2
Pat P ersan# Ni ri
Ldkesprtng Headews Bevetopment
Lvd, 44 A
COLLECTED: Jae . 5 I2
BY: wt-I'l OM Riuoh
BACTERIOLOGICAL EYANIINATION
Coliform Count, MF Method 0. per 100 ml.
This result
indicates the
source of
the sample was
of satisfactory sanitary
quality when
thi sample
was collected.
June 7o 1972
0
r ichwit P. E.
Director
1'
- - :BIBBO ASSOCIATES
CONSULTING ENGINEERS
. - GOL E:NS BRIDGE.'N.'Y.:
_ OF NEW C.-
.I A.1 t \l
*,v,z . -'.2uN SAF1D J y.
r zoo Cs AL i R_ rs. ,',-
:D NL• SIC C jAm IL.
• .. .. � _j / �f•`� .. � _ - 1'T BOX �9 53 - .
Box
IZZ-51T M 4c:..- S S
i 33 ' JUN 151972 .
f r .! - j -` pC�LL • -�� —S N7
COIFIAM. UY 'IfE DF HER ..
�.G tSG,c or- : i �,� Z5'-• r� t J - C.'}, EAfAL HEAL. SEBYICFB
AZTr;L;Rc
AS BUILT SEWAGE. DISPOSAL SYSTEM
SAY - t_q PATTe2S
�eLL:I.aCATlcn� I.LCT AS ':Eg Pa oi-Cfi
L=-'
SHEET.._..... ..._... LOT .1..
. FIELDS REQUIRED= 't s FT, iL IN. VIDE TRENCH I ��iN• ;
FlE.IDS.INSSALL D `�
FT- = ° -'IN. TRENCH T HrlfFiEi�
.:SYSTEM INSFALLED Sy-- :g1LTitu¢ :isu2i:G'- /-75 S Tb- SEPTC. SYSTrcM A
pQfi.. /ST<<c ►LY: . TLGC lfA 012EGTTi_1NS CAF' G2A►NiIC�H -
-Ar-4 Lz
DATE _ _.
I #represent` that ,.I am whol y and,
aP1a: y
ths re
i
cons =truetE
as
bl,e far the design '
�s_epp_r_attee. sewage die- .
s ” the�appro ed
with the standards,
t Realth, and ,th at
Comrpl ance" • sag's
t: ®d- -to the, Departmexi,t
iii
s,,- s uc a e s s o r s hairs
ace An._ good oper, , t'i
ring' the period of ` fwo
ce of the appvove,l.
; Wr
al systam,or:
. �ve will, be l ' be 'installed `
of Putnam County
APi'RO,VF`., C NSTRLICTIQN: This `agpovai` e�p zy o
4
e%'from the date
is.s�.ed unI s construction 6f the bu .,?.ding has.'b'e ,�`e�i�tsken and is rem'
vocable -fo cause or inky be' amended :c�•r modified when• considered necessary
by -the _-Commissioner ,of Heal.th Any - caange . or` alterat on `Of �constructibn
re u3res{ ;e sw: permit.: Appro� red -for. dispo' a ` /dool� t.i6 sariI tart' sc�wsge .
._..�.
PUTNAM COUNTY D U HEALTH
Separate Sewerage
System
.. - . • Municipality
.
CONSTRUCTION PERMIT'
Located at__
E -Section Block
.N
3ubdivi`oionA n
'too tvs JO _ b-
Owner, Tff iC 1� SI
R Address c l,A 1EF 5. o of Area Ql�?� T
Building 'Type ll
-..
P� tt �51G
i
_-.-
No. of Bed rooms,
Total Habitable: Space / „!?O sq.ft..
Separate Sewerage •System
to cons ,&,'Gal. _Septic Tank lineal feet
width .trench
1'0 :be constructed by r :Address -
Dater Su -ply
PP
-: = ; Public Supply: -from •
Private Supply.o be drilled by
..Addre's's
1h,�a Requirements
= 't.};� �_. .�. a(' u .: JI•40J
I #represent` that ,.I am whol y and,
aP1a: y
ths re
i
cons =truetE
as
bl,e far the design '
�s_epp_r_attee. sewage die- .
s ” the�appro ed
with the standards,
t Realth, and ,th at
Comrpl ance" • sag's
t: ®d- -to the, Departmexi,t
iii
s,,- s uc a e s s o r s hairs
ace An._ good oper, , t'i
ring' the period of ` fwo
ce of the appvove,l.
; Wr
al systam,or:
. �ve will, be l ' be 'installed `
of Putnam County
APi'RO,VF`., C NSTRLICTIQN: This `agpovai` e�p zy o
4
e%'from the date
is.s�.ed unI s construction 6f the bu .,?.ding has.'b'e ,�`e�i�tsken and is rem'
vocable -fo cause or inky be' amended :c�•r modified when• considered necessary
by -the _-Commissioner ,of Heal.th Any - caange . or` alterat on `Of �constructibn
re u3res{ ;e sw: permit.: Appro� red -for. dispo' a ` /dool� t.i6 sariI tart' sc�wsge .
._..�.
COUNTY OF WESTCHESTER DEPARTMENT OF HEALTH-Division of Environmental Sanitation
DESIGN DATA SHEET SEPARATE SEWAGE SYSTEM FILE NO,
OwerfiRTRU 2C qjfirRVj Address PF- c
Located At (Street) ley t-,& m e_a&p kr Z 2- See. —L.Pio 6k__LLo tLY-0
AIndicate. nearest cross_ street )
Municipality, eft E R 5 ej N Watershed- Aji-sly 104K.. elry.
SOIL PERCOLATION.TEST DATA REQUIRED,TO BE,-SUBMITTED WITH APPLICATION,.....
Hole
Number!
CLOCK TIM.
PERCOLATION
"PERCOLATION.,
'Run'
'Elapse
tDepth to Water
Water
Level"'
me...
'From Ground
-Surface
in inches
'Soil Rate
I
Start Stop t Min.
'Start
Stop
in'
fMifi/in.-drop
aches
!'
Inches
Inches"
t
I
t
t
I
2 2'. 1 :
a; I
t
-
t
1 =4
t
T
I
i
1
I
t
V
t 1
1
t
I
r
I
1 2,1
1
1 -:A,.
3;
t
4
t
1
1
1
A-
5
T
or.
A I
1 2 1 1 t I t
t
3 ------
t
4
1 5 1 t
Notes:
1) Tests to be repeated at same depth until approximately equal soil rates are,
obtained at each percolation test hole. All data to be submitted for review.
2) Depth measurements .to be madefrom top of hole,*
e I , , D
TEST PIT.DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION- OF-SOILS ENCOUNTERED IN TEST HOLES -
DEPTH HOLE NO.' HOLENO. HOLE NO. HOLE NO.
G.L.1 22UPI ®0
nb
1®
3011. _.
36" ` M 6-Ayy C L #q y 10 :M
-- , :..
42,.
4811
54"
ze e, ...
6011 .. .:...... ;.
u
78"
INDICATE LEVEL AT WHICH.GROUND WATER�IS ENCOUNTERED.,
INDICATE LEL TO- C AFTER BEING ENCOUNTERED
TESTS -MADE. 8�
DATE
GOLDF-NZP t3m"a' .o. DESIGN
-Soil Rate Used 'M n /1" Drop: - S.D. Usable Area Provided,_„_® ®
No. 'of BedroomsSeptic Tank Capacity_Z� �i Gals. Masonry
Absorption Area Provided By 3 L. x. 36" Other`
�10
Name S1BB0 AS OCIAT S - ;I o�
Signatur o
CONSULTING
Address GOLDENS BRIDGE' Nt.•, Y- Ste,
otysFA 4f 3522.
Westchester Courity Health Department
Soil Rate Approved Sq. Ft. /Gal.
S.D. 27.6 (Rev. 5- 24 -66)
Checked by Data
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T 3 }AVG P V D_:GLEAN
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150 l .Y
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