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•PUTNAWCOUNTY,blPi 44WALT-H
Divided dEnvb6nnitentai A6816,seirikei. 6ffliwk.y. 10516
ON
Alls Car Mad Pi&W
NAM
PXA.D: Pefulft
31
CA 0F toksmf Ice F,OijM*AdKDISPOSALSYSTEM t
"J
or
Tazz - 4- 4_6
Located at A 1
-SubAlvidonName
iw_a 4-t,-3.-7
Manisa tAJJ� SiAdV -o
Fee Enclosed,. 46-tint_ Tatia. Permit * lssuod..'
'— w S-ials Ss-m e System
CQU&fts of GaflonSejpdc Tank and 5d q eAd
Water 1511101i4: RuN; SaOply _R6 sfi Address
on , dvktb Snok Drilled by A 1 Z Address
7-
8 andf.9 110i 1,6i, Size Q3Z peiHas Ero.sion, rnntriil
Number d Bedwinni ][as Garbage;: Grinder Biash Installed?'
Other Requimments
I certify that the sisism(s) as listed serving the above•preinises were constructed essentially intially ad shown on the /plans of
the completed work copies
of which are attached), and in acc6rdanc6 - viLth the stand", - r'u'14i'id and At L ions, in I accordZ"Ce with the ;0 an -issued by the
0 a
Putnam County Department Of Health.
ti led b
errti Idd b
Date t
rr
Add, Kicen WN 0 669
Simi,
Any person occupying premium served try the atiove 5yitani(s) hall 6 lit a such action benscessary.to.secuni the correction -of an unsanitary
is it shill" null slid ld
conditions . resultin . 9, !rovn such ussils. -Approval of the Shall as soon as( a pubuz. unitary vinver becornes
Par.
oval bl and the h* prTs . I of the 484 lovatei supply,thin become, When a.,pub water supply becornes. evallablk SucW approval$ we
0 it 11 ' _': ' ,
subj t: 0 r"men. in -Ahe jiud Mont f� t of H t1i avoiMlon, rnodification or necessary
047� thO change It
By
_ff — Title
3/0
--- --------
0
Ir
Putnam .aunty Department of Health
" Division of Environmental Sanitation
- AFFIDAVIT - CORPORATE OWNER - -- APPLICATION
FOR PERMIT. APPLICATION .SUBMITTED TO -
;�` :. PUTNAM COUNTY }IEALTH DEPARTMENT i
A
Tb: Lommissioner of Hdalth - In the matter of application for. '
_ SU Bsl�„fL�,��
-1— — _ _.....:..._ . represent ;
'.: W .
that I am an officer or employee of 'the corporation and arri autlioriied-
to act for
(name of corporation)")
having offices at �. 1L'/l� � �.. �•�•� �•- .f�._ A. Z...
— — — — ,.. _ .:....:-_ .!: `;� '..a•..:.:. :.:.::,_`'r- WhosL- officers ,are
President
ame an
•ex;,ddres — , .............
Vice- Presidenfi
(Name and Address)
Secretary
• (Name and Address) _
.Treasurer... _ ._ _ - -• - - -- -- --
• (Name•and Addrese)-
!
. 4 !
and that I am anal will be individually responsible for any or all, actp
io :the borporation cwith :respect to the approval requested and all' sub- • ,
Sequent: act$ relating - thereto.
. Sworn to before me this` day Signed
o f 1.9-2-7 Title . ,/ [x.[ .c.L-1>!'d .
' N t y Public '
JOANNE Mr MASUR
Notary Public, *State of New Yort r'
s' Qualified in Putnam County D 19
Commission Expires Dm. 29, .190 U
..
Seel
Corporate '
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PUTNAM COUNTY DEPARTMENV OF HEALTH
DIVISION OF ENVIRQi A HEALTH. SERVICES -
Owner or Purchaser o Building Section Block Lot
Building Constructed by I
Location - Street Subdivision Nam
Mu;hicipalilty ( Subdivision Lot #
Building Type
GUARANTEE OF SUBSURFACE SE AGE 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 sham 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 ,systca_n,._or any- -
re s ri ade by i«e --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 Environmental 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
wpiy
General Contra for (Own ) - Sig ture
Corporation Name (if Co .)
o t t a G�J ► i� ZSIo
Address
rev. 9/65
mk
Signature
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(9 14) 245 -2800
Director: Albert H. Padovani M. T. (ASCP)
F
L
1
N Construction, Inc
South Quaker Hill
Pawling, NY 12564
J
REPORT ON THE QUALITY OF WATER
LAB fY _ . 2. clo 3 kl I -
Date Taken: 4 -17 -91 Time: 9:30AM
Date Rc'd: 4-17 -)l Time:
Date Report _-d: - r Im
Collected By: Jerry
PO /Client #
Referred By:
Sampling Site: Tap
Ouebac Rd, Patterson, BY
Phone ( )
INORGANICS (mg /L) MICROBIOLOGICAL
_ Alkalinity
Chloride
— Copper
_ Detergents, MBAS
_._. Hardness, Calcium
_ Hardness, Total
_ Iron
_ Lead
_ Manganese
_ Mercury
_ Nitrogen, Ammonia
_ Nitrogen, Nitrate
_ Nitrogen, Nitrite
_ Phosphate, Total
_ Silver
Sodium
Sulfate
Sulfide
Sulfite
_ Zinc
PHYSICAL MISCELLANEOUS
PH (S.U.)
_ Color (Units)
Conductance (uhms /c)
_ Odor (TON)
_ Turbidity (NTU)
_ Standard Plate Count
(CFU /1.0 mL)
Coliform & Related Organisms
Circle Method: a MPN P/A
I Total Coliform (V
Fecal Coliform
Fecal Streptococcus
E. Coli
KEY FOR
TERMINOLOGY
IT =
< =
Less Than
GT =
> =
Greater Than
NA =
Not
Applicable
SA =
See
Attachment(s)
TNTC =
Too
Numerous To Count
P =
Present (Positive)
N =
Not
Present (Negative)
* =
Also
done because To-
tal
Coliform Positive
REMARKS COMMENTS b Use
THESE RESULTS INDICATE THAT THE WATER SAMPLE
SATISFACTORY.SANITARY QUALITY ACCORDING TO T
WATER CODES, FOR THE PARAMETERS TESTED, AT T.
THESE RESULTS INUFORPARAMETERS T THE WATER SAMPLE (DID)
SATISFACTORY CH ITY STANDARDS OF THE NEW
ING WATER CODES, TESTED, AT THE
x
D hors- 9 rt -nt:nr
(For Lab Use)
SAMPLE TYPE:
(Check One)
x Potable
_ Non - potable
OUTGOING:
(Check Each)
HNO
HC13
— H2SO4
_ NaOH
ZnOAc
Na2S203
Other:
INCOMING:
(Check Each)
LE
40C
GT
4 /LE 200C
GT
200C
_ pH
LE 2
pH
GE 12
_
_ Other:
NYS FLAP #10323
(WAS NOT) (NA) OF A
YORK STATE PUBLIC DRINKING
OF SAMPLE CO TION.
(DID NOT) (NA T THE
YORK STAT PUB C DRINK -
TIME OF S COLLECTION.
7 /87(Rvsd1 /90)RWE
j �a
::..t
W
WELL UUMrLh11UA N-trUNI
DEPARTMENT OF HEALTH
- Division Of Environmert-a - Iieal- &b-Ser ices. -- - --
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
- -�� S/
WELL LOCATION
STREET ADDRESS. TOWN/VILUCILIC11V TAU GRID NUMSER:
'
I
WELL OWNER
NAME. ADDRESS:
PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE �Q ygal.
REASON FOR
DRILLING
V NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft.
STATIC WATER LEVEL �4� ft.
DATE MEASURED
DRILLING
EQUIPMENT
O ROTARY FCOMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
/
❑ SCREENED O OPEN END CASING. IE OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH fL
MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE ft.
JOINTS: O WELDED THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT O BENTONITE VOTHER
WEIGHT PER FOOT -Z lb. /ft.
DRIVE SHOE: YES ONO
LINER: O YES IVN0
SCR
DETAILS
JDIAMETER (in)
'SLOT SIZE
LENGTH
DEPTH TO SCREEN (ft)
DEVELOPED?
IRST
_
.-NO -
-Na um
um
S CONO
-
- — - --
GRAVEL PACK
O NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH tL
BOTTOM
DE, iH ft.
WELL YIELD TEST I If detailed pumping
METHOD: O PUMPED i tests were done is in-
COMPRESSED AIR , formation attached?
O BAILED O OTHER ❑ YES O NO
WELL LOG It more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE
wafer
Bear-
ing
wen
Dfa-
meter.
FORMATION DESCRIFTtON
COOE
ft
ft
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
9Pm
Land
Surface
a6 0
6
0
WATER CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
1
STORAGE TANK: TYPE (kX// xf�,
CAPACITY GAL.
PUMP INFORMATION/
TYPE�J6 9 C t9j ZA CAPACITY
MAKER DEPTH
MODEL VOLTAGSoUdHP
w LgERT MMEHYA & SONS, INC. DATE ..
ADDRESS Well Drilling 610ATURE
Rte. 311 R. R. 2 Box 171A
PATTERSON, NEW YORK 12563
gr,. L �-� L•,IS Cat_
Ic L_==a, by
CRIER
- Ts
ES area lc=
_ _ _II- � = -- ?tip= :,I_._ . - - -- Ca•'�r_
b_ E411 sC_. Ica - Dam c= Plac:_=r--�lt
C_ PTar i� sci? r_ct s - i=e
tin I-5' f-
E-C - Gii
..tJ_
1 C'O fi___ f_C : ticL� CCl'r��T:vc— 7 cnE--_ f f
a. Eentic tank 00 I,;c
cr-
r
Ono i-ar .=c - CI? Gi Z �^ 1-(} -- C= I I
2.
E. R a! -� =cr Er- �5_cr_, 50%
S�=
C-=
U . DEC'I C C ��T�
ir-! tr =. Ica L"
• Pi =a c =-= Ea _
j S_ze of r:= C:--a
1rar cvcle
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b _
C_ li vi=es w � i '`T _1 t =in05_G1°1 1
of LCY a�_ vi=es f_'�
ir` i l i -- ^ i CCr i Zc s tcnes < a .. rl
to clan
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C. i_-Ct,2.n n - = C_= ` -arce away t =t.Ci c--
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cn 5'_ct`° c =ter =r t 1
el evat cm
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of LCY a�_ vi=es f_'�
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c_� r--
C. i_-Ct,2.n n - = C_= ` -arce away t =t.Ci c--
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cn 5'_ct`° c =ter =r t 1
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. llii�rllM� Pima - '�++`L6t`i
77 777
PP a
�tl�divsion Annroved siN`�A-
i eriiwsa Z �. c
8e�aeeM Sew�ip S�ilits is aestiat al�de®i® Sa�lr''1
b
Tr bell
e 71; ,
Watt= � UJLYw i� •
ees wiaia S_Dil�ea b! -�
1 rePraant that 1 am ver1iO11Y anst: cOmPNtily ieip �fiCN for tM rM
abovo,i, tcritxfd will (N'o0nst ►YGt®d ii illown OII tONipprOVaA a/11t
COYllty . pepwtment :01 /fMlth. anA, 11N On eoiilpNtior� tfi}erstoti
tle '-swbatitteO -to t11o:'.OpOt iNnt and - -i° writtMl ,gwrantN :will
PtK� iiia ope►ati11/ ".eow0ltion i11Y.' Dirt of `p10 eawaN 6N
Saeis Of *6 apP/oval of tNi :CatNieafs - of ConsArlrctiorr :COrrlp
ww aio Ioeit�0 as tAewli orl thi iPPreveit pNn andtllBt sikl.wN1 w
coinny rtnlerlt Ot F1MItN G
cc) tO-,t
APPROVED FOR COwSTRI,ICTIOM Thro appaovil expire two y
r1111"i0le iiir Cause cw,- tie aeilerlded, or "Odfiid wfan bonsldl
mu "I a permit: AHPr eO tO► 9isp -1 of domestic stir
Rev. /�
ano location of ,tne p►oposeo tsyst ®m(q t1j tAat tna•1ssparat®;'fsw } ' di fN� ` ftem
ent tMie to ind'in accoi9anco witti�tM ataritlards,iulrie a r�u , nt o 4 nam <
artif{ eats, of Construction:COmpllin'fiti fsctory ao tM Coriimisfb�ii of Mfailt1►w111 s
lurnhAeA tM OYIIM/ his sucasaon,'UONs or lf6ipii by t6e &Md4lr that ,fiid &,Mo will; ._
1: iyst�rii Aurfng the, PW104 Of two (2) yeirs (rnnwalotoy fOlOOaiin, tMtlate Of tM hw -.
i_ of the orginal syrtem„or any. reOiMS tMr t 44 Mt t1►e Ailhid wN1_Aesp10e0 ibow'
In in accoritanOi.. rsitll t aiioa ulss siia rayuraE oni s of: tM Vutnam
F
r w
� '`k:ense'Plo 3
from the Ante` issued Yn005 GOr1ftlYCtion, 04 tM bYilAing Jwss;'been uextaRpkin -and ,is
IeCWlti9r�I�by tM� °,COIIInliffiOnM ot:, tigtth..,•Any chiin®o ov eltpatlon of eomt►irctkm
Other Beg4,imente
I represent that 1 am wholly. and completely responsible for the design ai
above described will be constructed,as shown-On the appiovad amendmer
County, Department of Health; and'thaf on completion thereof a; "Car 1. be� submitted to the Oepartment,' and: a written,guarantea will Ibe.fu
place in ,good operating condition. any part of said sewage disposal
ante of tM'.app ► oval` of the Ceybficate.. of Constuct�on Compliance
will be lo'eated as st dw� on the,approVed plan and tF_ at said well WIWbe h
County - 'Department• of Health: `
Date I' ` 24+ �,. g% 5 nad_
Adtlress 7
APPROVED FOR . CONSTRUCTION ..This,'a6piowal.e' pires..:two years `fr
revocable'for cause or may be amenaed or.motlifierJ "when consitlair ne
requires a,hew permit. - Approved /fo�rjdi�spJosLe� ot� domestic sanitary�l
Rev.`.
1187-1 Date
location. of. the.. propgsed system(s); ai. t, hat the separate .sewage disposal .system
here to and in iccoidance with the standards, rules and reign a ions o e 4 nam
Bate of Construction Compliance" satisfactory to the Can rhiasioner of Health will
sheathe owner, his successors, heirs or assigns by the builder, that said builder will
ltem'durinq the period,.of two (2i years{mmadiately following the'date of the.,lssu-
q�ortq lnalsystem.,o►,dny repairs thereto; 2) that the:drllled well despibed „above
, in a ccordance ::w.iith the standar �71 ' an repu O i�f the Putnam
vW
P
E.
License. No tG1�2�
0”' i sued unless construction of the building has been undertaken .and is
sary 'by the Commissioner of Health. Any Change or alteration of const►ust ion_ G
age;;:a ate water.
,Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
rW0 COUNTY CENTER - CARMEL, N.Y. 10512, (914) 225- 3641',
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
WELL LOCATION
Street AddreM
Q a & k P_ A= V_'�
Town
a Ce
e e► Tax Grid Number
=A S, 41 - - Ya-S
WELL OWNER
�,N a
ailing Address
WATER MAIN:
Private
O Public
USE OF WELL
- primary
2 - secondary
O( RESIDENTIAL
O BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY
O FARM
O INSTITUTIONAL
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT__5_gpm /# PEOPLE
SERVED /EST. OF DAILY USAGE' 0
REASON FOR
DRILLING
NEW SUPPLY
OREPLACE EXIS
OPROVIDE ADDITIONAL,_SUPPLY
NG SUPPLY 0DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
ew—
s id e
WELL TYPE
DRILLED
DRIVEN
ODUG O GRAVEL
O
OTHER
IS WELL SITE SUBJECT TO.FLOODING? YES _ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 9
Lot No.
WATER WELL CONTRACTOR: Name �,�j °�. Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _,&_NO
NAME OF PUBLIC WATER
SUPPLY:
N
TOWN /VIL /CITY
DISTANCE TO PROPERTY
FROM NEAREST
WATER MAIN:
'V JA ,
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION ON SEPA E S
(date) signature
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 thirty (30) days of the completion of water well construction,
the applicant s.hall:
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 De artment.
Date of Issue: 19_ - ---`�`
Date of Expiration: 19� ermit Issuing ici
Whi
o H D Fi 1
e
Permit is Non - Transferrable
2/87
copy° . .
Yellow copy: Building Inspector
Pink Copy: Owner
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL ;�%
PCHD PERMIT # I-0 -a s
WELL LOCATION
Street Address
P&&rsoh
Town /Village City Tax Grid Number
P.-Y. Mae 51 -- 81a61k-- 7- to f 4
WELL OWNER
.dame ` Mailing
J - V , l„ QV)'51 J1Utlf'i7'
Address ,� ��
V -,� epc,� f U' 1G/,e
]&Private
O Public
USE OF WELL
primary
2 - secondary
O'ftESIDENTIAL 0PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP
O BUSINESS O FARM -O TEST /OBSERVATION
O INDUSTRIAL L31NSTITUTIONAL O STAND -BY
0ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT 57 gpm/ #
PEOPLE SERVED 3 '-4 /EST. OF DAILY USAGE 46'0 gal
REASON FOR
DRILLING
MEW SUPPLY
OREPLACE EXISTING SUPPLY
OPROVIDE ADDITIONAL SUPPLY
13DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
ew Q
WELL TYPE
®DRILLED
DRIVEN
ODUG
OGRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name '-ii7 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V0, NO
NAME OF PUBLIC WATER SUPPLY: Vj IIa TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Q
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION ON SEPARATF SHE
(date) signature)
2auzM
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 thirty (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
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the
Date of
the Putnam
Putnam County
Health Department. _
Issue: 19 -Z�r 'd,
Date of Expiration:
Permit is Non - Transferrable
2/87
19
Permit Issuing fficia
White copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orange copy: Well Driller
APPS IDIX B
PMMM COUNTY DEPARII�ENr OF HEALTH - DIVISION OF ENVIROMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY _ &.. SUBSMFACE SMAM DISPOSAL. - SYSTEMS
C���, /• Gam17 Govy ��,71t.
0/ '�O
6) >P
l
REVIEW SHEET -
^` tech}
DCCU &qTS
Pernit Application
Corporate Resolution
Plans - Three sets
Engine -rs Authorization
Design Data Sheet (DDS)
Deep Hole Log
(Name of Owner) (Street LCC3
CCi�N`I`S I YES NO
I �
I
I I
- I
I I I
�i�nn.,/, // Uor /dyjGP
I
LF trench provided ? `7 O f /do j I I
reguir
G -- 60 ft. max.
GParellel to contours .
X05 eKp.
1
FILL SYSTEMS
cla barrier
to ft.
fill notes
new spec. - do
depth gauges
-2 0 o ff
100. . flood ele s d�
200 ft. reservoir, etc.
� l
150 ft. trigall /gall.
x
F 2-1 v
DATE '- ',Y-ED •
BY:
s/s
Consistent Perc Results (3)
Perc Hole Deoth
Plans - Two sets
Well permit, PWS 1e _te_
iance Request
SAL
Legal Subdivision
Su'rdi vision Approval Checked
F:�- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Sarre
REQUIRE] DETAILS ON PLANS
SUEDIVISICN
Perc / /5
F-i!_
C';
Sewage System Plan - (north array)
S -.Vage System Hydraulic Profile Flcw
Fill file & Dimensions - Volum
D o ;Trench /Gallery; Pump pit details
Sept' ank - Size, Detail
Well Detail, Service- Line if over
Consn (iff Notes (grinder rate)
Design Data: perc and deep result se /
Two -Foot Contours Existing & Propo
Drive,ry & Slopes Cut
Footina/Gatter,Curtain Drains (disc: -urge OR)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; sham grave y f ad's' T . siz V
If Pc�ecl Pit & D Box ! own &Detailed
House - No. of Bedrooms
Wells & SSDS's Win 200 ft. of Proposed System;
Prof - .1 Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Binds; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fi]
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake ( inc. e-Tan
15' to Drains - Curtain, Leader, Footing
35'to catch basin, stormdrain, piped Watercours
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Minks
•_10' from Foundation; 50' to we'll
F 2-1 v
DATE '- ',Y-ED •
BY:
s/s
Consistent Perc Results (3)
Perc Hole Deoth
Plans - Two sets
Well permit, PWS 1e _te_
iance Request
SAL
Legal Subdivision
Su'rdi vision Approval Checked
F:�- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Sarre
REQUIRE] DETAILS ON PLANS
SUEDIVISICN
Perc / /5
F-i!_
C';
Sewage System Plan - (north array)
S -.Vage System Hydraulic Profile Flcw
Fill file & Dimensions - Volum
D o ;Trench /Gallery; Pump pit details
Sept' ank - Size, Detail
Well Detail, Service- Line if over
Consn (iff Notes (grinder rate)
Design Data: perc and deep result se /
Two -Foot Contours Existing & Propo
Drive,ry & Slopes Cut
Footina/Gatter,Curtain Drains (disc: -urge OR)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; sham grave y f ad's' T . siz V
If Pc�ecl Pit & D Box ! own &Detailed
House - No. of Bedrooms
Wells & SSDS's Win 200 ft. of Proposed System;
Prof - .1 Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Binds; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fi]
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake ( inc. e-Tan
15' to Drains - Curtain, Leader, Footing
35'to catch basin, stormdrain, piped Watercours
10' to Water Line (pits -20')
50' intermittent drainage course
Septic Minks
•_10' from Foundation; 50' to we'll
p(3TD AM Wl1i�tA'Y �r,Yructlnciyl' yr izrliLiiu
.•DIVISION.OF HEALTH SERVICES.
DE.c7rnq MrA SH=- SrJBSUFACE SU?AGE DISK— SYSTEM FILE No.
owner P141i 140 404 Address lea iarnn,1 l�, Yl �o��,i .. %G
Located at ( Street) Q cfp -hY 200d fe Block Z_ riot 4 +5'
(indicate nearest cross street), MAP
Municipality '10",, n,' PG Watershed
SOIL PERCOLATION= DATA RD7UIRED TO BE SUBS= W= APPLICATIONS
Date of Pre- Soaking -11 i� s? �' _ Date of Percolation Test— I g']
HOLE
NU4EM CLOCK TIME PERCOLATION PERCOLATION
1 Run Elapse Depth to Water Fran Water Level. j
No. Time Ground Surface In Inches Soil Rate ..' `
Start-Stop Min. Start Stop Drop In Min/In Drop �.
Inches Inches Inches
1111121- II:SS
2
3 11:32 I ; 05
4 ..
'27 3 . .. 9.s
27 3
27 $
®1a
n
t 1 II ;Z 151 23 24 21
2 24 24 27 3
3 IZ; I j -` 12 ;42 26 24 27
4
5
1
2
3
NMS: 1 1.
2.
rev. 9/85
7t is to be repeated'at same depth until approximately equal soil rates
ale obtained .at Amch percolation test hole. All data to' be submittlaz%
for review.
Depth. measurements to be made from top of hole.
F
NMS: 1 1.
2.
rev. 9/85
7t is to be repeated'at same depth until approximately equal soil rates
ale obtained .at Amch percolation test hole. All data to' be submittlaz%
for review.
Depth. measurements to be made from top of hole.
F
TEST PIT DATA RMUIRM TO BE SUBMIT m 'WITH APPLICATION
l' -ro PSoIL
So�nc+ 15 141. trccc 5c�»►et 5ilf, +�4u
3' f Grxva L� v
4,
5'
.6'
i
7 S &44, T. P,
8!
10'
11' ;
12'`
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED
DEEP HOLE .OBSERVATIONS MADE BY: J DATE: 8-7
DESIGN
Soil Rate Used t1 -tS Min/1" Drop: S.D. Usable Area Provided Sc) qo
No. of Bedrooms 2 Septic Tank Capacity Woo gals. Type C'6.xe,a, p,
Absorption Area Provided By 253 L.F. x 24" width trench
Other
Name �,- f� +t;foh.�. r,nr�,�ar�ar;r�. x:�.�.00. Signature Q
Address ? f fi L' I G! (y ✓ SEAL
ip
THIS SPACE FOR USE BY HEALTH DEPAP-UTM ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
I
i A-/ o eZG?
8
�5:3
LINO'
rte'
:-,9L3___
�-� -4cc 3� -
14 f,lq 1 4 f / 5 5<G /Cv
i
02i
9
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_C.'s
m G�
V
5 \,
,moo -r.E
D.aTUM GL-oS�
TDFtX,- IPNICAL �UeV Y
J'.V. C OillJ STiZVCTIO�V
LOT- kJOS . 1-4 G 31- 4 Co ail
-,, ✓�P �Tl�� �a .- - c 1. ,c : /*9 P�- cJLl✓L�;, 3- O- 31
TO►v.v oF" t� 771- z F`--iL.JrA-JA !U co,�v. Y--
iG1Gd'r10Jai ILr->'CATEZ) 144 -yFr� S1��JlG`( t} TNIS
.Y vLL veal PO, vF n 1 u Accce L- AI-r lejT -'nom
4-y- cce L.A1.10 ALx-- -fF_L-
E t,JE]c1 -f004 SWE AI�dk-T106j c� F YI 4i!CA Ai._
SJ�IE iOP/i l!L GEYTTF��4'�G lh ':,Ndl-L 2UI i xJL',
- �fi0�l R� 'vJFJCYvI f}IE. S >�E' f Ih POSF4kKEL A/ IC,
�:vAAPAJ -!'1 AI-lC>
JT -101-1 t-.15TF -7 Heimc*j ceonC7 CA - !otitc. A2E. L-CS'
;P-:'P.4ai-F --ro Ac -cmo+ AL- t"Sfrrul iokj,i oo-
�L>E�.rr- actis.lces.
vuALYI` o 17 A,L7E-z4T'IOr•..1 CO AcoMO -f -0 711+5
S� Ie�rEY 1,-7 A \,/IOLATIOi J cG- SEc7looJ* -72ce oc
-T14 IJEICJ -(b SrATE7 E sCT104 ! LAV-1.
�U2E5 IF 41- ( KI:V SNOkL I.;
A, L ck-- TIFIGA`no"-,5 HEOE -CII J Ag!F- \A4 JCS f=bC
7P K MAP AQD coP1Gfi 7)4E2EC>C- OUL`( IP -!5d.1 C
Mdf-' oe Go6iE; BEAe - F- INtPOE-51�- SEAL
eG -Twe SUe\/E"koe 1LWosF- 4C4-I n-9! F APPEAM 1
F�.r?L.Oi. -� • I
E.. "Q sTY��-
Uo. 4CIIAO 7
I:
COUNTY BOARD OF HEALTH
President
DANIEL SELDIN D.D.S.
Vice President
914/225 -3641
- County —JOHN -S IMMONS- -M-.-D--- - - - - - --
Deputy Commissioner
J. ROBERT FOLCHETTI P.E. M.S.
Director Of Environmental
Health Services
PAUL ROLAND DEPARTMENT OF HEALTH
Secretary ELAINE KRUEGER R.N. M.A.
GERALDINE A. ZAMOYSKI M.D. County Office Building Director Of Patient Services
ALFREDO F. GARC I A Jr. M.D. Carmel, New York
PAUL CHANG M.D. 10512
JOYCE MILLER M.D.
WILLIAM ZURHELLEN M.D.
HON. THOMAS BERGIN
August 18, 1977
AUG 19 1977
Mr. John Prentiss, P.E.
R.D. #6, Box 353 ;JOHN h• ?R-EN I ISS, P.E.
Carmel, New York 10512
Re: Castelluzzo - Lot #9
Quebec Road, Patterson (T)
Dear Mr. Prentiss:
The Board of Health, at their August 16th, 1977 meeting,
granted Mr. Castelluzzo's request for a variance from the 100 foot
required separation from his own well and sewage disposal system;
with the following requirements:
The well be doubled cased and this department be supplied
with a statement from the well driller on the depth the casing was
cemented into bedrock, and that cementing continued until a steady
stream of cement was observed at the surface; this statement should
accompany the filing of the Construction Compliance documents.
If you have any questions concerning this matter, please
feel free to contact this office.
•
Very �ruly yours,
Bruce R. Foley
Public Health Sanitaria
BRF:dlh
I 3.A
PUTNAW ;COUNTY 'DEPARTMENT OF' :'�HEALTH
Ofwsion j
of Environm6ht'al. Health.Servidet, Carmeb-i N. Y. 105
Pa tte rn s6
4 0R.SEWAGt - DISPOSAL
CONSTRUCTION itRMli SYSTEM
.,Town or Village
. Located !Tax map B'loc 'k,
t! " il
Subdivision. Putnam Lnkp J� Lot o "Job
Anthony CaSt! f1l I UZZO
owner Address 3+
21jitaie"alk r
Building Type •Trame Area I e., 4, JL Mp
Lot Ar
... ......... .. .. . /0 >a
056*�,,-,Aiquare Fdet
Number of Bedrooms Thm Design Flo, 600 teal - 'rotal Habitable Space
.Separate Sewerage systeA'Ao',colnsist of: �nntlW Gal. Septic Tank (and
To be constructed by Ail-dress 1 11
Water Supply: Public Supply�'Froff.
P vate.
r .
! Supply to be drilled by
Address
Other' Requirements None:
I represent that I am wholly and, completely: resipon sib le for the design and location of the proposed system(s) 1 1) that the separate ^sew age di sposar system
above described will be constructed as shown on the approved amendment there to and In accordance with the standards, rules an regulat ions o FORM
County Department of Health, and that on completion thereof, a, I 'Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted..to the Department, and -a written guarantee;wlli-be furnished the owner, his successors, heirs or assigns by the builder, that said builder will'
place in good operating condition, any, part of, said sewage ,.disposal system during the period of two (2),years Immediately following the date of the* Issu-
ance of the approval of the Certificate of. Construction Compliance of_the original system or any repairs,thereto-. w
2):that the drilled eWdescribled above
will be located as shown on the approved plan and that sald'well will be InAstallein accordance with stanOprds,, rules,and,.-reguia ons_of,,,.:the Putnar►
County Department of Health.
I Fpbruptry.1977 ne R.A.
Date _gr._d� P.E.
43,
5, rM.
, 1 , I License - -'
Addrels 0 X rmej . Ti Y 1 r� 131 N .1206
0.
a. APPROVED FOR CONSTRUCTION:; This approval expires one.,y�Mfrom the date issued, unless� construction of the building has been undertaken and 11
revocable for cause or may be amended or modified when considered necessary 'lby-"i Commisslohor, of Health. Any change or alteration of construction
requirei,a new- permit.... Approved for: disposal of,,domestl sanitary sewage)and/or, private 1Watef, supply only. •
Date Title's
INI,
OVERFILL fOR 5VfLEM0-NT
FINISHED GRADE
+ 609
4610
4611 4612 x}613
H61+}
4615
4616
tGl9
GLEAN FILL
LAYER OF SALT HA--f
NO'20'00N
LLFO.00'
4620
OR UNTREATED ELDG.
__
•�
PAPER
PERFORATED PIPE
o
��o
4637 (6
Z'+636�7
- --
—
— ++635__
- - - --- - - --
4634 4633—
r
_ —_
X1632—
—4631
i ��
o
0
�
�'�
"YFT.
' �--
Vvc) SLOPE %3Z
--
i
" '
'�/ Ii2" CRUSHED STONE
",P6
FUTURE` Gel,
I � —�
I Y
O� WASHE D GRAVEL
t�Anllc
—
Lt, 22)'
RESIDENCE
�g632
le
�
(020,\
RI;tAIr11nIG
I WALE
tED
��IDMIN-
RATED PIPE
;�AFE5K
PE %32' FT
AP ENO
EACH
i6
'�(ryp.OF
OINT
LATERAL
C(
�\
p-noo
��G —.�
�� 2c• �� 'f2Er1Gl���
�
'f
INAI. SECTION
�}
IAfZp
ALL- tRENGNES IN WET SOIL•.
301"TOM OF TfZENGH PRIOR
ENDS OF ALL DIStR16UTOR�
�Jy)v`\O'20;00"G ��\\\ \ �� \\
�o�tQe6
14
O'\\�oB�
p.
I6
\\
SORPTION TRENCH
FO 5CALE
S
KNOGKOUT/�,
{i
'
51TEE P1-A N
- -. J
SCALE I "• ZO'
L G
3.5 "DIA. INLET5
PINISHED GRADE?
EX 15-f
n16-.:
i
i