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Home My WebLink About0963DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.41 -1 -29 BOX 10 11 qpm IN miV. d v MINI 11 6 MIN IN IN T 1 16 r y I MINN ol I � � , � �,� me .4i MINIM 00963 i-t a PUTNAM COUNTY DEPARTMENT OFHEALTH x e V . 3/ 86 Division of Environmental Health Services, Carmel, N:Y 10512. ` Engineer Mast Provide ,p P.0 Ay Perntlt p / =30 7 0 , NSTRUCTION'COWLIANCE FOR SEWiku i'fiSFa�SA ;S S il– Town or Village.. Located at Tax Map Z Block ;Z Lot 2- fi 3N7 - 3 12.2- Owner /applicant Name A/ FoimOrly Subdivision Name � M Subdv. Lot-#` 6o F /Q /Pzb OR.' �4,e src 2 loSO9 Mullin Address —��..P Date Permit Issued 8' . Separate Sewerage System built by Address *';r4i¢A2667f M 1050? Conslsting of /doh Gallon Septic Tank -7K. G •F. ¢ �� . �i9t:Ll�S Water Stpply: public Supply From . Address warJXAv o.44rala, MA., 44- rn:� or: Private Supply Drilled by Address 44Y1 S A, RD • Building Type `-� /An At > Has grosion Control Been Completed?__ /`!d Number of Bedrooms 31 /tr) IbI✓ Has Garbage Grinder Been Installed? Nd Other Regalrements I certify that the systems) as listed sarvinq th'e above premises were'conat acted essentially as,sh6wm 6 _the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County ,Dewpar/ °ant Of Health Date Car fifietl by , P.E. R.A. Address ~... L' . License No.' 6/ 931 Any person oecupying, premises served by'the above'•system(s) shah "promptly take 'suchection as maybe necessary to, secure the correction of any unsanitary conditions resulting from weh'.us ye._'.. Approval of the separate sevversyeaystem shall become null aeid:void.at. soon as a pub +:': sanitary sewer becomes available and -the approval of the private water iupply shall become null and void when a public wata+..iupply becomes available. Such approvals are subject to mg ificatlon or change when, Iri the )udilmbnt of the Commisefon WS !j tlon, modification or change Is necaa►y. Oats s A BREifiiSTER- LABORATORIES Box 224 - BREWSTER, N.Y. (914) 855 -1930 - WATER ANALYSIS REPORT - /�-` 97 SAMPLE NO. 8238 TEST WELL SOURCE: Jhon Betrum Patterson, N.Y. 12563 COLLECTED: 1 -10 - 9 2 BY: Haviland Plumbing & Heating BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 1 -15 -92 0 per 100 ml. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES /Z Owner or Purchaser of Building Section Block Lot Building Constructed by Location - Street o Municipality Building Type All -A 9M LAk.11r, Subdivision Name 31/7 - 30!.2_ Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, worknanship, 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 tailure 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 _� 19_,9 2— Signature --Title Gen Contractor (Owner) - Signature Corporation Name (if Corp.) /e��.� -� Addr rev. 9/85 mk Corporation Name (if Corp.) Address maP110 rL WELL LiUrlrLL' 11U1V. rLrUr%i DEPARTMENT OF HEALTH Division Of Environmental Healff Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only — �- STREET AOURESS: TOWN/vIrLAGLIC11V TAX GRIO NUMBER: Garland Road #1 Putnam Lake 'NY WELL LOCATION WELL OWNER NAME: ADDRESS: Bertrum Construction 100 Fairfield Dr. Brewster Ny ] PBIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary fl. RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -8Y ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 / EST. OF DAILY USAGE 300 gal. REASON FOR DRILLING X) NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 605 ft. STATIC WATER LEVEL 24 ft. DATE MEASURED 10/31/91 DRILLING EQUIPMENT ❑ ROTARY M COMPRESSED AIR PERCUSSION ❑ DUG. ❑ WELL POINT ❑ CABLE PERCUSSION ❑OTHER (specify): WELL TYPE ❑ SCREENED 13 OPEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 210 tL MATERIALS: 8 STEEL ❑ PLASTIC D OTHER LENGTH.BELOW GRADE 208 ft. JOINTS: : O WELDED ® THREADED ❑ OTHER DIAMETER y in. SEAL: ❑ CEMENT GROUT -13 BENTONITE OOTHER WEIGHT PER FOOT 17 lb./ft. DRIVE SHOE O YES ❑ NO LINER: O YES i4 NO SCREEN 'T _. DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? _ _ . EIR$T� — - - -- �.._._.._.__. �___. _.___----•---_- - - - ❑ YES -O -NO _..-_- _ HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP. DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED a tests were done is in- t X7 COMPRESSED AIR r formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water sear- ing Well Dia- Meter FORMATION DESCRIPTION CODE. ft. ft WELL DEPTH tt, DURATION hr, min. DRAWOOWN ft. YIELD. gFm. 5 nt, 605 — U 121 605 5 6 Granite WATER X) CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE . HP WELL DRILLER NAME DATE Eastern Water Dev. Co._ nc. 11/7/91 ADORESS � 0 3 - G _ ex/ S.3 SIGr RE Benson Rd. Oxford Ct. 1 COMPLAINT OR REQUEST New home, waiver is brown and smells like sulfur_ t ACTION TAKEN BY �2� �— DATE FINDINGS FOLLOW UP INSPECTION DATE -__..- - - - - -- PERSON NOTIFIED G 4 ESTIMATED TOTAL MAN HOURS SPENT 77 `[die a 1�w '11a ri: � "►N!ataA ,as�w: ut o.a■Ky':e M s1�wH rlae+a tai n ism of Haatte. Any 'Change 'or sit INation' of oamtnutl" `water wovb oqiy D TINOi• m DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 0 WELL LOCATION Street Address Town/Village/City T Grid Number R 1.1D Name Mailing Address ''Private WELL OWNER g r'1 loo E ST D Public USE OF WELL VRESIDENTIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 1 - primary ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2 - secondary ® INDUSTRIAL M INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_L_ff&a/EST. OF DAILY USAGEjLoo�oal E3 REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION 12 ADDITIONAL SUPPLY REASON FOR DRILLING NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING ELLd L-1 DETAILED U MUCYANE -1 REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ODUG ®GRAVED ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: floTmAn Lot No. -.211 -1 — 31 zZ /LOTT WATER WELL CONTRACTOR: Name To �7E �E''i�2M� nlCl� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAINS LOCATION SKETCH SOURCES OF CONTAMINATION EPARATE SHEET (d e) PROVIDED. (signatur ) 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 thirt }c (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 g operations be contained on this property and in suc a manner as not to degrade or ot. r 'se contaminate surface or groundwater., Date of Issue: 19 a/ bu Date of Expiration -� 1923 Permit Issuing fficial Permit is Non- Transferra le White copy: HD File Pink copy: Owner. 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller I represancthet 1 am wholly. and completely responsible for the design and location of the proposed system(s). 1) that the ! rah saw di sal slam above described will-be constructed af,shown on the approved amanumeet thire to and In accordance with the standards, ruies a regu ns o county Wpertnwlt' M, kUelth, and that on `eompleEbti.thareofe "Certificate of Construction Compllenp" set{sfadory, to the Comnlissbne► of tfeaKhwill M, submitted to the Oepaitnerlt, 'and _a mitten .lfuuantea will W furnished the owner , his successors, heirs or assigns by the builder, that said builder will plum N "hoed operating csMRbn; any Oert .ef tpiA sswaN, Aisposal system during the gala* of twoa2), yens Imnksdletely following the date of the how allce of tin appralal of the Certifieati m Coestruct" ,Comolihm of ,lho orig inal* system or any repairs thereto* 2) that the drilled well described above sri11 N IOCateA of ahouln oh tM�epporiO.pNn arm that said well wiltbe Insta11e0 in:.aCOerdanCe with the arderds, rules ahsl regu s :ot the Putnam ' :.OYntY- OepartbiMtOf NMlth. - _ .. .. . P.E. R.A. Deb Signed r. __ r Addrett 11 1 P_oL TS. License No I-G208 APPROVED POR CONSTRUCTION: ThN approval ikpMes_two years from the data issued unless construction of the building has been undertaken and is revocable for cause or may M amOldaO or modified when considered neeassary by the Cornmissiomr of Health. Any change or alteration of construction nouNM a new permit., Approved fe►. dNpoial:'of do�k�saa�ltasr.Y 4irvAgo, riwt� w r supply only. /yam Rev. Date rI7 �Y�G ey itle 9 — T 10/88 - r ( ) I WILL HAND DELIVER MYSELF ( ) PLEASE SUBMIT TO THE SPECIFIED DEPARTMENT FOR ME SIGNATURE APPLICATION FOR PUBLIC ACCESS TO RECORDS TO: RECORDS ACCESS OFFICER DATE: Name of Agency JOSEPH L. PELOSO, JR., PUBLIC INFORMATION OFFICER Address I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: �12fiR,UM Con,S7 . �° TS LU T'S /- J / .W Signature Representing Mailing Address AGENCY USE ONLY APPROVED DENIED Date Record of which this agency is Legal Custodian cannot be found. Record is not maintained by this Agency {,-) C m N-N Signature Title Date NO U? c- NOTICE: YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE. b Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: n_ -., ,r - T — r DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 Erika Waring Board Of Assessors Patterson Town Hall Routes 311 & 164 Patterson, New York 12563 lO/2/9l Re: Bertr00 Garland Road, Patterson ��L Jr.,e,w� I Public Health Director Dear MS, Waring., Enclosed please find copies of the approved Construction Permits for thelots referenced in your letter*(copy attached). If you have any fUrth8r qW8StinhS,l may be reached at the'above nU0D8r. / ( ��- - `~--------~' Christine Johnson~ Tnte�mediate Clerk Ci Supervisor Lawrence Lawlor PATTERSON TOWN HALL Routes 311 and 164 Patterson, N.Y. 12563 TOWN OF PATTERSON BOARD OF ASSESSORS (914) 878-9300 Department of Health Div. of Environmental Health Services 110 Old Route Six Center Cannel, New York 10512 Dear Mr. Morris.- Chairman Erika Waring, S. Assessors Frances Kardausk, Edmond P. 0 1 Conn( September 29, 1991 RE: SSDS Construction Permits .John Bertum (T) Patterson Could I please trouble you for the lot numbers for the three SSDS construction permits that were issued. We have just received split/ccmbines on these tax map numbers and I would. like to -be information corresponds 25.41-1-32 (22-2-16), lots -3100 through 3110 = 11 lots 25.41 -1 -29 (22-2-13), lots 3117 through 3122 = 6 lots 25.41-1-31 (22-2-15), lots 3111 through 3116 = 6 lots Thank you for your attention to this matter. Sincerely, DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A.WATER WELL PCHD PERMIT # P- 30-8-1 WELL LOCATION Street Address ,a. D Town/Village/City Tax Grid Number rj 2- Z - 1% IZ ✓ 13 WELL OWNER Name Mailing Iwo Address , Wy Private O Public USE OF WELL 1 - primary . 2- secondary )K RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT Mjn1 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE (000 gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION 12. ADDITIONAL SUPPLY ❑ DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING F_a=,1zM&f 'T'1 ate. "�yPPL� WELL TYPE DRILLED DRIVEN QDUG 13GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 'X -NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: FitT A~ L..Ay-jE Lot No. -511 -1 - 3i22 Lar 1 1�i�lsp WATER WELL CONTRACTOR: Name o Address: - IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEARE'ST'- WIA'rE-R' -WAIN: �a� "'� 5: .�_: %,iii "°"' —•'�" '- LOCATION SKET H" & SOURCES OF CONTAMINATION PROVIDED Q4G� t�C?a ON SEPARATE SHEET IIII `�c n - ^' (date) �'?A (s� "'. azure) PERMIT TO CONSTRUCT A WATER WELD ; -'` 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 Department. -- Date of Issue: q �0 19 --d � �`'� ' f Date of Expiration: 19 Permit ssu f a Permit is Non - Transferrable Mite copy: H. D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller ~ DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT -J Tn+ #i PCHD PERMIT # / �v�Z/ WELL LOCATION Street Address Town /Village /City Tax Grid Number WELL OWNER Name Address lapriVate O Public USE OF WELL 1 - primary 2 - secondary ®:RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ® PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ FARM ❑ TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY D ABANDONED 0 OTHER (specify ❑. AMOUNT OF USE YIELD SOUGHT min S gpm /# PEOPLE SERVED 1 fam /EST. OF DAILY USAGE 6p0 gal REASON FOR DRILLING KINEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING Public Supply not readily available WELL TYPE UX DRILLED IDDRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING ?. YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: P t ar laka Lot No . i1� --2117 WATER WELL CONTRACTOR: -Name T. L�g 6�=i;14a Address: -. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES_NO NAME OF PUBLIC WATER SUPPLY: —N/A TOWN /VIL /CITY -'--'-IS Sl .__ A�� Ik' DTANCE- T�'pROPERLY "YrUi�i TvEaKrS- WATEit TiAliv _.�.__.._� _ __.__� 6� Greater than 3 ca e\ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION ®O EPA ?A ET T C�1 ✓ � C "'h1• (date) i plans 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 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. Date of Issue:�,� j 2 19 9:5 Date of Expi rat i 19 Permit Issuing ff' Permit is Non - Transferrable LIbffl DIVISION OF /• •' 1a Y• HEALTH SERVICES - - - - -- .- - - -: -- DESIGN - DATA -SHEET- SUBSUFACE SIMAGE--DISPOSAL SYSTEM—— - -- - FIDE -N0. �� O;aner ,�O!�r-i I'�C:('if'l:M Address (OV Farr/odd Orr,)t. 43 t'.t" IbS'O`Y Located at ( Street) Gar a , d R o a. d Sec Block 2_ Lot /,3f-P/" (indicate nearest cross street) municipality PCL l l erson Watershed C.,-oton Date of Pre- Soaking IZI 1 . C Date of Percolation Test. i2yz I86 HOLE Nu�mER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches :' 14 _'.1 3 2 a 4 S- 10.'00 l S 7,f 3 S- 3 to':ot- 10'ZZ 21 -- 24 -3 3 7 2 4 10:2.3 -10:4 7 2u 2.4 3 5 10:40 i1: 12 24 2-( z4 3 3 1:27 -1: Si 2-+ 'zt 2 -et -3 5 4 !'5 Z i 6 2a 2 r �4 _3 $ 1 3 4 5 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 subnitUd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 9 - 2 I -- 24 -3 3 2 2-2- zs S 3 1:27 -1: Si 2-+ 'zt 2 -et -3 5 4 !'5 Z i 6 2a 2 r �4 _3 $ 1 3 4 5 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 subnitUd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _.._. _DEPTH __ _. .HOLE N0. G. L. 1' 2' 3' 4' 5' 6' HOLE NO.- . - -• - - - -- -- - __.__ -- HOLE NO. 7' 8' i 9' 10' 12' _ 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED on (e INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ROD DATE: 10 DESIGN Soil Rate Used 0 -1u Min /1" Drop: S.D. Usable Area Provided (5-00 SF No. of Bedrooms Septic Tank Capacity (OOa gals. Type m Mortl Absorption Area Provided By 46x' .4,0 L.F. Y-24" • ^ dt * -eneh. 4 x4 re c a t t CCv�7 c T&Ie S Other PInw Sp Ii Her 6 Curt�rn � Name CAA i n l S5 o C l C1 T e S Signature Address Rf SZ O(w IvLed SEAL N (0 C (1— 2 600 �``� • of rhE STA�� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked. by Date PUTNAM COUNTY DEPARTMENT OF._ HEALTH' J \�b. eV . 3186 Division of Environmental Health Services. Carmel N:Y.1051? Engineer to Provide Permit N ''+ a w on CERTIFICATE OF COMPLIANCE CO TRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM LOt, #;1 rermit y Patterson. Town or Vulage cated Lo at -Gar ad _. Subdivision Name Putnam Lake Snbd. hot a 3122-3117 T" Mar, 22- B�tic>i . .Z r tlt. 13+ 0 12 Renewal_ ❑ Revision ❑ Owner /Applicant Name Tnhn RPi°triml Date of Previous Approval ManingAddress, 184- rlair_fi ®l4 Dr-, � Towu'$rz8Was-te��ir� 71p jQ2()Q Building Type 1 Fam. Res . Lot Area 12 , 000SF Fill Section Only Depth Volume Number of Bedrooms Design Flow G /P /D —6 0 Q PCHD Notl9cation is Regullred When Fill Is completed Separate Sewerage System to consist of 1000 Ga u Septic Tank end 40 +40 LF of 41. X 41 precase concrete tallies To be constructed by to 444; t QtA=J:np_tj' Address Water Sappb': Public Supply From Address X to be (let. Address or: Private. Supply Drilled, F7 ww 1 i t r 61 Curtain .T}ra i n Other Requirements S.T2 r. represent that I am wholly antl completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as 'shown on'the approved amendment there to. and in accordance with the standards, rules an : regua ions o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Comppnance,, satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns'by the builder, that said builder will place in good operating condition any part of said sewage . disposal system during the period of two (2) years immediately following the date of the Issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the stsn O ards, rules and regu a i - ons of the Putnam County D'e artt/ tt__of�$Health. Date ry.�J v? Signed �QLii�... P_E. X R.A. Address Cashin, Assoc. RiC., Rt. ,52,_Carmel, N.Y.10512�1Cen,e No 26008 APPROVED FOR CONSTRUCTION: This approval expire ease year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered neegs�aiy by the Commissioner of Health. Any change or alteration of construction requires a w permit pproved for disposal of domestic sanitary sewage, an pri a water pppiy only. Date /��J/ G/ /��B _ /''c' �- Titl - APPENDIX B ~PUTNAM COUNTY DEPARTM M OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) CC MMENTS IF W /'10 REVIEW SHEET - CONSTRUCTION PERMIT DATE E 3,7ED GG-✓ I C'J ,i. I, BY:4 (Street Location) ( t6+ YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth contours Plans - Two sets s/s SUBDIVISION Perc (3,) Fill cd Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same 'REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) )Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep.results . %lYrv'ivut''. "vntcurs Ei'.istin7. Prot -nG?d Driveway & Slopes Cu -, Footing /Gut fain Drain (discharge OK) Perc & Deep Hole Representative of pr' expansion Expansion Area;shown cavity f ,suff. size _..Zf Rm:ped Pit & D Bo & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe . No Bends; 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, Take (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercour. 10'. to Water Line (pits -201) 50' intermittent drainage course 10' fran Foundation; 50' to well i' Well to PL WO-11 mo} Ltr`l rf I )C'A]TioiiO NEAR EDGE OF---\ MACADAM PA VEUEN T QO GRAVEL DRIVE -.era Al S TOR Y S3 FRAME DWELLING U//VT ! VULt j GUY y WIRES F 4/ 1OL'?620, .e2o- IV R, O C\V AS -BUILT MEASUREMENTS NO. A g REMARKS I� I ��I JtJrGlt� -1 �b7C I J � I fir! RECORD OWNER: TOWN OF: PUTNAM COUNT\ TAX MAP NO. ;�2 4, NOTES: 1. THIS IS TO CERTIFY THAT THE WAS CONSTRUCTED AS INDICA THE SYSTEM WAS INSPECTED DESIGN, P.C. BEFORE IT WAS WAS CONSTRUCTED IN ACCOR[ RULES AND REGULATIONS , OF DEPARTMENT OF HEALTH AND DEPARTMENT.OF_HEALTH. _