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00973
PUTNAM COUNTY DEPARTMENT OF- HEALTH E NG I'.N E E R `MUST' }
Carmel, N, Y 106!2 PROVIDE ' :"
Dwis�on of Environn%nta/ Heath SAr.W 1,
PERMIT.. #P 4.85 .
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DfSPOSAI''SYSTEM - Patter`son_'Putri am Lake
.
.,.Town or Village. : ',•,
Located at Newburg, Road - - _ Tax teap 54 9lock 1
Owner M to'grai;c•ci' Formerly.. Tax Map I,ot s 3. subd. I.ot_a4404_ 4409:
Separate Sewerage.System 'built by Jim. 'Gag.alard Ada,�s23 .Rhinecl•iff Road, Put: `,Lake.;-
consisting of 1 nn0 Gal. Sepilc:Tank and 136 Lin. Feet Tri- Galleries
other requi rement: 3� fill: Inst`a11ed
Water SuDplyi Public Supply; From _
_ X'private Supply DiHled . By- .P a -F . Beal & Son Inc _
ada ►e :: Brewster, NY .;10509
Building Type Raised, Rarich No, of 'Bedroom:: 3 Data hermit Issued', '2/27/85
Has Erosion Control' Been Completed? Ha's garbage grinder been installed ?'.
I certify that the systems) as listed se premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached)', and in`aocordance with the etan3ards,.rules'and regulations;. in actor ce ibith' "the filed, plan, and.the permit'Yssued by the
Putnam. County Departaieat Of Health. -
Data 2 / 19 86 Certified by.. P.E ' 0 X
Muscoot No RFD$- 48.8 ahopac NY 105 li 11056
Address , L arise No.
Any person. occupying premises served by the abovesystem(s) shat ?' piomptl 4ak suc/-p-bllt a s may be necessary to sseun th eorndion of any unsanitary conditions resulting from such usage. 'Approval of `the separate .sewerage me null and, void as soon as 'a public unitary sewer .Hecomes
available and the approval of the - .private .water supply shall become null and wh water supply becomes, available.. Such approvals are
subJect to modification., r change when; `In the judgment 0i' the do- Mm6i"oner`of Health, " " h revocation, 'modification or change It necessary'
Date Title
��r4?
Rev. 6/85 .
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3171 , . 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.
L REPOR i - MUST BE- SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Maureen Lobraico Ic/oAction
ADDRESS
Assoc.,Barnum Corn- rs,Brewster,]
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Newburg Rd., Putnam Lake Patterson, NY
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑TEST WELL
if )
1:1 SUPPLY El INDUSTRIAL ❑ CONDITIONING El (Specify)
PROPOSED
USE OF
WELL
DRILLING
EQUIPMENT
® ROTARY L ACOMPRESSED CABLE IR PERCUSSION ❑ PERCUSSION ❑ OTHER
(Specify) -
CASING
DETAILS
LENGTH (feet)
31 f
DI it
61t
WEIGHT PER FOOT
-19 lb s .
® THREADED El WELDED
YES NO
CASIR
YES
?
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED, PUMPED ❑ COMPRESSED AIR 6.
YIELD (G.P.M.)
20
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC(Specifyfeet)
100 f
DURING YIELD TEST [feet)
�
:J20
pth of Completed Well
feet below land surface: 240 1
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of -well including
gravel pack (Inches):
GRAVEL SIZE (Inches) FROM (feet) TO (lest)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
O
5
D3:^illing in overburden
clay and boulders
u..
Hit rock at 5 feet .
5
31
Drilling in rock,set
casin routed.
�:._3,1 .._ -., -..
-240 111rillin
in rock granite.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
/0'z
DATE WELL COMPLETED
11/11/85
DATE OF REPORT
12/12/85
IWELL,DRILLER re)
C`F
vY
Owner urc aser o Bui ing Section �—
x/ S ael"d /C -S -;L7/j/
_ Building Constructed by----, _.- -- ...._._._ - — - -Block - - -- - -- -- -
Location - treet Lot
,Municcipality Subdivision Name
Building Type Subdv..Lot #
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material,. construction and drainage of the.s.ewage
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 success.
ors, heirs or assigns, to place, in good.operating condition any part of
said system constructed by me which fails to operate fora: period of two
years immediately following the date of initial use of the, sewage. disposal
system, or any repairs made by me-to such s.ystem,` except where.the.failur.e
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 determin-
ation of the Director of the Division of Environmental Health Services
of the�Putnam County- .._De- nax..tnn.Qnt._ of_ .t P.a 7th.. a,g_- to _ whoth.�r -not _ tho__4 a .l.P...___._
ure of the system to operate was caused by the willful or neglig,ent'act
of the occupant of the building utilizing the - system..
Dated this 1 day of eG _19 �.Sr Signature LW
Title
Corporation Name if Corp.
�3 Q�i1W 4F//r- AM-
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
a
BRE:"lSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 2254072
-
WATER. ANALYSIS REPORT -
SAMPLE NO. 6011
SOURCE: Action Assoc. - Maureen Lobraico
Putnam Lake - Newburg Rd..
Patterson, NY
COLLECTED: December 2, 1985
BY: P.. F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
December 9, 1985
b a l�� ARTIMENTU.-J4
PUTNAWCO
IUNTY,�,,DEP )F-J HEALTH } J:1 Permit
POP
Ft
-
`,WNST UC. E'AMIT-FOR SEWAGE :DISPOSAL SYSTEM ,Patterson '
ow
Town �or vz
Ninage
2_ q IAt L,
q
io
j
R -,Subd.,.,tdi ocx
Subdivision 4�
enewal,
A111 z, Z
2
z NYR;�,%-_ZAB Arco. Date Of Previous App v�l� {
Pix - Lake Brewster Adjr
;material
eighoing Typg), 'One Fam Res shot Area 13820 5 e� 1 Section Only �aranu =lar
-k
7.,
-i�i. Bid&i6o
-4 G P h'
444 ms = Design ig ow� jSIP _Required
�Onolr. et-1
6
.,Separate "Sewerage System ltcs�. consist .. Tank antl NY -
.0 j to
ei�j
;Lake, J
.9 ti�a_-,pqnstrilited--�b�,,�, -
�T
Adtl(,
77.77
7
7*
41,
Water
iv _0k
'ate*:SuOpWtn
Beal
�T,
x-
X.; Q&_ U d
r'O Y,
Other ,;,R4qu
ritt" a
y that the separate sewage,Aiiposal'
hatA a rh wh"011" esponsiblie for de�ill4�,ai�d ibi�atf
repr6sont-t I �d 4.`,� plet�iy' i ion of- the�';Progib
't <systern'
above,descnbetl will be Itrigct6a'ai-shosWKqn so A I? pf," d:Jn,a'c. arft rules and �!e ations of-.,�the,
66r4_1,tqpn t _,Futnam
6" e v "t.
- go 0 tnls�'Coimii�i6i4i 6i Hedlih,Will
County pgopifirt'sojetlit of :Health a R:f`__go:,. i--,,bf� Coiistru ctory.'�
-bilifd I
t kill. b
6, "i and :a�wfittenguaran pe i i 46m ighsid fj�
'be sub;4i'ked-.j` -ih9-L,ePar Mer- owner s I#t, said buik,e 11
14
Id"Coring, •i
place -Jn clood:6peritin-4 condition any,.'pi f said sewage, dispoiai-sy�1ern' f t diatel -,f 11 �l
_rt .!-t- t,Ri data of thi"Aisw.
approval _t6it i
-!Ace of-,t"he the Certificate l�i-,C6�*sti-uctii�h�.it-o'('n"plip!i��:#,.'.p,i,,!,�q�6-r.i inai or,, so 6`11 lfdiiiliiiiied above
will plan ,,a7_. i K, .4 c c the-,
be located ow approved '- th" -tn Outnam' -
�� � p, al;_sail��esl_ Ektjqst I a and
Health
C go rl: sit
Date RA
RF.
U
S QO
•
.,,.A�ddress' , ?_ -_ I "I .: _'A 8;
m
1D# Lj Lic6rise-, N
jb, 6
c C
IF
jn
A
2. k�
APPROVED
VED, FO R CO N ST R UCTI h is'� i p p id mol u t� dbb - 'I d i has anci
us nq,�
or Mjy_ ioi�hers6 It n 'o
mvqcap!e� for 6dified-when do so 1 0 :c change ation'o construction.,
T.,cause
Approved F.e4uk4s7j,,new permit f "disposal,6ifdouriosi-
?T -
Its.
PUTN; COUNTY DEPARMM OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FIELD INSPECTION REPORT
( -b INSP. BY:
of,Owner) (Street Location)
;IiIAL SITE INSPECTION YES NO COMMENTS
Wetlands on /or proximate to property...............
Property lines or corners found ...................
Can estimate: house location .......................
Will driveway need cut....... ...................
Must trees be removed - note these ................
Deep holes representative of entire SDS area......
Additional deep holes needed......... ... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics ............................
D. H. 1 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft
Soil
r-
D.H. 2 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
Soil
r--
D.H. - Deep Hole
G.W. - Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
0
ft.
3
ft.
6
ft.
9
ft.
12 ft.
DATE:
FINAL SITE INSPECTION SP.BY:
UES
NO
COMMENTS
House SSDS located per ov 1an ......
Length of trenc meas
Width of trench aver
Slope of tile 1 e tren c e........
Roan allowed or si h ... '
Over 100 ft. f wa se. ... ��
Natur soil stri or ar� �••
unn cessar: ded .... ' .. .
10 ft main i ed fr p o 1' e d
20 f . ®. hous .. ...
Distance w o (ft.) . ... I ........
Number of checks..... .................
Stones, brut , s s, rubble, etc., gr ter
than 15 ft. nearest tren h .... ..........
15 ft. of peripheral soil horizo y
fran. trencl z ..... ...............................
Boxes properly set......... ...................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS...
FINAL GRADNG OF SITE ACCEPTABLE.. ..... ... . ':'-
FINAL
PUTNAM COUNTY - DEPARTMENT OF HEALTH.
DIVISION OF ENVIRONMENTAL HEALTH- SERVICES
FFICE - BUILDING, . - ,
- -- --
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. n , '
Owner Maureen LaBraico Address "RA .d6& KA, 1�4w41rV:�.(,�
Located at Street ( Manchester Sec . 54 Block 1 Lot
- . n ca e nearest cross.s.ree_
Municipality, .Patterson Watershed Croton River ..
SOIL PERCOLATION.TEST
DATA
REQUIRED T.O
BE .SUBMITTED WITH APPLICATIONS
o e
Number
.-CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to . Water
Water Level
..No..
Time
From Ground
Surface
in Inches.._
Soil.Rate
Start -Stop Mina
Start
Stop
Drop in
Min. in drop
-- Inches
Inches
Inches
P1'I 1 -1
9 :45 - 10:15
30
16
19.33
3.33 _
. 30/3.33-9
210:19
.. ....- 10 -:49
30
16
19.33
3 3
-30/3,.,3 -9
3..:10.':.53,.
... .11:23
30 .....
16
5 -
Notes: 1) Te�ts-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 made from top of'hole.
Address,-`Miiscoot N6rth,RFD #2;-Bx` -488_
SEALfi,
0
-License 0; ..11.0.5.6 :..... tio:.:... .. ,
v
THIS SPACE `FOR USE BY HEALTH DEPARTP9EIVT ONLY: NE.
Soil Rate .Approved Sq: F't; /Gal Checked by Date
MfEalm ■
.`.PEST PIT DATA REQUIRED
TO BE SUBMITTED WITH "APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN.TEST.HOLES:
- - DEPTH — HOM --Nfl: -PH #1
M LE O: -PTH #2
G.L. _ Top Soil
Top Soil
611. andy Loam
S andV 16 am
18"
2 �1 "
If
42" .Rock..
-
481
Rock
n
60"
66"
72„
78'•
8411
INDICATE I=L AT WHICH GROUND WATER IS ENCOUNTERED NONE
INDICATE IM'EL-TO WHICH WATER LEVEL
RISES AFTER-BEING "ENCOUNTERED N /A._
TESTS..MADE.BY. Rdv:- Cartes__,_..___
_- _- _._.._ -.: __..__�._____,.__---- -_D�te _bC _t489.__ - ------- -._ - --
DESIGN
Soil Rate Used 8- lOMin/V'Drop:
S:D: Usable Area Provided - -
No': ' of Bedrooms 3. °Septic "
ast -conc.
Tank Capacity, - :1000. :. . Gls -,- r lleries
Absorption.-Area Prided 136
L.F. x24" b" t� .
e_.:
Fill seet.ion 3' -0" deep @ 40
Sq. Ft. / Li,n.Ft.
Name -`Joel L,__Greenb'erct - ... .:..
, .:: ..... Pte.._.
i ure -...
* I AMK.i,-
Address,-`Miiscoot N6rth,RFD #2;-Bx` -488_
SEALfi,
0
-License 0; ..11.0.5.6 :..... tio:.:... .. ,
v
THIS SPACE `FOR USE BY HEALTH DEPARTP9EIVT ONLY: NE.
Soil Rate .Approved Sq: F't; /Gal Checked by Date
MfEalm ■
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