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! PUTNAM COUNTS DEPARTMENT OF HEALTH
Division o_f Environmental Health Services, Carme% /Y., Y. 10512
CE'RTIFICATE`OF'CONSTRUCTION COMPLIANCE "FQR;SEWAGE' DISPOSAL -SYSTEM `" " "" "'PdttersOn-
Town or Village
Barnat,d Rd d
Located at rseciion Block
Owner
Forrester B1 drs. , Inc .'. got;, l °308 -10 & .1271 �5 yob S0952
Forrester Bldrs znc. Moose Hill Rd Patterson NY
Separate, Sewerage System built 'by Addiess y
Consisting oi. OOOeGal. Septic Tank: `�� lineal Feet X 36 inch width trench
Other requirements'' '1 0�� �-o -s' Over Topsoi 1 A:r- ound.:_& Ins.i de::of .:Trench. Area
Water Supply:. v Public Supply From _
X Private Supply Drilled By Boyd 0tds.jAn Well Co..' I�hC
:Address R0 5, °Route 52 ,.Carmel_, -NY
1051`2
.Building Type - Frame No, of Bedrooms Three - Date Permit Issued 12 7/72
f•2
Has Erosion Control Been Completed? Yes
i certify ,that the system(s); as listed serving the above premises were Constructed esse6tiglly,as :shown on. the -plans of the completed work (copies,of which are
attached), andin accordance with.the- standards, rules and• reg`uiationi,,:;Olans filed, and the permit isiued. ,b Putnam 'County Department. of Health.
ko-
s
r
g A,fi l .1974
Date R Certified by P.E. R.A.
Address R. D:.. ^6 BoX ; 353 a . el'' , NY` 1;059. l_Ice'nse NO'.
;Any person .occupying •premises served by the. above systems) shall -promptly take "such action.as may be necessary to secure the correction of any unsanitary
conditions resulting frorri,,.such usage.. Approval of the ;sepa rate_ aewerag'e..system.,. hall.,6ecome null -arid void:as; soon as a public sanitary sewer becomes
'= _.`available and the approval of the private water supply shall become n " -d voitl when a, public water :supply becomes available. Such approvals are
_subject. to 'modifiwt n or change "when, in the judgment off omm sinner, of- Hea such revocati ,modification or change is necessary. ]
:Date B -, Title
�;_aV VI(GC: VP rtllNfCii1N6. LJ ._ .: KiS.(V Gd lax -
p Blood ^ SAAEAR U! TURE
❑ Sputum R
p
`Forrester. Builders
❑ Nose ❑
❑ T. B.
❑ T •roat :
: =❑ Diphtheria
p Spinal,Fluid, :
: _ ❑ Fungus°
G.
❑.F ®ce: ❑
❑ 3
3/28/74 Water Test
❑ P
PUMAM DIAGNOSTIC LABORATOROES
p. Ova and Parasites,
p; aural •Studies" 1
10 STONELEIGH AVENUE - CARMEL, N. Y.
❑ SENSITIVITY, S
STAPHLOCOCCUS - ❑'Aerobacter
Chlo m
ra p en
Colistin Sulphate` ❑ Hemolytic -Coag. To Follow -1 Escherichia
D"ec omycin ❑ Coag. Positive ❑ Klebsiella
DiKydrostreptomycin'. ❑ " Negative' ❑ Paracolo. Bact.
Ery-thromycim, STREPTOCOCCUS, HEMOLYTIC ' ❑ Proteus
- Neomycip- "-_ , ❑ Alpha ❑Beta ❑Gamma ❑ Pseudomonas
Pl trofurantoiri _.: ,,; ❑ Ertteiocoi cus Enteric Pathogens
0xacillin p •'Pneumococcus ❑:Found
Panalba 0: Neisseria - _ ❑ Not Found
Penicillin _ :. ❑ _Hemophilis
.—Tetracycline,--. TUBERCULOSIS SMEAR., TUBERCULOSIS CULTURE
— Triacetyloleandomycln ❑:Acid Fast:- Not Found ❑ Neg. For Acid Fast
,.
Ampicillin' .' El Acid Fast -Found ❑ Pos.
❑- Smears, Routine Neg. ❑ O & P Not Found
❑-Cu Lures, ❑ O &P Positive For
ATo coli'."forin b.a°ci11,1 isolated'. from specimen submitted. At time
of examination, water was of good qualitya „/
7
-- - Forrester - B l drs : - -Inc --. _:._� .,_.______. __ . '"Plattersorf
Owner or Purchaser of Building Municipality
Owner
Building Constructs •by Section
Barnard Rd.
Location - Street Block
Frame 1308 -10 & 1271 -5
Building Type Lot
r
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I an 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 made 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" tie sy's'tem to" operate was caused by the willful -or negligent
act of the occupant of the building utilizing the system.
Dated this 8th day of April 19 74 I Signature
Title I
llr corporat n, g
and addres
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF CO MP.7,ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OFiDATE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
T
WELL COMPLETION REPORT ; PUTNAM COUNTY DEPARTMENT OF HEALTH,
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This, report.. is-to be.. completed -hy- Well - driller-and -submitted to County - Health- Departmen € €ogether With - laboratory repo- 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
OWNER
NAME
Foraester B1drs Inc, 111looney
ADDRESS
H? 11 Rd,, Patterson, N. Ye
LOCATION
OF WELL
(No. 6 Sheet) (Town) (Lot Number)
B4nyiurd Rd. , Putnam Lake, , 'Flcitter$On, IL Y.
PROPOSfED
USE OF
WELL
f a BUSINESS El ❑
U DOMESTIC ESTABLISHMENT FARM TEST WELL
❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING El (specify)
DRIL
EQUIPMENT
Q COMPRESSED ❑ ❑
ROTARY AIR PERCUSSION PERCUSSION (spe ify)
CASING
DETAILS
LENGTH (feet)
50
DIAMETER (inches)
rr
WEIGHT PER FOOT
® THREADED El WELDED
E O
YES ❑ NO
CASING
YES
NO
YIELD TEST
❑ BAILED El PUMPED R, COMPRESSED AIR HOURS G.P.fi1.0
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
25
DURING YIELD TEST fleet)
Depth of Completed Well
in feet below Land surface:
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (teat)
DETAILS
SLOT SIZE
DIAMETER (Inches)
=GRAVEL
Diameter of well including gravel pack (Inches): .
GRAVEL SIZE (Inches)
FROM (toot)
TO (feet)
DEPTH PROM LAND-SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
3
ps011 .
t0-
3
35
clay or hardpan
35
65
soft brom roc'_
65
100
hard grevT rock
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
'72
6
DATE W ll COMPLETED
�G
DATE, /OF REPORT
"�
WELL QRILLER (,Signature) ke Boyd ArtC'S5r) Well CO., (1Cc
✓::fs. ^ +,rep
MW/
' / Carmel, N.Y. 10 -OiZ
IR
a �uxz._
WHEREAS, Forrester. Builders.,_ Inc.,:'a-.N6w York
corporation having offices at Mooney HillRoad, Patterson, New
York,' is the owner-ld fee simple of�the following described
I '
premii,ees : .
ALL that certain plot, piece or parcel of land with
the buildings and improvements thereon erected, situate, lying
.and being in'the Town of Patterson, County of Putnam and, State
of New York; an _d described as follows: to wit, Lots Nos.
A1271, A1272 A1273;' A1274, A1275; A1308,.'A1309 and A1310,
all as designated and delines.ted on the map.entitled: "Map -A
of Putnam Lake, Putnam County,. New York, land filed in the
Putnam County Clerk's Office on the 20th of March, 1931,
File No, 149H; and
WHEREAS an application was ;Wade to'the Putnam-County
Department of Health for a permit to Construct a sewage
disposal system on the above described premises; and
W1MREAS, as part of such application a request for a.
variance frgm the Hundred (100) foot required.separation
between the well and sewage disposal system was made; and,
WHFFEAS, the: Putnam County Department of Health desires .
i
that there be placed on record in the County Clerk's Office of
Putnam County a record of such request for the variance and
of the
granting thereof;
NOW, THEREFORE, the undersigned hereby has caused to
be recorded;ths document for the purpose of providing notice
to any subsequent owner of the parcel described above of the
fact of the granting of the variance above recited,
-1-
S a.
F
v
Viz.^
t
FORRESTER BUILDERS, INC.
Bys
William C. Bush, Piwesident
STATE OF NtW YOLK_
COUNTY.OF PUTNAM
on the ��rl day'of April, 1974, before..;ne personally
Caine William C. Btish, to' me known; who; being by m® duly sworn,
did depose and say that he resides at No. 126 Oak Street,
Brewster, New York; that he is the. President of,Forrester
Builders, Inc., the corporation described in and which executed
the foregoing instrument; that he knows the seal of said
Corpoationthat the seal affixed to said instrument is such
corporate seal; that it was so affixed by order of the board
of directors of said corporation, and that he signed his name
thereto by like order.
NOTARY M—
iY Stub of New York
QL& ted In Pu4nam County
+7 .L' § ytic "f �7rJ'3':; r-' — , = - -R�-^ �. Y.. _.�. _ r i i •e. 1 . "` 1 -
Y1 1* dp r' - Y > '%'G. Lt 4 -.,7 1 ..• �. A -
,;�. BT BUILT DATA -
'. iructure,locoied from survey by surveyoi n yy
oted Delow_2 I} %rt•
Weil locgtr_d b y: .S "urve yHr s serve -
r-t
w:eCi Arrllors report — . —.—.-
{ Er,jineers rresu'r.ement =s:�. — — — — — -
: Tdr'it; ectas, pi?>, gallerie6 & laterals incated Dy:Contractor-
_ x
En. now Q
Hear Bahr,
' I
Prei_o ::ur }= actlori t >y: H�.attfi` dept -�. do o: _ _ _-
I, r " :'Enalnerr �.: dots�?� —
'k
Noyes �
3 -2: .'x 3 b' Z , -nac r+'e s rJ s rr-. L.; f �-a --w
T—_4
o n
'D I ME N SION'S
Y �
r1
0
0
-- - - - \ -- -- - - - - - -
FSSrehk
APP ROVED. i a
1:91974. of nrt at�!E
cou
Isl or �L -
wvreDnwuwni uran seadr0>y .
SAN.ITAR -Y SYSTEM_ DESIGN 'AS E3U..1-LT
LOCATION' §rient:
Torrn��l 2— County: _�i_ Srnte; t_Ky
SU.13rbIVISIONi_PVrw�a
,block., �_ _ •— — LOT N 4.13U@ 9_10 1�I ^N
Builder:/rQR3'Rt:s "Ssy pZ,-q:eCt- ut1�Lx, --
Surveyor:
Draw- - -v_ -- Dotes —_- Seal - -. Job
Dv+g, e
J O H N, H, P R E,N TLS S P_E-
CONSULTING ..ENGINEER �'�
I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date _ 11
Re i Property of l o6 V%a. Con s ,e. _17wue
Located at B&emsoxil
Section Block LotAMO!L q.
to +
Gentlemen:
This letter is to authorize, John H. Prentiss, P.E.
a duly licensed professional engineer, X or registered architect
(Indicae-
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the Commissioner of the Putnam County
Lcpart`,cil� o 11Ctb" th, and to sign all 'neuea6ary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147,'' Education lay, the w, and the Putnam County San -
/IKe . ae TS 7f . l�+e // stow .q .rMa-&ad aF -rAr
– ode LQ"p ` ' A„r' 4►i // Nd�l4 . R►ie If Tv' Of ruff Iii: o.► To s'i! %(�: /.5., �a
• r .. 'f
.._I&; // r6e Ae` /ibi s,/ T8 y p ry. truly rs,
i w� a «: OyL`i a+�e�• .Zi, �1! q/ 1/A 1.
R. A..,,
owner oiq vroperLy
m
• �C�r.1wV►� ��.� l�a��
06 address P.rM.►w. V.r�1a� �W.1t .1 OS`1�
..aOFESSIONAI
Carmel , Aew York
914= 8784170'
o PRE�ris c'F a ep one
�si�, No• 2926
i
V
Other13
eq uirbmbnts,i
r.
;above :described willabe�c
�bo.',subrqittOd ,tp,,,thq�iD�
;;place _In xqoqd: opor . ini
APPROVED FOR?;(
requires a new per
K
2;
'location of the proposed, system(s); 1) that the separate sewage cUi$poqal system
,here to and' in accordance with Uvestandards, rules M regulat ions of the Putnam
irate of Cqnstruction ComOlijartco,, sausfa ctory,to fhe Commissioner of Health will
Oidd the owner,, his successors;, heirs or assignsby. the builder, that said builder will
iidm during; the period, of two (2) years Immediately, following the date of the issu-
1he original system or any repa
Its thereto; 2) that the drilled well described above
Aliedr In accordance with, -the standwdV rules and roulaTM— nsof the Putnam
R:A.
2920C.
R i ns n 'No.
now r -LJcO s&
njlLii d-date UsUod unletv tqnfqtr4ctiom-of'the building has been undertaken and is
iiity by Ifte-Commissi , oner of Heaft-ft. . Any Ohadge or alteration of construction
t water sup I I
_JoUpriva e wa e only
Z_Z�
__ �05140 M
ip" d-to NTY DEPARTMENT OF HEALTH
fPUTN i
Division, ,of En* vironmen tal Health Services, Carmel, N. Y. 10512
4-0. NW)ROR, MOT- 01 N'A d t
'CONSTRUIPT, Patterson
Town or Oil
Barnard
Section Block
SUbdrvision Putnam �Lo 197-1 _5 Job S0952
Bou I nc I
Rabenat 4,, J, Os�qa_wana. Lake
Rd.
Owner dress
•
.4 _3 7M Valley, N.Y..10579
-Rutnagm-
ree Total Habitable *000
24 Space
F04
rn�p ri*
Square Feet
2 36 1
!W!401 3o G 2 2
Septic Tank lineal feet X rvch —width
trench
E Address
Maters SuPP w-1P From n
'SUOPIY s, ]�
AV,
'n g 4V R �i 71
s
by, Z
;0
r 9
Orcii) TKin-t,ri. MR QiAW i; tip of Tranrh Arpa
4 1
Other13
eq uirbmbnts,i
r.
;above :described willabe�c
�bo.',subrqittOd ,tp,,,thq�iD�
;;place _In xqoqd: opor . ini
APPROVED FOR?;(
requires a new per
K
2;
'location of the proposed, system(s); 1) that the separate sewage cUi$poqal system
,here to and' in accordance with Uvestandards, rules M regulat ions of the Putnam
irate of Cqnstruction ComOlijartco,, sausfa ctory,to fhe Commissioner of Health will
Oidd the owner,, his successors;, heirs or assignsby. the builder, that said builder will
iidm during; the period, of two (2) years Immediately, following the date of the issu-
1he original system or any repa
Its thereto; 2) that the drilled well described above
Aliedr In accordance with, -the standwdV rules and roulaTM— nsof the Putnam
R:A.
2920C.
R i ns n 'No.
now r -LJcO s&
njlLii d-date UsUod unletv tqnfqtr4ctiom-of'the building has been undertaken and is
iiity by Ifte-Commissi , oner of Heaft-ft. . Any Ohadge or alteration of construction
t water sup I I
_JoUpriva e wa e only
Z_Z�
__ �05140 M
01 k�
-PUTI NAM -COUNTY DEPARTMENT -bF- HEALTH- ---.....---
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. .10512
DESIGN-DATA-SHEET-SEPARATE
SEWAGE DISPOSAL SYSTEM FILE NO.
Owner
op
Address. �6kc%,iI4 Co
Located at (Street ""&
EM C-A "x0c,
Wor-00
Aw oat Lot
- J04P, 4
IndiqEmAd
e
W-
nearest cross street)
Municipality Raw
Watershed Cob -to
.SOIL PERCOLATION TEST
DATA .REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole-
Number CLOCK.TIME
PERCOLATION PERCOLATION
Ran Elapse
Depth toWater Water Level
No. Time
From Ground Surface in Inches Soil Rate.
Start-Stop; Min.
Start Stop Drop in Mih./in drop
Inches Inches Inches
2
3. ///jQ
24
4
/A 0 HIS /t
4
5 i.
Notes : 1) Te#'-to be repea
�pd at same depth until approxirlAtcil dual soil
rates are obtained at ea,� V.prcolatioh test hole. All data-,to---1�4ubmitted
for review.
2) Depth mea'surezh6htb to be made from top of hole.
t V b
e K-.iy
r r.. y
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
" DESCRIPTION OF SOILS.ENCOUNTERED IN TEST.HOLES
DEPTH HOLE 90._ HOLE NO. HOLE NO..
G.L.
o a
6" 0�' �jc9go c�4
12" a
18" o
24"
3.011
361 '.
42" (�
o.
48"
O � ,
54
60"
66"
72..
781
84%
-INDICATE LEVEL-AT WHICH GROUND WATER IS ENCOUNTERED.
INDICATE LEVEL TO WHICH W RISES AFTER BEING ENCOUNTEREDTESTS MADE BY o QC� o : �„ , ro ° $ to
DEIGN
o.
Soil Rate Used J6 °bMi�/1 "Drop: S.D. Usable Area Provided. 9 0.
No. of Bedrooms Septic Ta. nk Capacity AD O g Gals. Type
02
Absorption Area Pr By�zL.F.x24" -`b" width Trench.
Other
O! °o o o 9 a
_ ;917 ° � A.. i � � R / �~ �•.n, i'_
THIS'SPACE FOR USE BY HEALTH DEPARTMENT ONLY*
goll Rate Approved Sq. lit/Cal. CheM,
` ►t O
a Date
0