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01169
other requirements : R-� ^g F I`l $ECt 4011 `" 3�n�
Water Supply: Public Supply From ' p [2
A Private 'Supply Drilled; By �
Address- Breatster, N
Building Type hodu 1 at 1 No "ofr Bedrooms Tree Date•. Permlt Issued 4/ 1 6 84
Has Erosion Control Been Completed? AS "'MC 1 red
I certify that the systems) assisted "serving the abode premises were, constructed,essentially as shown. on the plans of the completed work (copies of which are
attached), and in accordance with the standards; - rules -and regulations ,,plans, "fil/e�d,'•aand the permit issued by the Putnam County Department of Health.
1 �. 0 �
I 1 1 Certifi etl b
Address RD
.Any pe►son occupying premises served by the above ;system(s) shall prom)
;conditions resulting from such usage. Approva_l'of the sepa rat
ersewera
available' and the approval of the,;prjvate:water; supply, shall become null
Subject to modification ',Or change when, in the judgment of the C'
omr
°Date~ BY
U1
take,such ac
system shall t
Void when`'
%i ner of Heal
1 '1
s P.E. _6— R.A.,
M ' 051.2 License No..3��D6
ion as; maybe , necessary to'secure the correction `of, any unsanitary
ecome'null'and void as soon as a public sanitary sewer becomes
:water supply ,becomes available. Such, approvals are
such revocati cation or change is essary
Title
•Owner /Address M7.ehae1� Sfin�cla��r,;E
eulldingaTYpe —rrie l, t'I'�„� I.
Number`of ,Bedrooms` � 'Des�yn _F <
Separate'Sewerage System to consist of
To be constructed by
Water Supply public Supply Fri
,Private Supply to
' Address'`
Other Reqv
uements 90 x .:l $n ji.f't
I represent that j am wholly and completely_
above describ ®d,will be constructed-as shown
County' Departrnent.,of Health„ and that'oi
be; submitted .to the Oepartment, and_,a IN
;.place in; "good'' - operating - condition any .par
ante 9, f `the approJal of the Certificate Hof
will be; located as;shoys n on the approved pier
'- County Department` of Health ` �.
F
'Data,
30 March :1983 ', � '
R
R[
"APPROVED FOR' COIVSTRUCTLQN This'
-`revocable for cause or may be amended or!n
requlies`;a new rperm it 'P ro 'd fo dLSp
Date a
'Rev 9 81'
2
✓ — 7
(n•����pp�� COUNT
►p,�(�{T� tcln 1� p[f1CAitT 1C 1UfTC Tf 1[7f
J7[ RI Ih11Vll N ®Qj� ll ®1G1C 1N�1vlllC+ly ll �II' HIEA1L.TH ' - Permits q
on: of EnvMq jrneneal.` HWtti Services Carmel N Y 10512
4
AGE 6kSP6SA9. SVSYE J. Patterson
r . Town or. village
'�flrl't� Tax Map 6� Block 2 1 Lot 4410
nrAll �` -,subd Prot #., -.,, .10� Renewal �;� - "'Revision -(] '
i1 T t
Date of Previous A proval 11 f 72 (De Geroni"no)
,y,` rews er g
L'Ot Are � Fill Section`Only
P C :, Y D . NOtificatio6 Required
�nf1 Gal Septic Tank antl ' L -X i� 2Yr ateraIs
-� Address
Imp
be drilled by i
1 ' ^. ;5 c+,�nnc' A 1 Q °> Ilcnr► v an r
x 5 Deep Curtain tlrain� w /SOI�d F,na Fxtai� „ �o
i]1 <S.ectann /nod art of >prev1ous _a�n+proal '
reiponsible foe-the•design,an location of the pioposed syStBm,(sj .1) that
the separate sewage disposal System
on the epproved.amendment thereto and in accordance.vd ;th the tantlards, rules an regu a ions o e u nam
rco,mpletion, thereof a - 'Certificate. of Construction Compliance" satisfactory to the Commissioner of "Healthwill
d4en. :guarantee wUl,De furnished the .owner, his wccessor,heirsor assigns _by the builder, that said builder-will
of said sewage disposal system during,the':perlod of twio :(2) years- immedfately'tollowtng the late of the issu
Construction :Compliance of .the orlgmalaystem or any repays,thereto; 2) that the, drilled ,well described` above
and that said well wlll;be mstalteA; In accordance wrdh the =standard's, rules and regula L of the Putnam
License No'
pproJal expires %one yeaP'.from the date issued - unless construction "o4.the bullCing' has been.uridortaken and is
odifled..when considered`,necessar`y by :•the- Co07LI_A' Moire of •Health... Any change or alteration.of construction
osal of Comesti - sewage; an r ':priv Lf I onf r
Title
— B.Y
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1
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 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
OWNER
NAME
Michael Sinclair
ADDRESS
P.O.. Box 393, Brewster, NY 10509
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Bernard Dr., Putnam Lake Patterson, NY
PROPOSED
USE OF
WELL
' BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
'
❑ SUPPLY 1:1 INDUSTRIAL ❑ CONDITIONING OP�R )
DRIVING
EQUIPMENT
X❑ ROTARY ❑ A COMPRESSED CABLE R PERCUSSION El P PERCUSSION ❑ OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)
1} z t
DIAMETER(Inches)
6 t..
WEIGHT PER FOOT
19 lb S .
THREADED ❑ •WELDED
x YES ❑ NO
�`
CASING
YES
t
NO
YIELD
TEST
❑BAILED :n PUMPED ❑COMPRESSED AIR HOURS G.P.M.
6 5
YIELD (G.P.M.)
5
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Speclfyfeet)
40'
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below Land surface: 4051
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)'
"DETAILS
-SLOT SIZE
DIAMETER,(lpches).
IF GRAVEL-
PACKED:
Diamete
- - -• r •,
of well�neluding,
gravel pack (Inches):
GRAVEL SIZE (inches)
• ,_
FROM (feet)
' '
TO (teat)
DEPTH FROWLAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent. landmarks.
FEET to FEET
O
27
Drilling in overburden
clay and boulders
i
Eit rock at 27 feet
27
42
Drilling in rock,set
caslng,grbuted.
42
405
Drilling in rock granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
•
DATE WELL COMPLETED
7/2/84
DATE OF REPORT
7 /l0 84
WELL DRILLER (Signature)
r
°o RG W STER L1.d J o ®RATORKS
Batt 224 - BRGWSTER, N. Y.
WATER AMAL Y39S REPORT
SAMPLE NO. 5532
SOURCE: Mike Sinclair
PO Box 393
Brewster, NY 10509
COLLECTED: September 7, 1984
BY: Mike Sinclair
BACTERIOLOGICAL EXAMINATION
Coliform .Count, MF Method
Storage Tank - Well
T hit remit indicates the toevee of the (ample waf
of fatiffactory maitavy quality -when the i4mPle waf collected.
September 10, 1984
..... 0_ per- ICa • m1. _ ... _. _ .. I,I
C
Bichwit P. E.
Director
PUTN W COUNTY IIEPARTMENT OF .-HEALTH. '
Dwision . of Envr'ronmenia/ Heahh 3Serwces, Carme %: N Y -10512
CONS __ BE RMIT . :'F, OR ,SEWAGE DI SPOSAL SYSTEM PTdowtn t or SVillage
Located i arMM `'ROad fT _�. ,•- by :y _
i s Block
ection I
utnam'Lake 1"266 -70 1 1311 -5
_ Subaivi P
slon, Lot Job SQ951
Mra &: Mrs Lew e ' '' o nc 63.5 .E. 228th St..
Owner Address -
Frame ` �''� 20 000' TBr -onx; New' Y,oi^�k
Building TYPe- Lot Area
Number of Bedrooms `Three f Total ,Habitable',Space •000' 't Square Feet
Separate Sewerage - System to consist of 1 OOO Gal., Septic Tank 300 lineal,.feet X 36 inch' width trench
To be ;constructed by. ` { 1 Address
r
Water' Supply: - Public.Supply.' From
X .. • Private• Supply to be. drilled by
' Address I i
Other Requirements 18" R =`o B Over . Toosoi l Around & Tnsi de Of 'Trench Area = 90' x "48" Gurtai n Drains
:'To '4 C K* P. Around Field Area
I,eepresent that,l;am wholly and completely responsible for the design and location of the proposed system(s);'1j' that'the separate ,sewage disposal system
above described will be constructed as shown on the approved amendmeni,there tom and In accordance with the standards; rules an regu a_ ions o e u na.m
County: Department . of Health,, iaiid that on completion thereof.a Certificate of. Construction Cornplian&l 'saiisfactory o the Commissioner. of 'Healthwill
be= submitted to `the Department and, a. written',guarantee will'be furnished t, ,' , per ,,fiis successors, heirs or assigns by the builder;'that said builder will
?';piace 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 Cornpliance._ of,'the original system, or any repairs thereto; 2)'that _the drilled well described above I
will be located as shownwn the approved "plan and'that said well wiil be installed in' cordance; with the s rds, .rules. and regu a iTf ons ' of the. Putnam
Courity Department of ;,Health, f
Date ,� / W / 2 "t
I Signed P.E. n. • R.A.
,
~ i
t. Address ; R. U.. 6, 'DOx
;,APPROVED F.OR CONSTRUCTION This approval expire:
revocable for;'.cause or` may be amended,or modified when c,
requires a, new permit. ,'Approved for',disposal :of domest
Dace 7 �ITy ay,'O
'Vew. York - I UID 1,4 :.' License No: 29206
e issued unless construction of the pwiding has been undertaken and is
the: Commissioner of••Health.. Any change.or,alteration of construction i
toe priiete'water supply only. .-� 1
Michael Stnclaer
,aner or Purchaser of Building
Building Constructed by
Barnard & Addison Roads
Location - Street
-T p An
Municipality
Modular
Building Type
61
Section
2
Block' -
4/10
Lot
Putnam .Lake (Map "A")
Subdivision Name
1266 -70 & 1311 -5 Incl.
Subdve 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 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 success-
ors„ 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 determin-
ation of the Director of the Division of Environmental Health Services
o f.. the • Putnam County- Depa- rtinent --of---Hea -lth a•s - to whether-or-not the fail - --
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this 4th day of September 1984 Signature aCt4 tom, A -
Title
Corporation Name riff corp.
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
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
OwnerAfk Mo2r. JeWis Qp �,,,,M,a Address &Weww 40
Located at ( Street �
q. Zia �� ^ ^�- Lot����s�r„e/
Indigrate nearest cross's ree /io t.fri
Municipality to�1,.$� Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
4
5
5
1
2
3
4
Notes: 1) Tegts to be repeated at same
rates are obtained at each percolation
for review.:. a.
2) Depth measurements to be made
depth until approximately equal soil
test hole. All data to be submitted
from top of hole.
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth
to Water
a er ve
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop
r in
Min. /in drop
_.. �.- ...._. _....... , ...
"'° ' "''°
Inchess
_
-' Inches
-,Inches----
' �
® 1 //Sr
7
3 /3W°
3®
4
5
5
1
2
3
4
Notes: 1) Tegts to be repeated at same
rates are obtained at each percolation
for review.:. a.
2) Depth measurements to be made
depth until approximately equal soil
test hole. All data to be submitted
from top of hole.
v � ?
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO._�
T
12"
18"
24 If
30 If
36"
1
`F2"
48"
54 If C&g �
�66"
7211
78"
84 It
INDICATE LEVEL A!T�%&GROUND WATER IS ENCOUNTERED56
INDICATE LEVEL TO WHICH WATER LEVEL'RISES AFTER BEING ENCOUNTERED 41W
:'TESTS MADE BY %, ��/J, to °
DESIGN
Soil Rate Used-le-(q Min/l "Drop: S.D. Usable Area Provided 00 °o
No. of Bedrooms M(.;;2 Septic Tank Capacity ®900 Gals. Type A _
Absorption Area Provided By ,@9 L.F.x24+" _ z_width trench.
Other
D' � ��aa/7 Mo{ /IJI/A0r?� // i1n/7ff fin/! /OS- -I � n......�+/ /_/ /(�[7/✓Y� / /J_ S �i�')..� /G /.P! --Yn M o �/d1 ��TCX�.1 �' (LMiTO�iine / /J_7}-7n/, cl
Address R.D. 6, Box 353 N f�` �.91
Carmel , New York 10512.
THIS SPACE FOR USE BY HEALTH DEPARTP/MT ONLY: p
Soil Rate Approved Sq. Ft /Cal. Che y A Date
°Rif 07
70, 900V 1
aaa�
PUTNAM COUNTY DEPARTMENT ;OF HEALTH
DIVISION OF ENVTRONMENTAL HEALTH SERVICES
-- COUNTY OFFICE BUILDING, CARMEL,.N. Y. 10512--.,- _._..
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
%n
Owner l C.� S I / 4 r, Address
�� ,p iaX �a
Located at (Street � �^� � ?C/. See. (�BlockL � Lot /a
Indicate e n re cros� s ree
Q `n ali 7 * yA ; 4a& it Q . 70
Municipality a� erSQrL Watershed
SOIL PERCOLATION TEST DATA REQUIRED 50 BE SUBMITTED WITH APPLICATIONS
0e
Number CLOCK TIME PERCOLATION PERCOLATION_ -
apse Depth to Water . e
a r ve .
No. Time From Ground Surfce in Inches -',Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
2
3 /,2A5 a3a- a7
3 14030 105. 9 .2-7, J.
2 io57 rl3b /3 3
i/ 3,k
A 30
MAR 3 0 1984 9LL 41eS �r e s� e�.
PUTNAM
• U1��s t ' o be repeated at same depth until approximatelyy equal soil
rate brained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
J
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. j HOLE NO. HOLE NO.
G.L.
6" I I 4-s
12" ,o 4.
18" L.wdQ 2 L O'h
2411
36„
48" �'.' a tR► see_
6o"
'66 11
7211
.78 it .
INDICATE LEVEL* (IHIIH GROUND WATER IS ENCOUNTERED ffii)e„ ^ X aK•..
INDICATE LEVE TO WHICH A LEVEL ISES ER BANG 'N OUNT _
TESTS MADE BY , �. - d -� 1-7,2 ( t d / 0. S'-
........
Soil Rate Usedol.- as Min/l "Drop: S.D..Usable'Area Provided 5~ t4-
No. of Bedrooms bree Septic Tank 7 Capacity / Gals. Type
e¢
Absorption Area Provided By L.F.x24" 3b"- width trenc .
Other " -04
`Name a kj, f,7 1,?--!V1TSS-,
Address c" � � `
( Y ^
THIS .SPACE FOR USE BY HEALTH DEPARTMENT:
.tip, "
Soil Rate Approved Sq. Ft /Cal.... �ekjy� Lhe___Y______
jt.)0-U0 i
UAW-ALh c.' " �,r i
L.r_-AJ4.jfr 11110 1�-Tisq
ri
37'
L
sox,
57'
+
P -J
%¢.A L-,
rutriam bounty 1)eParLm'3r`1 0
Division of zavir,amental Health SOr71066
rjtb
Approved as, r-Ot- Yorr O:E the
lu
1pPlica
at.--
3, 1A 44—
I
I
"AS BUILT" DATA
Structure located from survey by surveyor noted: belown
Well located by* Surveyors survey.-
Wait drillers report
Enginee. ra mesurements -0
Tank, boxes, pA6, galleries B laterals io•cated by: Contractor:
Engineer:.
Healthda,;A7'r
Field inspection by: Health dept dote:.— _Ail
Eng.f n set
I
NOTES:
1) CLJ fL -1'& 1,J CIZAI
'b I m f N S ION S
A 8
A C -B C
A 0 D
M,
A F B F
A G -0 G
A H
2Z-4
A K = -8 -- K
, XZ
VWKtR -11 1L"�.H—AC L==-- I ti--: 11:41K—
LOCATION Street,.
fot;�Tow n r-1
: — County: ty: 7-0
SrJ 8 DIV I S I ON - f1j]
Ma P:
Block• LOT; N 9 .4—/L----
Builder:—C;-v✓r- 1�
- '9
S urve y or:
Drown: L::,4 1 Dots: jJob N
J 0 H N H, P R EN TI-St"S E. Dwg.Ni
CONSULTING ENGINEER
uvtnt LVW_ Ity pr•j ,ra _._. __ ��.. ... ,
31Ttg o �nt pope from aepl+t took ro Doa ana between nn aoxoo IjC YPICAL C °RTAIN DRAIN FILL
L is 418afAt naure mquol diatr uon may o ropulroo,
PLAN S- EGTI.ON -y —
I _
- - PWe �t. G Io►j I Mo I�
oll/ o Fn SKI hli 0�
1.. - � loo' Foot -�I �.D�S� � 4�'�cM�' PIPE F2�orM ct1P,T�ii� Df�Alf� ff •'
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