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-P My' Wdoldm. -i1bE'PARTNWMj0E-,'HEALTIfl(
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SEWAGEDISPOSAIST
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I certify that the a) ae listed serving the above *;prem sea -,were'. onetructed esaenfiallyf as shorn on,the ,-0I'iris.df the` dbAplefekl- rk copies
th_ iili . rd , 'r!d
of.-whi 41ftabhed)' -,aind,' j�_ - :Z
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Yt14LL VVL'li LL' i1V14 ANLJ Vices
DEPARTMENT OF HEALTH
-- Division Of Environmental .Health .Services-
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office, Use Only
WELL LOCATION
STREET AOORESS. �HV Y TA-i'61110 NUMBER:—
,�&) 0 2 —
WELL OWNER
NAME ADDRESS:
P8iVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL O .INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
06 gal.
YIELD SOUGHT gpm. /N0. PEOPLE SERVED /EST. OF DAILY USAGE If-
REASON FOR
DRILLING
WNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH YOE ft.
STATIC WATER LEVEL ft.
DATE MEASURED
DRILLING
EQU,IPNIENT
❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH it
MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE ft.
JOINTS: ❑ WELDED IYTHREADED ❑ OTHE9
DIAMETER. in.
SEAL: ❑ CEMENT GROUT O BENTONIT'E NOTHEIR
WEIGHT
PER FOOT. 17 lb./ft.
DRIVE SHOE 9YES . ❑ NO
LINER: ❑ YES' dNC
SCREEN
Q I T I LS
DIAMETER (in)
'SLOT SIZE
LENGTH
(1t)
TH TO SCREEN (ft)
DEVELOPEW
FIR57
YES ONO
U RS
S ONO
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE
DIAMETER_
OF PACK in.
TOP
DEPTH fL
BOTTOM
DEPTH It
WELL YIELD TEST if detailed pumping
l
METHOD: O PUMPED 1 tests were done is in-
• COMPRESSED AIR , formation attached?
• 8AILED O OTHER ❑ YES O NO
It more detailed formation descriptions or sieve analyses
LOG are available. please attach.
DEPTH FROM
SURFACE
water
Bear.
i "g
wen.
Oia=
meter
In
FORMATION DESCRIPTION
CODE.
fl
ft
WELL.DEPTH
IL
DURATION
hr. min.
DRAWOOWN
It
YIELD
9Cm-
Surface
o
WATER CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE a-
CAPACITY GAL._
PUMP INFORMATION
TYPE �� 'p
MAKER
MODEL
,x CAPACITY
DEPTH
VOLTAGEgIS-0HP
W.ELL�D.RILLER NAME DATE
ADDRESS ERT M. HYATT & SONS, INC. �,�
Well Drilling SiGf&MRE
Rte. 311 R. R. 2 Box 171A
PATTERSON, NEW YORK 12563
I
�.� PUT[VA�M GOON � `hHE�►L�THs DEP,�T`
PUTNAM COUNTY DEPARTMENT OF HEALTH
. DIVISION OF ENVIRONME UAL HEALTH .SERVICES
,1i 10 W /..1'
• - • - .
.
td ea .
... - _
.-
I3 /
Section Block Lot
Subdivision Dame
Subdivision Lot #
GUARAI E OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
w8rlianship, 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`vy n►e t6 such system, *except where the failare-ta' operate properly is
caused by the willful or negligent act of the occupant. of the building utilizing
the systems
I. The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environkental 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
• n al Signature
. 4Crp/ora_tiXon1=a1a4�_ �(if C�®rp.)���
ess
Title
• •• ration Narffe- • •.
rev. 9/85°
mk
"all W
' YML Environmental LAB NUMBER 32, 3313-
Services DATE /TIME TAKEN
321 I��a treet; crk.awn Y., , Irs; NY 105° . F"DATEMMt RC'D _ 119 _
ELAP #10323 (914) 245 -2800
DATE REPORTED 1 1-23-91
5
JV Con- 6- tauction
Hanmony =.Rd::
Patten.a on Ny
COLD BY
NOTES
X
RESULTS OF
ANALYTE
RESULT UNITS
PHOSPHOROUS
ALKALINITY
mg/L.
mg/L
SILVER
AMMONIA
mg/L
mg/L
SODIUM
,CALCIUM
n-g/L
mg/L
SULFATE
CHLORIDE
mg/L
mg/L
SULFIDE
COLOR
n-g/L
Units
SULFITE
CONDUCTIVITY
mg/L
umhos /cm
TURBIDITY
COPPER
NTU
mg/L
ZINC
DETERGENTS
n-g/L
mg/L
FLUORIDE
mg/L
HARDNESS
mg/L
IRON
mg/L
LEAD
mg/L
MANGANESE
mg/L
SPC
MERCURY
per 1.0 mL
mg/L
TOTAL COLIFORM
NITRATE
per 100 mL
mg/L
FECAL COLIFORM '
NITRITE
per 100 mL
n-g/L
E. COLI
ODOR
per 100 mL
TON
FECAL STREP.
pH
per 100 mL
S.U.
SAMPLING W"Aton P.Cace
SITE Patte,%a on, Ny
Kite h
For Lab Use Only
XXX Potable _ HNO3 _ pH LT 2 _ <4C
_ Nonpotable _ NaOH _ pH GT 9 _ <20 >4C
_ HCI _ Na2SO3 _ >20C
XXX STAT! H2SO4 ZnOAc
COLIFOR
R,METHORUSEb
X
RESULTS OF
ANALYTE RESULT UNITS
P
PHOSPHOROUS
mg/L.
SILVER
mg/L
SODIUM
n-g/L
SULFATE
mg/L
SULFIDE
n-g/L
SULFITE
mg/L
TURBIDITY
NTU
ZINC
n-g/L
SPC
per 1.0 mL
TOTAL COLIFORM
per 100 mL
FECAL COLIFORM '
per 100 mL
E. COLI
per 100 mL
FECAL STREP.
per 100 mL
These results indicate that the water sampl WAS [WAS NOT] [NA] of a satisfactory sanitary quality according to
the New York State Sanitary Code, for the eters tested, at the time of sample collection.
These results indicate that the water sample [WAS] [WAS NOT] [NA] f a satisfactory chemical quality according to
the New York State Sanitary Code, for the parameters tested, 'at a of sample collection.
G9 ��ri�i�(.i f F = = Not Applicable N = Not Present (Negative)
•
SUBMITTED BY: � P = Present (Positive) SA = See Attachment(s)
= Also done because Total Coliform was present
Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count
Director > = GT = Greater Than < = LT = Less Than
- - - - PUTT M-1� -HE?&M -1)EPA1k1:;t!3M4T- --
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simnons, M.D.
Deputy Cimmissioner of Health FIELD ACTIVITY REPORT - Sheet of
INSPECTION
NAME �=�Orig. Routine
Orig. Complain
ADDRESS Orig. Request
No. Street Town IM No. Compliance
Complaint Comp
MAILING ADDRESS Final
P.O. Boat Post office zip Code Group Illness
Construction
TELEPHONE
Reinspection
PERSON IN CHARGE Field, sampling Only
F
OR INTERVIEWED Field Conference
Name and Title
Other
DATE TYPE FACILITY
TIME TIME LEFT Explain
FINDINGS: .. ' -00-0-1
-7 odd
INSPECTOR: TELEPHONE:
Signature and Title
PERSON IN CHARGE OR
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
... - ....PtFnNAM COLT." FY - : :LT€?- nEpzU RIIVIE1i' _ ... _ ...- - -� . . .. . -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet of
INSPECTION
NAME / AO BAAA 6l ZW EL a-61 ' 38
Orig. Routine
/ Orig. Canplain
ADDRESS V � -5qc ►ptotz Def ut Orig. Request
No. Street Town TM No. Compliance
Canplaint . Camp
MAILING ADDRESS Final
P.O. Baas Post Office Zip Code Group Illness
Construction
• i�
Reinspection
PERSON IN CHARGE e Field, Sampling Only
OR INTERVIEWED W I &-iicd L Field Conference
Name and Title
Other
DATE (0 0 41 TYPE FACILITY _
TIME ARRIVED 'TIME LEFT Explain
m
FINDINGS:
INSPECTOR:
ture and Title
TELEPHONE:
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE: _
6/86 TITLE: _
ni a
i tt
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Enclosed M
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ti0�®VO 6ifs►ide® will ®i c®ntt "ruc@a® as tROleva oao the ap®vova� a/haltd 9 ra altP @o i"M"t tw ro m raqu 1t.o h _® o6 '
: C�a?i�8g ft1P1011t'`Ot tdilllt�, a11® t11Dt 001 c91e01atiow tiiaaaot q'�'CartiPitata of Coell�PUe4ioco CovFi80i�rrue' �t®QI$Pac4oPY�to ¢hm'Conlmi�iiov 09; P�litRztlU ,
saeoPVlitQOm' Qo the ° +papartneahQ, 9'11tl. m I;dPif @ai 9ua►ave4 a arlU iw PUmiaMA @i�s'ownor hi8: ¢me ti,:G�EvB'oP iptgwu
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r b POP 'Q:OYt'a �.yWICY �(� DPI ®P nlodlti66 OIhaP1 :COP1tiAafaB Ploesel�,Y ray �tl1e' CommlgsborgP 04'ICCaflB@R. t8lP1y Comm o or, el@Q6@1011 OP Oorw2rtmuon
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. (�Ma
10 %88
n.
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 #'
WELL LOCATION
Street Address To V
ct v N 2 'v` `D r t %/ ct
e C4t-y Tax
v-s or,
Grid Number
WELL OWNER
N�°e Mailing Address
rivate
,va0Ov%C v CGY�LD►1
GU
OPublic
.,USE OF WELL
PRESIDENTIAL 0PUBLIC SUPPLY
❑AIR /COND /HEAT PUMP
_
[ABANDONED
- primary
O;BUSINESS O FARM
O TEST /OBSERVATION
O OTHER (specify
2.- secondary
D'INDUSTRIAL O INSTITUTIONAL
O STAND -BY
O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE
/EST. OF DAILY USAGE '/'go
SERVED' -j T
' REASON. FOR
LXNEW SUPPLY OPROVIDE ADDITIONAL SUPPLY
❑TEST OBSERVATI0:9
DRILLING.
OREPLACE EXI ING S PLY O DEEPEN EXISTING WELL
DETAILED
e.wl
REASON FOR
_
DRILLING
WELL TYPE
EDRILLED
ODRIVEN
ODUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES __,!?�_NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: N A _
Lot No.
WATER WELL CONTRACTOR: Name '�'�: 6 ,.D, Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC'WATER SUPPLY: NIJ9 . TOWN /VIL /CITY
'DISTANCE.''i.0_- PROPERTY- FROM'NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION
!I
(date
�ON IPARATE S T
(sign ture)
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 Department.
Date of Issue: 19
I lop, Date of Expiration: 1g -1? / ermit ssuing c a
Permit is Non - Transferrable � White copy: H.D. File
Yellow copy: Building Inspeo or
2/87
Pink Copy: Owner
Orange copy: Well Driller
ILI
SUPERVISOR
Lawrence M. Lawlor
.(914) 878 -6564
TOWN COUNSEL
Judith M. Goldberg
(914) 878 -7106
(203) 792 -3050
Fax (914) 878 -6343
ROUTES 164 & 311
PATTERSON, NEW YORK 12563
June 27, 1991
Mr. Randy Laurent
Laurent Engineering Associates
?3 Fairfield Drive
Patterson, NY 12553
Res Property of Mr. J. V. Coughnett
Dear Mr. Laurenti
TOWN BOARD
Antoinette T. Gillotti
Thomas T. Keasbey
William Peragine
Deborah W. Taylor .
TOWN CLERK
Josephine Campanaro
(914) 878 -6500
I have inspected the surrounding property of Mr. Jo V. Coughnett
at the corner- of Warren D_°ive and Weston Place and I have
determined that ,the small wetland area to the north of this
site is less than two acres in size and therefore is no-k;
regulated under the Patterson Wetland Code.
In addition, it appears that you-- -gave located - -the -aSDS-
_. :sure than ZUO"3e�ti -from 'tnzs -pie �� grid edg o __... .
Sincerely,
d- c( CQCCs'!�G(
Ted Kozlows;:i, E aC o I a
TK/
ec s I +Iro Robert Morris, Putnam County health Dept
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 # - D�
WELL LOCATION
IS WELL SITE SUBJECT-TO FLOODING ?. YES _NO
,IF WELL IS LOCATED IN A REALTY.,SUBDIVISION, NAME OF.SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name8. Address:
IS. PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME.OF PUBLIC WATER SUPPLY: N /A TOWN /VIL /CITY
DISTANCE' TO 'PROPEl TW"VRbM NEAREST WATER VMAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR -OF THIS APPLICATION ON SEPAKYE S
t5 g
( te) ( nature)
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: I .
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: — - 19
Date of Expir on: 19�.
Permit is Non - Transferrable
2/87
eerrmitIssu Issuing Of is .
White copy:
Yellow copy:
Pink Copy:
Orange copy:
H. D. File
Building Inspector
Owner
Well Driller
&eet dd ess Toi Village City Tax
�\ E
Grid Number,
WELL OWNER
Name Mai in Address
L U 6M
t 1 "k C IV
WPrivate
OPublic
USE OF WELL
T>- 'primary
2' - secondary
Gi RESIDENTIAL ' O PUBLIC SUPPLY
❑: BUSINESS O FARM ,.
13JNDUSTRIAL O INSTITUTIONAL
(3 AIR /COND /HEAT PUMP
O TEST /OBSERVATION.
O STAND -BY
_
O ABANDONED
❑ OTHER (s.pec ify
O
, AMOUNT OF USE
YIELD SOUGHT J 'PEOPLE
SERVED 3 -5 /EST. OF DAILY USAGE 5Ogil
REASON FOR
DRILLING
NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY
[3REPLACE EXISTING SUPPLY .0 DEEPEN EXISTING WELL
OTEST OBSERVATION
. DETAILED
`REASON FOR
DRILLING
E
WELL TYPE
ODRILLED
DRIVEN
ODUG
[:] GRAVEL
C]
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: Name8. Address:
IS. PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME.OF PUBLIC WATER SUPPLY: N /A TOWN /VIL /CITY
DISTANCE' TO 'PROPEl TW"VRbM NEAREST WATER VMAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR -OF THIS APPLICATION ON SEPAKYE S
t5 g
( te) ( nature)
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: I .
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: — - 19
Date of Expir on: 19�.
Permit is Non - Transferrable
2/87
eerrmitIssu Issuing Of is .
White copy:
Yellow copy:
Pink Copy:
Orange copy:
H. D. File
Building Inspector
Owner
Well Driller
i
m
a
t
' Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT -_ .CORPARATE..91NER A.PPLTCATTON
FOR PERMIT. APPLICATION SUBMITTED TO
PUTNA,M COUNTY }[EALTH DEPARTMENT;
The Commissioner of Health - In the matter of application for
—. S Srf
represent
that I am an officer or employee of 'the•• corporation and arrr authorized
t® act for _ ..�! _ �-�� L:i.�.�2. .,.. o m m ® _ - d
(name of corporation)
having offices at _
Whose officers are
__m__m__ >__�a._�:m� _-
President _ �%ei Cang y .�,I�m - 'id�dres�
Vice - President
_ _ _ — — — — Name and Address)
Secretary _ _ -., _ _ _ m
(Name and Address)
- Treasurer - _..:.. _... _ _...._.... . -. _ , ...
..(Name- and Address)
and that I am anti will be individually responsible for any or all,acte
ok the corporation with - respect. to the approval requested and all - rub-
.. Sequent act$ relating . t}iereto, '
S�orn to before me this 1 day Signed ��
APPENDIX B
PUTNAM COUNTY DEPAFMMU OF HEALTH - DIVISION OF MWIROMM9TAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE I SEK9GE DISPOSAL SYSTEMS
i
REVIEW SHEET - CONSTRUCTION PERMIT
- DAB -
(Name of Owner) (Street Location)
COMMENTS YES NO DOCUA MUS
Permit Application
Corporate Resolution
Plans i - Three sets s/s
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
Ho Plans - Two sets
permit; PWS letter
Variance Request
LF trench provided c�
required 3�
60 ft. max.
Parellel to contou
Minos .
L_71"Mtzi
W1P
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked 1
Wetland (Town/D2ermit R & D) G ? r
Data Chi DDS Plans & Permit Same c
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
,,Sewage System Hydraulic Profile - Gravity Flow
ill Profile & Dimensions - Volume
D o(J�ox;Trench/Gallery; Pmp pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design Data.: perc.and.deep re I-+!
Two = Foot.' Contours Existing Pibposec _.....__...........,..� ._
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
--° - -If R, roped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells'& SSDS's Win 200 ft. of Proposed Systems
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 1'0; Type pipe
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields'
10' to P.L., Driveway, Large Trees,Top of fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
X00' to Stream, Watercourse, Lake (inc. expan)
15! to i"ai Dr"�'ins-Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercourse
10' to Water Line (pits -201)
50' !intermittent drainage course
10' - ran Foundation; 50' to well
15' Well to PL
9
i
PUTM M= DEPARTMEV-."OFIMAXTH
DIVISION • F ENVIRUMML FMALM SERVICES'
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Add ress2t•,t0�
Located at (Street) ��1VC Sec. _ (.p0 Block Z Lot {o22- 4t, -e,+
(indicate nearest cross street)
Municipality
Watershed
SOIL Pk�CLA'I.-ION TEST bATA RDQC= TO BE SUM= WITH APPLICATIONS
Date of pre - Soaking -7 /2j6/67, �; Date of Percolation Test
,HOLE ,
'NUMBER CLOCK TIME PERCOLATION
PIItOO=CN
Run ` ..'.Elapse- Depth to Water Erma
Water Level
No. Time :- Ground Surface
In Inches
Soil Rate
.Start =Stop Min. Start'- Stop
Drop In
Min /In Drop
P
_
Inches Inches
Inches
13 03 - 3 20 27
�
�• � _
2 3'. 21 _ T41 ZD 24 271
33 -'4 -y;pZ :?.d 711147
4
5
1 AF -4.E -7 • IS 24 27 G. n
3 0 !2-6 ?z- . (..o • i
Mm
3
�.� -i :z m
4 tT
5 tr
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.sutmitte3.
:., for review.....
- 2.-' Depth, measurements ' to be made -fran top of hole.
2°
3'
41
HOLE NO. I
51
89
90
BOLE NO.
WITH APPLICATION
IN- TEST HOLES
HOLE NO. 3
loo
11 °
12°
13'
141
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
- --
INDICATE. LEVEL TO WHICH WATER I.E'VEL RISES AFTER BEING ENOOUNTERED (�(�
f
DEEP BOLE .OBSERVATIONS MADE BY : DATEo P�
DESIGN L
Soil Rate Used (O-% Min/1" Drop: S.D. Usable Area Provided �g0�
No. of Bedroans 3 Septic Tank Capacity gals. Type
Absorption Area Provided By ... ' L • F • x 24'° width trench
Other
Name l & I N CM& SAC „X.0 Signature
Address rz-q SEAL,
13-66-3
``THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
NO. 56124
Soil Rate Approved sgaft /gal. Checked by
To be_j6wistructed Pb y - - .Address
Water- Supp)Y - t ublic Supply om -
I
IL
r.' J xriT x M
II
r—. Il
z. Private:bupply to ibe, drilled, b' _
a
- 1
Address
*M •. _ l r
Other. . e irement �
IF
1 represents ME— wholly c mpletefy responsibfefor h sign and IocaUOn of the ,proposed` system(s), 1) ,that t sepgrate iwage�disposal isste1 esc bori ructe ?a show on the approv as endment thene`to and In accordance with the's_tandar�di; :u es anregCi ons o t e . u•r�a4l»
County D partme of "Ith;f s hat' R compiet�on e e f a ',CertIf�Cate, of Construction Compliance" satisf5ctory to the: a of Healthwl�ll
=a % — . s
e-, submitted fp t e ,Dep rtme �; d JVritte guarantee:. II be .furnished' the owner, 'his 'successo[s heirs -b- assigns by'the;bui der; that said - ;builder w II
place 3�n gp d ".;op at�ng' coM any it sai8 `age; isp�osal system. during_the, period of two (2) .years immediately following__fte of the iss -
ance `of ;th` a "ppro al o t'h Certrficat'e " n e of the original stem or any ,repairs thereto; 2) that the'dr Iledkw,ell descr9bed abo '0
will"be loca ed as s a on ;the appro Ian and 'that id.w I will be; installed in rdance'+wlt ,1 the ndar, rules and• regU!a, s", of the Putna% n
GoUnty# De artme t�` ��`
Date f Sign 'P f P E ~R Ar
e cafy `s ,,r
r ' Atl ress License No
r
Ap�PROri [� tO CONSTRUCTION This approval�h.n._,�Ssiglered ne year:from the date ,issued unless construction of ,the 'building has been' uncle taken, and. is
revocable ;for, caUSe or may be amended or modified necessary by the' Commissioner of Health. Any ,change •or alteration of.conatrugti n uores 'a new , :'; .. ,:: Yer�l
permd, Approved for disposal of domestic sanitary sewage, and /or private water stipply only
Date = By Title
_ .. Y. ` _ ♦wL' -(' .r:� :R.� Cam' tfy y< � - I.
PUTNAM COUNTY: DEPART ti LTHi .9
�1
Division of tEnwronme�tal Hearth Ser ices, Carmel N. Y
CON$TRUCTIONPERMLT. FOR SEWAGE SYSTEM. ,
:DISPOSAL_
i
o'
"
r. Located at
Tax
,SUbdivisiori�
_ _ �LOt _
s
r
Address
BUilding
Lot Area
Type
`'A�
n
Number of Bedrooms . "Design.
Flow ! lJ `��� >�� Total_ Habitable Sgice
Separate ''Sewerage,'System to consist of - - -- - G I. Septic Tank and -
To be_j6wistructed Pb y - - .Address
Water- Supp)Y - t ublic Supply om -
I
IL
r.' J xriT x M
II
r—. Il
z. Private:bupply to ibe, drilled, b' _
a
- 1
Address
*M •. _ l r
Other. . e irement �
IF
1 represents ME— wholly c mpletefy responsibfefor h sign and IocaUOn of the ,proposed` system(s), 1) ,that t sepgrate iwage�disposal isste1 esc bori ructe ?a show on the approv as endment thene`to and In accordance with the's_tandar�di; :u es anregCi ons o t e . u•r�a4l»
County D partme of "Ith;f s hat' R compiet�on e e f a ',CertIf�Cate, of Construction Compliance" satisf5ctory to the: a of Healthwl�ll
=a % — . s
e-, submitted fp t e ,Dep rtme �; d JVritte guarantee:. II be .furnished' the owner, 'his 'successo[s heirs -b- assigns by'the;bui der; that said - ;builder w II
place 3�n gp d ".;op at�ng' coM any it sai8 `age; isp�osal system. during_the, period of two (2) .years immediately following__fte of the iss -
ance `of ;th` a "ppro al o t'h Certrficat'e " n e of the original stem or any ,repairs thereto; 2) that the'dr Iledkw,ell descr9bed abo '0
will"be loca ed as s a on ;the appro Ian and 'that id.w I will be; installed in rdance'+wlt ,1 the ndar, rules and• regU!a, s", of the Putna% n
GoUnty# De artme t�` ��`
Date f Sign 'P f P E ~R Ar
e cafy `s ,,r
r ' Atl ress License No
r
Ap�PROri [� tO CONSTRUCTION This approval�h.n._,�Ssiglered ne year:from the date ,issued unless construction of ,the 'building has been' uncle taken, and. is
revocable ;for, caUSe or may be amended or modified necessary by the' Commissioner of Health. Any ,change •or alteration of.conatrugti n uores 'a new , :'; .. ,:: Yer�l
permd, Approved for disposal of domestic sanitary sewage, and /or private water stipply only
Date = By Title
_ .. Y. ` _ ♦wL' -(' .r:� :R.� Cam' tfy y< � - I.
0
April 27t 1071
Hr. Oeor-ge Maughneyj 0'4o
Route ,52
Car, mel 4 ftw York 10512
Re t Frederick
Weston & t1arren Prive
Pear W,- HaugWY-6
The proposed submittal for constructics of a sanitary Dewage,
di- 1 ea- s4rVo the aboye .pt pposeO reside=e has baeA :.Veviewed
spo". gytt -to
by this d0paftmw#
The propo961 has $ome sdrious problems in bi�iag able'
justifiably.c. tneA c O-Unty Rules & ReoUlat ions - -lot the
1 -4on Sal in -hit -followi,
l
inaw ti
11) 4xisting. swampy, area at the sr(MW of the propoted -
'ar" .00 9 away, tfig. pro 10�.
lot-' t�q 00 �O be I
SOMP -101 eal isyft fts p not PlOU'Aw- On, 'Plan"
2) Adj�C@ t 41
but ebt eve O,:�.n fleld by this WI t lac -Ozopoi -
Well IW46 tha4 100 feet iWay pod'sibly in direct line
fleaiksip: t4w' tact �-hlz of Ace, if, you' haft ahy. questions, joelati
to this matter,,
Vevy truly yourS9
Robert Y, Tutoni
Publi c Health Admiastratdc
sd1h
Re: Property c-
Located at
Section f/q. G' Block Lot
Gentlemen:
This letter is to authorize George A. Haug h n e y a duly
licensed professional engineer X, or registered architect
(Indicate)
'to apply for a Construction Permit for a separate sewage system; to serve the
above noted property in accordance with the standards, rules or regulations as
promulagated by the Commissioner of the Putnam County Department of Health,-and
to sign all necessary papers on my behalf in connection with this matter and•to
supervise the.construction of said system or systems in conformity with the pro-
visions of Article 145 or 147, Education Law, the Public Health Law, and the
Putnam County. Sanitary Code.-
Very. truly yours,
r� {.Yf��,,
_ ,
Countersigned:
.�` , P 3
q J
4
P.E. R.A.; # "'.il'Ai,� .� 9
�r�rrii�t��t�T
Route .52
Address
Carmel, N.Y. 10512
(914) 225-9353
Telephone
�io-�
`owner of Pro-pert
awl
Ad ress
Telephone
F PUTNAM COUNTY DI,PARTMENT OF Ii1!�,41,'PIi
DIVISION. OF ENVIRONT,1Tv `TTAL IIE LTIT SERVICES
COUNTY 0FICka L'1JILDII +G, dARMrL.L N. Y.- 10512
DESIGN DATA . SIIFE IT- SEPARATE SD1 4AGE DISPOSAL SYSTEM FIL{ NO.
Owner Ci Address 7
Located at (Street Sec. 10 Block G; Lot
n Ica e nea,res cross street)
Municipality. //% Watershed
SOIL PERCOLATION `PEST DATA REQUIRED TO BE SUBMIT D WITH APPLICATIONS.
Hole.-
Number. CLOCK TIPS'
PERCOLATION
PERCOLATION,•.
Run. Eiapse
No. Time
..Start -Stop. Min.
Depth.to •;a i,er
From Ground Surface
Start Stop
Inches Inches
WaLer-LeVel
in Inches
Drop in
Inches
..Soil Rate,;.
Min. /in drop
2 / %f - /-' /D
d?�' a;
ZD
/rrV2 /� ��
(JI �
/5
1 i2�r CIV• /y /.5
- 0�
5
2
Notes: 1) Tests to be repeated at same depth -until approximately equal soil
rates are obtained at each percolation test hole. A11. data to be submitted
for review.
2) Dopth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO DE SU13t41-TT-P0 W19111 APPLICATION'.
DESCRIM'TON OF S01'Lc3 .11i'l-MOUN" 1.TRED IN TEST HOLES
DEPTH HOLE. No.
HOI2,' NO. HOLE, NO.
G. L.
611
1:211
1811
2411
30"
3611
4 it
2
'481.1
5 it
.4
.6o
66
72 60'
78
0
INDICATE LEVEL AT WHICH GROUND WATER IS tNCOUNTERED X-)026�,
INDICATE IMEL, TO VBICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS 14ADE BY Date
Soil ].late UsevA-/5— Min/l "Drop: S.D. Usable Area Prbvid,d,-<006��
No. of Bedrooms V Septic Tank Capacity?M Gals. Type
.Absorption. Area Provided Bj-?�--L.F.x'2)411 b" width trench.
Address
ure
.SEAL
THIS
SPACE FOR USE BY
BEALTH DEFAIMIRMT
'ONLY:
Soil
Rate Approved
�Sq. R/Gal.
Checked by
M
U.J
UF�SS . . . . .
i
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d
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