HomeMy WebLinkAbout1212DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25.63 -1 -32
BOX 12
1 ru
. .
J
L
6
P.J
myF
,,L
01212
R CATE OF CON
PUTNAM COUNTY DEPARTMENT OF HEALTH <
Division'of Environmental Health SeMe"'C4, Cermei, N.Y 10512
• Engineer Mast•Provide
P 6H D. Permitk --
MCTfON COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM _
. T: Patterson. :•
Located at1 )Tyrone Roaa
Owner/applicant Name Key Realty . Corp . Formerly Goldhammer
Mailing Address 93 Glerielda Ave: , . Carmel. NY Zip 10512
• Town`or, VWage ... ,
Tax Map 59 Block 2 Lot 2& 3
Subdivision Name'Putliain'- Lk 8ubdv. Lot #6648-511 nc
Date Permit Issued. 4 Mai 1 9A9
Separate Sewe e System bunt b Owner . '.Same as above
rag Y Y Address
Consisting of 1000 Galion Septic.Tmk and 352 ° sq. ft. of 4' xV xV galleries
Water Supply; Public Supply From Address
or: X Private Supply Drilled byaoyd Artesian Wells Address Rte. 52, Carmel, N. Y. 10512
'Banding Type Modular Has Erosion Control Been Completed? As required
Number of Bedrooms Two Has Garbage Grinder Been Installed? NO
Other Requirements None
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), ind'in,aoccrdance with the standards, rules and figu tions, in accordance w th the filed plan; and the permit issued by the
Putnam County Department of Health.
Date
7 February 1990 Certified by
P.E. —X R.A.
Address RD9- Fair.'St. ; : anal, N.Y. 10512 License No. 29201;
Any person occupying premises served by the above system(s) shall promptly take. such action as May be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the'.separate sewer' am shall become null and void as soon as a pub,_ sanitary sewer becomes
available and the ipproval of the private water supply shall Decome_ n and id'+wheri a public water supply become available. Such • approvals are
sub)eet to mod{ Iratlon rueh/a\ /nge• when, inr the Judgment of the m isf er' of .M It h regocation, modification or change If necessary.
Date —_�_ "v" BY Title IA ki
PUTNAM OOULMY DEPAHIMENT OF HEALTfi
DIVISION OF ENVIROiZ=AL HEALTH SERVICES
Rey Realty Corp. 59 2 & 3
Owner or Purchaser of Building Section Block Lot
Owner
Building Constructed by
Tyrone Road
Location - Street
T. Patterson
M=icipality
Modular
Building Type
Putnam Lake
Subdivision Name
6648 -51 Incl.
Subdivision Lot
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the lotion,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as s.homn 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 an good
operating condition °any part of said system constructed by me whichi 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
.Lep<,!Lrst i aue by cite to such systi-m, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the^ buildincy UtilizilIg
the system.
The undersigned further agrees to accept as conclusiv
the Director'of'the Division of Environinental Health Services
Department of Health as to whether or not the failure of the
caused by the willful or negligent act of the occupant of the
the system.
e the determination of
of the .0 Eh in Coinnty
systeilt
Dated this
day of Feb. 1990 Signa
Title
Same as
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
.. I.
rev. 9/85
A/
M COQ.
WELL UUP'1rLt11ULV Mlruml
►et DEPARTMENT OF HEALTH
�� ' Division Of >Javironmental Health - Services
W Y0 PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADURESS: WN/ IL 1 TAX GRID NUMBER:
—F io 11 9-
WELL OWNER
NAME: ADDRESS:
, b, v hl Y
19 PRIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
® RESI ENTIAL ❑ PUBLIC SUPPLY - ❑ AIR /COND. /HEAT PUMP O ABANDONED
O BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED S / EST. OF DAILY USAGE SQ0 gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
NEW 'SUPPLY (NEW DWELLING) DDEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH '� �� ft.
STATIC WATER LEVEL ft.
DATE MEASURED
DRILLING
EQUIPMENT
O ROTARY 10 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING M OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH J r ft.
MATERIALS: 19 STEEL O PLASTIC O OTHER
LENGTH BELOW GRADE _ _' ft.
JOINTS: ❑ WELDED 5THREADED ❑ OTHER
DIAMETER ____!`2__— in.
SEAL: WCEMENT GROUT ❑ BENTONITE OOTHER
WEIGHT PER FOOT _lam
1b. /ft.
I DRIVE SHOE:•® YES ❑ NO
I LINER: ❑ YES ;S NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
0-YES- ❑ NO
SECOND •, :.
_..._ :
._
_...._.. _ _.
URS... . _ ...
GRAVEL PACK
❑ YES
$1. NO
GRAVEL
SIZE:
DIAMETER
OF PACK in
LTO&H ft-
BOTTOM
DEPTH It.
WELL YIELD TEST N detailed pumping
METHOD: ❑ PUMPED t25ts Were done is in-
IR COMPRESSED AIR , formation attached?
❑ BAILED ❑ OTHER YES O NO
'WELL LOG 11 more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
well
Dia-
meter
FORMATION DESCRIPTION
cool!
It
ft
WELL DEPTH
It,
DURATION
hr- mm.
DRAWOOWN
ft,
YIELD
gpm.
Surface
S
SD /
�S
36 S
WATER O CLEAR TEMP.
QUALITY ❑CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME �c1r,a/ # t(ZO �� C, DATE ^_p
AoDRESS 1�� SIG, yr d
CCA441 p.� /V /0,-1
3 /69 1 If � /
Yorktown Medical (Laboratory, Inc.
_. .. _ __321. Kear..Street. .
Yorktown Heights, N. Y. 10598
(914) 245 -2800
Director: Albert N. Padovani M. T. (ASCP)
T_
KEY REALTY CORP:
93 GLENEIDA AVENUE
CARMEL, NY 10512
K
L
J
LAB
Date Taken: 2/12/90 Ti : ►ie � PM
Date ttc,ds- 2.../12 90 Ti one:
Date Reported: Z-71, !C
Collected By: ELLEN McGLASSON
PO /Client #
Referred 'By:
Sampling Site: KITCHEN TAP:
tyrone RD. PATTERSON, NY
Phone ( 914) 225 -1357
REPORT � ON �'.THE' `QUALITY. � -0F WATER.
INO GANICS m L MICROBIOLOGICAL U 100mL
Alkalinity-
_ Chloride
_ Copper
— Detergents, MBAS
Hardness, Calcium
f Hardness, Total
— Iron
_ Lead
Manganese
Mercury
— Nitrogen, Ammonia
— Nitrogen, Nitrate
_ Nitrogen, Nitrite
Phosphate, Total
_ Silver
Sodium,
— Sulfate
_ Sulfide
Sulfite
Zinc
PI1 �' SICAL MIS ELLANEOUS
— pH (S.U.)
— Color (Units)
Conductance (uhms /c)
_ Odor (TON)
— Turbidity (NTU).
Standard Plate Count
(CFU /1 mL)
Membrane Filtration Method
Total Coliform
. Fecal Coliform
Fecal Streptococcus
Most Probable Number Method
Total Coliform
Fecal Coliform
Fecal- Stre-Dtocpccus.:_
Presence /Absense (PA)
Total Coliform P A
KEY:FOR_TERMINOLOG
CFU = Colony Forming Units
IT = � = Less Than
GT` = > = Greater Than
NA- = Not Applicable
SA = See Attached
TNTC = Too Numerous To Count
REMARKS COMMENTS For ab Use
(For Lab Use)
SAMPLE TYPE:
(Check One)
Potable
Non - potable
OUTGOING:
(Check Each)
HNO
- HC13
— H2SO4
— NaOH
ZnOAc
— Na2S203
— Other:
INCOMING:%
_ZLE 40C
_ GT 4 /LE 200C
GT 200C
— pH LE 2
_ pH GE 12
Other:
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS)) (WAS NOT) (NA) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE
SA'1'.':iFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE P C DRINK -
ING WATER CODES, FOR TH PARAMET S TESTED, AT THE TIME OF SAMPLE COLLECTION.
/x/ �lrN�2'z -1-t /77'/ 7 /f3 %(Rvsd1/90)R�rrt?
- •• • ' T tCN
I =-
V.
V_-
Fir, Si'r'_ DIS :PE —C.1
Sr.Ectad by r
CIANER
IOV�
SEiAG DISPr.Scr, naEA
E- rS a--a-- ic=1— as per ar oroved ni a_ns
b. Fii1 s ica - Date cf plac-=ne-ht
I
I
2:1 rc1" e_y LGTE yv . E A:.TC- I::
i
I
C- mat -1 =? sc not s - i Lc
d_ St-ne, bru= , et-,'c. , ar t =r flan 15' f =Cliff Sias a1' _
I !'I^
e. loo ft- f =c:. water scut= 7l�N�SCt1�
c c Srs�,�
�'��• DI rC�.P�
.1
�E —sentic
b. SettiC tar -: i ^c ` _ leve i
I
I
I
c. 10 minim m. = -- ^r - =t=CrL
-c1�=
I :/1_
--
°0° b nos -cut wzt��n 10 f= CL;
I
E. =N
1. P? 1� CLiT_ °=: c. =�T= E! =rc c?1
4 11/t C� -1 c:l c: es n = i- C r C L
I!
2_ D? s t = ^.C_
^ -C c:.e C= -_� °- V ^ - 1/32
•.Lr= _- ; CicS
6. 10
T_C.`-
I I I
� C^1CC L2.--03
_- _ r.=-
-_•._
7. De emu ^ C. < 0 .-
-��1T
I
6. Rc= a! i c- a -rcr e::--- nsica, 50s-
I
0 Cite CL., C = "ice 31
-�-
lG c- c-= . a In t= "C.•? 12" I"iLi 1 r -r1
I
h -- CR
1. Size of II_�,.. G==—.- '
2. Ctie_rflcw ink
I
I
•
C Pm-o e°_S' -T: aC= =s Sibi °_ Aa--hols to crace
5 First tcx calf
I
6. Cycle by E =mil to L�::ent I
-
i
I
I
I I
es ti nets cry Ca Cr Cie i
14d
a- EcusZ r_r a crcvr_! plans
cf
y -Wall
( I
I
e lcCaL as z —°' acorovei plans
b. E- =-;"rc=_ f_= s,c area tr=- _=-urea ft_ I
I I
c- Casing 18" a:--ve c=ame- I
I
a_ Yes rrcc-._�r C- -Cll:te
�---
b. P_1 ices
c. A:--, vices flush with ins-ide or ircx I --I--
" -'
c. Ba•�k =ill rr. -:t= G? cent .ins stones < a" in ci`matz -
e c.,-- • `ins 11 ed acc^rdirc to piLn I
I —
—!-_
-
f. (- +-- ai n dr--_ Cum =i 1 crctart & c_r. to evi=t.wat *Ercct.-.41a
—
L I
S=a ce a7Way t =C it EDS
I
CI7 S I GOES C-==t
ol
�--a+rre- r, "- -' +-. 7«,- t••rvrr�r- 'F++T.v..wc- ^r•vr•� -. - y- .s.::- +---'- m^ , `- -'^" ^.,wx "— .m-r,.- -P--- •Y— v- emu.- �°*T -, ; ^1
PUTNAM COUNTY DEPABTMENT'OF HEALTH
Dlvlaloa of Eovbonmeotal Healtti'Servkei: Caemel. N Y 10512 Engineer to Provide Permit N
on CERTIFICATE OF COMPLIANCE
CONSTRUCTION PERMIT, FOR SEWAGE DLSPOSAL SYSTEM
s on
Porntit .a P. =16 - 83
Tyrone Road ' T Patter z wa or v e
sabdit+Won Name Putnam 'Lake T
Biotic Lot 2 0 Sabd Lt N Tair Mn ,
Ke ''Realt Cor Renewal , i� Revwon p
Owper /Applicant Name' y y P • .
Date of Prevlone.Approvd Aug. 1 88',
29. 9
MWIIngAddreea 93,:Gleneida_ Ave .Carmel:, N Y. p 10512
.:,Date Subdivrs ion Approved Fee ._Enclosed Amount
Bauamg Type Modular,' Lot Area 9 350.
Fi0 $ecdoo Otay Depth Volume
Number of Hedroo TWO Desigtt Flow G P D 400 i PCHDNotlHcadoiias Required When Fill Is completed
Separate Sew 1000. 40' x `4' x 4' Galleries . W1 -211 stone sides`. & bottom
er�ge.Syetem to.ctinalaf at GaUan•Septk Tank "A
To be by . AT Addrose
Walter Sappy; Pdbllc SuPp1y From Addiess
r
PrlvaterSapp�yDrWedbyP F iBea l & Son�d P.O. Box B, Brewster, N:Y 10509
OtbeR ReQuiremeaq ' u . ' ' .
,tiepresent"that-1 am wholly- and��completely responsible for- thedes�yn_ and location of the propoted ;'system(s); 3); that the separate'sewage disposal - system
above described will be,consiructed as shown on the approvetl amendment theie,t ' and in accordance with'the standards, rules an regu a ons o e u nam
County Department o't Noalth,'and that on eompletion. thereof a ,Cerbfkite. of construction,ComDliance" satisfactory fo.the Commissioner of Nealthwill
bs'submitted to 'this �Departmeht, anda written quirantee,'will be- furnished the owner his successors, heirs or assign ,Dy the builder, that saftl builder,%4111
place. in •good operating coridition any 'part of ,said •sewage disposal system during the period' o ears immediately following,thedate of the issu•.
ante'' of the appro4al,:of the 'Carts /�cate ,of Constructor Compliance o ahe..originaI -syste ,; 'any repairs., ark o 2) that the drilled well, described above'
will be located as shown: on the taDDroyed, plan antl that said well will Davin a ed accordant ith the 'stand rds " ulea and requ ads of the 'Putnam
.'County Department'of1Health ,';}, r
wte ` 3 `May 1989 F signed[ P. E. _X_ R.A. —
:RD9 Fair St. , C ' m N 'Y. 29206
Aildran
ADPR. 1W FOR CONSTRUCTION This'approvil ;expires`two yeais 11opi the
revocable for cause or msy bo arnentled or.modifI when conildentl n e650y
requires new permit.. proved for disposal 'Of- domestic sanitary-sewage'
Rev. /j
1/87'
License No
issuetl unless construction of the building has been undertaken and is
E Commisfione►,of.: Health, ; Any Change dr alteration of construction
_ AA9CIIP IIt a i vac iwau . _ .. �: - _ _ _ _
Stabdtylaion RTi�e Putnain Lake 6446 =51 Inc1T 59 2 2 &3.
Subd -Lot q eu.., BlWh Hat
1P
lien ®oral R ®vlalon ❑
. n��.6ia..mus.�,�►ra,.J:A . .Harry Go:ldhammer
I ;iepfaient that I am wholly enC completely, re
above described will be constructed as shown "oi
County Department of HoaKh,. and that�on c
be submitted to ,the D'epaitinerit, and. 'a' writ
place m good operating condition ariy part.
.Once 'of the. ropproval 'of, the - Certificate o1. C
will tie locatetl, as`shoyvn`on the.'approved,plari,a
will ;De
County Department of Health.,' '
Date- 28 July 1988.: "Sign
Address RD _ Fair St , C
APPROVE_ D FOR CONSTRUCTION This'approval- expves -two ya
revocable tor, cause or may be amentletl or modifietl, -when coniitler
require s a n` permit. Approved., for disposal of domestic sani,
Rev. 1 Data _
SE
ocation of the proposed system(s); 1) that the separate sewage disposal tsystem
sere 'to and iq accordance with the Standards; rules an regu a ;=o o . u nam
r.ate.: of Construction ComDliani6" satisfactory to the Commissioner of Healthwill
hed the owner, his successors, heirs or assigns'by the builder, that said buildor„e5ill
iem- du ring.the period of two,i2)_`years immediately, following thedato of the ismii-
the;o►iginat <system or'any, repairs thereto; 2) that the drilled well desc[ibod,abovo
11 accoidanco' with the -' ndards,.,rules anif regu aaTFlons of `. Oho 'Putnain
// P.E. X'. R.A.
NY ._. 105.12 29 206
t icen :e No '
the "'pate issued unless construction of the building has been undertaken and is
Lary by th*' ommissione,r of- Health. Any change or alteration of construction
oge ;'and /or piivate'. '�,,. susup —poly only.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914).225-3641
APPLICATION TO 'CO NST�._.___.__..�___. __. _. ._.......��..
RUCT A "WATER WELL
PCHD PERMIT # P16 -83
WELL LOCATION
Street Address
Tyrone Road
Town/Village/City Tax Grid Number
T. Patterson 59-2 -2/3
WELL OWNER
Name
Harry Goldhammer,
Mailing Address Private
311 South Holl brook Dr., Pembroke. Pines, F1aD Public 33025
USE OF WELL
1 - primary
2- secondary
]U RESIDENTIAL
O.BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED
O FARM O TEST /OBSERVATION 0 OTHER (specify
0 INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT
Five gpm /# PEOPLE SERVED Four /EST. OF DAILY USAGE 300 gal
REASON FOR
DRILLING
13NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
DETAILED
REASON FOR.
DRILLING
Residential
Supply
WELL TYPE
DRILLED
DRIVEN DDUG []GRAVEL [:] OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X 'NO
IF WELL IS LOCATED IN ,A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Putnam Lake Lot No. 6446-51 Inc l.
WATER WELL CONTRACTOR: Name P.F. Beal & Sons Address: P.O. Box B, Brewster, NY
a A
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
` DISTANCE TO' PROPERTY 'FROM NEAREST WATER-M&Ij it Over one mile- -
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See Dwg. #2, Job S.0.2048, By John H.
[]ON REAR OF THIS APPLICATION ®ON SEPARATE SHE Prentiss, P.E.)
28 July 1988
(date) (signature
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.
2.
3.
Date of
Date of
Pump the well until the water is.0 ear.
Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
Submit a Well Completion Report on a form provided by the Putnam County
Health De rtment.
Issue : —�,;�Ir 19 �� ', �
Permit ssuing fficial
Exniration. 19
Permit is Non - Transferrable
2/87
White Copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orange copy: Well Driller
1P><.T'II'R1k1M 'CO ®IEIPAIIB'1<'IYtIBI�'II' �]F 1HIIEAILT9- Permit "r P'n16 -83
^= D/V!S/On 'Of Environmental Health• .Serrvlces, Carme %° Al._ Y. 10592
L:
CONSTRUCTION' ��IRRAO�`IF06i S�1R1AGE,.DOSPOSA� - SYSTEM.;.
} Town or lags
i
;t cs aS: at TyrtCn6. Road .ax' iviap S,4 ex x . -� act 7 ^
Subdivision Putnam Lake sutra .Lot a�!}1}ti 5 j:7 Renewal Revision _]
/��
Owner /Add etN
rH GgddK 6lr . .of Previous Approval
=1ots.
Buiitlin9 TYPeIAd61 �r From° Cot Ar 935'0 17,, S�t Fil1'`Section only 0.
Number of Bedrooms P� Design`Flow G/P /D Wdn' P C , H D Notification Recnnred
Separate Sewerage System to consist of 1 (� uo
M Gal Septic Tank: and t- / t B it ,,
3
To be :constructed by ' Address Ste`)' ° %52�
w
Water, Supply:: Public CU6Ply''.From \ _ Under
- Pr vate Supply to be drilled by
Address
'Other,', Rqqu remen s
One
I represent that 1 am wholly antl completely respon eble for t`he d&gn•and location of the proposed system(s) ;'.,1) that the. separate sewege disposal, system
above': described will be con as;ihown on the approved- amendment ;there ao and-.in accordance with the standards; rifles an regu a,tons o ® u nam
.County- ':Department of 'Health,- and that on completion thereof a 'Certificate 'of Constructio_ n `Compliance" satisfactory-to the Commissioner of Healthwill
be submitted to the 'Department, and a wriiten guaiantee`will befurnished the owner, his successor S. heirs, or assigns4y -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',inimediately following thedatd of the issue
ance of the - approval of the Certificate_ of Construction Compliance of:'the original, system or' any `repairs'tnereto; 2) that the drilled well described above-
will be_'Iocated as sho.Ydn on the approved.plan and that said i iell will be installed in accordance- with; the .standards,' rules and regulations — of; the ` Putnam.
jCounty Department o4 Health
Date 14 September 98+ P Et—
Signed R A
`rig Perlis i.t s i gne! _J�83 =
�4�06.
e - License No ,
DROVED FOR CONSTRUCTION: This approval,exp;res: one year from the date = issued unless construction of the buiiding` has been undertaken and is'
Mile for cause or may be :amended or.modifiad- when,consi rednecessar,y, by the Co T ®r of Health. Any change'.or alteration of construction'
s a riew permit pproveit for disposal of _domestic n tar sews e, a d /or`. va er supply only.
i
- PUTNAM COUNTY DEPARTMENT :OF HEALTH` Permit A
` Division of Environmental Hea /th Services Carmel N. Y 105122O4H
CONSTRUCTION :PERMIT, FOR SEWAGE DISPOSAL•T8YSTEM ` T_._
. _ Pdt�QI^SOn '
?vrone :Road
. T
r'! Deal tl,-et r 'i - K9� ,,AI v ,(,(•. Ota.:'�
or village '
,
F
Subdwisicn Putnam° Lake" s„�t +!6446 51' Tnw81 Revisign.
y Harry ,Gol dha_rrm�er• %39 'Ravena- ..Road ;Brewster; -'�Nl� �.•-
+Owner /Address _ ate7Of Previous A +oval
PP -
/r61(� is
..Building •Type�OdUl ar Frame Lb[ A'fea 9350 Sn Ft Fili 'Section Only O
Is ;.
:,NUmb @r, Hof BedrOOmS - -Design Flow G /P /,D 600 , P C tH D NotMcetiOp Required
1000 60'xA'
-' Separates "Sewerage System to consist of'. + Gal Septic Tank: antl `r X4 Ga19 erl.es w %12• iS'tone : Surroun
i `' -;
` •To be ionstructed by } Address r
& 'Under
Water Supply:. :,Public;- SuPPIY From. a
r
Private `SuPPIy to be drilletl by _ i
-Address"
J.
.. N
Other Req ents Pne
U lremi
Y c
-a represent that 1. ;am whoily and .completely responsible -for;the design' and location.' of, -the proposed systems) `-4) that the'separate sewage, disposal system
above d'escribed'w�ll bo' constructed as shown on the approved amenAment there to anC in accordance with`ttie stantlard ;; rules an regu a ons o e Arnim .
r County :Department -of °',Health, and thai'on completiorf thereof a'tCert�ficate of Constructwrt Compliance" satisfactory to the Commissioner of Heaithwill
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
pkce, in good - operating`'condition any part ot. said .sewage disposal system during-the period or two :(2) years immediately following thepate of the Ifsu-
:ance_:of the approval of the- Certificate of'Construction Compliance of, the origih5l'system ^ or any repairs thereto; 2)`that the drliled well described above
'will be located as shown on the approved plah and; that said welt will•be installed in ' ccoidance witn-.the• stan s rules ;and regulations . of the Putnam
„COunty_Depa►tment of Health..
.4
•r
r Date " 23 August 1983
or
Sion X
� P� 292Q�6 R.A.
. .
9 Farr S
�. -Addreu License No.,
APPROVED FOR CONSTRUCTION This approval expires one year from the date ,issued unl struction-of the.builtling has been undertaken and is
revocable for cause or may be amended or'modiiied`.when'eonside ► a -necessary-by,the.,Com stoner- i,HeaIth. A'n :change `o btion .of 'construct ion
requveS ,a new ermit/ ApDro�1(Yed for disposal of. domestic n s age; /or priv water - .:only.
~.
Date �! f7 V i� By 8 T" iEle
9 91 i ,
� t
} a
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.
.Owner ddr� �,��ie, aro �a Address
�mAr
Located at (Street�lndigp&te e, �' Block Lot �-� .3
cross s ree $�&#;v Z,A S� Lis: g6 -�' /�/
Municipality �� � o, Watershed Ga-t -a o,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
o e
Number CLOCK TIME PERCOLATION PERCOLATION
Ruh apse p o a er Water Level
No. Time, From Ground Surface in Inches Soil Rate
Start -Stop Min. Start' 'Stop Drop in Min. /in drop
.Inches Inches Inches
11,1336 1337.
213 3 /
313f0 13 fl, b /�.
5.
Notes: 1) Te'pts 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
I -D-F.Srli�t-PTTM OF !S6Tf'.6. —P'Tqr0Tm9�T41.RP.n.-'T1\j - tR'c;T% RhtOR,
INDICATE LEVEL ..AT . WBICH, GROUND WATER IS AMCOMERED A/6-re
INDICATE LEVEL ., TO WBICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Alemp,.
TESTS. .MADE .PY4 v-1 'Date
Al"g- (&,r -
DES
Soil Rate Used Min/l'IlDrop: S.D. Usable Area Provided- 2-0', 6,o
No . ',OP Bedrooms• Septio:Tahk Capacity, 016-0 Gals. Type Mqsv,&rok
Absorption Area, Prq%.ia.od . By width trenchi'
SSIONA Other Mo"p
m M "V f� t IN) I 10 0, r. r-
Ad . dress -R 9, 'FAIR ST.,
�t
THIS 'S.P,A'qE, . OR USE BY HEALTH U I EP . ARTMENT Olk
Soi . 1,,,Rat .. e'Appp7ed, Sq. Ft/Gal. Ch
Date
1001
` �__-------_
- -
|�
- .
| � '
. .
' r- -
o~
|
~ |
| �
v
'
fz
~~~-----' niaum"m*r"
wit'
Altimm c*u*=x u*^^^= "~°~^^~--'
� .
~
/
�
.`
i�
! '
\ '
./
,
wm,En
OCATIO
I xz,�,L
SV
JOHN -H. PRENTISS PE
CONSULTING ENGINEER
'
^�
'Well located by:. Surveyors survey.—
Engineers mesurements.0—
TGnit, Poxes,
pit., galleries 8k laterals lo-cated by:Contractor:
Plata inspection
by: Health deptN'- d.'t . :-2-Z= .2-!?-
This .. ^" '°.../. ^^". ,^"�,.��
_
^*r""/ ","'~" °"° �"""`'"��^ =
morsy.
'"w.=.d "" ** ,r." "*u_ h� .^.
"v"""" =" *,"^u"^ ^, =" J`..= it
was c°=,,^ n1V ","L°, ="
'
.
"""".,"u.^ in ="°,^""." with "'/ '
"L""^",^ ,"u'° and rt,*./,,',"° ,,
,^" ^ .h, :,.x.o.o.
�
'.
A - o
� C
' ' c
'
A ' o
~- '
' o
A c
o' c '-����C)�' |
A F
_u ' IF ^-4����e-/-
A u
a.- n
A ' *
^-_----B - n
j
o ' J
A K^
'
----' a x �-'-----
-----�- - ------- |
\ '
./
,
wm,En
OCATIO
I xz,�,L
SV
JOHN -H. PRENTISS PE
CONSULTING ENGINEER
'
^�