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Home My WebLink About1266DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.70 -1 -18 BOX 12 16 1, 1 1 r,� , , r:. , ' ; , Ir Be re r A. I - iL f �r C, _. *'61%� r rr , ' ; , Ir Be re r A. I - 01266 UTN 0 .DEPARTMENT OF HEALTH ��`�T�-�•`�, � r'.-ry -'— ,. Rev. 3186 D. {vision of Environmental Health Se=vicex, Carmel N Y 10 En gmeer Mast Provide l i `g Q P C:H D. Permit CERTMCATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 1 lL1C � ;\� , .,I 4 �. •. .Town or'Villago M. _.. �/LD Ta='Map Z Block 7!,'.' Lot g Owner. cant Name ' Formerly Subdivlslon NameJL Subdv Lot HIQ�? Z Zip _ rl,� 9 Date Permit leaned A n MaWng Address --t /�l�t✓� �.- 19 V cJ Separate Sewerage System built by" .1 Cf]V l�1LG -i 1V Address (� Z• �/c�� oT �1-: -� 11 Consieting of i °�� Gallon Septic tank .and �O 'L i' �- �� 4_X4_ Water Supply:, Pnbllc'Sapply From Address or I Private Supply'Drilled�by e0'A _ Address Building Type I Has Erosion Control Been CompietedY Number of B,edroome Hes Garbage Giinder Been InetalledY -. :Other Requirements - -- I certify thpt the 'system(s) aseliated serving •,the above premises were constructed essentially. as s own on•t e s of a completed work ( copies of-:which , are attached)', a d in. accordance with the standards rules and regulitiona in a rdanc with, ed' lap d'the permit issued by the Putnam' County.'Department.' f tte 1 ' i Date l't�p. Certified by P.E. R.A. i IAdtlieu scents No. Any person occupying. premises served by, the above systemis) shalt. promptly take such action ai`may be necessary to see n the correction of any unsanitary conditlons resulting from. such'.usage ;Approval`.:o the separate sewerage systsm;,shall'become null 'and void at soon s a pubtt. wnitary pvwr becomes availdbleIrid) the approval of the private water suDply'shall,'become null 6nd'�'votd when a- 'public 'witty wpDIY becomes available. Such approvals are subject to,mod }if,tation;or chan•e� when, {n the `.judgment of,the:Commissioner of H ch'ieyocatton,.modlflcatlon or change Is'necaswry, Date BYGZ✓ Title 7 b PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchase# of Building K - Lj4c:e� Building Constructela by Location - Street Municipality I�C'.40-�C4& Building Type 6 z 2- Zov 2i Section Block. Lot Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEiK I represent that I am wholly and completely responsible for the location, worknanship, 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 by me to such system, except where the failure to operate properly 'is caused by the willful or negligent act of the occupant of the building utilizing . the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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 -3/ day of LL- 19" .. -* "r� �J►. •: mk Signa Title Corporation Name (if Corp.) Address BRIEWSTER- LAiBORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE No. 6320 SOURCE: R & R Development Barnard Rd. Faucet - Well Put bake COLLECTED: Sept. 23, 1986 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Sept. 24, 1986 0 per 100 ml. WELL.COMPLETION RE,P OR 7 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM 'COUNTY DEPARTMENT OF 'HEALTH SIRE: .,-W _T AOURESS: fOY1N/V1LLAGEjCI1Y fAA G;1O uuEA: Barnard Road Patterson 2 NY 1 WELL LOCATI OPj WELL OWNER NAME: ADDRESS-. R&R Develo-pment,c/o R.Rapp Drewville Rd.,Brewster,NY ❑ EUELIC USE OF WELL 1 - primary 2 - secondary tDcRESIDENTIAL 0 -PUBLIC SUPPLY 0 AIR/CONO./HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARNI 0 TEST/OBSERVATION ❑ OTHER (specify) ❑ JNDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY C3 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE C-21. REASON FOR DRILLING &NEW SUPPLY = ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION! ❑ aEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL 140 ELL DEPTH ft.! STATIC WATER LEVEL L3�1_ft. DATE MEASURED 7/8/86 DRILLING EQUIPMENT ER ROTARY CR COMPRESSED AIR PERCUSSION DOUG C1 WELL:P61NT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 ED ❑ OPEN END CASING, SCREEN' QCOPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 21 ft. MATERIALS: (3 STEEL ❑ PLASTIC 0 OTHER CASING LENGTH .BELOW GRADE 20 it. JOINTS: ❑ WELDED [R THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: &CEMENT GROUT 08ENTONITE DOTHER Ab _"t' WEIGHT PER FOOT 19 Ib./ft. D11VE,' DRFVESHOE:)aYES ONO LINER:CIYES - 010 SCREEN I DIANIETER (in) 'SLOT SIZE LENGTH E�G (f I LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST ED 0 YES ONO SECOND GRAVEL SIZE: PACK GRAVEL P E 0 y ❑ NO DIAMETER OF PACK in TO DEPTH ft.1 BOT-10M DE.7-)i — ft. WELL YIELD TEST If detailed pumping METHOD: CkPUMPED t tests'were done is in- 0 COMPRESSED AIR ,formation 'attached? ❑ BAILED ❑ OTHER 13 YES ❑ NO it more detailed formation descriptions or sieve analyses WELL LOG scr are available. please Vlach. DEPTH FAOI SURFACE E l Water Bear- ing Wtil Oia- meter 11 FORMATION DESCRIPTION COE ti ft WELL DEPTH it. DURATION he. min. 11AWOOW , N It. YIELD d S Lanurface 8 Dr .4 ling in overburden clay anTTrlTr—s Hit rock 8 feet 140 I 6 120 20 8 21 1).r JL L tin in rock set casing,•grouteld: 21 140 Dr i L ling in rock granite, HATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? 0 YES ❑ NO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE . TANK : T Y P E W e_j.j._ • X-t i,. 0 1 WX .250 Ciii&I_TY: 44 13.6 L GAL. PUMP INFORMATION TYPE SubmersiblOAPACITIY 10 jg MAKER Gould DEPTH H 100, MODEL 10EJ05412 VOLTAGE�_3_OHP 4 WELL DRILLER NAME RF.• Beal & Sonsj OAT " S ()/23/86 ADDRESS PCr Box B 10501 1 141 n. PUTNNA COUNTY t a ,. a Divisfon:of Environments/ H a•. " -00 - ;RUCTT16"N PERMIT FOR $LINAGE 'DISPOSAL SYST V 0 AR Subdtvitlon subs +Lot 'owner /Address` N s� Building TYPe�j„'��' Lot Area. 'Number;�of Bedrooms { � - Design Flow o /P /Dr TSeparate Sewerage System to consist of Gal To be constructed by s `p r�✓� l :•Water Supply �,'•`� t'Pubhc'Supply From t a P 1 7 " Private $apply 'to be drilled by F i z: >c Address `Other; Requirements � l represent that'.t am wholly and, completely responsible for`the design'an y- .above descnbeq „will betonstructed as shown on the approved' amendment _ ounty �Depar`tr rent of "'Healtti sand that on completwn thereof a Cert� be submitted Ito the'Departmen "t, sand b- wratten;- guarantee will be` turn place in.,good operating, ;conditionianyltpart of ;said sewage disposal s ° •Vance Of "she approval &Ahe Certifkcate'of .Construction Compliance o . will be lowted.as shown on the approved plan and that said well will be -ins , . County Department of Health 1 " •'. - Oate s a Signed t r Address a� ,APPROVEOIFOR CONST'RUCT10N t'This' approval expiresyone, year, ro revocable for causehor may be amended or modified when cgns etlSnec �equ�res a w ,permit Approvetl� for tl�sposal of._ dome sfic ni y r _ s elf , �,�,•" i `� .. � y , 1-v' i a - .. DEPARTMENT UFO HEALTH Pecmitl ealih Services Carmel N Y 10512 EM ' Town or iIlage ri -• �22.//1�� T �! ,lRp y�� 3 Al ork.4 fog N tm /L� Renewalr t❑ ti Revision *,Q T!• a• f 4 � i SDate.Of�Previous Approval F ; . -.'' Section- Only ❑ P C ". H D NoEi/fi�catioe Required ✓ /� ,•�� ,I Septic Tank antl �rl '•l t �F(/"71 ac�'tw�das j ��• �� Address ;' '• x _ �s � � , jf., r41. X t ''* ,< Sf ., nE 3 •” '� .•,t d IocaUon tof.`,the proposed system ( s); -1) thA.Ahe.separata sewage.disp"osal system there to and `in accordance with the standards; rulesan regu a .ons o. ' e Putnam nam 1 f,cate of Oonstruc ;ion Compli5nce, satisfactory to the Commissioner of Healthwilf fished the -owner his successors, heirs or- assigns`by the builder, that said builder, will ystem during• the period of two (2) years immediately..following, the,datebf the''issu i f:`the ongmal system`ior any epaus „thereto;,2j,thaYfA ri ad Well above talle'd in accordance wit e'tstandards rules' d; ul on ' of , the' Putnam ' r P. R A ` License 1 m th_e date. i3sued unless construction -of the Duilding' has been undertaken and'id essay Y b Y th °e Corn ii' 'of: Health; Any;.change or alteration of construction wage,_ and /or� "pn to . ater'^ apply only ` t" V. Title ; )D11 , ,4�V,104�04 *I !111wolhtplzi NIDDVAMM %;w 10M -F =-- iNSPECTIM RE2M / ✓d/ �i �/� 1 d INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO OamME TS 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..... o ................ 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 Soil Descrivtil 0 ft. 3 ft. 6 ft. 9 ft. 12 ft FINAL SITE INSPECTION D.H. 2 Lot Depth to G.W. Depth to rock Soil DescriDtia 0 ft. 3 ft. 6 ft. D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil 0 ft. 3 ft. 6 ft. 9 ft. Y 9 ft. 12 ft.. 12 fit.. INSP.BY: House SSDS located per approved plan....... ..... Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches. ............. Over 100 ft. fron Watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. from house.... .. .. Distance well to SSDS (ft.) .... tnf > ...... . Number of bedrooms checks ........................ Stones, brush,.stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally from trench.... o ............................... Boxes properly set. <.......o ..................... 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 . i . - VJ oral �� ..J -tee -.,•� -_ r •F r ME _ PurNAM Cowry IDEPARnr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES F - ..._..,/ �.��4ON- RFPJRT1SPT DATE: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO C!'S 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. D.H. 2 Lot Depth. to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. _..... __..a_2 ft. Soil Description 0'Z AFU D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Descrl tlon 0 ft. 3 ft. 6 ft. 9 ft. DATE: ` Of FINAL SITE INSPECTION INSP.BY: YES NO CONMEM House SSDS located per approved plan....... .... Length of trench measured O Width of trench average Slope of tile line and trench acceptable........ % a0s% r�- Rom allawed for expansion trenches ............. Over 100 ft. from watercourse......:..... *' *. .. Natural soil not stripped or SDS area .unnecessarly graded'......... ... ........ 10 ft. maintained from property line and 20 ft. from house.. . � .......... Distance well to SSDS,(ft.)...1. ............. Number of bedrooms checks ........................ - "'� �'°` �" < Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. ............. `.Y^ 15 ft. of peripheral soil horizontally from trench....... .... ............. Boxes properly set...... .. ............... Could surface runoff from driveway, roads, ground surface, etc., channel near SDS area.... I wl Does lot drainage appear OK in area of SDS. *'. * FINAL GRADNG OF SITE ACCEPTABLE..... / U 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 lGt- 1s°�t�' Address :Located-at (Street JPM� - Sec. Block Lot' -00 L eC �Indica e nearest cross sfreefT Municipality- Watershed ® SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION;,. .. apse Depth to Water a er Level No. Time From Ground Surface in Inches Soil Ratea;,. Start -Stop Min. Start Stop Drop in Mine /in drop' Inches Inches Inches l j -1'q ` �Z - Z� OCv Ci Z Z{o 3 _. __. . 5 11 =43 - ]69- 27 3 2) 3 2 : O(a - 2 :1 12 23 Zoo `� 5 1 2 3 5 Notes: 1) Te'skts 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) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS LNCOUNTERED,- IN°TEST HOLES-.' '- DEPTH HOLE N0. HOLE NO. HOLE -NO,. _ G.L. 6" 12" . 8�� 24'n 30" 42'ii 481 5" 60" 66�� 7211 78�� INDICATE LEVEL AT WHICH GROUND -WATER IS.ENCOUNTERED ...... . INDICATE .LEVEL `TO :�3I.CH WATERLEVEL ,RISES AFTER BEING ENCOUNTERED TESTS MADE BY , . _ ........._.. DE IGN Soil Rate Used Q �LMin/1 "Drop: S.D. Usable Area Pjovided No. of Bedrooms ) Septic Tank Capacity �0 Gals. Absorption Area Provide d By�L.F.x24'' w "� o Address SEAL w 11C 2 L� _lily THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date 61 .. ....... 92 81 A 1288 A;P90 l o N v 41291 O,(tj _ Q . _ D.., ry . 3 ' �P F � 41292 cr AIZ93 - --- ._7H_68 A 12 94 A1295 2 ,oD 1 ` } aD F V \ A 12 95 P etj C'hl 5 ti r 76 0 _-..._.__._ _.. _ _ \ I N N � A1297 A; 298 ' I �' ' _ A /p /g to CO o - - n I� -•/ N i � I � � G7' - - ... _......dam � � ryry _.. -�- -• .. , - Ai I A Jv � ' < Aigp3 A A A/gn5 v to o -p' 19 ' OGo loo , I I i I I I �, �0AJ �� V's I_z Z_<J IVA-1- V-A 'RIO\ -V - V — ---------- ��-'!�IVCLC7VV4 coo 16 MOTTLr"911 Pm Bar% o1quoT-Iddl LN3-W.l,HVd'lQ 1*00TA"g RITWR M,MM'SO,'POTGTAMrL :10 SNIOUV-1:101i)f Cl,,,iv qi-1119 RILL WT"H.xo vs NI ()_lj-)i,*jjS.Njo') rgvJ.\ jv:IJSAS 31.11 21 TAO 0121:1 , do.t:hl 1W All (T_I.f.'Y;,lINI SV,N\ WIISAS , , AHJ, IVIII 'I IV Nry ld Fill-L slU 0 N-j- MOTTLr"911 Pm Bar% o1quoT-Iddl LN3-W.l,HVd'lQ 1*00TA"g RITWR M,MM'SO,'POTGTAMrL :10 SNIOUV-1:101i)f Cl,,,iv qi-1119 RILL WT"H.xo vs NI ()_lj-)i,*jjS.Njo') rgvJ.\ jv:IJSAS 31.11 21 TAO 0121:1 , do.t:hl 1W All (T_I.f.'Y;,lINI SV,N\ WIISAS , , AHJ, IVIII 'I IV Nry ld Fill-L slU fin- � y �A T p c _ N - {- ® Q z9.81 i { O { s m uo Lo # A