HomeMy WebLinkAbout1430DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
34. -2 -16
BOX 13
or I
oil I
01430
h a. 'EIR 2
a v \ " k h ?PUTNAM COUNTY DEPARTMENT OF HEALTH j
f
f ' r; Ow�siort of,. Envrronmentel: jHele:ldr Services, Carme/ N Y 10612 4Permii e,
r
CERTIFICATE'_OF CON STR.UCTION:_GOMPLIANCE FOR 'SEWAGE DISPOSAL "SYSTEM l r',(J��ef'ScT+►
To will
. p wn or V �
;Located at y T 1+aP / �� Block
Owner �" Qil/ i R'0 .. %7 !S .� Formerly /Gti/it PF`Q /�r lie r_ Tax 4ap Lcf # Suhd Lot f
�.. .,�
Separate
Sewe►a9e System built by „!� «� / C Adtlress r�•S ��-+�' mot/(/
Consisting. .6 Septic Tank and; �O L" nT Z /t `T % C
J Other requirerrients
'Water Supply Public Supply From
-Private 'Supply` brilled :By
Address /'
'Building TYPe r "S /
N' of Bedrooms Date Permit Issued
iHas Erosion Control Been, Completed?; �� AA
. ,.;I certify that the spetem(s) ae listed serving the above'.'premiaea'.:were constructed essentially as. ,shown oa the plans of the completed work`( cop:
de wi latone ordance with the filed; plan and the permit issued Y:'. he of which'.aire attnched) and in accorc h
Putnam County Department'0P Health
} 2
Q
it
8S
2;
Date J �! �e4 ert�fie°
7 s�- y
PE. RA
Address
C d
Li 19i. No � 5 6 �� 2
?An ing premises se►vetl by the above systems) shall promptly take such action is may be necessary to secure the Cq#,*016e bf any unsanitary ,
y person occupy
:�eonditions resulting from° such usage APproval3ofpthe separate sewerage`tsystsm shall become null;antl void as soon as a public sahitary ssvver' becomes
available and. tljeappprpvbt of the private;water'supply she'll becomenull end vocal when a :pu ter supply gicomss available. Such approvals 'are
subject .ao modifieation, or change; n the judgment of the mis ei of Nealt such r cation, modiflcetlon or, change necessary
`..
Date ° h 4 BY , T
,Rev. .9 -81
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
WATER ANALYSIS REPORT -
SAMPLE NO. 5828
SOURCE: Joseph McCaffrey
Patterson, NY
COLLECTED: June 25, 1985
BY: Peter Tavino
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Hose Bibb - Well
Map 1496
Lot 1
O per 100 ml.
This. result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
RECE
f- Ou' "Ty
June 29, 19$5
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed byewell_driller and submitted to County Health pepartment togetfher with laboratory report of
analysis of wafer sdmple indicating water'is of satisfactory bacterial quality before certificaie of construction compliance 'is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Tavino Builders Inc.
ADDRESS
Deans Corners Brewster NY
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Dover Lane Patterson, NY 1
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
DRILLING EQUIPMENT❑
COMPRESSED CABLE,
ROTARY A R PERCUSSION ❑PERCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH (feet)
30
DIAMETER (inches)
6
WEIGHT PER FOOT
19
D THREADED ❑ WELDED
RI S O
x YES NO
CASING
YES
NO
YIELD
TEST
❑ HOURS G.P.M.
BAILED X PUMPED ❑ COMPRESSED AIR 6 25
YIELD (Q.P.M.)
25
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC (Specify feet)
35
DURING YIELD TEST [feet)
Depth of Completed Well
rfa: 125 t
in feet below Land su ce
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (inches)
FROM (feet)
TO (feet )
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
2
Drilling in overburden
clay and bould ers.
0
Hit rock at 2 feet
Z
30
Drilling in rock, set
_cas -i_n - . - routed.
30
125
Drilling in rock granite.
i U L
If yield was tested at different depthV ' WANIg,ROWTY
FEET
DEpAiLOSPENSARIPH
DATE WELL COMPLETED
3/21/85
DATE OF REPORT
7/8/85
I WELL DRILLER (Signature
�A
Jose`h - Mcdaffre
Owner or Purchaser of Building Section
Tavino Builders, Inc.
Building Constructed by Block
Dover Lane
Location - Street
Patterson, New York
Municipality
1 family dwelling
Building Type
Lot
Clara A Pfeiffer
Subdivision Name
Lot #1
Subdv. 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-
_._..__ "'ati.on- of the •Dire. to_ _..oy . - the-D•ivi -s- ion.. of -._ Environmental --
of.the Putnam County Department of Health as 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 21- day o ,19��Signatur
Title
Corporation Name if 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
K
uu
0
v
� d �
3
V)
U
d
" Vc
3 d
~F0�9
. F•r
}
v
U
N Q
o OD
M �
�v
rn
w
v
Z
N
—2
;
Cd
U1O
F9/
n
w
1`
a0
H
rn
2 i Q
-
ss,
10
t15
2.a
\
m
v
o�
J
I
Ol
W
b
I-
M
in
O
N
If
W .jyo
w
W
m fS
n W
ki
z
N
M
w
M
Cwt
M11h
N
'
z
'
N
g
II
YW
/
�
S
O
«
M N
t0
j'
2 p
3 •
+ v iu
99 O8a
z In
/
�
in
1
N
/
/
117
z
I
U
N Q
o OD
M �
�v
rn
w
W ;-
•z
o s
in '9�S S r- r f` CO 41T.O� IA7 N'^1
tl n n u Il 1, n 11 u p II It 11
OxCift0F1 -- OaY:S>
,^ t 1 I t 1 t 11 I t 1 , I D I I I
W QQ �QQQ QQ�Qef7dl CD go
2 Oao ar N,v IrN NN NM �N�
�� I'IIN It
y tt 11 N I• 11 U It h n 11 h p 11 11
�- VQtijiL HYJ:Z2O'f"XN
I I I 1 1 1 1 1 t t 1
�_ dp OMto0000Of00mAJtO dd._..
:r 0 M^ .Q r � O
17M 7? yVl S1. nra0,n,gN�7 N
n 4 11 tl 11 n 11 p u p a
it 1. It It d It
U0 bitl. 071 HVI YJ:r 20.N >— Cl
Q�Q2000Q`¢ ,< e0dM
N
3
N
N
O
C
N
z
3N17 &3137
v
Z
N
—2
;
Cd
U1O
Z
w
1`
a0
H
rn
2 i Q
-
--
t15
\
m
v
o�
J
W ;-
•z
o s
in '9�S S r- r f` CO 41T.O� IA7 N'^1
tl n n u Il 1, n 11 u p II It 11
OxCift0F1 -- OaY:S>
,^ t 1 I t 1 t 11 I t 1 , I D I I I
W QQ �QQQ QQ�Qef7dl CD go
2 Oao ar N,v IrN NN NM �N�
�� I'IIN It
y tt 11 N I• 11 U It h n 11 h p 11 11
�- VQtijiL HYJ:Z2O'f"XN
I I I 1 1 1 1 1 t t 1
�_ dp OMto0000Of00mAJtO dd._..
:r 0 M^ .Q r � O
17M 7? yVl S1. nra0,n,gN�7 N
n 4 11 tl 11 n 11 p u p a
it 1. It It d It
U0 bitl. 071 HVI YJ:r 20.N >— Cl
Q�Q2000Q`¢ ,< e0dM
N
3
N
N
O
C
N
z
3N17 &3137
w
Q
N
tD
W
W O
V I�f
Wi �
N
;
Cd
N
1
2
p
w
1`
a0
H
rn
2 i Q
t15
\
v
N
My3A m
W
b
w
Q
N
tD
W
W O
V I�f
Wi �
CONSTR CTION PEI
Located;.at ��`�.A
{i
i., Owner /Addaess
BuilCing. „Type tom'
-
Number of Bedrooms
3- parate' Sewerage Systen
To be constructed by
Water Supply
`i
•'Other Requnements ip
r' represent that :l Smwfioll
aboveAekriti 99 will be con
s.County'- pepartment of .' -
su
tie bmitted, to ;the Qepa
Place' in' 06od operating ' c
-,,- ,fiance of'the approval,oi;:t
;,will be- located asliorvn on
County -11 epartr ment of «Ha
..o f
Address r7 E l =y `/
APPROVED FOR CONSTRUCTION: This approval ;expires one year from the °,tlate issued unless.c_onstruction of the -± Lleense.No �67
revowtile for cause;'or maybe amended or mod fled when con d;riecessary `by the' Co+ ission �., building has been undertaken and is '
►equ�res new permit Appro f r,tl�sposal of dourest sa _Health. „Any Chang r- alteration of co�st►uctlori.. ”
_ s F sewage :antl /or pF ate water
Date �` PPIY Only.
,. sy
Rev 9- el.,,:. .,',: .•`;.' ” - Title
e '
.{
FUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTfY OFFICE BUILDING, CARIVIEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
K,O he, Addre bms of nfrs Bfew'.'stee_
Owner-] -&) By i 'M 443 s SIN 6
Located at .(Street� Davw t"Pe Sec. Block Lot
7-n-dicate nearest cross street)
Municipality,
Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Rm Elapse
No. Time
Start-Stop Min.
Depth to Wa:ter
From Ground Surface
Start Stop
Inches Inches
Water Level
in Inches
Drop in
Inches
Soil Rate
Min./in drop
Is
Z A
2-4
"IS
13.7Y
3
1 V -16
11: 25
i
Z 11 .719
ZS
P4.00,
4
)1:7.3
1): L9
l0
2 5
Z, 5
2 q.
5
It
2z3/8
2 3
Uss
1 .)1
1 4 1
-111-Si
Ito
23 YL
10-:67
Z 2
S-la
3
12 #*1 Q*
Z2'%
Z14
12-47
5 ZO 00
1 Z. �Z' 1 AL 00
2 11'. Va X1:30 4 Z Z�,% Z 3 /F8 .57.
3 /P 3 G 1) -'?4S 9 z z -z z d4- 5'0
/ 5 -'- / 2 '/ o /:S'- z e. .0
P S . -Z AS ea. 3
Notes: 1) Tests to be repeated at same depth until a roxinta�i,
1 soil
rates are obtained at each percolation test hole. Ayy dat
for review.
2) Depth measurements to be made from top of hole.
PonqAAA
OF
DEPTH
G.L.
12„
24"
30„
36"
42"
48"
5411
60"
66"
72"
7$"
.w-. `•l.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO . • Z HOLE NO. WeAg -
�C . i �• , i M. OVA /0-k w
r .
G;a, + b0%)wv% s,l-A �v
H d 14,4JA e s a Kd
cl
G�r av o a.w.
84"
a t � /fit,.. , M /�.,,�s .
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 3, g b,�pERE1��"o k.-
INDICATE LEVEL -TO WHICH WATER LEVEL RISES ASTER BEIN'v`` COUN •
_ ,PESTS v E' EY �' .. �. �-�. r 67- . 'Dat6 IO LIT
DESIGN
Soil Rate Used /0 Min/1 "Drop: S.D. Usable Area Provided Z°i'00
No. of Bedrooms 21 Septic Tank Capacity /00C) Gals. Type COricr'e.;tG
Absorption Area Provided By 4 4L. F. x24 " jb"— width trenc .�
Other ,
ame T 6' S'io a ure ,
Address 17 U) S C S )''- SEAL
THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date