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PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. 3,186," Divielon d Eovironmentel Health Services, Carmel'; N.Y 10512 - '
� • Engineee Mnat Provtde�
P C.Ii D Permit N
111!!!
TIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
C SD
own o _ -
Loca .TBlockrLot
e
'�' �n�Pp�J faN' erg��,� az
Owner/ t Name. • !" formerly Subdivision Name Stibdv. Lot'#
MaWng P
Address .,. �d X� ZI L Q �� Date Permit Tweed
7
v. /V
Separate'Sewerage System ballt_by R4Mf O "�i E- 7^'21 'Gy %life Ada
Consiating of 44 0,
Gallon Septic Tank and
Water,Supplys Pubilc Supply From Address
or: X Private Supply 'Dr¢ted by e L Address TEL, ?S-n c .
Banding Type l�JQc�7� i£' ttHas'Erosion Con_ trol Been Completed?-�S
Number -of Bedrooms Has Garbage-Grinder Been Installed?: Alt, ;�
Other .Requirements
2 certily, that the system(s) as .listed serving the above .premises were consiru es nti�ix]as7y r, s� o he pia'- ofs- t1he completed work.( copies
of. which are attached), and, in accordance with, the 'standards rules and "_regu s n a C e l¢ p and, d the permit issued by the
Putnam County Department:of 88alth
Cate P E R.A.
• Address ,,aa+, _ } LRAM No.
Any person,.occupylno Prsmises-sa►ved by the above systems) shill _promptly take such actfon'as ma #, ePr%0ass'sa Yrio+saeuc%tM lo[reetbn of any unnnita►y
conditions resulting'frorn such usage ADoroval of the s6parate aawerego systeih -shall become null�a dvioid;i.}gon�ai ,�Dub,'_'sanitary gwei becomes
avalNble and tfie. approval of the ?Drivate vtiater; supply shalrb4come'null and 'void .when a public' wafat,� pply �betomas avallapN. Such- approvals are
wb)sct to modification or chanG�e' whence; in "the Judgment of the Commissioner of`Health reVocatid'n;�modififation or change is neeccessssarry.,�J��
Date C2ri �/ �/ B
4
-, •.....,... „ :.. �..r_ _�.. _.._.__ . __ BREWSTER - LABORATORIES ... �... _.
Box 224 - BREWSTER, N.Y.
(914) 279 -4945
- WATER ANALYSIS REPORT
SAMPLE NO. 8707 TEST WELL
SOURCE: Crompond Contracting
Windsor Oaks
Lot. #2
Ca —mel, NY
COLLECTED: 10/8/93
BY: P.F. .Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, IVIF Method 0 per 100 ml.
10/11/93
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRO1NMENTAL HEALTH SERVICES
RD�1P -n0
Owner or Purchaser of Building
uilding Constructed by
_ Location - .Street
Munic' lity
Building Type
__34 2
Section Block Lot
Subdivision Name
Z,
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 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 day of ACT" 19
ay-Contractor Own ) - Signature
�orrlPa�U!� n
Corporation Name (if Corp.) /
Aw V51 d
R:r. -
rev. 9/85
mk
Signature `6��� -C_�
Title �5
Corporation Name (if Corp.)
Address
, 5�_ � a.
U40''; WELL UU111rLL11U14 rUxual
DEPARTMENT OF HEALTH -_•. ' .: Division —Of .. Environmental Health � Services•:: PUTNAM COUNTY DEPARTMENT OF HEALTH
Off ice Use Only
_
WELL LOCATION
STREET A00RESS: ,,/�6'�/�/fl -D;Q OI I TAx GRIO NUMBER:
Windsor Oaks Carmel NY Lot #2
WELL OWNER
NAME: ADDRESS: Joe Mirra
Grompond Contracting Corp. Box 451, Crompond,NY
O PRIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
:91 RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ®ADDITIONAL SUPPLY
j3NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 4051 ft.
STATIC WATER LEVEL __ 03_ ft.
DATE MEASURED R.42/43.
DRILLING
EQUIPMENT
4:1 ROTARY fR COMPRESSED AIR PERCUSSION 0 DUG
0 WELL POINT 0 CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH E2__ fL
MATERIALS: 91 STEEL O PLASTIC ❑ OTHER
LENGTH BELOW GRADE 61 ft.
JOINTS: O WELDED ® THREADED O OTHER
DIAMETER 6 in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT
PER FOOT 1b./ft.
DRIVE SHOE ® YES ❑ NO
I LINER: 0YES W NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE;
DIAMETER
OF PACK in.
TOP
DEPTH tt.
BOTTOM
I DEPTH K.
WELL YIELD TEST If detailed pumping
D P 9
METHOD: ❑ PUMPED i tests were done is in-
COMPRESSED AIR , ! ormation attached?
O BAILED O OTHER :OYES ❑ NO
�1 ELL LOG If more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water
pear-
Ing
Well
ova-
meter
FORMATION DESCRIPTION
pot
ft.
ft.
WELL DEPTH
it.
DURATION
hr. min.
DRAWOOWN
ft,
YIELD
gpm.
surface
30IDr:.11j,ng
in overburden clay & boul
er
/H
t
ock at 30'
405,
6..
340t
15
6O_DX_-_LLng
in rock, set casing, grout
60
405
Dr
ll
ng in rock granite.
kQ:"Te,
R O CLEAR TEMP.
TY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPEWellXtrol 250
CAPACITY 44 GAS.
PUMP INFORMATION
TYPE submersible CAPACITY 5 g
Gould �0'
I'MA1111 DEPTH
'�OEL 5ES07412 VOLTAGE 30HP J/ `f
WELL DRILLER NAME P.F. Beal & Sons , I D
4 Putnam Ave. 0/18 93
AoIiRESS SIGrfATUftE
Brewster, NY 10509
1 rte- --� .�. - ._ _ -- �.��.:�•::- � _:. _ -n:_ •- - _e,:v:: .. �- .
above
comity
be "
aeoe o
101011,1110
cou.0tt
APPROVED FOR CONSTRUCTION,. This
revocable for ciuse.or may be amaWnd or
requires a ur per Approved for di
Rev.
10/88 Date -,
m
w will
issu-
a6ow
P A.
dwtaken and is
of construction
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
_._ ;::..AYPLhCON TO CONSTRUCT"�A`WATER WELL`:° ': `-
PCHD PERMIT #
WELL LOCATION
reet. Address
Town /Villa C y Tax grid Number
WELL OWNER
34de sling
Addres /C//"/ 7 OPrivate
iy (��pra� , OPublic
USE OF WELL
1 - primary
2- secondary
CJhg-S I ENTIAL O PUBLIC SUPPLY O AIR /COND/HEAT PUMP O ABANDONED
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify,
O INDUSTRIAL b INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /#
PEOPLE SERVED /EST. OF DAILY USAGEal
REASON FOR
DRILLING
O RE SCE EXISTING SUPPLY
SUPPLY NEW DWELLING
O TEST /OBSERVATION Q ADDITIONAL SUPPLY
0 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
W LED
DRIVEN
ODUG
GRAVEL 0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 4L NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. _
'WATER WELL CONTRACTOR: Name * �' �' Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '°---- NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO NEAREST _4�A 9A, -MIN
;�_•..
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ".
ON SEPARATE SHEET r �'
(d te) / a�sagnatue)
e;. a
PERMIT TO CONSTRUCT A WATER WEL`I<.
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:
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.
During all well drilling operations, the applicant
any and all water or waste products from such well
property and in such a manner as not to degrade or
Date of Issue: g� 19 5
Date of Exp' ion 19
shall take appropriate
drilling operations be
oherwise contaminate
Permit Issuing Ofd ial
action to assure that
contained on this
surface —o groundwater.
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
Re: Property of'_
Located at--
(T)- C,-
Subdivisior3—
PUTNAM COUNTY DEPARTMENT OF HEALTH
OF- .-ENVIRONMENT-AL---RE-AL-Tlf---SERV 7- 1
-ICES:
Date
Section Block Lot
,0-/-,-
Subdv. Lot # Fi
d Map #
Date
our
Gentlemen: "!. I`.,'nvkrdi
iBea`lord, N- Y. 10506
This letter is to authorize
a duly licensed professional engineer .'I' or registered architect
- 7—
(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
-..--.-.--...,...c,onnec,t.ion..,w.1th. this- mat-te-r-.,a.7ad-..t.o...-s.uper...v-i se- the ..construction. of.. sai-d-..-
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigne,
P.E. R.A.
N. Y. 1050S
Address
Telephone
Very truly yours,
Signed
."Owner of
Property
7
Town/'
r z -, ��
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA .SHE - SUBSUFACE SEWAGE ._DISPOSAL_ SYSTEM...... FILE NO.
Omer GU�LI V r� G .'/ " Address
Located at (Street) Sec. Block t
(indices nearest cross street)
Municipaiity%r' LI Watershed
Date of Pre- Soaking
Date of Percolation Test
HOLE
NUMBER C = TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Fran
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min/In Drop
Inches Inches
Inches
1
7
3
4
5
.l
2
3'
4
5
1
2
3
4
5
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.submitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
-.. : DEPTH HOLE NO. HOLE NO. _ . HC)LE NO.
G.L.
1'
2'
3'
4'
5'
6'
7
9'
10'
11'
12'
13'
_ _ 14'.'" -
INDICATE LEVEL AT 'ifHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO MICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:
DATE:
DESIGN
Soil Rate Used �`— %G` Min /1" Drop: S.D. Usable Area ProvidedG
No. of Bedrocros ✓ Septic Tank Capacity f(%U(/ gals. Type ellco e
Absorption Area Provided By. J^--2 C) L.F. x 24" width trench
Other n r
Name ___ _ ._ _____Signature
Addr s SEAL
C
THIS SPACE FOR USES BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved. sq.ft /gal. Checked by Date
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