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BOX 14
V ,� f ic
PUTNAM ,COUNTY DEPARTMENT . OF 'HEALTH '
( ., . j
Division of. Enviconmenta/ Health. Services Carme% N. Y.'10512 I
CERTIFICATE OF "CONSTRUCTION COMPLIANCE FOR, SEWAGE DISPOSAL SYSTEM - a
., ... .._•. .. .,,,._.. .... =Town or Village ,
ULL F_ L %3
Located at / �✓ D Tax Map Block ct
Owner �2e 8�e 7" 1B 4 K �C—` Lot —f' /o •� Job..
i
Separate Sewerage System built by 14 TO. Address `RR. *_ L AJ Y
Consisting of t %.0 Gal. Septic Tank and
Other requirements
Water Supply Public Supply.- From G' w' 'I' -
'Private Supply Driiled By R0' YAQ .4 /Z rirG S`A � iJ' Jrr 4.1— CO. /A/C--
r Address ,/C..490 k90 V f-F J/8., lam'4R— !.E,4: V. Y l 0.f_/ Z-
Building Type eewd '-Al No, of Bedrooms Date Permit Issued , —
Has Erosion Control Been. Completed?
I' certify that the systems) as listed, serving the above premises were constructed essentiolly as shown on the plans of the completed work (copies of which. are
attached), and in accordance-with the standards, rules and regulations, plans nd the permit sued by the - Putnam Co nty. Department of Health.
Date -
/0 7 7 by-7/4— `
Certified ' P:E.o R.A.
.
Address ( f` �Tll /G �� - C ./' /• �-' 's License NO.. �y 1,. 9 p .
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 =e system shall become null and void as soon as a public sanitary- sewer becomes
available and the approval of the private water supply shall beco a null a d vo�" ten a public water supply becomes available. Such approvals are
subject to m /dificat "on! /oar 'change when, in the'. judgment of he Comm sio r of fl r%su evocation, modification or cha 1s necessary.
Date Title
NO n2 -'A/101PY'vo Q ✓ll a r o %i
A S
Lo C.4,prat %iXL&T-, �Lf;-
A
24
1971 , A-
).--\v ✓
5Y �. j Fz,
5c o, Ltt, , I "' --- 4.0
152
co
r
P L to -P L
—Ito
01
kT4 64t: '14
2 -zs L i 41 &N k"s
44
k/ U
i4l
YORKTOWN MEDICAL LABORATORY INC.
Y.orktow ;n Hei h N:Y., 98 245 -3203
P.O. Box 99 321 Kear Street
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER 2%27/77
OWNER DATE RECEIVED
RCBM BADS 3/1/77-
CITY, VILLAGE, TOWN VOR NAME OF SUPPLY DATE REPORTED
Et#2 BULLET RD. PATTERSON9 N.Y. 3/4/77:
.S,AMPLING POINT .
'ARTESIAN Td=
BACTERIA PER ML. (Agar plate count at 350C).
8
COLIFORM. GROUP (Most probable No,/100m1 -)
less than 2.2
HARDNESS, TOTAL -ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm
FLOURIUL (Y') - mg. /1.
These results'indicate that the water was YM of a satisfactory sanitary quality when the sample was colledted.
PER: LAS CARMEL PHARMACY
149 SMADBECK AVE. Qil 1A
LAKE CARMEL, N.Y. A. H P.A O A j M. T. (ASCP)
f ,
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This.Teport. is to be- completed4y. -well driller_and, submitted: to ,County Health Department together -with I -boratory. report _of ;.
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Robert Baker
ADDRESS Bullet HGAGL Rcl
Patterson
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
Hullet Hole Rd Patterson.
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC [] ESTABLISHMENT F1 FARM El TEST WELL
❑ OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING
EQUIPMENT
❑ OTHER
ROTARY tJ A R PERCUSSION PERCUSSION El (Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER(inches)
ra
WE:uHT PER FOOT
�'�
El THREADED ❑ WELDED
E SHOE
� YES ❑ NO
W�S CASING U D?
u YES In NO
TIEST
5 HOUR G.P.A
lei
❑ BAILED ❑ PUMPED ® COMPRESSED AIR
YIELD (G.P.M.) 6.1
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
ISO
DURING YIELD TEST [feet)
total. draesd wn
d Well Completed of C
De om
Depth
P P 3W
in feet below Land surface:
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
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
overburden
2.
330
granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
2'40
DATE EL COMPLETED
DA /E OF EPORT
WELL LER (Signature) Boyd Artesian .e Co., Inc.
)Te 2
C 111�'
Building Tune
Lot
GUARANTY OF SEPARATE SEVIAGE SYSTEM
r.',. 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 guaranty to the owner, his succes-
sors, 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 follo Jir_g 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 de -.
_the- .Director of the Division of Environmental Health Ser-
vices 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 ofQ, .Signature ��',
Title
If corporation, give name
and address)
- - .._ - _ _ - - -
THi3EE (3 ). COPIES REQUIRED WITH THREE (3)" COPIES . OF FINAL' PLANS BEFORE
CERTIFICATE OF COMP.7.,ETION 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
F — ---a - -s r — --• _
aZ
PUTNAM COUNTY. II�EPE#RTMENT OF HtktTI
Division of Enwronmenfal Health Services Camel, N. Y 10512
CONSTRUCTION PERMIT FOR SEWAGE iDISPOSAL SYSTEM.:.
��"[i"EieSCa�i
Town or V �Ilage
Located fat
tion 1ocK
Subdivision
• Lot
Job
i
Owner N�i� Address g . ._ 4, On/ IE1L
`.Building Type �.��I; Lot Area �C - �GU� °aE� ry i•:
Number of Bedrooms ( -f Total Habitable Space 1 5U` �� Square Feetttt
Separate'.;Sewera9e, System to co115ist of J`C%� Gal. Septic Tank lineal feet X width trench i
fo be constructed by _ TO �E.' '�ETgis /itJ�-�. Address }
:!
Water Supply '`Public "Supply ,From..
Private Supply -to be drilled by
Address
Other Requirements V �2 Rd�A11� UF�i ILU �CQVIrvG1� _tl'.peo -A ...96 G d — -� .1 �5. i`tlC�A -td
I represent that 1 am wholly and completely responsible for the design. and location of the proposed. system(s)- 1) that the' separate. sewage .disposal
- System �l
above described. will be constructed -as shown- on the approved amendment. there to. and in accordance with the standards, rules and regulations o the - Putnam
County' Department of - Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health'will
be' submitted to the Department, and a written guarantee will bii furnished the owner; h(s. successors, heirs or assigns by She'bullder;`_fhat said =builder WIII
place iA •good 'operating condition any part of-said sewage ..disposal system during .the period of two (2j years irnmediately,followln4-thedate of .the' issu f
ance of the approval 'of the .Certificate 'of. Construction Compliance of . the original system;.or_ any repairs thereto; 2y'that.the drilled well described above
will -be located,.as shoWn on the approved plan and that said Well will be installed in, accordance :with th standards, 'rules and: regulations of ,ihe - Rutnsm
County Department of Health,
Date
. 1-�$J >t` J 1 519ned.' / P.E. 1' •R A.
Address �1 �1� STS [� �QMiE1� �`i License iv o. A !9
APPROVED FOR CONSTRUCTION. This approval, expires one year from the date issued 6n less construction 'of the building has been undertaken: and is
revocable for. cause or may be amended or modified when considered necessary by the .Commissioner of,:Health. Any change or°alteratlon :of .construction
requires a ne permit. Approved for disposal of domestic tar sewage, and/ ivate water supply only.
Date- O
gy Ji —.C�� Title ...
jj
PUTNAM COUNTY DEPARTMENT OF HEALTH:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE. BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SIMT- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. QO%
Owner /�61)P4 Address 10lr as 12L �� %f�C� %� r x q _
Located at ( Street 4dicaE6 O�Z Sec. 7,3 Block / Lot (Z14 D . .
neares cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Water- W Water ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
C7 _
Inches Inches Inches 1 j
1 Id a.4 rte.
2 /.y
/
/o
Q�/
o� o?
0
3 lOQ�
_ %G. S
���
as a7
7,i //
is a" 5
/ /.' r i
ado
' %z.
3
4
1
2
3
4
5
Notes: 1) Tuts 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.
DEPTH
6"
12"
18"
24"
30"
36"
`t2"
48"
54"
60"
66"
72 lf
V.-
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
I
HOLE NO. HOLE NO.
INDICATE 16L AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE!,7EL TO WHICH WATER LEVEL RIS S AFTER BEING ENCOUNTE D
TESTS MADE BY
DESIGN.. -
Soil Rate Used_�Min/1 "Drop: S.D. Usable Area Provided d�c�2Sb
No. of Bedrooms Septic Tank Capacity (M Gal oFFE s
Absorption Area Provided By '0 L.F.x24" 3b" e nc .
Address a2 -
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
J
S; 38998
r
E OF NEW �
.Z
Date
YNTIPTAT, STUT'. *1*J1'-',Pj"1CTT0rJ
P.rop6rty lines arcorncr.,i found
Can hoil..,;C location.
Vil). drivoway n�cd cut
troec.,, be rCirjoved-note t1ioSe . . . . . . .
13 deep hole of ontire ST)3 area
J,,C)c1:*PJ-J_ona)_ dc.:,,r) nu,cdod . . . . . . . . . .
S'Lifficielit SDS arca ai,a.11ablc con sidurii),-
drivel,"'a'y - Cut, house location, separation
distallooc,
etc
D-TIelfi:? BOLE, DPIIIIA
Dopth:
Hater eleva 0, tion. 0,
RI OC kr Clevation:
_Soil s desc-o-,
Bat C
F-TNAL SITE PTSP CTIODT InsT), by:
House located -,-iher- shown on approved plan
SDS loc-'a t e "'t I,, he re appro:red
,;loj,,- of ti - I _e line and"trench acceptable
Room allo-,,,,ed for expansion t-Irenches
Dver 50 'Lt. from s-k-lai-iino-latercourse . . .
..atural soil not stri-D-oad or SDS area
unnecessarily Sraded.
LO' TEL. iron;, prop .line a*nd*
20 fr&m" 'I'louse . . . . . . . . . . . . . .
)eparation of trench front house., well
.etc.' follo-urs plan
hmbor of bedrocms checks
'tcnos brush stumps, nibble etc. greater
than 15 ft. from nearest. trench . . . . . .
z� -L-L from
.5 Pt - of --_,,.-iDheral soil hori-13 -a-13y
trench . . . .
Fihiction boxes. properly set
:01ad siwf,,_,_ce run off froth driveway roa-d�
1 .1 roads,
growid surface., ctc. cha.-ruiel'r-car SDS
area
b--s -16t draiim--P-,-_ armcar O.K. in ar.-a of SDS
THU GRADING OF SITE ACCEPTABLE
),(!"I I 'Ho. 1 1
w �r J
SEPAP,A TION DISTANCES SPECIFIED ON PLXi
10' to P.L.
20' to Foundation walls
100' to Nearest well
50' to stream, march, la
15' to Curtain drain
101. to water line (pits -
15' to storm drain
10' to large trees
101 from foundation to s
5 to pipe from leader
etc. (incl.
c tanx
n & fcTo
on
!
� i
REVIEtT CIIL;CK SHIM T
f
Meets Std.( Remarks
des No. _. .
DOCUMTNTS
House plans O.K.
Design data sheet
Peres resoaked?
Min., 30" Pere test depth
I
Const. results for 3 runs
D. Hole log O.K.
Corporate Affidavit for.other than individual
;A' R i
Authorization for engineer
I y I
Letter from Water Supply if applicable
i
If variance requested -such noted on plans & apps.:
i
DETAILS
if charge is proposed,)
Existing contours shown � show new contours)
�xa
Slopes for driveway cuts, etc. shown
Water service line location
Footing.drain, etc. location
!
Top slope, bottom slope; of fill
Percolation tests and deep test pit location
Septic tank size and conformance to std.
3 B.R. house minimum
House setback shown
! I
L _L t_,I_ t7 Ni
1.11i waLe.1• vi-uran. FL 511UW1!
P]-an- and profile SDS
I
All other wells and SDS closer 200'
!!
shown or reference made
I ,
Property boundaries (metes and bounds- clearly
shown
SEPAP,A TION DISTANCES SPECIFIED ON PLXi
10' to P.L.
20' to Foundation walls
100' to Nearest well
50' to stream, march, la
15' to Curtain drain
101. to water line (pits -
15' to storm drain
10' to large trees
101 from foundation to s
5 to pipe from leader
etc. (incl.
c tanx
n & fcTo
on
!
� i
x
4 loo I
41 1 �a_
JUNCTION BOX
YAC :,n)7
I IIN-r L NOTES-
PLAN MANHOLE COVER
L
GRa __,/EL__
milli MANN C E
4" MIN iN 12 d
14NU
L
(13—M I N Ai..
CAST IRON
SECTION .;At.l I AR,Y TEE
TYPICAL CONC.
I RE -CA ST CONC.
SEPTIC TANK (LiFI.NF 8`qC Eszw
18"- LO
24
GHQ LEVEL
ARTH
T
COVER
8L Dr- PAPER
.6 OR Ii Ai
0. PEqF',R-7:-
ZARAVEL OR
cR05N, D -TONE
ABSORPTION TRENCH:
1. SYSTEM TO BE CONSTRUCTED IN ACCORDANCE WITH THE RULES AND
REGULATIONS OF THE --Pwr NAr"\ COUNT)l DEPARTMENT
OF HEALTH.
.�.
V(s TA1LfCh; .5%? To.
SYSTEM SHALL NOT BF. BACKFILLEC U14TIL INSPEdTED BY DESIGN
W (AL)Ai.
ENGINEER AND (H£ LOCAL HEALTH DtPAR'[?.,Ff,4Tl';F REOUlpr'3.
_-A0.' -A. TR t Ls
_
SYSTEM TO CON 1,T OF A -)00 GALL) S PT 1,: TANK
Vispc'sAL:. P.4f-,- IkEekovev
AND-FT. QF 1 TR E tj C H KITH A M X tM, tj M
?_'c
ICk.Slpf.,?`ICE.
PITCH OF I/Ic F-ER FOOT.
4. DISPOSAL SYSTEKA GPA(,)FS f4EFERENCED Tf "I �i -.5 T
1 ;HELI F!,
'Ffo
IIAS 6errLZ0- r-OfZ SO 'DAV.5___ AT
FLOOR E.I.EVATIO,, , UNLeSS OT4LF�'V�i iFf N'JTED,
S. D.
SYSTEM rcR ROE
&j"' 'I" t,'AKE:
ts
A.
REvisic'Ns HOWARD A. KELLY, Jlq.
ASSOCIATES
NO DATE By
V
CARMEL, !jE W YORK
25.1 (p TAX r4AP NO. -I3 BLK.NO. I LOT NO. F
"LO F" LA
TOWN OF PA-V(6_kf45,(-:�I,-A
By 1—ole-A
r4 -' ale V'o.i"q 040
? .
0
. . . . . . . . .
17 30 1
141
I IIN-r L NOTES-
PLAN MANHOLE COVER
L
GRa __,/EL__
milli MANN C E
4" MIN iN 12 d
14NU
L
(13—M I N Ai..
CAST IRON
SECTION .;At.l I AR,Y TEE
TYPICAL CONC.
I RE -CA ST CONC.
SEPTIC TANK (LiFI.NF 8`qC Eszw
18"- LO
24
GHQ LEVEL
ARTH
T
COVER
8L Dr- PAPER
.6 OR Ii Ai
0. PEqF',R-7:-
ZARAVEL OR
cR05N, D -TONE
ABSORPTION TRENCH:
1. SYSTEM TO BE CONSTRUCTED IN ACCORDANCE WITH THE RULES AND
REGULATIONS OF THE --Pwr NAr"\ COUNT)l DEPARTMENT
OF HEALTH.
.�.
V(s TA1LfCh; .5%? To.
SYSTEM SHALL NOT BF. BACKFILLEC U14TIL INSPEdTED BY DESIGN
W (AL)Ai.
ENGINEER AND (H£ LOCAL HEALTH DtPAR'[?.,Ff,4Tl';F REOUlpr'3.
_-A0.' -A. TR t Ls
_
SYSTEM TO CON 1,T OF A -)00 GALL) S PT 1,: TANK
Vispc'sAL:. P.4f-,- IkEekovev
AND-FT. QF 1 TR E tj C H KITH A M X tM, tj M
?_'c
P L--V- C u Orr
To be*
PITCH OF I/Ic F-ER FOOT.
4. DISPOSAL SYSTEKA GPA(,)FS f4EFERENCED Tf "I �i -.5 T
1 ;HELI F!,
'Ffo
IIAS 6errLZ0- r-OfZ SO 'DAV.5___ AT
FLOOR E.I.EVATIO,, , UNLeSS OT4LF�'V�i iFf N'JTED,
S. D.
SYSTEM rcR ROE
&j"' 'I" t,'AKE:
ts
A.
REvisic'Ns HOWARD A. KELLY, Jlq.
ASSOCIATES
NO DATE By
CARMEL, !jE W YORK
25.1 (p TAX r4AP NO. -I3 BLK.NO. I LOT NO. F
"LO F" LA
TOWN OF PA-V(6_kf45,(-:�I,-A
By 1—ole-A
r4 -' ale V'o.i"q 040
? .
0
. . . . . . . . .
17 30 1