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Home My WebLink About1529DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -25 BOX 14 01529 li i im,q r ,. , At I mr '- E �'4 r 11 1,:f' rk 01529 Water Supply: Public Supply From Address ot: x Private Supply Drilled ,by q an WP1 l AddrQ•. Rt•e, 52- Carmel r NY 10512 Building Type. Modu l iu - Has Erosion Control Been Completed? Vp s Number of Bedrooms ..'Three _,Hae.Garbage Grinder Bee's installed? No otber.Re6ulmments R O -:B Fill Section: 12 Deep x 4474.sq. ft. (129 cu. Ards. ) 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)', and in accordance with the standards', rules and'regulatio in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. - Da�e May `;2.2, 1986 : carrf�ed,by P:I-. x A.A. Address RD _ License No. �92n Any person _occupying premises served by the above system(s) shall pr ptly take such action as maybe necessary to secure the correction of any unsanitary conditions "resulting from such usage Approval of the separate ' rage syst+an. shat o e null and void nd as soon. as a pubt'a Unitary sawer becomes available a t e.appr al of the private,water supply shall become! I and vo, ; -wh a blic water sueply. becomes available. Such approvals are subject to mo IfIcatI snsor change when, in the judgment of the misfiob of 1 h rev lion, lflcation or change me wy. Z V� Tit Is Oats- By m Cheryl & Thomas SlAith Owner" or urc aser of Building own Pr Building Constructed- by Bullet Hole Read Location - Street T. Patters- - Municipality TM 7A Section 6 Block. 1 Lot d �y 8 i-v& - JJ�eds Subu division Name Modular a Building Type 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- ation of the Director of the Division of Environmental Health Services ...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 day of 19 Signature Title Lercod'e.�ce Smith Corpor tion ame if corp.) C/iS'd Patterson, NY 12563 Address N- ,ta "ten .L 'II — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — f;i 7�'r 2 ��o THREE (3) COPIES ARE REQUIRED WfTH Hibi (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WIR1JT§% ED. GUARANTOR IS REQUIRED TO FILE NOTK� E *DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health -NELL dOMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 "' Division of Environmental Health Services COUNTY OFFICE BUILDING • CARMEL, NEW YORK ,to-.be: completed:by well =drillevand submitted to- County. Health- DepartrOeht= together with= lebcratory 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 Thomas Smith ADDREs9 F Patterson Village, Patterson, N N. LOCATION OF WELL o* a street) own Lot umber) Clifton Court Patterson 9 PROPOSED USE OF WELL BUSINESS {=J DOMESTIC ❑ ESTABLISHMENT ❑ ❑ TEST WELL FARM ❑ SUPPLY INDUSTRIAL ❑ CONDITIONING ❑ (Specify) (Spe DRILLING EQUDMENT COMPRESSED r❑ ❑ ROTARY fJ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH fleet) 21 DIAME ER(Inches) 6 WEIO T PER FOOT 19 Q THREADED ❑ WELDED TES NO CA31140 YES NO YIELD TEST HOURS G.P.A. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR G I°M YIELD wLE ELL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 28 DURING YIELD TEST (loot) total drawdown � of o Landd wall 180 In foot below. Land surfas� SCREEN MAKE LENGTH OPEN TO AQUIFER (toot) DETAILS DIAMETER (inches) IF OR ED: PACKED gran eNr of well Including gravel peek (Inches): V l SIZE Ine ee) M lest (leer) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with dlstanco , to at least two permanent landmarks. FEET to FEET 0 15 Overburden 11986 COUNTY HEALTH Boyd Artesian Well Co., Inc. t. 52 Carmel, N.Y. 10512 15 180 Quartz & felspar I'dAY PUTNA DfiPT.. If yield was tested of different depths during drilling, list below PEET GALLONS PER MINUTE DATE WELL COMPLETED 1 -4 -86 DATE OF REPORT 1 -17 -86 WELL DRILLER (Signature) 1 Yorktown Medical Laboratory, Inc. 321 Kear Street LAB N 306- 88.0 Yorktown Heights, N. Y. 10598 Collection. Station Used: :.,.- -z- Ca.rm:el� .. Peekskill .. .24'5- 3.0$'.� -- - Mt.��Kis o � Nev.> - City .�...�.._... Director: Albert H. Padovani M. T. (ASCP) — N ' 3� Date Taken: �Iil T �Gj�t�YN iQ S Date Received: Date Reported: l Collected By: MV3. :S n ^ �/ � Referred By: Sample Source: ( LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA c Standard .Plate Count per .100 ml U ! (Agar plate @.35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml_ Fecal Coliform per 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) .Total-- C-91i•fo °rm:.... MPN Index per- 100 ml- Fecal Coliform: OTHER ANALYSES MPN Index per 100 ml F ^� %:qY p v 466 r� Ply THESE *RESULTS INDICATE THAT THE WATER SAMPLE AS (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect- ing Water Source < = less than TNTC = Too Numerous Too Cheryl & Thomas Smith TM 73 .Owner or urchaser of Building Section owner 6 ._ .0 _ - - - Biri'rding Bullet Hole Road Location - Street T. Patterson Municipality Modular Building Type 1 Lot Burdick Woods Subdivision Name 9 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- ation of the Director of the Division of Environmental Health Services ..6f- the "Putn6m"- County"D 'epartment 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 day of. 19 Signature Title owner Thomas & Cheryl Smith Corporation Name if Corp.) 69 Patterson Village, Patterson, NY 12563 Address - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL B V FrD_ GUARANTOR IS REQUIRED TO FILE NOTICE OF DAAF_F FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - Division of Environmental Healt}DBW- W*tnam County Department of Health FI E LTH IE PUTNAM COUNTY DEPARTMENT OF HEALTH b- VISION -OF ENVIRONMENTAL HEALTH SERVICES :=COUNTY OFFICE BUILDING, "CARME' , "'- N..;.Y.' _,:.:1051:2:,- -.. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM . FILE NO.' :. _ . Address Owner Nlef Uv PU- X Gam- Located at (Street HgHg! r.s d• - Sec 6 Block Lot - �Inndicate nearest cross s r e k Sur4 a W oods S464- Lot *11 Fi fed Kq " � Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIO S6 ., S.O. W,0 Hole Number CLOCK TIME PERCOLATION PERCOLATION.,, apse p o a er a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start .Stop Drop in Miri. /in drop Inches :'Inches Inches Per 1 S�Gd;v 2 (v(q 3 Sew S J ( • o vv., 31131 U40 Notes: 1) Tuts 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 APPLICATTON DESCRIPTION OF SOILS'ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. - HOLE NO. - HOLE NO.^ G.L. 48" 5411 66" 66" 72" 78" �` V INDICATE LEVEL _AT -WHICH GROUND WATER IS'-ENCOUNTERED INDIGATB- • LEVEL- TO- WHICH WATER LEVEL_ RISES AF.TER..,BFJ G,.IIV.CDUNT ,:.. ,._ TESTS MADE BY . ��, C td. f�.�) Date�� - DESIGN. Soil Rate Used 8-(A Min/1 "Drop: -S.D. Usable Area Provided ® ®'� 4 No. of BedroomsT�Vlee_Septic Tank Capacity 1000 Gals. Type Absorption Area Provided By 213 .L.F.x24" -d/ width trench. tia 9 C__ u. . • 0- of JOAN N. �'`."`SSS, P. E. Address R09 FAIR _ RMEL, NLet :: C 10512 L THIS SPACE FOR USE BY HEADPH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by n r Structure Incoled tiom survey by surveyor noted below'.0 Well located -oy: Surveynrs survey El _- Well dimvis report Engineers Tr,i.R, torus, p.l,,90HOrfd-, (A 10te!`01a fnL(31eCJ ry:Conricif Y,) i E n gi n .41-r: ❑ H 4! a 1 1h pi Fiew inspection by health dept d,, f Cr-oifietir Vucnam County DeparfW111t Of health ntal Health Servioes N OTES: ff mnfwmnoo With i U, 6 Regulations of the int. Z D too: D I'M F__f S 10 N zi / --f7. A P zzo /8 F 3,7 f 6 40— 7 7'7- 6 G IQLe- A H B H J B d- -_ - - -- A K 777� 6 K QIAN1 `9R SYS-FEM DESIGN" "AS BUILT" Y�NLR - ---- -- 0 C A T 10 N v i e c 1: L W 11 —C u n f State- ,a T Hock, LOT Ne Iwidef: 0_�,/ iuryeyor: µ. r1 -7-4. L,4:;?2 , 7 ,L.n tZ,,�7 16.te":' JOHN H FAR E N T I S S P. E. CONSULTING ENGINEER P., c-1, F-It-, CAf,M[L' N) 1 7.0