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01535
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/PUTNAM COUNTY DEPARTMENT OF HEALTH-
; RV. 3,! 86 r ` '' ^ e of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide � p
" . P.C.H D , Permit N
CERTIFICATE OF CONS UCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM_ .Patter S•o n
Town or Village
meted at
Bullet H of e Road~
Tax Map 7 3. Brock 6 Loc
Owner /applicant Name Little Associates Formerly Rayesen _ Subdivision Naml Subdv. ' t H
Mailing Address 5 Kelley Ridge Road yip 10512 Date Permit Issued
Carmel,- New'York
sepamtesew8ri*e'Systembullt-by North County Const Co Adds Carmel, NY 10512
Consisting of l O O O. Gallon Septic Tank and 5 0 0. L F of Tile Field s
Water Supply' Public Supply From Address
or; x Private supply Drilled by Mill Drilling Address Putnam Ave . , Brews ter i NY
Building Type Ranch Has Erosion Control Been Completed? N/A
Number of Bedrooms - 3 Has Garbage Grinder Been Installed? N o
Other Requirements .31 Fill Require d 600 C.Y.
I certify that the systems) as listed serving the above,premises were construe ssentially a s on the p ns of the completed work ( copies
of which are attached),/ and in accordance with the standards, rules and regula in ace d e th i d rmit issued by the
Putnam County Department Of Health.
Date 1,0/22 86 Certified by P.E. X _ R.A.
Add res or Baldwin & Cornelius , :P . C . ,Brewster, N.Y. License No. _q
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 sewerage system shall become null and void as soon as a pubt'o unitary tower becomes
avellabla and the approval of the .private.water supply shall become null and • void when a public water Supply becomes available. Such approvals are
subject to modification or change when, in the judgment o1 the Commissioner of Health,.such revocation, modification or change is necessary.
5_ �.
��(/ C/ l � � y 'rte Tit le
� T Date �,, .�—
7 E
WELL,.GOMPLETION REPORT-
DEPA.RTMENT, OF HEALTH
Division Of Environmental Health Services
PUTNAM tOUNTY DEPARTMENT OF HEALTH
STREET A DURESS: low. I ILLAGEICI[Y IAX GRIO NUMBER:
Burdick Woods Patterson, New YOrk j4ot'3
WELL LOCATION
WELL OWNER
NAME. c/o' L&0?26F-.Holf elder
T.K. Services, Inc. .5 Kelly Ridge Rd., Carmel, NY.
PRIVATE
PUBLIC
USE OF WELL
1- primary
2.- secondary
0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ... ❑ TEST/OBSERVATION, ❑ OTHER (specify)
0 INDUSTRIAL ❑ INSTITUTIONAL - ❑ STAND-BY ❑
AMOUNT OF'USE
YIELD SOUGHT -5 gpm./NO. PEOPLE SERVED 4 /-EST. OF DAILY USAGE 450 gal.
REASON FOR
DRILLING
'NEW SUPPLY = 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
.❑ aEPLAGE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 6 25 — ft. I
STATIC WATER LEVEL 19 it.
DATE MEASURED 7/25/$6
DRILLING
EQUIPMENT
❑ ROTARY 4'COMPRESSED AIR PERCUSSION. ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. <OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH 25 ft.
MATERIALS: O'STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE 24 ft.
JOINTS: ❑ WELDED ;9-jHREADED ❑ OTHER
DETAILS
DIAMETER 6 in.
SEAL:,M'CEMENT GROUT ❑ BENTONITE OOTHER
WEIGHT 'PER
FOOT 9 lb./ft.
DRIVE SHOE• WES ❑ NO I
LINER: OYES ONO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH.(It)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
HOURS
GRAVEL PACK"
1
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK In. I
TOP
DEPTH ft.
BOTTOM
DEPTH - 11.
WELL YIELD TEST I It detailed pumping
METHOD: 0 PUMPED tests were done" is in-
,09COMPRESSED AIR formation attached?
0 BAILED OQTHER 0. YES ❑ NO
It more detailed formation descriptions or sieve analyses
WELL LOG are available. please attach.
DEPTH FROM
SURFACE
'a"'
Bear.
ing
Well
Dia*
Ineler
In
FORMAnON DESCRIPTION
COOE
it.
ft.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
YIELD
99m.
Land
Surlace
8
Clay & boulders
R
625
Hard granite
625
6
500
7
WATER X�CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
❑ COLORED ANALYZED? AES ONO
ANALYSIS ATTACHED? J%rES 0 NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE ' HP
WELL DRILLER NAME MILL' DRILLING, INC - 6 8 6
ADDRESS SIGHAI ruRE
• Putnam Ave.,
-Brewster, NY.10509. Robert M. mill, ires
Yorktown Medical Laboratory, .Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
._._(914) 245 -3203 _
Director: Albert H. Padovani M. T. (ASCP)
LAB
Collection Station Used:
Carmel Peekskill _
Ait':` Kis o Neer fCi -ty
Date Taken:
Date Received: ;i fa
Date Reported•
Collected By:. !-
Referred By:
Sample Source: ZKY
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE.(MFT)
Total Coliform ner 100 ml L
Fecal Coliform ner 100 ml
Fecal Streptococcus per 100 ml.
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total-Coli-form: MPN Index ner 100 ml
Fecal Coliform:
OTHER ANALYSES
MPN- Index per 100 ml
THESE RESULTS INDICATE THAT THE WATER SAMPLE. A) (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.
,�XXA-l1 � �- �- �C�.e�l ems► �'3'),�°
Albert H. Padovani, M.T. (ASCP), Director
LEGEND
RDS Recommend Disinfect-
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
O
PUT'NAM COLUTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building Section Block Lot
Building Constructed by /
d a et' 91/C �a¢
Location - Street Subdivision Name
Municipality Subdivision Lot #
,&ed &C'A
Building Type
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'bo 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. /1 / A
Dated this 9 day of OCT, 199&
eral Contr cto (Owner) - Signature
O A16 rI SSOCI�¢
/Corporation Name (if Corp.) ,p
Address
rev. 9/85
mk
Signature
Title
JNJ12-rd 4- i) vor/,[I ,w Corporation.Name (if Corp.)
�alrA.l y
Address
•�] ClJi11�191r1 I.VVt�lli :ucrt�nai�iri�i va aaa.�a.aia ON CERT IC-47 E -OF
'COMP 3A'NCE�!
Diws�on of Enwronmental%Health- Services Carmel N :Y 10512 PERMIT
CONSTRUCTION -PERMIT. FOR SEWAGE. DISPOSAL •SYSTEM '. A.TI'EP�S07V
_ .Town or -. illage
be*.submitted' t
place . in good'
ance of the,'ap
Willi bedocatedzi
County O/epi rti
Date
standards, rules and regu a_ ionso a utnam
Satisfactory to the Commifsioner -of Healthwill
dor assigns by the builder, that.said. builder will
years immediately following- th'idate, of the issu'- r
'thereto; 2) that the 'drilledw'ill; described .above
iyard ► es an regu a ons- . of the Putnam,
License No
ion ;of the building has been undertaken and
slth... Any change or_ alteration of constructs.j
requires a new permit Approved for disposal of -dome is sa dry' -sews ._an /or -pr vats w r iupply `only.;.__,
Oate�L_. gy Title
rinq
PUrNAM COUNTY DEPART OF HEALTH - DIVISION OF ENMONMMAT, RFATrm' SERVICES
INDIVIDUAL VUMM SUPPLY SUBSURFACE SEIVkGE DISPOSAL sysm4s
FIELD INSPECtIOWREPORT
DATE:
-INSP. BY;
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO CCMKDM
Wetlands cn/or proximate to property ... : ............
property lines. or corners found...
Can estimate house location...'.:'..
Will driveway need cut ............................
Must trees be re!mved - note these.. *** ............
Deep holes, representative of entire SDS area ...... .
Additional deep holes needed...... .. I ...........
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacentwells/septics .............................
Access to urcuosed well location for drillinq .....
ole
D.H. - Deep 1,
G.W.-Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 loot
Depth to G.W. Depth to G.W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
Soil Description
0 ft.
3 ft.
6 ft.
9 ft.,'
12 ft.
0 ft.
bo3a uescri
Soil
0 ft.
FINAL SITE INSPECTION INSP.BY:
YES
NO
camMEMS
House SSDS located per approved plan.. � .......
Length of trench measured
_
Width of trench average C.
Slope of tile line and trench acceptable .........
Roan allowed for expansion trenches... ......
Over 100 ft. fran watercourse.......... .... ..
Natural soil not stripped or SDS area
unnecessarlygraded...... ... ... .............
10 ft. maintained fran property line and
20 ft. fran house..
Distance well to SSDS (ft.) ...... .0 U .........
Number of bedroans checks ........................
stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench,
15 ft. of peripheral soil horizon
frantrench .......................................
Boxes properly set ............................... 7
Could surface runoff from driveway, .,roads,.
ground surface, etc., chainnel"near SDS area.......:
Does lot drainage. appear OK -in area,' of :SDS.....:.
P-MAT. r-PIMMr. OF STTF A(rF.PTARTR_ * .................
L_I'
Z
(
I
DIV15ION Or ENVIRONMENTAL jiriALTii SERVICES
CQUN1'Y OFFICE BUILDING. CARMEL;. N. Y. 10512_
_ DE510II DATA .SIIWV- SEPAIIATE_ SEWAGE DISPOSAL_.SYSTEM . _ _ _ VILE. NO. 7599 _ _ ......�.
Uwiier- Van:dra-ve,- or Address 15 Ta ur 1 Taney cha=,qqL,' NY 1051L�
Located at (Street Sec. 73 Block h Lot 1
�Ilidica�"Veross itreeEj'
Mmiicipality Patterson Watershed croton
Bulb PERCOLATION TEST DATA MQUIIIED TO BE SUMMED WI'1'II APPLICATIUNS
5 � -
2
3
iJoten: 1) 'Pests to be repeated at same depth uptil a roxlmately egml soll
rates are obtained at each percolation test hole. All data to be submitted
-for review.
2) Depth measuremeitts to be nude from top of hole.
LOT +134 aokp
ck
wooPS
6uBP1V1S(a►.L
]tile
Number 3 CLOCK TIME
PERCOLATION
PERCOLATION
— liruii
IJo.
Start -Stop
Elapse
Time
Min.
155pEli to Water
From Ground
Start
Inches
-.
Surace
Stop
Riches
a water Level
i.n It cI►es
Drop rn
Inches
Soil hate
M1.n./iu drop
1 146:76
30 min
23
25.75
2.75
10.90
2 17-4,q
31 min
2-3
25.50
2 50
12.40 _
3 49 -80
31-mia
23
25.50
2.50
12.4Q
4
'
1
5
-
2 148-78
30 min
'28
29.25
1.25
24.00.
219_51
32 min
28
29.25
1.25
25.60_ _
352-8-3
31 min
29
29.25
1-2-9
94 -An
5 � -
2
3
iJoten: 1) 'Pests to be repeated at same depth uptil a roxlmately egml soll
rates are obtained at each percolation test hole. All data to be submitted
-for review.
2) Depth measuremeitts to be nude from top of hole.
41
I
r? 5 , -�_
f :E T SPIT DATA REQUIRED TO BF' $t,'I ,'T;ITTF.D i:ITti APPLICf�TIOII
DESCRTPTIO ?d OF SOILS 00TYP ' FED II, TEST HOLES
DEPTH HOLE.,:__n0;. _:. 3A ::,:. HOLE .h0,. ...:3B _._ _ . T . HOLE NO._ . 3C.... .
G. L.
611. ?5—
12" rp(i -hrnwn
18" mix
2411
clams Gilt
i0" sand
36"
42"
4811
5411
6011
66"
7211
78'1
rock
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL ' TO- - WHICH WATER LEVEL RISES AFTER BEING ENCOUNTER3-1/t/ ED
TESTS MADE - -BY -� o fH w -; G86P LE - Date.:.. " I's S .
DESIGN
Soil Rate Used 25 Mir4/1 "Drop: S.D. Usable Area Provided 5000
No. of Bedrooms Septic Tank Capacity Gals. Type
Absorption Area Prov ded By �nn_L.F.x24 "_'bj — width trenc OF
till. Qther
00 R IU�c,,,v
Name ` Ratdwin � Pr bignature-
-6on ro y, ` Q ;
Address RD 6, Rte. 22 SEA
Brewster, NY 10509 = m
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal.
Checked by,
SEAL
. +� : W
1980 32
!� �FESS1011P�'�
Date
P7S.
DIST.
PTS.
DIST.
:A -1
41.2
B -1
24.3'
rA -2
51.4'
B -2
44.2'
A -3
47.6'
B -3
45.6'
A -4
43.5'
B -4
47.2'
A -5
40.5'
B -5
49.6'
.•A -6
35.6'
B -6
54.2'
A -7
32.5'
B -7
59.6'
A -8
82.4'
B-8
81 .0'
A -9
80.2'
B -9
81.3'
A -10
77.4`
B -10
82.2'
A -11
74.5'
B -11
83.1'
A -12
72.5'
B -12
81.7'
A -13
70..5'
B-13
89.1'
A -14
69.3'
B -14
89.1
8 -15
43.2'
4 -15
51.7'
8-16
44.5.
14- 16
49.2'
8 -17
45.9'
4 -17
'46.8'
8 -18
47.5'
4 -18
44.6'
-8 -19
49.8'
4 -19
43.2'
8 -20
52.4'
4 -20
42.6'
THIS IS TO CERTIFY THAT THE SEWAGE
DISPOSAL SYSTEM WAS CONSTRUCTED AS
INDICATED ON THIS PLAN AND THAT THE
SYSTEM WAS INSPECTED UNDER MY
SUPERVISION BEFORE IT WAS COVERED
OVER. THE SYSTEM WAS CONSTRUCTED
IN ACCORDANCE WITH ALL STANDARD
RULES AND REGULATIONS OF THE
PUTNAM COUNTY DEPARTMENT OF HEA
AND THE NE14 YORK/' PART NT
OF HEALTH. /
C. C' SA IL
Co 980
fW YO �
Putnam County Department of Health --
Division of Environmental Health Serviced
Approved as noted for conformance with
applicable Rules and Regulations of the
Putnam County Health Department.
Signature & Tide- e
o nr_aTtnN CHART
PTS.
DIST.
PTS.
DIST.
A-1
417
B -1
24.3'
A -2
51.4'
B -2
44.2'
A -3
47.6'
B -3
45.6'
A -4
43.5'
B -4
47.2'
A -5
40.5'
B -5
49.6'
A -6
35.6'
B -6
54.2'
A -7
32.5'
B -7
59.6'
A -8
82.4'
B -8
81.0'
A -9
80.2'
B -9
81.3'
A -10
77.4'
B -10
82.2'
A -1 t
74.5'
B -11
83.1'
A -12
72.5'
B -12
81.7'
A -13
70.5'
B -13
89. '
A -14
69.3'
B -14
89.1
8-15
43.2'
4 -15
51.7'
8 -1 6
44.5'
14- 16
49.2'
8 -17
45.9'
4 -17
46.8'
8 -18
47.5'
4 -18
44.6'
8 -19
49.8'
P 4 -19
43.2'
8 -20
52.4'
4 -20
42.6'
BALDWIN & CORNELIUS, P.C.
CONSULTING ENGINEERS -LAND SURVEYORS
WELL O
HOUSE
B
A
1
7 6543
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6� S.D.S. PLAN
SCALE 1 " =50'
BURDICK WOODS LOT 3 SHOW
acre 9129/86
S.S.D.S.'AS BUILT' �n9,.e �SZZz