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01653
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Divtsronrvof Environri
OF 4�$�9El �L N �AAI!°4IAN E
— /
Located =at • �� /l �' ` � J�° � �d 4
Owner
plc �asse s 8
i Separate Sewerage System built by ,
Consisting of �� Gal ptic k
Se Tan
n/C /bh
^� - 'Other` requirements ".
Water SupPIY Public Supply From
'By-
Pr ate'SuPp1Y;Drilled .BY
- Address
Bwiduig= Type . aL�rrP a,i
Has Erosion Control Been Completed r' re
l
e' s asli3ted ser "vin" the atiove remises w
-:. I certrfy+ that the syst mO . ,9 2 -, P_ •;,�, -.:
attached) `and in accordance with the standards 'rules andtrey
f r %
1.
Date .c. ,.:. .�
c
k . Adddress
Any;; per son occupying premises served by the lab ove system(s);,.
conditions resulting from such` usage riAppro`val,Yof the sepal
available and the approval of the private; water supply sfialf be.
sub)ect totimodification =or change when; Fm athe judgment of
t
Dated
.y
1
77
Y ' DEPARTMENT OF HEALTH � M
1l Health Services, Carm% N Y ` 10512 �k � y ';,�
t a.EW�4a! POSAfY$TEM �"r4'3?s2
•� a "' � `- � s ' � ,y Town'orV�lla9e� �II-
Section Block
Lot Joti�`IO 1
G
��� lineal Feet X width trench
O �
No =of Bedrooms Date Permit Issued �T��
onstructed essentially as'shownon the plans of the completed work (copies of which are .
ms, plans fiI and the {permit issued by r the Putnam ° County :Department of_Health..
fled ` • P E R Ay
License Noy u�
promptly take4such action as may, be' necessary to secure the correction of ,any 'unsanitary
sewerage system.shall become null and void as soon as a 'public', sanitary,sewer becomes
: null Viand void when a ?public water 'supply becomes available, Such •approvals are
Comni�ssionerof Health such revolat�on modif:iwtioh,or change 4 necessary -'
-99 321,KearStr et:,_
DATE COLLECTED
�RESULTS OF EXAMINATJON OF WATER
OWNER DATE RECEIVED
,SAMPLING POINT:,
WELL� LOT I -BULILETHOLE RD PATTERSON N.Y.
LESS THAN 2.2
rmWA.lT.m(ASCP)' �
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WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK
4
.et itwd�!-.7i_cou Pty._-,HealtK -DeRaa-mew _Vgejl_,er-,w_ith:Jahjn; ratory_--.rqpt
W
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
NAME ADDRESS
OWNER McGlasson Builders Carmel N.Y.
LOCATION (No. & Street) (Town) (Lot Number)
OF WELL Bullet Hole Rd. Patterson N.Y. Lot #1
BUSINESS
PROPOSED R DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WEILL PUBLIC AIR OTHER
11 SUPPLY INDUSTRIAL CONDITIONING (Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT F1 ROTARY A AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CA—SING GROUTED?
DETAILS 45 7 26 THREADED [:]WELDED ii YES F1 NO 0 YES NO
YIELD HOURS G.P.M. YIELD (G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR 1 2 25 25
WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST ffeet) Depth of Completed Well
LEVEL 2 total drawdown in feet below.,L.and surface: 200
SCREEN MAKE LENGTH OPEN TO AQUIFER (feet)
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including IGRAVEL SIZ ' E (inches) FROM (feet) TO (feet)
PACKED: 4ravel pack (inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least
FORMATION DESCRIPTION two permanent landmarks.
FEET to FEET
0 35 sand and bankrun
35 200 ledge
well is connected to
well next door
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL )Royd A . Oezlan W611 60., 1
R.
COMPLETED DATE OF REPORT WELL DRI LLE�' (jignature) 52
3 A1,4 �c
AZ3 7/2OZ7 I g -2
?'044 4- e�
Jr - z
Owner or Purcs'iaser cif building'
Building Constructed.by
Location - Street
. �rgir,E
Building Type
Kinicipality ,.
Section
Block
Lot
GUARANTY 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 guaranty
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 initial use of the sewage disposal system, or
any repairs made by me to such system, except where the failure to operate,'px•operly
is caused by the willf-al or negligent act of the occupant of the building utilizing
'the) cvctam
The undersigned further agrees to accept as conclusive the determination
of the Director of the Division of Environmental Health Services of the Putnam County
Department of Health.as to whether or not the failure of the system to operate was
_ c ause_n..by thewillful or., neg:!, gjent„ act of the occupant of the but ding >> t i.?_izing fine
system..
Dated this .,? day of J 19a
Signa
Title
(ir corporation give
name and address)
AV_5V:aQ'- ,12 --- - - - - -- -----=-------------------------------------------- - -
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
PUTNAM COUNTY DEPARTMENT OF HEALTH
_. - - - -
.
DIVISION.. 0�' F,�]VI�tONMENTAL.,HEALTH. SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512._
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO.
Owner �� sson 9,0;AdPMxkddress ,w Ile I` b &o
a
1&h9 V4 5410.
Located at (Street.' �,;,� $�, Sec. Bock- Lot .�
nearest cross s.ree
Municipality,pa . s ®„ Watershedo
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH;APPLICATIONS
Role
Number CLOCK
TIME
PERCOLATION
PERCOLATION
apse
Depth
to Water
water Level
No.
Time"
From Ground -Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min: /in drop
Inches
Inches
Inches
1
2 Zg . /o ?0
6
.f
3 /03
4
5
you
4 \
5 ..
Notes: 1)' , Te'�ts to be repeated at same
rates are obtained. at each percolation
for review. , .
2)' Depth- measurements to be made
depth until approximately equal soil
test hole. All data to be submitted
from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH 'HOLE NO.- HOLE N0. HOLE NO.
G.L.
6,.. .
12"
18"
24"
301
361
"
�+2
48"
54"1
60"
66"
78« .. .
8411
INDICATE LAT OG OUND WATER IS ENCOUNTERED �✓ h/�e.� .�'so�►ti
INDICATE LEVEL TO CH WATER LEVEL RISES AFTER BEING ENCOUNTERED V Av/va/ 01►d11%
TESTS MADE BY Pere . �.
Soil Rate Used / DESIGN Mi Vl "Drop: S.D. Usable Area Provided ��i�►
No. '.of Bedrooms 7� Septic Tank Capacity /f0® Gals. Type /_
Absorption Area Provided By y3 %. L.F. x24 b ✓ width trench.
Iii' // Se,�� a r�•�n___ �a�io_� .� �i _�_m/J��. e/��
Other _. - - -- - -_�
pFtS�iu�r
Address R. D: 6, Box 953 EA
annpl t4pi r Yod 100 ytiJ�r* H. PR�y� /sue �tF
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
� G Y
Soil Rate Approved Sq. Ft /Gal. Checked by
2g2a6
0p TNf $t
:PU$NAM COUNTY DEPARTMENT OF HEALTH
4 Diiiisron` °of Enwronmenra/ Health_ Services, ;Carmel ,N Y .10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Patterson,
i
Town or Vrllage
LocacaSo. I I; I, P I ��Cr i R(1
Twl n Acres Sub'd
subdwision Lot ( VJob S01048
i owner McG l assort Bull >ders Inc _ Address 93 vG l ene i da °Avenue
y a
` A New�3York'° (0512
B ildm9'TYPe Frame Lot Area I 000 Carme( ,
y
Number_, of Bedrooms Three £ _ Y Total Habitable Space I25D� Dn lit 'Flquare;Feet
Separate. Sewerage System to consist of` tr 1 000 Y Gal .Septw Tank p.. - 480 lineal feet X 36: -:I nch • -width drench "
=To be constructed' by r ? ' Address
IV
Water suppiY PubIic'Su poly ,_IF: m ro ' k,k
Private'
"Supply `.to be dialled by
Address
otherRegwrements F °1 I i Section 128' f` L x 45`t Wx Deep e
her i
0.
I represent that l - -.am wholly and :completely responsible for the des�9n and IocaUon of the ,proposed- systems) 1) that the .separate sewage, disposal system -
1 above described w,ll be constructed as shown on the approved amendment there to and ur`accordance with the standards; rules an regu a ions o ..A he Putnam
County,;_Deparfinent of ;Health, °and thit'on con pip. ion thereof a,!`Cert�f�cete of "Construction Compliance' =.aat�sfactory -to the Commissioner "of Health will
be..submitted to' the ,Department; and 'a ?wntten' guarantee wUlbe furnisfied the'.owner .his successors heirs or assigns by.the builder thaYrsaid builder will
place: in "goodoperatmg condition any, part-
'of, said sewage disposal system •during the -perwd of two (2j..years.inimediately; following the date of, the issu=
1 ance.'of the approval of.`the Certificate of . Construction •Compliahce of tthe original system or, any repaiisdhereto; 2) that,thedrilled vrell.destribed3above
_twill tie: located as shouvn on the approved plan and thatrsaid' well will be installed m; accordance with; -the startilards, rules and; iegula ions of ahe Putnam ,
i County Department Of Health
t r.. ,17 8/73 P.E. X. RzA
Date _ - S.i9n
h
Address License,No. 29206
�, ed {
RrD 6 B 35 ,
APPROVED FOR CONSTRUCTION ..This approval expires one year from the date issued construction of the bull "ding has been undertaken ;and is
;revocable- for cause toe-May be amended or= modified when considered necessary by `the mm�ss�on r of Health Any change or alterat ion -of construction
regwres a new permit ..A proved for disposal of domestic `r s age qr rrvate r. supply only
:
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