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Rev. 3186 PUTNAM COUNTY.4DEPARTMENT.OF. HEALTit
/wq Divlsioaof Environmental Health Se vicex,�Cermel, -N.Y 10
\ gyp; • J � -
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CERTMCATE -OF CON
- UCTION COMPLIANCE .FOR SEWAGE DISPOSAL SYST
Located at
Owner /appllcanf Name . ,• - Formerly - Subdlvteion Name •Spbdv.•Lot' N '
Melling Address :LION& Vie 90_A t1," 6/ t N Zip 105 L s Date•Permit Issued
Separate Sewerage System bull! by •46VI k.&1411 Address 1
Consisting of , IOC Gallon Septic Tank and —_e2 LF d F 4 %_!-
Water Supply: or / Pnbll Supply From Address
V Supply
Drilled by t &- Address(zF�nIr7'-
llulldlug Type Has:Eroslon Control'Beeu,Completed?
Number of Bed ooms Has Garbage Grinder Been Installed?
.
Other Requirements
I certify,that the system(s).as, listed 'serv,ing the above premises war a.conatructed esaentially,as ah the pl s of e d work (copies
of which are.,;atteched),_and in,accordance.witti ahe standards; rules and regulations; in 'accordance ' he fil -plan, it issued by the
Putnam County Department Of Health
Date + 8x Certified by R.A.
Address _ oX . %/ 3 . �t"ta tVtl�- Y,�l� --i0. iYt License No 44.,6
Any person occupying premises served by, ,the above. systems) 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'antl vold.as soon as a. pub:!: sanitary sower becomes
avallable and 'the approval of the `privateiwate► supply shall become null and vokl when a public "ter"-supply becomes avallable. Such approvals are
subject to• modification or change when, tiin the tJudgmsnY`of the :Commlisloner of:�ealth, aueh re n, ;rrioalifieatlon of ehange Is necessary.
Date By ' T
0
b/It1111N11 fdl 110111111111611101 Ilvellll yplv1100
a ®' CODUTY orFICC DuiLDIUC • CAnmCL. NEW vi
'Shia report is to be•completed by well driller and submitted to County+icalth Department together with laboratory report of
arWy;i; of water ;ample Indicating water n of satisfactory bacterial cluility before eertlfiriote of construction compliance is iitucd.
REPORT tpUST HE SUBMITTED WITHIN 30 DAYS OF WUL CO.-APLETION
crWRIZ
KEVIN &
EILEEN KELLY
Longview Road,
Carmel, NY
®CATIOk
65.
the. 6 sl,oey,
oar
(T of
µo1 irlrinoor/
OF trrEu
Fair Street'
Patterson, * NY
35
.
0
®
®
tDPOSt®
® DOA4E37IC
$SIAZLISHMENI
FA8A4
TEST %VM
tlSt OP
' WIll
j
INDUSTRAE
j�
CONDITIONING—'
CO ND RIONING •
OTHER
tipo�idrl
aI UING
i 1
jj COMPRESSED
PIRCUSSION
® CABLE
PERCUSSION
® OTHER
]LIiPF/[IdT'
L�J
ROTARY
AIR
Isoc.:(r1•
CRSIHG
tlleGla (IO01j
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taAaALILSI /nCA081
wcnorsl Pla 0001
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jjUla��d[ SMOTj''� I ^AS LA G C��v�iJl
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DETAILS
7 5
6
]� 9
THREADED WELDED
I.XYES L H U TES WO
Al
VIEW
nn HOUeS
D 6
G.Pan.
7
TILtD (G.P.0 j .
7�
• TEST
&AILED
PUMPED lX_: COMPRESSED
AIR
WATER
A%LASUiE PLOln LAND SUaFACi— S1A1JC(.pe9*/rl96 t/
DUSIf:G ifLLD TtSI Pecs)
Depth of Cornpleled Well
tiltiL
61
300 o
In f¢ot below Lond svrtoce: 360
Jtti.ieF
lNG1M O►L:1 TC+ AGL;1FLi
S'CRFfK
DLTAl:b
UG1 1:i
0IA4AL1LS pncnoa/
IF GRAVEL
I Woreeter of wall inclvding
GQAvLL S;U (/ncnes) 120AA heal/ poop
RACKED:
prowl pock (1n.A1
I10
1
a ►i ✓m t411*'171lA:!1
PER
to P[El ; POR"TION D.S007TION
0
60 1
Hardpan
60*
65
Medium to. hard 'fractured
bedrock
65.
360
Medium to hard grey granite
.
o
If'Nlet was ivolool 01 oiRarom t3sptAo alrrints 4411 :n0• Lot boiew
PEft cAUO►+S r(R )AINUIE
SMOICh orJ3C1 I000110n CI -Of .1111 O /ilaACei. 10 Of I®aaf
two porenononr lonomarns.
/,00 pro,
. 1
I- - I , . . I . 01,&; A S
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I- - I , . . I . 01,&; A S
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@RlNTER L4�OR4TORIES ..... .
_ - �- .-
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 6117
SOURCE: Kevin Rielly :Jell
Fair St.
Patterson, NY
COLLECTED: April 4, 1986
BY: Nall Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 ml.
This indicates res It o r he
u the source ce oft sample le w as
of satisfactory sanitary quality when the sample was collected.
April 12, 1986
f
PUTNAM COU91Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRON[ WAL HEALTH SERVICES
Owner or Purchaser of Building
C� I j :-
Building Constructed by
Location - Street
Municipality
Building Type
°1 ` IF
Se � Block Lot
Subdivision game
Subdivision Lot #
GUARAIq= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that .I am wholly and completely responsible for the location,
workananship, 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 iaade' oy' nie- to -such system,- except where the failure" to lope 'ai.e -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 Environmental 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 19i Signatur
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Title
ww 2--
Corporation Name (if Corp.)
Address
V.
ENGINEER TO PROVIDE ,PERMIT. # j
PUTNAM COUNTY: DEPARTMENT OF HEALTH
ON.CERT IC ATE 0 - COME L,IANGE -r!
e
Divisionrof Environmental Health Services, I,arme! N ,Y 10512 PERMIT
.CONSTRUCTION PEfiM1T FOR SWAGE _DISPOSAL SYSTEM 477`'' *),�
Town or illage ,
4 C atodd, _ r _� Yax N!ap� Block-I-
Subdlvis�on iJVU r r' S "SUbd Lot A� Renewal Revision _ !
a
Owner /Address Date Of Previous Appioyal '
F
Building Type Pill Section only (]
�!z / ^� tl/D •.. P.C. -H. D Notification Required .
;Number :of Bedrooms Oesign,Flow G P p'' d
Separate Seweiage System to confist of f %L3L "' Gal Septic Tank and
To be' constructed by Address
y
Water Supply Public. Supply •From.
P ivate Supply to be drilled by
aiddreis
Other 'Requirements
i represent thattl.am wholly and completely!,respons ble for the desii ' —d location of the proposed system(s); 1) that the separate' sewage - tliSposat:Syftem
above descrvbed, will be constructed as shown`'on the approvetlbmendment there to antl in accordance withlhe'itandards rules an - regu a ions o >. • e Putnam
County ^:Department of Health, and that on completion thereof a Gertificate? of Constructiori,'COmDliance satisfactory: to the,Gommisiloner ' of liealthwill
be sub_ mRted to'••the Department 'and a'.w"itten guaranteedwill be tfurmshed "ahe owner, his successors,. heirs.oc assigns by the.bullder,;that said builder .will
place in good 'operating _condition.` any part of said sewage. disposal system zduring ;the period of, fwo (2) years immediately fo owing thedate of the issu-
ance•of,'.the approval of:ahe.Ceititicate of�: Coristruct�on'Co'mpliance of the original system or any .repairs {hereto 2p;that't filled "well describeG'above .
will be located as shown ori'.the appYoved plan antl that said wall will be installed m accordance 'r he ,hand ds, rules n r a ns, of the' Pu4nam
County Departure of Health° I F �'` � ` - •.
•
bate.:
Signed, !It'' P.E. R.A.
Address z. Z
r Lice fie No '
APPROVED FOR,;CONSTRUCTl(jN Thzi approval -exp res one y"a... rom the date issued ur!less construction of a building'has� een undertaken and is
revocable' for cause or maybe amended ormod�Letl when cons�deretl necessary :by the,;:Co issi6ner 'of. Health., ny change- or alteration of construction
regwres' a new I permFt liDProved for disposal of tlomestic sa tart'' wag ,'and /or 'pr wl,,y Y. �y
Oate_.
Bev. .!5Z85, .
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PUTNP,M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONmEalAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
_ , ... FIELD INSPECTION..
ZZI
r y
%alt. FrCc.C�^ IN P. BY:
( Name of Owner) ( Street Location)
INITIAL SITE INSPECTION YES NO CONII�ITS .
Wetlands on /or proximate to -,property.
Property lines or corners found....... .
..Can estimate house location.......
Will driveway need cut ............................
Must trees be removed - note these.................
Deep holes representative of entire SDS area......
Additional deep holes needed......
Sufficient SDS area available considering driveway
'cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
Access to r)ronosed well location for drillincr.....
D.H. 1 Lot
Depth to G. W.
Depth to rock
0f
3f
6f
9f
r 12 ".
- j.
D.H. 2 Lot
Depth to G.W.
Depth to rock
0
ft.
3
ft.
6
ft.
9
ft.
:.... _L �"-2 ..f�.
Soil Description
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
DATE:
FINAL SITE INSPECTION INSP.BY: YES NO COTS
House SSDS located per approved plan..............
Length_of trench measured ej
Width of trench average
Slope of -tile line and trench acceptable.........
Roan allowed for expansion trenches...... .........
Over100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded...... ..... ! ........
10 ft. maintained fran property line and�
20 ft. from house ..............................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
fromtrench....... ...........................
Boxesproperly set......... ....................
Could surface runoff from driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage.appear OK in area of SDS.......
,FINAL GRADNG OF SITE ACCEPTABLE..
. ................
r
-' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
M' COUNTY OFFICE BUILDING, CARMEL, N.�02 .� ., .._.
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner AddressirLr5y2/
Located at ( Street) Block Lot s
n lca e� neares cross s re
Municipality, jUti Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
3
0 C
S7':,3
Number
CLOCK
TI4
l�
PERCOLATION
L� i
PERCOLA_TI_ON
Run
Elapse
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
/E
/7
U
-3
.
5
3
0 C
S7':,3
4,6
4
-/�
l�
��
Z
3
0 C
/6
2.
4
-/�
l�
��
L� i
6
5
Notes: 1) Tuts to be repeated at same depth until approximatelyy 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L. atjyf�ta/
6„
12" -
r
18"
24"
301 r�
3611
42"
48" i
54" t
60" ,
781 , f
84"
:_IlVIJCATE:TE�IEL AT WHICH ,GROUND WATER IS „ENCOUNTERED,,..,_..__.:�i
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY i7 Date i�
DESIGN
Soil Rate.Used ,�--7 Min/1 "Drop:. S.D. Usable Area Provided
No.. of Bedrooms Ji Septic Tank Capacity/0-0 Gals. i
Absorption Area Provided
�y ,Gifu -_ v I `x4 `
Name . �'>lcc.4 u� signature
Address sf Z-` SEAL
�.
THIS
SPACE FOR USE
BY HEALTH.DEPARTMENT
ONLY:
Soil
Rate Approved
Sq. Ft /Cal.
Checked by,
Date
_o WELL
PKi,qr-, TO
t-07 W
'05 5cz FT
A
-Ox
'e-r L., 0 t'l GOW-
Ff)O-TIKICa Sovj F;rO,5,:T
rL,Al,
�
:5CAL,�,
42 O'p
IOX e4l- MA:50�1i?-Y etc -iAt4-
(aO L.F. OF -1 -4 L-ALL-r--Y-,
Hou,:;a v\i emu. GKi \1 a;WAY
L,OCAT!Ot,6 AS eye- SUV-,Ieiy
2)y -10 Hw50,,-1
l000 �-.AL, -'-At. ti
&b L.F. OF
TANK
LAgr 9--1X Z'- to" 29.0.
C.O. f 32 ry8
O'j 49
u b11— CouritY JJePa-rTm8n1, ui nua.LLL
:vision of Environmental Health Servica�
' ?roved as noted for conformance with
,E,licable Rules and Regulations of the
LLtnam-County Health Department.
,ienqturp A .1. nnto
T/Aq' FAA'
PAIZ ST.Q
1FU7 tJAM CO.
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