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BOX 15
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.ownerY.' Vi rg nx a M. &Donald- A Sanborn
1 Separate Sewerage System bwlt "by Tyndall Septi`e S
1,000
a , Consisting of Gal, Septic Tank
s None
f Other requirements,
Y {
'- Water, Supply ' Public Supply ••From `' `''
X Private Supply Drilled By �014 1,S
Address Croton
Building >Type Frame
{r aHass Erosion Control Been 'Completed?�' ��•$ -� " }
1 i
n •�
"I certify',that the ,_system(s) as listed serJing, the above premises were c
attached)', -and in accoroance' with the 'stair rules and regulatit
FDate
( Cert!
Lr;S �Bo
Address 7+`a
Any person occupyjng premises served bytthe above systems) shalt
conditions resulting from; such' ;usage A "pprovaP'of the _separate
`available and -the approval of h e private water supply shall bec'orrig
csubjectt to mod ification or charige when, m t #judgment of the,
a1 encC�uk_�& son >, �nc�.
Fala s; NY. ..
No 'of Bedrooms't Three Date Permit �e9ued -7/10/74
utructed essentially as showrcon the"a the completed work (copies of which are
s plans filed, and the permit issued a 'Putnam 'County'Department of.Health:
R.A.
armel;r Nr 10 2
r inptl`y take such action a'sjm`ay',be7 necessary to:'secure' the correction of any unsan(tary.
Overage- system:'shall become null and void as;soon'as a.,public sanitary sewer becomes
lull antl void -when a- public;'water supply' a Zs available. . Such approvals are
ommi ion o HealtF% such -- r ocation ication --or change is :necessary.
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t �
Title '
r '
s� t: kG .r �, H) apt. a�` rt '..xJS:.,a :i.rr�...,�n'.r':A.M „{ten .�tf,... �..;�. _2.::a.H. � -r,. k�, �,µ ,..:_. .,•
' DEPARTMENT C, -,ACTH -
,0011th Services, irarmel; - /V ).`• :10512 I:
�EINAGE,;I�PQSAL �STE"1',4 �Y
:. pa�CY'SOr
'
.:
_,, -- '.. =„.,z .�.; c'•: .. F
-• Town :or, village
Sectwn'
Block
F,
Lot- �-
S0141
.7
Job
ems Address Brewster . NY
10509
184' lineal Feet X
e t,
36 inch nQll ` width trench.
a1 encC�uk_�& son >, �nc�.
Fala s; NY. ..
No 'of Bedrooms't Three Date Permit �e9ued -7/10/74
utructed essentially as showrcon the"a the completed work (copies of which are
s plans filed, and the permit issued a 'Putnam 'County'Department of.Health:
R.A.
armel;r Nr 10 2
r inptl`y take such action a'sjm`ay',be7 necessary to:'secure' the correction of any unsan(tary.
Overage- system:'shall become null and void as;soon'as a.,public sanitary sewer becomes
lull antl void -when a- public;'water supply' a Zs available. . Such approvals are
ommi ion o HealtF% such -- r ocation ication --or change is :necessary.
s
t �
Title '
r '
s� t: kG .r �, H) apt. a�` rt '..xJS:.,a :i.rr�...,�n'.r':A.M „{ten .�tf,... �..;�. _2.::a.H. � -r,. k�, �,µ ,..:_. .,•
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This. report Js. to.be. completed_ b ..y.well.drill -er. and. submitted to County.Health Department together with laboratory 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
n.c w J' -d U"' ir/i . ✓4 41
e
K
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NAME
ADDRESS
OWNER
No. B reef) (Town)
(Lot Number)
LOCATION
OF WELL
64,
"V _
BUSINESS
❑ ❑FARM
❑TEST WELL
PROPOSED
LCF DOMESTIC
ESTABLISHMENT
USE OF
WELL
11
El AIR
❑ CONDITIONING
❑ OTHER
(Specify)
SUPP Y
INDUSTRIAL
DRILLING
®
COMPRESSED CABLE
❑ ❑
❑ OTHER
EQUIPMENT
ROTARY
AIR PERCUSSION PERCUSSION
CASING
LENGTH (feet)
(
DIAMETER (inches)
WEIGHT PER FOOT
❑
R E Ojj��
CASING
T
DETAILS
L
�i
�� THREADED WELDED
YES NO
JeNj
YES NO
HOURS
G.P.M.
YIELD (G.P.Af.)
YIELD
❑
❑ ® COMPRESSED AIR
6
C
TEST
BAILED
PUMPED
7
WATER
MEASURE FROM LAND SURFACE— STATIC(Speclly feet)
DURING YIELD TEST (feet)
Depth of Completed Well
LEVEL
�_
in feet below land surface:
MAKE
LENGTH EN TO AQUIFER (feet)
IN
SCREEN
DETAILS
SLOT SIZE
DIAMET (1 hes)
IF GRAVEL
Diame of 11 including
GRAVEL SIZE (Inches)
FR eet)
TO (feet)
PACKED:
grave pack (Inc s): .
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
�L (i
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d
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Z
.J
G
W
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
J ��
L
�
4
-
DATE WELL COMPLETED
DATE OF REPO T
WELL DRILLER (Signature) t
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n.c w J' -d U"' ir/i . ✓4 41
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BREWSTER LABORATORIES
WATER ANALYSIS REPORT
SAMPLE' No. 3,267
SOURCE: Donald Sanborn - new well
Big Elm Road
Patterson, N.Y.
COLLECTED: August 20, 1974
BY:. Lo.0 -i s ..Ma l.anchuk.. & Son, Inc,
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
0 per 100 ml.
_ t
August 22, 1974
oy Bickwit P. E.
Director
� � J
mi)er Car L "arC)la.S'ti` G� �JU7.ld:Lng Mullicipal.J Ly
)i6ilding Constructed by
Locat.' n - Street
0
a
Il3ul_lai3�g Type
Section
Block. .
Lot .
-GUARANTY OF SEPARATE SEAIAGE SYSTEM
I represent that I am .rand c2FjM1etejy responsible for the location,
workmanship, material, construction and,gge 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 reo latiohs 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 properly
_•Iti l'r+flti(�(j
11V Tr1P W-1.1- L:1111 01* JIE'V_.L_L! tall cIU.4 U1 LH{-' ULa.:U�./ctll�:-Vl "-1.�1C ULL11U.t:rl - �at.a.i..cc.1.b -
•! he C�lC 1'�nl r
The undersigned further agrees to .'accept as conclusive the determination
of the Director of the Division of
Environmental Health Sorvices
of the Putnam County
Depa.rtment.. ;cf }�calth_as, to. whether..or,
not-,
the--failure of the
system to operate was -
caused by the�'�willful or negligent
act of
the occupant :of'We'
'the -"
system..
Dated this day ��
L/
1971
Signature
_1/
of
Title
f corporate
, give me ancT addres.
THREE (3) COPIES 'ARE REQUIRED WITH THREE '(3)
OF COMPLETION WILL BE ISSUED,
COPIES OF FINAL PLANS BEFORE CERTIFICATE
GUARANTOR IS REQUIRED TO. FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
9
11
Donald - &.Kathleen Sanborn Patterson
.,:ncr or 11orchasev of build:i.n- Municipal.i ly
T-..', Be. Paoli Inc.
gilding Constructed by Section
Big Elm Road ..
:)Cation - Street
Frame
iildirg Type
GUARANTY Or SEPEIRITE SYSTEM
I. represent that I am taholly and completely responsible for the location,
)rknlanshirr, material, construction and. dra iii..'age of the sel•:age disposal system
!rvinU the above described property, and that it has been constructed as shown on
►e approved plan or approved amendment thereto, and in accordance with the standarcls..
.les and regulations of the Putnam County Department of Heall.h, and hereby guaranty
the owner, his successors, heirs or assigns, to place in good operating condition
y part.of said system constructed by me iahich fails to operate for a period of t,,,o
ars immediately foll.o,0ing the date of initial use of the sewage disposal system,, o
y.repai „s made by me to such system, except where the failure to operate properly
C'all�t'il .u`' 'l:he willlul Up llE'k; Li tai L dc ►: of Jit UL:i:UPCXil L UL ulv s.,111J. 16 :. a.
The undersigned further agrees to-'accept as conclusive the determination
the Director of the Division of Environmental Health Services of , the Putnam C'oun c•.'
paz ,.trren:t.`cif'' „ }3cal.tb..as: 'to- c.�h:e.the.r- _.o�,. not.. the..fa litre .o.f : the' - system °to :.oEic:i �t L- e'.was .:..,..
used by the willful or negligent act of the occupant of t building. utilizing thn
stem.
ted this 12th d f March 9 75 i Hato ��,e
ay o 1 S g
Title
corporation, give name and addres:-
--------------- _ -----------------------------------------------------------------
EPEE (3) COPIES .ARE REQUIRED WITH THREE (3). COPIES OF FINAL PLANS BErORE CE};TIFI.CATE
COMPLETION' WILL BE ISSUED.
1RAN TOR TS RF.OUIRI;D TO. FILE NOTICE Or DATE Or FIRST USE Or - SYSTEM.
.
--- .. ----- -- --- ----- -- ---- -- -- - ----- ----------------------------------- --------
rision of Environmental }Iealth Services, Putnam. County Department of Health
(ON BOX.,
n outletsj' 1�11_�*
rerhov'Oble cover
A
Sam elava
ol
I
n.
joint i_2 -4 mi
0
t 8 1 Q
161 P AUN.
SECT-EON A'-.-
Mx
,-I V w V U w %.WVWI
IL
f
2 Min,
ti in. I lei ht i
bo
era
01"t vitreous
is clay PkP* or 04uly,
nd
cost line-. FoOttng to ontond to 36"
is
to
ink ?o box -0,hd between all boxoo
ibution ma!, be required,
S
Cr)
4.
1 -7 " �_ I I I I . 1?6.
..........
T
trenches in fitt
see disposal filel.l detail
2. C,.A
parvoo
it fill f o be R
grove
Clay
all fill to be
. ROB gravel
top goal
G" top ml
I r
Wervious matelial
Cla Y etc...
-NOTES
Re:Run -Of -Bank( R.O.8) gravel only ty
sourcos approved by- the local houlff
I authorities. if required, isaraple
..shall b Rresente to the arig
M health o leer.
or lava ?f
7 1 Fill Stiqll - Consist of Run Of son
qnd r a v? " m X 46 CRn
1 - I I w , . 6 a
pa roughi&.& 15116"Vealfficall hdVG
a mii�-t.weight of 115 lbs/cuft . dod
have Pe '*ability and percolation
charattiaTt-fitics %Iho% compacted
greater qn 10- cm/ so C.
co As per Stdi-y,,of A.ASHP. soil C1Q4
mit or cft.yey
Wt will DOI
a,-- --- 16T S PercolationjItJ ft le
Grade Hole n-1
Tank insidelangth
Tank inside widh-.-t Depth
(.squid love I- o 2 A D
EM rim
C a pac I f Y_ ".1 _.Y,_C� teal
Field Rredd
4
Width-_
Nglaterals
L p n 9t h ®c 6
N-Doxo
7
Q ±�4,sect_ion
r-, Yr
G a 1. % G a i /S q Ft/D a —
9
Req d. —
Fl 0
I-'
orb
ICY
O�z
•
I f y Q�e
I,Z: M C e
C! L `i7)
t r, s from oui -1 c s u p p v
c
t C- U-�
7 ;1 n vat t IV (,-I I i S S T C'`
co file c;�rrent Pul es
f
j J Le col 1 iP e T Ei r) t aan J,.
I i' ran,-
i- r I b t i t!,) s a i D e r, f-,
e5 3 c e r o 'I c. n
s to
3
A.P dftl& ffl%%
% B
V
UL
V E P��
'V'SIOIV-OF
HEAVR4 lfti@M
I
NO I Date
OWNER
LOCATioN Straq
T
S,
C ounry,
L 0 T
8 u kid
S urve it Ou 15 0 10 c b
Dro DO t a: SCQI
Jc�b NO
J 0 H N H.
P R E N TISS RE,
M.-
iL
i
lvl�
-
lr-
A-4
I f y Q�e
I,Z: M C e
C! L `i7)
t r, s from oui -1 c s u p p v
c
t C- U-�
7 ;1 n vat t IV (,-I I i S S T C'`
co file c;�rrent Pul es
f
j J Le col 1 iP e T Ei r) t aan J,.
I i' ran,-
i- r I b t i t!,) s a i D e r, f-,
e5 3 c e r o 'I c. n
s to
3
A.P dftl& ffl%%
% B
V
UL
V E P��
'V'SIOIV-OF
HEAVR4 lfti@M
I
NO I Date
OWNER
LOCATioN Straq
T
S,
C ounry,
L 0 T
8 u kid
S urve it Ou 15 0 10 c b
Dro DO t a: SCQI
Jc�b NO
J 0 H N H.
P R E N TISS RE,
M.-
e
iover of a o s trt A
3 6 settling or stone over 4 D i alI~
'1l0e Abottorr, of 4 rierttt bldt poplf-
trepch on erode PtP�g or o i
oa. . ;.ntr. toot # �� 16"to 0" Gaff 18 •..._ �_. --
t Beek f t !1 Max depth - - -" r
clean - — - - -=�
�.
" i 501 ' ' A . stone or j 4 -- 1r A
1 e grovel O. a - , °.tJerfoAt
From settlit3'q ar � ; � e 3/4 m i a I -
< _ - ° ? i t/ sstos 4'minaBsBVO 4''� p9rfcrated ground Motor nl ®t
do s m g t o -* -_ c� 2 1 .. ;.
-- P,QQ leve ._• min I �!
e :edge rock Q� 1
eorth to be, tvr{Iped l
tightly around to add "l -- -- - - -
dlstnbut,on box laterals
out
1
DtTAILS OF DISPOSAL FIELD
EQUAL t a
to aDsorr re n
.1 �Itnit of 4 ( cy M
i
gravel A
;, F i' - -�
d 5oltd P�Ipes % ' + O.pildln9 paper. 6„ top soil ,nisi ✓ �o� jc
to next tads
from septlf tank box i2'�d9ep3 �, to dl;sorpvlxtrt trel
3 /4`�stone or .- (801111 boxes)
grave! - -I - 5off6n of box must be .
�=
:i -; ; � • ` � � � ,� .._
firmly supported to b
graded ,/ 4 0- �forated be�lovt round level
stones �.1 �p a 2)Waterproee+d masonry. or
3 Tl s,
it joint pipe from
TYl_e -� L,CPTA� f Id D� Alm 4�Bafflea to ansuro eq!tect
PLAN. SECT10N
7 1.
w •
REtTILW c HFJCK Sl=
Meets Std.
Remarks
Yes
No
DOCUMENTS..
House plans 0. K.
..-
Design data sheet
Peres presoaked?
Kin. 30" perc test depth
a
Const . results for 3 runs
D. Hole log 0. K.
Corporate Affidavit for other than ind.ividual�
Authorization.for engineer
:litter from Water Supply if applicable
i
j
If variance requested -such noted-on plans & apps.;
I
L
DETAILS
if change is proposed,)
Existing contours shown show new contours)
_- Slopes for driveway cuts, etc. shown
✓
J
Water service line .location
Footing-drain, etc . location
I
Top slope, bottom slope of fill
Percolation tests and deep test pit location
i
(.
Septic tank size and conformance to std.
3 B. R. house minimum
House setback shown
till 'w�cez• W-Lw li DV L'U. Vd. ri -i Z3auWii
Plan and profile SDI
! ✓ -I
::.. __. _ ....: : :.::.:.:::.:.. :::..:.:_ : :. .
All other wells and SDS closer 2001
sh.owil- ..or...r.Pfexence madam _._
i
-
Property boundaries (metes and boluzds- clearly
show
SEPARATI0N DISTANCES SPECIFIED ON PIAN _
10' to P. L.
20' to Foundation walls
LOO' to Nearest well i 1
50' to stream, march, lake, etc. incl.expansion )
15' to Curtain drain
10' to water line (pits -201 ) ! I I
15' to storm drain !
10' to large trees !
10' from foundation_ to septic tank
51 to pipe from leader drain & fooL ng drain I
.�tilsj7.
:. ZId.T`['711L " >Tl�L ITjSPD:CTI.Oid
Ye��
o
Ccrr rent;:
Property li nes or corner- fc•,;nd . >: •. . .
Can estimate house location . . .
._
Will driveway reed clot . . . . . . : . .. . . /
r/
_
Dust .troes be - ernotied -note these . '. . /
Is deep hole r. ;;presentat i.ve of entire SDS area
Additional deer) hcies n °eded. . . . . . . . . .
Sufficient SDS wr,.;a available considering
driveway cut,house location,,separation
•d.istances, etc. 0 . . C . . ..
'
DEEP 110=,, .DATA . �.
Depth:,
Water elevation: C
Rock elevation:
Soils description: 'f l-r L ��r-- • `
i
Date.
.FINAL SITE Insp. by:
.
.House located where 'shown on approved plank
.
. -
MyM .._L >PLr - ^w vi .•. •y .-V ubyr• yr �.V . . . . . . . .
Width of .trenc'11-i avera -ge
Slope of t_le line and trencri acceptable
..
Room al.�:otre�i �'or e;;po psi or_ ty er_cres . ' .
.... -...
✓'
a
�T_
giver 50 -;/. from sra.,mz,.;at.rccvrs::
...Natural soil not stripped or SDS area
unnecessarily graded
10 11"t. rrainta *r_ed from prop. line and
20 ft. from house . .
Separation o-f trench from house, well
etc.. folic'Us plan . . . . . . . .
HLITDer of bedrocr-is checks . . .
•�''
Stones. brush, sturrps, rubb?e, etc. o�-eater
than. 15 ft. from near-st .trenhr,
-15 Ft. of peripheral soil horizont -ally from
trench . . . .. . . . . 0 ..
Junction boxes prope_,ly set
Could surface run off from drivel,-ay, roads,
;roarid sur-�'ace, etc.. channel near SDS
area
Does lot drainage app ar 0.. K.. in area of SD
FML GRADING OF SITE ACCEMMILE
p .
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�. COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner1/,f?*,Ara xl Aaamil ,f -X►a xess
So•�,6oi , S.. ..
Located at Street
( 2 Ste„ Lot 2 .
ldica e nearer cross street)
Municipality %�a►'erte.. Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED. WITH APPLICATIONS
5
1
N
Notes: 1) Tests. 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.
Hole
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
apse
Depth
to Water
Water 7e ve
No.
Time
From Ground Surface
in Inches. Soil Rate
Start -Stop
Min.
Start
Stop
Drop in Min. /in drop .
Inches
Inches
Inches
/ 11004- /0 d
d:
1 /
Ys-
2 /ni9 /o'9U
5
1
N
Notes: 1) Tests. 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 SUBMIT WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE N 0..
G.L.
611 r,- 'e -q
1211
1811
'9
.2411
30
3611
4211
7o
4811
5 If
4
60ft
4 P
6611
7211
7811
&A'
INDICATE LEVEL AT WHICH OUND ATER IS ENCOUNTERED Neaq
INDICATE LEVEL- TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Pb,
TESTS MADE Date
DESIGN
Soil Rate Used
_jJ& Min/l. Drop: S.D. Usable Area Provided T600
No. - of Bedrooms 2ute*'Septic Tank Capacity /00 0 Gals. Type NVffV4 Q4
Absorption Area Provided By_,4pLj,.F.x24" 5b tol width trench.
Other
Address R. D. 6, Box 353
Ca- 1. wy� 10519
THIS SPACE FOR USE BY HEALTH DEPARTMENT 'O'NLYI:
Soil Rate Approved Sq. Ft/Gal Che
I k
C
'C
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3 day ,� '%"•�,� 5k $ + f }' � f I. .
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