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01685
PUTNAM COUNTY
:Rev::3 6 ` Division ofEnvlronmentaI
CERIM TE OF CONSTRUCTION COMPLIANCE I
Located B i e _ E lin -Rriad
EPARTME
ealthSer,&9
IR SEWAGE
NT OYE EALTH
Carmel, .Y 10$12
Engineer Muet Provide P<9 .84
C
P .H D Pe®it N — C 2
DISPOSAL SYSTEM T,: Patterson
Tzwm or Village
Tax Map 7 1 Block_ 2 Lot 3.2
Owner /applicant Name John MOrlarty Formerly Gladys .Birkman Sabdivisio'n Name B Sabdv. Lot q
irkman 2
Mailing Address ` Rte 6 B 2;' ew s t e r NY ztp 10.512 Date Permit Issaed 512/86
Separate Sewerage System`46ailt Winer Address _
Above
1000: 500' x 24 w. x 18". D. laterals
Consisting of Gallon Septic Tank and
Water `Sapply: Pnbllc Sapply From Address
or X pdvateSupply:Drlll edby Albert .Hyatt & Sor}d�e Rte. 31:1, Patterson, NY 12563
Baudin Frame'. yl Eioston:Control Been Completed? As. required.
Nambei of Bedrooms " Three gas Garbage Grinder. Been Installed? No
Other Requirements 12 R 0 -B F •11 Section x 3200 sq.� f (120 ° -:CL Yds -i-)
I certify that the syetea(s) as aisied`aerdinq, the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are at and in.;accordance :.with the standards, rules and - .regulations, in accordance with .the filed plan, and the permit issued by the
.Putnaua COunty Department,- - Health -
Date 28 Apr i1:,j'�987, :; _ Certdied bY: P.E. X_R.A.
RD 9 Fair'Stre Carmel, NY 10512 29206
Address
License .
Lice No
Any, person occupying premises served by the above systerri(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 systom; shall become null and void as soon as a "pub.': unitary rower becomes
available aril .the,appioval of i ie,private water •supply shall become(nult and'void when a public water supply becomes available. Such approvals are
subjects 6 modification or change "on, in the judgment' of in 'a -bomp MIS slbnar of It such revo tlon, modificatl9an or change Is necessary.
Date,l
a,
f
z aU\
T T f1/ %AnT "M r^AT 7)'L *n
f/J
YY�
.t
YY L'aLL VVlla LLJ1 iVL aW
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
-
Office Use Only
WELL LOCATION
WELL OWNER
STREET AOO ESS: WN /VI ! 11 W'61110 NUMBER:
rc NAME. ADDRESS: PRIVATE
/�%r �++I -t ❑ PueLlc
USE 0 -F WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PtIRLICIfiPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT �.z—. gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE 600 gal.
REASON FOR
DRILLING
VNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 3 0 ft.
lowi etc
STATIC WATER La _ ft.
q
1 DATE MEASURED 4
DRILLING
EQUIPMENT
❑ ROTARY V1COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING (OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft
MATERIALS: STEEL ❑ PLASTIC L7 OTHER
CASING
LENGTH.BELOW GRADE fL
JOINTS: ❑ WELDED a2rTHREADED ❑ OTHER
DETAILS
DIAMETER �— in.
SEAL: ❑ CEMENT GROUT BENTONITE ❑OTHER
WEIGHT
PER FOOT 1_ Ib.. /ft.
DRIVE SHOE 9TYES ONO
LINER: OYES 9NO
SCREE!
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES, O NO
-
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH.. ft.
BOTTOM
DEPTH it.
WELL YIELD TEST If detailed pumping
t
MVH00: O PUMPED 1 tests were done is in-
ff COMPRESSED AIR , formation attached?
O BAILED O OTHER ; ❑ YES ❑ NO
WELL LOG It more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE
ling
Water
gear-
well
Dia-
neter
FORMATION DESCRIPTION
coos,
tt.
ft.
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft,
YIELD
9Pm.
Surface
I—r>
szvid 4 E
.30o
6
it
00
,
fWATE� O CLEA R TEMP. '
O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
WELL DRILLER NAME HG� DATE
i't c�Gr/t 5
ADDRESS SiWTURE ••/�,��
�f /r // �/ !ya�'0�.✓
PULP INFORMATION
TYPE CAPACITY
MAKER DEPTH
VOLTAGE HP
Of
LAB CA.004147.
Yorktown Medical Laboratory, Inc. - - ,
321 Kear Street Collection Stat -ion. Used:
Yorktown Heights, N. Y. 10598 Carmel. Peekskill
Mt Kis
.... _. _ '(9F14)'24 5 =3203. .._.:........� _. .,..,.. _ _._ ..
Director: Albert H. Padovani M. T. (ASCP) . D ate .Taken :
Date Received: -1-S
T_ t T�/ Date Reported:
1/. Collected By: !L
fI G �� Referred By:
Sample Source: URA&yi 7AP
L 6C ew S� n �l ius 0�
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 per 100 ml V
Fecal Coliform ner 100 ml
Fecal Streptococcus per 100. m1
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN Index ner-100 m1.
`Fecal° 'Coliform: '"- -- F!PN� index "per4100Ym1
OTHER ANALYSES
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS ('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.
LEGEND
Albert H. Padovani., M,.T. (ASCP), Director RDS = Recommend Disinfect-
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
•l
PUTNAM COUNTY DEPARTMENr OF HEALTH
DIVISION OF ENVIROIZ=AL HEALTH SERVICES
John Moriarty 71,2
Owner or Purchaser of Building Section Block Lot
Building Constructed by
Big Elm Road
Location - Street
Brewster
Municipality
Frame
Building Type
Rirkman
Subdivision. Name
2_
Subdivision Lot #
GUARAWEE 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 fai. lure. to . operate...pr.operly -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 o£ the occupant of the building utilizing
the system.
Dated this 28 day of April 19_-.&7
- P0, Z
Gen al Contrac or (Owner) - Skjasture
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Rte. 6, Brewster, NY 10512
Address
IV.
V.
VI,
APPENDIX C
FINAL SITE INSPECTION Date
f � i ( Ins ed by
LION •' OWNER
IM # OR SUBDIVISION LOT
COMMIIvTS
SEWAGE DISPOSAL AREA
a. SDS area located as per approved Tans
b. Fill section - Date of placement
_
2:1 barrier. LGTH fib' WIDTH S p AVG.DPTH
c.. Natural soil not stri
de Stone, brush, etc., greater than 15' from DS S area.
,
e. 100 ft. from water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size '00 1,250
b. Septic tank instal evel
c. 101 minimum fran foundation
d. No 90° bends, cleanout within 10 ft. of 450 bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
�.
3. Minimum 2 ft, original soil between box and trenches
7
..
f, JUNCTION BOX - properly set
s ba
TRENCHES
g.
1. Length required - Len installed
�c-
2. Distance to watercourse measured: ft.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot,
A-
6. 10 feet fran property line - 20 feet - foundations
Jc-
7. Depth of trench < 30 inches from surface
�
8. Room allowed for expansion, 50% 7.
9. Size of gravel 3/4 -.11" diameter
.10. De th of gravel in trench 12" minimum
11. Pike ends �ed _
k
_....._... - - -_..
M r Y
h. PUMP OR DOSE- SYSTFMS�
1. Size of pump chamber
.-
2. Overflow tank
3. Alarm, visual /audio
�-
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed b y Health Department
estimated flaw per cycle
HOUSE -
a. House located per approved plans.
2 + ►-�S CC ��
b. Number of bedrooms
-
t l
WIIL
a. Well located as per approved plans
zs C�J � e�
b. Distance from SDS area measured cz ` ft.
c. Casin 18" above grade.
d. Surface drainage around well acceptable.
S eC
OVERALL WOPI MASHIP
a. Boxes properly grouted
b. All pipes partially backfilled
c. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. Curtain drain installed accordip2 to plan
f. Curtain drain outfall protected & dir.to exist.wate 'Course
9. Footing drains discharge awa fron SDS area
h. Surface water pLotection adequate
i. rosion control provided on slopes reater than 15 %.
�
be' 'submitted to the Department and '&" written guarantee w I
place.:: in good operating' con ddion any per of said ,sewage'G
ance,of' the approvals of the Certiiicate "of Construction Com,
will 6e located'ai sh4iWn on the approved plan antl that said WSJ l %0
County `Department of Health?
Date April 22,..'1986 5.
Adesress{: .RD ,9� FaiynS
:
APPROVED FQR CONSTRUCTION . This:approvsl expnes onr
requires a new permit, proved ror - disposal or ioome is I
Date�� ey
fished the owner; his wccessors,`heirs or assigns 6y the Duildat, that, said builder'vvill
stem during the period of two (2) years immediately following the date of•,the,.issu-
f+the original system o► iffy repairs thereto; 2) that the drilled will described above.
ailed in accordance with the, ndards,' rules anQ regu a !ons f. the Putnam
o':• P.E. ' - x R.A. _—
License No 299�h
n t 'ldate sue u ess.. ton ruction• - the budding has been
undertaken and Is
s y` m Toner f.;Ftealt Any. Chang' or, alteration, of construction
e r P i ate e
Title
d. LO
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-'.. T';� T,,-� T2T. T -'T :n.nr,T. .i�V.: .'1 .. .. 1.�51G r. _ ..,_. �.i.l
CO�.1 0� 1c� �JiLD1 G;' -CA-17 rili,
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Ja k h Ho n a r-L v Address c
Located at (Street) r7�d Q . 12- �ree Bloc k Lot 2, In ica e neares cross s ci-lAAJS giriSmah S' ,tbdy 4sl-*2
Municipality. Watershed (frA_b&„
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number CLOCK TIME PERCOLATION PERCOLATION
RM apse Depth to Water Water ve
No. Time From Ground Surface in Inches,.. Soil Rate
Start -Stop Min. Start Stop Drop in - Min. /in drop
Inches Inches Inches
1(100 1133
2 rzL►
312-7) 1833 72 Z�
4 (3 33 1445'
2 11105: 12-
3 I Z23 (319— 57 y4- 27
2
4
FEB 2 8
PU T N AM
HEALTH
Notes: 1) Te'�ts to be repeated at same depth until approximately 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
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
- . DEPTH ' .,
HOLE 'NO. " �._.....: ..:N , - .:- ,.1....-.. _.a..:.
HOLE NO. ��
.... ._ ... _. � _ __.. _: _. -. . _...... �.u;
HOLE N0.
G.L.
6"
TP90;f
12"
KGs
_
18"
5a V412
2411
30 It
361
.421t
8
54+"
•� eZ
Fik b
60"
66"
D
it smwyl L.®
72"..
78 ".
84"
3o „.
INDICATE._L
qq .
L XJTnf GROUND WATER
IS ENCOUNTERED See
made
INDICATE
LEVEL TO WHICH WATER LEVEL RISES AFTER -BEING ENCOUNTERED
_
TESTS -MADE ;j. �:�?
Date°t:
L1JIJ1UlY
Soil Rate Used jr 0Min,/l "Drop. S. D. Usable Area Provided '
No of Bedrooms re-a Sep tic
ppp���.,q Tank Capacity. O 0l) Gals. Type cl Sc;4�y
Absorption Area Provided By�L.F.x24+ V ... width trench.
A[ F Other
QRO4
PR .�ci
Name p� [ . ig
E- �a Y e' C ST.
^+ y _�V
Address n -ii,
y j�
THIS S
SPACE FOR USE B
BY HEALTH DEPARTMENT O
ONLY: �
Ok
-rl �
J:f Health
al ilealth Servic-
Of 2nV!ronm3r-t
rovoa as noted for Conformnee with
_:,licablo VULLes and Regulations of the
t.itnam County jje. th Department.
r
Structure located from survey by surveyor noted belo wN
Well located by: Surveyors survey•—
Well drillers
report
Engineers mesurernents❑—
Tank, DGAeS, pits, galleries
8 loteFols io-ccile4 by:Contr 4itnr:
Engineer: ❑
Fidia inspection
by: Health depi do? a
Engineer
date —j556
NOTES:
J
'-1.
'21 ." fk"'- it.
DI ME N SION i
A
A C
41
Z"
—t/7r
A
3 Q
A
J,'5T j 6
F 4 L
A
6
G
A H
A K
77t:— J0
SANITARY SYSTEM DESIGN
OWNER:
LOCATION STrecl:-- Z:;
Town
Zt5,D'�J County: .7- K . V t e
SUBOMSION
Mop:
Hjz,cl • ;+ LOT N°
f: Ouilclet:
zz -
S b N'
4—
N T IS P F
R
06
it
_
4
A
•� ; . PUTNAM COUNTY HEALTH DEPAR7MENF
cK -
A a
DIVISION OF ENtiIRONMENTAL'HEALTf3 #SERVICES
John 'M: Simnorris, M.D.'
•Deputy Canmssioner'of Heatth� -FIELD ACTIVITYREPORT5heet' f
L INSPBCTION
VAE Orig . Routine
Orig. Complain
ADDRESS -. A.i�i,./�oai f�I�$°'� ° r % %-'�' -.� Orig., Request
Ng. Street-- Town 'IlK 'No. Canpliance
Gamplaint Cane
MAILING ADDRESS Final
-P:O. °'Beat- .. ` . °Post. Office :zZip Code Group Illness
Construction
TEIEPHONE`
.
Reins pectin n
_
PERSON JWCHARGR << Field, Sampling Only
OR INTERVIEWED !��^%��? Y "s '' /f^�,�'•� -r./, Field Conference
-
air��t. Other
`DATEI %O 'TYPE. FACILITY
TIl� ,ARRIVED TIME Explain
FIDIDINGS `
Gds r ✓ iG. /- %L G:'._ .. 1/J!� ^ .
_ / 40 .�/'
`51 oe-
;/er— cif •or..�. s
w ' J
_
r ✓ �. C
4r �A / o
ez
w
�
- INSPDC't�OR• TELEPHONE: .
Z- - Signature 'and Ti - ,
k
y��pp��+ry���� Aq 1 nD
r `PJJLY7Vi`Iv' IN ,q ARGFi OR
;I ack*1 ': 0 °this -:7 eld. Activity.. Report: SIGNATtk2E:
6/86 t. TITLE