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Home My WebLink About1694DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -9 BOX 15 ;�T •E 1 0 1 11 1 r oil I IN Tti 6 LA i NO 1'6 IN me ;�T •E .r Rev. 3186 `PUTNAM COUNTY DEPARTMENT of HEALTH Division of Enviropmental Health Serviceei; Carmel, N.Y 111512' ' Engineer Mist Provide �r P:C,H D 'Permit N =- CE CATS OF,CONSTRUCTION CO MPLIANCE FOR SEWAGE-DISPOSAL SxSTE- . ,A ` ATTER80N_= Town or `Village ~ Located at FARM TO= MARKET ROAD TaiMap 80 2 'Lot 2',3 . LOFT,1- CORP . FARM 7�6= OAD 2 Owner /applicant Name Formerly ,Stibdivlelon Name -Sabdv. Lot # Mailing Addreea PUMP sHl7 T R F. ROAD ZIP 1rising Date Permit lashed BREWSTER,NEW YORK Separate Sewerage System bout by JACK F.ORBES ;AddressPUMP ;HOUSE:.RD, BREWS•TER, NY10509 Conslating of Gallon Septic Tank and 333LF OF 'FIELDS Water Supply: Public Supply From Address or: XXXX Private Supply Drilled by' BOYD Address ROUTE 5.2 ,. CARMEL ; NY10 512 Bdildipg Type. r Has Eioeton ,Control Been Completed? Number of Bedrooms 3 Has Garbage Grinder Been Installed? NO Other Requirements -' Lcertify' that the syetem(s),as listed,servinq the above premise s,wers constructed essential as shown on the.plans of the completed work ( copies of 'which are'attached),;and in!iccordance.with' the standards, iules. and equlations, in acco an a with the filed an, 'and the permit issued by the hutnam County -Department Of Health. Date. 11/10/8'6',, Certified Dy _ P,E, R,AXXX Adore C,O',NY Icense No, 110 5 6 y An person occupying_ premises ieived by the above systems) shall prom tly eke such n as may be necessary to secure *correction of any unsanitary conditions resulting, from such usage., Approval,pf •the sepa ►ate. ;Sewerage „sy tam -shall bscorne. null an vold as soon as a pub(': unitary sewer becomes available and the approval of'the' private water iupply'shall become null and void when a public 'water'' supply becomes available. Such approvals are sub)ect jto` odificatfon' or change' when, In-the” judgment of the Commisafonerof Health, such revocation, modification' or change Is necessary, Date (✓ z° G /�e. �jG' 13r 7 i� ��'�� m .. ... ... ., .T .. .. ,,.. -: ..- ..art. ,., .. � ... TTTT T t'^XMT L+TT^M DVDADT naJUar v Office Use Only a� 4 DEPARTMENT OF HEALTH. ... — D1visiar. Of PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET AOORESS: WNI I I Y TAX UIO NUMBER 8 Farm -to- Market Road Brewster Lot 2 WELL OWNER NAME. ADDRESS: ZKPBIVATE John Forbes Pump Road Brewster, N.Y. 10509 0 PUBLIC USE OF-WELL IKI RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1- primary ❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 5 / EST. OF DAILY USAGE 500 gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 290 ft. STATIC WATER LEVEL 30 ft. DATE MEASURED 5 -31 -86 DRILLING ❑ ROTARY 10 COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. 9 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 61 ft. MATERIALS: IR STEEL ❑ PLASTIC O OTHER LENGTH.BELOW GRADE 60 fL JOINTS: O WELDED 13THREADED ❑ OTHER CASING DIAMETER 6 in. SEAL: 10-CEMENT GROUT O BENTONITE ❑OTHER DETAILS WEIGHT PER FOOT 19 1b./ft. DRIVE SHOEZMYES ❑ NO LINER: OYES E$NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST _ SECOND HOURS GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE OF PACK �i in. DEPTH ft. DEPTH It. WELL YIELD TEST It detailed pumping LQ(� It more detailed formation descriptions or sieve analyses r are available, please attach. METHOD: O PUMPED 1 tests were done is in- DEPTH FROM Water well CYCOMPRESSED AIR , formation attached? SURFACE Bear- Oia' FORMATION DESCRIPTION CODE, ft ft O BAILED ❑ OTHER ; ❑YES NO ing In WELL DEPTH DURATION DRAWOOWN YIELD s nape .50 overburden it. hr, min, ft. 50 290 White & Blk. Granite - 290 6hr 290 10 vith Seams at 609, 701, 130', 1801, 2701, & 290.' WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE*. CAPACITY GAL. PUMP INFORMATION WELL DRILLER NAME Bo d Artesian Well Co Inc, OAT10 -13 -8 TYPE CAPACITY MAKER DEPTH Aooaess R.D. 5 Rt. 52 VOLTAGE Carmel, N.Y. 1051 MODEL HP PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L o 7 C -D u - J A Q�4 Eo-mr--:s Building Construct by Bi re-m -T- o - mAl �,K-T--- R--D- Location - Street icipality O& E-5- 1 %6& • S Building Type )FA P-M --To MA T L S T. Subdivision Name Subdivision Lot # GUARARM 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:..wh&i i..the_Yfailu�4e to 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 Environirnntal 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 % d day of QV 19 eral Contractor (Owner) - Signature Corporation 1N'ame (if Corp.) ess ,b,, S p-- rev. 9/85 mk Signature IL ,�% �r►� '- Title 0 f=--r Corporation Name (if Corp.) U c! SE a Addrest Owner or Purchaser of Building Section Block Lot L o 7 C -D u - J A Q�4 Eo-mr--:s Building Construct by Bi re-m -T- o - mAl �,K-T--- R--D- Location - Street icipality O& E-5- 1 %6& • S Building Type )FA P-M --To MA T L S T. Subdivision Name Subdivision Lot # GUARARM 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:..wh&i i..the_Yfailu�4e to 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 Environirnntal 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 % d day of QV 19 eral Contractor (Owner) - Signature Corporation 1N'ame (if Corp.) ess ,b,, S p-- rev. 9/85 mk Signature IL ,�% �r►� '- Title 0 f=--r Corporation Name (if Corp.) U c! SE a Addrest Sox 224 - B REWSTEIR, N.V. (994) 225 -2072 SAMPLE NO. 6347 SOURCE: Farm To Market Lot 2 COLLECTED: October 17, 1986 BY: Jack Forber BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 19l 086 0 per 100 ml. VI_ ;, l PUTNAM COUNTY ,DEPARTMENT OF HEALTH ENGINEER To,PROV.IpE PERMIT #. YYY I r ON CERT FICA OF MPLIANCE Division of EnvndhiriMtal .Health, Services Ca�fiel N , Y 10512 PERM I T } I. CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL 'SYSTEM P" at ft own, ,or-- Qfi!age Located `at Farm TOt Market Road Tax MaP Al 77 r "' S,ubdwis :on, FRrm !To MRrkPt °FctatQc •�suba Lot R Renewal Revision` a' owneriAddiess. Far�miTo, Market Esautes InC - Date.Of Previous Approval Building Type, Residents 1 Lot Area; ;� 47 r Fill Section onlyb . t '- ' 3 a 600 -' ` +' P,x. H: D iioti fication': Required- f 4'. Number of Bedrooms Design Flow c /F /D 7 € separate Sewerage System o consist of lOOO. Gal septic Tank and 375 1`in ft. fields To be constructed by TO be C�etern1111Ed Address , Water suPPly P,ubhc SuPP1Y From P..nvate supply to be driiietl by _L_f1P �p CP,rRII ned Address Other Requirements t L iapresent-, that l am wholly and�completelyAresporisiple for the design and location of ffie proposed systems) 1p that the sepaiate.sewage.disposal system! j above,descrfbed will be constructed;as shown: on the'6pproved:amendT0nt there to and in'accortlance with `the standards; ►ules;an .regu a ons o e u nam County : Department of Wealth, and that on,coinpletion thereof a Certif,cate' of Construction Compliance satisfactory to the. Commissioner of,Healthwill be submitted to the Department 'and :a .written guarantee will be furnished =the owner his successor heirs'o►' assigns;by the builtler; that said builder will place : in good operating ,conddion, any: part of saitl sewage „_tl�sposaf,'systemauring ,the penod_ of o (2) years - immediately- followirg the date of the issu j 1 ante of ;the. approval of. the Certificate' oi;,Construction Compliance': oft ong�nalsystem or a r epairs.tnereto 2j th t ;the drilled well, described above fated as shown on ",the aT - will be: located on-,the],-app plan and ,,,.that- well will be insta W! accortlance w,�t the standard i. rules' nd requ aT oEi—ns of the', Putnam County Department of Health i ti `Sept 4 1985f i,/ Date s z +r' iy signed P E R �A" ;Address M t I ` _ FD `` a�jalcense No. APPROVED FOR.CONSTRUCTION. 7 is•approyal'expfres'one yea► do a date iss unless construction of the ti iltling._has been undertaken and is 4 revocable for cause or maybe amended , mod-f,etl when cond�dered necessary =by th ,Co issioner :of Health. Any.�c/hdnge or a ration .of construction i requ,kes,:a new, permit Approved for disposal of domestic ita y ' wa and /or p ate r supply on { pates ^ I i BY Title i r • n =�. � i I � � i + 1 1 ` � I, � li i I t 1 ..11 � +, � 1 1 I' �' � 1 1 � 1 \ 1 �l � �I 1 � -� 1 ' 1 ' 1 ' 1