The URL can be used to link to this page

Home My WebLink About1695DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -10 BOX 15 I 1,` m. T t - kMi 01695 rvr m � +.�— - .r'r.'_ s �. 'c i �- i-:.�n � ,r... -- T.p�a:: .. F;•.: ..K' ,ra�tR'!v.•t--n^S' ?4,r••^•^ ""�.�`�" r k �. ^'a' xc"^w } z � ' ,a PUTNAM COUNTY DEPARTMENT OF HEALTH Rev . 3/86 /• �` Division of Envhimn%6ntei Heal Services, Carmel, N' Y 1612_ s. y.• r l t Epgineer Mast Provide 1 1�� 1 t p.0 H D Permit p PATTEE O ONSTRUTI W RSON TMCAT M . . 4. Town or :Village. :Located at FARM TO MARKET ROAD Ta:•Map 80— Block= _Lot_2.2 LOF :T CORP . - FARM TO— M1�RKET EST Owner /appltcant`Name Formerly Subdivision Name Sabdv Lot per_ Malltng Addreae P UMP = H OU S F. R nAT� P : 10509 Date Permit Issued 9/ 10 8 5 BREWST.; RN YORK 10509: Separate 1 -,JACK FPPs S Adar�es PUMP HOUSE -. ROAD, BREWSTER, NY rate Sewerage System bailt li Consisting of 1j0.00 -Gallon Septic Tank and 360LF OF FIELDS, 09 106 k �• , i Waiter Supply Pubdc Supply From Address or!, XXX Private Supply DrWed by BOYD Address ROUTE 5.2 , CARMEL, NEW YORK Building Type Has Erosion Control Been Completed?- 10512 , NO Number of Bedrooms 3 Has, Garbage: Grinder Been installed? Other Regalremente I certify that ;the syatem(s) aslisted serving the above premises were constructed essentiall as hove on the plans of the completed work (copies of which are aitachedj, and in`accordance with 'the . standards' rules and r gu tions; in accor anc with the filed , and the permit issued by the y par,._ Putnam Count 'De tment Of ,Health.- 11/10/8'6' XXX Oats " Certifieri:'- P.E. R.A. Address 'MUSGOOT NO -RFD X 488 HOPAC NY105'. shoo No 11056 Any person. occupying' premise's ierved by the above system(i) shall, promptl _ta wch act as may be necessary to secure the orrection of any unsanitary conditions'Resultiny from such usage. Approval ot'.the separate sewerbge Ch become null and void, as soon as a p ': ,unitary sewer becomes available an'd the approval of the `private. water supply'sliatl• become null and. void when s public water supply becomes available. Such approvals are subject to..,modif)catlon or •chahje:.wAen, Jn the judgment .of the CIommissjpnbr of Health, such revocation, modification or change Is necessary. Datez°G / .,.�r� Itle By W I 7_ C TTr4T T fl^XMT VM AM DVDADM DEPARTMENT OF HEALTH 1)1visioll of Healtit, SenTices PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only 'STREET ADDRESS: WNIVI I TAX GRID NUMBER: 00-1 /2.ql Farm-to-Market Rd. Brewster Lot I WELL LOCATION WELL OWNER NAME: ADDRESS: John Forbes Pump House Road Brewster, N.Y* 1050 �M PRIVATE 0 PUBLIC USE OVELL 1 - primary 2 - secondary Z) RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED 5 500 / EST. OF DAILY USAGE gal REASON FOR DRILLING 0 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY C3 TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 305 ft.1 STATIC WATER LEVEL 32 ft. DATE MEASURED 6-2-86 DRILLING EQUIPMENT ❑ ROTARY IN COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE ❑ SCREENED .0 OPEN END CASING 70 OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 61 tL MATERIALS: Xk S*TEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 60 ft. JOINTS: ❑ WELDED :0 THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: MXEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT 19 Ib./fL DRIVE SHOF_*X1 YES 0 NO LINER: ❑ YES II NO SCREEN ''-DETAILS DIAMETER (in) SIZE I GTH LEN (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES 0 NO HOURS SECOND GRAVEL PACK 11 YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH _fL BOTTOM DEPTH — It. WELL YIELD TEST If detailed pumping METHOD* 0 PUMPED 1 tests were done is it.- 16 COMPRESSED AIR formation attached ? 0 BAILED ❑ OTHER O' YES 0 NO 11 more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Oia- eter peter FORMATION DESCRIPTION CODE, ft fL WELL DEPTH ft. DURATION hr. min. DRAWDOWN ft. LD �d L[an Surface 61 Overburden 61 3051 Granite with seams at 70, 305 6hr 305 g 1209, 1901, 2551, 2701, & 305, WATER ❑ CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES ONO 1 STORAGE TANK: TYPE CAPACITY GAL. Well WELL DRILLER NAME Boyd Artesian Well C IncjAlb-13-86 ADDRESS R. D. 5 Rt. 52 51Gr *Tu Carmel, N.Y. . 10512 PUMP IXFORMATION TYPE CAPACITY MAKER DEPTH [fLOEL VOLTAGE.— HP PUTNAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -. - -... �4... r ..rC.�.. _� �....�... ..w. i.. ♦•✓nw...a.a- c'.s__, z�._ aw w.e -�a._3 -, ac4.� a. .w•ru as.� - .w�"!� -4:� .... ir�.r- ...i�.i..�.......a....w. nt.t- 3a.sa.wcl+tGa+�'s'+a.w.•.w .s.M.�. r'�w.� r.N.� -.c.u� Owner or Purchaser of Building Section Block Lot L o F T. Cop-p- _ J A c y— Building Constructed by Location - Street Municipality 1 I4 W- P—E-5. Building Type w -T o - MA E_V.eT J�Jq� Subdivision Name i Subdivision Lot # GUARAN= 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.auch system, except, where._.the failure. -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 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 's' ,�` day of J,,46V 19 196 Signature 14 01 Title eral Contra for (Owner) - Signature Corporation Name (if Corp.) Address I 10E0 rev. 9/85 Ilk 01" Z, QWN.(' Corporation Name (if Corp.) �Fbmp �a6)zr Piclr ess g._LA)sTEp Box 224 - BREWSTER, N.Y. (914) 225 -2072 ® WATER ANALYSIS REPORT SAMPLE NO. 6346 SOURCE: Farm To Market Lot 1 COLLECTED: October 17, 1986 BY: Jack Forber BACTERIOLOGICAL EXAMINATION - Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. October 199 1986 uirector ' € f " ' ENGINEER TO PROVIDE PERMIT #. +, r , PUT NAM COUNTYDEPARTMENTOF `HEALTH oN CERT FIGATE F:C P NCE ` Division of EnvirAnrriei-W Healtti`- Services Camel `N Y 10512 PERMIT' # - .L� CONSTRUC N PERMITFOR SEW AGE "DI SPOS_AL SYSTEM�� , $ Patterson :.= Town or 1Ilage L Ocated 2iFt a< e� T�.T` Marken: Roar' v s Tax Nl� P 8� n7 i F +^ H1ocY Z Lut SuDaivisiuri Farm �To _Market Estates S yet a { }: f� Renewal �': Revision ❑' Farm Toe ;'Market Estates Inc Owner /Address - - Date Of Previous Approval Bwldmg Type Re ide'ntiya] 'i Lot Area 1.536- d�C. Fill SectionEOnly ❑` Number of Bedrooms T 35 Design Flow G /P /D U�� P CH D Notification Required `y Sepaiate.'Sewerago 5ystenito CxOhti9t 64L, Gal SepUC�Tankt;c ands 333 �'ln" :ft f..:`elds' To be constructed by 1o,bey'determined 4 �` Address` r ry 4 - o- �' Water Supply Public Supply From -Private 'Supply to be drilled by To beU de rml n ti ari Address, .� Other Requirements E o S � \ I represent that,L;am wholly and completely '`responsible for;the design and +location of the proposed sys4em(s) ,1) that dtlie separate''sewage. Cisposal. ±system i, '63 abovedescribed will be constructed "as shown,on the approvedamendment there ,to and m accordance with the standartls rules an regu a ons:o e Putnam y ounty 'Department of - ;Health 'and that on completion thereof a CerLf�cate of ConstructionrComplience satisfactory.;to the ,Commissioner'of Nea7thwi1l. ., ae submdted to5;the. Department; and a':written,'guarantee' will De'turnished' the owner shis successors, -heirs or,ass�gns by the buildei, that said builder ,will„ n; place+�n, goodY�operat,ng;conditiori' any pant of said sewage disposal syi6 'i *during the'periotl f two (2) years immediately'.following ; dhpdate of -the issu- °once ;of the approval :of the Certificate .of ConstrucUOn Compliance of _the',original "system any�repa�rs thereto 2) ftiat the drilled well described above' will be. located as shaWri op he approved plan and that said well will be= nst led in accordance tth the standards ,ules: and regu a iTf ons °oi Elie : Putnam County 5Ipartmeht o1�Flealth * Date, Sept 4., ''1985 °m "srenea= tr - P.E 12.A X }, t46d ►,eisr.� v,, i 11, W r $: i "Llcense,NO 11n5— k v }G . t Yom'` ties been .undertaken and 'is APPROVED FOR;CONSfjklb IOfV This, approval_ expues:one yeai;fro he'date sued unless constiuct,onr of�the'liu�ldfng „ _ revocable' for cause or, maybe amended or,modNed when consI dere r. "; Dy the;Co issioner'ot Health.: Any change or_ alteration of „ co, nstruction' requnes a knew peimit ApproJeC3forsdisposl {of- domestic's ary ge` a d /or `p i ater supply onlyx s J 3 r'. r .,.F w i `i q H 1�' s ry,:, z Ta a i ,� r Frt Date Title - S - PUI'NAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS .,FIED.D.:INSFFCDION:,REPORT - F'�VYY� CCU DATE: INSP. BY: (Name of Owner) (Street Location) J INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ........................ Willdriveway 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 .............. < >............ D.H. 1 Lot Depth to G.W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. ..121--f t D. H. 2 Lot Depth to G.W. Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. ;9 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO CQVMWS House SSDS located per approved plan ............. �Gn om Length of trench measured Width of trench average Slope of tile line and trench acceptable......... .�.� Roan allowed for expansion trenches .............. Over 100 ft, fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded........... . .... ........ 10 ft. maintained fran property line and 20 ft. from house... .... . ............... ...... r/ o C Distance well to SSDS (ft.).. .......... o I I o o o D 6 o 6 i/ ._ Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench..... ........... 15 ft. of peripheral soil horizontally fromtrench.... a I o I I o I o 6 1 6 o o o 6 a o o o * o * 6 o o o * a o o Boxes properly set.. ..o — .o. — ...... — oo . 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 AIXTABI�.< .<, >. .,.., pUnqAM COUNTY DEpARTMERT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL * SYSTEMS . NaP -TO... R Y _7.7311) P .1". N Fi,.',P-T DATE:' -rn m INSP. BY: (Name of Owner) (Street Location INITIAL SITE INSPECTION YES NO cctqnaI'S Wetlands on/or proximate to property, Property liries 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 pro posed well location for &illing-,-. D.H. Deep Hole G.W. -Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G. W. Depth to G.W_ Depth to G.W. Depth to rock Depth to rock Depth to rock .1 Soil Descriptio 0 ft. 3 ft. 6 ft. 9 ft., 0 ft. 3 ft. 6 ft. 9 ft. 12 f t. soli uescri 0 ft. boll uescri I DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan.... ...... Length trench measured - .of Width of trench average Slope of tile line and trench acceptable .......... Roan allowed for expansion trenches ................ Over 100 ft. from watercourse .................. Natural soil not stripped or SDS area unnecessarly graded...... .. ....... 10 ft, maintained from property line and 20 ft. frcm house.. .. .................. ....... 04=A Distance well to'SSDS (ft.) ...................... Number of bedrooms .checks ......................... Stones, brush, stumps, rubble, etc., greater.. than 15 ft. frcin nearest trench.... • .......... 15 ft. of peripheral soil horizontally from trench..... ........................ . Boxes properly set ................................ Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area Dpes lot drainage. appear.OK. in area of SDS...,... -FINAL GRADNG OF.-SITE ACCEPTABLE.. V �1 Zq4 L W —Lo �7 4/ \CP. 0. I. PIZ owl 7' -el P .. ...... .. R AIF- CF. a w n 13 Y: Checked By:,. JOEL IAWRE ARCHITECT - MV SCOOT - NORTH MAHOPAC NEW