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01821
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01821
Rev. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH J ��
Division of Environmental Health Seivicee, Carmel, N.Y 10
r�� €r, .� Engineer It%Inet Provide ¢� N . �D
�' ice{ P.C:H D Permit N '.
f 1✓
Owner /applicant Name ]A I I .t.l ^Nr
Malting AddressT�-
FOR SEWAGE DISPOSAL SYSTEM
rormeny
Zip ,450
-
Taa _Map_ Block Lot
Snbdivlelon Name
° Subd Lot #
v.
Date Permit Issued
.Separate Sewerage System bullt by Address
Consisting of ha Gallon Septic Tank and 44A
Water Supply: Public Supply From Address
or: ✓ Private Supply Drilled by � �+, �! Address L 1b.1 A O 9, , 9,VST L l�ti ,
Building Type Ax 1 ' Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been InstalledY -
Other Requirements
I certify that the,system(s) as listed serving the above premises were `ponstructed essentially:as shown.o the .plans of the completed -work ( copies
of which are attached), and in accordance with the standards,_ rules and -regal "ions, in acgordan with f plan, and the permit issued by the
Putnam County Department Of Health.
/�t.J�
U P.E. R.A.
Date J Certified by, ;
..
�LIcanSe No. /ddress .
I � :
Any person occupying premises served by the above system( ;) Shall. such action as may bs neeesury.;to Secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage',systam shall become null and void as soon as a pui)V: sanitary Sewer becomes
avallable and the approval of the private water supply shall become null and +4oid when a public water supply becomes evailaba: Such approvals are
subject to modification or change when, in. the judgment of the: Corn '14dciner of Health, such revocation; modification or change Is necessary.
Date �C �_:� BY i Title
W
ANALYSIS DATA SHEET
TYPE:
PW
LOCATION:
Elting
REPORT TO:
Mill Drilling
ADDRESS:
Putnam Avenue
CITY, STATE, ZIP:
Brewster, NY 10509
DATE COLLECTED:
09 -17 -93
TIME COLLECTED:
11:15 AM
COLLECTED BY:
Mill Drilling
REPORT DATE:
09 -21 -93
LAB # :
93 -4648
SAMPLE- -SOURCE: .
DATE
ANALYSIS RESULT UNITS METHOD ANALYZED
Total Coliform MF Absent
SM17 (9215D) 09 -17 -93
THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET
THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS.
tory Director
NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218
618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914 - 278 -7600 / FAX 914- 278 -7754
co
J WPrLL VVL'lr LA11 VLY Llt!r VA1
DEPARTMENT OF HEALTH
iuson Of- Environmental 'Heall`h=-S
4 �� Y0 PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
�tu _
WELL LOCATION
STREET AOURESS: 75ON791EDIEZIC11Y TAX GRID NUMBER:
$allyhack Road, $rewster, NYS,
WELL OWNER
NAME: ADDRESS:
QLALZTY &LILT HONES, $allyhack Rd. $rewster, NIJ.
P81VATE
Q PUBLIC
USE OF WELL
1 - primary
2 - secondary
x9cRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP O ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 2 – 4 / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
QNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 200 ft.
STATIC WATER LEVEL 35 ft.
DATE MEASURED 911193
DRILLING
EQUIPMENT
❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING ,@x,OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH - k
MATERIALS: ZMTEEL ❑ PLASTIC O OTHER
CASING
DETAILS
LENGTH BELOW GRADE 29.5. ft
JOINTS: O WELDED Q THREADED ❑ OTHER
DIAMETER 6 in.
SEAL.N4&CEMENT GROUT ❑ BENTONITE OOTHER
WEIGHT
PER FOOT Ib. /ft.
DRIVE SHOE O YES O NO
I LINER: G YES O NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HOURS
OURS - --
SECOND
- -
GRAVEL PACK
O❑ YES
O
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
OEM ft.
WELL YIELD TEST It detailed pumping
METHOD: ❑ PUMPED t tests were done is in-
o& eOMPRESSED AIR ;formation attached?
t
O BAILED O OTHER , ❑ YES O NO
L LOG
If more detailed formation descriptions or sieve analyses
are available. please attach.
acE�l
NWE
wat er
Bear.
ing
Da I
meter
In
FORMATION DESCRIPTION
CODE
ft
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
gpm.
Land
5 .
Soi l
5.200
Medium to hard _granite
200.
6
–
175.
7
WATER xg CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHEDPO YES O NO
STORAGE TANK: TYPE 13U others.
CAPACITY GA1r.
PUMP INFORMATION
TYPE s
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME MILL 1)ItI11. TE 10/1/93
ADDRESS Putnam Avenue �
$rewster, IVtJ R 1 r
W V7
PUR,IAM COUNTY DEPARMEW OF HEALTH
DIVISION OF EWMONLYiENTAL HEALTH SERVICES
7 .
9n it
'Owner or Purchaser 6f Building Section Block Lot
-b2,MLJ-T 4daWC-6 F INC -
B -!�ilding nsEructea by-
ui i I d i �nc r
I,ocation Street Subdivision Name'
7TO-10- M /Zf f6�-e
Fianicipblity Subdivision Lot #1
Building Type
GUARAI= OF SUBSURFACE S& --GE DISPOSAL SYSTRM
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, y, apd. that it.has -been constructed as shown on
the.:approved plan'-or 'approved amendment thereto and in acco.rdance-,with. the
standards, rules and regulations of the Putnam County Depa±&,ent of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating conditioh 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
to= -system, except wberq-t e-♦to operate properly is
repair's. made ft�e - to- !,�h --be. -failur
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 Environlrental. 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 19A,2_ Signature
Title
General Contractor (Owner) - Si e
Corporation Nan-e (if Corp.)
Address
rev. 9/85
mk
!426-4-
Corporation Name (it Cor�-)
Address
f
PUUfAM COUlf1T DEPA1111�'fl' aF 6eM.'l'9
f , \°��
r Dh�li� s[��iYs1��hl 8M1A 9edeN: Q�d. N.Y Is1S1? 1e Feww
lbslt`I.
ZB OF
F., , °°tea 9a
j I�I�t MR WWAOE DMOSAL US1IR8[
<j
TOWN- OF.PATTERSON
u, d ai BALLYHACK ROAD
'aiialflaa lire ' "iVl LLIAN . ELTI'NG"" f' 2"
X OP =rM 90
p OwMrYAcat ltr 1N l LL I AN ELT I NG - Daps of YrevM�a 8/2/,90 .
M S1aMft Alien R.D.-6, BALLYHACK ROAD Town BRENSTER, NEW YORK . Mp 10509 .
n—#-- C..1 A4:ric-inn A.nnrnvcA 7H8 /9fl RY. PCM FAA FnnInRed
1 represent that 1 am wholly and eornplate* responsiblo fp` the dN
above desvi0 ed ed will ba tunstruct as shown on tne:approv La'
County O0oaftment_ of : MMRh, and that on eompietin threOf a
M gft►fnRteO.te tM;_.ti-1 wit, an0 'a written "Id, g6oitilti�: win I
t11a« UI �oea ep!at!M: teMtllsn any pert of :aawne <ai 4
anon of the ajpseval 'ef .the Cast"Mate of ; Comi uetiol CanPll
will be located as haulm - 610 alia -i i A pion and that -iiid i `will
COenty OepartwMnt Of NMlth .'
Data AUMT 4, 1992..'-. sip
lnrC'DU zeorcr l D r
APPROVED FOR CONSTRUCT10442 This approval expires twe
Ieveiab6 for ceute.er nwy e• elh«10a0 -or xnodifle0 whan,conW
naquNea' a new ermftj Approved for disposal 'of domestic .
LO /88 pate F my
and kieation of'the propolad system(s). l) that the sepnate_sawage dispose) syaem
mt than
to and in- aeeordanee with the stanaards, rum a regu m5 Ti�1�
rtificati of Construction Complianp' "sfmtory to the Commisaonw o1, Maalthwill
urnisMA' the poser his uwxesro►s, heirs or-assigns by the builder, that said builder will
1 syataih du►irl/ tha pesfoA of two (2) .years Nnmetliateljr tolwprliq tneAate OtaM
f th orlgieal a ` or any fapatre thereto: 21 that th• drNlod well' describes) above
In led. YM ,with t . andarda, rulac and reauTa Ohms of the Putnam
P.E. XX RA.
6 ALi AC URT MILINC 6112654 License No 61468
efh the ifs .unles construction of the building has been, undertaken and is
Oc9slary min er of Maalth. Any thange or jKeration of construction
and/ lira r -wet r fupphr only. ���
Title
c
t
RUG 1 s eEC Joseph Zarecki, P.E.
CONSULTING ENGINEERS
.6 ALBERMAC-�-COURT' PA'WLING °NEW= tX�RW1 -2564' x.. __......... �... .
(914) 855 -3771
FAX (914) 855 -3772
August 11 , 1992
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 Old Route Six Center
Carmel, New York 10512
ATTN: WILLIAM HEDGES, Public Health Sanitarian
Re: Renewal of Construction Permit #P -32 -90 for Sanitary Disposal
System Design for WILLIAM ELTING, Ballyhack Road, Town of
Patterson, NY
Dear Mr. Hedges:
Enclosed is a copy of the Putnam County Department of Health approval
for a sanitary disposal system for William Elting. The property is loca-
ted along Ballyhack Road, Town of Patterson, NY.
I have inspected the site and found that no changes have occured to
the site since our original submittal and approval of the enclosed plans
by your -- Department on August 2, 1990. _
It is hereby requested that the approval and construction permits for
this lot be renewed in compliance with the regulations of the Putnam
County Department of Health. Attached are the necessary documents
for renewal of Permit #P- 32 -90.
Should any additional information be required, please advise.
te , P.E.
Enclosures
cc: Mr. William Elting
AU _l s a REM
PETER C. ALEXANDERSON
_County Executive.. -
.
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
JOHN KARELL Jr., P.E.
Director._
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310 C 0,0p�
IMPORTANT NOTICES
1. SEWAGE SYSTEM CONSTRUCTION IN ACCORDANCE WITH APPROVED PLANS
PROVISIONS OF ARTICLE III OF THE PUTNAM COUNTY SANITARY CODE REQUIRE
THAT THE INDIVIDUAL SEWAGE DISPOSAL SYSTEM, AND WATER SUPPLY IF A WELL
IS PROPOSED, FOR WHICH THE PERMIT TO CONSTRUCT HAS'BEEN ISSUED BE CON-
STRUCTED IN ACCORDANCE WITH THE STANDARDS, RULES AND REGULATIONS OF THE
STATE AND PUTNAM COUNTY HEALTH DEPARTMENT, AND THE TERMS AND CONDITIONS
-OF THE PERMIT ISSUED OR APPROVED AMENDMENTS TO SUCH PERMIT.
CONSTRUCTION OTHER THAN AS SHOWN ON THE APPROVED PLANS OR NOT IN ACCORDANCE
WITH THE AFOREMENTIONED APPLICABLE STANDARDS DOES NOT COMPLY WITH THE ABOVE
REQUIREMENTS AND MAY BE CAUSE FOR APPROPRIATE ENFORCEMENT ACTION AS PRO-
VIDED BY LAW.
ANY CHANGES IN THE LOCATION OF THE HOUSE, WELL OR SEWAGE DISPOSAL SYSTEM
OR ANY OTHER CHANGES THAT MAY AFFECT THE WELL, SEWAGE DISPOSAL SYSTEM
OR ITS EXPANSION AREA SHOULD BE DISCUSSED WITH THE DESIGNING ENGINEER OR
ARCHITECT AND THE HEALTH DEPARTMENT BEFORE ANY CHANGES ARE MADE.
H 2. USE OF SEWAGE SYSTEM (i.e. OCCUPANCY OF RESIDENCE)
PROVISIONS OF ARTICLE III OF THE PUTNAM COUNTY SANITARY CODE REQUIRE THAT
THE OWNER OF A PROPERTY FOR WHICH A PERMIT TO CONSTRUCT A SEWAGE SYSTEM
HAS BEEN ISSUED SHALL NOT USE OR PERMIT USE OF THE SYSTEM UNITL A CERTIFI-
CATE OF CONSTRUCTION COMPLIANCE IS ISSUED BY THE PUTNAM COUNTY DEPARTMENT
OF HEALTH.
THEREFORE, NO DWELLING MAY BE OCCUPIED UNTIL SUCH TIME AS THE DEPARTMENT
ISSUES SUCH CERTIFICATE. YOUR ENGINEER SHOULD BE CONSULTED REGARDING
SUBMISSION OF AN APPLICATION FOR A CERTIFICATE OF CONSTRUCTION'COMPLIANCE.
ASK FIRST — AVOID PROBLEMS
S -P '.r' "-"'.fir ,• ± � � i
s • , p)Aj 3/86
DEPARTMENT OF HEALTH
AUG 13 RECD Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
a ;AP:PLIC.AT.ION: �O.: CONSTRUCT,-.A.; WATER-WELL::_.., ;�. . � ...;- ...�:�,a:
PCHD PERMIT
WELL LOCATION.
Street Address
BALLYHACK ROAD
Town/Village/City Tax Grid Number
TOWN OF PATTERSON 81 -1 -24.2
WELL OWNER
Name
WILLIAM ELTING
Mailing Address
R.D. 6, BALLYHACK ROAD, BREWSTER, NY 10509
Private
O Public
SE OF WELL
( - primary
2 - secondary
U RESIDENTIAL
® BUSINESS
® INDUSTRIAL
® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM p TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
0 ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY
❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
® TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
POTABLE WATER SUPPLY FOP, INDIVIDUAL-RESIDENCE
WELL TYPE
13DRILLED
DRIVEN
®DUG
®GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES g NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: W111IAN ELTING
Lot No. 2
WATER WELL CONTRACTOR: Name TO BE DETERMINED Address:
IS PUBLIC.WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY N/A
DISTANCE TO- PROPERTY FROM. NEAREST WATER MAIN: -.N/A - ; -- --
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION k;E E S
August 4, 1992 4k
(date) (s nat re
PERMIT v �j
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provid y the Putnam County
Health Department. A/�
Date of Issue: 19 ��
Date of Expiration: � 19� ermit Issuing Official
White copy: H.D. File
Permit is Non - Transferrable yellmw Buildin
Py= g Inspecto r
2/87 Pink Copy: Owner
Orange copy: Well Driller
rufftAm COOIfPi DSillil
a[ Coil. N.Y IMP ` > sear w Fwdi•)<�falt I
Cl�l�K)ATZ OF
)lam l!O:>eIIAGN DmOFAL SYSlEUI, ,. , -
pl
TOWN OP�PATTERSON
BALLYHACK_ROAD Pie
Laelrtad alt ,
laiilrltiw Nro WILLIAM. ELT I NG , ,: Sid. Lit I 2: _ - :.. -- � �P "81 poet 1 r.. 24.2-
ltmewal_ ❑ > O
OwrdApMaa�t I'fi�i W LLL I AM •FETING ,
Date of ]how a Approvd .
tldlb{Adkan R.D. 6,- BALLYHACK _ROAD To,, BREWSTER, NEW YORK "n 10509.
Date Subdivision "w roved 1/18/90 BY PCHD Fee Enclosed 0 ,nt-
WOOD FRAME: 2.5t ACRES
DaiiD ijpa Lot .Arad Fib Se 'o* Volooe
piaetIsoittlidta FOUR (4) . -Dail PMWG P D 800 GPD P ®Nedbadeb'Is> Wbim"m1aoaaplrtW
So�aeate Seaeert;� Spdta to trrlat of 250 agm gq* Task and 448 L.F. x 24" WIDTH TRENCH ABSORPTION. FIELD
' To be -0 bj TO BE .DETERMINED sadtm
WMW Sop*: Fine Stipp4 Frota
A 1dtetla
on. X fthka. Sgp* 644 by TO BE DETER Md NED Adis..
Otrtr )Raflilf�aite ' ..
i represent that I am, wholly and completely responsible for the design and location. of the aopesW system($): 1) that the separate -d' !W' Rem
above described will be constructed as shown on the approved amanAnnent there to and inya:orAenca with the standards, rums a - ►pu Ions o nam
County Mpartnwtt Of IIMRA, an0 that Ogeompmtlon_fM►eof a ��Ceftifieiite- of Construction Compliance" satisfactory to the Corninwgbner at HWIthwill
M.Sob -' kal to tM Oepntnient, and .a written 9liaralttoe win ba.,furei" the dean►, his aitaao►s,'MNSOr ssipts -by the buigei, that'sald buikmr will
pleCa b good ooeraewn/ a OdItion'a"y 'part of Said seMpM` ditpoYl systam I I . tM pariod of two (2) Y•ar hnnnadlelely following the"te of the Iseu-
anst of. tM`apoiaval 'of tM.;Cortlfk,ata of Construction Conlpience of th "_orpkull syatinl Or any repairs the►•tO.4) that the drilled wdl desar11 d allow
Will be bKGted j"Lo W'ra 0In the 1 p00 PM"' and:thet aid well still bar_ 'instal n accordance w - the star >ti rums and rquiaifo s of iM Putnam
County De""O,awtof. Mouth.
.�
Dam JULY.;9, 1.990 •
P.E. X R.
Ada►es - ".6 ALBERMAC.000RT. PAWL NE YO 1256 License No 61468
APPROVED FOR CONSTRUCTIONtThis approval the data; i less ruction of IoM .buigiM has bMn undertaken and is
revocable for amts or may be arnafWed or modified wMri aooslder r bY. the m I f
Health. Any change o► alte►atbn of construction
reeuilN • MW pNm App/O1N0 for dispoeeliof dOmettk any and_ /o►a�r at yi. only. /F,(D
Rev. Title / 7'
10/88 °see. Py
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT # / °3:2`
ALL LOCATION
Street Address
BALLYHACK ROAD
Town/Village/City Tax Grid Number
TOWN OF PATTERSON 81 -1 -24.2
WELL OWNER
Name
WILLIAM ELTING
Mailing Address ®Private
R.D.6 BALLYHACK ROAD BREWSTER NY 10509 0 Public
USE OF WELL
Q1 - primary
Z - secondary
® RESIDENTIAL
® BUSINESS
® INDUSTRIAL
® PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
D INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__gal
® REPLACE EXISTING SUPPLY O TEST /OBSERVATION GIADDITIONAL SUPPLY
E3NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
POTABLE WATER
SUPPLY FOR INDIVIDUAL RESIDENCE
WELL TYPE
13DRILLED
O DRIVEN ODUG O GRAVEL ® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: WILLIAM ELTING
Lot No. 2
WATER WELL CONTRACTOR: Name TO BE DETERMINED
Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY N/A
DISTANCE TO PROPERTY FROM NEAREST WATER MAIAT: N/A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[DON SEPARATE SHEET Q
7/26/90 f
(date) sign ure)
PERMIT TO CONSTRUCT A VATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall
any and all water or waste products from such well dri
property and in such manner as not to degrade or o er,
Date of Issue: 19 49L-)
Date of Expiration 19_ P
Permit is Non - Transferrable White copy:
3/89 Yellow copy
take appropriate action to assure that
operations be contained on this
e contami a e surface or groundwater.
Issuing Official
HD File Pink copy: Owner
Bldg. Insp. Orange copy: Well Driller
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
July 19, 1990
Joseph Zarecki
#6 Albermac Court
East Main Street
Pewling, New York 12563
Re: Proposed addition:
Elting
Balley hack Road
(T) Patterson TM #81 -1 -24.2
Dear Mr. Zarecki:
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project has been completed. Comments are offered as follows:
1. Septic system hydraulic profile not provided.
Typical profile is not acceptable.
2. Standard notes 1, 2, 3, 4 and 5 are not provided on plans (enclosed).
3. Well permit not submitted.
- ..Upon. receipt- -of- .a submission, revised to reflect the above .comments,. this
appreciation will be considered further.
RM /jp
Vzzt;;;01/110 uly
Robert Morris
Assistant Public Health Engineer
ILL
3 109 t� i
• TNAM CrXJN= DEPARTMENT OF HEALTH
DIVISION • ENVIPDNKEVM HEALTH SERVICES
DESIGN DATA SHEET-SUBSUFACE S&qAGE DISPOSAL SYSTEM FILE NO.
Owner "WILLIAM ELfINd Address R.D. 6, Ba11yhai::k-R62id-, Brewster, 'r 'New;"Yo-rk
Located at (Street) BALLYHACK ROAD Sec. 81 Block 1 Lot 24.2
(indicate nearest cross street)
Municipality, TOWN OF PATTERSON Watershed
WOTI d N ULD 00;
Date of Pre-Soaking 7/19/89 Date of Percolation Test 7/19/89
HOLE
NUMBER CLOCK
TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water Fran
Water Level
No.
Time
Ground Surface
In Inches
Soil Rate
Start-Stop
Min.
Start stop
Drop In
Min/In Drop
Inches Inches
Inches
HOLE
41 1 10:32-10:56
24 MIN,
27" 2411
3"
8 MIN/IN
2 10:56-11:26 30 MIN, 2711 - 2411 311 10 MIN/IN
3 11:26-11:56 30 MIN, 27" .24" 10 MIN/IN
4
5
HOLE
#2 1 10:33-10:42 9 MIN. 27" 2411 311 3 MIN/IN
2 10:42-10:54 311 4-MTN/IN-:—*:
3 10:54-11:06 12 MIN. 2711 2411 311 4 MIN/IN
4
5
2
3
4
5
N=S: 1 )ests- to--156- repeated
are obtained at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approdmately equal soil rates
percolation test hole. All data to' be submitted
be made fran top of hole.
9
r
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO.
G. L.
6" TOPSOIL 6" TOPSOIL
1' 6" - 7': SANDY LOAM 6" - 616 ": SANDY
2' WITH TRACE GRAVEL LOAM WITH TRACE GRAVEL
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE - LEVEL_ AT WHICH GROUNDWATER IS ENCOUNTT -= - NONE- --
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - - - --
DEEP HOLE OBSERVATIONS MADE BY: MARY ANN BURDICK DATE: 7/18/89
DESIGN
Soil Rate Used 10 Min /1" Drop: S.D. Usable Area Provided 6000± S.F.
No. of BedroCMS FOUR (4) Septic Tank Capacity 1250 gals. Type PRE -CAST CONC.
Absorption Area Provided By 448 L.F. x 24" width trench
Other
�KJ
Name JOSEPH ZARECKI. P.E. Signature ,�.T
Address 6 Alberma
c Court SEAL
Pawlin,,,,Newt'Yok 's12564`
03
THIS SPACE FOR USE, -, IIS L 'Fi ebw, ' ONLY:
Soil Rate Approved `I 3 r
sq.ft /gal. Checked by Date
' � f f,1VH(rl ll./ULV 11 L.urntu•ua y yr
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHED- SUBSUFACE SEWAGE DISPOSAL SYSTEM. FILE NO.
= :... -•w ."ILLIAM; EL.TING..._,,., , ,;., � Address. R.D. #6,. ,Ballyhack Road, Brewster, NY 10509
Located at (Street) Ballyhack Road & N.Y.S. Rte 22 Sec, 81 Block 1 Lot 24.2
(indicate nearest cross street)
Municipality TOWN OF PATTERSON Watershed
SOLD PERCOLATION TEST DATA REQUIRED TO BE SUBMI= WITH APPLICATIONS
Date of Pre- Soaking 7/18/89.
Date of Percolation Test
7/19/89
HOLE
Nii%= CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water From
Water Level
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
P1 : 1 10:32 -10:56 24 MIN. 24 27 3 8 MIN. /IN.
2 10:56 -11:26 30 MIN. 24 27 3 10 MIN. /IN.
3 11:26 -11:56 30 MIN. 24 27 3 10 MIN. /IN.
4
5
P2 1 10:33 -10:54 21 MIN. 24 27 3 7 MIN. /IN.
- - .2.. 10,5.4 -.1.- 1:2.1. 27 MIN. 24 27 3 9 MIN. /IN.
3 11:21 -11:48 27 MIN. 24 ;4 27 •__ 3_._.._. -- - -`9 MIN. /IN.
4
9
NOTES: 1. Tests 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.
rev. 9/85
TEST PIT DATA REQUIRED TO BE .�
DESCRIPTION OF SOILS ENCC
DEPTH ZD HOLE NO. 1
6" TOPSOIL
611-to 7' SANDY LOAM
WITH TRACE GRAVEL
PO
T' c�
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE. LEVEL- AT - WHICH ..GROUNDWATER- IS ENCOUNTERED NONE .._ _.
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED N/A
DEEP HOLD OBSERVATIONS MADE BY: MARY ANN BURDICK DATE: 7/18/89
DESIGN
Soil Rate Used 10 Min/1" Drop: S.D. Usable Area Provided 6,000 ft.t
No. of.Bedrooms FOUR (4) Septic Tank Capacity 1250 gals. Type Precast
Concrete
Absorption Area Provided By 448 L.F. x 24" width trench
Other OF NElN
'L ..PK ZAR
Name JOSEPH ZARECKI, P.E. Signature
Address 6 Albermac Court �3 V S SEAL '
IV
° ° 6146
Pawling, New York •-12564 �p�•
THIS SPACE FOR USE BY HEALTH DEPARTMFM ONLY °' f°
WITH APPLICATION
IN TEST HOLES
HOLE NO. 2
6" TOPSOIL
" to 71 SANDY LOAM
WITH TRACE GRAVEL
HOLE NO.,
Soil Rate Approved sq.ft /gal. Checked by Date
John M. Simmons, M.D.
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of
INSPECTION
NAME Orig. Routine
Orig. Canplain
ADDRESS Orig. Request
No. Street Town TM No. Compliance
Complaint Comp
MAILING ADDRESS Final
P.O. Box Post Office Zip Code _ Group Illness
Construction
WD I A m MITI
Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title
Other
DATE TYPE FACILITY
TIME ARRIVED TIME LEFT Explain
FINDINGS:
i
INSPECTOR: TMPHONE:
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
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