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01827
3/86 V/\\` \ Division of Environmental Health Services. Carmel, N.Y. 1051? E�� to Provide PermU '
` \ on CERTIFICATE OF COMPLIANCE�2 Qr+�
�CONSTRUCfiON PERMIT FOR SEW GE DISPOSAL SYSTEM Permit N
'Located at
Subdivision Name AI's d L L Saba. Lot #
Dwaer /Applicant Name P `f" PPE Dp-- u , C o2 A
Vlailln9 Address �7'A LLf X j-3AV NT l
I� i T EA_PSo N
Town or Village
Tar Map Block Loth
Renewal_ ❑ Revision ❑
Date of Previous Approval
Town Zip
jailding Type S � I aot Area( al, _() v9 Fill Section Only Depth Volume
'umber of Bedrooms -� Design Flow G /P /D PCHD Notification Is Required When Fill Is completed
�parate Sewerage System to consist of Q 50 Gauq. Septic Tank ana 'Li A) � T � I � /
To be constructed by 6i - P�Q4 Cxj Ns Address n b A*/ (Ay 1 .[Y &W I y`J %,
rater Supply; Public Supply From Address
On Private Supply Drilled by R eA Address
'her Requirements C o -M1 1, i J:!1Q A 1 AJ
epresent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
pve described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of o Putnam
unty Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
ce in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
':e of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu aTfrons oof the Putnam
inty Department of Health, j %
P.7 /Q �( Signed P•E._{,L_ R.A.
Address r License No
ROVED F R CO STRUCTION: This approval expires one y r fro the date i ued unless construction of the/building has been undertaken and is
07 cable for use o y be amended or modified when consider a scary by t ommiss• r f Ith. Any change or alteration of construction
ires a n7MV pp roved for disposal of domestic $a t swage, and/ p a a r only.
--i•
By Title 9)tYL
Rev. 3/86
1 \�
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512 ��-
Engineer Must Provide P -42 -86
P.C.D. Permit q - - --
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DL'
Located
SYSTEM 61
Town or Village
Tar Map 6.9 Block 4 Lot 6.4
Owner /applicant Name -Apple M 1l Formerly Subdivision Name Anz 1 P H i 1 1Cabdv. Lot #
Malllng Address 17 Ri irpr 41-rpet- zip-1-0990 Date Permit Issued 7/14/86
Warwick NY
Separate Sewerage System bullt by N. Per-agine - Address RD 1 Wingdale, NY
Consisting of 1,250 Galion Septic Tank and 720 1n ft abs. trench
Water Supply: Public Supply From Address
or: X Private Supply Drilled by P -F - RPa1 Ad tnam Ave. Brewster
Bul1dlng Type S n g l P family r a c Has Erosion Control Been Completed? 7 P G
Number of Bedrooms 5 Has Garbage Grinder Been Installed? no
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date 1-6-88 Certified by— _444A ✓'�� P.E. —R.A.
Address 17 Ri yer StrPPt r •ri rk ANY 10990 License No. 05665
Any person occupying premises served by the above system(s) shall promptly take such action a$ may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubt'_ sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner ofHaM It 'su- oca_t�,�fication or change Is necessary.
Date 2
BREWSTER 'LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 6402
SOURCE: J & P Development
Apple Hill
Brewster, NY
COLLECTED: November 28, 1986
BY: P.F.Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Lot 11
hose Bibb - well
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
P
December 3, 1986 k !
oy Bickwit P.E.
Director
0 per 100 ml.
PUTNAM COUITEY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Apple Hill Development Corp.
Owner or Purchaser of Building
J & P Development
Building Constructed by
Old Route 22
I,ocation - Street
Patterson
Municipality
Single family residence
Building Type
69 4 6.4
Section Block Lot
Apple Hill
Subdivision Name
11
Subdivision Lot #
GUARANTEE 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
_. rep irs..made..by..me .to ..such._system, _.except, where., the . failure. - to..op,erate• .proper-- ly.. -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 Environinental 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 6 day of January 1988 Signature
Title
.. 96neral Contractor (Owner) - Signature
Apple Hill Development Corp.
Corporation Name (if Corp.)
17 River Street, Warwick, NY 10990
Address
rev. 9/85
mk
Corporation Name (if Corp.)
JOHN LEHM- ', P.E., P.C.
CONSULTING ENGINEER
io GALLOWAYHTS.
WARWICK, N'.Y. 10990
914- 986-7737
June 23, 1986
Putnam County Health Department
Division of Environmental Health Service
Carmel, N. Y. 10512
Gentlemen:
This is to certify that I am President of Apple Hill Development Corp.
and I own one third of the development along with Mr. Peter Goertzel
and Mr. Jerome Monasch. I have signed the enclosed forms on behalf of
Apple Hill and as President of Apple Hill.
Sincerely yours,
_ -John Lehman, P. E. —.7
RECEIVED
UN 3 L 1986
PUTNAM BOUNTY
DEPT. OF HEALTH
PM M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMEZUAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW, SHEET..° CONS�'R1f�CTIQN- ..PERP�iIT ...._.,.
DATE REVIEWED
BY:
MW-o-f Owner) (Street Location)
t ® n YES NO I DOC[]MENrS
Permit Application
® Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions.- Volume
_ L,?. , c 1 ; �p pit
Septic Tank n. it
Well Detail, Service Line if over
Construction Notes
sign Data
details
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
9 ft Representative of Sewage & Expansion Area
_
Expansion Area; shown; gravity flow, suff e
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedroans
f` a Wells & SSDS's Win 200 ft. of
_ a / 1, Property Metes & Bounds
s -ize
Property Located
House Setback Necessary (Tight lot)
W r - 1 /4 " /ft. 4 '0; Type pipe
x, Bends 45° w /cleanout
DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- . C OUNTY.:. OFFICE- BUIL-DING9--
GARMEL; -
=N-: �Y: -A -
-- 10512.__
DESIGN DATA SHEET - SEPARATE SEWAGE
DISPOSAL
SYSTEM
FILE NO.
Owner APPLE Hill Development
Address
Old Route 22
Located at (Street / CL ,A -Sec. 69 Block.
( Indicate neares t cross street)
Municipality Patterson Watershed
4 . Lot 6.4
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Proposed Lot #11
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Wa er a er Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
2 t;z: 3n — P.00 3c5 a
4 C5- l D, T c-) Ea` ni C q ri CLA )� Ln,__4m X] /Si T ,-�))Ot L.
5
_- 4 0- 507_C>QSn) � ".- �" C Lny Lo-9 m w L t LT_ Rd=) v r= L
5
N
2
;l PUTNAM rOUNTY
DEPT. OF HEALTI-t
Notes: 1) Tests to be repeated at same depth until apppproximately 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.
5
`'
�1 U
e
;l PUTNAM rOUNTY
DEPT. OF HEALTI-t
Notes: 1) Tests to be repeated at same depth until apppproximately 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.
_2
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
:..:. DRPTH : - HOLE NO. ti - - Hr� r,F...nTn ... _ ..<.. `TTOT 'M AM __., _ .. ... . _ . _.....
G.L.
611
1211
1811
2411
3011
)3611
4211
4811
5411 _.
6011
6611
7211
7811
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE..LE.VEL..TO.WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED—
TESTS -MADE,.•BY - ° °R-.• Demarest & John Lehman Date.
Soil Rate Used % � Mi 1 11 Dro DESIGN S.D. Usable Area Provided
p:
No. of Bedrooms 4 Septic Tank Capacity 1000 Gals. Type concrete
Absorption Area Provided By�L.F.x2411 3b" width trench.
,e., Other
ri
Name John _Lehman, P. C. Signature _
Address 10 Calloway .Heights SEAL
Warwick, N. Y. 10990
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: j r; 6i n 1
4 sae
Soil Rate Approved Sq. Ft /Ca.l.. Checked by `�F �Q � � to
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNT TOFFICE "'BUILDING, CARMEL, _•N. -10512 ""
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner ASE I LL1)FC E YD r- -/MMre s s OLD L-R- ( o� o�
Located at (Street) ! \) C Sec. Block_Lot
( ndlca e nearestcross street)
Municipality PAIME RY('Z K) Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
hole
Number
CLOCK
TIME
PERCOLATION
PERCOLATION
Zu�z
Elapse
'Depth to Water
Water
Level
No.
Time
From Ground
Surface in Inches
Soil Rate
Start -Stop
Min.
Start_
Stop Drop
in
Min. /in drop.
Inches
Inches Inches
in 1/).,S -1a :27
3
aaya.
a5%
a3 /y
2 Q:.�C)-LCb
3C)
aaV2
Z2y /a
as
033%u
i 31Y
/7
#A- Fops:!)i
L ly -
g ar- y LQP
►M c v ,1 L. �
311:5 3 a 32. 15
a' T
-- 4 ()_S „Fr)tS01c ',- QR`(2 LRN1 LLn ►rn u-)A- I ��-- t C-
r�
5
1..; F-1
3
5
Notes: 1) Tuts to be repeated at same depth until approximatel equal soil
rates are obtained at each percolation test hole. AY data to �e submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
- DESCRIPTI.ON_�QF....S. OILS ...uNC.OUNTERED__IN.TEST. HOLES
DEPTH HOLE NO. �_ HOLE NO. HOLE NO.
G.L.C2��C>I
6"
121'
18"
2411
30" \
4211 S L=
84"
INDICATE °LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED.-
INDICATE LEVEL TO WHICH WATER LEVEL RISES' AFTER BEING ENCOUNTE
TESTS MADE BY ,17�1�'11)��y�T 3 • LE.Hm f) N Date) �)
DESIGN )
Soil Rate Used )-7 MirVl n Drop: S.D. Usable Area .Provided sq r"
No. of Bedrooms Septi Tank Capacity Gals. Type'
Absorption Area Pro — v ded By�_L. F. x2�+" width erenc
Other
ure
Address S . SEAL �� �� A- Bey\
THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: 2
Soil Rate Approved Sq. Ft /Cal. Checked by N�� °•
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services APPENDIX L
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR PMKIT "APPLICATION' SUBMITTED` TO
PUTNA.`i COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
Construction Permit for Sewage Disposal System LOt #11
I, John Lehman
represent that I am an officer or employee of the corporation and am authorized
to act for Apple Hill Development Corp.
(Name of Corporation)
having offices at 10 Galloway.Heights Warwick, N Y_ 10990
Whose officers are:
President: Peter Goertzel, 46 Wall St., West Hurley, NY
(Name and Address)
.
Vice—President:
J. Monasch, 60
East 42nd St. NY.,
N. Y. 10165
(Name and
Address)
Secretary: John
Lehman.
10 n11 nway HP;
�, Waiwi Gk' i,. y-
1'0799
(Name and
Address).
--
-- Treasurer: John
Lehman
7., - - -- :- (Name and
Address) _
'. "..:' _:. -'. •- '. ",,:
and that I am and will
be individually
responsible for any
and all acts of the
corporation with
respect
to the approval requested and all
subsequent acts relating
thereto.
Sworn to before me this
10 day
Signed:?
Of July
19E6
Title: See
1
i
1
Dell Wino fond
Notary Public
8/84
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No.'s counq 0
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' PUTNAM COUN'T'Y DEPART OF HEALTH - DIVISION OF ENVIROI�IENTAI, HEALTH •SERVICES '
INDIVIDUAL V�TEEZ SUPPLY SUBSURFACE SEt�►.GE DISPOSAL SYSTFT9.S
FI= 70SPECiIC7N" dig '° ._�,,.., . .k..._... .., ..... ,._........._ _
// / �J �,L DATE:
y *(l �JI tY. -� /�: -INSP. BY:
( of Owner) (S Location)
INITIAL SITE INSPECTION YES NO CCMMERrS
Wetlands on /or proximate to property......... :....
Property lines 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 nrorosed well location for drillina.....
D.H. 1 Lot -
Depth to G. W.
Depth to rock
Soil Descri tia
0 ft.
3 ft.'
6 ft
9 ft
12 f
t.
D.H. 2 Lot
Depth to G. W.
Depth to rock
5011
Ltilr;: _
FINAL SITE INSPECTION INSP.BY:
House SSDS located per approved plan.............
Length of trench measured r- 00
Width of trench average p1
Slope of tile line and trench acceptable.........
Roan allcwed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarlygraded ............................
10 ft. maintained from property line and
20 ft. fran� house ..............................
Distance well to SSDS (ft.) ......................
Numberof bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench................
15 ft. of peripheral soil horizontally
fromtrench ....... ..............:................
Boxesproperly set. ...... .........................
Could surface runoff from driveway,.=oads,..
ground surface, etc., channel near SDS area....
Does lot drainage. appear OK in area'of SDS.....:.':
• FINAT, r.RAT)w, np STTF Arrpp'PART F
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
:.'6 ft'.':
12 ft.
Soil Description
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DEPARTMENT OF HEALTH
_. Division Of Environmental Health.Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
IWELL LOCATION
STREET ADDRESS. WNIVI ! I Y TAX GRIO NUMBER:
Apple Hill Sub —Div. Patterson, NY Lot #11 69 -�.�,�
j
WELL OWNER
NAME: ADDRESS:
J & P Develo ment Cor a Iowa Hts. Warwick,NY 10990
F001PUBLIC BIVATE
USE OF WELL
1 - primary
2 -. secondary
9RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS O FARM ❑ TEST/ OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
XXNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 280 n ft.
STATIC WATER LEVEL 30 ftFDATEMEASURED
10 /16/86
DRILLING
EQUIPMENT
91 ROTARY ED COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH 41 ft.
MATERIALS: M STEEL O PLASTIC O OTHER
LENGTH.BELOW GRADE 40 ft.
JOINTS: O WELDED ® THREADED O OTHER
DIAMETER in.
.SEAL: iaCEMENT GROUT 08 . ENTONITE OOTHER
WEIGHT
PER FOOT 19 lb./ft-
DRIVE SHOE ® YES ONO
LINER: O YES ®NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST _ _..
O YES -. O NO
HOURS
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH ft.
BOTTOM
DEPi}i lt.
WELL YIELD TEST If detailed pumping
t
METHOO: X?cPUMPED 1 tests were done is in-
• COMPRESSED AIR , formation attached?
• BAILED ❑ OTHER ❑ YES O NO
WELL LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
Ing
Welt
Oia-
Deter
FORMATION DESCRIPTION
CODE.
it.
it.
WELL DEPTH
lt.
DURATION
hr. min.
DRAWDOWN
ft,
YIELD
gFm.
Lurtace
2
Dr
lli
in overburden clay & bldrs
t
280
6
260
10
2
41
D3111ing
in rock,set casing,groute
.
41
90
nwilling
J_n k granite.
WATER ❑ CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE Well Xtrol 203
CAPACITY 32 GAL. 9.9
PUMP INFORMATION
TYPE submersible CAPACITY 7 g
Gould
MAKER DEPTH 2 50'
MODEL EHO 5 412 VOLTAGE 2—aOHP Jj__2.
WELL DRILLER NAME F.F. beal DA
PO Box B 86
AODRESSEIrew s t er , NY 10509 5IGrMWE
SAM c�U
t
-
��
PUTNAM .COUNTY DEPARTMENT OF,HEALTIi
DIVISION O€ r N VIRONIVIENTAL REA.TLH s— VICES
�'ki
.Y04
FIELD ACTIVITY
- r
REPORT
=
;<a
jv NrF • M A 61,
AIII24E
l �?l
Cr t�
Street
'Town
State
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PERSON, IN CHARGE
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putwal County Department Of RMIO
Division of Environmental Health Sgr7'oqe
approved as noted for conformance With
&pplioable Rules and Regulations of the
Ktn" Coun th Department..,
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0 N S L LT US` E �Mj�
10 GALLMVAY MONTS
VARVACK9 NEW YORK
nasal C Ill. rn' nATF: 10-31-86