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01837
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PUTNAM COL] RTMENT _OF AHE ALTH
n
t � � ` a �¢" Division of Enwro`hmental Healthb Services Camel N, Y 10512 � � k' � � �, .
CERTIFICATE'OF CONSTRUCTION COMPLIANCE FOR SEWAGE Mr POSA'L SYSTEM Patterson
a sTONn tl' Viifdge
Located ;'at ROUt e ,> 2 2 i
Section r Block o- •� �
Forrester "_Builders;, Inc sublot 40 Lak�spririg Meadows .=
Owner Lot Jo
Forrester Bldrs Inc, Brewster, N Y
Separate ;Sewerage Syst {em built by Address
P C` cone.
Cons�sti�g,of 1000 Gala Septic Tank 3O5 (meal Feet X 36" width trench
Other reGwrements
Water Supply Public Supply From
X
Pnvate Supply "Drilled Ia Y Boyd Arte an Well s
R') 52, Carmel,1New York _
Address
Building Type
RPSI CPY1CP' No: of Bedrooms - Date Permit Issued
% Has Erosion Control Been Com leted�
p ,m
1 certify that the system(s)as listed °sery mg the above_p em,ises were constructed essentially" - _ogrfn1ti$(e)p of the • �a'WO "rQ�( of which. are
attached), and in'accordalnce with' °the standards rules and ;regulations plans filed grid rp„ r �ss� P' of Health
September 6,
;Date Certified by 3
Address
Any person occupying premises served by the above systems) shall,promptly t "sh a do : ane�es;` re f sanitary
conditions resulting from`such' usage Approval of the separate seweragelsy m' ty comeht,u'_aidvoi \ b ntary becomes'._i
:available and tne.;approval;' of the (private water supply -shall become `null :and void -w utl�Yl� t 'Is s !e ovals. are -i
;subJect to modification ortchange +when`2• m the Judgment of the .Comm so r o - p o1fj� tl _` a� � �'e ,ry
Date
al
v
`r r .BACTERIOLOGY -,PAR
ASITOLOGY VIROLOGY 4
6- ANTIBiO C ,USElY
SRCE t?F`tJiATE1�irSL �..,.,. Fi t6EST Lt
W146z
Q Blood ❑ "SMEAR CULTURE
CJ" putum ou ne Fork � S ter Bdi l der, S
[]. Nose] T
_ _ Q Dithert> Wr T
, roat r �r
Pina _ it [] ungus - -
❑
Urine -_,E] G. C.
Q eCes. Q Lake Spring' Meadow Development
Pus :From
Ot er }p P
:.:
Q -ova and Parasites, PIHIVAM DIAGNOSTIC I:ABORATORIES
p= -AVENUE . M, N oral studies- 315TONELEIGH .Y. .
❑ SENSITEVITY s s. RES sL. STAPHLOCOCCUS 4 fp'
{ . _ ' . AeCyobacer
C Ioaphenieoi ❑Cornelact
erium . .
Co istin Sulphate "'❑ emolytic -Cpag, To Follow ❑ Eschddc is
Dec omyein . ❑ Coag.. Positive_' ❑ Kle6sietla
Dihxdrostreptomycin , ❑ . Negative • ❑ Paraco(o. Bact.:
Eryt roinyc�n :K - THE TO OCCUS,, #IE -OLYTI • , "a, 'O Protikyc
F 3
Neortly2in' a p pha ; ;p ,Bet s-40 Gatatna. " Pseud"ononas .
Nitrofurentom :> - ._ ❑ Enterococcus ' '` Enteric•Pathogens
Oxacillin:' Found Pmos
Pans ba. • ❑ - Nelsseria. Not Found,
Pen(ci lin ` . ❑ Hemophllis '.
Tetracycline _ TUBERCULOSI5 ,SMEAR',_: TUB ERCUL.0SI5 CULTURE `
ciacefyloleandomyc n ' ` : °v. 777ff " Acid Fast Not found C1 Neg. for Acid;. ast,
mpicillin Cl Acid :Fast - Found-,.: ❑ Pos
❑ Smeais, Routine;Nej: 0 O$P of Found
oMivp -For
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WELL COMPLETION REPORT
PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER "
NAME A
ADDRESS
f
r T
a. a
FORaESTER BIT UMS' ix Patterson, Ne T.
Owner or Purchaser of building Municipality
Forrester Bldrt-•-Inc Lakespring Meadows Developementl.
Building Constructed by Section
Old Rt. 22
Location - Street Block
Single Dwelling Lot._'
Building Type Lot u
GUARANTY OF SEPARATE SEWAGE 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 tle•tan.dards,
rules and regulations of the Putnam County Department of Health, and hereby` s•guaranty
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 initial use of the sewage.dis.posal system, or
any repairs made by me to such 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
- c -aused- by mthE� - willful:- or- •negligent- ac•t of Ehe -. occ.up.ai�t_ .o �,. he_ bu ld Ong
system. ,�
Dated this day of 19 -� Signature
Title PreS 7
(if corporation, give name.and address)
-. -------------------------------------------=-- - - -�-� c ad. • -j - �- ------ - - - - --
THREE (3) COPIES ARE REQUI�� D WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE
OF COMPLETION WILL B& ISSUED.
GUARANTOR IS RE UIRED.TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
------ - - - - -- ---- --------------------------------------------------------------
Division of Environmental Health Services, Putnam County Department 0 f: Health
TEST PIT DATI REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES.
HOIE NO*---- HOIZ- NO,.
G.L. %0PSel1.
64
24" rwer r o firm fj
se 1-Z t t- Y
M42p'
48 Mr-qVY
54 OR m
60m,
720
78"
INDICATE -LEVEL AT 'WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES-AFTER BEING ENCOUNTERED
-TESTS' MADE BY7318,90 ASS o r- /)q rZ.5 ATE_Sd 7 49Aa Z d7o
DESIGN
Soil Rate Used Min/I" Drop: S.D'o Usable Area Provided 0 k9—
No. of Bedroom
_9'.Septic Tank CapacityZg&gL- " Gals. Mae®a�% i
Absorption Area Provided By 9_6 2--L*F em*�==36"�4�,width' +=web Other
•Name
ING ENGINEERS
Address: CONSULT SM.
Westchester County Health Department
11
L
f.
Soil Rate Approved Sq. Ft./Gal. Checked'by Date
S.D. 27.6 (Rev. 5-24-66) (Februaz7 18, 1969) /,
COUNTY OF WESTCHESTER DEPARTMENT OF HEALTH m Division of Environmental Sanitation
,.4. r.....:DES�G1�1 DATA_rSI3EE� �- SEPARATE; SEAGE..S
Over %�,Qt`[/� �ESj1fJ Address
Located At (Street) Oi-P Z Saco -Block Lot��
(India nears cross at
Mu s�es
nicipals ty d ���® Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
l
'4
Notes: _....
1) Tests to be. repeated at same depth until apprazimately equal evil rates are
obtained at each percolation test hole. All data to be submitted for review.
2) Depth measurements to be made frm top. of h03®..
Somers Field
BOX x,08
Ply I T'r7n1
WES=IF � COUNTY DEPARTMENT OF HEALTH
Division of Ehvironmental Sanitation
Date
ce
Place, /N. Yo 10505
GreenburkYleld Office
332 Tarr,. Road
Whit/P1-.!'-ns-' N. Y. 10603
PeekField five
234 gton Street
Peekskill, N. Y. 10566
Res Property of
Located at GLV 10T z
Section Block Lot
Gentlemen: I I30.ASSOCIAT S
CONSULTHNG ENGINEERS
This letter is to authorize GOLDENS BRIDGE, N.Y.
a duly licensed professional engineer or registered architect to
(Indicate)
apply for a Construction Permit for a Separate sewerage system;
P g
private water supply; to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Commissioner.
t
of the Westchester County Department of Health, and to sign all necessary
papers on my behalf in connection with this matter and to supervise the con -.
struction of said system or systems in conformity with the provisions of
Article 145 or 147,
County Sanitary C
Counters
P.E. , R.A
BIBBO ASSOCIATES
R5 (Seal)
�-GOLDE -NS [tMGV )N. Y.
t c sbs'r
' , (Telephone )
Law, the Public Health Law, and the Westchester
(Telephone)
'V / /0 -41
FIELD CIE= LIST
r.
INITIAL SITE INSPECTION
Yes
No
Comments
Property lines or corners found
Can estimate house location.. ... . . . . . ..
_
Will driveway need cut . . . . . .
Must trees be removed -note these
Is deep hole representative of entire SDS area
Additional deep holes needed. . . .
..
Sufficient SDS area available considering
.driveway cut,house location,separation .
distances, etc . . . . . . . . . . . . ..
DEEP HOLE DATA
Depth:
Water elevation:
Rock elevation:
Soils description:
_.
Date:
FINAL SITE INSPECTION Ins p. by:
House located where shown on approved plan
M),9 Toc ?tpd Z -There ?PproS ei_9 . . .
LiCl!b' i,il 01 Ll'efich "'t: as- La-e(i ��� 75�G %�v.l�_•
Width of trench average
!.
'Y
v"_
ICJ o V
Slope of tile line and trench acceptable . ._._�_
Room allowed for expansion trenches . .
Dve_r_ 5O._. ft. . from swamp, watercczurse-
-Natural .,soil -not• -stripped -or. SDS- area-...__.._._.__..:.. _
unnecessarily graded .
- --
10-Ft. maintained from pr•op.line and
20 ft. from house
o
Separation of trench from house, well
etc. follows plan . . . . . . . .
_.
�`-
Number of bedrooms checks
Stones, brush, stumps, rubble, etc. greater
than 15 ft. from nearest trench . . .
15 Ft. of peripheral soil horizontally from
trench
Junction boxes properly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS o .
-
area
Does lot drainage appe ar O.K. in area of
FINAL GRADING OF SITE ACCEPTABLE
._4
PUTNAM COUNTY DEPARTMENT OF HEALTH
Separate Sewerage-System PA:
Z� �ZS (D
Municipality
.. CONSTRUCTION PERMIT
Located at —01-D 12-C,(-,7-&
SubdivisionL.i V 5SA�6�g I,,/
QfOwner 9
Building Type I
No of-Bedrooms
Separate Sewerage §X.Ltem
width trench
-Section- Block
Lot Job
Address Lot
I A
Total Habitable Spac
to consist ofj3e��,Coal. Septic
To be constructed by — Address
'WateLr
.Su } 1y
Other Requirements
Area 2_)C ¢- -Sri,
Tank_Lp� _lineal feet
Public Supply from
Private Sup-ply to be drilled by
Address
I. rep re sent --tha-t --_T. -am - whoIly, -and c.--,)mpletely responsible for the d
.10 catTbh-'7df-'_tK6 tha-t- -the- -Zepara-t*(-�r;.'-SewaRe-
posal system above described will : —
.)e constructed as s9own on' Me approved
T_Ca_n,or- appFoved.* amendment thereto and in accordance with the standards,
rules and regulations of the Putrun County Department of Health, and that
on completion :,thereof a "CertificFte of Construction Compliance" sat-*,-7,-
factory to the Commissioner of Health will be submitted to the Depar�..fo,°1Lf.,
and a.written guarantee will be furnished the owner, his successors, 'heirs
or assigns by the builder, that said builder will place in good operating
condition any part of said sewage disposal system during the period of -two
(2) years imtrediately following the date of the assurance of the approval,
of the Certificate of Construction Compliance of the original system or
any repairs thereto; 2) that the diilled well described above will be'
located as shown on the approved 7)Ian-and s aid . 11 be installed.
in accordance with the standards, rules and regulation _ 4T",tho Putria-ri -COUrIt7
Department of Health.
0
Date Signe d
APPROV CONSTRUCTION: This -approval expires EV R CONSTRUC ire;s bn6 date
I less e`rtake'ft'&n is re-
issued i less construction of thr: building has 1�rid d
vocable for cause or may be amen(.ed or modified necessary
by the Commissioner of Health. Any change or, alto r`6iti
requires a new 't Approved for di d m s ic-san:L
pe i spos of o eAl"' 'tary sewage.
Da-te 4:� 7� By
J , FIELD CHECK LIST
I
Date:
N�
Proms
G -
INITIA_L SITE.INSPECTION +Yes
No
Comments
Property lines or corners found . . . . . .
Can estimate house location . . . . . . . . .
Will driveway need cut
_
Must trees be removed -note these
_
.._.� ..._..
Is deep hole representative of entire SDS area
Additional deep holes needed.....
- - --
Sufficient SDS area available considering
driveway cut,house location,separation .
distances, etc. . . . . . . . ...
DEEP HOLE DATA
,
Depth:
'
Water elevation:
Rock elevation:
Soils description:
Date:
FINAL, SITE INSPECTION Ins p. b
House located where shown on approved plan.
_SM, Toca,t e T.ThAre approved
.LLUll6l 11 .U-L 'uVeliUll '1I1e8,t3LLVU(L ..• d �r., 5�� %.
Width of 'trench average
Slope of the line and trench acceptable
Room allowed for expansion trenches . . . . .
!�
-- -- -- -
® ° 5 7` °� ''�"wr'
Soo°v
-Over ::50:.. ft. sk7amp ,_watercourse.-_- �- . -._�_:
Tfrom
Natural soil not stripped or SDS area
unnecessarily graded . . . . ` . . . .
,, 0 FV . maintained from prop.line and
20 ft . from iou :- : '-.. 4-es .
Separation of trench from house, well
-,�(
--
etc . follows plan .
Number of bedrooms checks
Stones, brush, stumps, rubble, etc. greater
than 15 ft. from nearest trench . . . . . .
_�...
15 Ft. of peripheral soil horizontally.from
trench - o - o ... . . . . . . . . .
Junction boxe properly set
_
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS .
_-
area . .
Does.lot drainage appear O.K. in area.of SDS.
__.
St
_
FINAL GRADING OF SITE ACCEPTABLE
�.G -73
^4 .PUTMA r ?Tlrf
; m ate savraraa vot
Gam: �-T RUCTI0: FED:T
.. , .
o
ziida
go. fro.t�.' x ! %i2s Tot
a sr t bra a ftAtex� . to,, , C()Ps
T,6 bey dadnst, cted b
�. Sup
..., Pia v a ". uc to be dx !led x)7;
- - - -
recent: .t :, � s� �rho� � �r and, e:ea?�a�le ��� � re:��aora �.b� e ��� �"�� e���
�.
€ ]. b-o- ul11 be- cara true :od -.s i ;-
tT9 r., appror d ,- amendment tkleri to Wad .rl.n`= ,acC:o -'loan
raa* d r ;,A or�p - f the
coxra letx 4 the reo ' A �1I;ertl t1 eate of G'O f't =; u'l on
1' *0tox :;t® I e Caa sionbr of llpa . WA 6e to Iti.,
arid . � mitt " ra .1.1 be`Tv,tA d `. 3ao ". �s � J
r assigns %:Wy the builder,'.-that-said builde r w,iI5. PI,2 C' <> s
itaxa sn, pt" tmf' sm� w4 sad I�posa s
, are i " diatgl foll6tiinr, the d to a �. is b =. c, �. .s °5 .w _• �� _
: "'lche er 3fica" e ® C'enstruction Ca i oe . � t cn I =4L s ..
rep irs, I herato; . h_t< .tY dri :00, Fp.
%�$ted `:s ao a on .the e� roved , � d tit ° �1 s- , W
A .ae;cgrda a.oe xfitla the stetdard. rules d ?�ag�
' }€trt2i�A a fs He
Lx r
:i a. #k.i�7 �1,�, / ". '. n? µ f ,If X -S•' fJ •4f -a `1
e " a i
k2' � RiTC `iO Tt Th a app az c� 'n
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a
vc.d�} al tee es¢'� co yshtritayey-¢tj c •n, - o�7 the buiiyc��'� � I��a� ���,� � • �� � �'�'� y�� �x� r .,.� r �;
ur� -'�/?• �JS !E.6": 'if L? 0Y,t6-ftdet.;. `O.4. 1n
117 �...��,� V2i6�?+�.i�W s iog �r i.7f. Ho SL I:Lho '7O2M+•� \- ti�G.�aFi�.kl 1r�� "�����✓� t.. -. H�� =1? I"t Y� '� �i,_ -. � _ ,
y $ �
4 $_x.• 4 } . a ;dpw, pes,�J. App3 �°CA ved �,� i fit. �„ �4.'•��. t1 _ ti- k ±^ � - '
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COUNTY OF WESTefigMER DEPARTMENT OF* Division of Environmental Sanitation
BAY 1-(EaD
Over At5ODage-_ 17U- R-S-r Address
Located U (Street) sbc Mmck Lot
Undicate nears A cross it-rest)
Municipality, Watershed , Y, , -C
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUMMED 14ITH APPLICATION
Fain Elapse Depth-to Water water Level
No. Time From Ground Sm-fam in Inches Soil Rate
Start stop, Kin* I start Stop Drop in )Kn/in.&op
Tnr.ha-.r Tn&-hamr, Inches*
®/ / � Vz
Z.6 F.
0
Notes:
1) Teats to be repeated at mme depth until approzLmately equal soil rates are
obtained at each percolation test hole. All data to be submitted for review,
2) - Depth measurements to be made fran top of hole
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST. HOLES
. --ROLE ,�0a...._.:_._HOIE 11TOe.... 4 m
54"
609'
660
72"'
78"
INDICATE LEVEL AT IMCH GROUND WATER IS ENCOUNTERED kOd
INDICATE LEVEL TO WHICH WATER LEVEL RISES. AFTER BEING ENCOUNTERED
TESTS MADE BY $ S ®G
DESIGN
Sbil Rate Used 0 Mi.n/5." Drop: SOU® Usable Area Provided .� ® ®® $- E�'
No. of . Bedrooms. Septic Tank Capacity ® Gals. Masonry �
Absorption Area Provided By L ®Fox24- 36 19' wid YOR r
Name S9BSO ASSOCIATES Signat .
CONSULTING !
Address: GOLDENS BRIDGE., N. Y. �, � �
��c> • NO 35�
t'�,rEU PIS, iFLSS���P�
Westchester Coimty Health Department
Soil Rate Approved Sq. Ft./Gal. Checked by D
S.D. 27.6 (Rev. 5 ®24®66) (Februar3* 18,q 1969 )
i
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+1
11 t:
Jl
• �'. I _ III �� �,
CL. C7/L /G
�AIL TANlt
.. 2F3 3
IV— — — -- — — —
A� C ?�7-1 A1-4 SI�1 -,a
.. .........
� —�r^
�4
h
F
I y
f AS BUILT SEWAGE DISPOSAL SYSTEM
S I
'� Q �'-- � -C STS r=• C���..) �L- L7�� --.✓ aJ�
mLD 2TE 2'Z, J�. f'iV Z3Cx�
. SHEET ..S....A . ....E.[.? .._ :BLOCK .. ................ . .............. .LO T...! : P.........
FIELDS MT 7oo F'rx ?:C, INWIDE TRENCH
FIELDS 3'Fr- ? e-
IN. WIDE TRENCH
SYSTEM INVA66fiO BY: fr[7Rfzc�r� CiUILDI_�? 3
DATE: Su N1 =. t<-; 1-173
- SCALeff "41281
. BOO ASSOCIA7ES
BONSULTING ENGINEERS
6OLbENS BRIDGE. N. Y.
APPROVED
I J
SE 3
Qtf - Of MEb6ft1
t d , d1Vl�fdq �
VMR MM dL KFA M HAN
t cuto' -