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AS BUILT SEWAGE DISPOSAL SYSTEM
SHEET .. ...... ...... 10T . ............ . ........ �uSL"T- 24 --Ave-spril4e,
FIELDS REQUIRED= k-77 FT. 3<- IN, WIDE TRE,".'CH
FIELDS INSTALLED= : •7 F-, 3,- IN. WIDE TRENCH
SYSTEM INSTALLED BY:
DATE:• Ate, 21; t9?.:t.
SCALE: V-20'
Toe
A-
APPROVED,
NOV 2 21972
12MV11 411.IEA.LTI
EMRONMMAL HEALTH SERVICES
,. PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental: Health Services, Carmel, N. Y 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE. FVR"SEWAGE DISPOSAL SYSTEM Patterson
Town or Village
Located at Lake spring .Drive
Section Block
Richard Lnqus.t,` sublot #24 Lakespring.Meadows
Owner Lot Job
Separate Sewerage. System built y. Address BreWste , N.Y.
C conce 177! 36►►
Consisting of 900 Gal, Septic Tank lineal Feet X width trench
;Other requirements
Water Supply: P.ubhc Supply, From
X P.F. Beal & Sons
Private Supply.- Drilled BY
Address Brewster, '.New. York
Building Type Residence No. of Bedrooms 3, Date Permit Issued
Has 'Erosion Control Been, Completed? .
y' y se. of the "completed work (copies of which are
I. certif )that then stems as listed.servm the above premises were constructed esselSYially a rr£_a t�R Putnam County ,Department ;of Health,
attached), and in accordance with the standards, rules and regulations; plans filed and 't
J ` :Q
November 22, 1972 ;
Date Certifies! by P.E. R.A.
t. :_Address
Any person occupying premises served by.the above system(s) :shall prof
conditions resulting from such usage., 'Approval of the separate ,sewe
available and the approval of the private water supply'shall become nul
subject to modification or change, when, _in the_judgment'•of the -Cor
Date /e/t� / / By
m
License No.-1 " o4s2
tly take su ;ac on as yi r ' & urwthe correction of any unsanitary
e,.system s I,t om@ flull'end i'' a as 'a public sanitary sewer becomes
nq Jo. id wh, ublic wafer s pp mes available. such approvals are
issioner of H, �. rW6eys ib" 3 nation or'change is necessary. {
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
' >Thiy report =is to-be completed by well drikler and submitted to County Health Department-togetKdi; 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
PATIL ON BUILDERS IM.
ADDRESS
LAKE SPRING MEADOW3 T019N OF PATTERSON
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
MEADOW, TOWN OF PATTERSON NLV YORK
PROPOSED
USE OF
WELL
NESS
® DOMESTIC ❑ E TABLISHMENT ❑ FARM ❑ TEST WELL
❑ if )
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El (Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE HER
❑D ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTHER
)
CASING
DETAILS
LENGTH (feet)
20
DIAMETER(Inches)
WEIGHT PER FOOT
Ib
THREADED ❑ WELDED
tlE SHOE
YES ❑ NO
CASING
YES
ED?
TI NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED ® COMPRESSED AIR f ive 12 GPM
YIELD (G.P.M.)
12 GPM
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST [lest)
Depth of Completed Well
in feet below land surface:
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
3
Drilling in overburden -
earth
Hit solid rock at 3 ft.
3
20
Drilling in rock - settin
20 1240
Drilling in rock -
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
7/20,
DATE F REPORT
11%21/72
WELL DRILLER (Signature) B L tQG O IN
Richard Lindquist
Owner or Purchaser o . Bui idi.ng
Paulson Builders
Building Constructed by
Lake Spring Drive
Location - Street
Residence
Building Type
Patterson
Muni c ip al i ty
Section
Block
Sublot #24 Lake Spring Meadows
Lot
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 the standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, 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 disposal
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 occu-
pant of the building utilizing the system. --
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices 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. S,,6J'ec4
Dated this day of J E V" 19Z Signature��
Title
If corp ration, give ame
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, h.
pPutnam County Department of Health
T W"11 h a� je, to des,,�Ie, �or L4am,& je.0 ci one. �a i ve k)4Y -� 4 IcAt, h x
lnconve-n,'ehee�_ �1)��wfioh Or e)64 r;, AP411?? UI�t �Q rte°,
BREWST,ER LABORATORIES
WATER ANALYSIS REPORT
SAMPLE No. 2832
SOURCE: Paulson Builders, Inc. hose bibb - well supply
Lakespring Meadows Lot 24
Patterson, N.Y.
COLLECTED: Novo 14.. 1972
BY: Paulson Builders, Inc,
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
Nov. 18, 1972
0 per 100 ml.
s
Roy Bickwit P. E.
Director
PUTNAM COITNTY DEPARTMENT OF HEALTH
Sewerage,-System �IV
Municipality
CONSTRUCTION PERMIT
Located Section Block
Subdivision J,Aar- sa& iV&. ft_/iPc VS Lot Job '
Owner h�,Q '� R. f Sit R�i> AddressAop/ L�IVF, . S2MF T ;VLot Area
Building Type
No. of Bedrooms ¢Qu2) Total Habitable Space -0 �' sq.ft.
Separate .Sewerage System to consist ofIZOO Gal. Septic Tank 23 lineal feet
width trench
luo be constructed by Address.
'dater Supply Public Supply from
Private Supply to be drilled by
Address
Other Requirements
I repr-e.sent -. that ..I am. wholly and completely responsible: for the-design
and location of the propoded system(s)': 1) that the separate sewage �a dis
osal s stem above described will be constructed as soon "t - pro eed
p. an ,or approved amendment thereto and in accordance with the standards,
rules and regulations of the Putnam County Department of Health, and that
on completion thereof a "Certificate of Construction Compliance" satis-
factory to the Commissioner of Health will be 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 place in good operating
condition any part of said sewage disposal system during the period of two
(2) years immediately following the date of the assurance of the approval
of the Certificate of Construction Compliance of�rgnal system or
any repairs thereto; 2) that the drilled well ��cr�b�e� �bDve will be
.d
located .as shown on the approved awn and tFiat% ' wel'1 �Ta4.T1 be installed
in a.c and ca with the s.tandards,prules and r�e�, a.t�e��`so��{ th'e Putnam County
Depart nt of Health.
Date !.L Signe'
APPROVED CONSTRUCTION: This approval expi e q ua from the date
issued urLYess construction of the building has` b .b eV a.ken and is re-
vocable for cause or may be amended or modified when considered necessary
by the Commissioner of Health. Any change or.alteration of construction
requires a ne permit.. Approved for dispos .of domestic sanitary sewage.
Date � �TG' By
ASeparate
PUTNAM COITNTY DEPARTMENT OF HEALTH
Sewerage,-System �IV
Municipality
CONSTRUCTION PERMIT
Located Section Block
Subdivision J,Aar- sa& iV&. ft_/iPc VS Lot Job '
Owner h�,Q '� R. f Sit R�i> AddressAop/ L�IVF, . S2MF T ;VLot Area
Building Type
No. of Bedrooms ¢Qu2) Total Habitable Space -0 �' sq.ft.
Separate .Sewerage System to consist ofIZOO Gal. Septic Tank 23 lineal feet
width trench
luo be constructed by Address.
'dater Supply Public Supply from
Private Supply to be drilled by
Address
Other Requirements
I repr-e.sent -. that ..I am. wholly and completely responsible: for the-design
and location of the propoded system(s)': 1) that the separate sewage �a dis
osal s stem above described will be constructed as soon "t - pro eed
p. an ,or approved amendment thereto and in accordance with the standards,
rules and regulations of the Putnam County Department of Health, and that
on completion thereof a "Certificate of Construction Compliance" satis-
factory to the Commissioner of Health will be 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 place in good operating
condition any part of said sewage disposal system during the period of two
(2) years immediately following the date of the assurance of the approval
of the Certificate of Construction Compliance of�rgnal system or
any repairs thereto; 2) that the drilled well ��cr�b�e� �bDve will be
.d
located .as shown on the approved awn and tFiat% ' wel'1 �Ta4.T1 be installed
in a.c and ca with the s.tandards,prules and r�e�, a.t�e��`so��{ th'e Putnam County
Depart nt of Health.
Date !.L Signe'
APPROVED CONSTRUCTION: This approval expi e q ua from the date
issued urLYess construction of the building has` b .b eV a.ken and is re-
vocable for cause or may be amended or modified when considered necessary
by the Commissioner of Health. Any change or.alteration of construction
requires a ne permit.. Approved for dispos .of domestic sanitary sewage.
Date � �TG' By
COUNTY OF WESTCHESTER DEPARTMENT 'OF HEALTH - Division of Enviroinmental Saz d.tation
DESIGN DATA SHEET - SEPARATE SEWAGE SYSTEM FIIB NO.
Oyer flR EA% 9.1 51,AF12 dress Af ®Pt 4 NgF. SO .�
Located At (Streetw c Mock Lot
(Indicate nearest cross street)
Municipality°. `E AN" p Watershed +.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMLTTED W� TH APPLICATION
ftn - Elapse Depth to Whter water Level.
No. Time From Ground Surfam in Inches' Soil Rats
Start Stop Min.. Start Stop Drop in Min/in.drop
Inche.T Inches Inches
l a 3
0: /0:7 1 A:,1
4
5
19, 30
Notes:
1) Teats to be repeated at one depth until approximately equal soil rates acre
obtained at each percolation test hole. A11 data to be submitted for review.
2) Depth measurements to be made from top of hole .
24"
i
60", . F i x/.15 ro
DE GN ; ;;..
Hbil Rate IIsed �!` - q,r,MMnA" Dropo :. 4o4- Usable Area Provided
Noo; of BedmsF o,, ;; �Sptic Tank Capacity 0 , Gals., Nlasoruq
R
a :
Absorption Area Provided By& LoFac 36 ". N€i+�e Other.
`v0 60
Name—B1859 ASSOCIATES. Sift
CONSULTING ENGINELRU
Address: C2oLDENS BRIDGE, N. Y. may,
. r'�F•ys ha .:35022 ����a '.
We:stchester Count► Health Department
Soil Rate Approved Sim < Ft. /Gala Checked by Date
S,Do 2706 (Rev. 5 ®24®66) (Febraary 189 1969)
r—