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Home My WebLink About1864DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -57 BOX 17 1, -2 , ,J ., 'r ,r . , T IN T Jr r �,, rL .' , PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 318 Division of Environmental Health Services, Carmel, N.Y. 10512 /� Engineer Mast Provide !C�r P.C.H.D. Permit iy CERTIFICA 0 .CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSALS STEM � �� Imo% �� , V �..- .�Located .at— Map_ lock .�.. •.... -.. Owner /applicant Name ; / G L Formerly / Subdivision Nam ^ , bdv t # a Melling Address —Zip- Date Permit Issued Cn Separate Sewerage System built by_��'" # ! V Address Consisting of �. - Gallon Septic Tank and 3 8 (�j t-!`1 ET- Water Supply: Public Supply From _ Address ors Private Supply Drilled by 1 L Address �. (Z G J Building Type s_.2:.h� �` 1 i— - i 7 _Q Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been Installed? `! z 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,, i_I accordance with the filed plan, and the permit issued by the Putnam County Deeppp.artmenntt (Off Health. P. E. R.A Date " 't License No. Address (� %� Any person occupying premises served by the above systems) shall promptly take such action as may be necessary t0 C ri-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 pub(': 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 changes when, in the judgment of the Commissioner roofHealth, such revocation, modification or change Is necessary. Date 8 Title L— PUTNAM COUNTY DEPARTMENT OF HEALTH permit a Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTR 7TI0N__P_EAMII.T__ F0R_.. SEWAGE_.DISP0SAL_.SYSTEM_... Town or illa/� ge — Located at OI eie 'i.t. XZ Tax Map Block Lot If Hi LL L /J Sum. Lot # 2- Renewal Revision Subdivision/ LP Ott! —ABM OClaz /�-� —U —� Owner /Address �lA bit a: L L Al SOe, / V G v Ltpws V H tS __ _ Date Of Previous Approval '�/ grwf cK Y 2. , Building Type l It FsAsiLS RD' S Lot Area �•1t] % �. 2' Fill section only ❑ Number of Bedrooms Design Flow G /P /D UV P.C. H. D. Notification Required Separate Sewerage System to consist of 1,_(?t7G Gal. Septic Tank and 3,9'0 Lm Ft A►h< Teen G/1 To be constructed by p —� A H Address ►3 d c 2 .i9 4 Water Supply: Public Supply From — Private Supply ,to be drilled by ! • r L } S b JO Address y IQwroolm A-o - /t e1j-' `re-h- d Other Requirements I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam. County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu amens of the . Putnam County Department of Health. Date -- L —I— % S- Signed l/lA-- P.E. Y R.A Address 10 Q L Loa.`__ H 2,�7/i t S L.tfn re..: C It N y License No.flS: 4 L APPROVED FOR CONSTRUCTION: This approval expires one year from the date i unless construction of the building has been undertaken and is revocable for cause or may be amended or modifietl when c sideretl necessary by t e Co missioner of Health. Any ch =alteration f Construction requires a n permit. Approved for disposal of dome i ry sews e, and r ter poly eniy - - -- Date ��1g/ By Tit Rev. 9 -81 WELL COMPLETION REPORT 3)711 PUTNAM COUNTY DEPARTMENT,OF HEALTH 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, arxiysi� watt sa tipie irtdicatir►rfvvriier is rifs3tisfaetbry bacterial" quality before`certi €icate of construction,compliance-is issued: REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME J &P Development Corp. 110 ADDRESS Galloway Hts, Warwick, NY 10990 LOCATION oFwEU (No. 8 Street) (Town) (Lot Number) Apple Hill Sub -Div. Patterson, NY (p4��_(o.c� 2 PROPOSED USE OF WELL BUSINESS K DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Spefy) DRILLING EQUIPMENT COMPRESSED CABLE r- ' ROTARY' AIR PERCUSSION ❑ PERCUSSION ❑ ((SSpe ify) CASING DETAILS LENGTH (feet) 301 DIAMETER (inches) 611. WEIGHT PER FOOT 19 lbs . ® THREADED ❑ WELDED SHOE Lx J YES [I NO CASING GROUTED? X YES NO YIELD TEST X HOURS G.P.M. ❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR 6 .5 YIELD (G.P.M.) 5 WATER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specify feet) 301 DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: 4051, SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (test) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (teat) 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 8 Drilling in overburden clay and boulders Hit rock at 8 feet Drilling in rock,set 30 40c; Drilling in rock granite If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE. WELL COMPLETED 10"22 8 DATE OF REPORT 11/5/8 WELL DRILLER (Signature) `d PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRON -MUAL HEALTH SERVICES Apple Hill Development Corp. 69 4 6.4 owner or Purchaser of Building Section Block Lot J. & P. Development Building Constructed by Old Route 22 Location - Street Patterson Municipality Single Family Residence Building Type Apple Hill Subdivision Name 2 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, worlananship, 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 � such- "systEni,- except wYiere'trie - 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 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 8 day of October 19 86 Signature Title Gen al Contractor (Owner) - Signature Apple Hill Development Corp. Corporation Name (if Corp.) 10 Galloway Heights, Warwick,NY 10990 Address rev. 9/85 mk Secretary Corporation Name (if Corp.) 10 Galloway Hts,Warwick,NY 10990 ess BREWSTER LABORATORIES �Box,224�- (914) 225 -2072 SAMPLE NO. 6176 SOURCE: Jr & P Development Lot #2 Apple Hill Brewster, NY COLLECTED: I.'iay 29 19 86 BY: P.' . heal & moons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Faucet O per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. June 3, 1986 4 i ' • O�.v ROC�� ZZ c ° r '-- __—_ - --- - - - - -- ---- _— SANt� t S1LIr _.1 _— 1 Vi, — — _ '� / �0 -1 oa sAn► mr %-Oo.VA w l PERCOLATION "PIA-re is 4WEA M%14. / INC" --- - - - -r_ L_ Z - L1N. Tr 1:tCRlE:),.1GH 'PROV tT.IEV '3S0 _ ' 4r r� \ Health i ► so' 1 — -- eutmin County Department of r j — — 8�'sion }ot zavironmental Health Service: I"Tnc I / \ 1wroved as -noted for conformance with . a licable Mules egulations of the County H th epartment.4i o. o° tv L N 2 � / � PRO�.e.EY� •� !vim 'l` Jcaai L�M�� , 1 (� / /, i - - - i0 CaAL►.JCIA`f 111 AD WAVV49CK MY N. C. `.1 C. N0. 0S43,C*S'5 4 i Ko i SI =PTIC LOCATION'` SCALE : 1" =30 55 46 3B a 3 LLOti TANK S29`.'1G.G9'F- '4�' "13.1'1 S3Z°3t "E i. LOCI �. - -- j - -- -- -� - - - - -_ r` \` O "-12" TOPSOIL 5. - `N- -�----- - - - - -- - - --- 12 °-30'CLA -( LOAF WI ---- - - - - -- -- - - - - -- SANG $514fi LGSM W 1 ------ ------- - - - - -- CiKAUEL 1 r - -�` - - -- �-- - - -_ N 6EPI"1G. LACAmoN SCI- 1EDULE THIS IS .TO CERTIFY THAT JuNFCRnOOM N HOX CR-tNo R AA CRTNo R 3$ FROM CGITNa R AC GRTNo R 06 FOM CRkhj A �o 4A GR Nq P�9 THE SEWAGE DISPOSAL SYSTEM 1 42' 4-1' 14 36 3 12' 41' WAS CONSTRUCTED AS INDICATED 2 50' 154 zA Be' -tee 25 -IZ.'- 49 ON THIS PLAN AND THAT THE 3 55 rats 3A 41' 0fl �0 82'. 5i SYSTEM WAS INSPECTED BY 4• G4 to t' 4A 5e; 85' 45 $p: (c6' ME BEFORE IT WAS COVERED 5 OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE rutaam county Department of Meialu .L WITH AL STANDARD RULES Jivision of Environmental Health Servioee AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT %Dproved as noted for oonformanceivith Of' HEALTH. applicable Hules.and Regulations P the Putnam County Health Department.. ' OLD TlOUTE I Rtanaturs b 1 Dnt.w Ko i SI =PTIC LOCATION'` SCALE : 1" =30 55 46 3B a 3 LLOti TANK S29`.'1G.G9'F- '4�' "13.1'1 S3Z°3t "E i. LOCI �. - -- j - -- -- -� - - - - -_ r` \` O "-12" TOPSOIL 5. - `N- -�----- - - - - -- - - --- 12 °-30'CLA -( LOAF WI ---- - - - - -- -- - - - - -- SANG $514fi LGSM W 1 ------ ------- - - - - -- CiKAUEL �ernc w L7y 1 440 - 1 N ' J I FC X10.0 �// O• 1 - -T I. � t a� 04. z3. - ' — - -- PES2COLA�T IO1J .� TZATE 10 M1N. / INCH LIti1. F'I'.�'CXENCH R'EQ�• - 333 LIN. V iT f TRE.),JCH 'P-120V tDED' 350 LOT 2 AREA = 42T'72 9F = C° 5E�-r1c S`�STEM APPLE 1-11 LL DEVELOPMENT PATTER•SOtiI � -P�.t Tl�t AM , CO�.�` JO 4-11.1 LE1 �MAP1 , �d GoNSUt_-YttSG EN. a 10 GAl.\. p A`( "et W ARW 1 CK , KI.Y. UccO N •`!. L l C. N p. O SCotoS F: X. r - -�` - - -- �-- - - -_ N I 3' 1 35 ' �- �ernc w L7y 1 440 - 1 N ' J I FC X10.0 �// O• 1 - -T I. � t a� 04. z3. - ' — - -- PES2COLA�T IO1J .� TZATE 10 M1N. / INCH LIti1. F'I'.�'CXENCH R'EQ�• - 333 LIN. V iT f TRE.),JCH 'P-120V tDED' 350 LOT 2 AREA = 42T'72 9F = C° 5E�-r1c S`�STEM APPLE 1-11 LL DEVELOPMENT PATTER•SOtiI � -P�.t Tl�t AM , CO�.�` JO 4-11.1 LE1 �MAP1 , �d GoNSUt_-YttSG EN. a 10 GAl.\. p A`( "et W ARW 1 CK , KI.Y. UccO N •`!. L l C. N p. O SCotoS F: X. �. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING.,, DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. App lac f►. LL Assoc. Owner A . Address Old e R t 7.2 Located at ( Street )- $ ; L J��Sec . (, Block 4 Lot Io4 n ica neare- st cross s ree Su 6dtvis/or7 Lot P �. Municipality Pa -�^}. r o,., Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Lot 1d;L, Hole Number CLOCK TIME PERCOLATION PERCOLATION Run 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 9:30-9"5A 21 2 o, ore .. 0 :!g'3 3 S 3 2 FS %z 3 4 U - g " ZWsc: L B !, j' Gl 5 r - 4 C.Lc Log /ca„d 4. LL, 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. it TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF.SOILS ENCOUNTERED IN TEST HOLES DE DTH. G.L: Toga,.; L JJ 6 �. Glad Lj26 1811 Se.,;d...$, 30, 36If Sa►,a6 Lc) r,w, 42" �e.l 48" 54 60" 66" 721 _ 78•• " o 84" INDICATE LEVEL AT WHICH,GROUND WATER IS ENCOUNTERED %' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED , s TESTS Date.-) DESIGN r Soil Rate Used 1:0 Min/l "Drop: S.D. Usable Area Provided 5', oa G No. of Bedrooms - - Septic. Tank Capacity I oo G Gals. Type Co c, fe Absorption Area Provided, By_3ffo L.F.x24" .uth trench. ure Address /o o�,�a� SEAL c.L� 14•�s_ r THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: NCO ti °• 0568h3 �� . AROFESS�ONP� Soil Raise Approved Sq. Ft /Cal. Checked by Date