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Home My WebLink About1886DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.09 -1 -1 BOX 17 . ;ir 'r. 1 6 �- r. � nm . 4. -t: PUTNAM COUNTY DEPARTMENT ,OF HEALTH b . Division of Environments/ Helg /t/►. Serv/oea, Carm% N Y 10512 . Permit a P -7 ^86 CERTIF•I TE OF CONSTRUCTION COMPLIANCE FOR :SEWAGE =DISPOSAL` SYSTEM �attetson Town or village East Branch Road. _ _ _ - �W, kip, 8 2 Block 1 Owrier Bill Laufer. i Formerly Y Tax Map iot �. 19 subd Lot a Separate 5ev ee system bunt by ,' i11 Latlf -r Address ??t ;dQ- BreWSter 9`'NeW Ynrk ' ' 1(l S09' i consisting of 1000 pal.. Septic Tank and 420 L. F.. X 2' wide trench Other requirements • Water Supply :. Public Supply From. _ x Private Supply Drilled By Mi 11 T7ri 11 in g., Tnc _ Add ►as: .Putnam Ave. , Brewster, New York Building Type 1 Fain_ Resid6prt- No. of Bedrooms S Date Permit Issued Has Erosion Control Been Comoieted7 yeS I certify that the syeI tam (a)'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 '30 ��L ; Certified by ' P,E: X R.A. Cashiri'Assocates P.C. , o'Add ► l License 26008 Any person oeeupying premises, served 'by' the above systems) shay. promptly take such. action as may be,neeessary to secure the correction of any unsa.nitary conditions resulting` from such usage.: Approval of the' separate "Werage.systern shall become null and void, as soon as a public sanitary sewer becomes available and the approval'of, the private water supply sh'all.pecome riulI- ind,vold when a public water supply becomes available. Such approvals are subject to modification 'or, change When, -, :in the judgment :of the 6rninfssloner of Health, such revocation, modification or change is necessary. Date T� 9 -81 - Cl �•��OI. S TTT/�TT `� WALL l,Vi'ir LL111V1Y i\L'r Vial Office Use Only j a a .e DEPARTMENT OF HEALTH Division Of Environmental Health Services OF HEALTH PUTNAM COUNTY DEPARTMENT STREET ADDRESS: TOWNIVILLAG11CRY TAX GRID NUMBER: WELL LOCATION Putnam Lake Road, Brewster, NY WELL OWNER NAME: William Laufer ADDRESS: PO Box 348, Brewster, New York PRIVATE ❑PUBLIC USE OF. WELL j RESIDENTIAL O PUBLIC SUPPLY ❑ AIRICOND. /HEAT PUMP ❑ ABANDONED 1 - primary O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL. ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT ' 5 gpm. /N0. PEOPLE SERVED .,___L _/'EST. OF DAILY USAGE 300 gal. REASON FOR j® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH .3615 ft. STATIC WATER LEVEL ___ 4__ ft: DATE MEASURED 12 /2/86 DRILLING O ROTARY IN COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O. WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED O OPENKENO.CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH a 1 tt MATERIALS: 19 STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE 4 n fit. JOINTS: O WELDED I(THREADED ❑ OTHER CASING DIAMETER 6 in. SEAL: 00 CEMENT GROUT O BENTONITE ❑ OTHER DETAILS WEIGHT PER FOOT 19 .b. /it. I DRIVE SHOE: Ps YES O NO LINER: O YES ONO DIAMETER (in) 'SLOT. SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? SCREEN FIRST O YES ONO DETAILS .. _ . _ _ _ _ ...... - __....... _.. _..... _. - . .... ... _... _ _- GRAVEL PACK ❑ YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE; OF PACK in. DEPTH tL DEPTH It. WELL YIELD TEST It detailed pumping P P g It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. METHOD: .O PUMPED tests were done is in- DEPTH FROM water Well COMPRESSED AIR r formation attached? .. SURFACE Bear• Ora' FORMATION DESCRIPTION caoE I{ ' tt O 8AILEO ❑ OTHER ❑ YES D NO in9 mate DEPTH DURATION DRAWOOWN YIELD s nice 20 Hardpan & boulders, It. hr. min. It. gpm. 2551 Hard___qrey & black granite 200 1 — 30 200 2 granite 300 2 300 311 328 365 Hard grey granite 365 6 300 8 WATER CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS �y O COLORED ANALYZED? Id YES ❑ NO ANALYSIS ATTACHED? JX YES ❑ NO STORAGE TANK: TYPE Diphram CAPACITY 62 gal. GAL. 19 PUMP INFORMATION WELL DRILLER NAME DATE ADDRESS Mill Drillistc`�rimI 2/ /86 Putnam Ave. TYPE-q1' mprsible CAPACITY 7 MAKER. DEPTH 30Q' MODEL 7EH07412 VOLTAGE�1P NY Brewster, Robert Z. Mi , , PUTNAM CXXRM DEPARTMENT OF HEALTH DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerjiL_l: �y� �= Address CCU W(L'-�- ;4 F -t> Located at (Street) &A�z�, -. _ ge=A,,WA . Sec. i-2�2 . Block Lot t (indicate nearest cross street) municipality �� 1 `7"� �c� i Watershed C T- Tr-> IJ SOIL PERCMATION TEST DATA REQUnW TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking 1 21 /5 f Date of Percolation Test la 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 Co 4 jo:o2 -lb'Z3 2 kt� "2- 1 1 5 !B- 9:3-3- r..2�.3� 3 2A 4 t'. o i> - !o'- 4'Z 1 5 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 suhmi.tted for review. 2. Depth measurements -to be made fran top of hole. rev. 9/85 1' 2' 3' 4' 5' 6' 7' 8° 9' 10' 11' 12' 13' 14' I. I INDICATE LEVEL AT WHICH GROUNUAAMR IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /A DEEP HOLE OBSERVATIONS MADE BY: DATE: 12 15,E DESIGN Soil Rate Used g N (c> Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity (CCO gals. TypeDr�{ Absorption Area Provided By +'' ��`� L.F. x 24" width trench Other !. Name �SSix,1 S P�� Si nature a� g c t Address �'�,o`tE<' -°T, SEAL � THIS SPACE FOR USE BY HEALTH DEPART ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser . of Bu//i��l ing Building Constructed by Location - Street 0 ) Il Section Block Lot Subdivision Name Municipality Subdivision Lot # tjov dam, Building GUARANTM 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 Construct-ion-Compliance" for 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 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 caused by the willful or negligent act of the occupant of the building utilizing the system. r� Dated this % day of C_ 19 6�b Signature Title G,enneral tr ctor (Owner) - Signature Corporation Name Addy s rev. 9/85 mk Corporation Name (if Corp.) AX _?K� ? Address ;a:�� -A X 10 9 0 BREWSTER! Box 224 - BREWSTER, N.Y. (994) 225 -2072 WATER ANALYSIS REPORT, SAMPLE NO. 6422 SOURCE: William Laufer Putnam Lake Rd. Patterson, NY COLLECTED: December 8, 1986 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method well This result indicates the source of the sample was of satisfactory sanitary quality ' when the sample was collected. December 14, 1986 Roy Bickwit P.E. Director 0 per 100 ml. P. N, C ®l7DTTV "13EPAR'TMENT ®F -HEALTH ; ENGINEER TO PROVIDE PERMIT # 11 / ON CERT F I CAME OF COMP IANCE. C ,` Division of Environmental Health Services, Carmel, .N. Y. 10512.. PERMIT # _ CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM. �PtT71=g�� f . T e n - i , [ own or. �Ilag i✓ .. a�71 U. . -. _... T Ma Sd -Z ock - t oceteq:.et _.._ az a1 - r Subd. Lot R Renewal _ Revision Subdivision owner /Address 1� y 'T -i - - (•v Date Of Previous Approval Building Type �f "'� S Lot ifArrea�1/\ ��TTU f Fri Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D 11 9 P.C. N. D. Notification Required -gyp Separate Sewerage System to consist of � �•� � [� Gal. Septic Tank and _S� J L, To be' constructed by 1`�� \� t`- tY�t +y�`� Address Water Supply: Public Supply From �y Private Supply to be drilled by 1v Ea: eG�® Address Other Requirements I represent that I 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 thereto -and in accordance with the standards, rules an regulations o e Putnam County Department of Health, and that,on completion'thereof a "Certificate of Construction Compliance ^satisfactory 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.'siid sewage disposal, system during the period of two (2) years immediately following thedate 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 a regu amens of fhe Putnam County Department, of Health. ' Date �® v Signed C «t-''� P -E. R.A. Address ��)i� 5r- e 1 ��L 04 License No. 2 APPROVED FOR CONSTRUCTION: This.approval. expires.one year from the date issued unless construction of the building has been undertaken and is revocable for, cause or may be amended or modified when a idei id necessary' by the over of Health. Any change or alteration of construction requires a new permit. Approv for disposal of dome c it. _sews e, and/or rivate suryplp- ot17��- Date ��. By Title Rev. 6/85 in PUTNAM COUNTY DEpARD4RU OF HEALTH - DIVISION OF ENVIRON ENTAL HEALTH SERVICES a INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS - -MELD. INSPECTION DATE: INSP. BY: (Namel of Owner) Str t Location) INITIAL SITE INSPECTION I YES I NO, I CHI'S 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 ............................ D.H. 1 Lot Depth to G.W. Depth to rock oaf Soil Descri tion 0 ft. 3 ft. S 6 ft. 9 t. D.H. 2 Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. t.. Soil Descri tion D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of the line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded:............. ... ........ 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.) ...................... Number of bedroans checks........ .............. Stones, brush, stumps, rubble, . etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench .................................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.......... ... PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SENAGE DISPOSAL SYSTEMS IELD INSPECTION REPORT 1�G1 U �{ ✓ �. `� r "C�� -: c°. C�: INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway,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 ............................ D.H. - Deep Hole G.W.- Groundwater D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot Depth to G.W. Depth to G.W. Depth to G.W. Depth to rock Depth to rock Depth to rock 0 f 3f 6f 9 f 12 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. boil Descript DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan.. "........ Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded.......... ..... ......... 10 ft. maintained from property line and 20 ft. from house... .............. .r..... Distance well to SSDS (ft.) ............ 1 .Q ...... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft, from nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set.......................... ..... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. -\K- �- k -� r� ,! st4v zo`- ob "C L I i 2 /S.o , qu r - O LOCATION 6[ i I A OF WELL � L''107 LU u O W / NA 7. J� o � ti0 \ .\ q �p 2 vX i n. q re (V, \ LO C,4'TI UrJ .� ' ExISTItiC �. WAT£RcouR5E \ ---Q-- 2vo t -- 7o Ro�iTE «-Z EA ST ,CSL.NCt e l 5 z Z. Z (e 3 Z 37 yo Jz' 37 31 3c� 9Z A15 QUID( NoC� '(4:{FJ' t5 TD C,Et2.'t'{�'( iNb'[ its. SEwn,pa; Dt�'x.-�,,ai.. `a'ltitEM sJa�a {T aYa4, . cwt eo ov eg . t U E srt eil1 cM bcc��aNCe wfTLj Oty6.- STa.Nr�aBc� C2t.11:is5 aeJt7 �Ers��.d'C�ars� dF .T t1 peMACTMMhiT or E451%CT4 ANPTUE t�� `S�KK STATE. D>ct�P�Tt�tE.nYf C� f1� -'��. N crrE CONSISTS v1= q f000 &AL. cJrG';:sT)C iArJ YJRN !f 2,0 1 , �. ol= 2' vvlVE TRENCH. e