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36.09 -1 -7
BOX 17
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PUTNAM COUNTY DEPARTMENT OF EWALTH
Division of Environmental HeeM Servloeo, Carmel, N.Y. 10512
1q R eer Mar Pro vide
P -67 -88
H.D.Pmit0 Ij
Wes CEl1TD�ICATE OF CONST iiCT10N:COMPLiANCE.Fti3t SEWAGE DISPOSA STEK
Tomm or V91W
River Road Tta M pNew36.9 Block 1 Lot 7
=appHmntN&me- Peter & Laura Bell Formerly Subdivision Name
MaOb>QAddrew 9 Intervale Ave, N. White Plainap NY 10603 Subdv. Lot #
Fee Enclosed Amount $200.00 Date Permit Issued 10/28/90
Separate Sewerage System built by Edward M. McGoorty Add 101 Walnut Dr., Pawling. Lake, N.Y.
Coditgof 1250 Gallon Septic Tank and 446 Lin. ft, of 2 ft, wide trenches
Water Supply: Public Supply From Address
on X prlvate Supply Drilled byAlbert M. Hyatt&Son,1dre"Rte. 311, Patterson, N.Y. 12563
Building Type Frame Lot Size 2.70 AcresHas Erosion rnntrnl Rppn rnm! 1ptprl9 As required
Number of Bedrooms Four )Bea age Grinder Been installed! No
Otber Requirements None
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.
18 December 1992 P.E. X R.A.
pate certified by
Address RD9 -Fair Street, mel, N.Y. 10512 t.koeneswo.29206
Any person occupying premises served by the above system(s) shall promptly take such action as 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 pub(:: sanitary sewer becomes
availeble' 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 Commission of Health, such revocation, modification or change Is necessary.
Title
��
.e
WL,LL l,Vl'1CLL.1IVLV t�.rvr<t
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only .
WELL LOCATION
STREET ADDRESS: MWNIVILLAULICIly TAX GRID NUM8ER:
o �, �= I� --.�P .
/' :z
WELL OWNER
NAME: ADDRESS:
f 40it 1
PBIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP b ABANDONED
O BUSINESS ❑ FARM O. TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE ooV gal.
REASON FOR
DRILLING
❑ PLACE EXISTING SUPPLY ❑TEST /OBSERVATION [:]ADDITIONAL 'SUPPLY
OVEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH -- ��..-ft.
STATIC WATER LEVEL 313 ft.
DATE MEASURED I� a-
DRILLING
EQUIPMENT
O ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): .
WELL TYPE
D SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: KSTEEL O PLASTIC ❑ OTHER
LENGTH BELOW GRADE —-- ft..
JOINTS: ❑ WELDED THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ENTONITE 0 OTN
WEIGHT
PER FOOT 19—,lib—/ft—
DRIVE SHOE YES ❑ NO LINER: DYES NO
SCR 'EN
DETA LS
OIAMETE n .
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
EVELOPEI)Z
FIRS
O YES t7,N0 -
HOURS
ONO.
GRAVEL
❑YES
• NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST ' If detailed pumping
t
MEJi00: O PUMPED tests were done is in-
t
COMPRESSED AIR , formation attached?
O'BAILED O OTHER ; ❑ YES ❑ NO
�IELL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE.
water
Bear-
In9
Well
oia
peter
FORMATION DESCRIPTION
cDDE
tt
It
WELL DEPTH
1t.
DURATION
hr. min.
DRAWOOWN .
ft.
YIELD
gFm.
Surface
f
4
^
WATER 11CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES ONO
STORAGE TANK: TYPE
CAPACITY GATT. a
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WEALIIE („11rA� &SONS, INC. DATE P°
ADDRESS Well Drilling SIGOATURE
Rte. 311 R.R. 2 Box 171A 744��_
PATTERSON, NEW YORK 12563
of v-7
Ad1hk
NORTH AMERICAN
LABORATORIES, INC.
ANALYSIS DATA SHEET
COUNTY: Putnam
LOCATION: Bell residence
REPORT TO: Peter Bell
ADDRESS: River Road
CITY, STATE, ZIP: Patterson, NY 12563
DATE COLLECTED: 12 -11 -92
TIME COLLECTED: 11:15
COLLECTED BY: Client
REPORT DATE: 12 -14 -92
SAMPLE: DW 9367
SAMPLE- SOURCE:- Well tank -
DATE
ANALYSIS RESULT UNITS METHOD ANALYZED
Total Coliform Absent COLILERT 12 -11 -92
THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET
THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS.
v
atory Director
NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218
618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914-278-7600 / FAX 914- 278 -7754
PUTNAM COURN DEPAR'IMMr OF iLFd3LTfi
DIVISION OF ENVIRO -N-WAL HEALTH SERVICES
Peter & Laura Bell
Owner or Purchaser of Building Section. Block Lot
Owner
Building Constructed by
River Road
Location - Street
T. Patterson
Municipality
Frame
Building Type
Subdivision Name
Subdivision Lot #
GUARANI OF SUBSURFACE SE AGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and dirainage'of the'sewage disposal system
serving the above described property, and that it has been constructed as shawr 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 ayste�n, except where the failure --to- operate- properly. -is
caused. by the willful or negligent act Qf the occupant of the building ptilizi*
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 of not the failure of the system t:n
caused by the willful or negligent act of the occupant he'buiildiny
the system.
Dated this 18 day of Dec. 1992 Signature'
f
Title C�y iL
GQa (Owner) - Si nature
Corporation Name (if Corp.)
poi wAe_n.C;?_ pca�c
,Address '
rev. 9/85
®lam A
Corporation Name (if Corp.)
ess
ci� 4t l6o
aii approval "Of, t"
cowtv'C"imftim." of Mollie
-
oa A,PPR,8V6 oowcO"STLAW
rewoi6fo for cawas.,or
90
sinned
souk" a new Aw It Appoved for dislociii of 4i41446C.
Rev.
ti
kv :the pPriod'o f I onoidlately:lpt"Ing
thodate of the SNP
M"l."syst"n'.6F..any relia" t6weto; 2)� that the &1116111111 *01 • 6890 OW a6W40
accordance :wlth the 'd foo4 mg. 'rule ad iequSTOWs of t
Putnam
P.F
29206L
'N�y o 5 l"nu NO-=
f t
It* .issued unless construction a he bUilding has been undertaken and is
Plialth. Any change of of,constrtiction
OM Of_ as
only.
!:d iii hial "Yo
Title /V &
q1q= M TRW AdR
.`Patterson
A :River Road.
13
Peter, & Laura Bell
t -1
Dade at PtsvMo �APpaoval
Jntdrq�dle',Ave..
mh -Y
whii�e't:'_", la' s ',N 10603
-77m 777`w
Datp. Subd ipi
Fee,En'dlo6edLJ -Ainniint-
%
-70 A6re.'
Frame_:�, 2, 0 s-
74
Four Dooks F10*13 P D 800.
77.
PCHD NoMoodaut In Requilind Wbm FM in emoloded
250 444 Lin,
Sqp&dft Smw Symmim waimm d 1 �i- SON& Tmk,S§A—
:oi 'i -hes
Ft Vide txeng
Pat ,Tyndall
Brewster,
wasoF Saa�l+i Petite. Far Adiew!
P:_ Box '"B", Brewster,, NY 10.509
Ott L.aw None Y:
_
iiiinaild location of the .'pi600ftd'sy# S); 1) that the siparate. d
.. WWI I,
ndimis as
abq*o dew ar-7 re nam
ft" will bostowistructed as ihimin on there to inoi.ii accordance With the Sta .rul umfoons of
ci� 4t l6o
aii approval "Of, t"
cowtv'C"imftim." of Mollie
-
oa A,PPR,8V6 oowcO"STLAW
rewoi6fo for cawas.,or
90
sinned
souk" a new Aw It Appoved for dislociii of 4i41446C.
Rev.
ti
kv :the pPriod'o f I onoidlately:lpt"Ing
thodate of the SNP
M"l."syst"n'.6F..any relia" t6weto; 2)� that the &1116111111 *01 • 6890 OW a6W40
accordance :wlth the 'd foo4 mg. 'rule ad iequSTOWs of t
Putnam
P.F
29206L
'N�y o 5 l"nu NO-=
f t
It* .issued unless construction a he bUilding has been undertaken and is
Plialth. Any change of of,constrtiction
OM Of_ as
only.
!:d iii hial "Yo
Title /V &
... � ^,^�`R�'t'u .n;:'S�'. ,- a._j "�°«,���'- a'.- `�"m�'".•:x- a�ts,y { a� t Y,r - ".,.�?':"3.. i �-�n
' (��!7 � PUTNAM COUNTY :DEPARTII'IENT OF�HEALTH � °,y s �Y:� s
� -, DIvb1 Caemel. N Y:10511 ;.. ,Eia�teer to ProvldePermlt q
on'of Environmental Health Servlcee ATE 0
CO UGTION PERMR FOH SEWAGE DLSPOSAI SYSTE(Yl
T •Patterson .r u
'a R;> yer ?Road trn mega
To or V
S on Niiiie x ... — did Lot q s Ta:
- Peter & Laura Bell 'Re>,ew.1_❑ `8evhlbn O
• Owner /AppUcant Naime - _ ,
,--s 7 ; Date
of Prevb APpro al
Msllling,Addrese„ 9, Intervals Ave Town N, White Plains, 'NYC :10603
B� Type Frame Area 2,-M Acres Section Oril
y
Nmnbor of Bedrooms "Four Design Flow G P D' 840: PCHD NoH6catlon Ia xegaleed,When FlDolsoompleted
Separate Se!V r System oo,conelet of 1250 Gabon d Tank "d_ 444 Li . Ft of 2:
ft - -Vl a trenches
" ; f Tope �conetesict«Iby Pat Tyndall ilddteaa Maple D•r` Br:ewster, NY" 10'5. 0
t Water SnPPII Paibllc Supply From Addrose
fr it X Private }Su vii - �darese P 0 Box B,;. Brewster,:NY V 09
4
p DeIU
by P F Beal';& Sori
Ofhai �R
None arratremonte
�' , -' 1 repreaentnthat -l;,am wholly MR, eey raspOnsiDls for tno tles�gn and location of thO proposbd syrtem(s) �1) :that the .separate sewage' d posal System
above0escnbetl. will�beconstructed as showh on theaDProved amendment thereao and in5ccordarice wdn;t�a standards rules an regu lotions o.: e.; u ham
: County?n apartment of 'Health',rintl that on eompletwn "thereof ay Ce t�fi...... t Construction Compliance! satisfactory to:the Corrimissloner`:of Healthwill
Ms
"F be wtimdtetl to3rthe Departmen ;, and s vJritten guarantee will be, furnished the owner,,his, successors, heirs or assigns byatie builder,;that- said'builda lFrill
�> place n good- operating condition any �peit of said sewage disposal .system .during tAe_ Pei iod.of two (2) °Years.immediately'followin' the date of, the isw-
ance of the approval of the Certificate of Construction Complutnce _.of the original system on any, repsirs thereto; 2) that the drllle<i well.descrit►ed above
will De located as shown on the approved plan sntl that said well will be Installed i ccordines with the stag rules and.,iegu RTons of the ,Putnam
County Department "of Health '
Date w 17 November x198'8 s�gnetl / P E 1: A. -
RD:9 Fair St . =, Carn NY 10512 ` 29206
Addratt license No
APPRQVEO FOR CONSTRUCTION Th�s:epprovsl expnes two years from he date Issued unloss`:construcbon of the Du�Itlmg has been undertaken „and is
revout le /Or. tAUSe or maY tie amended or.motlified when considered necessar .b he.'Commissioner of .Health An change of alteration of construction
Y { . Y...�,- Y e9
mit
rsOUires a no per -Ap ro //v��e•_A to►,d�sposal ot.:domestlrsandary sewage ,_and /or.'pi,iv ppF _ .
c
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO '-eONSTRUCT A `WATER WELL
PCHD PERMIT
WELL LOCATION
Street Address
River Road
Town/Village/City Tax Grid Number
T. Patterson 81 -1 -13
WELL OWNER
Name Mailing Address di Private
Peter & Laura Bell 9 Intervale Ave, N. White Plains, NY 10603 O Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY QAIR /COND /HEAT PUMP OABANDONED
O FARM O TEST /OBSERVATION []OTHER (specify,
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT
Five gpm /# PEOPLE SERVED eight/EST. OF DAILY USAGE 800 gal
REASON FOR
DRILLING
GNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
Residential
Supply
WELL TYPE
XODRILLED
DRIVEN
ODUG
GRAVEL OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name P.F. Beal & Sons Address:P.O. Box B, Brewster, NY
0509
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
NAME OF PUBLIC WATER SUPPLY:
YES _Z__NO
TOWN /VIL /CITY
'DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: "
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See Dwg., Job #S.O. 2486, BY John H. Prentiss
O ON REAR OF THIS APPLICATION 00 SEPARATE SH_W P.E.)
17 November 1988
(date) (sign to e)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health Department. �-
Date of Issue: / 19 /
Date of Expiration: 19 e icia
Whi
Permit is Non - Transferrable 1 copy: H. D. File
Yell Buildin t�or
ow copy. g Inspec
Pink Copy: Owner
287 Orange copy: Well Driller
APPLY B
PUTINA_+! C: L'NrY DEPaMMI W OF HEALTH — DIVISICN OF 2NVIRCMENML HEALTH SERVI(JS
PI D=[1P_L WA= S`JPDLY & SUB- gMFACr Sc`T�vtA=- -- DISrCE;,L SISTEm-S .
Sr3Ey'I' - - - ......_
CONSTRD PF.'D,M _
/ _ -. -0 DATE RS7V=,vr :
r�y v x BY:
(Name of C,,vne_Y) (S�:reet Location)
c� ors i •
I NO
I
I
4�
I
I
I
I
7////
- I
LL tre.^_c1 prCV_cec
rwu_rad I -+--
'Et.
60 =_
Par`' lei to contours I
100% I
-- I
1
I �—
fi-
.
��
i
I
_
r'= S STEMS
clavEarrier
10 f
fill notes I
ne v
deotn cauces I `
100 yr. flood elev
200 ft. reservoir, etc.
150 ft. tric=_11 /call.
�
1
/1'
0
DCC'LRX-P4=
Pennit Fmolication
Corporate Resolution
Plans - Thrc= sets s/s
Engineers Aut- horizati cn
Design Date Sheet (DC-)
Deer Hole Lcc p _
Consistent Perc Res, i _s (3) --F'
perc Sole Depth c"
House Plans - Two sets
Fe_rmit; Pi�� ?et�er
Variance once Rues t
IAL
L&_-al S:'tci.vi sicn
Surcivisicn Aoeroval C :eckad
Ex -a_ crcval SSOS Pd=
Yutaam County Department' of liealt,.
Q, ¢3` a4rielon of jbivirplimental Health ft, ;.
p
8g, 1 proved as noted for oonformanoo wit).
,pplicable Rules and Regulation of the
'utnam County Health Department.
C9 o
90-11
41 0' ks
o" 391
0 �S
STy �. m
o
POP vgrvEwaY Z\
"AS BUILT" DATA.
Structure located from survey by surveyor no,�tt,e((d below
ell located by: Surveyors survey.- -_ad- -_ - -_
Well -drlllersreport -- .1 -
Engineer's mesurementan -_
Tank, bakes, pits, galleries 8 laterals Io•coled by: Contractor:
Engineers
Health dapt:
Fleld InsVettlon.by: Health dept ® s dot e:- —JL91 -
Enganeer ® date
This is to certify-that the seva;
dieposal system was conatructed..
NOTES: indicated on this plan and that i
systea was inspected by me befor-
was covered over: The sys�e:A via:
constcucted;(n accordance Uith a'
dtandard rules and regulatione'o.
the P.C.11.1)?•6 the N.Y.S.P.H.
4" C.2. �" PE 5�PRfN
\fir`s A _ B 24_3__
A �y ,�•.., X86 A- C y 5' =Q e - --
\ v 1250 CAI , ff 6CASI' � �
CONC. SE�(C �/a N K \�� �:� A - O •1�_�?;:_9 D •_i��i2�_' G
uSoLIp \' '� � F A - F -012 -B - F °1.11 /- -='�-- a 0. 292C,
�vl P,P� ?s A - e •LZ� :e - o •�i _4— 0F THE STPt
\� ` >91 A H qii B _ H ■1_79
A - L _ 'L74'- 0•. �_ -
r-.p S \ \ YS r
lj� R� !- AjEKALS V -o" p•c• \ \ \ \\ �yy �e ;q ` ' kt,
TAL) A L,l �Np,- "��� s3�o
\� Ca�PD, �� . �,y se >34a NI S S DESIGN U L,
eCoo OWNER _ i 1` -L- 6 - iG �l L
\4 2 9 2 LOCATION ��
9
99.0 "h Town:2AIIJ c &7L& -County:-euli--� &\ State:
S_� 4 SUBDIVISION'
,20�t1 i\ RiGN c�SS�oY LOT N
Buiilder:��L�(�f'c�i_— -s -
3 -- -
�o Survey or:
/D�J- YJ`l�, -
�� 5� �q Drawn: Date; Scale: ,: Jo N=
Sit Y A• M. i2 i It' �. . 2
Wg
ny ^^ JOHN H, PR ENTISS�� P—E,
CONSULTING ENGINEER
di
�L
1
Ll
VIRED TO BE SUBMITTED WITH APPLICATION
OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. 7/ HOLE Al O.
G.L. -
! jY
1' ®073 i (b- ►4- ►-� t c— S ,
2' iVl c D hM LA-1
3'
4'
5'
6'.
7'
8'
9'
10'
11'
12'
Go k.S �S1'�i�e - -T TtD
13'
14'
__ INDICATE LEVEL AT WHICH GROUNDRATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used (`) Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms _ Septic Tank Capacity gals.* Type /
Absorption Area Provided By L.P. x 24" width trench
Other doFE,SS10N4�
F..
Al
Name
V ho(,
JOHN N. PRENTISS, P.E.
Address
R09 FAIR ST 914- 878 -6170
GARMEL, NEW YORK MHE
2 �
No 29�Ob
OF SEO
THIS SPACE FOR USE BY HEALTH DEPT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
DESIGN TA. SHEET- SUBSUFACE SENAGE DISPOSAL SYSTEM FILE NO.
Owner . 9 i ,( LU ro �____ Address
Located at (Street)_ 1 Q r' �R�c 12-� Sec. Block _(_ Lot
(indicate nearest cross street- _
A
Municipality ` �= Qs� U Watershed
SOIL PERCOLATION TEST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking / 0// Date of Percolation Test
HOLE
NLEBER CLOCK
TIME
PERCOLATION
2
PE ROOLATION
Run
No.
Start -Stop
Elapse
Time
Min.
Depth to Water From
Ground Surface
Start Stop
Inches Inches
Water Level.
In Inches
Drop In'
Inches
Soil-Rate
Min /In Drop
1
q - 9o43
4 919- low
l.7
3
-
2
JOJ - q �7
►
y3
z
4
9yy-looz
G
z-3
5
cool- jy �
1
2. -
4
5
4f
2
3 93/ - 9u9
/6
Z
4 919- low
l.7
-
5 PC& -/o ,�-q
NOTES: 1. Tests to be'repeatad at-same`'depth until approximately equal soil rates
are obtained- at A*ch::= percolation test hole. All data to' be submitted
for review. —
2. Depth measurements to be made from top of hole.
rev. 9/95