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BOX 18
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02031
PUTNAM COUNTY DEPARTMENTQQ OF HEALTH'
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Division of Environs sntal Hpulth Services Carmel N. Y.'10512 Permit r "" v
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE' DISPOSAL SYSTEM Town of Patterson
Town or Village
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Located at Tax Map Block
Owne ►C• Worsham / Formerly Tax Map Lot t 6 subs. Lot a 12 5 4 - 1 758
Separate Sewerage System built by John Bertrum Address Brewster, NY
Consisting of 1000 Gal. Septic Tank and 60LF of 4 x 4 x 4 Galleries
Other requirements
Water Supply: Public Supply From
xx private Supply Drilled By P.F. Beal
Address Brew-Starr NY 10 50 9
Building Type One Fama Res. No. of Bedrooms 33 Date Permit Issued 3/12/85.
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving the above premises were constructed essentially hown on the plans of the completed work (copies
of which are attached), and in accordance with the standards, rules and re ions, in accord c �ith the filed �, and the permit issued by the
Putnam County Department Of Health. 1
Date 8/1/85 Certified by P.E. R.A.xx .
Address Muscoot No. RFD 2 48 Maho ac N.Y 0541 al No. 11056
Any person occupying premises served by the above system(s) shall promptly torte Such SCIon as may be necessary to secure the dlrrection of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall ffecome null and void as soon as a public sanitary "wer,' 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 o(rmodification or change when, in the judgment of the, Co issioner of Health, such r t n, modiflution or change Is necessary.
Date v r By �� Title
Rev. 9 -81
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.; . j. - Box 224 = BREWSTER,` N.Y.
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u (914) 225.2072
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. —, WATER ANALYSIS REPORT
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SAMPLE NO 5.870
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souRCE Craig- Worsham Hose Bibb :- Well
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Rhinecliff .Rd'
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.COLLECTED: July � 29, 1985 "_
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1. BY P. F. Beal & Sons'znc.
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'BACTERIOLOGICAL EXAMINATION...
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• . Coliform `Count, MF Method 0
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- This result indicates the source of the sample was
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of satisfactory sanitary quality when the sample :was collected
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.. August 1.1985
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PUTNAM COUNTY DEPARTMENT . OF HEALTH
DIVISION OF-EPNIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE Sg-,AGE DISPOSAL SYSTEM FILE NO.
Owner Craig Worsham Address 145 Rectory St. Portchester,NY 10573,`
Cameron &
Located at (Street �Indicate R i Sec. 29 Block, Lot 6
nearest cross s ree )
Municipality Town of Patterson Watershed New y6t it-_y
SOIL PERCOLATION TEST DATA REQUIRED TO BE-SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Eiapse. 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
PTH 11 8:02 -8:14 12 48 51 3 12/314
2 R- 15_R -97 12 48 51 3 12/3 =4
3 8:28 -8:40 12 48 51 3 12/3 =4
4 8:41 -8:53 12 48 .51 3 12/3 =4
PTH 21 8:07 -8:19 12 48 51 3 . 12/3 =4
2 8:20 -8:32 12 48 51 3 12/3 1-4
_ ..... 3 8`: 33 -8 :45 ._..,.....- 12�-- _- ___ - - - - -- 48- . _ ___..._ =5�. � . _.. -. - - � - . - - - 1. 273.;1-- �--- ._. —_ - -- _�_• -._
4 8:46 -8:58 12 48 51 3 .12/3 =4
5
1
2
3
4
Notes: 1) Tests to be repeated at same depth until approximately equal so-11
rates are obtained at each percolation test hole. All data to be submit-zed
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED'TO BE SUBMITTED WITH APPLICATION..
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO.
G.L. Tnn fini 1 Tnp So 7
6" Sand & Stones Sand &'Stones
11
12"
If
18"
2411
3
42"
48" of
5411 of
If
66"
12" if
7
8411. "
1-2011 11
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTEREDNONE
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NONE
TESTS MADE BY Ray Carter Date .10/31/84
DESIGN
Soil Rate Used 0-5 Min/1 "Drop : S.D. Usable 'Area. Provided 5 00 0 SF
No. of Bedrooms 3 Septic Tank Capacity 1000 Gals.:. Type
Absorption Area Provided By L.F.x24" Width tr 1�11 -- 'A
Oth
(2) 1OFt. Diam. x 8Ft.. Deep precast concrete 1 a' ha n
Name Joel L. Greenberg Sig na ure"t
� � � U • • \ • ► 1 C i . � i i
Mahn]Qac \Y
• 628-b613
THIS .SPACE FOR USE BY HEALTH DEPARTM-71qT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by
Date