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BOX 19
02142
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02142
tNb 1 RE;ER MUS �.
.f PUTNAM COUNTY DEPARTMEN7I' OF HEALTH PROVIDE
MJ� Division of Enviro'nmentO Hqa i i
h I PERMIT # PV,29 -86
CERTIFICATE OF NSTRUCTION COMPLIANCE .FOR SEWAGE DISPOSAL .SYSTEM Putnam Valle
:Town or`:Village' ,•,
�.y ova ea ai .<N6rth` R ehaxdsville� Ri ad:._ .._ ,..•�aX yap x,4 ke>o�k
owner Keileher' ,Formerly Taz Map Lot `N i5 15 $ub8: Lot Y 16
Separate Sewerage 'System .built by .: Excavators... Add ►ess'6N NlaYiopac, NY 10541
Consisting of 1000 Gal. septic Tank and 350 �LF of 2' 'wide trench
oche. requirements 21 ave ROB fill
Water Supply: Public Supply From
X PF Beal , and :Sons . Iric .
Private' Supply Drilled By _ .
Address PO Box B Brewster, .NY 106091 ,�)p)
Building Type 1 Family Residence No, of. Bedrooms 3 Date, Permit issued May. 15.:1986 LS
Ltd �
His Er: control Been Completed? Yes Has garbage grinder been installed? NO jJ)lN� a {il }Ly'�s�•'i1Jj
ALL
nN3
I certify that the system(s) as listed sere ng the above premises were constructed essentially as shown on 'the plans of the completed 03 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 ��
Certified tiY P,E. X , R.A,
Add ►e :, Cashin Associates. . R- C. Rt :5 Carmel; NY 10512 ',26008
Any person occupying'premises'seryed by the .above syAem(s) shall pror
conditions resulting 'from such usage. Approval of the :se`parata sewe
avallable. and the approval of the private water supply shill become nul
subject to, modification or chsnye when, in the judgment of'tfie'Con
Date _ BY
Rev. 6/85 -
License No.
tly take such action as may tie necessary to secure the correction of any unsanitary
le system shall become nuifin'd void as soon as a public satnitary sewer becomes
nd yold when,a 'public water supply bes available. Such ipprovals are
iissioner of Ne "h, such revocation, modification or change is necessary.
Ki"IMIOMM
G1
Box 224 - BREWSTER, N.Y.
(91 4) 225.2072
SAMPLE NO. 6489
C16
G�
, r,
SOURCE: John P. Kelleher
hooze
b bb - well
N. Richardsville Rd.
Carmel, NY
-0
, r-M
COLLECTED: March 8, 1987
BY: P.F.Beal & Sons, Inc.
p
:�
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
March 12, 1987
Roy Bickwit P.E.
Director
Uri
--baj;i
,= r1l C-)
_4 X rri
77
Wz1jij UVririjr1LLV" L11ULWL%.L _V
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
-Y
.K Of fice Use Only
.
WELL LOCATION
'STREET AOURESS: TAX GRID NUMBER:-
North Richardsville Rd. Putnam Valley,NY
WELL OWNER
NAME: ADDRESS:
John Kelleher, 315 Willow Rd _. Maho-pac, NY 10 41
C3 PBIVATE
0 PUBLIC
USE OF WELL
1 - primary
2 - secondary
I.N RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED 0
BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY
AMOUNT OF USE
YIELD SOUGHT 5 gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON- FOR.
DRILLING
[3 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0 TESVOBScRVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 180 ft.
STATIC WATER LEVEL 30 __.ft.1
DATE MEASURED 1/26/87
GRILLING
EQUIPMENT
ff ROTARY UCOMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING, FLI OPEN HOLE IN BEDROCK O'OTHER
CASING'
DETAILS AILZi
. TOTAL LENGTH - 22 ft.
MATERIALS: :0 STEEL O'PLASTIC 0 OTHER
LENGTH.BELOW GRADE 21 fL
JOINTS:. . ❑ WELDED :KI THREADED 0 OTHER
. DIAMETER 6 in.
SEAL: 19 CEMENT GROUT 0 BENTONITE 0 OTHER
7
WEIGHT
PER FOOT i _q. lb./ft.
DRIVE SHOE. EI YES ❑ NO
LINER: 0 YES 13 NO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELOPED?
DETAILS.
FIRST
ONO
HOURS
SECOND
,.OYES-
GRAVEL PACK
❑ YES
0 NO
GRAVEL
SIZE-.
DIAMETER
OF PACK --in. 10
TOP
OE
DEPTH —ft.
BOTTOM
DEPTH — It.
WELL YIELD - TEST It detailed pumping
METHOD: IS PUMPED i tests were done is in-
❑ COMPRESSED AIR ', formation attached?
0 BAILED ❑ OTHER :OYES ONO
VELL LOG
It more detailed formation descriptions or sieve analyses
are available, please attach
DEPTH FROM
SURFACE
Water
Bear-
ing .
Well
Dia-
Mete
In rl
FORMATION DESCRIPTION
CODE
—
it.
I
WELL DEPTH
ft.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
9pM.
Land
s,jace
B it
at 3'
180
6
16o
10+
11
22
.
-rock
iii-rock.set casing,zrouo�p�
22
180
Dr-,11ing.
in rock granite.
WATER ❑ CLEAR TEMP.
M�_
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED?. OYES, ONO
ANALYSIS ATTACHED? 0 YES ❑ NO
STORAGE TANK: TYPE
CAPACITY- 5kL-,� z
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
— DEPTH —
VOLTAGE — lip
WELL DRILLER NAME P.F. Beal & soins n c/6
ADDRESS . Pb Box B P2, �8
5:1Gf1ft
Brewster,NY 10500 , A
9�
L
r�
Owner or-Purchaser of Building Section
I` s - - -- . __ .... . .. _b:_� . _s__ ~lock _ ...._....� . _. u ..
.,. .. - rB*,3•� l d•irn C orr s � r-ud t e d� b . • .:. ; _. � •....... - < ..:� .: I „ <.... �- . .._. .
Location - Street Lot
PJn am Qnjle y k
Municipality Subdivision Name
ran i 4 ce. 15-
Building Type Subdv. Lot .#
GUARANTEE 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 guarantee to the owner, his success-
ors, 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 determin-
ation of the• Director of the Division of Environmental-Heaath Services. •. r,
of the Putnam County 'Department of Health las to whether or not the fail
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the-system.
Dated this 6 day of 19 9-7 Signature
Title A- c S,
/V6R b/i
Corporation Name if Corp.
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, Putnam County Department of Health
-_•�-- - :n-^�-- r-n,, "- a-- �'T"ti--- ++: <.� --•. ---a. ++r,.:-?;?:e-- .^^.'+. _ r.°,,,5•:. ".4s -�T.a -+rr — "--•^._c' .°'qes' r
I PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVID.E.PERMIT #
41 �V •; ON CERT� FIC- E F 0 IA C
Division of. Environmental' Hea_., l Services, Carmel N Y 10512 RERMIT _
CONSTRUCT N PERMIT FOR "SWAGE DISPOSAL SYSTEM Toian i nam
i- LacteQveU.. r village
_g ' e
1 o Py
0 4 t i
. Nox lle•Road h Rtchrds s
e. .. .,
Subdivision
FOT eSt Park. Silbd. Lot 8 15 Renewal .0i Revision ❑
c/o H: Fu�' TAttnV Carmel, New York Date Of Previous A roval
Owner /Address / r � l•- 1 ' - T PP ,
Building Type 1 fam•greS� Lot Area ��++T31T1•tZS ac Fill Section only, 0
Number of Bedrooms ..'3` Design Flow'G /P /D 60.0 GPL P.C. H. D.,Notificstion Required-"
' 1000 333. L.F..2',wide. trench
Separate' Sewerage System to consist of Gal Septic Tank antl, -
To be, constructed by to be determined Address
.Water Supply: Public Supply From
X Private Supply to_ be drilled by to be " determined ;
Address
Other Requirements 2' average ROB-Fill ( I's0 to 200 required.)
I represent that) "am wholly and completely responsible for the design and location of the .proposed system(s); 1) that the separate "sewage disposal system
.. abo4e'described will be constructed as shown on the approvediamendment there to and in accordance with the standards, rules and regu a wns o e Putnam
County •Department •of,; H'ealth,' and that on. completion tliareof'a';GerUficgte. "of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to he 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 Imntedlately followirig•thedate of the issu-
ance of the approval of :;the. t7vU4i ate of Construction Compliance of the origihel _system or -any repairs thereto; 2j,that the drilled :well described above
will be' located ai shown on the approved planand that said well will De- installed -.in accordance with .the ifantlards, rule and -regu aeons; • of .the Putnam
County Depa`r/t men t of Health,
'Date — a Signed �?'�'c''-�: •, P.Ec —;R.A.
Ada ►BSS Casten Associates P:C: 37.:Fair .Carmel N:Y:,I_Icense No. 2
b,008
.APPROVED FOR CONSTRUCTION `This approval expires one yeas; from the data Issued unless. construction of the building has been undertaken and Is
revocable for cause or .may.be "amended or modified when considered . necessary by,the Commissioner of Health. Any change or alteration of construction
regwres a new permit. Apppro/'ved for disposal of domestic sandary sewaq; and/ o pri 4e . far su pply only. AA
Date �`� 4-1 1710 By Title
Rev. .6/85
i
APPENDIX C
FINAL SITE INSPECTION
LOCATION f OWNER
Date I I'
Inspected
Z-F
'924 OR SUBDIVISION 6 "LOT #
YESI Nd COMMENTS
SEWAGE DISPOSAL AREA
a. 'SDS area located as per approved plan��
b. Fill section - Dat of placement J-el &-t)
2: 1 barrier C WTH WIDTH AVG.DPTH,#
c. Natural soil not 9tripped..
d--. Stone, brush, etc., reater than 15' from SDS area.
e< 100 ft. fran water course/wetlands.
I. SEWAGE DISPOSAL SYSTEM
. a. Septic tank size 1,000,) 1,250
b. Septic tank installed-revel
c. 101 minimum fran foundation
do No 900 bends, cleanout within 10 ft. of 450 bend
e. DISTRIBUTION BOX
1. All outlets at same elevation water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX -_pro
]?axly set
,go TRENCHES
1. Length required - Length installed'
w
2. Distance to watercourse measured: ft.
3. Instal-led according to plan
A-
.4. Distance center to center
5. Slope- of trench acceptable 1/16 1/32 "/foot.
6. 10 feet fran property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for expansion? 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of.gravel'in trench 12" minimum
ipe
11.- -P en s d
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber .
....... -1
2. overflow tank
3. Alarm, visual/audio
4. P=p easily accessible manhole to grade
5. First box baffled
6. 9cle witnessed by Health Dej tment
estimated flow per cycle
V. HOUSE
a. House located per approved plans.
b. Number of bedrocms
WELL
a. Well located as per approved Plans
b. Distance fran SDS area measured ft.
c. Casin 1811 above grade.
do Surface drainage around well acceptable.
'I. OVERALL WOPJQdASHIP
a. Boxes properly grouted
b. All pipes partially backfilled
c. All pipes flush with inside of box
do Backfill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir-to exist.watercours
go Footing drains discharge a:;Wa�yran SDS area
b. Surface 'water Protection ad to
i. Erosion controi provided on slopes greater than 15%.
PU=M CCUMY DEPARU4ENT.
DESIGN DATA SH,k' rSUB.SUFACZ . SFWAGE DISPOS7, -SYSTEM - L.....,. < FILE N0:
Owner � d �C7�! Address FoZOC6 CA LF Aj€W Y-0Ae.
WjCN4mVSV1,"4 Apo
Located at (Street) - (AgA -Z>jC, -MJA1W )e 0) Sec. �_ Block Lot'/-015
(in 'cate nearest cross street)
Municipality —mwpi <DF TtnWAA L � Watershed #0050,
SOIL, PERCO=ON TEST DATA REQUIRED TO BE SUBMITIZ) WITH APPLICATIONS
Date of Pre- Soaking
AQRACA A Date of Percolation Test
AU=4 Syr,-.
HOLE
5
2 1 Z9
NUMBER CLOCK TiME
PERCOLATION
A9
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
1. 0 �ol
2�5 t
2A
19
5
2 1 Z9
1 Z.35
0
A9
Zo
3
.3 12595
4 1 Z66
5 119
14?--
��
1
1. 0 �ol
2�5 t
2A
5
3 45
Zo
3
P7 '
4
5
1
2
3'
4 �..'.
ry
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are'- bbtained.at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
• TEST PIT DATA REQUIRED M BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO, HOLE NO.
G.L. -
1°
2°
3°
4°
5°
6°
7�
8'
9°
10°
11°
12°
13°
e
14°
INDMATH`MvEL AT WHICH GROUND&TER IS ENOOUNTEREI) `- _ oNl . .
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED A1046
DEEP HOLE OBSERVATIONS MADE BY: gor J"FAI DATE: 3/ MAjWN&b
DESIGN
Soil Rate Used B-10 Min /1" Drops S.D. Usable Area Provided 5000 51'
No. of Bedrocans 3 Septic Tank Capacity 1000
gals. Type f1�
Absorption Area Provided By 535 . L.F. x 24" width trench
Other z F9 905 FILL AW/Z Cl S0— G X /
Name ,3 r . r ASSOC44TeS r . - _ �ii�� �IA`�
Address SEAL
/! y
SPACE THIS • ° USE BY'HEALTH t ' • ° 6' ICI ' ONLY:
- -- - ----= �� -G�� -- - --
Soil.Rate Approved sq.ft/gal. Checked by Date
Purim COUNTY DEPAH<mm OF HEALTH - DIVISION OF mvnnmaim HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEK .SHEET - CONSTRUCTION PERMIT
1
i
BY
(Name of Owner) (treet Location)
W24ENTS YES NOI DOCUMENTS
c ennit Application
Corporate Resolution
Plans - Three sets
/ Engineers Authorization
f Design Data Sheet (DDS)'
i t Deep Hole Log
A
IL-L tl�
rmm-
RED -
Consistent Perc Results (3)
30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Swage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions. - Volume
D or Box- rench /Gallery; Pump pit details
peptic ank - Size, Detail
Well Detail, Service Line if over
✓onstruction' Notes
Design Data
Two -Foot Contours Existing & Proposed
driveway & Slopes Cut
/Footing /Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown;gravity flow,suff. size
- If._PumpeclvPit & D Box,..Sh6ki &' Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
1 100' to Stream, Watercourse, e (' )
15' to Drains- Curtain,Storm'&d' Doting
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' ___to to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
tland ( Town /DEC Permit R & D)
✓eta On DDS Plans & Permit Same
PUMAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL %AM SUPPLY SUBSURFACE SBU GE DISPOSAL SYSTEMS
FIELD INSPECTIM- REPORT = -=
DATE:
INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION 0 YES NO OBI'S
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. 1 Lot
Depth to G.W.
Depth to rock
Soil Descr' tii
0 ft.
3 ft.
9 ft. "
12 ft.
SAA
D. H. 2 Lot
Depth to G. W.
Depth to rock
Soil Descri t�
0 ft.
9 ft
D. H. - Deep Hole
G.W.- Groundwater
D. H. 3 Lot
Depth to G. W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
soil Descri
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.......,..
Roan allowed for expansion trenches ..............
Dver 100 ft. from 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 bedroons checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
frcan trench ..... ...............................
Boxes properly set... ..........................
:ould surface runoff fran driveway, roads,
ground surface, etc., channel near SDS area....
+
j
Does lot drainage appear OK in area of SDS....... (
FINAL GRADNG OF SITE ACCEPTABLE.. ...... ....
�—
.a
PUTNAM COUNTY DEPARTMENT OF'HEALTH
- -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES
f
Date AP. l4 9UUD
Re: Property of le. 4 FUg%/
Located at Af 91C 1T OS VQLLd 947AD &A<A
(T) F Section Block Lot.
Subdivision of PA
Subdv. Lot # Is Filed Map
Gentlemen:
This letter is to authorize Cashin Associates:
a duly licensed professional engineer or registered architect
(Indicate
.to apply for a Construction Permit for a.separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary.papers on my behalf in
connection with this matter and.to supervise the construction'of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigne
P.E., R.A.,
Address
Telephone
U
S
Town
Telephone
PUTNAM COUNTY DEPARTMENT OF'HEALTH
- -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES
f
Date AP. l4 9UUD
Re: Property of le. 4 FUg%/
Located at Af 91C 1T OS VQLLd 947AD &A<A
(T) F Section Block Lot.
Subdivision of PA
Subdv. Lot # Is Filed Map
Gentlemen:
This letter is to authorize Cashin Associates:
a duly licensed professional engineer or registered architect
(Indicate
.to apply for a Construction Permit for a.separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary.papers on my behalf in
connection with this matter and.to supervise the construction'of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigne
P.E., R.A.,
Address
Telephone
U
S
Town
Telephone
71
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