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03706
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~ PUTNAM COUNTY DEPA {RTMENTx OF HEALTHx
Divisron of Environmental Hea %th SerJices, Cam% N Y 1'0512 fi; ,�1 r
,QERJEU;AT9: QF ;!_ ON$TRUQ,TIOIq. GQMPLJANCJ ,FOR SEWAGE ,DlSP.OSAE. SYSTtm n,
r - t Y Town or :,Village :.
Located it A N section <06 9 Block e:2
P�Tn/,9e'! AC,eES live
Owner Lott_ p JOb t
Separate Sewerage System built.'by r� ,EX.CR�A %nib'
T Address
Coris�stmg gf �� Gal- Sept�c'.Tank -3Z lineal Feet :X width trench -
r
r ,`'
T, t; her requiements NO N 6
Watert.Supply PublicSuPPIy 'From.
/Yi 4
_ <Prwate' Supply Drilled BY /��� A A/ A N fj EIS ar✓ BA�eGGr' SY �!/T�✓�f /N A /�P��.
r
g
Address
Building Type �.Rr 3�d /PQN Ch No. of Bedrooms Date Permit Issued
` x GrrfdPC�
Has Erosion Control Beeri Completed?
i x 3L
�Y certify that the Oyster (sj as listed serving the above premises were constructed essentially as 'shown.- ori`the plaris of the;corTmpleted work, co ies :,of which ara
i
x r, P
attached); antl m, accordance with the standards .rules and regulations plans filed and the permit issued by= the Putnam County ,Department of Health
Date P E _1 R A. E
Address _� �%% /Y Lyt°/ F�/ O/'': /�'1 �Z�CJ I
.License. No ,l
Any person occupying premises served by :the above systems) snallpromptly take such action "as may be necessary to secure the correction of any unsanitary. i
•conditioris ,resulting from such usage ,;Approval of.the`sepa� ate sewerage- system'shall diecome null and void as soon as a public sanitary. sewer becomes s
available and the approval, of the =private 'water !supply shall become null and void ,when a., public ,water supply becomes available.. ' Such I subject-10
modification or change when,: .an the judgment' of the;.Commisswner of• Ith : <suc revocation'`modification br ",change is necessary '-.approvals Is are ..'
Date, / T d le
- sY
eti C'
VXLL `COMPeETION REPORT PUT19APA COUNTY Di! :PARTMENT OF HEALTH
3/11 Division. of Environmental Health Services
COUNTY OFFICE BUILDING : CARMEL, NEW YORK
This report is to be completed by Well driller and sul�;,iitted to County Health Department together With laboratory report of
eriaiysis-of Water sample indic- atirig-w8tiw,is-of sa is�actary bacteria,`quality� before certificate.of Corstructicn compliance is issued:
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME o Mn
nam cres
ADDRESS
Partridge Lane
F
Lof » °LI
(No. 6 SVest) (Town)
PARTRIWE LANE, PUTNAM VALLEY, N.Y. 10579
(Lot Number)
PROPOSED
USE OF
WELL
® DOMESTIC
SUPPLY
BUSINESS
ESTABLISHMENT
INDUSTRIAL
FARM
CONDITIONING
TEST WELL
(Specif )
DRILLING 7d
EQUIPMENT
ROTARY
A R PERCUSSION
PERCUSSION
a OTHER )
CASING
DETAILS
LENGTH (feet) TO—
68'
IAMETEPonches)
6"
WEIGHT PER FOOT
15
® THREADED ❑ WELDED
DRIVE SHOE
YES ❑ NO
WAS CASING ROUirl3-
1� YES � NO
YIELD
TEST
BAILED
HOURS
PUMPED ® COMPRESSED AIR 7+
G.P.M.
8
YIELD (G.P.M.)
8
WATER
LEVEL
FROM LAND SURFACE— STATIC (Specl /y feet)
7y
DURING YIELD TEST !feet)
Depth of Completed Well
in feet below Land surface: 170'
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet)
100090
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
L
Sketch exact location of well with distances, to at least
Iwo permanorl landmarks.
FEET to rIET
1'
58'
overburden
58'
170'
bedrock granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WEIL
7/10/74
DATE OF REPORT ]WELL
1
D ER (Sxnatuyo)
ti
TOWTT OF PUTNAM VALLEY
. i v- � o:... ... ,,;. ..: .. .. ....:. . y. as :. -,.1- .: +• �. - . . . ... � -,- ...� _. .. ....:. < ..... v . �- y.... - .: ... _ .. .. ..r'a. _.... r,.. �,w ^. � a .., . .. -'
VTLLL DRILLERS LOG AND REPORT
WELL LO ^1�'TION P_U_TNAM ACRES, BARGER ST. _
street section block lot
':dEL 1- (' "TER
_ name address. city or town
izL ANDERSON WELL DRILLING R.D. #3 PUTNAM 'ALLEY, N.Y. 10579.
narric address city or town
bailea. Uleasure Irom 1 ci surrace)
Le_10 681 feet . or
# _Pumped 7-+Hrs. Static _ft Make:
When Bailed lot
_._6" _ Inches 8 GPM or Pum e: ft Length Ft.:�ize
TT
steel I Diameter In
,JT AL DEPT1E OF 'IWELL 170' Feet f
�Depth from 'Give description of formation penetrated, such as: peat, -
krround Surface 'silt, sand, gravel, clay, hardpan, shale, sandstone,
ranite, etc. Include siza of gravel(diameter and sand
fine, medium, course), color of material, structure
(Loose, packed, cemented, soft, hard).(Ex. Oft.to 27 ft,
__ fine��acked,. ellow sar.d, : 27. ft to 134 ft gray granite) —,
_ � %µ�1�c:� rf fi:_� �. 'o niati_' n Descri- tion Skotch exact location of well to
11 w 58' overburden overb at least two p ermenant Landman ks;
". v ...tea .
581 1701 bedrock granite l
Late .�Jel 1. Cola. pi.eted__- ___�_l /lU /74 Date of Report
Wel'_ Driller_
signature
.. C1�;rLer or 1':.�z•ciia;, >cst��oi' ,:;ui.La�.ri ._ _...... i.._�___ __.{
G J_ i-al i `. �'.
/� V�7 /W /i.�� rr „���.�.. -.r_1k 91.w1. �. � •stn, .� ♦.��1.....,.��.- �Y�n��.... rte.. �+1 .!.4..•1AY 1.T. �.�Y: ..
1.aT:l_c?n LrnstrUCred b " �: --- 1.0
U Y a�ct.�.on.
Lcc9.non _ Street: - --
9"/ 'ea, n CA _
ng Type
O2
O�
Lot-
GUARAi TY.OF S;`PA_Fin.` B S ".1AGE SYSTEl
I represent th:�t I alp wholly and cmripletely responsible for . the
Wort- ma.ns117p, . rrrater. ial, construction 'and d: air_a4e of the sewaJe
disposal .system serving the above described property, and that it has been
constructed as st:own on the approved plan or approved ain_en.e'gient thereto,
_ .and in acc.ordancc 11 Mile standards, rules wind regulations of . the Putri2111
County Department of :T.ealth, and hereby zuaranty to the of ner, his succes-
SGI'S, 11.,'i rs or assigns, to place in good oDer tin` condition any dart of
said system constructed by me t%:hich fails to operate for a period of two
years i11L.�ediately fol.lor:ing the date of initial use of th seiaage disncs:il
system, or any r ep,airs made by me to sued S -ti stt°1'1, except where the failure
to operate pzz openrly is .caused by the ..illful or negligent act of the occu-
pant of the building utilizing the slst e in.
cl
flee unders4'-ned further agrees to accept as conclusive the de-
ter- m1nation of the Director of the Division of 1 -1V4 on_ment al t= ealtll Sar-
vices of the Putnam Couan.ty Department; of ?iealth as to or not the
......failure of tale system to operate ,ms caused b -T the willful or negligent
act o A the c,ccUpant. of the buildin.g..utiilizing.:.t.he.- system....:_ =
Dated this day of ✓�� D _EXCA 4 RS_
?� y 19 7'� Signature
PU M..
(Ii' corporatzo_ , give name
and address)
TH£tFF (3) CGP_l;S ARE R:� ilIt�r 4IITIi THREE ' �� �' o *.
(3) COPES O�� FINAL PLAN, BEF013E
CERTIFICATE OF COINIHIETION WILL BE ISSUED.
GUARANTOR IS RT'QUIR','D TO FILE NOTICia OF DATE OF FI?5T USE OF SYSTEM.
Division of Environmental Health Services, Putrl.am County Department of 11ealta
MILGOR ASSOCIATE83 .INC..
CITY, VILLAGE, TOWN VOR NAMI OF SUPPLY DATE REPORTED
PUTNAM VALLEY N.Y.
§AMPLING POINT
WT;7,T,__ TTOURF .47
BACT8RIA PER ML. (Agar plate
count at 350 C).
COLIFORM.GROUP (Most, probable No. /100mL)
RDNESS; TOTAL - ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppm.
These results'indicate . that the water was YES of, a satisfactory sanitary quality when ti
f;
_a7 I � I F � �� 1.1 i
IL ipk-[111�t�A.10 tIC)f!S,,!,TFN` D',ERAR-IRTEN REA
t"If5�'4T j k. g 0.1 �Q MN
i-oq7��, ev- �Mea-
, W X
PR" j
" W
fi mA!Ad Dr. Freundlich
50 Partridge Putnam Acres.
MZ. ......
same Putnam Valley NY 10 57.
U ID
L,J,
76id6!
U,
'r
I ,
ad ,
12
7 wr
Alp.Y a a, e I i _- , R ;uIFU4 9
MUD
WST
AVA W
0 Z 20
A
_U _3 IM,
201 total drawdown
8 10 1 10
Ooi,,dl .yf3 Wdl
1:60
M;3
o WA
M114 ViMWQW%, ;!P M ',MGI
goi
clay overburden
30 sandstone
-79TT: 68
1051 160
granite
sandstone
S
at 1,051 well reduced to 55/811
4.,J was k1k,11 01 -0V7cw12 doper.-, &'�k n.-
100 3, gram
1145 1.0 g, P rp
Boyd Arteslan Well Co., hic.
''j."
5/1/75 . 5/5/75 Carmel, N.Y. 10512
C
4
0
N yip
LOT 29
LOT 49
X
41
kz1v
APPROVEL
01,
N T--> -sl
0
W.11 OCT 191973
w 10' Popo- 4
W. 7 I —ri. OF ll[Ailf•
z
DMECTORDIVISION-OP
-4,00 OMNbIENTAL HEALTH SERVIIl)
Ar PIH Cv
AREA: 1.187 ACRES.
It
-T—qt'ik W I
A'D*:i()RI"I'�%"kP O flh n.fil s4
F,c!f,R F3 PC tt ia F C I! 1f,. VW!-t-, l.'ANDA
7 ul
G I f t; t!
A I
70 V, v 4t:," i
b � OfJrsion of Enwronmenta/ HE
r CONSTRUCTION PERMIT FOR SE_WAGE'DISPOSALSYSTE
„ l.oc to of
at�.9.E►T.e /�l,�,,
#
5ubdiyision 3EC /�• /4L�i"/Y /jI' / ���$' �%'
Owner ;- s
Building: Type '���+rCd ��MG/E✓ Lot Area; ��'��
Number`,,bf Bedrooms _ -
Separate'Sewerage System to consist of �ZG�O Gal
To be constructed by ' /!9ti�rr.S
Water Supply., ` Pubhc.'Supply „F,rom
Prwate ;Supply o be drilled
r Addre55 ri��i� _ ,•
Other Requvements °'
I'represent that .' am wholly and 'completely responsible forthe design and:
above described will be'constructed as show`,n on the:approved amendment .ti
'`County, "Department of .,Health, ;and that on completion thereof a .Certif;i
bi submitted t, the Department, and a written guarantee will be= furni.
place �n good operatmg,`conddion, any part of said Sewage disposalssy!
`ante of ahe approval ;of',the Certificate of Construction Compliance' of
will be located as,shown on the approved plan and that Said well will beinsfa
6.
County Department of Health
Date `�� Signed
i W tl b
..Address
APPROVE O
D FR CONSTRUCTION This approval expires one year from
revocable for cause or may be amended or modified when considered neces
regwres a new permit Approved for di4posal ^of: domestics nary` sew
Date
1
i
ZTMENT OF
Services C',L 'e ry N Y 10512 _
Town 'ors, V it lags 1
�Oy AJol
Address u4 ®X �. (v'a� /G a� �7.• �/dQr(;/��' t�01
x
C ' y,oViil✓�Jl�l Gli� 4Ls:L� Y �V � ` - I!
Total Hab {table Space Square Feet :�
Tank �' iineaI feet X -” .w�dth'trench
s
n of the proposed systems) 1) that the separate sewage,disposal s'yitefn
and �n accordance with the standards; rill nso .t the s u_nam
rf Construct,on Compliance'.aat�sfecfo q �h r;of Heaifhwill`
e owner his. successors heirs -or assi ' ba%�h 9t - 'd bwldew, will; >:
ur:ing the period of two (2,j ?.years'i d a:" i ollow i d of theIssu`
iginal system, or any.repairs;fhere 'lfie , ' 1 ibed :ab6v'e,
i accordance with the standard -[ul �`a -:r io LO't :Putharli
L r � "l • w , �' a� �, �� r A
ate issued unless construcLon of_ a ctrng h `(@ aken "and is
y the Comm1551oner, f Ithl trucf,ow.'
1d /or, private water supply oh
nrp 7
---TST -
Dam e
Re /VCeZ-J, AIV C
Locaued. at 7- 4A
S--c B). o clw: 0 z Lo
G e n 'I.- lee :
a d u 0 f
v� n
s E; 'f,
0
D
s o
5he P u Co nt y Sar
L aw
]El' d, 0 a
Lt-71
y Code
til
Very rl y -'
you-s
S • gm
C o 1-m t e r s _J Id.` Address
OF NEW y Teln,-pacne-
ddress.
Ad
rli
T ed? 4Q
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH:SERVICES
DESIGN DATA SHEET.- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner '.
/P1 ;00M" 1�7C:�4c_x %/✓C° ` Address 454eVy z-7-
Located
at (Street),i .@�" /Q t�s;1 Sec-. 'Q�i �. Block . �j
Lot Off" �1>
(In ire. cross street)^ .
Municipality,
nearest
�'yrdr'/�/�'�. Gf. Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED :WITH APPLICATION'`
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
ZA
4
5
5
l
2
;
i
3
Notes:
r I
1) Tests
to be.repeated at same depth until approximately equal soil
rates are ob-
tained
at each percolation test hole. All data to be submitted for
review.
.2) Depth
measurements to be made from top.of hole:
DEPTH
G.L.
6tt
1211 .
18,
2411
3 0"
361f
42 it
48.11
5 411
6 011
661t
72tt .
7811
DESCRIPTION.OF SOILS ENCOUNTERED IN TEST HOLES
�i
8 Ott
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICHl WATER LEVEL RISES AFT BEING ENCOUNTERED
TESTS MADE BY e� /Y�,tf,�j -� L'.,E'��/u��`,� �. Date
DESIGN
Soil Rate Used / Min /l Drop: S.D. Usable Area Provided'���
No. of Bedrooms _Septic Tank Capacity �j000� Gals . Type 9:5:i0ivC .
Absorption Area Provided By ..-?OcTL. F.x24tt 36tt 4/ width trench. Other
Name �/c, ✓. '44nm —w 64,60'r iE� 'C►, Signature
Address oo SEAL ��� �►� =���y °� .
i .. iu I .
PUTNAM COUNTY DEPARTMENT OF HEALTH
Soil Rate Approved A.? Sq. Ft. /Gal.
Checked by
'�T14m Q�s REVIEW CHECK SHEET
(Meets Std. Remarks
e s No�
DOCUMENTS',
House plans 'O.K.
Design data sheet
Peres presoaked?
Min. 30" perc test depth
Conk results for 3 runs
D. Hole log O.K.
Corporate Affidavit for other than individual
Authorization for engineer I
Letter from Water Supply if applicable ;
If variance requested -such noted on plans & apps.:
i
�
I
!
_.._ .- _ _ _ _... .____......_.
- -
�f
DETAILS
— if change is proposed,)
Existing contours shown show new contours)
Slopes for driveway cuts, etc. shown
Water service line location
Footing drain, etc. location
Top slope, bottom slope of fill
Percolation tests and deep test pit location
Septic tank size and conformance to std.
3 B.R.. house minimum
House setback shown
T,
L15J 1' Zb i J .L71 JIi fV�. .. t7�_GiN...ti'.Or�t .._ .. .....;_i-
All water within 50 ft -: -of --PL- shown
Plan and profile SW
All other wells and SDS closer 200'
shown or. reference made
Property boundaries (metes and bounds- clearly show
7
i
i .4
f
I ✓
✓
I
I ,/
__ ✓. f
I -
_.L,
i I
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P. L.
20' to Foundation walls
100' to Nearest well
50' to stream, march, lake, etc. incl.expansion
15' to Curtain drain
10' to water line (pi7ts -20'
15' to storm drain
10' to large trees
W ''.from foundation to septic tank
.to pipe from leader drain & foo ing drain
I .
'PUT NA.M County Department of Health
-bivivion of Enviromwntal Health Servi.ces
AFFIUVIT CORPORATE CiWR APPLICATION
FOR PERMIT REWIRED BY PUTNAM
COUNTY.SANITARY CODE
(Ple"e type or print in ink)
TO: Commimdoner of .Health In the matter of application for
V4
reprevent
that I am authorized to act for the
TNZZ 3f7c7orj6—ra7ti.Gn7 —7 — — — — — — — - —
ha A ving offices at N-6 2h9 3 Qa (ICL
whose officers am
—
-- -- — ---------------
-----
Vice-Pres - — — — — — -- �L Ile
Dag
by Resolution adopted a�j�'' 19_7-3
with respect to the approval requested and all
subsequent acts relating thereto*
Swom to before me this 7-4' 7 day Sigh
of
Title
m- ss 'RAO,
EILEIN A. PUE!.J C SEAWYLUT.
NOTARY.
t � $tat,, of New York
1*1 in Wesic;i;K.tar C4W.ty
Cornm!!;ion Ex.,7.,.ires i Iq 7 A/
Late.:
INITIAL SITE. INSPE CTION
Yes
No
Comments
Property lines or corners found • .
Can estimate house location
✓
-�
Will driveway need cut
Must trees be removed -note these
Is deep hole representative of entire SDS area
Additional deep holes needed.
_
Sufficient SDS area available considering
driveway cut, house location, sepa.r. ation . . .
di stances, etc. . . . . . . . .
DEEP HOLE DATA
Depth:
Water elevation: �dw
Rock elevation:
Soils description: lvl,lPps -w !e
- Date:
—_-
FINAL SITE INSPECTION ins p. by:.
House located where shown on approved plan.
__.�..
ST)S l oa.ted t•rhere . a.?-,nrov -e . . . .
Width oz trench averagev�
Slope of tile line and trench acceptable .
Room allowed for expansion trenches .
Over 50 ft.. from swamp, watercourse ,
Natural - "soi trot stiff ipped._ or SDS area,
unnecessarily graded ,
10 Ft. maintained from prop.lin.- and
.20 ft. from house . . . . .
Separation of trench from house, well
etc. follows plan ... . . . . . . . . . .
Number of bedrooms checks . . .. .. . . .
Stones, brush, stumps, rubble, etc. greater
than 15 ft. from nearest- trench . . . . . .
15 Ft'. of peripheral soil horizontally from
trench . . . . ... . . .
Junction boxes prope--ly set
Could surface run of from drive ray,. roads,
ground surface, etc. channel near SDS . . ,
area . . . .
Does lot drainage appear O.K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE