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631 - 589 -8100
1 -1 -10
BOX .1
00010
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00010
-s.
"o'h•nt .tl+d 1 aT wholly and completely responsible for ten dK�
�o �osid will a constructed a$ shown on the atpprom amend
DDYnty DSW*nsnt of NMRh, and that on completion ths.7 a
be �hittw to the Department. and a written guarantee will be
fake i11 too operating condition My pat of pa snags
ante Of the hpproal' of the -Certificate of Construction. Compile
*MII be %taw as shown on the approved plan aid that laid well will
icy Daoye of MMRII.
Signed
Adorer CASNA 4'51 -, [ T
A0"ROVEOFOR CONSTRUCTION- This approval enpMes two yea•
�Ocabto fe Cause or may be ameem ed or modified when consider
Rev. I"u.*y a Mai permit. Approva0 for disposal of domestic an
10/88 °"'—
SS� �&
n location . of ten proposed . systern(Q1 1) that the la •rat• !• • des owl. s Rem
there to and in accordance' with the standards, rules en r"—u hs • •
'C Ilitate of Constructleb C~Jat W satisfactory to the CorhmitYorw of NaalthwiR
ltfred ten owner, his succesors, heirs or assigns by the builder. that laid bugger win
dfipOYI system during ten bd Of f Immsdiatety.tonowl" thodato of the )eau-
of ten wp a repairs t or t) that ten drNled well dsat►lOW aiee•
be h standard rules and rqu ns of the Putnam
p.Ea_L R
'� 5 Lie•na No
from the date issued unless construction of the building has been undertaken and Is
neeatlsry . by the Commissioner of 1feeRh. Any Change or alteration of construction
V savage. and /or private water supply only.
TRIO
APPMMM B
PUDIAI i CCUYI"_' DEPAR'MM OF .HEALTH - DIVISIC'1, OF EqVMCNENTAL HEM.L,-.E SzRVICE_S
J�
RE'V=/I S= - CONSZ"- =ICN PERMIT
DATE RS'T- ,vim : df
z#
BY:C -- ---_ --
(St e°_t LC)C..ticn)
Dccavpm
Permit Application
Corporate Resolution
Plans - Three sets
Engin —eers P_ut-icrizeticn
Deli- Dal Sheet (DOE)
Deep Hole Lc;g
Corsist__nt• Perc Result—;=
Ps---- Hole Dept-
s, s
Su�?lDr,7iS1cN
par` 6 O
(3) F_II
C
Ecuse 'Plans - Two set---
Svel1 --' Pen-rat;
Variance . e _ mest
Lyr��
L l Subdivisic'n
Eubc i °rsicn P -cproval Ciecked
Ex -ac zruwa -c-SCS P--: Ects ec!<
Wetland (Tcwvil/DEC Ps= ,-It R & D)
I c - Cn OC:S plans & Ps- iii`. ScT.=
REYLLR-M DEITI.TTc CN PT.AtS
S;.aaae Sv t,� Pan - (crtz a==ow)
��d%GCC
S js z. a' n r v-dra- 11].c Prof ___ G-r-a'i _ t i - .
_ r _L
F°i 1 1 profile & D?.T. as _cns
D or J Bcx;Tr e nc':, C -' 1=ry; de_ i?
-Cen Lc Tank - Si3 °, Der�,1
We l! Detail, Ser ica Lii e if over
Ccnstmcticn Notes (crinCer talc)
Design Data: Pere andraeep
Two -Foot Contours Existing & Prcpcsea
..Driveway & Sloces C. t
Footing
/Gat te Drains (discharge CK )
Pere & Deeo Holes L%cca t
Representative of prLn.!r and Ex- zansicn
Rcoa-isica P.rea;shcwa;grGvi,j f1c�H,suf= ..size
I= P�*+�%+ Pit- & D Bcx Shc,.m & De4 i led
House - No. of Be^reons
Wells & SSDS's Win 200 ft.. of Proposed SYste
Proper ty i•�t °_s & Erurds
House Setback Necessary (Tight lot)
House :-:,aver - 1 /4 " /ft. 4 "0; rrca pipe
No E nds; MGx. Eends . 45' w /cieanout
SERIREMCN DISM�N =13 SPE='I IM CN PL•2N
Fields
10' to P.L., Drivevay, Urge T= e-,TCD of f
20' to Foundation Walls
100' to Snell; 200' in.D.L.O.D, 150' pi
100' to St— =cn, Watercourse, Eakc (inc. er=
15' to Drains Cur"i-i, LGde_ , Footing
35'tc catca Ezsin,stcrm=in,ni=ei wate_rc-CI.s
10' to Seater Line (pits -20')
50' intarrnittent dr =iraae cent se
;ent;c Tanks
r 10' f,an Foundation; 50' to wzl
L5' Well to PL °
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL pp
PCHD PERMIT d tf ".
WELL LOCATION
Street Address Town Village
City Tax Grid Number
O� LT T9 Fz "
- (- [0
WELL OWNER
Name. Mailing Address rivate
ase L rio O blic
USE OF WELL
RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
1 - primary
O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify,
2- secondary
O INDUSTRIAL O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT n'1 l gpm /# PEOPLE SERVED ��,4M• /EST. OF DAILY USAGE )(M gal
E3 REPLACE EXISTING SUPPLY O TEST /OBSERVATION D. ADDITIONAL SUPPLY
REASON FOR
DRILLING
NEW SUPPLY NEW DWELLING) 13 DEEPEN EXISTING WELL
DETAILED .
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
DDUG
[]GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _ No
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 5 tjrzV /M 1v1AtQ-W-
Lot No.
WATER WELL CONTRACTOR: Name` R2 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X_NO
NAME OF PUBLIC WATER SUPPLY: ��/� TOWN /VIL /CITY
" DISTANCE TO _PROPERTY FROM NEAREST WATER MAIN: n4tj _LM lX-t-
LOCATION SKETC$ � SOURCES OF CONTAMINATION PROVID
ON SEPARATE SHEET
(date) (s
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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and, in su a manner as not to degrade or otherwise cont a irate surface or groundwater.
Date of Issue: 19� �---
Date of Expiration 19 Permit Issuing Of 1
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
11V121 0 01- owlf�bm
"DIVISION OF
HFAMU ti KV1Cx5
:.- DESIGN DATA SMEEI%- SUBSUFACE SEWAGE'DISPOSAL SYSTER, FILE W.
owner
Address I-0. 16s - -T►+eka%%foo�
Located at (Street)
Sec: .Block 1 Lot �g
(indicate. nearest
cross street)
mu icipality . _..
-Watershed.
5bII; PF�OOLATICw lzt ' � .REQUIRED'
TO BE SLMMrrrM WITH APPLICATICNS
;Date of pre- Soaking g . zo 'e8
Date of Peroalation Test g z.: as
HOLE l'
NU -IBER CIACR TJME:
PEFbCOUMON.. PEFitUI,ATIOCI ..
Run Elapse Depth
to Water From Water Level
No. ''Time Ground Surface .1b Inches Soil Rate
Start Stop Min.. 'Start"
S�dp Drop In Min/in Drop
Inches...... Inches ; Inches .
1 z,: 00- lo:sl ►�1 !zo
23 3 -5'mi
2 16;1§
3 i:51 -9 s-r IBD •ro
z3 3 �O
4
3
2
r
'
.. 21
3 1 • zz A ---7
. . Z9 ... •3 _ Cpl
4
2
5 ,l
t
'1 "..'. :Tests,::to.be repeated' at
same depth until ,apprcaimately equal soil rates
are'obtained,at each percolation test hale. = data to be.suhnitted
• fnr ravicaw_
DEPARTMENT OF HEALTH
Division of Environmental.Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATI.ON TO CONSTRUCT A WATER WELL
PCHD PERMIT
WELL .LOCATION
Street Address Town/Village/City Tax
O P-Q. a tLi0&% iY AMA- RA. ,tirTTCi
Grid Number
WELL OWNER
Name Mailing Address
J-4o Srre� �saoc. P o. Bo1c 5 ooa NY
Q�Private
O Public
USE OF WELL
1- primary
2 - 'secondary
*& RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
O BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL U INSTITUTIONAL O STAND -BY
O ABANDONED.,
O OTHER'(specify
O,
AMOUNT OF USE
YIELD SOUGHT,.y„j 5 gpm /# PEOPLE SERVEDI FAM /EST. OF
DAILY USAGE &2Q gal
REASON FOR
DRILLING
14NEW SUPPLY... OPROVIDE ADDITIONAL SUPPLY
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING .WELL
OTEST /OBSERVATION'
DETAILED
REASON FOR
DRILLING-
i.1e` fam, barj
WELL TYPE
DRILLED
ODRIVEN
[]DUG
GRAVEL . 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A'REALTY SUBDIVISION, NAME OF SUBDIVISION
�AlRlilw� M,a.lo� Lot No. 12
WATER WELL CONTRACTOR: Name —� L�s_t�ar?SurJ Address:.
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '*X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 61ze��. '�W�
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON.REAR OF THIS APPLICATION 1
(date)
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 pro ideediby.tDo Putnam County
Heal th Dep rt ,ennt.
Date of Issue: ( �-- 19
Date of Expiration: -19 g.! ermit Issuing fficia
White copy: H.D. File
Permit is Non - Transferrable
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
PETER C. ALEXANDERSON
County Executive
April 5, 1989
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
Mr. Daniel Amicucci
c/o Homesite Associates Inc.
PO Box 185
Thornwood, New York 10594
Construction Permit # P-11 -89
Dear Mr. Amicucci: Mooney Hill & Manor Road, tot 12, Patterson
The Department has approved on March 28, 1989, the above captioned permit to construct
sewage and water supply facilities serving this property.
As is our policy, the approved materials have been forwarded to your engineer.
However, since you are the.permittee, your attention is directed to the attached notice
relative to construction of these facilities in accordance with the approved plans and.
occupancy of the completed structure. A similar notice has been forwarded to your
engineer.
IN ADDITION, DUE TO THE NATURE OF THE SOILS IN THE PROPOSED SEWAGE DISPOSAL AREA, IT IS
REQUIRED THAT PRIOR TO ANY .CONSTRUCTION ON THIS LOT, THE SEWAGE DISPOSAL AREA BE STAKED
OUT AND ROPED OFF. HEAVY EQUIPMENT OF ANY KIND MUST BE KEPT OUT OF THE SEWAGE DISPOSAL
AREA. DURING INSTALLATION OF THE SEWAGE DISPOSAL SYSTEM CARE MUST BE TAKEN TO AVOID
COMPACTION OF THE SOILS.
THIS SYSTEM MUST NOT BE INSTALLED DURING A RAINY PERIOD OR AT A TIME WHEN THE SOILS
ARE WET.
This approval is subject to all local permitting and approval requirements. You should
contact the local municipality relative to the need for such permits or approvals.
If you have any questions, please contact me at this office.
V ry trul yours,
hn Karell, Jr., P.E., Director
nvironmental Health Services
NOTICE: This department must be notified 48 hours prior to the installation of any
portion of the sewage disposal system.
Please notify Christine Johnson of this office prior to commencement of any
open work.
Calls will be accepted by the engineer only.
JK:cj /
cc:- JK, EC, Cashin Assoc., File i/
PETER C. ALEXANOERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
December 1, 1986.
. TO: Professional Engineers, Land Surveyors,._ Registered Architects
FRCM:. Jd n Karen, Jr., P.E.
RE,: UPDATED HEALTH DEPARL DENT SUBMISSION & PRCCEDURAL REQUIREME1y'IS
JOHN SIMMONS. M 0.
Deputy Commissioner
JOHN KARELL. Jr., P.E.
Director
On Cctober 5, 1985, revised November ll, 1985, the writer published a document
entitled:
"PROGRAM REVI=v1 AND POLICIES
SUBSURFACE SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES
SINGLE FAMILY RESIDENCES"
'Over the past year, practical application of the Guide has indicated the need
.for certain revisions.
Revised pages are attached with a short summary of the major changes or
clarifications as noted below:
1. The "details" check sheet has been revised to include information relative
to pumped systems.
2. Well permit requirements are added.
3. Field and office review check sheets have been modified somewhat.
4. All new Construction Permit approvals will be granted for a period of two
years.
5. Requirements to field stake the location of the sewage disposal area will
be based upon the location with respect to perceived construction traffic.
If it is felt that the system or area may be damaged by heavy equipment
during construction, staking of the system will be required by a note on
the plans.
6. Where equal distribution boxes are provided, a minimum.of two feet of
undisturbed soil must be provided to the lateral before the gravel trench
begins.
- continued -
2 -
7. In order to verify soil percolation rates, Department representatives will
be witnessing percolation tests as follows:.
Any lot less than 0.5 acres in size.
Any lot with percolation rates of 45 - 60.minutes.
Any lot where all or most of the area on the lot available for sewage
is utilized for the primary and expansion sewage areas.
Any .,other lot where our engineering review indicates a concern
relative to the soil rate.
The Departmental representative will observe a minimum of three
30- minute runs in each of two holes in the sewage area. This will be
perfonned after the holes have been presoaked and after initial
percolation runs have stabilized.
8. One additional "construction note" has been added relative to garbage
�rinders, as follows
v
The sewage system. -design shown hereon does not provide for
installation of a garbage grinder. Such installation requires
the approval of the Putnam County Department of Health."
Such installation requires increased septic tank capacity and trendh
length.
9. pth gauges will be. required on all fill sections at each corner and one
in the center of the fill. This must be noted or shown on the plans.
10. As a reminder, F&MA Flood Plain Maps, (State) and local wetland maps must
be consulted for all projects as appropriate. The 100 -year. flood
elevation, (State) and local wetland boundary must be shown on all plans.
11. See Appendix Q.
0
Putnam County, Department of health
Division of Environmental Sanitation
AFFIDAVIT -. CORP=NTE WNER Appr iCATION
FOR PERIIIT APPLICATION SUBMITTED TO
PUTNAM COUNTY 11DILTU DEPARTMENT
TO:.Commi.ssioner of Health - In the matter of application for
ccT -- - - - — - - - - - - represent
that I am an officer or employee of the-corporation and am authorized
to act for / /- _ _ _ _ I tz- 1 wr CS % 1-� SSOC %G97`�S r zLUl -- - - -
(name of corporation) - -
having offices at _ /0 _/IoTKtJI16 Cw G�a� J2� Q �(��tJ_L/
tit, tew e
• Whose officers are
President - %�c�1ivl2 � . 1-91-" -icA4c c4 _%0 �orK /fr�c�c_�%�'a(- 1-7or_�_��c'��e( _
Name and Address)
''ent ..�v7�onl..Y�_ I u4 e Ct
-
�GitiC_/-ye_
-
and Address)
Secretary r - - - _ _ _ _ _
(Name and Address) ) "-'-"-'-------- -
Treasurer _ _ ____ --- _____
(Name and Address) -
and that I am and will, be individually responsible for any or. all acts
of 'the corporation with respect to the approval requested and all sub.-
sequent acts relating thereto.
Sworn. to. 4efore me this day ' ' ' Signed
of 1,91, Title r--r5f V r��cJ�`- -
KELLY H. WILSON
NOTARY PUBLIC, NEW YORK STATE
QUALIhED IN
ONDEXPIRES 7(211U'
Corporate Seal'
First Floor
NINNUUMBEIN
All room dimensions are approximate. Developer reserves the right to substitute materials of similar quality without notice.
- atrview Manor • Money Hill Rd., RR 2, Box 348A • Patterson • N.Y. • 12563.014.878.4480
TUE CHATHAM
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRON ENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health
- FIELD ACTIVITY REPORT -
Sheet _L of
ADDRESS
No. Street Town TM No.
MAILING ADDRESS
P.O. Boat Post Office Zip Code
ONE n; • i
Name and Title
DATE 3 TYPE FACILITY
TIME ARRIVED ; ayP!'Yl TIME LEFT
FINDINGS: A
Orig. Routine
Orig. Complain
Orig. Request
Canpliance
Canplaint Canp
Final
Group Illness
Construction
Reinspection
Field,-Sampling Only
Field Conference
Other
Explain
INSPECTOR: TELEPHONE:
Signature and Tille
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF' HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
August 8, 1988
Cashin Associates
Route 52, Seavey Plaza
Carmel, New York 10512
RE: Fairview Manor
'(T) Patterson
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director .
Gentlemen:
Review of plans and other supporting documents submitted at
this time relative to the above - captioned projects has been
completed.. Comments are offered as follows:
1. Lot 11 - Fairview
House is considered to contain five bedrooms.
SSDS design must be revised appropriately.
2. Lot 13- Fairview
Show pipe in easement, if any. If not, show 35' to.SSDS
to any future e
3. Lot 15- t 127 Fairview
'
The Departure itnessing of two soil
percolation tests in proposed sewage disposal area.
House is considered a f've bedroom. SSDS design must be
revised appropriately.
Upon receipt of a submission, revised to reflect the above
ommentsr this app ication will be- considered further.
ervl ^ I trilo AvduAs I
r vlli 1 \Gil Vii, Vi•ector,
ironmental Health Services
JK:Pt
cc:JK
Fee riclosed ' Amount '?_ Date Permit- Issued_.
#_ k_II* - J N1f��t�G_ d �cac • ...x..42 Gor36t� tF,i:� �p . 0, Ptkrr�s rJ�'I lc6+o�
I certify that ehe.eystem(a)-_as.listed serving the above preaises were oonstrut
of which are attached);
and accordance with the atandarda,,rules '
petnam: Count - W t of - health.
Date, Ram Certiiled.by/ +rte
:.Address"
Any person "occupying premises served:by the abOvO'siftem(s) shill promptly_ like s
conditions faiuning from- such urRM Approval of the separate seweings system
available and the approval of. the private water supply shill become null grid void
subject to modification or Manna vvhan. i�n�ths judgment of tM.Co Orar s
oats
3/$9
e 11 ae shown on of
a plans l,the coapleted work ( copies
dance with-the sled plan, - ard.tha permit issued by the
may,
P.E. RA.
dl lid
G' r'iGi 2� I,ywr NO.'
action as may be necessary to seedre'the correction. of any unakn", ry
Itbecoi" null and void as soon as a pub(;: ionitifynnr _ sl becomes
n a public water supply baobmes avalubli. Such ipp!ovils are
ss .such sevocatlon. modification or change Is necisin
This
t�Q,
i WELL Cumi'LIJ11UN to -rune Office Ua Cml
• ,'�� DEPARTMENT OF HEALTH _
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
s,7: ?3Qj;ESS. WKIVIL /,I TAX GRID N e4;:
WELL LOCATION �t' 8QS0 nJ
WELL OWNER
ADDRESS: ( p P81VATE
� m0 �v� ' — /,' ❑ PUBLIC
uk. �-e.0 > 11
USE OF WELL
c HiDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
�1 - pnm�ar
❑ E SiNESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify)
- s ndary
0 ":!40USTRIAL ❑ INSTITUTIONAL ❑ STAAlD -BY ❑
MOUNT OF USE
yIEJ SOUGHT gpm. 11110. PEOPLE SERVED / EST. OF DAILY "'IS 1G= g21.
REASON FOR..
[] _E ?1-ACE EXISTING SUPPLY [-TEST /OBSERVATION E] A.DDITTO:vAL SUPPLY
GRILLING
SUPPLY (NEW DWELLING) E] DEEPEN EXISTING WELL
DEPTH DATA
,f,1`__
ft.
STATIC WATER LEVEATE
D_'TH �S
MEASUFED
GRILLING
C =J T, =. Y COMPRESSED AIR PERCUSSION ❑ DUG
POINT C CABLE PERCUSSION C C OTi;ER (specify):
WELL TYPE
C ED C OPEN END CASING ``SOPE..N HOLE IN BEDROCK 0 OTTER
G T H
T _
ERIALS: LSTEEL C t AST;C ❑ OTr,ER
CASI }1G
L =: BcLOA� GRADE U ft.
JOINTS: C WELDED X37 R --,DED ❑ OTHE
DETAILS
r: 1-- _ in.
SEAL: CE'l1:NT GROUT C : = NTON!1E 00THER
FER FOOT lb. /ft.
D IVE SHOE'S YES CZ N(J
I Li l; ;: U YE5 ON 0
SCREEN
I OIAMETER (in) SLOT SIZE
LENGTH (ft)�
DEPTH TU SCREEN (I;) DEVELOPED?
DETAILS
F' =` I
I o YZ� ❑ 1,40
_
xoups
GRAVEL PACK
GRAVEL
DIAiMErER TOP EOt1IGM
(OE?ir{ (
I SIZE:
OF PAC :< _ � in. _ tt Cc.=i}: ft.
ti ` ;f detailed un ^:n
WALL YIELD TEST p N 9
ALL L(�G "' If more detailed formation descriptions or.�ueve analyses'
a're available, please attach.
METHOD: U PUMPED t tests were done is
in-
— _COMPRESSED AIR attac
DEPTH
P
yater
Well
Gia-
j J BAILED � OT �; C3 YES C t0
ep r
meter
In
FUMATION DESCRIFT " :N
Ce@
It.
WELL OEa(H
a DURATiC:`; -0, CG14,V
YIELD
Land
Surtacc
c.. Q
(t.
tlr, min.
9Sr.
C-�2N fly
,
1 IYATEit'AELCLEAR —ic:siP.
QUALI -I, CJ CLOUDY.
_
— —
O COLORED AN- AL 'eZ_D? --&YES ONo
j YES
STORAGE �
ANALYSIS ATTACrE.7.! 0.140
TANK: TYPE _ V
CAPACITY � __5 GAL.
WEL ORIL) E`R`tIAhtl . DAL'
PL'h1P ixF RMATION ,
TYPE Uv i14� i CAPACITY
—
"
� S'U� '
MAKER DEPTH . L —r'r._
I
MODEL '- �'�'_i� Lt 'iCLTAG �—o HP��Ut
dDh}css \fir 51 tttTLIm
�t-9 'Ie
I
'3/'TV`9
08/03/94 MF T. COLIFORM ABSENT' /100 ML ABSENT
COMMENTS:
,BACT `..THESE RESULTS INDICATE THAT THE WAT -.A >,(WAS NOT) OF A
SATISFACTORY SANITARY DUALITY ACC DI THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS.
STED. „AT
;:TE : THE TIME OF COLLECTION.
xi.
ti,
tt
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
:: ..
(9 14) 245 -2800
Albert H. Padovani, Director
icy ',.
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"LAB #::33.400146
CLIENT
#: 114 NON STAT PROC PAGE, 1'
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':TORLISH &
SONS
DATE /TIME TAKEN: 08/02/94.:13:30
::BOX 271
-
DATE /TIME RECD: 08/02/94.;1'4 :20
'ATTENTION4
DWAYNE TORLISH
REPORT DATE: 08/03/94
`AAMONK, NY
10504
PHONE: (914)- 273 -3448:
i•_
a -
'SAMPLING SITE
::AMICUCCI
DEV. LOT #12 SAMPLE TYPE.. :. POTABLE
...'.
s PATTERSON
PRESERVATIVES:. NONE
7'COL' D-BY e `
D-... ORL I SH
TEMPERATURE,.
-NOTES...:
COLIFORM METH: 'MF
----« M«« N. JNN«««« «K. «.,..: «N
«ti «N «.H « « «.,. «N... «« .......................
z. DATE�` FLAG PROCEDURE RESULT NORMAL - RANGE
_
08/03/94 MF T. COLIFORM ABSENT' /100 ML ABSENT
COMMENTS:
,BACT `..THESE RESULTS INDICATE THAT THE WAT -.A >,(WAS NOT) OF A
SATISFACTORY SANITARY DUALITY ACC DI THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS.
STED. „AT
;:TE : THE TIME OF COLLECTION.
GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYS=
=:z 2 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
tiy£ 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:=
E ;operate for a period of two years immediately following the date of approval of the >.
`'� ::,'Certificate of Construction Compliance" for the sewage disposal stem, or an
..,. P g Po sy y
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 Fs'nvironirental 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.
Dated this day of 19 74, Signature
x' v
Title �% S• r
:` eral Contractor (Owner) - Signature _A%w►es17fA5oc.?',vc.
Corporation Name (if Corp.)
Corporation Name (if Corp.)
I- IQ Coh hl<
Address
`..: Address AcJ14 7 %� %iNS, N- /.. /0 6DS"
rev.`9 /85
mk
PMJAM COUNTY DEPAPM41= OF HEALTH
M: DIVISION OF ENVIRONMITAL
HEALTH SERVICES
z
{'iolul�slT� � v�G •
� � �
0 � `�'' �a
>.`
Section
Block Lot.
Owner or Purchaser of Building
K
Building Constructed by
Location - Street
Subdivision Name
Municipality
Subdivision Lot #
Building Type
GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYS=
=:z 2 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
tiy£ 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:=
E ;operate for a period of two years immediately following the date of approval of the >.
`'� ::,'Certificate of Construction Compliance" for the sewage disposal stem, or an
..,. P g Po sy y
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 Fs'nvironirental 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.
Dated this day of 19 74, Signature
x' v
Title �% S• r
:` eral Contractor (Owner) - Signature _A%w►es17fA5oc.?',vc.
Corporation Name (if Corp.)
Corporation Name (if Corp.)
I- IQ Coh hl<
Address
`..: Address AcJ14 7 %� %iNS, N- /.. /0 6DS"
rev.`9 /85
mk
,F_
APPENDIX C FINAL SITE,INSPECTION DATE:
f Inspected by:
STREET LOCATION G � O �- �/' OWNER /i7 S
ss I
/
PERMIT # ' TM # OR SUBDIVISION LOT # � 2-•
I. SBUCE DISPOSAL AREA
a. SDS-area located as per approved
b. Fill section - date of placement
2:1 barrier LOTH
c.
Narurai soli nor- su
d.
Stone.brush.etc.Rgr
e.
100 ft. /from water
11 SEWAGE DISPOSAL SYSTEM
a.
Septic tank size -
b.
Septic tank install
c.
10' minimum fram fix
d.
DISTRIBUTION BOX
Room allowed for
1. All out 1 ets at s<
Size of gravel 3/
2. Protected below 1
Depth of gravel ii
3. Minimum 2 ft. or-
e. ."w.;1 1uN tiu A - props
f. TRENCHES
1.
Length required -
2.
Distance to water
3.
Installed accordi
4.
Slope of trench a
5.
10 feet fran prop
6.
Depth of trench <
7.
Room allowed for
8.
Size of gravel 3/
9.
Depth of gravel ii
10.
Pipe ends capped
g. PUMP OR DOSE SYSTEMS
1.
Size of pump chaml
2.
Overflow tank
3.
Alarm, visual /aud
4.
Pump easily access
5.
First box baffled
eptable 1/16 1/32 "
ty 1 i ne - 20 feet - f
0 inches from surface
pansion. 100%
- 11" Aim,nfe.• nleftr
6. Cycle witnessed by Health Department
11. HOUSE
a. House located pe
b. Number of bedroo
V. WELL
a. Well located as
b. Distance from SD
c. Casing 18" above
d. Surface drainage
OVERALL WORIUIIWSH I P
a. Boxes properly gi
b. All pipes partia
c: All pipes flush i
d. Backfill materia
e. Curtain drain in
f. Curtain drain out
g. Footing drains d
h. Surface water prc
i. Erosion control
T
YES I NO I COMMENTS
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!'DTNAIi[ OODNTY DBFAn7MW OF EMALTH
DhbtY�e[ riktaeoagWHaalWSardoaa . "Caisel.N:Y IPSl?' BalSYwer'MPwvWalee�lt/
1 ,
w CS<1fF[GTS OOMCI4ANCB QOI7$itDC i N PAID FOS SawA6�R DrMMU 81fnm
Nom : TT 'r
L.ea.�.t icL ... er VOase
t... j g_ Im M 4 4 3 = . ( O .
Tax Mal tom.
Date- ot Ftevloea Appeov�l 3, ZQ"
rliries Aaia+ia� . I Tdwn'((- foCt�n1.:'v
Date Subdieisidn Apprdved Fee Enclosed n,nn,rnr
" t.s T" I`C - f= W l_ Litt A. a -1 —, - "d-' D N=bW 1 H iee�a Design Flow G P D �`' )a Yegsthred:Wben FM d �F�dS_qw- Seweeese,- 7 S h i-ii'M Q.L�C". Soplk Task ,ff
¢:
Tr,M eeer�eieMd tyl 0 EE. h AfNien
Wabr Sn!!�r pare Seipg� Ft Addzees
erf'>
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-
I represent that 1 am; wholly a'n0 eonipliNly responsiblN'for,the design and location of the proposed system($) 1) "that ,ih. se rate ,sew di set system
abov d•su�Ma will pe'eonstruet•d as "shown on the,ltpprovad amendment -tower• to and in accordani• with the standards, rules a _ regu ions:o M
County lOpetnwlt- of /fa•Ith;` avid that on completion thereof a .•Certifiato of Construction _Compliance° satisfactory to the CommiselonN'of Haalthwill
A "mitt•d: to ter - OepartmMit, ;anA a. written gwrant" will be furnished the owner• his sucpa6r; hairs or assigns ey, the b4lkei. that said builder will
Wn' 6, -966d'_06866_'
n, goee ep•ritting osnslNbn any;Pait,of said swage disposal system du irpahe kxe of t' •�►spnmediately'following tMdeN_M -the issu-
aia?Ot ter appwal -of thb •CertNkate--of Constructim Compliance of the orig an 'rtpiir _t eto; 2) thOt the drilled wall AisiWiMd•a6ow
mill be local" as Ylartiw on tM'appewq plan and that said well will be In r h " standard rules and regu a� 7Wn of the Putnam
Cou O p it
nty •rtment ot,,hlMith .`
_ r•
ofta - 3 Sisned✓�
.V�ISIItO- --tens No
APkOVEO FOR CONSTRUCTION This.aporo"I •xpirestwo years. from the data issued unless construction of the building has been undertaken and is
'revocable 1for :cio o.anay 64 41- end•0 or modifiad when considered necessaiy ,by- the - Commissioner of :kuRh. Any change or skiiation of construction
Npuires a new Permit. Approved for disposal of domestle sanitaiy swage•: a private wai fYPply only.
REV. .• : . ,
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CASH I N ASSOCIATES, .P. C. REVISIONS
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ENGINEERS — ARCHITECTS — PLANNERS
an R_ ROUTE 22. BREWSTER, NEW YORK
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A,5-WILT MeAoWFeM:a. 4 Ts.
CASH I N ASSOCIATES, .P. C. REVISIONS
N0.
ENGINEERS — ARCHITECTS — PLANNERS
an R_ ROUTE 22. BREWSTER, NEW YORK
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