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Rev. 318 PUTNAM COUNTY DEPARTMENT OF HEALTH
I. Division of Environmental Health Services'', 5
Carmel , N.Y. 10 12 Engineer Must Provide
-U P.C.11M. Permit q : - P. -8 -87
13. t
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Pat prsnr
Town or_X e
Locates at Mooney Hill Road Tax Map Bieck Lot 19
Owner /applicant Name Fairview ;Manor. Dev. Corp. Formerly Subdivision Name FairvleUftru bdv. Lot #_26-
Mailing Address P.O. Box 1.85 2Jp 10594 Date Permit Issued.-2%27/87
rho w r d s NY
'Separate Sewerage System built by Hekla Construction AddressaC, New York 10541
Consisting of 1250 Gallon Septic Tank and - 889 if of 21 trench
Water Supply: Public Supply From Address
or: X private Supply Drilled by Tor 1 i. sh & Suns Address Armonk, New York
Single Family,
' Building Type Has Erosion Control Been Completed?
Number of Bedrooms 4 Has Garbage Grinder Been Installed?
Other Requirements Curtain drain installed.
'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 accordanc with the filed plan,, and the permit issued by the
Putnam County Department Of Health..
'Date 11/20/87 Certified byhr m a B a r o ri P.E. �— R.A.
Address for BaIdAdn & Cornel ills, P.0 _,RD] , P._99,Rr9ArtPr W10 5C19 License No. {. 1
Any person occupying premises served by the above system(s) shall promptly take such action as may be necasury to secure the correction of any unsanitary
conditions resulting from such usage. Approval_ of the separate sewerage'system shah become null and void as soon as a pub;': unitary sewer becomes
'available and the approval of the private water supply shall become n a void when a public water supply becomes available. Such approvals are
subject to mo ificati n�nlor change when, in the judgment of the om IS o erDrf( HHeeeaallth, ►Y�IFVh('rnye/vlLocstion, modification or change is necessary.
Date V v� By r — " 1 �1 _ Title �P" r
I
WELL COMPLE'EiUN Ktt'UtU� Office USe Only,'
i.
DEPARTMENT OF HEALTH
iv
Divisl0i► Of i: v1 c c
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREE T AOURESS. TAX GRID tIuIaqEij:*_
WEL.
.'CO
I
WELL COMPLE'EiUN Ktt'UtU� Office USe Only,'
i.
DEPARTMENT OF HEALTH
iv
Divisl0i► Of i: v1 c c
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREE T AOURESS. TAX GRID tIuIaqEij:*_
WEL.
L _rO Aj (j 4
A00RESS:
W.ELL OWNER 11 cc Car
PRIVATE
❑ PUBLIC
USE WELL "RESIDENTIAL L 0 PUBLIC SUPPLY ❑ AIR/CONO.IHEAT PUMP 0ABANDONED
primary-. ❑ BUSINESS .0 FARM ❑ TEST /OBSERVATION C3 OTHER (specify)
Secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑
MOUNT OF USE YIELD SOUGHT. gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE; gal..
REASON FOR (NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
0 REPLACE EXISTING SUPPLY: ❑ DEEPEN EXISTING WELL-
z
/T7
ELI-*-"DEPTH ft
STATIC WATER LEVEL It.
D ATE MEAS
TARY. COMPRESSED AIR PERCUSSION
'DRILLING :' ION
❑ WELL.YDINT :0 CABLE PERCUSSION
IPAI 0 OTHER (specify }:
`OPEN HO . LE IN BEDROCK
FE 0 SCREENED 0. OPEN END CASING ❑ OTHER
TOTAL LENGTH _fL,_Z ft.
MATERIALS: _`SSTEEL ❑ PLASTIC 0 OTHER
LENGTH -BELOW GRADE ft,
JOINTS: 0 WELDED '_'rSTH R EADED'..00THER
TAIL -'°DIAMETER* 7 =2 �in.
SEAL: ❑ CEMENT GROUT 0 BENTONITMOTHER
:VEIGHT PER FOOT lb./ft .
DRIVE YES. ENO
LINER: OYES ONO
C BEE
DIAMETER (in)
'5LOT SIZE
LENGTH
(it)
DEPTH To SCREEN ((t)
DEVELOPED?
FIRST
DETAILS.
0 YES ❑ NO
SECOND
HOURS
GRAVEL PACK 11 1E1
GRAVEL
DIAMETER TOP
=upni
BOTTOM
0 NO
SIZE:
OF PACK- in. tt.
DEPTH — It.
WELL ELO TEST It detailed pumping
If more detailed formation descriptions or sieve analyses
WELL LOG
METXOD�.![] PUMPED tests were donei—,
are available. please attach.
COMPR�Ed AIR:. formation attached?
1 " ". E - � I
DEPTH FROM WWII
SU Wzier
R ACE .. 1, WWATION DESCRIFri�?O-i�-
Meier
0 skt�,. 0 �6TH ❑ YES: ONO
ing .
In
WELL DEPTH DURATION.:*." DRAVIDOWN YIELD
L2n d
Surface
0
-70
7
WATER '0 CLEAR" ;TEMP.
QUAUTY 0 CLO UOY HARDNESS
0 COLORED ANALYZED? OYES ONO
STORAGE TANK: TYPE
CAPACITYe�-/�, GAL .
ANALYSIS ATTACHED?''-�YES ONO,
PUMP I FIRM�47ian
TYPE Sy r-) CAPACITY
MAKER C-�fVwl "I �fl,
DEPTH L112-
E ER Ilk 4E
W�&L DRIL
V (_I-�
.
MODEL vo�tAGi��2C HP
1`
ADDRESS SIG1 TURF
q:
Y9e own Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N.: Y. 10598,
(914) 245 -3203
Director: Albert H. Padovani M. T. (ASCP)
T
TORLISH & SONS
PO Box 271
Armonk, NY 10504
L
-1
J
I„ �K „ 004341
LAB N _
Date Taken: JA-al- Time o� P
Date Rc' d : fa - ;a3L -198 t Time: 10'SO A
Date Reported: DEC 241987
Collected By: D. Torlish
Referred By:.
Sample Location: __F() P
e
Phone
Phone N Sample Type:
Repeat Test? _ ((check one)
LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count (CFU /1.OmL) 7i Z
(Agar.Plate.8 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform (CFU /100mL)
Fecal Coliform (CFU /l0.OmL)
Fecal Streptococcus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform: MPN Index (per 100mL)
Fecal Coliform: MPN Index (per 100mL)
OTHER ANALYSES
RE14ARKS (For Laboratory Use)
~' Potable
Non- potable
STP INF
STP EFF
Other:
Sample Status:
(check each)
Outgoing
— Na2S203
Incoming
LE 4 °C
GT 4 °C
Other:
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Coun
CON = Confluent ( =TNTC)
LT = Less Than (< )
GT = Greater Than ( >)
N/A = Not Applicable
LE =Less than or equal t
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Albert H. Padovani, M.T: (ASCP), Director
., 12 /85(Rvsd7 /F7)RWE
For Lab Use Only:
H/C to
LAB OFFICE HOURS (Main Lab):
9AM -5PM, Mon. -iri.
9AM -NOON, Sat.
II.
IV.
MIA
Vi.
?9
t�
t•rr�vai.ea �,
INAL SITE INSPECTION Date iS
I Ins t )
r
y� �i ►'�. �>,.• OWNER rr C �J C c ' 1 ' V
TM # OR SUBDIVISION LOT #
P�- 7 r --
YFONO
CQMME TS
gEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
J�
fS >or'
b. Fill section - Date of placement
2:1 barrier.. LGTH WIDTH AVG.DPTH
c. Natural soil not stripped
d. Stone, brush, etc., greater than 15' fran SDS area.
e. 100 ft. fran water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. tic tank size - 1,000 1,250
b. Septic tank installed level
c. 10' minimum fran foundation
d. No 90" 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
o "/n-"
f. JUNCTION BOX - properly set
g • IRENCHES
1. Len required - Length installed
2. Distance to watercoijrse measured: ft.
,.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
w
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 ravel 3/4 - 1 " diameter
10. Depth of gravel in trench 12" minimum
11. Pipe ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber
_-
�-
2. Overflow tank
3. Alarm, visual /audio
4. Pump easily accessible manhole to grade
5. First box baffled
?
;
U
6. Cycle witnessed by Health Department
estimated flaw per cycle
HOUSE .
a. House located per approved plans.
- -- -
b. Number of bedrooms.
a. Well located as per approved plans
b. Distance fran SDS area measured ft.
c. Casi.n 1$" above grade.
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
a. Boxes properly grouted
b. All i s fall backfilled
c. All pipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
i 1
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to exist.watercours
g. Footing drains discharge away fran SDS area
h. Surface water protection adequate
i. Errosion control provided on slopes greater than 15$.
10
INSPP]=IR;
6/86
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION: ;OF ENVIRONMEI�IPAL, 'HEALTH SERVICES `
ir
John M, 5 -'
.ns M:D: `
Deputy
'ssioner�of Health -.- FIELD= ACTIVITY REPORT
Sheet -of.
INSPECTION
�: y
Org. Routine
t,
S
Org: Canplain
AD
Y 1
G
Orig est
..Requ
--77
St t Tern TM No.
,Cunplance
:Can pla nt Comp
MAILING ADDRESS
C�
Final
P O.. ]EbSt- Office:.` Zip Code
_ Group Illness
n
TELEPHONE
Construction
Reinspection
PERM& IN
CHARGE -
Field ,.Sampling Only
OR INTERVI
Field Corifererice
Name.and Title
Other
DATE
TYPE FACILI
TIME ARRIVED2�`
TIME
Explain
FINDINGSa
("
INSPP]=IR;
6/86
PUTNAM COUNTY DEPARTMENT OF HEALTH
` Division of Environmental Health Services
APPENDIX L
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
f �L �Ek'T/ C ce a4g- L L- - o ve- WW e111 7 - 7`Z�g %�f� /2 VAFUJ A-) fAl&e_
..5tJ82> /1/1.5.1 o AJ
I, U6 =1Mlz. � %� /ivwic.�rccj
represent that I am an officer or- employee of the corporation and am authorized
to act for JMi614CCi Nller'"gmeiu C0,0
• (Name of Corporation)
having offices at r ,�'ccK /a�9�ENt2`
/ B
,PUTNAM COUNTY
Whose officers are: DEPT; OF HEALTH
President: nG'iN1{ A041'Uuc C
(Name and Address)
Vice - President:
(Name and Address)
Secretary: j-, 1 Mj'414eCj
(Name and Address)
Treasurer:
(Name and Address)
and that I am and will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subsequent acts relating
thereto.
Sworn to before . me this /'��day Signed: cel.
of 19 Title:
Notary Pu
BETTY L. ESPOSITO
Notary Public, Sta ?a of New York
No. 452E303
Qualified in Putnam County
Commission Exp1rs3 April 30, 19. "�
8/84
� 't... (ic •sC,,,, -. t M� $ ,"` r a3 .. s �t�- "Y.""� iC"�"3 ,"'�""r �..`"s�r'� 5 �g" i���",..�..- ,..""�.",. } ".a- ,.."�?" T,
x PUTNAM COUNTY= DEPARTMENT OF HEALTH
ReV 3/ 86 L� Division of Envhronmental•Health Services Carmel N Y 1051? `.' Engineer to Provide.Permit # 3
t s J �1 on CERTIFICATE OF COMPLIANCES `
Permit q'
CONSTRUCTION PE FOR 'WAGE DISPOSAL SYSTEM
Moons H1.1 Road
Located at Y. Town or, :Vlllage
Fair'View Manor. 2.6. 1 1 19
Subdivision Name Subd: Lot # Ta: Map Block Lot' '
A Ii11;GU C C l ::.� ey e;l O p m.e n t :C.O r p:. Renews►_ p -= Reyleion p
i Owner /Applicant Name
Date of Previone Approval
p.'0 Box 185 Thor:nwood NY 10594
MaIDng Address' Town f
Buildinge_ .511n Cg 1 e F a m i 1 Y: • iLoi Area 1. 8 4 3 Acres FM season only Depth Voume
Namber of Bedrooms A, : Design Flow G /P /D . .8 0.0 PCHD Noffimflon is Required When FM is completed
Separate Sewerage System to consist of 1 2 5 0 Gallon &Wde Tank and 900 L F Fields
To be constructed by .T 0 b e B e t e -r m i n e d Address
Water ,SUPPly. Pdbllc7 SdpPly: From Address
or." • x Private Snppiy I)rllled bpT o b e d e t e r m �&la
Other Requleements
1 represent tnar I'ain �whoily and.completely responsible fouthe design and location of the proposed system(s): 1) that the: ".separate" sewage, disposal:_system
above'desoribed. will be.constiucted a''sshown on the approved' amendment there to and in accordancewith the standards,.rules and 7egu a j1ons.o e ° u nam
County Department of Health; and that On completion thereof a..'Certif irate_ of Construction'Compliance satisfactory to'the Commissioner. of Health will
be submitt6d?
P
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #/
WELL LOCATION
Street Address Town/Village/City Tax
Mooney Hill Road, Patterson New York 1 -
Grid Number
1 - 19
-WELL OWNER
Name Address OPrivate
Amicucci Development Corporation, Thornwood N.Y. OPublic
USE OF WELL
1 - primary
2- secondary
®RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
® BUSINESS O FARM O TEST /OBSERVATION.
O INDUSTRIAL O INSTITUTIONAL O STAND -BY
O ABANDONED 1
O OTHER (spec'fy
a
AMOUNT OF USE
YIELD SOUGHT 5+ gpm /# PEOPLE SERVEDAvq.4 /EST. OF DAILY USAGE600_800gal
REASON FOR
DRILLING
ONEW SUPPLY OPROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
Well for one new single family dniell'
WELL TYPE
ODRILLED
®DRIVEN
ODUG OGRAVEL
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Fairview Manor
Lot No. 26
WATER WELL CONTRACTOR: Name To be determined - Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED No SSDS within 100ft. downhill, 200' uphill
[]ON REAR OF THIS APPLICATION ® ON SEPARATE SHEET
2 _ J5 7 � �� P
(date) (signature)
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 111 Completion port on a form provide by a Putnam Co nt
Health D
Date of Issue: 19
Date of Expiration: 19 mft Issaing Offic ial
Permit is Non - Transferrable
s
8/86
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APPENDIX B
PUi'NAM COUNTY DEPARTM U OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL DATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
Name of Owner)
CCMMENTS
LF trench provided
required
60 ft. m
REVIEW SHEET - CONSTRUCTION PERMIT .J
DATE REVIEWED.
BY:
(Street Location)
YES - NO DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets s/s
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
to contours
House Plans - Two sets
Well permit; PWS letter
ariance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked -
Ex- approval SSDS Mj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pimp pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design Data: perc and deep results .
Two -Foot Contours Existing.& Propose
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Proposed System
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe .
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fi'
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expa
15' to Drains - Curtain, Leader, Footing
35'to catch basin,stonTdrain,pipea watercour.
101. to Water Line (pits -201) .
50' intermittent drainage course
Septic Tanks.
10' fran Foundation; 50' to will
�f 15' Well to PL ^
TEST PIT I)A`I'rl REQUIRED `I'0 Ph 131114;1',l'TIPID 11I'I'11 APPL•IC/' PION
DLSCIIII "1'I011 01*-' SOIL) i:,I-1C01J1!'1'EIiC;U Ill `I'L3'I' 110L''3
DEPTH I1OLr, 1J0. 261 11OLL 110. 262. BOLE 110.
G.1,. _ sandy loam sacdy clayey.loam
6
21111
J
'36" sandy clayey loam
11211
h [I"
l!511'I
VU"
,6611
[,11" 7' to rock 7' to rock
11MICA'I'E LE'VI,1, AT WHICH C110U11D WATER IS ENCOU11'1'LII1,D
111D I CATO LEVEL '1'O WILIC11 VIA'1ER LEVEL VISES ! FTE111 I E11110 LIICOl1Il'1'LIILD
TESTS I•IADL BY Iya Le
L MI
:loll l=ate Used 1.1liVI "Drop: S.D. Unable Area Provide=d
Ilo. of lY- droonls Septic '='milt Capacity Gale. Type
Absorption Area 'rovl�Iec 13y ' ' L.I�'.:c211'�� "— widLheiclT.
OLhet-
] ia- Me i6na tine
Address SEAL
'1'1113 :H'AL'L 1011 USL LIT IIEALIVJI DLI'AI THE -11'1' OILY:
Doll 1laLe Approved Sq. 11'L /Gal. Checked by WLe
w CURNF''%
Baldwin & Cornelisu, P.4`- >'o Owirl��r l m�te Assoc., Inc.
RD 6 Route 22 `/ �rt� cA� R+ �rQ�F
Brewster, NY 10509 t � �� \ l- oca -1-4V : Mooney Rill Rd. Patterson
X131
i
'1'.iST PIT 1)AT,(I IiI;QUHED '1'0 PE 11I'1'I1 l ►ITUCATIUII
DMIC1111 "1' T 011 01 "' SOILS 1 1.1'OU1Pl'EPE'D I11 TEST 11OLI0
1)E11•1111 IIDLE 110. 261 f , IIOLL 110. 262. 11O LE 110.
G. L. _ sandy loam sai4dy clayey loam
611-
12"
1811
21111
�o '
J
j6" sandy clayey loam
1121'
11 U"
60
66"
.121 -- - --
U11" 7' to rock 7' to rock
111DICATE LEVEL AT WHICH 011OU111) VA'1'EII IS ENCOU11'PERED
1111 I CA'1'L LEVEL '1'0 WHICH 1• AT ,11 MW EL VISES AFTEII DEIIIG EIICOUN'1'ERED
'1'LES'1'3 I.1ADE Dy I)aLe
• I�lUFJ '
13011 Rate Used 1-111 /1 "Drop: S. D. Unable Area I'l-ovide-d
11o. 01' bedrooms Septic Tank Capacity WIS. Type
AbourpLioii A:,ea I'rovidiiff Dy ' L.Ii.x211" S "— width rr—eI16110
OLI1er
llalne iguaE'tire
Address S L
1111115 1311ACE 1011 USE DY I1 '1'lI DEPA1i`lME-11'1' ONLY:
:Solt hate Approved Sq. FL /Cal. Checked by Da-Le
„cIV CUIINF,
Baldwin & Cornelisu,,P.4:" - -- YOB.` Owr16f. --;;1 n►c� 'te Assoc., Inc.
• RD 6 Route 22 ,;• �,,� eqR' ,�..•-G��, c) ��F . :
Brewster NY 10509 ,f o'L \ l- 0ca:�pn: Mooney hill Rd. Patterson
�• ' i iV '1 I`'. •
431, ! ..
' ?JFE.3310
TEST 1317' DATA REQUIRED TO BE SUBMITTED 11ITH hi"PLICAT1011
V.
D 'CHIPT1011 Or' SOILS i:.I��G1JI!'I'rtil;l,D III TEST 11OLL3
DEPT11 11912 140. 261 ► , HOLE 110. 262. • HOLE 140.
G.L. sandy loam sacdy clayey loam
12"
All
24" '
r
36" sandy.clayey loam
112."
11(3" • • ,
Gull
GG"
'1211
7' to rock 7' to rock
INDICATE LEVEL AT WHICH (111OU11D WATER IS ENCOUNTERED
I 1ID I CATS, LEVEL TO 111LiCH WATER LEVEL RISES AFTER 13BIlIG EII0011111'ERED
TESI'S 14ADE BY I)ate
DEJESIUN
Boll HaL-e Used I.LLiVI "Drops S. D. Usable Area Provided
11o. of hedroomis Septic Tati1t Capacity, Cale. 'Type
AbsorpLIDU Ai.ea 'vov dec By ' L.I�.x211�� b"—' Cal
"—' vidLlt Ceitclt.
• OL'her
]isnie 1Btia' -Or e
Address 813AL
'1111:1 SPACE I�OIi USE DY MUM DEPARTMENT ONLY:
Boll BaLe Approved SCI. l'i't /Gal. Checkod by
IXi to
on Baldwin & Cornelisu, P.4:' V-- „cwYOR Oum�'1e Assoc. , Inc.
F t1'
RD 6 Route 22 "A eA�• •�. ~' Mooney 14111 Rd. Patterson
.Brewster, NY 10509 `.�� _ o' \ t -ocpn: �_
o�sto;
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 1.0/21/86
Re: Property of AMICUCCI DEVELOPMENT CORP.
Located at Mooney Hill Road
(T) Patterson Section 1 Block 1 Lot 19
Subdivision of Fairview Manor
Subdv. Lot # 26
Filed Map #
Date
Gentlemen:
This letter is to authorize Baldwin & Cornelius, P.C.
a duly licensed professional engineer X 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.
Very truly yours,
Signed
Counters Owner of Property
igned � �10��
P.E. , R, # %f��l
RD 6, Route 22
Address
Brewster, NY 10509
(914) 279 -7115
Telephone
Address
Town
71-17 - -4 9n
Telephone
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