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00102
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00102
Permit N ' .. ,
PUTNAM COUNTY DEPARTMENT OF HEALTH Ra 5-83
Division of Environmental Health Services, Carmel, N. Y. 10512 Jgla _# $ , 1 g40
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM T. Patterson
Town or Village
Ba l dw I , n Road.' Tax Map 1 l Block �Y l.ot '(I
Located at a }� '(F-,1/12N � 1
Mooney H! 1 1 Hts' Map +I 1 26 Renewal _$j Revision _ ❑
Subdivision NY` 105067
Owner /Address
Mary Ann 'i1 i i 1 an i , Late Shore Dr ire, Brewster';Date Of Previous Approval 5/24%83
Building Type
Frame Lot. Area Fill Section Only 0
Number of Bedrooms
Four Design Flow G /P /D 600 P.C. H. D. Notification Required
Separate Sewerage System to consist of
1 250 Gal. Septic Tank and 667 ft. x.24,, w t de laterals
i Address
To be constructed by
Water Supply Public Supply From
Private Supply to be drilled by
Address '
Other Requirements Pump G n pump P t� t w' /11► s, 1 b 1 e -�Auc1 61 e Alarm Panel
1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there. to and in accordance with the standards, rules ancTregulations oT e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his su ccessors, 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 immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be Install in accordance with the standards, rules and regu a ons of the Putnam
County Department of Health.
December 19, 1984 Signed P.C.X R.A.
Date _
Address RD 9 - a 'St re. Carme`1 ' � 10 12 License No. 29 206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when idered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approve , for disposal of dome is to sews , and /or pri a wat supply only.
Date
BY Title —
Rev. 9 -81 -
PUTNAM COUNTY DEPARTMENT OF HEALTH Permit r�/
Division of Environmental Health Services, Carmel, N. • Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Located at Baldwin Road
Subdivision Mooney `Hi 11 , ..Ht§. Subd. Lot a 16
owner/Address-Mark Ann .'1111 rani, Patterson, Ny
Building Type Frame Lot Area 2.6 Acres
Number of Bedrooms FOUr Design Flow G /P /D 800
Separate Sewerage System to consist of two ^ 1000* Gal. Septic Tank
To be constructed by ' ?
Water Supply: V Public Supply From
J1 Private Supply to be drilled by
?
T_
*
�ttervi
amain o► � lags
Tax Map 11 Block 2'. Lot 16
Renewal _I] Revision _
Date Of Previous Approval
Fill Section only ❑
P.C. H. D. Notification Required
and
Address
Address
Other Requirements * One for pump pit; effu n _ D-- # hie yiCihile clam (rontro -1 box)
I_ represent. that•1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ons O the Flutnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the 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 Immediately following thedate of the Issu-
ance of the approval of the Certificate of. Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance with t andards, rules and regu a�lal onsof the Putnam
County Department of Health:
Date 25 February 1q8.1 Sign P,E._ R.A.
Address RD 9 - Fair 5 arms License No. 29206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unles onstruction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commi o er of Health. Any change or alteration of construction
requires a new permit. Appyoved for disposal of domestic age, and/ private er,j(p_nly spiv j
Date By Title
Rev. Q -Al
PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER MUST
Division of Environments/ Haglth Servioss, Cbynel, N. Y. 105 12 PROVIDE
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM TPERMIT
. Pa
sin
Located at Baldwin Road Town or village
ii$or Tax Map I Block 9
Owner Leigh & Anthony S�_rbomerly y; 17 an;
Tax Map Lot B j (� Subd. Lot p
Separate Sewerage System built by —John BPrtor• chi 1 6
Address
Consisting of 1— 00 Gal. Septic Tank and .667'
Other requirements 1000 Ga 1. um 4 t & effluent Pum wand ' b ;r2 8
water Supply: Public Supply From
X Private Supply Drilled By — P F B a t inn c Tn r
Address Brewster, NY 10509
Building Type Frame
No, of Bedrooms three Date Permit Issued_ august 28
Has Erosion Control Been Completed? yeS
Has garbage grinder been installed? no
I certify that the systems) as listed serving the above premises were constructed essentially as shown on the plans of the completed work c co
of which are attached),
Departm , and in accordance With the standards, rules and regulations, in accordance with the filed plan, and the
Putnam County Department Of Health. pies
permit issued by the
Date �gn G t R 1 A R S
Certified by
Address
RD9 -Fair ;tree Carmel, NY 10512 P.E._ER.A.
License No. 29206
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate
available and the approval of the private water supply shall become null s StOr whall se public water void es won as a
sub)ect to modification or change wh n, in the Judgment of the Corn ssl e f Public sanitary seyrer becomes
r� Ppiy becomes available. Such approvals are
Ith, such revo on, modlfl on or change I necessary.
Date — y
By
Rev. 6/85 Title
�l.� ENGINEER TO PROVIDE PERMIT #
PU'TNAP�I ®�Y EPC A E T F HEALTH ON CERT FICA OF COMPLIANCE.
Carmel, N. Y. 10512 PERMIT _
�) Division of Environmental Health Services, Ca ,
: ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM . Town or illage 16
Baldwin Road Tax Map
1 1 Block 2 Lot
Orated at Revision _ ❑
ubdivision
Mooney Hill Heights
Subd. Lot H 16 Renewal _I]
Date Of Previous Approval 1'981 orginial (Villani)
wner /AddressLe]. h & Anthony III Scirbona no
Frame Lot Area 2.325f acres Fill section only ❑
luilding Type no
P.C. H. D. Notification Required
Dumber of Bedrooms * Design Flow G /P /D 600 667' x 24" wide x 18" deep
ieparate Sewerage System to consist of
1000 Gal. Septic Tank and
ro be constructed by John Bertocchi Address
* -Three bedroom dwelling; four bedroom design.
Nater Supply: Public Supply From
P.F. Beal & Sons, Inc.
X Private Supply to be drilled by
Brewster, NY 10509
Address
dible visible alarm panel
Dther Requirements
1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee wilt 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 immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regu a ions of the Putnam
County Department of Health.
P.E. x R.A.
Date jji l y 29 1985 Signed
NY 10512 License No. 29206
Address
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and n
revocable for rouse or may be amended or modified when co s red necessary by the om issioner of Health. Any change or oration of construction
requires a new permit Approved for disposal of domesti san ar e, a d /or priv water wpp1Y only.
Date
BY Title
COLLECTED: August 15, 1985
P F. Beal & Sons, Inc .
BACTERIOLOGICAL EXAMINATION
Coliform' Count, MF Method'
Thii. ruult
. ixdicatti tht
iourct of
tht fampli wai
of iatisfactery- iaxirary
quality whtx
the iampli
wai colltcttd.
0 per 100 ml.
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance, is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Anthony Scirbona III
ADDRESS
342 Fair St. RD 9 Carmel,NY 10512
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
Baldwin Rd. , RD Patterson NY
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
1:1 SUPPLY El INDUSTRIAL El CONDITIONING ❑ O(specify)
DRILLING
EQUIPMENT
COMPRESSED
® ROTARY AIR PERCUSSION ❑ PERCUSSION E] ((Specify)
CASING
DETAILS
LENGTH (loot)
61,
DIAMETER (inches)
61
WEIGHT PER FOOT
1 lb s .
® THREADED ❑ WELDED
RIRIjVES OE
LX I YES [:]NO
X
D9
YES NO
YIELD
TEST
HOURS, G.P.M.
❑ BAILED ® PUMPED ❑ COMPRESSED AIR
0
YIELD (G.P.M.)
60
WATER
LEVEL.
MEASURE FROM LAND SURFACE— STATIC(Specifyfee t)
t
DURING YIELD TEST jfeet)'
1(6
pth of Completed Well
feet below Land surface: 2451
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (leaf)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravol pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet) TO fleet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION .
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
45
Drilling in overburden
clay and boulders
-
Hit rock at 45 feet
45
61
Drilling in rock,set
casing, grouted.
61
245
Drilling in rock granite.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL 2COMPL TED
DATE O RPORT
8/20/85
WELL DRILLER (Signature)
Leigh.& Anthony Scirbona
Owner or Purchaser of Building
Owner
Building Constructed by
Baldwin Road
Location - Street
Patterson, NY 12563
Municipality
TM11
Section
2
Block
16
Lot
Mooney HIll Heights
Subdivision Name
Frame 16
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 Health Services
of the Putnam County Department of Health as 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 31st day of July �9 85 Signature
Title)
Rte. 52 Stormville, NY 12581
Corporation Name if corp.
(abnvP)
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
Owner or Purchaser of Building
Owner
Building Constructed by
Baldwin Road
Location - Street
TM 11
Section
2
Block
16
Lot
Patterson, NY 12563 Mooney Hill Heights
Municipality Subdivision Name
16
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 Health Services
of the
Putnam County Department
of Health as 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
thie___Ejrt day of . July
19 85 Signature
Title
I e hfY
t
Corporation Name if co p.
R
a„ �titi_R..1 rl�ai n Road
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
z
OdlwEhndKfththrmafi=:
Rec&ed by.* Date:
. .. Pam n''Oling1w.
REWRDS
Pmimd br.*
Rohmed t®1 70
PatL-
Md: I Date:
lm 12/14 i q®
-A
JOB STATUS REPORT
TIME : 04/15/2016 15:11
NAME :
FAX# : 8452786026
TEL# :
SER.# 000009110223
DATE,TIME
04/15 15:10
FAX NO. /NAME
RECORDS
DURATION
00:00:39
PAGE(S)
01
RESULT
OK
MODE
STANDARD
run(
now
'
ncom
y -
yew
itcomm
a —��
! -7
r7
Notes: 1) Te 'Ate to'be.'repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for .review>
yep h` measurements to be made from top of holes
TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION �
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. I HOLE NO. 2. HOLE N0.
G.L.
6" G�i �► o �,s
12 ►r � ,
18r►. a
24
301 t
36"
42" Le
48
54 r► , . ..
6o
66"
72'►
7811 a�
84n
INDICATE LEVEL, AT WHICH OU D TER I ENCOUNTERED itloK�
INDICATE LEVEL 'TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4"r";04- 7.4" r'w 02-
TESTS MADE BY a, P. • T) a.8 0
DESIGN
Soil Rate Used Y o Min/1 "Drop: S.D. Usable Area Provided 10d e).o
No. of Bedrooms o r Septic Tank Capacity Z- oe teals. Type o
Absorption Area Prov ded By &,7 L.F.x24 width trench.
- . Other.
2E e i P. '',L . .
4.05 10NA[ _ ♦ LAP& aLllo ®O -_w.-
Address-
THIS SPACE FOR USE' BY- MIAALTH DEPARTMENT ON
No. 292�rO
Soil Rate Approved Sq. Ft /Gal. C E Asp-° Dete