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BOX 4
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00147
sat;` �° F� c F;Tf (IN R iVRT P14 TE1 AM COUMTY DEf'APlTP4EN T OF. 11�411 lf11
R.!71 Division of Enirpnmental. Health INorvi"a
COUNTY OFFICE 13UILDINQ • GARMEL , NEW Ypfil
TITia rf3p9n N tit bo ¢antplated by w0l chiller and submitted to County Health Department together with labouatorV r@flon of
n@lpj� ref xuq.;or ggnpia indicating water is of satisfactory bacterial quality before certificate of construction.complipricb is j&WO,
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
e'^dfyireR ADORES$
PtrJhEP John Weizenecker North Brewster Rd. Brewster, NY'
00! 4 0001),
Oe V11M Cross Rd.., Patterson, NY
oPCasR�? ".ST1; { �i�r }s�IMEs�T 4—a FARIA t.. l Tfgiwt
TtSR
op., ("� PL1ttLiC ("�9 AIR �''"{ OTHER
�yCl 11 �L pny : El INRUSTRIA4 a GANDITIQNINQ
f Ei!9tE.Ltct47 Q COMPRESSED j —( CABLE OTHER
GS U;pfrll Ft}T L�t ROTAPy AIR PERCUSSION (_ _J PERCUSSION LJ ($P ";fy}
-� IEt>eTtf lRf.0
*Alta Sot
DtItiMETER( /nghog)
6 tt
WEtGFtT {'ER FOOT
1g 1bS .
El THREADED L_ VV9LA €p
R R'
YES too
YRS
NO
*- --
j�j
T� =3 0 BMW.) El QUMPECd
El
HOURS G.C(i,
j
C6MPRE$SED AID 6 30
MUD (0-101011
30
l'��Yf 3 4119i�$UR' CRAM E% 49 SWRMCE- $iF17(!G($pogltr loot)
E ft a, 261
DURiN4t. }(IECp TEPT PON)
Ropth of Complated Wolf
In feat Itelow Land surfacot 220'
Lt j9TH A1'911 TO �PVjgf? (l4vtj
t;�,sl. K T tz11 pI ETFR (1g9hP3J (F GRAV! 1, pipmotor of wog inc {vdlnp MM WZ9. (lnp0q) Fight ftgo1J TP (fa9u. <,..
PAGYEt)t prwol pock (lncAael: � � 4•
CeeTt€ s ^oF+ L1 4',, St�TFt�tE Sketch ®xact cation of well with dlafsnCOa, to et 19041
FEET to FECY MRMATION QESCRIPTION two permanent landmarks.
Drill.iri in overburden
cla .8e boulders
.
.. 5�7.�„i` .•.,•'."w'•('O: '�-.''�i
Hit rock at feet
•O
Drilling in rock —set
30
220
Drilling in limestone
If flrfd waft IC0164 at diperent daplhe during drilling, list bolow
1 :C_ET
GALLONS PER MINUTE
awew +fin •
axnwnxM.•ItYiMC�9sML KS �.
1„ �rti f!„'1F4}s�`L RD 1X10 t0f'6�F1T t�+{oL.1, Pf�li LE^R i5lgnaturo
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 4453
SOURCE: John Weizenecker
Cross Rd.
Patterson, N.Y.
COLLECTED: January 7, 1980
BY :P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
faucet -well
This result indicates the sourct of tht sample was
of satisfactory sanitary quality whin the sample was collected.
January 8, 1980
0 per 100 ml.
Bickwit P. E.
Director
Private Supply to be drilled, by.
a ,
-Addres5.
`other ReGuiremen s
400' x 36" Dee J422'_
` :
I represent that I am wholly; and completely; responsible for the design.and location of the proposed systems) ;. l) .that, the separate sewage_ disposal system
above described will be constructed as shownon the approve-d_ amendment there to and. in;accordance,witl 'the standaids;'rules an regu a ions o t e u nam
,..County Department of Health,' and that on' completion thereof a "Certificate : of. Construction .Compliance ":satisfa'ctoryto the Commissioner . of - Health,will'
'be'submitted'to the Department; and a "written,. guarantee. will' be .furnished the Owner,`his.success ors; heirs "or'assigns by the- builder;'that said builder will
place In 'good operating condition.any,part of said sewage- disposal ssgOem'durin the eriod.,of -two. 2
g; p _( )years immediafely following the date ofahe- 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 %4611 will be installed accordance with the ards, rules and regulaions f the Putnam..
nt of Health
'l n O jy,�
Date County, Depart me� May ,1 770
..':Signed ' .•� P E. R.A.
R:A. _9; Kafir Str e Carmel NY . 5 `2 29206
t
Address License No.
APPROVED FOR CONSTRUCTION: This approval expires one year "o the Cate 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 "Corn sioner of Health. Any change or alteration of'construction
requires a new permit Approved :for disposal of domestic'sa s age, .a d of priv wj ter supply only.
Date eyL!�:<,.' Title
0
FUTNAM C OUNTY Py PA T MEm OP TALII '.
DIVISION. OF rNVIRON DENTAL IitALTH 'SERVICES .
POUNTY OFFICE BUILDING, CARMFLr N. Y•.' 10512 ,
SHM- RPART 3AG OISPp" IQ1 ATA X05 N .
omv' J .ackeoP Address A Ceu sS' .. �' ..
�aa^�d a t (Street '90 Sea m Block.
/gyp /� ne y „ ps re .
►/ILA. I�7 d�Vb.?i �� YB�OV® '/rA J.'Me ';'i/',r♦ ' J' 'r'
SOIL.WC01A TION TEST RaTA BELUIRED TO BE SUBMITTED UITH A011LIOAffJOWS .'
, o 0
SM me . ERCOLATI .
OLA CLAK I
P N a__ar Ve
-tor aP? o �a
16,Gm arq=d Surace . fn =I
inahe6 add ° Rita ,
Start -Si ®p .r. •Mfn� Start atop •Drop n
f : Ir�chee Inah2s
. _ m ,1IIrs AI�IIP9 pmc..V I I ,! {,PI /�I - I�Va,r w •.;, • >t.••
i
,
• , ''I.i
Note r I pasts - pe t .L
o be re Stec at same de W un i an ox tee a d4
rat aro obtalned e4t each peecOAtion t94 hal&p 7.
.0 re
Aept4 moaeuremente to be =de, '�Ap � holLe► ;,:.,. t,, ' frm
DEPTH
G.L.
611
12"
24
3011
36"
4211
4811
54 11
6011
M.
7211
N
TEST PTT DATA 'J'0 M,: WJTJT APPLTMPION
DE113GRI.F.1110TIJ 01.1 lij- 11OLES
HOLES NO / . HOLE 1','0.
z P "
V 0 j, e rb ek pio - i m TF?
T
W,
INMICATE ID7FL AT 1,TaTCJJ GROU1,TD WATER IS AJO-+e
INDICATE LEVEL TO WI-aCH WATER LEVEL RISES AFTER P.'_,'1NG ENCOU-NITEREDNe--e .A 14#m
TESTS MADE BY tAtA. r
&prDate frS*
DESIGN
Soil Rate Use j!�_ -/o S. D. Usable Area Provided t4 A 00 '0 4
No. of Bedrooms nepe Septic Tank Capacity /,0 oo, Gals. Type
Absorption- Area Provided gib" width trench.
Otl),er
to JwN 2. 04 ve-4 off, 6
Name John H. Prentiss, Fx.
Address RX. 9, Fair Street
CarmeT, MY 10512 _k
THIS SPACE FOR USE BY E-EAMT1 DEPARTMENT
Soil Rate Approved Sq. Pt/Gal.
4
Cho
Date
t.
FIELD CHECK MST
Bate:
Insp.by:
INITIAL SI`IE IDISPECTION1 r
Ye",
. No
Comments
'Property lines or corner:3 found
Can estimate, Douse location .
Will driveway need cut . . . . . . . . .
..
Must trees be removed -note these
Is deep hole representative of entire SUS area
Additional deep holes needed. .
-
_
Sufficient SDS area available considering
driveway cut, house location, separation
distances, etc . . . . . . . . . . . . . .
DEEP HOLE DATA
Depth:
'plater elevation:
Rock elevation: /
Soils d.escr_l_pt.ion: Met loki.
- --
FIA?AL SITE IIIS:PECTIG�N Insp, by:
House located where shoi..n on approved plan
SDS located where approved . . .. . . . .
_
_
.length of trench m:;asured
Width of trench average
Slope of tile line.-and trench acceptable . . .
~ .
Room allowed for expansion trenches ...
Over 50 'ft. from swamp, watercourse . . . ...
_ _
Natural soil not stripped or SDS area
tuiriecessarily graded
10 rt. maintained from prop:line and
20 ft. from house
Separation of trench from house, well
�—
etc. follows plan . . . . . . . . . . . . .
'Ntnnber of bedrooms checks . . . . .
_
Stones, brush, stumps, rubble, etc'. greater
than 15 ft. from nearest trench . . . .
15 Pt. of peripheral soil horizontally from
^�
trench . . . . . . . . . . . . . .
Junction boxes properly set
Could surface run off from driveway, roads,
.ground surface, etc. channel near SDS ,... ,
area ...
Does lot drain ,•e appear O.K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE .;
REVIEW CHECK SF M T
Imeets Std.
Remarks •
•DOC _ ENTS
House P lans 0. K.
"
Design data sheet !
Peres presoaked?
Kin. 30" . pert test depth
Con. results for 3 runs
D. Hole log O.K.
Corporate Affidavit for other than individual
Authorization for engineer
u.
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps.
DTAILS
if change is proposed,)
Existing contours shown show new contours)
Slopes for driveway cuts, etc. shown
dater 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.
�L L
3 B.R. house minimum
House setback shown
I I
Distribution box ftg. below frost
!
All water within 50 ft. of PL shown
Plan and profile SDS
All other wells and SDS closer 200'
' shown or-reference made
Property boundaries (metes and bounds- clearly show L
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P. L.
20" to Foundation walls
MO' to Nearest well
050' to stream, march, lake, etc. incl
15' to Curtain drain
10' to water line (pits -20
15' to storm drain
10' -to large trees
0' from foundation to septic tank
5' to pipe from leader drain &.foo n
.exuansionj
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