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Home My WebLink About0341DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -43 BOX 4 I,yti I liss IN w. ��T JNNNNIN NAM :r vr- NNU, 00150 (!Located at /�OQi✓E �� A 7 L SYSTEM Town or % ,,illage ' �� Map Block. , 'WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3)71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARM EL, 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 NAME ADDRESS OWNER Cerlich Construction Co. Putnam avenue, Brewster, New York LOCATION (No. 6 Street) (Town) (Lot Number) OF WELL Mooney Hill Patterson, New York PROPOSED H DOMESTIC INESS ❑ EST BL SHMENT ❑ FARM ❑ TEST WELL USE OF A R PERCUSSION PERCUSSION (specify) CASING LENGTH (feet) WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING F] ((SSpe ify) DRILLING El ROTARY COMPRESSED � 1-1 OTHER 1:1 EQUIPMENT A R PERCUSSION PERCUSSION (specify) CASING LENGTH (feet) Soft pastey DIAMETER (inches) WEIGHT PER FOOT DR SHOE W, CASING j 7 DETAILS i c Q 111edium-hard 66 17 � .THREADED ❑ WELDED ER YES ❑ NO L`i! YES LJ NO YIELD TEST ❑ BAILED HOURS ❑PUMPED %t G.P.M. YIELD (G.P.M.) COMPRESSED AIR 4. 6 6 WATER MEASURE FROM LAND SURFACE— STATIC (Speci y feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 52 465 in feet below Land surface: 465 MAKE LENGTH OPEN TO AQUIFER (leaf) SCREEN DETAILS 1 DEPTH FROM LAND SURFACE FEET to FEET T IF GRAVEL Diameter of well including PACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. rs. 55 80 14edium -hard ledge. 00 95 Soft pastey brown fault. 95 465 111edium-hard ledge. y`ACI If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE V'V a J_ n� J I DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 9/27/"0 10/11/78 zze .z V Mil Drill ncT l Inc. ILIA 2 A041 opx APPROVED PA, GOT31 197 • 'i)1 �! Cis ..� HElf4� DI OR, DIVISION. OF. �v+0()W"JTA1_ HFALU! 5EM RN ` RE\/ISIO�lS: t £ star sys�alTr y� , I. ,. GEdRGE ,A, HAtJGHNEY, 6? E o Pl J+ rtv, `�. COIVSULTIIVG ENGFNEER_ t: Carmel',. New York 70512 CC c) Sr f xi� c r r f Tr TITL� ? t Y.: •C°.+`.'.'`""' r?.F' -�i 'F '3s+^'w� - .:a,�''�,w' i '4i "dc�Y q i AAA ��l9A +R iE k�l r SCALE Ji{ ..`DR BY DRAWING NO GK D: BY DATE _ } v . . .. ms.µ ,.. •v.L -Alp ` f�yy) r _ f'- 1 ^Y R � 5 e , •, . '^.. / f ... - ' "f,. �R`•�:V �* �J4s' vim. � ' ILIA 2 A041 opx APPROVED PA, GOT31 197 • 'i)1 �! Cis ..� HElf4� DI OR, DIVISION. OF. �v+0()W"JTA1_ HFALU! 5EM RN ` RE\/ISIO�lS: t £ star sys�alTr y� , I. ,. GEdRGE ,A, HAtJGHNEY, 6? E o Pl J+ rtv, `�. COIVSULTIIVG ENGFNEER_ t: Carmel',. New York 70512 CC c) Sr f xi� c r r f Tr TITL� ? t Y.: •C°.+`.'.'`""' r?.F' -�i 'F '3s+^'w� - .:a,�''�,w' i '4i "dc�Y q i AAA ��l9A +R iE k�l r SCALE Ji{ ..`DR BY DRAWING NO GK D: BY DATE _ } v . . .. ms.µ ,.. 4 -Alp f'- ILIA 2 A041 opx APPROVED PA, GOT31 197 • 'i)1 �! Cis ..� HElf4� DI OR, DIVISION. OF. �v+0()W"JTA1_ HFALU! 5EM RN ` RE\/ISIO�lS: t £ star sys�alTr y� , I. ,. GEdRGE ,A, HAtJGHNEY, 6? E o Pl J+ rtv, `�. COIVSULTIIVG ENGFNEER_ t: Carmel',. New York 70512 CC c) Sr f xi� c r r f Tr TITL� ? t Y.: •C°.+`.'.'`""' r?.F' -�i 'F '3s+^'w� - .:a,�''�,w' i '4i "dc�Y q i AAA ��l9A +R iE k�l r SCALE Ji{ ..`DR BY DRAWING NO GK D: BY DATE _ } v . . .. ms.µ ,.. • , o BREWSTER . LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 4141 SOURCE: Cerlich Construction Well Mooney Hill Rd. Patterson, N.Y. COLLECTED: S ept ember 28, 1978 BY:T11ill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Thir rtrult ixdicatrr the reurct of tht famplt war of ratirfactery ranitary quality whin thi ramp/t war colltcttd. 0 per 100 m1. Se- tember 29,1978 Bickwit P. E. Director Owner or Purchaser or uil ing ijulld ng Constructed yam /x'9064 Ir /I/t L R4 Loca on - str et PI-9 77.M.P6 RUETTC i P al i t y �l tion Block Building Type of GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I an 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 guaranty to the owner, his succes- sors, 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 oeeu pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination. of the-Director of the Division of Environmental Health Ser- vices 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. Ole Dated this day of 19 SignatureaeP - Title r TS If corporation, give name and 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 VOTICE OF }ATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - -• - - - - - - - - - - - - - - - - - •- Division of Environmental Health Services, Putnam County Department of.Health d - . j �,.��- �•-- c�c'€. x Ask. �.. _ - ^r-- PUTNAM COUNTY DEPARTMENT OF HEALTH ! Division of Environmental Hea/thr:Serwces Carmel N Y 10512 CONSTRUCTION' PERMIT FOR. SEWAGE DISPOSAL jQ -►� t�t aTO n or, village % Located at �� I " b rQ Seet ' ` -glob Subdivision -. - Owner Address OvTE� Building Type C ' Lot: Area Number of Bedrooms'�u C� TOtal Ha itable'Space Square Feet _ Separate Sewers a System to 'consist' ofd d Gal Septic'' Tank ? 0 lineal' width' =trench u"' 9 n r.. To `be constructed 'by TOE Address i y,. water supply: 'Public-.Supply From Private Supply, to -be drilled; by Address _ _ I O' „ther Requirements„ , t Ire I am wholly antl-co`mpletely'respohsibie forthe design and location of the proposed systa'm(s) ' ij” that the separate sewage" disposal systerri. .above describO wilf be constructed as shown on the approves amendment there,fp and 'in,acc� 4�rihAA , ith °the standards rules an, regu ations -o the Putnam County Department of. Health, and that on completion thereof a"" Certificate. of_ Con, tfi e "`satisfactory:•to the Comrnissioner,pf'Healttiwill t be submitted .to the Department; 'and 'a written guarantee will be furhiihed;the,6 �i�s iUCC t54jrs or assign's by'the builder, that said builder will !f placein good :operating, condition, any •part of said sewage disposal 'system; durir�- pflr jiY t Y;4(� �Qpars immediately. following thedate`of the issu- 1 .ance :of the 'approval of. the Certificate of Construction, Compliance:of, the_ori` std- Oran�`19i�pa5�„,%reto 2ohat. the drilled well described above '• will be located as shown on the approved plan and that said well .will be installs ' csorpje� ice' th�56tan�fiQds ' ules ,and: regulations: " of -the, Putnam` County -Department "of'Heal Date 'S. P E ✓ R.A. m n CA' z Address b U E,` ? {� "License NO 8 Q �� b APPROVED FOR CONSTRUCTION: This approval expires one,year from the date - u9� ass slibn of the,building'hae been undertaken and "is n !� _ revocable for. cause or may tie amended or modified when considered necessar`Y,by the':�2p�mne`- c�t,ealth ;jpny_ change or alteration of construction requiresa new / /permit A�p%p'ryov ed_for disposal of domestic sanitary, ewa a and /or privbl/MyjQQrllpply only C/ X ate"', •L /. �� // �/ BY V � s• Title' .��. .. ».- v...�.. ...._..�. �. .u..�_..,... a._..._._ __... r..� . x, x�._ � $ - ,a�.J._.........._.._._.._i i.ivu_...._.�v__ _..1.�. _.e�x..r....c �...........s.i:� .,.u...._ ....3tis..ar.. _ .......a.�.. _�....5n.......•r_t .,.J...i...r� , _ ^� -.+_w r. dL.. CJ Dat e : / Insp. by :. INITIAL SITE IMSPECTIOiJ � Yes No Comments .Property lines or corners found Can estimate -house location Will driveway reed cut . Must trees be removed -note these . . . . . . . - Is deep hole representative of entire SDS area Additional deep 'doles needed. Sufficient SDS area available considering .drlveway.cut,house location,separation distances, etc. DEEP HOLE DATA Depth:, Mater elevation: Ae. Rock elevation: Soils description: [' , Q Date: T- FINAL SITE INSPECTION Ins p. by- House located where shown on approved plan. .. . . . . . . . . . _ Width of trench average Slope of the line and trench acceptable . Room allowed for expansion trenches . , Over 59 ft. from swamp, watercourse .. . ..Natural soil not stripped or SDS area unnecessarily graded . . . . . 10 Ft. waintair_ed from prop.lin° and ft. from house . . . . . . . , , , Separation of -French 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__1y set Gould surface run off from driveway, roads, ground surface, etc. channel near SDS, , area . ' . Does lot drainage apbear O.K. in area of SDS FINAL GRADING OF SITE ACCEPTABLE 1 1 1V U V 1-LYV 1x17 -Llun 1 Meets Std. Yes NO DOCUMENTS Remarks House plans O.K. Design data sheet Peres presoaked? Min. 30" perc test depth Const.. results for 3 runs i ! I D. Hole log 0. K. Corporate Affidavit for other than individual. .Authorization for engineer i t Letter from Water Supply if applicable -If variance requested -such noted on plans & apps. :411 i j I DETAILS if change is proposed,). Existing contours shown show new contours) ✓I Slopes for driveway cuts, etc. shown.' Water service line location I Footing., drain, etc . location I Top slope,.bottom slope of fill Percolation tests and deep test pit location i i Septic tank size and conformance to std. 3 B. R. house miniffLim House setback shown ! 17.11 'Wc6661• w_I_U1J A.11 Plan and profile SDS' All other wells and SDS closer 200' shown or reference made � Property boundaries (metes and bounds- clearly shown)! SEPARATION DISTANCE'S SPECIFIED ON PIAN 10' to P. L. 20' to Foundation galls L00' to Nearest well 50' to stream, march, lake, etc. incl 15' to Curtain drain 10' to water line (pits -20' 15' to storm drain 10' to large trees 110' from foundation to septic tank 5' to pipe from leader drain & fooLin .expansion W5 M M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN IOTA SHEET- SEPARATE SEWAGE DISPOSALS TEM FILET .- Owner 4aE� ��(�( Address 0 TEI`� Located at ,Street M ( E .G��e�. (� Block Lot n ica e eare cross street) Municipality��(rtT�.S��? Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION RIM Elapse Depth to WK-Ter Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 4 Notes: 1) rates are for review 2) Tests to be repeated at same depth until approximately equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. 2)C,'. 71- 310: 33 -I0:4S 12 � io 2 i �� 01P 510 (:a8 to I( IZ 10 2d. 4 Notes: 1) rates are for review 2) Tests to be repeated at same depth until approximately equal soil obtained at each percolation test hole. All data to be submitted Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 18" 24" 30" 36" 42" 4811 5411 60" 66'.' 7211 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. i L W .SAKI oY �o� qo -w Lt-a6 E HOLE NO. � i�o l EQ6 HOLE NO. 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN _ Soil Rate Used LS Min/1 "Drop: S.D. Usable Area Provided ROCS No. of Bedrooms"-'-2) Septic' Tank Capacity `2)0c.D Gals\,`��r,� e renc�� 2Y Absorption Area 'Provided By o L. F. x24" -jb``� �l , ta Address �52 SEAL ' r" PE 0 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. 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':i-, i ]�,Q nv. , " -� i, -° i , V �q mY .t+� .fy a 1- 41ht 4 4rA `p 4 'i iY. 11 t Y ! } S ( ,¢r ,i 'a `f• �' I. ah 4 µ"41R 'N"r Y 4 v ;A , { o-° ,, �n o< , 4 +. 4;" s dy, z, °v, - 1' °n Nv Pik °hi, r rt� a '�� - "vS, 4,F ;.p: ° � s. 1. i } '� 5 .i - 1e "� ,� r t :'.y ,, "' t 'T r y v .v� ��_ "F&t t . t' i a x ^.1,r `' { .��Y a"•y .s 's4 s, "p ^t,� .. . . .. ,r B . r 'Y 2} 0. i st!', i, i'. Es^ r r �;�z s �,m t! u. lR k N a'� T� e t ° s a Y c: a (s r'»M d .nob ^, °�. ;,' ;c.. 7s, �' a° �' F, i 9 9. • d-, m Y ', ! . F A C y , 4 a , 4 i r i 11. t - - ' t ....' „ .. 11 ITTAL ST`JU.". -Prop ,rty :lines or corner.,.) found . ': • . • •. Can estimate . hou -,O location . Will dr•ivet,1zy need cut Mu-:t trees be removed -note th se Is' deep hole rer).v,c; sent tivc of - entire STNS area A d:i-t;:ion_:.l dc:cn hole.- ncodod. Suff.i.cient 'DS area available c:onsid:.•rin dri- vf.w-uy cut, house location, separation . distances, etc. .• . YE ►!;i IiOLE ]y -1 111 lbpth . • elevation: i 71:5+.1 1 Water 1 Plock elevation: o Soi s CGSCr- �ti On: .[x,sp . [)Y:— Yns F0. Con�tr,c.�nt�c 'IhT. L SITE PISPPCTIOT; Insn. by. . louse located i;here, shown on approved plan _ M loCatr- Ci..,here approved •s �1 M ,mot• r v...r. .... _... ........... ... -..._ ._ . to of tile. line and* trench acceptable..: - - oom allowed for expansion trenches . . . ver 50 ft e fro.-ii swarm, vaterc ours e . . _ - ---__ atural soil not stripped or SD3 area unnecessarily graded ...• L V L e . ir.- aintai :ed. fro- prop . line and 20 ft. from douse .. . . . . . . . . . . . . _ :pa.ration of trench from house, well etc. follows plan . . . . • . . . . amber of bedrocros checks - cnes, brush, stumps, rubble, etc. greater than 15 ft. from nearest tr-ench . . . . . . . i Ft • of peripheral soil horizontally- from -� trench e mction boxes properly set )uld surface run off from driveway, roads, . groLuld surRice, etc. ctraxlinel near SDS , • area .... - �es 16t dr-ainase a-orca.r O.IC. in area of SDS :ILLL GRADIhTG OP SITE ACCEPT BLE 4 w. .. RTVIEt1 CITL;CK -T .r DOCUMENTS ;.• House plans 0. K. Design data sheet Peres presoaked? 'Min., 30" pert test depth Cont. results for 3 runs D. Hole log, 0. K. Corporate Affidavit for.other than indivi Authorization for engineer Letter from Water Supply if applicable If variance requested -such noted on plans I I lua,l I i & apps. DETAILS if change is proposed,) Existing contours shown show ne ,,.r contours) Slopes for driveway cuts, etc. shown I Slater sert,T-Lce line location ! Footing.drain, etc. location I Top slop-, bottom slope; of fill ! Percolation tests and deep test pit location Septic .tank size and conformance to std. 3 B.R.. house minim-Lun ! House setback shown iiifi P- 11�!T•.�.lJl1 l.1V,�. ini; .• ��C; %t7vc i�'i�ui All 'Wa Let. vitf)_l.1J. ,U 1 1'. U-1. TL a11Uw11 :..i.. Plan and profile SDS J All other wells and SDS closer 200' shown or reference made Property boundaries (metes and bounds- clearly s Msets Std.( Remarks fes ; No J I i- I I ! SEPARATION DISTANCES SPECIFIED ON PIX 10' to P.L. 20' to Foundation ;,calls 100' to Nearest well I 1 50' to stream, march, lake, etc. i.ncl.expansion ; ; 15' to Curtain drain I ± 10' to water line (pits -20' 15' to storm drain ! 10' to large trees ! ! 10' from foundation to septic tank ! i 15' to pipe from leader' drai footing; drain IV 6 f �- te .. (1 47 t 4ZAA-) 4pif °�'`.�* _ ,eiw�- �..�f_;.- ,�•.... � -gal �.�..: '' ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES`>;. COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address y Located at ( Street % Sec. Block `hot .� n is e nea s cross s ree TT Municipality Watershed , , e 's. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS s Hole Number CLOCK TIME PERCOLATION ,,PERCOLATION Run apse Depth to Water Water Levei ti No. Time From Ground Surfece,in,�Inches ,.� .Soil Rate Start -Stop Min. Start stop ",-,D rop n, 0 Mini: /in drop Inches Inches Inches y �� ; s -3 -ate 3.3 i /' 33 S/- 3 5 Notes: 1) Tests to be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. A11 pp data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SbILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. . G.L. 6" 12" 1811 241► 3011 361 1 42.11 HOLE NO. HOLE NO. of � a�L, K -.fat" �. •'"C- '�"`+.�,s:�'�,•'�� ..� "k', rt,` `b,* ��,, r�'1,}�,�, ,�'�� 48" 54 11 7211 ; 7811 84 't ., w INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE IIEV'E W ER LEVEL RISES AFTER BEING'rENCOUNTEREID TESTS MADE,BY f � Date s DEIGN Soil RateUse %,.. w1Ki`n h"Drop,: , S. D. Usable Area Provided�j 00& No. of Bedrooms � _Septic Tank Capacity. �o� Gal Type Absorption Area Provided B� 5 L.F.x24" b' width trench. ..c l r'7 / A . ! -&,-, D .0. ----% Other ' Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq..Ft /Gal. Checked by o��pRTflJgyrG rC��% Cn ..r' q pF oaaa$ °�,� •,..510 \�\ B° °1°11111110 PUTNAM Cpl'` :'l'1' nr :I':1hT=u.A:T nr 11f.ArMl DTVTsTn\ or ITALIA S1- TZV[CF.S Re: Property of- Located at Date Section 'flock Lot U Gentlemen: e619j, �'O/, This letter is to authorize a duly licensed professional engineer I or regist ed architect •I (Indicate) to apply for a Construction Permit for a separate sew age•system; to serve the above noted property in accordance with the standards, rules or regulations as pro.^ulagated 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 cons truc'%--S.on- 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 ours, f1 Signed . i CkIner of Property ;ountersigne d ? •r i�e� E 043 Udress Zlk / A r��atltlJtt111Eti�`` 'eleptio�3e � • Address Telephone • 1 represent that 6 am wholly and {'co.mpletely. responsible forthe design and location of the proposes oabove described will be; constructed as.shown on.the approved, amendment there- hereto and.•in- accordance 'County Department -'of Health ,`.and that-on completion thereof a Cert�f�cate" of Construction Co be`,subrnitted ',to the Department;`: and ;i w. itten'guarantee_ will be' {:furnished the owner; his`succe C ,place in good operating condition any part said sewage disposal - .sy`stem:'during?fhe peciod.ol f' ance of the approval -of. the. Certificate ° -.of Construction` Compliance 'of, the origirial system or ar will be' locate d as shown on the approved plan and•that sald•well wiiI be installed ,n rdance:..witti COUn4y- Depar M tmen '6 t M Health _. `Date ay , 1.978 signed• A. Add res' Route 52, Ca:rme' N.Y 051 .APPROVED FOR CONSTR.UCTI,ON This approva'1`expire4=one year from the date issued ,unless. ;revocable for ;cause or'may,'be amended or,modifleq, when considere&riecessary-by t - ommission requires a new permit. .'Approved _for disposal of domestic a ar sew e, a d /or to Vh, :Date ;By -Y. I system(s); ,1) that .the separate 'sewage, disposal system Nith the standards, ruiesiand regulations of `.the Putnam p(iance satisfactory totthe Commissioner,of Healthwill ors; heirs or assigns by ,the �b "u*lder'; that -said "builder will :w o_(2) years immediately following thedate.of ttie;issu- repairs thereto '; 2) that.,the drilled well described -above he standards Pules -and regulations of the Putnam* P:E. ^ .R.A. ) Cleanse No =Q43880 )nstruction•of the bailding has;tieen undert.aken. and- is of �Health..''Any change or alteration .of- construction supply only RE NE W At PUTNAM COUNTY DEPARTMENT OF HEALTH /• i Division 6f Enwronmental- HeW Services "Caimel :10512 3 CONSTRUCTION QERMIT FOR SEWAGE DISPOSAL SYSTEM I Patters ".on Mooney Hill Road Town or Village 1'1 4 Located at J Section •- Block j Subdivision `" Lot Job ;owner Robert Oran =` Address Route =' 3.,_ 1 ; .P,atterson, , Building Type, Ran c h Lot Area E ' ,. tNumber of .Bedrooms Total Habitable Space 'Square .Feet =900. 375 2`q il. ? Separate Sewerage System. to .consist of'- Gal septic Tank` lineal feet X Y width trench ' To be constructed by T O b e B e t e r'm fi n e d - Address Water Supply: Public Supply From Prry pl ate:Supy ao be drilled by To befeterm� ,: ned Address -;run of �ankfill= insewa;ge area' _& curtai -n_: drain } Nrl}hne RAlIIIIrP.rtfP.ntG .`•"..31., • 1 represent that 6 am wholly and {'co.mpletely. responsible forthe design and location of the proposes oabove described will be; constructed as.shown on.the approved, amendment there- hereto and.•in- accordance 'County Department -'of Health ,`.and that-on completion thereof a Cert�f�cate" of Construction Co be`,subrnitted ',to the Department;`: and ;i w. itten'guarantee_ will be' {:furnished the owner; his`succe C ,place in good operating condition any part said sewage disposal - .sy`stem:'during?fhe peciod.ol f' ance of the approval -of. the. Certificate ° -.of Construction` Compliance 'of, the origirial system or ar will be' locate d as shown on the approved plan and•that sald•well wiiI be installed ,n rdance:..witti COUn4y- Depar M tmen '6 t M Health _. `Date ay , 1.978 signed• A. Add res' Route 52, Ca:rme' N.Y 051 .APPROVED FOR CONSTR.UCTI,ON This approva'1`expire4=one year from the date issued ,unless. ;revocable for ;cause or'may,'be amended or,modifleq, when considere&riecessary-by t - ommission requires a new permit. .'Approved _for disposal of domestic a ar sew e, a d /or to Vh, :Date ;By -Y. I system(s); ,1) that .the separate 'sewage, disposal system Nith the standards, ruiesiand regulations of `.the Putnam p(iance satisfactory totthe Commissioner,of Healthwill ors; heirs or assigns by ,the �b "u*lder'; that -said "builder will :w o_(2) years immediately following thedate.of ttie;issu- repairs thereto '; 2) that.,the drilled well described -above he standards Pules -and regulations of the Putnam* P:E. ^ .R.A. ) Cleanse No =Q43880 )nstruction•of the bailding has;tieen undert.aken. and- is of �Health..''Any change or alteration .of- construction supply only 40; 7 12 May 95 Putnam County Dept. of Health Div. of Env. Health Services 4 Geneva Rd. Brewster, N.Y. 10509 Attn: Bill Hedges Re: Hebrank residence addition Mooney Hill Rd. Patterson, N.Y. 12563 Mr. Hedges, ILJ We are proposing a two story addition to an existing two bedroom house which was built in 1978. The project would consist of a kitchen/ family room with a master bedroom above and the deletion of the existing kitchen for use as an office/ den off the main foyer. As indicated on the certificate of compliance for the septic system, it was originally built to provide for three bedrooms even though the owners opted for only two at the time of construction. It is now their desire to add a third bedroom, the master suite, with this addition. The final count would be three bedrooms. Therefore I am proposing that the existing septic be utilized, as -is, to accommodate the addition. Please call me if there are any questions. Please review and advise. Thank you. Since e , / Phi ip Ceradini PHILLIP CERADINI ARCHITECT .NO.1 BABBITT ROAD BEDFORD HILLS NEW YORK 10507 TELEPHONE 914 - 666 -0547 AIA ff ti PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health, Services,'. Carmel, N. - Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE: DISPOSAUSYSTEM Town or Village Located at Tax Map; t f Block Owner . /c:/� .�� r.. �/��. Lot Job Separate Sewerage System built by Address•`'•'" Consisting of � Oal. Septic ±Tank•;and Other requirements Water Supply: Public Supply From i Private Supply Drilled Br Address Building Type ,E-f��l�,4/ No, of .,Bedrooms I,Date Permit Issued Has Erosion Control Been Completed? •:•��7�.i.. ; ::. ,tip � -: i 1 certify that the system(s) as listed serving the above premises were constructed assent lallyAs.shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans flled,'a the permit,'Issued by the Putnam County Department of Health. Date /J Certifietl by P.E. R.A. Address. G C f/✓%� / License No. r t 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 sewerage system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void; when a public ' water supply- becomes available. Such approvals are subject to modification or change when, in the judgment of the Com Issioner of.Health, such'revocation'modJtication or change is necessary. Date ....- J By Title _ :s Am Not TPAM MNI ,Ifr7��?�,� rty 1j"k %n; 17 . x f32bsy Z 11 IY us v ri 9 i tyo� r 1r� 4 t. ` f t , t r t `.� Jk � � �•`• �:;y'1 J.J�'bf �f J� J/ J .e'4' i fa 4. 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