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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 13.07 -1 -67 Irmo ' sell M Is III I i e ly I I.- eer , m r ke 00276 �I'J ENG I NEER 111' PUTNAM COUNTY DEPARTldIENT OF HEALTH'. pROV I DE ` Division of Environmental Heath Services, Carn►el, N, . Y.,-10512 PERMIT # .2 " 8 5 CERTIFICATE'OF CONSTRUCTION COMPLIANCE FOR :SEWAGE DISPOSAL SYSTEM ,Pa te?^son Town or.Villege Located at 'R011te 311 atterson Tax yap. 1 Hioc k 6 Owner Jean Cloidt / Formerly Tax Map Lot t 1013 subd,"LDt a 3 Separate Sewerage System built by ' Paul Ross , System .M-i l l s Rc ad Consisting of 1000 Gal, septic Tank and 500 Z F ' x 2 t .wi d trench Other requirements -. ;I R (1 R Rill Water Supply: Public Supply From ter X Private. Supply Drilled BY Ro ''.... -�A�� task } Yv 3 Co. lam' o Address Route 52 Building Type 1 Family Residence No. of Bedrooms 3 Date Permit Issued 2-'1-85' Yes Has Erosion Control Been Completed? 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 ( copies of which are attached), and,in,agcordance with the'standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date / ' 7"0( 'i Certified by��G'C fn \._1. P.E. R.A. J r Address N License o. 260nR Any person occupying p►emises served by the above systems) 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 id a$ soon as a public sanitary sevwer becomes available and the :approval of the 'private water supply shalt beco ' and void when' a puDli at ly becomes available. Such approvals are subject to modification ' or change When, in the Judgment of th 'COm I Slone► 'of Health, ch revocation, edification or change Is necessary. Date BY Title J Rev. 6/85 0 Owner or Purchaser of Building Building Constructed by Location - Street PA- r -Y-E cD Municipality Building Type 1 Section Block Lot Subdivision Name 3 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 ne 'gent act of the occupant of the building utilizing the system. Dated this `I r� day of VoV 19e'J Signature Title RECEIVED Corporation Name if Corp.) Address PUT�IAPA coumTY - - - - - - - - - - - - - - 1AEACH - - - - - - - - - - - --- - - - 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 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 "• 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 Jean Cloidt ADDR SS 99 Ash Street Yonkers, New York LOCATION OF WELL (No. a Street) (Town) (Lot Number) Rt. 311 Patterson PROPOSED USE OF WELL . BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING . ❑ (spocif ) DRILLING EQUIP ENT COMPRES390 CABLE ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ OTHER ) CASINO DETAILS LENGTH (toot) 31 DIAMETER (inches) 6 WEIGHT PER FOOT 19 [] THREADED ❑WELDED E WIDE—_ YES NO 18W UYES CASING qMUTEDT UNO YIELD TEST ��jj HOURS G.P.M. ❑ EAILED PUMPED 8..1 COMPRESSED AIR 2 YIELD 2OP.dF.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Speclly lest) 35 DURING YIELD TEST (feet) total drawdown Depth of Completed Well in feet below Land surfaat 230 SCREEN MAKE LENGTH OPEN TO AQUIFER (lse•1 DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKEDs Diameter of well Including gravel pack (Inches): GRA E SIZE (Inches) M lest TO (loot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at leant two permanent landmarks. FEET to FEET 0 20 Overburden C tm'" V �•, O 1i ; PUTNAM r,0UNITY DEPT. OF HEALTH Boyd Artesian _Well 00., Inc. 30 230 Limestone .If yield was tested at difhrent depths during drilling, list below FEET GALLONS PER MINUTE GATE WELL COMPLETED 9 -21 -85 GATE F PORT 11 -0 -` 9 JW LL DRILLER (Signature Rt. Carmel, N.Y. -° Atown Medical, Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) r J iocAT�ows: O 321 KEAR ST.,;YORKTOWN HEIGHTS N,Y; 10598 245.3203 ❑ 201 BUTTONWOOD AVE PEEK Y.'1' 737.8777 ❑ 495 MAIN ST.; MT: KISCD; N.Y. .1064®- ;666.3335' ❑ STONELEIGH AVrE (NEAR H(?SPITAL) '.,,CARMEL, N. Y. 10512 278.9330 l �o yP DATE TAKEN t GATE RECEIVED.• ' DATE REPORTED: SAMPLE SOURCE: Lst 657 REFERRED RY - -- Collector SL L; LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY i P= ...........7,7.9,A= BACTERIA, TOTAL /mL .......1..0 .............................. BOD, 5 DAY ............................ ............................... ❑ BROMIDE ........................................................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................ ............................... ❑ CHLORINE ............................ ............................... ❑ COD .................................... ............................... ❑COLOR ( Units ................. ............................... ❑ CYANIDE ............................ ............................... ❑ DETERGENT, ANIONIC ........................................... ❑ FLUORIDE ............................ ............................... ❑ HARDNESS ........................................................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... FT. COLI FORM COUNT/ 1100m1 ••••�••••••••••••••••••• ❑ CONFIRMATORY TEST ............ ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ ODOR (units) ............................................... ❑ OIL & GREASE ........................ ............................... ❑PH ( ll11it3) ...................... ............................... ❑ PHENOL ................................ ...6........................... ❑ PHOSPHATE (ortho) ................ .............6................. ❑ PHOSPHATE (condensed) ••••••..•.•• .• ...............•••..•.•••••.- ❑ PHOSPHATE (total).................................. ............. ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ SOLIDS, DISSOLVED ............. ............................... ❑ SOLIDS, TOTAL . ...................... ............................... ❑ SOLIDS, VOLATILE ................ ............................... ❑ SPECIFIC CONDUCTANCE (uhmo s / cm) ............... ❑ SULFATE ........................... ............................... ❑ SULFIDE ............................. ..............:................ ❑ SULFITE ............................. ............................... ❑ SURFACTANTS ..................... ............................... ❑ TURBIDITY ( NTU) ............... ............................... ❑ ALUMINUM ........... : ............. :...................................... ❑ ANTIMONY ........:....................... ............................... ❑ ARSENIC .................................... .....I...:..................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ......................... ............................... ❑ BISMUTH . .................:.'.............:... ................:.............. ❑ BORON ........................................ ............................... ❑ CADMIUM ......................... a ............... ❑ CALCIUM .................... .......:...... .... ........................... ❑ CHROMIUM Itot.) .... ........ ........:. .................. ❑ CHROMIUM (hexavalent) .................... ...:........................... ❑ COBALT ...................................................... : ......... .... ❑ COPPER ................................ ................ ❑ GOLD ...... ........................... .. .. :..... ... ❑ IRON .. ...... ................................. ❑ LEAD ... ........................ ........ ....... ............. ❑ LITHIUM .................................... .:.:........................... ❑ MAGNESIUM .... .................. :............ ❑MANGANESE ........... ❑ MERCURY ...: ...............:.......:..:..:.. ..........::.s................. ❑ NICKEL ........... ..; . ............... ❑ PALLADIUM ....... ,r.,. ...... ! A ❑ POTASSIUM ........ •.- ❑ RHODIUM ........................... :........ ..:.::......................... ❑ SELENIUM .............. .... .......... ❑ SILICON ...... t f'.: 8s ............ ❑ SILVER .................. .. ❑ SODIUM ............ ..',P�.y.�ty��� !Ui�j�' OTIN ......... ....... ..�.1.....�l:�i� }4:�....... ❑ ZINC ....... .. .............. ❑ .... ........................... .............. ❑ ............. ...................... ........... ❑ REMARKS: :. w• ................ O........... R4 /�Ny1••). ......... ❑ ..... • • ..�5 ...C• ..e.,i .ir r •.......... ❑ ...••... �............ ............ ....... O•............ • • i�N /H N,, R (Y i'• ti .............. O............. • • Y • } N j,• M ?T R.•�M R •........• THESE RESULTS INDICATE THAT THE WATER WAS OF A 9AfiI$C`ORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED.' THESE RESULTS INDICATE THAT THE WATER DID MEET 2?H uATI}FAd, Y CHEM- ICAL-QUALITY OF THE .NEW YORK STATE ADM IN•ISTRA ;IYE'A'UL 'Z4. ?�.i iE'U ATIONS, tv DRINKING WATER STANDARDS (PART 72) FOR THE PAAM(TERS�E�fiED WHEN THE SAMPLE WAS COLLECTED. N/A not applicable 6 Uk e A _eeA j Albert H. Padovani M.T. (ASCPI. Directs - .. .. � . * - - , - C ", ... ,41-,--�z -,.�io- ., , ;- -, -, .. �: . A, i '.,.i -, � . -, -, � ....... - - " - I— ;% I, - - " . - %X; . \-" . -, r,.--�. .. , - ...., �4�1 ".1, � . ... . .1. -; � , ': -.,'f �� , %:iW4% .. ,�oi:,- �---:-, ... .. - I - i. - , "I 1- , , :f�l. *i -Z, - - -�-6t ,� .. ,". , . "., . -, I.,; t�,�... -A'-". - " - , , � ., , . � �, :, - : -.� ', , " , , I . . -- .", - % - - .1 � , �.. , I 1. � � I � '. t- , �,4� - �!il' " - - , . " - , , . . - -.' .'7�i` "., ,�, -�. 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Mai A I 1M. was "T A an :A;�� TWO LOW Awn final os 200' shown or- reference made ! �/ Property boundaries (metes and bounds- clearly shown J SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. ?01* to Foiu-idation walls )0' to Nearest well j0' to stream, march, lake, etc. L5' to Curtain drain 1-0' to water lira (pits -20 .5' 'to storm drain O' ' to lar;-c trees :0' V1,01ll Voundation to sopric tank .`)' to pipe 1.10111 leador drain & .I'(j . e,;pansion)_ le, i1I'<llll Nl � ' pip FJJ JA /0/ 00, i 10� „, A A3 3 (Meets S Str9 J R;marks es N No ' DOMi7E `ITS House plans O.K. Dr -sign data sheet Peres resoaked? ; ; l l V9"� L;in., 30” perc test depth O Or iUoTtD Const. results for 3 runs D. Hole log 6.K. t tug= r 0 1 i;P774'-. Corporate Affidavit for other than individual Authorization for engineer Letter from Water Supply. if applicable W Wt� If variance requested -such noted on plans& apps. 0 011A DETAILS = = - - Existing contours shown new. contours) Slopes for driveway cuts, etc. shown %titer service lire location Footing drain_, etc. location Top slope, bottom slope of fill ! ! . . P.of' SdaL"l Percolation tests and deeu test _Lit location I I i i Seutic tank size and conformance to std. 1 1 3 B.R. house > inim m House setback shown ✓ ✓ I I I Distribution box ft g. below frost i i All water within 50 ft. of PL shown Plan and profile SDS :' I I.. �,. N...... . ..... _...... • .. All other wells and SI?S -T o shown or- reference made ! �/ Property boundaries (metes and bounds- clearly shown J SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. ?01* to Foiu-idation walls )0' to Nearest well j0' to stream, march, lake, etc. L5' to Curtain drain 1-0' to water lira (pits -20 .5' 'to storm drain O' ' to lar;-c trees :0' V1,01ll Voundation to sopric tank .`)' to pipe 1.10111 leador drain & .I'(j . e,;pansion)_ le, i1I'<llll Nl � ' pip FJJ JA /0/ 00, i 10� I FIEND C1TT.Cl: LT ST. o ' Date: ' - Insp.by: INITTA.L SITE I1-13PECTIO ?: r � Yes No C61rmcnt - _ , Propert,y lines or corm-rs Found . . . . . . .. Can estimate house location . . . . . . . . . . Will drivcway need cut hjust trees, be removed -note, these Is deep hole representative of entire SDS area• Addit,iona.J_ deep holes needed. L7' _ _ Sufficient SDS area available considering.. driveway cut, house location, separation distances, etc. DEEP HOLE DATA Depth: 5- Water el_eva.tion Rock elevation n: OSOJJS dESC1L?t ► ' Date. t n P; , -, Y F II: L SI -� r�,f,-C T(). : Ins p. b House located i- rher.•. on 'approved plan • . _ SDS located whlere approvOd • • • • • . '1/ng-th of tranch maa sure" Width of trench avei , ga Slope of tile line and trench. acceptable . - Room allowed for expansion trenches . _ Over 50 ft. from st:anp,watercourse - Patural soil not - stripped or SDS area iumecessarily graded 10 Ft. inaintained from prop . line and 20 ft. from house _ Sep' -1- ration of trench from house, well --etc.—follows plan :- : - - ° - -; -. - -;- ; - -,--- ; -; - � - - - - -- - - -- N u1iber of bedrooims checlts . Stones,: brush, • stumps, rubble, etc. greater than 15 ft. from nearest. trench ' 15 Ft. of peripheral soil horizontally from trench Junction boles properly set Could surface run off from driveway, reads, • ground surface, etc. channel near SDS , area. . . . . _. Docs lot dr. ain:�l ,,e ar.re:�r 0. K. :1.n area, of SDS FINAL GRADING OF SITE ACCEPT11ME `T .( t U r n PUT CO a .. ,� r• �,,,.,. ; �- •'. � Drvisron ofzEnwronmi "• =.CONSTRUCTION PERMITS, FOR SEWAGE' DISPOSAL l 3 Route 3114 Patterson Located' at Fsubdwision F A' C` Schepperle s� Nner %Address .�'(1TTIGTA�a� �HlI Z Li Patterson; b BuIding:Type ��' Residence i Ldt Area r Number ,of Bedrooms Design Flow O /P /D 600 Separate sewerage system.,to consist of '000' G "To :be 'constructed by TQ ; "be determine,, ,. Water SuPPIY Y t Public SuPPIy F�,om s r_x prvvate,5upply,'to be drilled by ;. Address' N /A_ gcher aequvemen 3' R 0 B F111 Ay f Frepresent that 1 am wholly and completely responsible for the`d ;above;described' will be constructed is shown on the approved ami County`. Department 'o f Health, ..and that'on completion thereof ae submitted to she Department and a .written guaranteewill will be located as showm`iin the approved plan an0 that said well .w County Department of Health s w' Oate I Ax$4,4 �. '� Address Ca shin �Assoca 5 w ti APPROVED FOR.CONSTRUCTION This approvakexpires one revocable "for cause or maybe amended or modofied When ,con ? ,equues a new permitAppioved for disposal of domestic N n } �e By 61 4 w 1 �s. TMENT:;OF HEALTH Permit:n.` ervrces Carmel N {* 10512' by ` k :Patterson a ; Town or m illage = i 1 t,�Tax 'Map{ 1 0 1.3 �slock 6 i.ot.." i r Renewal" �0' - Revision ° 0' �' DateOf Previous Approval ' _ tl e Fill Saction,,Only ❑ .s a`- �.� Notification Required d Tank antl' �- 500 'LF -0 f „2 "'Trench° ,f N/A F IlllT)PC� t i of the proposed systems) `•i) that the separate sewage disposal system. d dahh ad rules n anin acornce wit't standrs regulations of the-, Putnam f Construction- Compliance satisfactor`y'to the.Commissioner of Healthwill e owner his: successor; heirsor.assigni�by the'builder,,that'said buildei,will umg -the perioC of two,(2) years immediately following,the date .of the issu- iginal < system or any r,epays thereto;_2) that the'drilled ,well described' above accordance wdh they;,,standards les and rep u a ons ?of the . ,Putnam X RA., License.No. 26008'" ate issued unless constructfoiri the building; has been undertaken and is y they Commissionei: 01- Health' Ally- change or'alteratloii ioCiiiinstruction id /or; <pnv w ter supply only. t 1 t� S Title d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 2. p - i ' Re: Property of Located atf� Section / Block 40 Lot �c Gentlemen: This letter is to authorize) a .duly licensed professional engineer or registered architect, (Indicate) to apply for a Construction Permit for a separate sewage system; to rules serve the above noted property in accordance with the standards, rules t or regulations as promulagated by the Commissioner of the Putnam County j Department of Health, and to sign all necessary papers on my behalf in - - ; $:01111t 1V L.W11 w-. girl i.11i5 mac i.ev aiui to. supervise the cunstxeuctiuri of said .`I system or systems in conformity with the provisions of Article 145 or r;1 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. , Very truly yours, a Signed 47, ..,{ Owner of Property .t V Counters igne %d+'V- �-- S .. .� tf Address P.E. R.A ,3'7 li41 K S 777 Telephone Address Telephone P � t 3. o-I ( G7 PUTNAM COUNTY DEPARTMENT. OF-HEALTH DIVISION-OF ENVIRONMENTAL HEALTH SEFRVICES r COUNTY`OFFICE IlUILDING, CARMEL,. N. -Y: 10512,. DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO;, Owner; /vThb,yY . LR—M /� CLC�FD7Address_ q� .4.5/� S� anfl�E T 7� Located at (Street // Sec. Block Lod tip' ln^`c cca e nearest cross street MunicipalitY_�I�,4T/r� ii`DiV. Water.shed SOIL - PERCOLATION TEST. DATA REQUIRED TO BE 'SUBMITTk� WITIAP�PI,I0 r'IONS' TT-07 e Number, TIME PERCOLATION P�C�C�ATION :..CLOCK � Run "lapse p o a er. a er No, " Time Start =St'o ' Min. From Ground. Surface Inches Start , Stop Drbp Mina tirbp p' /rid ;•, Inches.. (,;Inches . •Inches t / / ,. 1, u••�ri '. l - ., 2 J{ . r ' .'- .. . .. .. i (- t,t \ ". \ >r•'D �r l 1 t I t 141/11 \ y ' . ~' s• ..��""�'�' i! .lr. yneu'Ay'yK�,j - t,C. "1 •';'.•<", l.:' < v .1. v 4 _ .. f,, \ k, , wlis ti!r- altar• r''+e '1' l' ' t y• + 1 2 Notes: 1) Tests to be rates -aro obtained at repeated at same depth until approximately; equaloi'1 each percolation test hole:: All,.data.. t �`��tzbth�t ed for review. <; t 2) Depth measurements to be made frol,. t•op '.of hole.. TEST PIT DATA REQjJIRED TO BE SUBMITTED WITH'APPLICATIb1V .;. :;.•',': ;.:.: DESCRIPTION ,QF SOILS ENCOUNTERED IN: TESL MOLES DEPTH HOLE NO . l . IIOLE . NO..' �'1Y0:, , x •, • ,.,. U.L. 1211 1.8" +. X011` trY. "Q r f - t ^ 42 OAAJ ' .� /• 5411 6o" 66 IA18259 m� 7211' F r -= J: 7011fi:PEy` V 1 INDICATl'LEVEL AT WHICH GROUND WATER IS ENCOUNTERED: ' INDICATE, LEVEL TEST$ IA4D .. BY TO W1IC11 WATER LEVEL RISES AFTER'B9I1!G11,4 ENCUUN lhawo DEMN Soil Rate -U6ed?/- 30.•Mi.n/1 "Drop: ed 1 No. of Bedrooms Septic Tank Capacity OOO. Absorption Area Pro de By Sob L.F.x24" `!w d �,. ]�. J•V r .3 F71 LL V. nlame gna ure g'; • Address 44�15/A / _ SM0647'4 J% PC..- 9 i k 1 ��F 1 1 y .1 R i fr u i 1 1 SEAT; ,!r � .� • . g7 F1414 X7°40 a7. Aly .�,�Cr r, � � � f R•+4.7 m .r, r! 1. PHIS SPACE FOR USE BY HT';AU.PH DIJPARTMENT ONLY: Soil. Rare Approved Sq. Ft /Cal•.. 'bh cked7bi .`_ log Z