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PUTNAM COUNT , `
Y DEPARTMENT .`OF HEALTH "ENO I',N E E R MUST
Division .of .Environments/ HWith Servrc?es, ,Ceri»e% N, Y. ,10512 PROP I DE
�\ 'PERMIT,.#
-
'SYSTEM tOONSTRUCTION COMPLIANCE FIDA' SEWAGE.VISPOSAL •fON
ig T
Town or village
Located at ;e, O �'�' �� �/ Tax Map Block
Owner
. ` /��J% �X ./ Formerly .Tax Map -Lot -Subd. Wt
Separate Sewerage System, built by L S�'9`S�''�' G'O J% - Address .'.�� e2i4r✓�' .��, C�/ernEL
Consisting of /.2 DO Gal. septic Tank and �0 / Gds Tie /� Gi%GLE� SY
Other requirements
ra-
Water Supply: Public Supply From
X Private Supply Drilled By I' F ,6�fi L ' ..S a•✓ I' ! p
Address / • �! • .�OJC L4. ��El�%r%/.r= Q /V �aU /
Building. Type Ale, d oz g V 19 No, of Bedrooms_ Date Permit Issued
Has Erosion Control Been Completed? YES Has garbage grinder been installed? �U
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 accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
r
Date 7 Certified by P.E. R.A.
Address �✓ •'Llcense No.
������
Any person occupying premises served by the above systems) shall promptly take such actionas may be necessary to se re 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 an oid when s public water 'supply becomes available. Such approvals are
subject to modification qrrchange when; In the' judgment of the Corn ssion r of�Health; such.,revocation,.inodlficetIon' or change Is necespryy./.
Date BY �'" i Title
Rev. 6/85
0
s
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 279 -4945
- WATER ANALYSIS REPORT -
SAMPLE NO. 7706 TEST WELL
SOURCE: Benedx
Rte. 311
Patterson, N.Y. 12563
COLLECTED: 5-31-90 .
BY: P.F. Beal & Sons
BACTERIOLOGICAL EXAMINATION
. Coliform Count, MF Method
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
6 -3 -90
0 per 100 ml.
/_1 Q1 1. tom» nr.n�nm
��ti ry
r>~ ►�
WrJLL %�VrLrLlrL1VL7 L%L;!L VlXi
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
-
Office Use Only
WELL LOCATION
STREET ADDRESS: TOWN/ViCLAGILICITY,
TAX GRID MSER:
Route 311 Patterson,NY _� N
WELL OWNER
NAME: ADDRESS:
Charles &Barbara Benedix,Viola Rd.,Mahopac,NY
❑ P8IVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
M RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
.[]REPLACE EXISTING SUPPLY []TEST /OBSERVATION ❑ADDITIONAL SUPPLY
KINEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 28 ft.
STATIC WATER LEVEL o • f - ft.
DATE MEASURED 4/23/90
DRILLING
EQUIPMENT
® ROTARY I2 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING 0 OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 44_ ft
MATERIALS: 13 STEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE 43 ft.
JOINTS: O WELDED [3THREADED O OTHER
DIAMETER A in.
SEAL: .® CEMENT GROUT O BENTONITE OOTHER
WEIGHT
PER FOOT 19 Ib. /ft.
DRIVE SHOEa0YES ❑ NO
LINER: O YES V10
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH (f t)
DEPTH TO SCREEN (ft)
. DEVELOPED?
DETAILS
FIRST
❑ YES ❑ NO
HOURS
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
I OF PACK fn.
TOP
DEPTH ft.
BOTTOM
OEM ' It.
WELL YIELD TEST If detailed pumping
METHOD: ❑ PUMPED tests were done is in-
t
OIXCOMPRESSED AIR , formation attached?
O BAILED ❑ OTHER :OYES ONO
W ELL LOG )f more detailed formation descriptions or sieve analyses
are available, please attach.
I
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Dia-
meter
FORMATION DESCRIPTION
CODE
tt.
tt.
WELL DEPTH
It.
DURATION
hr, min.
ORAWOOWN
It.
YIELD
gpm.
surface
25
Dr
11
ng in overburden clay & boulders
141t
wonk
at 2
28
6
265,
20
2
44
Drilling
in rock,set casing,groute
.
rock-granite.
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY' HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK : TYPE WX 302
CAPACITY 86 GAL.
WELL DRILLER NAME P.-F. Beal & Sons In 40A% / 0
ADDRESS PO Box B SiGinmRr
Brewster,NY 10509
PUMP INFORMATION
submersible 7 g
TYPE CAPACITY
MAKER -Gould DEPTH 220'
Mao EL 7Exo5412 VOLTAGE 23giP Z
al 07
�, fe_S r a r& f5eoec � e
Owner or Purchaser of Buil i.ng
ta
Building Constructed by
Location - Street
Municipality
Building Type
Section
Block
Lot
Subdivision Name
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 12, o 19 C1W Signature
Title
Corporation Name if corp.
S 114r
y
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
FDIP� ci�T*c T .�c�_L"_ rV Cate
n =vim =C� t'i_V �riai
Cr
jv
11 ER
T'i 1 CFA SurDI'i_sIC'I LCT
�S area lc=-=ed as Fe-r a roved plan
b. F s — i ca - Dam cf placE:'—zt
2.1 b Tli`T L w�l TE
C_ b7Zt7 c- SC1_ ACL
t-s*i 15'
e_ 100 f`_ f wa__ cci:r ands -
17_
�
�. a__ _lc- - ,000
b. SEnt— y
c :--, k le•feli
C. 10' IIL rlirL -i .1
C_- =n_CL? W =Zrl' ' LI' L_ G= Q`- Cc_C
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C_
it .
AVG _ Dpr-rH
I 1
(� I
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D.SACC= C . ='- La: C_.L=
• 10 20
E .
Rc= a ! _ wei _cr Ems• -czs? cn,
cam-- c
re= C- C"z'i aL i t= =nc L n Iiliar -7 -a
I �^
-l-ft_
fro C'R LCS- c; �.sc
waLL
a_ B=es crc: _-r c=cLte
I
b_
.- Pires
^W
c-W tank
C_
] Lei -CEE f u�? L-1 lrls_C° cf Ecx
i r r =_.
c ^PL✓ "1c sL "nEc d 1P. C_ I
'
P'..: m eas 'i cC'"scc_Cl - tTc''rC - LC C •°
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C= a i n d- i i• c 1 1 s acccr^- r!C LC Qls'1
6 .
crcle W _- -- __' by I
I
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C' = cz�-_crce away fermi C �� a_ea
r_
lei .
ECUEE U l
a_ E ^usa lcc =^ c_ accrcL� pl_ s
cam-- c
-l-ft_
waLL
a_ B=es crc: _-r c=cLte
I
b_
.- Pires
^W
C_
] Lei -CEE f u�? L-1 lrls_C° cf Ecx
i r r =_.
c ^PL✓ "1c sL "nEc d 1P. C_ I
'
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e_
C= a i n d- i i• c 1 1 s acccr^- r!C LC Qls'1
C' =1 t r- Lar�cr sc C__ . t0 E'CisL .wci=
C' = cz�-_crce away fermi C �� a_ea
r_
C= =Z L C:1 S 7 cces C=�' t� ^• ! _ I
I I
2
Irepresent that I am wholly.ano completely responsible'for. t he design and. location ci ;the proposed system(s); )) .,that the separate sewage disposal system
above described will be constructed as shown on the approved amendment therq :to and inaccordance with =the standards, rules an regma ions o e Putnam
County Depaifmgn of Health, and that.on completion theieof a 'Certificate` -of Construction Compliance" satisfactory to the Corrimissioner'of Health will
be; submitted to the Department, and a written guarantee will be furnished-the owni► his successors, heirs or assigns,by the builder, . that said builder Will
place' in good,operating` condition any.part 'of said' sewage disposal`'systerti, dw�nq the period -bf two (2I yeai 'Imrneciiately following thetlate'of the Issu•
anca of the approval of the, Certificate, of Construction ,Courpliancii of tlie- original system or'any repairs_thereto;2) that,the drilled well. described above
will.be Iocated,as shown on�the approved ' c
,.plan and w�llbe "Installed: in''accor ce `with he. standards,• rules and regu anions oftbe " - Putnam
County Departure t of. He Ith.
Date . p Signed
f N , ei .
Add, Lit Se aG �
APPROVED FOR CONSTRUCTION:• This approval expires two yeais_.from a date, issued unless construction of the - building has been undertaken and is
revOCable' for cause Ar,may'ba amended or modified wnen•coflsitlara necessary by the 6" ommissioner 01 Ffealt ti ,. Any change or alteration of construction
requires a, new permit. Approved' for disposal of .domestic sanitary: sewao;'�and /or nvate water su ply only
Rev. /(/ D U q�8 f%2i —'—
1/87 Date �'i� '/ By / itle ��� J
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 # 11
WELL LOCATION
Str et Address
O
Town /V llage City Tax
Grid Number
WELL OWNER
Name
aw iE
Mailing Address
/ELF
rivate
F. O Puublic
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
(3 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY O AIR /COND HEAT P
0 FARM 0 TEST /OBSERVATION
13INSTITUTIONAL 0 STAND -BY
/ /O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
S gpm /# PEOPLE SERVED_, /EST. OF DAILY USAGE FaO gal
REASON FOR
DRILLING
A10 SUPPLY OPROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
❑TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
'zzo"e-
EW OdJE
WELL TYPE
MRILLED
DRIVEN
ODUG
[]GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _- NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name Z'.4r % L._ Address: X3,2 `JST�2
IS PUBLIC WATER SUPPLY*AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: A4z: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: e1 /A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION N SE ARAT S EET
(signature)
( ) g )
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 Well Completion Report on a form provided by the Putnam County
Health Department.
Date of Issue: ��'o Gam/ 19� .�°``�'
Date of Expiration: 19 �'d' ermit ssuing ffi ial {�
Permit is Non- Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
/ •' IN a S Zito I i.77,71 1� Y• M17.
�1• M�.
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
`R 91
Owner (' ,hn.,r 12� �;7 it C� r X Address`
Located at (Street) Sec. �_ Block' Lot
(indicate nearest cross street)
Municipality Watershed
• ■ • DI• •• •' Y / • Y• • �• /• �/ • 1 Y�• . • •
Date of Pre- Soaking
Date of Percolation Test
HOLE
NL1 BM CLOCK TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Frcm
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In. Min /In Drop
Inches Inches
Inches
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
NOTES: 1. Tests 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.
2. Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION '
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
r��
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
3
INDICATE LEVEL TO wHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
-- DESIGN -
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedroams Septic Tank Capacity gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other
Name Signature
Address I SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
Ramm •• RUY DE1• AR32MU OF HEALTH
-DIVISION OF.,,ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner
x Address
Aj
Located at (Street) 4-4e_ Sec. Block lot
(indicate nearest cross street)
municipality Watershed /V/141
SOIL PERCOLATION TEST DATA REQUMED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre-Soaking o o 1r9 Date of Percolation Test /0
0 . lei A
1:121WN •M' R 12
Run
Elapse
Depth to Water From
Water Level.
No.
Time
Ground Surface
In Inches
Soil Rate
Start-Stop Min.
start, stop
Drop In
Min/In Drop
Inches Inches
Inches
---2
A
3
4
Al
2
-7
3 .21
W,
5
C'?j If
It
2'
jc am
3 9:.2,;?-
4 1A100 4
A
1,. Tests to be.repeated. • at same Op. soil rates
:,�--
are obtained at percpi4 'hole-.All data to :,be ;subnLttbd
for review.
2. Depth masurements.,to bei made -fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBM
DEPTH HOLE NO.
G.L. D.eG i C
11. �Q�sa /G
2'
SOILS
HOLE No. 3
3'
/7
/ r
4,
71
l j
/r
8'
r
9'
10'
11'
12'
13'
/(
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED AJdT ENCOUnrTEo�G
,INDICATE LEVEL TO WHICH WATER LEVEL RISES BEING ENCOUNTERED ^%T eW614 vWTe ei �
DEEP HOLE OBSERVATIONS MADE BY ATE:
DESIGN
Soil Rate Used 02ep Min /1" Drop: S.D.- Usable Area Provided JZt)0 -7�
No. of Bedrooms Septic Tank Capacity / o''vU gals. Type � Ne
Absorption Area Provided By v? .. L.F. x
Other,
Name e_e w f �7%9►�l. Arg�natur. .
Address OG ,S x SEAL
ser
THIS SPACE FOR USE BY HEALTH DEPAR2MgT ONLY: 0646� `e
Soil Rate Approved
PP sq.ft/gal. Checked by
L
`° APDI-MrX B
PTMN _H CCURNT' DEPaR'2= OF MALT:i - D117ISICN OF ENUZRCW _aTLaL BQ?= S�c�TIC✓S
L,NDD/- CPL WATT S i -Pp-T T & SUBSURFACE aly-A- DIS: S,.L S'ISTEIr+S
( '-,.Tar;� of C%r��
CCLM_,,m'�S
RE'7=.g SI T - CCNSTRCCTICN P_I:�M?T
DATE
BY: YIWA
(^ire°_t ca-cm
(� YES II O DOMA—PUSS
I I I Per-ai t Apol ica t i c.^.
I I Corporate_ Resoiuticn
Plans - Three sets
I I Er:ci_nE°_rs ALy"Lhor_z ticn
I
I I
rema _Er I
EO 4--Z.
100 _- e. � I
FI:_I., SYS'1 E Lr-
10 fo. .}- -�- - --
fill notes
nca sue-. I
depth causes I
I
100 v-�-. flood elev. I -
I
200 f t. reSc_''vOl_', Etc.
150 f tric -ll /call
s/CZ
D`sicn * e Si:e t
5 EDITESIC
I eep Role Lx
�_ -= s _.-
Consist: nt Fero Rest_
(3) _ll
Pe_Yc tole L`EC�1
C.Z
Ecuse Plans - T: c set_
- -
V �- I fRc . pest
MiFRAr
Lac—al SuL iv, s; c.,
S- v-_sicn A.cc cva1
(TCwm/ )E': Pe=-:i = R & Di
l eta- Cn DCS Plans & P e_rm _
RE4G?-KJ DELI r CN -_v5
. � Frace Sy -` _ , ;n - (north
SFiace ic G_= .v___i 'F
F_ i i Pr.of_le & D := n=__crs
D or J dery
Se- tic TGnk - Size
Well Scrrics Line i= Cvcr
Construction Notes (crinder rate)
Desicn Data: pert and deep result_
T'v c -root Contours Exis tine & Prc_ccsed
Dri,:e'aav & S1oCEs Cat r
Frotin Drains 01K /- _ _
Perc & Deeo Holes L.^catea
Represe-r?tative or fir? RL' -�rJ and ei_cansicr
Exansice Area;s.cwn;cravity siz
_.Far�: :,Pit & D Box Shown & Lt t: ilw
House - No. of Beiroans
Wells & SSOS's w /in 200 ft. cf r oposed S_s
PrCL�' y Metes & Eauunnds
House Set ,ack Necessary (Tic;.t let)
Howe Sc'ai2_ - 1 /4"/%t. 4"0; T�Te pizc
No Bends; Max. Bends 450 w /cleanouc
S2-RaRA2ICN DIST. \.N S SPECIE= CN PT•�V
Fields
10' to P.L., Drive,, a_r, Large Traes,Tcp of
20' to Foundation Walls `
100' to Well; 200' in D.L.O.D, 150' plzs
100' to Streamn, 4vatercourse, Lake (inc:- e
15' to Drains- Ourtain, Lwde_, Fcoting
35'to C✓tcn basin,szormi rain,CH_ d
10' to 'water Line (pits -20')
50' int?- :Hittant drainace cc�-se
SeJLc Tanks
10' fran Found: ticn; 50' to we' l
15' Well to PL°
MERRIrt 6 CO
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SYSTEM DISTAN °CE TO CORNER
COMPONENT OF HOUSE
A D C D
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