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23. -1 -47
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00583
J^ Rev., .3'118
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Servicesi Carmel, N.Y. 10512
Engineer Must Provide
P.C.H.D. Permit L
Located at :)e11LGrfr_J
Owner/applicant Name _AA Ic k C, r- S,6,ik -)I
Mailing Address,
► C, 4-i S' it
SYSTEM, q n
Zip 10 Ed I-
Separate Sewerage System built by
Consisting of ZED Gallon Septic Tank and
TAX Map
Subdivision Named
Date Permit Issued
Town or V
7- Lot
le'r It iv 1
Subdv. Lot #_ 3
Ja V" [7
Of
Water Supply: Public Supply From Address
or., Private Supply Drilled by e, F. Address
Building Type R-r-5i d,`44141 Has Erosion Control Been Completed? Vee
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
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 Yd an, and thei,permit issued by the
Putnam County Department Of Health.
Date Cl z— a if 6— P.E._ -!��6 R.A_
I r
-6,1% License
Licens
Address 73 A I e- 4e, Aakel
Any person occupying promises 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 pub','-. sanitary "war becomes
available and the approval of the private we ' ter supply shall become null and void when-a public water supply becomes available. Such approvals are
subject t6 modification or change when, in the judgment of the Commissioner of*Health, such revocation, modification or change Is necessary.
Date
��s -tea
W Y
WLLL �,vrtrLL,tiviv �.rvni
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STAEEi AOOAESS: TOWNIVILL J i Y TAX'GRIO NUMBER:
Somerset Road Patterson
WELL OWNER
NAME: ADDRESS:
Westchester Modular Homes, Inc.,Route 22,Patterson,NY
❑ PBIVATE
0 PUBLIC
USE OF WELL
.I - primary
2 - secondary
® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRICOND. /HEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
.]REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY
ANEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 4o5 ft.
STATIC WATER LEVEL eft.
DATE MEASURED 4/6/92
DRILLING
EQUIPMENT
L3 ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING - U OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH 21 fL
MATERIALS: aSTEEL ❑ PLASTIC D OTHER
LENGTH BELOW GRADE 20 ft.
JOINTS: ❑ WELDED Q THREADED ❑ OTHER
DETAILS
DIAMETER 6 in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT
PER FOOT -? 9. Ib. /ft.
DRIVE SHOE ® YES ❑ NO
I LINER: G YES CS NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (1t)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER TInDOEFTH
OF PACK
P
ft.
BOTTOM
DEPTH It.
WELL YIELD TEST I If detailed pumping
METHOD: O PUMPED tests were done is in-
XkCOMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ❑ YES O NO
'WELL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
I Water
Hear-
ing
Well
Oia-
peter
FORMATION DESCRIPTION
CODE
tt.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
gpm.
Surface
2
Drilling
in overburden clay & bldrs
Hi
r
ck at 2 '
0
6
40
12
2
21
-Drullng
in rock set casing, grouted.
91
11 n
njp�
ing in rack granite,
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE WellXtrol 302
CAPACITY 86 GAL.
PUMP INFORMATION'
TYPE G»bw Pry i b1 a CAPACITY—'.j _
MAKER Gould n DEPTH 60'
MODEL VOLTAGE VOLTAGE230H4
wELL DRILLEA NAME p � F+` � $e al & Sons ,Inc . DATE LIAO
ADDRESS 4 Putnam Ave. SIGMMRE
Brewster, NY 10509
.3 /b.v l V _ i�
P H Y CC ' 7C 14 • 4✓_! r . r . nr-nL- i i I.,.
BREWSTER LABORATORIES
Box 224 - BREWSTER; N.Y.
(914) 855-1930
- WATER ANALYSIS REPORT -
SAMPLE NO. 8296
SOURCE: Westchester Modulars .
Somerset Drive Lot #37
Patterson, N.Y.
COLLECTED: 5/1/92
BY: ?.F. Beal & Sons
BACTER1040GICAL EXAMINATION
Collform Count, MF Mefhod
TEST WELL
This result Indicates the souroe of the sample was
of satisfactory sanitary quality when the sample was collected.
5/3/92
0
a per 100 ml.
PUrNAM COUM DEPARTMERr OF HEALTH
DIVISION OF ENVIRONME9M HEALTH SERVICES .
23, '17
e0� Pe c 5_eet1p11 1 s - 6 --& 9
Owner or Purchager of Building Section Block Lot
Building Constructed by
P
Location — Street
47'�K)iq
Municipality
KUM W My .-
Subdivision Name
Subdivision Lot #
GUARAIdrEE OF SUBSURFACE SEVVIM DISPOSAL 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 oonstructed 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 successors, 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 approval of the
"Certificate of Construction. Compliance" for the sewage disposal systen, 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 occupant.of the building utilizing_
the system.
The undersigned further agrees to accept as conclusive the deti nination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the sys too e
caused by the willful or negligent act of the occupant o ui ling u ili
the system.
nom, -I. ^.
d.710 p kQ Poft <<cam
Address
rev. 9/85
mk
Signature ,/ ,,-' 1 ',
Title
1AOCjr_W_QIVIA_)- jj,) (O"P
Corporation (if rp)
!OZFe—ss
Nm" Mr d Day 8M DoIp Fkw G P D i�Ja a
11-5 :ymm' mm s.MItle
APPROVED 'FOR Cr
rwrOeabM lair rJYfa'�
"quires a OW, per!
I
by AM,
r_,Lo-, A a A aeA ?oncf-riC ..
factory to tha Commie
sHilns by the buiklar;
bnnrdletely follewi O
toe 2). that the drilled I
ru",and rpu lion
lalth will
1041 will
the mm&-
b a6ow
l P.E. V R.A. -
N �l.icanso No
d unless construction of the buikliny has been undertaken and is
>mmisfioneir of Health. Any ehMOa or alteration of construction
Vale water supply only.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL C�
PCHD PERMIT
WELL LOCATION
Street Address o
5 Do(v E�5a'n.3
Tax Grid Number
i5 -�,-
WELL OWNER
Name , Mailing Address �
70�
n Private
FROM NEAREST
01UfieL I vcweg
Public
9&trT
USE .OF WELL
ORESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT
�O�
PUMP ® ABANDONED
1 - primary
® BUSINESS 0 FARM O TEST /OBSERVATION
O OTHER (specify
2 - secondary
® INDUSTRIAL U INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST.
0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION
OF DAILY USAGE_Jgal
12. ADDITIONAL SUPPLY
REASON FOR
DRILLING
O NEW SUPPLY NEW DWELLINGY ® DEEPEN EXISTING WELL
DETAILED
IV E3=s (D RL e k -w T ta,
REASON FOR
DRILLING
WELL TYPE
DRILLED
[]DRIVEN [:]DUG
®GRAVEL OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES y NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. 3i
WATER WELL CONTRACTOR: Name TO 6e >eTegA40JSIA Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X/NO
NAME OF PUBLIC WATER
SUPPLY:
JV %/g
TOWN /VIL /CITY
DISTANCE TO PROPERTY
FROM NEAREST
WATER MAIN: OVA
11-'11
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE
(70N SEPARATE SHEET +
(date) (.'gnature)
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 Due p rtment.
Date of Issue: tr19�
Date of Expi ion: 19 Permit Issuing a
Permit is Non- Transferrable White copy: H.D. File
Yellow Buildin Inspector
Dopy. g
Rev. 10/88 Pink 0oPy: Owner
Orange copy: Well Driller
------- --- - --
Run Depth . to Water ]From ....Water Level ...... .
Ed. Time Ground Surfs III Inches Soil Rate.
Statt -Stop Min: Start ... _ . SfAp Drop In MWIn Drop
Inches Inches Inches
2
'I- -
.4 . .
5
? 2 /o: 11 lo - i o:
96 . 3
.3 /O: ;?A �5 3
r
4 1
5
1
2
3
4
VOM: 1. Tests to be repeated•at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data t4'be sulmittbd
for review.
'� r--f-h rmasur rents to be made - fran too of hole.
PIT DATA RMUME D TO ]BE; SUBMITTW. WITH APmCATION
DESCR7hTION'.OF: SOILS,'ENODUNTERED : -IN .TEST._.gQI,ES
7'
Diu '
AO' A 1. '1 ul
• 'C'oPSoi�.
>.r.- 1\i0. S -
1�D�Sa J L
L{Mri-S7on/&I
INDICATE LEM AT WHICH GROONDWP= IS ENOOUNT=
IlMICATE LEE M WHICH WATM LEVEL USES APM BEING 1 1 " OUNTERED
.DEEP HOLE OBSERVATIONS MADE i BY:_ 2[ W Azj% V c W 3, g r<I -DATE: ,�(1
DESIGN
Soil Rate Used _ / n Min,/I" Drop: 0,.g o S.D. U,Sable Area Provided
No. of Bedrocm _ �- Septic Tank Capacity 12 <Zl gals. Type (e N C-.
Absorption Area-Provided By 4f4-lb L.P. x 24" width trench
Other
N
NamevYC� I til Irk n 1 n3CgS aG. 6T, Signature
cc
Address 773 �/F 1121 Fvt.11 brr- 68 S� = 7 w
H: ' of
A7T�LK°JiDN N v� 7��3 �' No. 56124
F
THIS SPACE FOR USE BY EFALTH DEPAMPT,
Soil Rate Appraved sq.ft,%gal. Checked by Date
GoRN�t/4LC R�DIGE ShcSo /V�
JOB No. - S� D/I t.0 iM 37-- SSOS
SHEET No. OF 2
COMPUTED BY GATE B
CHECKED BY DATE
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LAURENT ENGINEERING
/
ASSOCIATES; P.C.
73 FAIRFIELD DRIVE
PATTERSON. NEW YORK 12563
914.278.6108
CONSULTING SITE ENGINEERS
GoRN�t/4LC R�DIGE ShcSo /V�
JOB No. - S� D/I t.0 iM 37-- SSOS
SHEET No. OF 2
COMPUTED BY GATE B
CHECKED BY DATE
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�RNwAGC Ar/db�e SS0400,
LAURENT ENGINEERING
JOB No. J g
D 1 / L-DY 37 SSOJ
ASSOCIATES, RC.
73 FAIRFIELD DRIVE
SHEET No.
OF
;;.
PATTERSON. NEW YORK 12563 --
914.278.6108
COMPUTED BY
c
DATE Abf
CONSULTING SITE ENGINEERS
CHECKED BY
DATE
SCALE
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4$ . . . . .
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pr= ex--ans
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PUrM COUM • .�1• • 'M la OF T.
:DIVISION • I• •' E V• FflMLTH SERVICES
DESIGN DATA SHEETL-SUB.SUFACE SEWAGE DISPOSAL SYSTEM FILE NO. '
owner S+ euoAddress X65 SOMe�sc,`T gew5Tc-7z. AJ
Located at ( Street) S� eWeEr Block !o Lot 3�J
(indicate nearest cross street),
MunicipalityA-ge�2sQ N Watershedo ToN
SOIL PERCOLATION -•TEST DATA RDQU= TO BE .SUBMITTED WM APPLICATIONS
Date of Pre- Soaking ��� 5 Date of Percolation Test
'HOLE
N[gQHER Q�OCR TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water from Water bevel
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min: Start SEop Drop In Ai In Drop
Inches Inches Inches
2
'3
.4 . .
5 � '
4
5
1 -
2
3
4
5
NOTES: 1. Tests to be repeated' at same depth until approximately equal soil rates
are cbtained.at each percolation test hole. All data to'be submitted
for review.
2. Depth reasarements to be made-from top of hole.
DEPTH
G. L.
O,
1'
2'
3'
4'
5'
6' .
71
8'
9'
10'
11'
12'.
13'
TEST PIT DATA REQUIRED TO SE S* UBMITTED WITH APPLICATION
DESCRIPTION OF SOILS EDXXXD I U D IN TEST HOLES
HOLE NO. i HOLE NO. HOLE N0.
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENODUNTERED
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFM BEING ENOOUNTERED
DEEP HOLE OBSERVATIONS MAD& BY.- )2 W L DATE &11!5
DESIGN ,
Soil Rate Used Min/1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity X9-50 gals. Type
Absorption Area Provided By c_,0 L.F. x 24" width trench
Other
Signature / '.�,� ;� ij,� ;�,•
•�-
Address .J • r Y ft~��.
THIS SPACE MR USE BY HEALTH DEPARTHM ONLY:
:E`o+
Soil Rate Approved sq.ft ✓ gal. Checked by Date
i
,
1
'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENODUNTERED
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFM BEING ENOOUNTERED
DEEP HOLE OBSERVATIONS MAD& BY.- )2 W L DATE &11!5
DESIGN ,
Soil Rate Used Min/1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity X9-50 gals. Type
Absorption Area Provided By c_,0 L.F. x 24" width trench
Other
Signature / '.�,� ;� ij,� ;�,•
•�-
Address .J • r Y ft~��.
THIS SPACE MR USE BY HEALTH DEPARTHM ONLY:
:E`o+
Soil Rate Approved sq.ft ✓ gal. Checked by Date
��:i�• Nb...re.a1�
WOW FW&L
sop* gm
cwmd wk a
a�.luHt1.8' 1
^PP"O- VE0.:011'COI�
Undertaken and if
NoeCat►N tor, M,- I M modNNd when con ory by ,the nuss{ena► of waateh. Any clwnge or alteration of conat►uctNn •.
INrNM a mN 1or dyp��aP:af AeinaA « star supply only.
\ �%.
Ap n�M
�V.�.. /.
}
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT 0P_z(V_CP1
WELL LOCATION
Street Address Town
Zomfrx,et Dr- v
Tax Grid Number
L rr. p
WELL OWNER
Name Mail ' Addr ss
�` q.Y �elrire
ITV, . 19750 rivate
O 5; 01M E'rsf N► E3 Public
USE OF WELL.
®- primary
2 - secondary
RESIDENTIAL O PUBLIC SUPPLY
D BUSINESS O FARM
® INDUSTRIAL U INSTITUTIONAL
Q AIR /COND /HEAT PUMP O ABANDONED
O TEST /OBSERVATION O OTHER (specify
O STAND -BY
AMOUNT OF USE
YIELD SOUGHT__5_gpm /# PEOPLE SERVED /EST. OF DAILY USAGE __gal
0 REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION M ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
'DRILLING
'Lv-
WELL TYPE
LWDRILLED
O
DRIVEN
®DUG GRAVED 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 3C NO
IF WELL IS LOCATED IN A LT� SUBDIVISION, NAME OF SUBDIVISION:
Co- rwwq.�� c 1�C-e Lot No. 7
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES %�,_NO
NAME OF PUBLIC WATER SUPPLY: A) ! TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: C) V e- N ./ r,.,,,ZIc
LOCATION SKETCH & SOURCES OF CONTAMINATION
L ^R
MON SEPARATE SHEET
(date)
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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue:
Date of Expiration_
Permit is Non - Transferrable
3/89
19
19 Permit Issuing Official
White copy: HD File Pink copy: Owner
Yellow copy: Bldg. Insp. Orange copy: Well Driller
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!6 I
TION
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AS- BUILT
SGAL� I "= 30�
Y
AS- BUILT DIMENSION CHART
No
A
B
I
56. 0
23 O
2
6 1 0
2 ro �o
3
32.3
97
4
33.3
2J4 •'}
5
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38. 1
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80.9
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45. 10
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