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PUTNAM COUNTY DEPARTMENT 'OF HEALTH ,) E N G I N E E R M U S'f
\� PROVIDE
Division of Environmental - Health Services, Carmel, N ` Y 10512 PERMIT `.# P
CERTIFICATE, OF . S UCTION COMPLIANCE FOR..SEWAGE DISPOSAL :SYSTEM
Town or village
Located at Pov.io'asi►�oQla �ppp Tax Map .I.S Block - 5
owner,�,RNpti -'p. (�K, f ®� / Formerly Tax Map Lot a q Subd. Lot a 9
Separate Sewerage System built by �Rt i. t�A� PJUi�Ei� Address P 0• Bok 330 �i21 �gCLII =F t- tt.`oQ
Consisting of 12,50 Gal. Septic Tank and '400 L.F. ;dBSV�f"T�lOhl T1ZESkiG4�
Other requirements
Water Supply: Public Supply From
Private Supply Drilled BY F• g °�'L `aO^/ - f C '
Address J O. go- F-'.-> 10 SO `O
Building Type ��- +t�f =�C-� No. of Bedrooms _ Date Permit Issued
Has Erosion Control Been Completed? Has garbage grinder been installed? 11Jp
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.
Certified by P. E. R. A.
Address (2 141rJ _.4GCCDC— Tem� .QM 5z ��t -►c3�„ w,li License No. 26206
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 ewer 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 Commissioner of,. Health, such revocation, modification or change is necessary.
Date B Title r_
Rev. 6/85
se!
♦ C►; -, T7 -T T / ^kA*nT TI'S 'r ALT DV1r)ADT
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.DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
—
—�
WELL LOCATION
STREET ADDRESS:. WNHI It TAX GRID NUMBER:
Flintlock Ridge Patterson NY Lot #9
WELL OWNER
NAME: ADDRESS:
Arnold Greenspan, PO Box 330, Briarcliff Manor,NY 10510.
❑ PBIVATE
❑ PUBLIC
USE OF WELL
1- primary
2- secondary
® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM 1 ❑ 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
® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 705 ft.
STATIC WATER LEVEL 200 ft.
DATE MEASURED 22/29/87
DRILLING
EQUIPMENT
® ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. ❑ OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH ft.
MATERIALS: 5 STEEL ❑ PLASTIC . ❑ OTHER
CASING
DETAILS
LENGTH.BELOW GRADE 50 ft.
JOINTS: ❑ WELDED MTHREADED ❑ OTHER
DIAMETER 6 in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT
PER FOOT -- - 1b. /ft.
I DRIVE SHOE EVES ❑ NO
LINER: ❑ YES MNO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (f t)
DEVELOPED?
FIRST
OYES ONO
HOURS
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH tL
BOTTOM
DEPTH ft.
WELL YIELD TEST It detailed pumping
P P 9
METHOD: O PUMPED tests were done is in-
M COMPRESSED AIR , formation attached?
O SAILI O O OTHER ; ❑ YES •O NO
it more detailed formation descriptions or sieve analyses
1r�lELL LOG are available. please attach.
DEPTH FROM
SURFACE
Water
Bear-
i ^9
well
Ora'
deter
FORMATION DESCRIPTION
coot,
ft.
IL
WELL DEPTH
It.
DURATION
he. min.
DRAWOOWN
ft.
YIELD
gpm.
Surntace
30
Drilling
in overburden clay & bldrs
t
ock at Ot
705
6
685
5
30
51
D
it
ing in rock,set casing,groute
.
1
705
R.,illing
in rock granite.
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE Well Xtrol 250
CAPACITY 44 GAL.
PUMP INFORMATION
TYPE submersible CAPACITY 5.9
MAKER r-mi 18 DEPTH �.�
MODEL 5ES10412 VOLTAGE2�O HP 1
WELL DRILLER NAME P.F. Bea & Sons, Inc. DAT
ADDRESS PO BOX B SlGft Up / 5/$$
Brewster_ NY 10.5"09
/ 11
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 6886
Arnold Greenspan
SOURCE: Flintlock Ridge
Route 164
Patterson, NY
COLLECTED: March 25, 1988
BY: P.F.Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Lot #9 faucet -well
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
March 27, 1988
Roy ickwit P.E.
Director
PUTNAM COUN'T'Y DEPARTMEWr OF HEALTH
DIVISION OF. ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building
Building Constructed by
�ouTE i(o4 '
Location - Street
�,a-T'T'ERSo t�
Municipality
RES►vEtA cz
Building Type
15 5 9
Sectipn• Block Lot
Subdivision Name
oJ. '
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEfVMGE 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 thatjt 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 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 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 occupant of 'the building 'utilizing
the -system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of E.nvironimntal Health Services of the Putnam County
Department of Health as to whether or not the, failure 'of the system' to .operate was
caused by 'the willfui or negligent act. of, the' occupant -of the building u ilizi.ng
the system. - "1
Dated this
Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Corporation Name (if Corp.)
Mf
II.
IV.
V.
VI.
A.
APPENDIX C
FINAL SITE INSPECT
i ,✓ �i 1.1 Vi` -q.7 TM # OR SUBDIVISION LOT #
ION Date
Inspected by
OWNER CY .o .o— S �a,y -►
a]
10
i$
YES
NC
COMMENTS
SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
b. Fill section - Date'of placement
2:1 barrier_ LGTH WIDTH AVG.DPTH
c. Natural soil not stripped
d. Stone, brush, etc., greater than 15' fran SDS area.
e. 100 ft. fran water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size - 1,000
b. Septic tank installed level
c. 10' minimum from foundation
d. No 90° bends, cleanout within 10 ft. "of 450 bend
e. DISTRIBUTION BOX
1. All outlets at'same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX — ro 1 set
g. TRENCHES
1. Length required - °'G't Length installed
..�
2. Distance to watercourse measured,,t z .v ft.
c.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet from property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for expansion, 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11: Pipe ends capped
h. PUMP OR DOSE SYSTEMS
1. Size of pump chamber
2. Overflow tank
3. Alarm, visual /audio
4. PLunp easily accessible manhole to grade*
5. First box baffled
6. Cycle witnessed by Health Department
estimated flaw percycle
HOUSE '
a. House located per approved plans.
;
b. Number of bedroom
Y
WELL
a. Well located as per approved plans
-
b. Distance fran SDS area measured /'d ft.
c. Casing 18" above grade. r -- • ----�_
d. Surface drainage around well acceptable.
y
OVERALL WORRMASHIP ' r.:i:
a. Boxes properly grouted
b.,. All pipes'partially backf illed
c. All pipes flush with inside of box
x
d. Backf ill material contains stones < 4" in diameter
>t
e. Curtain drain installed according to plan
,f. Curtain drain outfall protected & dirto exist.watercours
,r
9.' Footing drains dischar e'awa frgR,,§LS area
�h. Surface water protection adequate'
i. Errosion controi provided on sl:opes greater than 15 %.
}C
a]
10
i$
�.� PUTNAM COUNTY DEPARTMENT OF HEALTH
,Rev. 386 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit q
f I on CERTIFICATE OF COMPLIANCE m �0
[. ' CONSTRUCTION PERMIT FO SWAGE DISPOSAL SYSTEM Permit q
rocatedat Off of Route. 164 T of Pawnsev e
I Subdivision Name `Flintlockldge Subd. Lot p 9 Tax Map 15 Block 5 Lot 4
Owner /Applicant Name Arnold Greenspan Renewal-0 Revision ❑
Date of Previous Approval ,
Mailing Address c/o Cashin Associates, P.C. Town Carmel, NY zip 1051 _
Route.52
Building Type 1 Fam. Resid. Lot Via. 9967± Acre Fill Section only Depth -• Volume
Number of Bedrooms —Design 4' . Flow G /P /D 800 PCHD Notification is Required When Fill is completed
Separate Sewerage System to consist of 1250 -Gallon Septic Tw&and 500 LF X 24f t. Tile Fields
To be constructed by To be determined. Address
Water Supply; Pdbllc Supply From Address
or: X Private Supply Drilled by TO be determi nP.ei;!ass
Other Requlremetits
represent that I am wholly and completely responsible for *the design and location of the proposed system(s); 1) that the separate, sewage .disposal . system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a.'•Certificate of Construction Compliance" satisfactory to the Commissioner of:Healthwill
be. submitted -to the Department, and a written guarantee' will be furnished the owner, his successors, heirs or assigns by the-builder, that said builder will
plce in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following.thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any,repairs the 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance with the stand s, rules and regu a icons of the Putnam
County Departure t of ealth.
Date Signed P.E.- R.A.
Address Route 52, yCya�r�mel, ew' Yot 0512 License No 260.08.
APPROVED FOR CONSTRUCTION: This approval expires oise�ryear from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended of modified when considered necessaw by the Commissioner of Health. Any change or alteration of construction
requires a new permit' Approved for disposal of domestic sanitary sewage, and /or ately only. -
Date Y�� 9y �� Title
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
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Flintlock Ridge Lot No.
WATER WELL CONTRACTOR: Name To be determined' Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Greater than 1 mile
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
,,n ❑ ON REAR OF THIS APPLICATION ON SEPARATE SHY 2S MR" inn ( ture)
(date) s
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:lay -2 19
Date of Expiration: ��/ z a,19_ ermit Issui f
Permit is Non - Transferrable
Street Address
Town/Village/City Tax Grid Number
WELL LOCATION
Off of .Route 164
Town of Patterson U4 1S blk
5 Lot 4
Name
Address-
Private
WELL OWNER
Arnold Greenspan
c/o Cashin Associates P.C.
O Public
USE OF WELL
&RESIDENTIAL ❑
PUBLIC SUPPLY. ❑ AIR /COND /HEAT PUMP
0 ABANDONED
1 - primary
❑ BUSINESS O
FARM ❑ TEST /OBSERVATION
❑ OTHER (specify,
2 - secondary
❑ INDUSTRIAL U
INSTITUTIONAL ❑ STAND -BY
O
AMOUNT OF USE
YIELD SOUGHT min
5 gpm /# PEOPLE SERVED1.fam /EST. OF DAILY USAGE800 gal
REASON FOR
10 NEW SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ OBSERVATION
DRILLING
❑REPLACE EXISTING
SUPPLY 0DEEPEN EXISTING WELL
DETAILED
New ress en is
supp y
REASON FOR
DRILLING
WELL TYPE
UJI DRILLED DRIVEN DDUG GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Flintlock Ridge Lot No.
WATER WELL CONTRACTOR: Name To be determined' Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Greater than 1 mile
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
,,n ❑ ON REAR OF THIS APPLICATION ON SEPARATE SHY 2S MR" inn ( ture)
(date) s
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:lay -2 19
Date of Expiration: ��/ z a,19_ ermit Issui f
Permit is Non - Transferrable
PUTNAM COUN'T'Y DEPARTMIIU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT _
/ �C DATE REVIEWER•
(Name of Owner) (Street Location)
COMMENTS YES NO DOCUMENTS
Permit Application
rporate Resolution
Plans - Three sets s/s
Engineers Authorization 7 /GG117/?r E,
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
ans - Two sets
Well permit; PWS letter
lance Request
CORAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
LF trench provided REQUIRED DETATSS ON PLANS
required Sewage System Plan - (north arrow)
---- O ft. max. Sewage System Hydraulic Profile - Gravity Flow
Parellel to contours Fill Profile & Dimensions - Volume
D cjjJ ;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design Data: perc and deep results
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
FI141SYSTEMS Representative of primary and expansion
clWybarrier Expansion Area;shown;gravity flow,suff. size
10 t. If PmVed Pit & D Box Shown & Detailed
.fia notes House - No. of Bedrooms '
n spec. Wells & SSDS's w /in 200 ft. of Proposed Systems
depth gauges I Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
100 yr lood elev. No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fill
20' to Foundation Walls
\ 100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (Inc. expan)
15' to Drains-Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL
• pUmm COUNTY DEPAR'IlENT of HEALTH
DIVISION OF ENVIRONMENIAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSUFACE S&gAGE DISPOSAL SYSTEM FILE NO.
Owner �r n o�c� Ire(--' a- c� Address ,Po �gn x .3.�c7 �')rrrr rclr P+ r%ln/lor NY
Located at (Street) 164 Sec. IS Block S Lot
(indicate nearest cross street) Lof 9
municipaiity p �e.l`.Saki Watershed Crofpn
SOIL PERCOLATION TEST DATA REQUIRED TO BE SLTBNI2TTID WITH APPLICATIONS
Date of Pre- Soaking 23
Ala rc � 197 Date of Percolation Test
2, .4 Iy6e " P-�'
HOLE
NUMBER CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water Fran .
Water Level
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
1 9 :3L 9'53 OF 23 3 6
2 8,54 - I A'9 9-4 23 26 3 8
3 q:2o ^ J, So 30 9-34 26"22 3 io
4 q :Si _ IB.zI 30 2-3 2.%
5 1 o: 22- 1 �� W 2, 3 2 5" 2 7 Ci
S`5-
- -19 3 G
2 2.4 3 g
3 1, Z4 - 9;5-4 30
4 10:2S 30 2S z-7 '2 2?1 12
5 /o,27 - rd:V 30 2 2-7 �y2 1z
1
2 it -I`; rnin��n
3
4
5.
NOTES: 1. Tests'to be repeated at same depth until appradmately 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.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNT'E'RED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L. .
. opso�
1'
2' n S Q r , a 1 174
3' b ro o p PlU r f s-9 A(-e 4- Q- sz:�'
4' �naM
5'
6'
7'
8'
9'
10'
11'
12'
13'
14' 1+ L
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED Nof �RrOUnlerect
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:
DATE:
DESIGN
Soil Rate Used I -!S Min /1" Drop: S.D. Usable Area Provided O
No. of Bedrocros :4 Septic Tank Capacity 1'2 5 o gals. Type
Absorption Area Provided By ,-oo L.F. x 24" width trench
Other
Name (Is 11 t o 0 S c occCL �e t Signature
Address m e' SEAL
_ l� O� %. 26009
10S 1 2 rNE sr
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date