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PUTNAM COUN'T'Y DEPAi TMENr OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�K�•.loL� �►Rrc�l�,c�
Owner or Purchaser of Building
G 0ge A4:FA -
Building Constructed by
Location - Street
�A"TTEiz�o J
Municipality
•P ES�D �1JGG
Building Type
12 5 . -1
Section Block Lot
Subdivision Name
1
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE 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 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,- 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 Environinental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to o was
caused by the willful or negligent act of the occupant of the building i izing
the system.
Dated this 24 day of Auca. 19E Signature
4tle
General Contrac Own ) - Signatuee7
Corporation Name (if Corp.)
Corporation Name (if Corp.) •?
.; , _. '� ess
3 �r�
#9 �-� 0
rev. 9/85
mk
�l
fiy the
BREWSTER. LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2672
arnold.GREENSPAN
V/
WATER ANALYSIS .REPORT
SAMPLE NO. 6628
SOURCE: Arnold Greenspan Lot .7 hose bibb -well
Flintlock Ridge,
Patterson, NY
COLLECTED: July 15-9. 1987 �.
BY: P.F.Beal & Sons. Inca
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result indicates the source of the sample was
Of satisfactory sanitary quality when the sample was .collected.
July 17. 1987
Roy,. Bidcwit ; P.E:
i ; Director
r } 40 °.a ' r 4 Lyr n F..G Y r•' K - Rr ^3'„`� e k v ey�cp f ry1 ' , - 4'�j,!
r F.r
COI�I.IrTION REPORT
anw'�
st
DEPARTMENT OF HEALTH...
x ..,�.. Division Of . Environmental Health " Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
ji Y CFt A M1
ritlock Ridge Patterson,NY Lot #7
<< t ADDRESS: :K1 .::
,r •.,..,,,{, r:. �"
Xs+nold__Greensnan. iff Manor NY' 10 I.0
a RESIDENTIAL O PUBLIC SUPPLY O AIR/COND./HEAT PUMP 0. ABA ,
O` BUSINESS O FARM O TEST/OBSERVATION O OTIyk
ndary.. Q FNOUSTAIAL O INSTITUTIONAL 0 STAND -8Y p
1
YIELD SOUGHT gpm. /N0. PEOPLE SERVED /.EST. OF DAILY:USAGE
�{ O,NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY 0 TES71�R�t+A OAt
I"i`AEPLAC.E QUSTING SUPPLY 0 DEEPEN EXISTING WELL
xA.
WELL DEPTH 305 tL STATIC WATER LEVEL .30 .__ ft. OATS MEA$ii $
01W : �.�pTARY I3 COMPRESSED AIR PERCUSSION 0 DUG
, Q WELL POINT O CABLE PERCUSSION O OTHER (specify ):
10:SCRE6NED O OPEN END CASING IJ OPEN HOLE IN BEDROCK ,0 01M
:TOTAL LENGTH ui fL MATERIALS:
�I STEEL. C .PLASTIC 0.03HER
LENGTH BELOW GRADE ft. JOINTS:. 0 WELDED 10 'iHREA ` "i303 03 t
:-: DIAMETER _6_ In. SEAL: [&CEMfNTGRflUT .C18 E1
. i 9 DRIVE SHOE O Y' # MQ
WEIGHT PER f00T lb./It. ES 0 NO
OIAI�IETER (in)
'SLOT SIZE LENGTH (11) KM .To SCAM }
staco�ro - k�
UAVEL DIAMETER TTO�pP�� y
Big
4 •,jL7; -4 � -1 .tii � s -w �r Pi,\ii� DEPTH
.t r
�+
If more detect lormstioe descriptlol�s
' ER 10 dtWed pumping WELL LOG are available. please aftA. ° .
tests were done Is In-
DEPTH FROM sur
�.forni�tticn attached? SURFACE ear• - L
' 17 YES: O No n• n. I,g cerau►T�x oacR11 coQe
MAWOQW YIELD Sur�iace
-VAXh don
WWI
it rock at 25
2
D et :
41 305 D iil ng in
304 ZIN
jr
9`OI,QRED:: 'fi!(l.Y7Ep7 .. Q YES O NO
YSlil *TTAC1 7 OYES ONO' STORAGE TANK: TY.PEWell Xtro 250
CAPACITY GAL.. Q
mei+m bl a `fAgnl 2 hp WELL nLLER NAME P . F. Beal Sons , nc r
x.A.:.' . •: (' ii,.:,i : PO Box B
DEPTH ..�— ADDRESS
- a= ?--- -- Brews ter, NY
."v.
s
..�. errr�wlx c
FINAL SITE INSPECTION Date J
Inspected b
IV OWNER
. LOCATION
,sIT # _ °' TM # OR SUBDIVISION LOT # 47/ � �'•-.
II.
M
V.
VI.
C
SEWAGE DISPOSAL AREA
a. SD5 area located as a roved lams
b. Fill section - Date of placement
2:1 barrier. LGTH WTIM AVG.DPTH�
c. Natural soil not stripped
d. Stone, brush, etc., greater than 15' from SDS area.
e. 100 ft. from water course /wetlands
SEIQGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,250
X
b. Septic tank installed level
c. 10' minimum from foundation
d. No 90° bends, cleanout within 10 ft. of 45° 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 - properly set
g . TRENCHES
1. Length required - ®�® Length installed �
2. Distance to watercourse measured: ft.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet fran property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for ion, 50%
9. Size of ravel 3/4 - 11" diameter
10. Depth. of gravel in trench 12" minimum
11. Pipe ends cancel Coll
h. PI3,21 OR DOSE SYST~' ,4-S
l . Size of pur:c chamber el
i
Overflow t -nk
Alarm,
PUMP easily =C risible manhole to grade
First box baf= ± =u
Vbv
6. Cycle wit-iessc-d' Health Department
estimated flow car cycle
HGuSE
_. -_use lcc. =tom - cnrcv= plans.
�?
- =ber of b� -
_.�c;ell loco tad as per - - =3 plans
I
c. Distance frc-m SDS area T,e-=sured ft
I
I
�
c. Casino 18" above grade.
II
d. Surface drain-ace around well accept.: ! �=
CVO'? LL•L WORKMASHIP
a. Boxes pro2eriy grouted>
b. All pipes par � a11v bac'. filled
c. All ipes flush with inside of box
d. Backfill material contains stones <.4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to exist. watercourse
g. Fcotin drains discharge away from SDS area
h. Surface water protection adequate
i. Errosion contr8l provided on slopes areater than 15 %.
water bu
ppy..
or*-
above
be submitted'.to the Department, and i)written"gUairantee:Wili be',furniihad':the owner, his SL
place ' in goo 'd' opera ' Ion— cor�ifion- ang y part of said sewa ge - 'ih
e pdri6,
in f te of constiucti". Compliance, of And original system,b
0 the approval of the
e 106 ow�n,on t j�aid- Ijwwjjjij;I-'jt Ij -.i' jccoj nce 4
will b aie�d as $6 plan and iiiat b n a 4i�d n c Chi
county Depart' nt of Health
Date 6d
APPROvkS*qR -66NSiAU '6 ib N This approval the date issued unh
,
revocable for cause or may be, amended or modified when 'C"O' 'si sled: necessary" by Commis:
re�uires a" new .permit. Approved' 'for "disipp'saf, 'of domesti. n.' ar ".se" a nd pr to
Date d By
gry.to,the Commitsioner.cif Healthwill
ns by. the, 66i-ider, that said buildeir will
iediately following thadate.of the issu-
2) that the drilled will described above
Ids and`ieg—OUR'sonsof the' Putnam
E R.A.
License No
a building has been undertaken and is
y change or alteration of construction
Title
PUrNAM COLWY DEPARTMENT OF HEALTH
DIVISION,OF,- ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner l2 etl01 50- at= i5 PAIJ Address y CASA 1 N CaAT� t
Located at (Street) Alim- . /b al�l�LL 14-4 T2D. Sec. /5 Block 5 Lot _
(indicate nearest cross street)
Municipality I A7-7- c'SOA-/ Watershed
Date of Pre - Soaking den
17 No✓ �?6 Date of Percolation Test
Tv t I r A)o u �26
6
HOLE
'NLEBER CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water Frog
Water Level
10
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop In
Min/In Drop
Inches Inches
Inches
1 9,2f�;- -73T 12
Zq
3
4
2 9:3d- 956
( 21y
2��Z
6
3,3; s7— 10 <2 7
4 10:77- IU= S8
3� . (
10
5 11:2.9
30 2►�z
2� y� s
Id
2 Pprc- Pafe_ I."; m,n
3
4
5 c rSe (S M VYL I n
r �► I
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 suYmittpd
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
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.
21
31 KAP41-1159
F,
41
51
61
71.
81
go
.10,
121
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE: 19,00
DESIGN
Soil Rate Used /6 Min/111 Drop: S.D. Usable Area Provided -,5wo
No—of Bedrooms Septic Tank Capacity 1,260 gals. Type.flIASo4ze
Y
Absorption Area Provided By L.F. x 24"'width trench
Other
Name C4 -544t" AStOQAre-;� Signatu
Address xrotN-6 SEAL
THIS SPACE FOR USE BY HEALTH DEPAIMENT ONLY:
Soil Rate Approved sq ft/gal. Checked by
4
Date
0�-;
APPENDIX B
PLITNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIPM4EMAL HEALTH SERVICES
INDIVIDUAL VAM SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
-1" o F
(Name of r)
COMMENTS
LF trench provided —
required _
60 ft. max.
Parellel to
REVIEW SHEET - CONSTRUCTION PERMIT
VL(ttbiet Location)
I YES LINO I DOCDME NTS
DATE REVI : / Pmex
BY:
'Permit Application
Corporate Resolution
Plans.- Three sets s/s
Engineers Authorization
Design Data Sheet (DDS) SUBDIVISION
Deep Hole Log Perc
Consistent Perc Results (3) Fill
Perc Hole Depth cd
House Plan - Two sets
Well it; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
/E!k- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAILS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
..Construction 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
Representative of primary and expansion
_ Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed System
,property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe .
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of f i'
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expa
15' to Drains- Curtain,.Leader, Footing
351to catch basin,stormdrain,p_ped watercour.
101. to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' fran Foundation; 50' to well
15' Well to PL A
L Woo
0
1.
r•
Re:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date `j• /J, 06
Property of kAA91-0 6Y-Oc�SFWJ
Located at or Or-F zn"�� 164
( T ) / QArr�,oA/ Section 1,5' Block Lot
Subdivision of 10�7-1-4�,K�
Subdv. Lot # Filed Map #__,/ % Date " ?,FO
Gentlemen:
This letter is to authorize �l�Sf/lA -% ,�/s5�GlgrESG.
a duly licensed professional engineer ✓ or registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated 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 construction 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.
Countersigned
P.E. , R. A. , #!
Address
-'
Telephone
Very truly yours,
Signed
�'f r•r
Town
Tele'phone —�
A
. 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 Al__v
IS WELL SITE SUBJECT TO FLOODING? YES X -NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
tot No.
WATER WELL CONTRACTOR: Name -7,'b Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:.,��
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
Q ON REAR OF THIS APPLICATION ON SEPARA SHE
E!4 \Ir 14611 (date) nature
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: ���� 2� 19
Date of Expiration: 19 ermit Issuing ffi is
Permit is Non - Transferrable
Street Address Town *kk+ft&e Tax Grid Number
WELL LOCATION
of Ti cats E i�D T 'S
F3t..,r- 4-4-r'
Name Address
Private
WELL OWNER
0 Public
USE OF WELL
XRESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
0 ABANDONED
1 - primary
❑ BUSINESS O FARM O TEST /OBSERVATION
CI OTHER (specify]
2 - secondary
❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY
❑
AMOUNT OF USE
YIELD SOUGHT MIAI gpm /# PEOPLE SERVED% /EST . OF DAILY USAGE � gal
REASON FOR
.NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
DRILLING
❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
DETAILED
�( 50 %&i �A
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN ODUG GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X -NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
tot No.
WATER WELL CONTRACTOR: Name -7,'b Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:.,��
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
Q ON REAR OF THIS APPLICATION ON SEPARA SHE
E!4 \Ir 14611 (date) nature
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: ���� 2� 19
Date of Expiration: 19 ermit Issuing ffi is
Permit is Non - Transferrable
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