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00719
PUNAM COUNTY DEPARTNIENT-OF-HEALTH
Rev. 3186 Division of Environmental Health Seiirvices, Caimel,'NA. 10512
eer
9 „ / /�((�� / P:C.H D. Permit #.,-,
Located at
6woodapplicant Name
Date Permit issued
Separate Sewerage System built by j y 2 ;—Address
4 Consisting of 17 -.5-V Gallon Septic Tank and
-0-1
Water Supply: Public Supply From Address
Or:. Private Supply Drilled by ✓ 0-Re"gul Address
Building Has Erosion Control. Been Completed?
Number of Bedrooms— Has Garbage, Grinder Been Installed? A10
J7 "00.7
Other Requirements.
I certify that the syatem(s)as listed serving the above premises were constructed essentially as shown on the plans of the completed work f copies
of which are attached), and in accordance with the standards, rules and regulations, a
c�
, with the filed plan, and the permit•issued by the
c
Putnam County Department Of Health.
F
Date to Y P.E. R.A.
Address JAI License N' 2-,!9
Any parson occupying promises served by the Aple system(si shiWpromi;tly.talso fit, Maims ry to secure the correction of any unsanitary
conditions resulting from go, Approval 'of the separate sewerage sy $to b y sower becomes
SUCII, ilia' O�Tjns soon as a Oubt.. sanitary
available and the, approval of the private water supply shall become .nu.114641 "fold 4fly becomes available. Such approvals are
subject to modification or change when, In 'the judgment, of the Commissloin-ii
modification or change Is necessary.
57
BY. Title
Date er2 �4:;� 0-
PU NAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r�G✓! Z24W 'A914
i eat s
Owner or aser of Building
f/
Building Constructed by
/W op ��•
Location - Street
Municipality
Building Type
✓j✓ -I-- A
Section Block Lot
Subdivision Name
4—
Subdivision Lot #
GUARANM 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 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 Environinental 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 willful or negligent act of the occupant of the building utilizing
the system. _ -' / V
Dated this � dy :aof v 1 9 Signature
6i /,-Q 4� r e 5 Title
nor 1 n c (Owner) - gna
/f
Corporation Name (if Corp.)
i -�
Address V:.Ctti,aI2,-
rev. 9/85
mk
Corporation Name (if Corp.)
Address
BREWSTER LABORATORIES
Box 224 -. BREWSTER, N.Y.
(914) 279 -4945
-.WATER ANALYSIS REPORT -
SAMPLE NO. 74,94 HOSE BIBB WELL
SOURCE: Greenspan
Flintlock Ridge Rd. Lot #4
Patterson, N.Y. 12563
COLLECTED: 9 - 8- 8 9
BY: P.F. 'Beal & Sons
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.
9 -10 -89
.4t� Chi.
`, .e
FW ��
WLLJL UUrlrLr 1iiVn R 1rUi\1
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADDRESS: WN /Vl lly TAX GRIO NUMBER:
Flintlock Ridge Patterson,NY Lot #4
WELL OWNER
NAME: ADDRESS:
Greens an Builders P Bo 0 Briarcliff i�anor,NY
❑ PBIVATE
O PUBLIC
USE OF WELL
1- primary
2 - secondary
ZJ RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT.OF USE
YIELD SOUGHT __5___-__ gpm. /N0. PEOPL'E SERVED / EST. OF DAILY USAGE 'gal.
REASON FOR
DRILLING
ZKNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 625 ft.
STATIC WATER LEVEL � 60 ft.
DATE MEASURED 814/89
DRILLING
EQUIPMENT
ROTARY Ill COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):'
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. ® OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 31 ft
MATERIALS: El STEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE 30 ft.
JOINTS: ❑ WELDED ® THREADED O OTHER
DIAMETER 6 in.
SEAL: aCEMENT GROUT O BENTONITE ❑ OTHER
WEIGHT PER FOOT ? A Ib. /ft.
DRIVE SHOE ® YES ❑ NO
LINER: ❑ YES O)0
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES O NO
HOURS
SECOND
GRAVEL 'PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED i tests were done is in-
.0 COMPRESSED AIR formation attached?
O BAILED OTHER
,a,�L� ��L7 If more detailed formation descriptions or sieve analyses
Y!I are available, please attach.
DEPTH FROM
SURFACE
Water
Sear-
Welt
Dia-
ete❑ r
FORMATION DESCRIPTION
CODE,
ft
i
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
gpm.
Surlace
12
Drilling
in overburden clay and bld
s.
't
ock at 12'
625
6
605
5
12
I—DrillLng
in rock set casing groute
.
629_j)jjj_L1ng
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
submersible 5 g
TYPE CAPACITY
MAKER Ctoul d DEPTH 56o
MODEL 5ES10412 VOLTAGE2 HP 1
WELL DRILLER NAME ATE 8
P.P. P F Beal & Sons 9
ADDRESS PO Box B SlGfffn^7
Brewster , NY 10509 Ft �
J� PUTNAM COUNtY DEPAHTAlEP1T OF HEALTH
tD Peovlde Permit IY
►m;, • �. i vhbamental 'HealthServlcee.Csumel.N;Y 1OS11 >`. ;fir.
Dlvlsdbri of Eti do CET:MCATE OF C011�LANCE //
Pe"est M %J - -- �y
e X
I represent that 1 am wholly and completely resporisible for.the desigr
above described will be constructed as shown on the approved amend"
County Department of HeaRh,- and that on completion thereof a -C
be submitted' to the Department .and a written guarantee will Da,
place in .good. operating; condition s4 :part of ,'said sewege Qispos
ance of. the approval' of the Certificate.of Construction,Complian
will be located as shown on the approved plan and that said well will W
County Da art met of Health
Data Signed
Address'
APPROVED FOR CONSTRUCTION approval expires two Years
revocable for cause or may be amend oi:modified•when eonsideied'
requires a new per it." ApDro4stl r disposal of domestic sanitar
Ste.
8) Date i /r.. By.
T
id' location of, the p ol<gV .lYEtd' i. 1) that the separ sewage disposal s stem
t there to and in: nce h $`hdards, rules an r u a ions o e u nam
tificate of Con sts o IgRM s Oifsctory to the Commissioner of.Healthwill
nished the ow r, hi K WWII.: r a"ns by the builder, that said builder will
system •duri the d'.0 (2) s linmedlately following the date of the issu-
of the:ongi, I sy o n irs t to; 2) that the drilled well, described above
istalled in ac d�1 c� a tie'` Y`d iliie and regu aYrons oof the Putnam
P.E. R.A.
License No
o a date issutltl r�i l u`cti of the building, has been, undertaken and Is
cessar.y by the Comipi ;s ��'HeeRh. Any change or alteration of construction
"a siBiVate — DDIy` only.
n
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 # P��� � Z�
WELL LOCATION
Street Mdress
Town Villa City Tax Grid Number
WELL OWNER
Name
Mailing Address
'I'll - ' 1
of rivate
O Public
USE OF WELL
1 - primary
2- secondary
SIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
❑ FARM ❑ TEST /OBSERVATION
M INSTITUTIONAL O STAND -BY
0 ABANDONED
❑ OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE �®a gal
REASON FOR
DRILLING
PSEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
❑TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
015RILLED
13 DRIVEN ®DUG ® GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: / i
Lot No.
WATER WELL CONTRACTOR: Name G�P� ,4 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY:
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: %% /�
TOWN /VIL /CITY
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION ON SEPARATE SHEET
(d e) �.. tur A./
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 s.hall:
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 Departm nt.
Date of Issue--,* Issuing fficial
Date.. of Expiration: 19
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2/87 Orange copy: Well Driller
PUI'NAM OOXINTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONKUvYTAL HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner D/'zo?0,�P %�i�/S Address �lr
Located at (Street) vll�
(indicate nearest cross street)
Sec. Block Lot
Municipality / u���� Watershed
SOIL PERCOLATION TEST DATA RBCCMED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking Date of Percolation Test !I
HOLE
NLEBER
C KE 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
Ile
3&
4
5
Ael
4
5
1
2
3
4
5
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.
rev. 9/85
lq
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO.
G.L.
1
�r 1
HOLE NO.
HOLE NO.
w
21
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: �7 %�G/�/ / 9 ✓G DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 4i 04,
No. of Bedrooms Septic Tank Capacity gals. Type�p�,�
Absorption Area Provided By S`� L.F. x 24 width trench
Other l/ f ��� �C,/Pi
Name � � �
% , S1Qna =ure ���'
Address V
THIS SPACE FOR USE BY
Soil Rate Approved
M
DEPARTMENT ONLY:
sq.ft /gal. Checked by Date
APPENDIX B
PUMNAM COUNTY DEP.AR` MENT OF HEALTH - DIVISICN OF ETv=NMENTAL HEALTH SERVICES
INDItiZDUAL WATER SiJPPLY & SUBSMF'ACE SgIiACZ DISPOSAL SYSTEMS
REVIEW S= - CONSTR=ICN PERMIT
DATE RWL7 -vED • S
d /
(Name o e-r) (Street Legation)
CC�FTS
YES
I NO
W07-
I
L' trench. provide.
required
60 ft. ma:;.
Parallel to contours
100'
I
I
I
I
FILL SYSTEMS°
-
clavbarrier
10 ft.
.fill notes'
rea spec. Q
depth gauges , l-
100 yr. flood elev.
200 ft. reservoir, etc.'
150 ft. trigall /cal .
o x.
DCCCII�.ET]TS
Per,nit Application
Corporate Resolution
Plans - Three s`ts s/s
Engineers P_uthorizaticn
Design Data Sheet (ICS) SL'BD ISICN
Deep Hole Lcg Perc
Consiste_rit Perc Resits (3) Fill
Perc Hole Depth c3 --
House PlansT o s2t-
ell Fe -^nit; F:vS le_�er
Variance Re::uest
Gr'�t�L
Leal Scbdivision
Subdivision Approval Che -_ked
Ex -a_ provai SSDS Ad ; . Lots Ctie_':
Wet and (Tcw-n/DEC Pe_ii_ R & D)
Data Cn DDS Plans & Per -mit Sine
RE',,-2Tj-= DETA TT S CN PT? \S
S`aage System Plan - (north a=:cw)
Sevage System Hydraulic Pror,l: - Gravi t_v. Flcw
Fill Profile & Dimensions - Vollzme
Du "I J"Eg" ;Trencn /Gallery; Pi�rp pit details
Septic Tank - Size, Detail
Well Detail, Service Line if cver
Construction Notes (grinder rte)
Design Data: perc and deep re=ds
Two-Foot Contours Existing & Procosed
Drivem y & Slopes Cut
FootinQ/Gatter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; shown; gravity flca,suff. size
If Pmoed Pit & D Box Shcan & Detailed
House - No. of Bedroans
Wells & SSOS's w /in 200 ft. of Proposed Systat
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Seaer - 1 /4 " /ft. 4 "0; Tyce pine
No Bends; Max. Bends 45° w /clernout.
SEPA =CN DISMNTCES SPECIFIED CN PLAN
Fields
10' to P.L., Driveway; Large Treeeesjop of fi
20' to Foundation Walls
100'.to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. eti-x
15' to Drains - Curtain, Leader, Footing
35'to catch basin,ston- drain,uioed waterccur
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to wall
15' Well to PL 9
P 4-
A
�
33
3
av
5/
24,
. 49,
6
ao
2.4
aV9
23
�a
3/
,0
19
3s
Zo
t�
40'
aZ
SGQIe I ` 2oo
303aI1d.1
S.,F � t- �a,I K
a.,,� a „'`4-
t
� C /? )� O R N
Al
"k
1, 9 -•0 sole
/2. 0j�A�wDs
13ox
Scm