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PUTNAM COUNTY DEPARTMENT`OF•HEALTH :PROVIDE
.Division of Environmental Health Services, Carnie/ N. Y. 10512 pERMhT
CERTIFICATE OF CONSTRUCTION. COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM '
Town or' Village'
Located at Rk Lrls 1(,4 - _ .. Tax Map ..'1rJ Block', -. is. �,.f.. .Y... .
Owner "p' ln._•rj C-A Formerly. Tax Map Lot N - Subd. Lot 4 - 4•
Separate Sewerage System built by Address P�• Box' SJO f3R1AtaC�i FF. M.01.jo�
consisting of t250 Dal. Septic Tank and 450 L . F lo►J TJJC�,i
Other requirements 'C)l waw -riOIJ Qo-A
Water Supply: Public Supply From
Private Supply Drilled 13Y p' F EjEAL. So ►.ISM /tic
Address PO P.So�t E-S gizEln/S'T(✓iZ r IJY wsc) -3
Building Type �g'SIDC —�IGC No..of Bedrooms Date Permit Issued 9 29 • 8�
Has Erosion Control Beep Completed? �-?. Has garbage grinder been installed?
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.
Date I2 j "
Address
P.E. 'A- R.A.
Vo. -46,008
Any person occupying premises served by the above system(s) shiil 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 unitary sewer 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 H necesury,
/ii
Date ,r v i / 7 -gig —�� �-� Title
Rev. 6/85
C1
c'�, -I�j�
r*
�.
W'tij O4
WI'JLL IJVi'1L LLJ11Vi\ i \J.:It Vitt
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
I� b.7
WELL LOCATION
STREET ADDRESS: WN /VIL ! 1 T X GRID NUMBER:
Flintlock Ridge Patterson,NY Lot #2
WELL OWNER
NAME. ADDRESS:
Arnold Greenspan, PO Bo 0 riarcliff Manor NY
p pgIVATE
O PUBLIC
USE OF WELL
1 - primary
2 - secondary
® RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O.ABANOONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY p
MOUNT OF USE
YIELD SOUGHT gpm. /N0. 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 345 ft.
STATIC WATER LEVEL 30 ft.
DATE MEASURED 8/10/8'
DRILLING
EQUIPMENT
EI ROTARY Q COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. a OPEN HOLE. IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH 23 ft.
MATERIALS: (3 STEEL ❑ PLASTIC O OTHER
LENGTH.BELOW GRADE 22 ft.
JOINTS: O WELDED 13THREADED ❑OTHER
DETAILS
DIAMETER 6 in.
SEAL: ® CEMENT GROUT O BENTONITE O OTHER
WEIGHT
PER FOOT 19 1b./ft.
DRIVE SHOE DYES ❑ NO
I LINER: OYES 9NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
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-
C1 COMPRESSED AIR , formation attached?
O BAILED O OTHER ; O YES O NO
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
We11
0ia'
In
FOR61ATlON DESCRIPTION
CODE,
ft
tL
WELL DEPTH
It.
DURATION
hr. min.
ORAWOOWN
ft.
YIELD
gpm.
Surface
1
D
it
in in overburden clay & bldr
345
6
325
30
1
2
D
it
in in rock set casi.ng,groute
.
granite
WATE8 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.
WELL DRILLER NAME P.F. Beal & Sons , nc . DAT5 /25/88
ADDRESS PO Box B SIGFTMRE
Brewster, NY 10509
a--
PUMP INFORMATION
TYPE submersible CAPACITY 7 g •
MAKER Gnt-I 1 8 DEPTH _210
MODEL 7EHO5412 VOLTAGi ?�HP1�
I 11
P[TTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF. ENVIRONMENTAL HEALTH SERVICES
Ae►,10
Owner or Purchaser of Building
Building Constructed by
o uTC ICoq
Location - Street
�p.'TT�.RSo t 1
Municipality
► E t.l CE.
Building Type
15 5 q
Sectipn• Block Lot
Subdivision Name
Z
Subdivision Lot #
GUARANI 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 foll_owing_the,date of approval of the
"Certificate of Construction Compliance" for the swage 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 'utilizirig
the-system.
The undersigned further agrees to accept as conclusive the determination 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 system'to. operate was
caused by 'the willfui or negligent act of the' occupant -of the building u ilizi.ng
the system.
Dated ' this �T" day of _ 19 8! Signature
wrporati.on Name tit uorp.
V.. -
rev. 9/85
mk-
Corporation Name (if Corp.)
PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. 3186 `n0 Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer twProvide Permit a
n . on CERTIFICATE OF COMPLIANCE
CONSTRUCTION PERMIT FOR GE DISPOSAL SYSTEM Permit N
Patterson
Located at Off of Route 164 Town or village
Subdivision Name Flintlock Ridge snbd. Lot # 2 Tax Map 15 Block 5 Lot 4
Owner /Applicant Name _Arnold Greenspan Renewal_ ❑ Revision ❑
Date of Previous Approval
Mailing Address PO Box 330 Briercliff Manor Town . zip 10511
Building Type _I Family Res, Lot Area 2. 74 +/ - Acres piffl— sm.gon Only x Depth- 1 /? volume
Number of Bedrooms 4 Design Flow G /P /D 800 PCHD Notification Is Required When Fill Is completed
Separate Sewerage System to consist of 1250 Gallon Septic Tank and_ 444 LF
To be constructed by to be determined Address
Water Supply; Public Supply From Address
or: x Private Supply Drilled by to be de t . _Address —
OtherRequlrements 3 1 /21 ROB fill Distribution Box
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 the 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
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs there O; 2) that the drilled well'desc►ibed above
will be located as shown on the approved plan and that said well will be installed in accordance ith the standard rules and regu a i'ons of the Putnam
County Department of Health.
Oats :'�'' �� Signetl r P, E. R.A.
Address Cashin Assoccil1ates, P.C. Rt. 2 Carmel, NY 10SIAc n :e No 26008
APPROVED FOR CONSTRUCTION: This approval expires"8�i5e0year from the date ' sued less construction of the building-has been undertaken and is
revocable for cause or may Pe amended or modified when considered n9cessad by eaCommis 'o r of Health. Any change or alteratieer of construction
requires a new rmit. pro d for disposal of domestic sanitar a e, an va a r su ly only.
13 Date A � By Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N
on CERTIFICATE OF COMPLIANCE
CON UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit M
Located at_RnuTE /log Town
so V411age-
Subdivision Name FLt 11414 -05JG R► CEe@ Subd. Lot N Z Tax Map l S Block Lot 4
Owner /Applicant Name
2S.Rt�1 O t -ice �p2��1.1�PA T.� Renewal_ ❑ Revision ❑
Date of Previous Approval.3 • 13 • 87 F'o2 Pl�•�-
Mailing Address f 0 DA 330 Town $stA ALQ% 11*- MA ;t zip toSll
Building Type R1RA De*J5 -F- Lot Area z",4 t �G FW Section Only Depth volume
Number of Bedrooms 4L Design Flow G P D 800 PCHD Notification is Required When Fill Is completed
Separate Sewerage System to consist of t�C Gall on Septic Tads and 450 t_. V A,26%e t.?TlotJ �%fJGbi
To be constructed by T$ Se Address
�i�T- E$M11.ttc'.b Address
Water Supply; Pgibilc Supply From Address
art nPrivate Supply Drilled by -rb 8a D@L A/ddress
Other Requirements u ` tSTW B "Ti b nl B oft 3th./ �.0 , B . 1=1
1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder Will
place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be Installed in accordance with the standa , rules and reyu aions of the Putnam
County Department of He th.
Date Signed J Signed P.E._ R.A.
Address (294S14114 AAMO. & 2- KC License No 71100$
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered Cecessary by the Commissioner of Health. Any change or alteration of construction
requires a new per Approved for disposal of domestic sanitary sewage, and/ pr' to water supply only.
1/81 Date yi ,�'Z / / �� BY / i��Z ✓iC =�'" — �' `— _ Titfe
pun" C1WM DEPARM -UM CP EEALTH
DIVISION OF RNMNEML MUM SERVICES
DFSIGN DATA si.mr- sLwuna SEDGE ' DISPOSAL SYSTER FILE NO.
owner Oi -'n Address FO-'Box Wso i2SyuAzc.�-%PF MA,.►oR
Located at (Street) / (-A Sec. tS Block 5 ' Lot 4..'
(indicate nearest cross street)
Municipality i�ATTEtz.So�.t Watershed. Cwo -rorJ
O X3104• ) #.'U M fuk. rMv �: �: :?�. �o ;a� �� `�i:��VVYyy .Iy1: • J r: M rLti.
Date of Pre- Soaking Date of Percolation Test a I 8`1
HOLE .
NU -SSER CLOCK TIME PERCO TICJN PERCO=CN
Run Elapse Depth to Water Fran ' Water Level
No. Time Ground Surface In, Inches Sail Rate
Start= -Stop Min. 'Start Stop Drop In Min/In Drop
Inches Inches Inches
1. I I o5 - 11 Zo I� zt z.a 3 5
2 it, '21-11:3c.:b,
15 zl ZA 3 S.
3 II °3'7- 11 : 5' 18. 21 ZA 3
5.
NOTES: 1.. Tests to be repeated'at same depth unUl approximately equal soil rates.
are obtained at each percolation test. hale. . All data to* be sutmitted
for review.
2. Depth measurements to be made from -top of hole} .:
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBFIITTFED WITH APPLICATION
DE.'SCRIPTION OF SOILS ENCI)(IIU RED IN TEST
HOLES
DEPTH. HOLE • NO. HOLE NO...., ..
HOM NO. .
G.L. .. , . ..
.
2'
3'
.4
5'
7' tl 17A"i"A
ET
8" ., 'o R. 7�t= P 77 ST
9o...
12'
.13'
14'
INDICATE LEVEL AT WHICH QIOUNTJLn1ATER -IS M=UMEPM tJ
�A
INDICATE LEVEL TO. WHIC H.' WATER .LEVEL RISES AFTER, BEING IIJUOUNTERE
D tii /A
DEEP HOLE OBSERVATIONS MADE BY: �A. 1
DATE:
DESIGN
.Soil Rate Used S- /o MinA" Drop: S. D. Usable Area .Provided 500Q �'..
No. of Bedrooms q Septic Tank Capacity tzso
gals. Type Nwso���y
Absorption Area Provided By AAS L. F. x 24" width trends
��MAL Other . ► s � Bu-r- 0 8 o x 3 ��i. . o. Q c.
a 'ti
Name C.�s�t rJ �ssoci A.TES Signature'
.:: .
SEAL Address � R.OUTB. 52
�' eIX
�J
y
M0-'-260
C'Y'E 7N��
, ARMEt -.a tl 10512
S
THIS SPACE FOR USE BY HEALTH DEPAMMW ONLY:
Soil Rate' Approved sq,. ft,/gal Checked by
Date
1 �' � y �° • l7 Y• ly . ?• M9►
DESIGN DATA SHEjjET- SUBSUFACE SEWAGE DISPOSAL SYSTEM
FILE W.
Amer _1 ROl(� Gre-to so&C Address
3w Pr(c rd l ci M cLflo r
2.4
Located at (Street) 0 � �oa. (� t
Sec. 15 Block Lot '4
(indicate nearest cross street)
F1,•1 dyu 1-Of
municipaiity PoAr'50 "N
Watershed Cr•afor,
SOIL PERCOLATICN TEST DATA REOUDM,To BE SUBMI= WTTH APPLSCATICNS
54-:(6-4:43
Date of Pre- Soaking a•z Date of Percolation Test 1,44C
2
2 S4 :: I'
HOLE
2 I
NU-sm CLOCK TTME PERCOLATIC7N
PEROD=CN
Run Elapse Depth to Water From
Water Level
No. Time Ground Surface
In Inche$ -Soil Rate
Start -Stop Min. Start Stop
Drop In Min/In Drop
inches Inches
Inches
1 .1 2:5-F — is v7 1-2
2 1: Oe •— (,7
19
2 r
24 6
2.4
3 9
3 127- 1. �I
2�
2i4
.24�.
54-:(6-4:43
2
2 S4 :: I'
L4
2 I
24
3
g
3;2U 7 2i '24 3 ��
4
3:40 - -4 -IS
27
2(
2.4
3 9
54-:(6-4:43
2
2 S4 :: I'
L4
2 I
24
3
g
3;2U 7 2i '24 3 ��
4
3:40 - -4 -IS
27
2(
2.4
3 9
54-:(6-4:43
"z 7
l
2
3
5.
NCII'FS: 1. Tests ,to be repeated at same depth until approximately equal soil rates
a're {obtained at each percolation test hole. All data to' be submitted
for- "``review.
2'." Depth measurements to be made from top of hole.
tev. 9/85
9
a. • • �e • �• • ai •
9. •1• • • • •• 7�• y� � • 9.
DEPTEi HOLE NO. HOLE N0. HOLE NO.
G. L.
-fop sot I
1'
21 `� �c�v�i CL5 Ce {1�eC� SuaWiStbn
3'
4 1 cu s
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 IIXXXR4TERED �}
DEEP HOLE OBSERVATIONS MADE BY:)s��Ivvt. I�Pline ak+ ;Iiit�ti DATE:
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 5v��
No. of Bedroans A Septic Tank Capacity I a g-0 gals. Type j4a.5o4g
Absorption Area Provided By 44+ L.F. x 24" width trench
Other 3 �' R O �i I1 del s ld (d u ! 104 3 In x
Name Ca S 12 d q Os5coc�q •I e S Signature
Address 'f y (�irme. SEAL
t o S(2
THIS SPACE FOR USE BY HEALTH DEPAMMEN!' aMY: Tq STptE
Soil Rate Approved sq.f t/gal. Checked by -Date
DEPARTMENT OF HEALTH
° Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO-CONSTRUCT A WATER WELL j
PCHD PERMIT #
WELL LOCATION
Street Address
Off of Route 164
Town/Village/City Tax Grid Numbe
Patterson 15 -5 -4
WELL OWNER
Name
Arnold Greenspan
Address
PO 330 Briercliff Manor
1private
O Public
USE OF WELL
1 - primary
2 - secondary
j9RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP
❑ BUSINESS O FARM p TEST /OBSERVATION
❑ INDUSTRIAL 0 INSTITUTIONAL O STAND -BY
0 ABANDONED
0 OTHER (specify,
❑
AMOUNT OF USE
YIELD SOUGHTmin 5 gpm /# PEOPLE SERVED 1 FamjEST. OF DAILY USAGE800 gal
REASON FOR
DRILLING
ZNEW SUPPLY
❑ REPLACE EXISTING
❑PROVIDE ADDITIONAL SUPPLY
SUPPLY ❑ DEEPEN EXISTING WELL
❑TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
Public Supply Not Readily Available
WELL TYPE
®DRILLED
DDRIVEN
®DUG
®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. Z-
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
[]ON REAR OF THIS APPLICATION
( ate
SEPP*E.HEEV See plans
sig.Aatur
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 Heal h Department attached to this permit.
3. Submit a We 1 Completion Report on a form p vid d by he P t -am C my
Health Depa tment.
Date of Issue: 1 191q
Date of Expiration: 19 r it ssuing ficia
Permit is Non - Transferrable
0
APPENDIX B
PUTNAM COOr"-Itr DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL
-- HEALTH SERVICES
DIVIDIIAL VOTER SUPPLY &SUBSURFACE SERAGE
TI
4"
(Name' of Owner)
COMMENTS
REVIEW SHEET - CONSTRUCTION PERMIT
DA
BY:
reet Location)
YES INO DOCUMEN'T'S
Pennit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
LF trench provided
_.
.0 ft. max.
Parellel to contours
EWE
S ®I
/iii i
s/s
SUBDIVISION
Perc
(3) Fill
cd
House Plans - Two sets
Well permit; PWS letter
Variance Request
GENERAL,
Legal Subdivision
Subdivision Approval Checked
Ex- 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 Bedrooms
Wells & SSDS's Win 200 ft, of Proposed System
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 110; Type pipe .
No Bends; Max. Bends 450 w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees,Top of fi'
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
35'to catch basin,stormdrain,piped watercour.
10'. to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15''1
!! Well to PL1
0
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