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Home My WebLink About0873DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -57 BOX 10 00873 ' : . '1 ♦ u i, L M . �1�� i '. 1� '� I Na , . �L ' O■ , Ir qr 00873 ru PUTNAM COUNTY,: DE1 Division of ` Environmental. Nealb INSTRUCTION'': COMPLIANCE F0R,IStWA Town or Village 1`and Dr1 e 3 i Located at - Tax Map 1 ,Block owne► Tax Antfony,,6agl iardo Map.LOt 3 Subd . _ L 7 L' Separate Sewerage,System ;built by Rt C! -lard 'yOIInSOn Address Saw Mil 1 Rd -. , New � -Fai rf4 e1 d d 0681 G AA Consisting of 1 OW pal Septic Tank and 420 ',L F r. r Other,Yegw►ements $° Deep .R -o 'B F�'1 . Sects on x :5200 ` _�] (300 Ydt }) Water Supply: Public Supply :From .:., :.. • ' X Private ,Supply Drilled BY M1,71„ Drilling,° InC, Putnam Drive, :Brewster, NY 1:0509 Add ress Building Type No of Bedrooms Three`,. Date Permit Isided - 6/20Z.86 None Re` `d H.as Erosion Control Been Completetlt q I that the certify„ system(e) as listed serving thgabove�preauses 'were constructed,.easentially as shown on the plans of the completed work'.'( copies of which. are attached),. and•ui accordance, with the,,standards, rules and regulations, :in accordance with the filed plan, and the permit asued bp. +the, ,PUtnam,COUnt De.. ". .. ._ - . � partment Of Health. 7 November '1980, q Date Ce►titietl. by P.E. R.A. 9.. Fair t Car -mel 29206> Address License No. An y person oecupying, prom ises served by the above system(s) :shall' promptly take such action as may necessary to secure the correction of iny,.unsanitary, per resulting from such. usage., Approval of -the separate sewerage, system shall become:null and• void as soon as a public sanitary sewer becomes available -and the approval. of this privatewater'supply shall become null and _void When a public water .wpPly. _becomes available. • Such approvals are aub)eet to modification'or ' ehange :when, :in'the ")udgment of the'Co'm eCOf Flealth, such revocatlone. ion of change is necessary, t i i date BY Title -s WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3)71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK -- This report is to be completed by well-driller and submitted -to County Health Department together with laboratory report of-,-- analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION NAME ADDRESS OWNER G�AGL!7jX %D0 Anthony Kno; woad, Putnam Lk.1 Patterson y.y. LOCATION (No. 8 Street) (Town) (Lot Number) OF WELL Flavilailc5 iri v,- - Pl;i.nPTn 'f;nkra A i- --J'Ar .goi1 itiacu i�nr3c SCREEN DETAILS I DEPTH FROM LAND SURFACE FEET to FEET I GRAVEL Diameter of well including .. _ 11 ACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at less; two permanent landmarks. 13z 480 s` E:Ciiu%t -hard Granite If was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 100 1 /,nn $I 472 4 S, 0 DATE WELL COMPLE' 9/5/80 6 L. Iv f N Cv-» P41ZK.- IN('. of AI _ NnV 7 -4 SEP 16 1950 14. 14-Tot-al DATE OF REPORT WELL DRILLER (Signature) . 9/12/GO PU 1 NAM COUNTY, h. OWro L.I. " , -eres O i ❑ NESS ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL 11 SUPPLY El INDUSTRIAL ❑ ❑ CONDITIONING ((SSpecify) DRILLING ROTARY ®A COMPRESSED ❑ CABLE ❑ (Sp�E Y) EQU PMENT R PERCUSSION PERCUSSION CASING LENGTH (feet) DIAMETER (inches) WEiuHT PER FOOT � ❑ MVE SHOE El � 1 G T ONO DETAILS 3 3 6 19 THREADED WELDED YES NO LHJ YES YIELD TEST ❑ BAILED ❑ PUMPED HOURS G.P.M. YIELD (G.P.M.) COMPRESSED AIR 4 14 14 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well LEVEL 30 48-j Q in feet below Land surface: 4-60 MAKE LENGTH OPEN TO AQUIFER (lest) SCREEN DETAILS I DEPTH FROM LAND SURFACE FEET to FEET I GRAVEL Diameter of well including .. _ 11 ACKED: gravel pack (Inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at less; two permanent landmarks. 13z 480 s` E:Ciiu%t -hard Granite If was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 100 1 /,nn $I 472 4 S, 0 DATE WELL COMPLE' 9/5/80 6 L. Iv f N Cv-» P41ZK.- IN('. of AI _ NnV 7 -4 SEP 16 1950 14. 14-Tot-al DATE OF REPORT WELL DRILLER (Signature) . 9/12/GO PU 1 NAM COUNTY, h. OWro L.I. " , -eres O i BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 4568 SOURCE: Anthony Gagliardo Haviland Road Putnam Lake Patterson, N.Y. COLLECTED: September 10, 1980 BY: Mill Drilling, Inc.. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method well 0 0 per 100 ml. . This rerult indirattr tht roarer of the ramph war of ratisfartery ranitary quality whtx tho rampit war roll ettd. NOV 71980 PUTNAM COUNT SEP 16 1980 °d:iK, OF, NE4LM JOHN H. i -r�LN September 12, 1980 -A Bickwit P. E. Director .,y r Owner or urd•l ser o Building Building Constructed by Location - Street' Building Type Municipality Tai 6 Section Block Lot 3 GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his.succes- sors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive. the de- termination of the Director'of the Division of Environmental Health Ser- - -- vices' of - the-- Putnam-- Doun-ty-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.b_uilding utilizing the system. Dated this �� day of % 19„ fV Signature qn/ Title �G ; (It' �,dorporat!=, give name and addre; s 'o THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - - --- - - - - - - - - - - - - - - Division of Environmental Health ces, u nr unty _,. NOV 7198U PUTNAM 60UNTY DEPT.. OF HUMi Department of Health ANTHONY GAGLIARDO Owner or Purchaser of Building CARE -IN HOMES:; INC. Building Constructed by HAVILAND DRIVE Location Street RAISED RANCH WOOD CONSTRUCTED Building Type Munici� pal y Section 3 Block Lo t GUARANTY OF SEPARATE SEWAGE 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 guaranty to the owner, his.succes- sors, 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. initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de termination of the Director of the Division of Environmental Health Ser- vic.es- .of-..- the y.. _ De -the-- artment of Health -as- --to-- whether or-not the P failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the syst . .Dated this 31 day of Oct. 1980 Signature V1 �vt�� tcv� .. � y g Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM._ Division of Environmental Health Services, Putnam C Health NOV 71980 PUTNAM COUNTY PULOF HEALTH .a,... 0TNc:2 d i u N 0 2 7 Ilil '; 77'� fit 2 1 .64 41 V •� G �� (V L, // Ip $ • Well � e 04, L..Ka .Sfi 6FV� H A�/ 14ANT� � D211%E 1Jo�e: Encroaci�.rrrn +s or easements belo,.� �radell�an� nm-F shown hereon 12 - P18 -52- �` IJo2t}- {WESTEtLL P02T {or...� o� P�oPEfZ- P(ZE P A P— Er=l F o TL ,ANT H OK)Y -A G L t A2 0 0'', . � 9� �; {(�(`.�. . �-o.ua of v..-i�czso .J .. �ut•�a. i�... to.�,.aT.y n� .y.. � .. fi ,f JC.p,LE 1�� =° 1J 0.%E HBEfZ 3� 1980 ' { I a„ Nov � NOV. FY V Y Q ��u7 . . `` pUTNAM COUNT' I EIEWLQE HEALTH JOHN H. PREM-1' 54 P_.4 1 A(aII cxr�Iticatlons hereon arz ,�Ild for 1i;s o�p and cT1e5 ihere-aC o „Ip� li sa,d "uP ormpes 6eAe 1 IMles 55r4kreaffea5s hDrre -n I (Icer+lf�k6a+ 4h,s map Qas made. rrom an "&I sit �e� of Ae- prDPer . Uciobar 31�i�j80 JJ L i • (�. YUALGV L A00 5020 E -eofZ- LLICE05E kf 41 5,S4 ' LAKE CA2ni! L NEx>Z/oar-7 914225 -1881 fx� s Builder 1i'-dt1r;. _ \ Surveyor Drawn Date: lScale. JoD N4S J 6 H:•N.. H P R E N TI S's s :. CONSULTING E_NGLNEER