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Home My WebLink About0905DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -19 BOX 10 00905 `o -' rp . i .9 : 01 �� JR.- �. BIB !mn ■ . I i r 00905 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE-`• OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Pattetson Town or Village Located at Slater il a Rds. A X Tax Map 19 Block '2 Owner— Parador Enterprises, I C. L I �1 6P Lot 5 (4040-4045) Job S01550 Separate Sewerage System built by Address Consisting of 1000 Gal. Septic Tank 254 1/2 lineal Feet X 36 inch width trench Other requirements FM Section 2940 Sq.Ft. x 18" Deep Water Supply: Public Supply From x Private Supply Drilled By Address Building Type Frame No. of Bedrooms. Two Date Permit Issued 7/27/76 Has Erosion Control Been Completed? No **No drainage installed (See drawtng No. 2 notes & Memorandum copy)� 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 "ulations, plans filed, And the permit issued by a Putnam County Department of Health. Date — 8 November 1976 Certified by P.E. X R.A. Address R.D. 6, Box 353t� .met l My 1054- Li . cense No. 29206 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 at a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply -jxecomes available. Such approvals are subject to modification or change when, in the judgment of the Com loner of ealth s revocatio ifica or change is necessary. Date By Title_. I 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 OWNER NAME £ 2C .r► ..J-+l �) � JA7T .�� ) ( /' V' J LOCATION OF WELL _SqG (No. d Street) Llq (To n) A (Lot Number) PROPOSED USE OF WELL ,V DOMESTIC SUPPLY BUSINESS D ESTABLISHMENT ❑ INDUSTRIAL FARM CONDITIONING TEST WELL OTHER (Specify) DRILLING EQUIPMENT ROTARY El ACOMPRESSED IR PERCUSSION CABLE 11 PERCUSSION OTHER E] (specify) CASING DETAILS LENGTH (feet) / DIAMETER(Inches) WEIGHT n (f PER F T � THREADED El WELDED O YES NO F YES NO YIELD TEST BAILED PUMPED HOURS CO PRESSED AIR G.P.M. YIELD (G.P.M.) yypTR LEVEL MEASURE. LAND SURFACE— STATIC(Specifyfeet) ( DURING YIELD TEST [test) � Depth of Completed Well in feet below Land surface: SCREEN DETAILS MAKE � LENGTH O N O UIFER (feet) 1 SLOT SIZE DI ETER In hea) �� IF GRAVEL PACKED: Diameter of well including gravol pack (Inches): GRAV (lnchea) FROM (lest) TO (lest) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with dlataneea, to at /seat two permanent landmarks. FEET to FEET i I v If yield was tested at di*erent depths during drilling, list below FEET I GALLONS PER MINUTE DATE WELL aCO ET §D DATE OF, EP FIT WELL DRILLER (Signature) �� y�/ Municipality Section Block of 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.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. Dated this day of 1976 Signature Tit If corpora ti on,,elgi ve 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 County Department of Health r Building -Constructed/by Location - Street Tu"ilding Type Municipality Section Block of 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.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. Dated this day of 1976 Signature Tit If corpora ti on,,elgi ve 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 County Department of Health BREWSTER LABORATORIES Box-224 - BREWSTER,- N.Y. WATER ANALYSIS REPORT SAMPLE NO. 3775 SOURCE: Parador Enterprtses, Inc. (J. Bell) Liuo'nta Pct t er.son.. Al. Y. COLLECTED: Nou ♦ BY: Barnshake Rrial, ty Corp. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Block 2 Lot 5 (4040 - ►4045, Tax Hap 19 0 per 100 ml. This result indicates the source 'of the sample . was of satisfactory sanitary quality when tht sample was collected. /Wove 6, .1976 C R iekwit P. E. Director Putnam Xy4"W§""§=)founty Department of Health Division of Environmental Health Sgrvices AFFIDAVIT - CORPORATE OWNER APPLICATION Putnam FOR PERMIT AND APPROVAL OF PLANS REQUIRED BY MKNWXM COUNTY SANITARY CODE (please type or print in ink) TO: Commissioner of Health - In the matter of an application for a(an) Permit to operate a(an) _ _ _ _ _ 0/�i %� _ - ja i - - - - n - - - (state type of operation, e.g. re£u area, eating place, etc) Approval of plans for _____�Vj7T ? _____________ ate t pe, e.g. ea y subdivision, public sewers, etc.) - - -- - - - - - - represent _ Name of authorized person) that I am authorized by Resolution adopted _ _ _ _ _ �- _ _� _ _ _ .19-76 z to act for the - - - - -- Name of C�orationT having offices at &4-Z ZAddress� _______ _ - _ - __ __ _______ __whose officers are President-- - /-`' _Wl -- -- - -- - - - - -- (Nam�'&AiL ome Address) -- 'Ce- Fres.__� "% - %L'/ �/ -�1 - - %� r? i!r_�v-- - - - - -- T/- - Name & Home Addles Secy. �y / (Name & Home Address) Treas._ -- -1&eH �- _- ��OZ---- - - - - -- Name om e Addres with respect to the permit or approval requested and thereto. ,ifl Sworip Infore me this&V . __day M.�ii�M; - Note* Public NOTE: ALL INFORMATION MUST BE GE -SD -28 July , 1974 all subsequent acts relating Sig T tl JORDAN W. BERKMA" Notary Public, State of New YAM Qualified In . Putnam Counfgg Commission Expires March 30, 1g GIVEN OR THE APPLICATION WILL BE RETURNED k5 x 1 >r Tr fr tKS lr �„�' • t j�€€�''i",A"Y�: _; ff� .' Al '3 41, �.��c��'�ii��,��cfer�al +��'► �&#,dr� csrt3r�� f'�±�t�s�rE , f S• 4 ' 4, y£! Fi�i!$� #£tA'�° '�" •�'`j ,e�- �.,.••�4 ,_ �.;{Ht �F. ! I�,�, �j�q .� a ° � . ' u �y�{�, -�_.�- �F'V'~�.{f,`'�i� Err l $ #18GIG-1 "ix3 TsiE �s'k. 4.�,,•�.y� ;q{y {�.. -.�3 h y ,. ,r��.^ �� , b s ., j v' -� ��', ii. �' +' • '.'i � iLn.�i�W 7p.Cll�E� R'��;�£} � .;'k {.e i +,rF , � ..4 -•� 8 � wrv. Y<'�• � � '. Z" f ! �,F•A6 µ� R yip; xX ty •�,�.y+y�.c1�, ..,�t{ wwl } m .,.e m i 2 'A 4 }v B`:4'x #'f`�A:i L%l""�, � �M��1 {iEltei' A'•.iv, i!3>�� '�i •� %- '. ASE` c Axa L, fIgn E W&€! w1 d ID het PITIT � s Al e 21 ` e. _�, � 'Fw ,. a •�``< � v ,? 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