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PUTNAM, C(
Division: °of Enyyviroi
_CERTIFICATE 6f CONS
h�/
i
4.
)LNTY DEPARTMENT OF HEALTH
rmental Health Services,Carme %'.N Y 1.0512
FOR -SEW.AGE DISPOSAL SYSTEM �
Patte;rSon .,
J ` Town or Village'
Ottawa Road
Located at S
ec ion,z, Block
Jacob & Jo:'sephlne.: Huff 001; -7. °In'cl S0641
Owner'` "Co Lt Job
Anthony.& Joe Ga,rc�a R2
`'Separate Sewerage System built.,by Address- � I d'. , N d, C
ew Fa rf T 068
lion R iel 1
1000 1:26 .36.. inch
Cons�st�n of Gal Septic, Tank lineal Feet. X width trench
9 ,
i a
other requf ►ements - Fi T1 Area 36" B
Water Supply Public .Supply .From
X P: F Beal &Sons'
Prwate.Supply - "Drilled By
,AddreSS Brewster, `NAY 1 , 0- 9
Frame I
IBwldmgaType , N YNo of;Bedroon
None. ?Re ' d I x;
a Has Erosion Control Been rCompleted? Q w
certify, that the'system(s) as listed serving the,ab've premises were cbrisl ,
Y „,attached) and ;in accordance wdhythe standards 'rules and regulations;
T -
16 ��Julya 973
'Date Certified
i RD.i6,Box3'
Address .
Any person occupying premises..served • by: the above systems) shall pro
i 'conditions resulting from such. usage. . Approval of the•separate "sews
available and 'the approval of ,the
private water" supply'shall- become nu
,subject to modification or' change. when,. in _the judgment of the Col
c Lt ,r -
Date z
! ; By
rmel }
ipt_ly take. such —
,age system shall l
and void _when
imiss�oner;'of Hea
RkA� l /13%72
is e” Permit Issued
rs`shown on the plans of the completed work (copies of which are '
e.rpermit issued b2e ,,,U ' tna m County, Department of Health,
u P.E. X R:A:
NY 105.12 29206
License'No
lion as may be necessaryto`Securetpe correction of any unsanitary
>ecome „riull and 4oid as.soo,n asr'a •public sanitary, sewer becomes
a•' -publk ,water. supply becomes. available.. Such "approvals are
Ith, jsuch, revocation modification or change" is necessary.
/57 s
- Title
J. H. HUFF
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 laboratorj 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
F
ADDRESS
1438 EAST 6TH STRM9 BROOKLYN, DTY 1123
LOCATION
OF WELL
(No. B Street) (Town) (Lot Number)
OTTAWA ROADs 2WHAN 1,AKE PATTERSON nV YORK
PROPOSED
USE OF
WELL
BUSINESS
J1 DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
DRILLING
EQUIPMENT
ER
J] ROTARY ❑ COMPRESSED R PERCUSSION ❑ PERCUSSION ❑ ((SSpe cif y)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
1
THREADED ❑ WELDED
SHOE
YES ❑ NO
G
YES
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED C1 COMPRESSED AIR 5 12
YIELD (G.P.M.)
12 GIM
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST [feet)
Depth of Completed Well
in feet below land surface: 1 20 fte
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
O
3
Drilling in overburden -
it solid rock at 3 fte
3
• '
20
rillin :Ln. rock - settin
g g
20
120
riling in rock -
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
l2/20/72
DATE OF REPORT
6/22/73
WELL DRILLER (Signature) a i
4
OtIcM.:', ?m '10senfline Miff Patterson
Owner or Purchaser of Building Muni cipa 11 ty
Building Constructed by
1)tt�ui.a Road
Location - Street
Section
Block
Ix r z!P _ -- A0,11-7 Ind
Building Type Lot
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 wi 1 ul or ne ligent
act of the occupant of the building utilizing the sys e .
Dated this day of 19 Signature
Title a,�� �/• r
L ,corpo,ration,
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMK ETION 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
Jacob &
Owner or
Plymout
Building
Josephine Huff
'Purchaser of building
1 B1 drs :� �
.Constructed by
Ottawa Road
Location Street
Frame
Building .Type
Section
Block
6001 77 Incl.
Lot
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.,`sNown 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 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 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 occupant of the building utilizing
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
.cause.d.by the willful or'negligent act of the occupant. of the building utilizing the
system. .. __.. ._..... _ _ .... _.
Dated this 1,12 day 'of — 19 Signature !Te-
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'County Department of-Health
PUTNAM 'COUNTY DEPARTMENT :YOF HEALTH
.. 4
Division of Enwronmentl Health 5ewices, Carmel N Y 10512 I
CONSTRUCTION PERMIT,. F.OR SEWAGE _;DISP,O
Y sAC.•sYSrEnn _...:Patterson :.
` xF �s Town or 'Village
.1 ti 4
Located at Ot °tawa 'load 4 ' 4 Section Brock
Putnam, lake k,t ' 6001: -'5. Intl y S0641
Subdrvision Lofr Job
Owner-- Ja.cob & Jose h .Huff. Address 1408E 65th- Street
euud�n9 Typerame�, got Area. 0 Bi^ookln, N Y. 1= 1234
Number "of Bedrooms Three Total Habitable Space Square ,Feet 7
Separatey$ewerage System toz con "list of r 1000, ,,Gal Septic Tank 150 lineal feet 'X i 36 �' >nch 'width trench
? + 1
To be' constructed by Address i
'Water Supply Public Supply .From x !
� I
Private `S o be dcill
upply tetl by ?
f
x Address+ w" '
=t F� 1�1 A ria` r ,36"
Other Requirements t S }
^: , : '�.zi:- t•' °,. - ,., °1
{ Frepresent that•I am wholly and completely responsible forthe design and toc'atwn of the proposed ;system(s);; 1) that the separate sewage disposal, system
-
above described will be constructed as -shown dr the approved amendment there to'an, in accordance with thesfandardg rules an. regu a ions o e u nam.'
County: gepartment of ?lealth, and that on complet�onthereof a "Certificate of 'Construction Compliance - satisfactory to;the Commissioner of; Health will
be submitted to 'the Department; and, a ,written guarantee will be. furnished tAe owner, his wccessors, heirs -or assigns by`the builder,�that said builder,wlll
place im „good.operatfng .cond�tlori any 'part of ,said sewage tl�sposat system tluring the per,iod`of two (2j years immediately following the date of'the' isfu
' ante of;`the approval of the Certificate of Construction ;Compliance lof the original system; or any _repairs thereto 2) that the drillad'.well .d`escr(bed above
:will be located as'shawn on the approved plan and Yhat 58id well will be Anstalied �n accordance ;,wd standards rules and regula"—"�'ons of the Wutnam;.;a
COUnty Depertme_nt Of Health p� g a s a 3 i s s� "� k
u
P.E n R A
r ..j
Address R 3D'. 6, 6 _353, C e'1 New Y k 10512 License No -20206 i
APPROVED FOR CONSTRUCTION This approval e`xpi're's'one'yeaifrom3he date issued' "un ristruction of the bwlding has,b,een undertaken 'and is'
'ievocabi_e for.cause or may be amendetl or modified: when considered net nary' byy`the Co ss�oner of Health 'Any change; or alterationpf construction,
requires a new permit A proved Sfor disposal of domestic sanitary w , an r. pr, at supply only
Title
.�.....wx 3%'y f e ,.
e
�,
�u FIELD CHECK LIST
p � 47
Date:
Insp.by: _
INITIAL SITE INSPECTION
Yes
No
Comments
Property lines or corners found ..._
Can estimate .house location
Will driveway need cut . . . . . . . . ... .
Must trees be removed -note these .
Is deep hole representative of .entire SDS area
Additional deep holes needed. .
Sufficient SDS area available considering
driveway cut,house location,separation .
distances, etc . . . . . . . . ..
__ -• --
DEEP HOLE DATA
Depth:
Water elevation:.
Rock elevation:
Soils description:
--
Date: -z
FINAL SITE INSPECTION Insp: by:�
House located where shown on approved plan.
STNS oc .t:Pr�. ?,there gpproved
JJd11 1.i1 U1. �1'611UL1 111easulleu . Q• '..... ...t
Width of trench average
Slope of ,tile line and trench acceptable,s
..... ...
Room allowed for expansion trenches . . . .
41-
Over.-5Q...ft._.. from Tswamp,waterc ours e
_
Natural soil not stripped or SDS area
unnecessarily graded . . . . . .
10 Ft. maintained from prop.lipe and
20, (from house . .?
Separation of trench from om house well
etc. follows plan .�
Number of bedrooms checks . . . ..:
Stones, brush, stumps, rubble, etc. greater
than 15 ft from nearest trench . . . . . .
15 Ft. of peripheral soil horizontally from
trench . . . . . . .
Junction boxes properly set
Could surface run off from driveway, roads,
ground surface, etc. channel near SDS „
area .
v
Gf
..
T
Does lot drainage appear O.K. in area of SDS
FINAL GRADING OF SITE ACCEPTABLE,
DIVISION OF E, X R
t, L n 1'177
D El S i G DA T SHL ILE E, T S LE P -R-A T Er S A G: D TS :z:�r S%7ST-'-'
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DIVISION OF E, X R
t, L n 1'177
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Ab s o r P t i on e a i1c o,. --ided BE x2 L" .5,; F,-,' wid-
Lh ire-ncln. Oth-r
kwgy
N-a-me John H. Prentiss7, P.E'. c'. a ta, r e
�A. PR "V
6,.B., 353
Addres�§ s
Camel , New York, 10512
P U'f N -A I
I C C UN, TY D E P-A R 1, N- T 0
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THL E.-`% L TH.
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./Cal
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ul* 0. 2920b.
or F DatE
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OTTAWA (50' wide) i E ( ROAD
SURVEY OF PROPERT Y
PREPARED FOR
JA COB R. & JOSEPHINE NI HUFF
BE /N6
L O TS 6001 - 6005 INCL .
SHOWN ON
EIGHTH MAP OF PUTNAM LAKE,
S/ MATE /N
TOWN 'OF PATTERSON
PUTNAM COUNTY, NEW YORK
SCALE l 20,
Said mop filed March 20, 1931 as Map N°/49- 6
/, James C. Edgeff, the surveyor who made
fhis mop, do here by certify that the survey
of the property shown hereon was completed.
Dec. 23, 1971 and this map was completed
Dec. 29, 197/. Revised Sept. 19, 1974.
r w York License N 7212
qn. Registration 5637
Offich of James C. Edge11
Lond Surveyors . 3 /main Street, Brewster, New York
hurch Street, Pine /? /Dins, New York
ih .
J�
Q
0
Q
@v
40 °E
Note: All certifications hereon are valid for this
reap and co s thereof only if said map
or copes bear the impressed seal ofthe
surveyor wkwe signature appears hereon
0
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