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PUTNAM COUNTY DEPARTMENT OF -HEALTH
Di d Environmental Health Ssrvicek, xrnle4.N. Y.:10512
vision,
CERTIFICATE OF CONSTR. TION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
-7
Located at Tax Map_ Block
Owner
Tax Map Lot #
Separate Sewerage System built by 11:::::.7 Address
-
Consisting of �Gal. Septic Tank and -310 o 711
�� XaV tp
Other requirements
Water Supply: Public Supply From
Orivate'stipoiy Drilled By
AAA.
Building ` Type
Has Erosion Control Been Completed?
No, of Bedrooms Date Permit Issued
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 regulitions, in accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.'
0^
6T V
Date , m Certified by P.E.-ZR.A.—
Addres*s.h
License No. 0— X3 AF0
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 as a public sanitary sower becomes
available and the approval of the, private water . supply ly . shall become null aw void, when a public 'Water .11"" becomes available. Such approvals are
Lo m
subject odification or change when, in the 16dgm . ent of the Co' isib erRf Health, such revoyftion,-Podification or change Is necessary.
: t 9rh
Date By Title
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` JUL 16 199 0
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uc`c1 N tNGfw ea,
w itzi�te tea: ;srnlel, New York 10'1
O y ,• s G , , t i .XJ 'fc"i9°t ,3^',`a.. x 4� ._• +�.'C= sp'�! "•J
FfSS10N ,I-
' pRAWING N$.
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DATE. � ° "T �'' i {C'D. BY.
•
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8wner or Purchaser of uild ng Municipality
S, c�Yoo�vr�Afte Norn.t:s PvfIVAIY7 AKt' --�
Building Constructed by glo
TYRONE ROAD S
iocat� Street Block
LAM;l. RA446� 38 f"o r9 Y00 L 0 -��
u. ng yps Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am whollt 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 Urhich 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-
t.
ermination of, the Director of the Division of Environmental.Health.Ser ->
ica's .of' the Putnam County.. - Department of Health as to. whether or not. the
1-.r-a- .of. the ° system tc� °aperai:"..w�tis" caused `by - "the wiilfuh or 'negligent
act of the occupant of the building utilizing the system.
Dated this �� day of 19 Signature
Title
TIT 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 FIEF NOTICF OF DAVE OF FIRST USE OF SYSTEM.
- - - - - - - - - - - - - - .. - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of,,Health
cLL �� �,�
ARTESIAN VVEL ONTRACTORS I
COMPLETE WATER SYSTEM STALLED AND SERVICED
°- SALESAND- SERVICE - STIC- AND-INDUSTRIAL -
PUTNAM AVENUE -- B j� STER, N. Y. 90509
T1,c, 9 -6004
Mr. Joseph Morrissey
Bangall Drive
Putnam L•aI e, Patterson, IT,Y,
L_.
INVOICE
JOB DATE
to 145 rto
11/12/79:
11/13/79:
O
PO . 2 9 91 Date NQV 1 9 1979
November 13th, 1979
Redrill existing 611 artesian Well
Well-plugged with -niscellaneous debris.
9 hrs. X, $00,00 $720,00
140 ft, Drilling x $7000 900,00
Bacteria Wa-ter ,"malvsis 16,00
Total $1716,00
WELL MEASUREMENTS
2C5 =t, Depth
10 GPI", Water Yield
10 ft. Water Level
Than 17ou .
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 44.102 ,
SOURCE: Joseph D-?orrissey ?x.1._1 .Lot -'!.r'.n
Ban:all Dr.
Putnam T,ake
Patterson, 'N.Y.
COLLECTED:Nlovember 13 ,1979
BY:1,111 Drilling, Inc ,
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
Thu rrlult imdieattt thr tourer of the tamplt wa1
of tatiifortery iamitary quality whim thi mmplt wai eolltettd.
ovember l , l97?
t
Bickwit P. E.
Dtrecmr
1PU'q'NAA UOUN'II'Y DEPARTMENT OV 1H[lEA1LN
} I
Division of Environmental Health Services, Garme% N. Y ; 10,512
I1 CONSTRUCTODN PgRfifl1T FOR SWAGE DOSPOSAL SVSTEflIi
. •-
./ Town or; ,Village
Located a4 0 ex Map Y
Subdivisjon T1G ° Tax Map Lot # /Q/ subd. #
Owner.- % rfYf7L' J r.0, /�?eb�I�ije�; Address
%a/vG��
8u11diri9 -TYRO , .., = Lot Area...
Number of BedrOOmS .— _ Design' Flow - -, Total Habitable Space. 'Square Feet
°-
��- iiifff III���A ,
Separate Sewerage System to coor4W ..of _ — .',Gal "Septic Tank aria 940 % ft. 2' trench / ( ) - ( X )leaching pits
To be constructed by ..__ _/ _.__� Address
Water Supply _ Publ;c $uPPly 'From -- —
Pnvate;SuPPIy to be d ►filled
Address _ —
L a! �EG ® ® #4A - P�ddi��
Other Requirements _____�L._ _z __
Z se" pteh.hafwey responsible for the .design and location of, the .proposed system (s) ; 1) that the separate sewage disposal „
`sk6tiem above desoribed,will biaconstructed is`shown on;the,appidved attachments' her and in accordance with the �standards;'rules and regulations
'of the Putnam'County Department -Of- Health, and'that on completion .theieof a "Certificate' of Construction Compliance ",satisfactory to-the Commission -
er of Health will.be 'submitted `to the Department, and a' written_. guarantee will `be furnished.the owner, his•successors,`.heirs or'assigns by the build-
er,'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 issuance'.gf the approval of the Certificate of'Cons tion Compliance of the original system,or any repairs thereto; 2)
that the dAlled._dtell',described above will ,be' located 'as . shown on the appr plan and that said. well wi be installed is accordance with the stan-.
dards, rules a— nQ—reghlations of ,the Putnam County Department•Of Health
Date P. E. R A
.T- c�
Address ` License No:[,r� °� f 6� J
A'PP.ROVED, FOR CONSTRUCT101y This approval expires one year from;the -date issued unless construction of the building has been undertaken and is
revocable 4gr.caluse qr may be amended. or modified when considered necessary by_ the Commissioner of Health. Any change., or alteration of Eon ;tructior
requires a new ptrm ..' CA�pproved for disposal of domestic iiary s wa a and /or private -water supply only. /
bate By Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner ' �A4,ej.) J MD!',e /3'J'E�Address ?�/,�m��'
Located at (Street Sec. Block Lot
6ndicate neares cross street)
i
Municipality, �rTE2�pn/ Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
'Hole.
Number
CLOCK
TIME
PERCOLATION
PERCOLATION
RLM
Elapse
Depth to Water
water ve
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
o,
Joe
31��/-
/%7
�✓a'6
!r
%
�'
5
�,_,3o . �...3:�
31,"3s - l V/ 6
t
5
5
,.: Notes: 1) Tests to be repeated at same depth until approximatelyy 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.
DEPTH
G.L.
611
12"
18►►.
2411
3011
36►'
4211
48"
5411
6011
66►►
7211
78"
8411
TEST PIT DATA REQUIRED TO-BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. �_ HOLE NO.
HOLE NO.
INDICATE LEVEL AT 1MCH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY —Z) Az Date
Soil Rate Used MWl "Drop: S.D. Usable Area Provided 5v670
No. of Bedrooms 3 - Septic'Tank Capacity 9ve Gals. TypeAAWOS�
Absorption Area Provided Byjjvo L.F.x24" X ,s► ► #f,:width Trent
Address Cggyg --L V
.a..v vaaa . - --- Li 1.LL1 '41 LJJl 111 L11'LLIlYt V11.u_L s •0 "'"
Soil Rate Approved Sq. Ft /Cal. Checked b
Date
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