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01420
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Vii: , . IE PUTNAM COUNTY DEPARTMENTF HEALTH
1 ,�. t ,
Division of Envi�onmenta/ Health Services Carme% N. Y (0512
.. :: :_ ToUrn of t�at�ters',on =
CERTIFICATE OF :CONSTRUCTION. COMPLIANCE FOR SEW "AGE DISPOSAL' .,SYSTEM,
Town or, Village '
Corner. Fair St'. � ?-dust Gate Terrace ?6 Z
Located at - - Tax. Map _ Block : -
Owner - 11 "'TerG Tne .� -- __ Tax.Map lot # Subd.' #
Separate Sewerage System built. by Pc'�tteY'sOns, �T: Y.
��rd; ck Add►es :�
900 W F., `2Zi 1riGh trend
Consisting of Gal. Septic Tank. and
Other requirements none
Water Supply: Public Supply -From
X Beat
Private Supply Drilled .By
.
Address
Ranch 3 -
Date Permit Issued
Building Type No. of Bedrooms
Has Erosion Control Been Completed? yes
i certify that the system(s) as listed serving the above premises were'.cgnstructed 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 fi]ed plan, and the -,permit issued by the
,`Putnam County Department Of Health. - - -
October 1, 1979 -
Date t1fied b . .r P.E. X R.A.
ss � Bette -, �
Address R p 8.. -Hor s epaund R .. d , Cannel, "N . . "
r license No:
'Any person occupying, premises. served by the above systems) shall promptly take such action as maybe necessary to, secure the,correction of any unsanitary
conditions resulting from' such usage. . Approval of the separate sewerage „system'ihall become hull: and ,y' s son'aa a' public sanitary soWer be
available and :the. approval of this private water supply shall become null d when ,a public, water p y becomes available Such approvals are
subject .to modi .1catiojn, pr, change 'when; in the judgment of •the Co lisioh Health such revo ti” modification: or "change` is.'neeesfary.
bate / ^' 7� / `/ BY Title
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WELL COMPLETION REPORT
3/11
PUTNAM COUNTY, DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK
This report is to be completed by wall driller and subn,61ted to County Health Department together with laboratory report of
analysis of water sample indicating water is of sati'sfa'ctory bacterial quality before certificate of construction compliance is issi ed.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER T
NAME A
ADDRESS
LOCATION (
(No. 6 Street) (Town) (Lot Number)
PROPOSED L
BUSINESS
DRILLING I
IN ROTARY ❑ ACOMPRESSED CABLE IR PERCUSSION ❑ PERCUSSION OPHE y
CASING L
LENGTH (feet) I D
DIAMETER (inches) W
WEIGHT PER FOOT D
® THREADED . ❑ WELDED ®
DRIVE SHOE W
WAS CASING G((�RROjj
YIELD ❑
❑ HOURS G.P.M. Y
YIELD (G.P.M.)
WATER M
MEASURE FROM LAND SURFACE feet) D
DURING YIELD TEST (teat) D
Depth of Completed Well
SCREEN
MAKE L
LENGTH OPEN TO AQUIFER (feet)
DETAILS S
SLOT SIZE D
DIAMETER (Inches) I
IF GRAVEL D
Diameter of well including G
GRAVEL SIZE (inches) F
FROM (lest) T
TO (feet)
DEPTH FROM LAND SURFACEI S
FORMATION DESCRIPTION t
Sketch exact location of well with distances, to at least
0 5 D
_ __
__ _ ..:.. _.. .r . .
Hit rock at 5 feet
Drilling in rock -set -_ _
30 1
110 D
Drilling in rock - granite
If yield was tested at different depths during drilling, list below
FEET G
GALLONS PER MINUTE
DATE WELL COMPLETED D
DATE OF REPORT W
WELL DRILLER (Signature)
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE No. 4436
SOURCE: Tavino Builders, Inc. hose bibb -well Lot 4
Deans Corners
Brewster, N.Y.
COLLECTED: December 4,1979
BY: P.F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
Thin mutt indicate the rourct of the sample war
of ratiifactery raxitary quality when thr sample war collected.
P
December 6,1979
Bickwit P. E. `
Director
F k'
� 9
4
....�..,,.... ._...:..et:. ......,... ...,.wo..,.,;.:........ :�., .rte:,._ :. .. .. .aa._,.
Y
C� it �� :ii:`L.���rvj: ti Tow n of �?atterson .
Owner or Purchaser o Building Municipality..
44 YL� �:t mss' :Z a , - j .
76
Building Constructed by section
Corner 11air Street .c. West "ate 'T'err. 1
Location - Street Bloc
Ranch Tax Tiap Lot 23-4 - :Sub Lot 4
BUIdIng Type of
LL. Cla.ra. A . "feiffer
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-
t =icca • of - t y3 Putnam County Department of Health as tc- whethG- or -not trs
failure of the system to operate was caused by the willful or negligent
act of the occupant of.the ystem
building utilizing the.s.
_
Dated this g day of Cci� 1q7 Signature te
Title ( �2
corporation, g ve name
and address)
- - — — — - — r r — - — - r - r r — - — r r — - r - r - - - - - r
THREE'(3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP "LETION WILL BE ISSUED.
GUARANTOR IS REQUIRg2 TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
r r r r r - r - r r - r • r r — r r r r r — r r ,-
Division of Environmental Health Services, Putnam County Department of Health
•
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DEC 19r7
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PR SIONAG EN6 //VEtRFiV E BAND SUA?VEYIMC I DI ISION Of
F oAtp ' C,4*AA'E.L, V. % FNT7k N4AITH
i
1
- T, -
ii ..Applicatiom, for P em. t'n i t
'T U FN COUNTY
di
to Th tal L or
, ( "i _Division
- EqvtOnMeqtqt
syst ew
dwSfFIUC I N. RE RMITf G.AIISEWAGE.-_,PI0dSAL:,ISYS
�
Corner P-1 Shn d* t
ocl at
S A,
.Lands _10f-
.
ub Clara
uVarib., -Bul-
AAd
Pet6r.T.a.vI o;
Building Type Lot
`Number of peO!c .Design inn F.v�t_ Z In
Separate Sewerage System. -to
T 0 be -constructied by.__- r
'4
waiei- sdj)ofy�� *rc�m,
o'x
:private 'Supply to be ,, drilled iby'
:-
. ' Address`'
:Other es
s"
,Other 'Ric '�em eitsT- nstA1 I"
, a q
grade Obproper proportions, a rid. Olen,ibmpleted prlbr to allow,7,
represent y . the tnsible or th de
,
iJiiystem; �O . - I , 1- shown on «the
of _64, a� �
�tK6 = constructed
to i D and that on coipletioh
er of Health will be submitted :,to the p6artmiant; - and a, written 'g'u".
er, ih t jc`jiuilder will place'in "good opepti
ig condition any
�rfollowing the.;date of the issuance of the,apQroval of the Certifi�,
that tge;dril)id will " -A6i ab6id*crkll b4i'lo
ed 'is sho 4fi
~lords -W74fid -rd-Rplitions' of the t Of 'He.
1'{ Ow
fDate `.�
U
Addr�si-
Horaep 1
APPROVED
._q. P4S:TRUCTION Thii ap'jiovil'b'kpi s
mta6bld for us* br�ni
be amended
. . �qr` modifie �r�
consider '
requr s.a-new pq ��hlt,,Aporov6d f O disposal .domestic
a t Ry-,
_4
,DEPARTMENT -itOF,..-HEA,L-T-IH 607
Health Services Carme% N. Y.-I
xx�
76L
M: ter�gdh,
3
TO�,-or
.
iL, Oo,
,7L Town
'Tax Ma��'
I P
S, o.r--he(r-,pII'IjI�reys;t
AdcIres
acres
Total Habitayble ;Spaye Square 'jreet�,,
1I Septic -'Tank and t 2
L(30
trench
-
tt.er s y
g pits
4ddre'sS
X�
.0
-55 U
me.ri,t of U U V UM 11 A. v K7 U V 0 V
y ..L' A,
-c pnst
. ru 10 n
ign axiA'location--of tfie 1) 1:6- iej�drafe�;'6eidkge disposal
_ _1 .1 - . , proposed P6
the date `issued
a oHginal. system -or any repairs
44-1 be -installed accordance with the "s-tan-'
sr
4
9814
on of i6e,bui_ldii g has been :Li`hd&takeh •and is
Of �ny: �h�nqa,or.alterat io n of-,construction
only
Title
i"
i PUTNAM COUN'1Y DE.;. iV'2 OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
939 ®607
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Tavino Builders.. Inc®
Owner Peter Tavino Address Deans Corners, .Brewster, N. Y.
a St &
Located at (Street West Gate• Terrac (tec, ?6 Hlock 1 '. Lot 23.4
�Indicate neares cross sEreeE of 4 C1ara.A. Pfeiffer Subdv.
Municipality Town of Patterson Watershed New York City'
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
No.
Start -Stop
apse
Time
Min.
Depth to Water
From Ground Surface
o Start Stop
Inches Inches.
Water Level
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
_
r 12:35 -2:53
18
24
25
1
18 Min
22 :55 -3:15.
20
24
25
1
20 tr
33:15°3:33
20
24
25
1
20 1P
43:35-3 :53
18
24
25
1
18 fr
12:40 -2:57
17
24
25
1.
17 tr
23:00 -3:19
19
24
25
1
19
33:20 -3:40.
20
24
25
1
20 }°
_
43:40 -4:00
20
24'
25
1
20
5
_..-
1
2
3
4.
�.
5 -- --
Notes: 1) Tests to be repeated at same depth until .0 data to iieesubmitted
rates are obtained at each percolation test hole: A11
for review.
Depth measurements to be made from top of hole.
-Q
TEST PIT DATA REQUIRED O BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH.. HOLE N0. 1 '` ' ';.HOLE NO.. 2 HOLE NO.
Topsoil Topsoil
i a
G.L.
611
Sand Loam, stones Clay
y
12"
' r
18 ff
. �•
241} ...... ,.. ..
3011 .. .
361}
4211.
i
4811
5 411
6 Off
66ff
Roc k
72"
f
78*1
8 411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE TO WHICH biurges EV�LBRgnr S �FTP�(t. BEING ENCOUNTERED
TESTS MADE BY 1972
& Mar 1973.
Soil Rate Used 20 Min/11t. Drop: S.D. Usable Area Provided
6, 000 SF +-
900 Precast
3
cone/
No. of Bedrooms Septic Tank Capacity. Gals._
Absorption Area Provided By430 L.F.x24f1 x 3611 wi ��tx nc '.►v
e
cy+
Csood quality r -.o -b . fi 1 to be instal ee x; ft er
c8�3 0
Name oy A .. Burge s s� Signature
Address Bur g e s s & Behr., P, C. SEAL
D - Horsepound Aoad
arme 1., 11010
PUTNAM COUNTY DEPARTMENT OF HEALTHY "..:%��'
Soil Rate Approved �Sq. Ft. /Gal.. Checked, by Date
Re: Property of Peter Tavno
Located at Corner of `Test Gate Terrace and Fair' S-tree,t
A.
Section 76 Block Lot
.._ Gentlemen: o � o v Lt Lf Subdiisio � Map of Clara A. Pfeiffer I '
� i
This letter is to authorize
Roy A,. Burgess
ja duly licensed professional engineer or registered architect
(Indicate)
to apply fora Construction Permit for a separate sewage system; to
serve the above noted property in accordance with the standards, rules
;or regulations'as promulagated by the Commissioner.of the Putnam County, I F
Department of.Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said �..
system or systems in-conformity with the provisions of Article 145 or
- - -' 47;- 'Education Law,: the' Public HealtK Lata; "aria fie Putnam County Saiii
tary Code. -
Very trul yours „�
Signed
Own r of Prop ty
Countersigned:. 9845
Address
P:E., R.A., # �? L!
! Burgess c?c Behr, Pm Ca T
Address�¢�
R D 8 - Horsepound Road
Carmel, N.Y. 10512
225 -3312
Telephone
`G��O S'IS I0NPJ"`�C1