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01421
PUTNAM COUNTY DEPARTMENT OF HEALTH Z t id3 i jv�t rt `riu a t
� ;. - .. ... IDE
Division :of Environmental Hatt /th. Sermvea, Caren% N.--)Y -,-,46512 8
PROV
PERM;I T #
CERTIFI E OF CONSTRUCTION' COMPLIANCE FOR,' SEWAGE DISPOSAL .SYSTEM '�/ `t'Cr AU e
_.
`TOVVn orVfllage :-
.. .-r. -
Located�af q
Owner d �'r'�11 / Formerly - - - Tax Map Lot # , 3v�„�7 MI5 Subd.- Lcot�U
Separate Sewerage System
built
�.,by�� �Xr'^�� ����) Address ` Z �11.�W'C- t_1F.E "Ft;> �tyT• �i4L1
Consisting of IVDU G, I. Septic Tank and ` L\ - !l
Other requirements 5 0 C— G
Water Supply: Public Supply From
Private Supply Drilled' BY
�JAddressJ�oi�4^
Building Type L'� No. of Bedrooms , Date Permit Issued.
Has Erosion Control Been Completed? Has garbage grinder been installed?.
2 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 regulations, in accordance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
R.A.
Date Certified by P.Et
Address �.X iana NO.
Any person occupying premises served tiy,the above system(;) shall promptly -take:suchaction as maybe•necesse 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 Nwe► becomes
available and the approval of the private water supply, shall become null and 'void whop, a publte watts "supply becomes available. Such approvals are
subject to modification or change' when, in the judgment of the Commissioner of Mealth, such revocation, modification or change Is necessary.
t
�l
0ate'[�_r ��� / v / Y� Title
® lilld V 301je, e iwn "J Gy e/-
Rev. 6/85 % S S
PU NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRO�ZNM�AL HEALTH SERVICES
Sue and Tony Bosco
Owner or Purchaser of Building Section Block Lot
Building Constructed by
West Gate Terrace
Location - Street
Municipality
Building Type
76
Tax Map Number
Subdivision Name
5
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
worlamnship, 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 guarantee 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 approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
-.-, repa -irs made by me :to such °system; e;ccept-wtierj "the`fai "lure "to "bperate 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 detenidnation 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
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this 30 day of Dec. 19 85 Signature
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
same
Address
rev. 9 /85
milt
Corporation Name (if Corp.)
23 Rhinecliff rd.
address - --
WELL COMPLETION REPORT
3171
PUTNAM COUNTY DEPARTMENT OF HEALTH
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
BOSCO, Anthony
ADDRESS
West.Gate Terrace, 1-'C1rmelNY 10512
LOCATION
OF WELL
(No. a Street) (Town) (Lot Number)
West Gate Terrace, Patterson, NY 5B
PROPOSED
USE OF
WELL
NESS
DOMESTIC ❑ ESTAB ISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
DRILLING EQUIPMENT
� ROTARY � A COMPRESSED CABLE IR PERCUSSION ❑ PERCUSSION ❑ O(specify)
CASING
DETAILS
LENGTH (feet)
301
DIAMETER (inches)
611
WEIGHT PER FOOT
19 lbs
0 THREADED El WELDED
R O
OYES ONO
YES
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED Cpl PUMPED ❑ COMPRESSED AIR I ( 5
YIELD (G.P.M.)
5
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specifyfeet)
301
DURING YIELD TEST feet)
�
Depth of Completed Well
in feet below Land surface: 32_51
_
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
:1F GRAVEL
CKED:
Diameter of well including
gravel pack (inches):
RAVEL 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
0
5
Drilling inoverburden
clay and boulders
1�2
Hit rock at 5 feet
5
30
Drilling in rock,set
casing grouted.
0
1325
Drilling in rock granite.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
11/12/85
DATE OF REPORT
24N;�l
WELL DRILLER (Signature)
rL /v/
PLJTNAINCOUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services; Carm 12
Q
5
f CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL 3SYSTEIW t {
age L�
s � Town or II r -r
F n,
°„
;Located, <at- -� -� - Tax' Map `:Block .gt
Subdivision �� "�tl `mow SUhd Lot q Renewal �/ Revision ❑
a gwner /Address - - Date Of Preyaous Approval /` -� 6 ' f
c¢
Building Typei Lot Area Fill section only �^�`
`Number -:of Bedrooms: Design: Flow c /p /v {`' N" v Notification' Required y r
Separate.-5ewerage'System`: to .consist of - ®� J Gat. Septic an
" s
z 4
70 ^be constructed by
Water `Supply Public .SuDPIY +F,rom
x
k P vats Supply to. be drilled by �'
x ( k �
a
Other R
e9wrements
.1 •,represent that 1 - -am wholly and _completely, "iesponsi_b le for the design. and location of ,the proposed, systems) 1•j that the separate sewage •disposal <system: •+
if - - -
above described -will be coristructeq,as shown on the approvegbmend' ent there, to and�in accordance with.the itandards;'rules 'and-re gu a ion ;:o e' u nam;
County °Department of Flealth anG'that.on comptetlon thereof a' Certltieate . of c__" truction- Compliance satiifactory,to the Commissioner of �Healthwill.
6e wbmifted to xthe Department antl a viritten .guarantee .will be furnished_ the owner, his successors,.heirs or assigns; by the builder, that said builder will{ -{
place In gootl operating 'conddion any part of said sewage;^disposal, system_ during the perwd of two_ (2) year.'medately following�thedate of the issu;
'ante
the a 9 Y
ry pp►oval of';,the Certificate .of, C *rf#rt cti6ri compiiance of. thi 6ri inal'I stem'o any repalrsYh, t 2) that theAiilled 'well descr tied above.
;will belocata asshown on, _he approved plan and that said well wlll;tie Install ►d rice +w the. ' rid i iu and regu a l� of ns:= of the.' Putnam
County Depart nt of -H
th y
Date
f rx'
Q Address, ` Lieense 'No
APPROVED FOR CONSTRUCTtOIV This- approval;ezplras one yearfromthe-tlate Issued unless constr,uction;o the,building. has been .undertaken and is j
revocable: for cause or mayabe amended orrriotl�fled; when aside ed necessary_'by fhe''' issioner of.IHealth= Any change or:;al atfon of construction;
requves`"a n "mit Flpprov `tor tllsposal of dome ic. n ary s ge' no o ,priv e I F IyM1 J
I� ® ~ 4 s
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