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1 M, - PUTN.AM COUNTY DEPARTMENT OF HEALTH
Division of Enwronmentel Health Services Carmel N Y 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE. FOR SEWAGE.- DISPOSAL SYSTEM Patterson
Village
SF
Located,:at f6 r Street` bd Fi 1 ed Map , #828
Acres Su
K:oh l'er Bros B,ua 1 dears ' #34� '64' -4 .
Owner Lot
Owner L9— LI.Carmel ; New; York 105] 2
Separate Sewerage System bwit •by Address
10'00 272 -' 3.6 inch
Con' ist" ..of Gat Septic Tank lineal Feet ,X trench
Other requirements
None
Water Supply:. Pubhc.Supply'From
X P >F Beal &Sons Inc
Private ,Supplyi Drilled By
i
B rews4te r.: New York ?;10509
.
A d dress
'f=rame; :: Three: ° 9/29/70:
i
Building -Type,,
No. of Bedrooms Date: Permit Issuetl
• .. Not Req�d
Has Erosion Control' °Been Completed?
. •
1 'certify .that the system(s), as listeq serving the above premises were constructed, - essentially as shown : on,the -plans o he completed work _(copies of which are ,
attached), in accordance with the standards .'r'ules.and.regulations; plans fil r `.and tl%e permit is ued. t Putnam County ;Department of Health
Date Certified P E R.A.
+ RD 6; B 35 rmeNl; NewE: Yor 10572 29206
Add
ress e ° License No
Any person occupying premises served by;the above systems) shall_'oromptly take such action as may _be necessary to secure the correction of any unsanitary .
conditions resulting; from': such .usage Approval ;of the�separate sewerage systerwiiall,k,;6me'nuil aqd v,oid.a ;'soon as a public sanitary sewer becomes
available. and the• - approval of the private water •supply shall, bec"'P null and void, when a public Water' supply becomes available. Such approvals are
subject to modification.or change when, ;jn the judgment of the'Commiss'oner.' f.Health,.such revocio odf ion o. change is'necessary. t
bR
Date BY �� Title ep '
ORMSTER LABORAT®RIGS
uox 2-24 - BRPX3 T CK, iv. Y.
WATER ANALYSES REPORT
SAMPLE NO. 2587
SOURCE: Koehler Bros® m hose Bibb m well supply
Fair Street
Carmel, N.Y.
COLLECTED: Jan, 26, 1972
BY: Po T. Beal & Sons, Inc,
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result
indicates the
source of
the sample was
Of satisfactory sanitary
quality when
the sample
was collected.
Jan, 299 1972
0
0 per 100 ml.
Roy 'Bickwit P. E.
Director
Koe.�nle __ os,. Qom, d ��[PtSr1n
Owner ar Purctiaser of Buiding Munici.p.ality
Iu Building Constructed by
Location Street
Building Type
=5-1V AA
Sec
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 describ>d 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 irLmediately 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 aPivironrriental 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
ac .Rf. .the -occupant of the - system-• -
Dated this '� }� day of 19� Signatunc�
.� 'Ti'tle A0.4,
If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF C0MFTT ETION WILL BE ISSUED.
IGUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health: Services, Putnam County Department of Health
7- 7
N
v"! JaN .�-MF;CO.151NT-Y-,,;D�E,PART E, T -jMATW-,`Z-
NN
ALocated
at
z"
Subdivision
Owner A
A p:
ress
J4
Build mg Type L-L""a""',-.4 `;`,Lot Are Al,
-Number zo f Bedrooms — Square Feet
J $
Separate ,:,5ewerage,, System-: .9 con f Gal 'Tank
lineal
et
fwidth trench'
'To be constructed -:Address
onstiuded
7,3
Water Supply m Public S U
rom . .....
-nvate Supply .,t be drilled
Other Requirements
dell
('represent that Ir am wholly ) fesponsible, orj the loca d systens);'I) that'the�separg
e9 WWagq' ISPpsp l
:sisipm
above_. ,escrib6&'Willb,ie`constructed as shown l there
e _ ,t
?, , p rd,
'Ftinc4 d ,
r 42
s,a regulations
th_e-- ` u
qpy - Department of Health, ajqjpp completion thereof f j t j46j C t Healthwill
e submit ed to the_Departpeqi written 46 a rs A xi e" w u n sh 6dt herowner -hjsjU6cespprs,-fieirs or'assignSLby hebuilder that -said,buil er will
l,
p ace,,n., good part of se c sewage _dis56i6Vsyit6 Q119WI,
�Ihecate of the I s'su,
-'. of -_ , -;Ctifcat x ConstructoIC 7 Ce 'i
J
r6i, �ep;�). that
th
O.w �
eW g
e"PutnamW i I I Fbe, ldca tod �a i "sh q# r� d Will'qi,n le and
7"
County �ftL of
'ilth'
f f
RA.
J
Lice
4
ress
en, and I
gPPROVED FOW'CONSTI�'Pq -L I�is "rpy construction tpe: il in L
,�gpp
Co construction
t
b M MI one
revocable -'for cause or
— ; - I - I'll .'Any j
f i S Tw, ;.take
reqyires-,a �new,�perm A "-t pr
rover
-te it 16 r9
Date
5'
Notes:*
1) Tests to be repeated at same. .depth until approximately equal soil rates are.'ob-
tained at each percolation test hole: All data to be submitted for review.
2) Depth measurements to be made from.top of hole
PUTNAM COUNTY DEPARTMENT'OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH: SERVICES
DESIGN . -DATA SHEET = SEPARATE SEWAGE DISPOSAL .SYSTEM FILE NO.
Owner �r o'as. ` �Na �®-s
Address , . S�
Locate d. =at, (Street) �y %//
o N:'sioA
See- -S
Y,ot .
Indicate nearest
ross stre t-
Municipality P. tY /dq ��ersv.h .
�: Watershed
SOIL PERCOLATION'.TES'T DATA REQUIRED
TO BE SUBMITTED WITH APPLICATfON'
..Hole
Number: .. CLOCK TIME
PERCOLATION '``
PERCOLATION
Run : -- Elapse
Depth to Water.: .Water .Level.
No:, Time
From Ground Surface. in Snches
Soil Rater
Start Stop. Min.
Start. Stop ..,Drop: in
Min/in- drop
Inches Inches - Inches
l Dt� 01'95'
3 OpS -h,� .1000 -�
5'
Notes:*
1) Tests to be repeated at same. .depth until approximately equal soil rates are.'ob-
tained at each percolation test hole: All data to be submitted for review.
2) Depth measurements to be made from.top of hole
TEST. PIT DATA REQUIRED'0 BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST.HOLES
6 0'f Sow_
661r �S
1727-
78"'
8 4"
c L lv. ...
INDICATE LEVEL AT I H Oe- GROUND �- WATER IS ENCOUNTERED Al"7 e
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY /� �/¢�i� 99�3�'A Q�r, /✓.,yc.P� Date 9 9/rt��o
DESIGN
Soil Rate Used /O Min/1" Drop: S le Area Provided
FtS5lorog4
No'. of Bedrooms _3 Tank Capaci e Type_lasohry
Absorption Area Provided By L.F.x24 �_ �`�3 trench. Other
Name Sign to e
Address e3 cG 5......
0
31, . No. 292�!b
PUIWAM COUNTY DEPARTMENT OF HEALTH
Soil Rate Approved Sq. Ft: /Gal. Checked.by Date
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