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Home My WebLink About1736DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -74 BOX 16 01736 .. 16 K Wo liti Lid 01736 `' t ,_.. -4 ? R � F 1 } .rte -°c` .� d '-•�• � __"RS "'4='T' ST- �"a..S �-'�'-+ R } ^'Y t'^ a r r PiJTNAM C OUNTY DEPARTMENT O OF °HEALTH , fi x 5 Dfwsion of Environmental Heafib' Services, C C04�STR;UCYION PERMIT F.OR 0 SEWA,MISPOSAL, SYSTEM ;:' 1101 - I Town or Village Located A 1 Tax map® rr n Subdrvisioq M Lot; Jpb 4 Own d � Frame 0 L' k 1 Budding Type Lot Area 9 , ; Number of Bedrooms F _. - Ta and a9 t To be constructed by A Address water SupPIY --Public- $uPPly From 4 - - prwate Supply to be drilled by s x Address Other R Requirements 1 1. represent that 1. am wholly and completely responsiblefor-thedesign,and location of'; a proposed systems) 1) - t ha t the,'separate aewage d'Sposal system above' described -will be constructed,as shdown_'on the;approved amendment there to and in accordance with the standards rules an ,tegu ations o t e wu nam r <County-.Depa tment of .,Health, .and that'ori completion thereof a 1,Certrficatq, of Construction; Compliance satisfactory to the Commissioner of'Meaithwill be submitted to; the Department, =antl a ,written guarantee will be. furnished the owner his''succe "ssors; heirs or' assigns;,by the Builder that said bui 6r "will r5 place in -_good' operating - condition any ,part of said sewage- disposal - system during -the period of two_(2) years immediately following ahe date of the iSSU _ ance of` the. approval of ,the Certificate :of? Construction .Compliance of;theroriginal, sys t em. :or any repairs thereto 2) that thedr,illed w$II described above -- ., -. will`b$ located ii showm.on the'appr, vedplan ana16it :said well will -be ,install „` in a=ccordance, with ah tlards rules -sand regula iions,—of the` Putnairf County, Department .of Health - 2 1916 Date ;.'Signed ` -PE R A a i Add ►ems R A 6 Box :3 rmel NY 10512 License No 29206 APPROVED FOR CONSTRUCTION This appro*i� yea rpm the- issued un ss nst, tion of the building has been undertaken and is revocable'for$ cause or may bwamended or'modifie d neces "" •b a ner f. Health: -.Any= change' eration of: construction . res a rie :pe m-t. ' Approved for disposal nitary se ge,; an o "r '`p a ate., up ply only Date le m BREWSTER LABORATORIES Box 224 - BRMSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 4210 SOURCE: William McLaughlin faucet -well. Old Rd Brewster, N.Y. COLLECTED: Deaember 4 s 1978. BY:William McLaughlin BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This rerult indicattr the roam of the raerplt war of ratirfactery raxitary quality whex the ramph war colltcttd. December 5 :1978 Bickwit P. E. Director son" Owner or Furctiaser o ui ding Municipality Owner Building Constructed by Hayt Road (aka Old Road) Location.- Street Frame Building Type Masperntc Realty Subd: Section Block 3 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., P.utnam..County- Department of Health as to- whe.t.her..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 12th day of December 19 78 Signatur@., wtz��c.�; Title C)_ev7r� If corporation, give name and address) Patterson, New York 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 WELL COMPLETION REPORT 3/71 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 Crit city Health Department, together with laboratory revert 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 ADDRESS LOCATION OF WELL (No. & Street) (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS DOMESTIC ISHMENT FARM TEST WELL ESTABLISHMENT B ❑ ❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ ❑ CONDITIONING (Specify) DRILLING EQUIPMENT ❑ COMPRESSED ❑ CABLE ❑ OTHER ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (!set) DIAMETER (inches) �j WEIGHT PER FOOT �' 9 �]j IL`J�THREADED ❑WELDED SHOE-... YES NO CASW YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) 0 WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Speclfy feet) DURING YIELD TEST /set) ['set) of Completed Well in feet below Land surface: 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 (lest) TO (lest) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION. Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPOR WELL DRILLER (Signature) V b p ilk. "to. A'dr Owner or Purchaser of Building Muni cipa ity Nner Building Constructed by 11 yt Ooad (aka Old Road) Location - Street Building Type Maspernf o P?ealfiy Subd. Section Block 3 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- vicas- of ..-thePatnam_ Coun.ty_l�enartment._of _Health..:as" to whether - r.not the._____..___T_. 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 12th day of December 19 78 Si natizre K� 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 II}'P[tAM CO?i;`TY OF DIVT "IM OT - _._ . _ y _ -.... . GOtlI7'I'�': OP'��) C F T, •J. ?)i .74 G ^,J,I rT, - - X.. 1,�1.r 1K - - _ J 1 . DESIGN DATA SKIT' .T =SEP,' RM'L S1 „.'A(,Es DISPOSAL SYSTEM PILE NO. Owners 2� �/i% /awe M� 4/; Address -- __ Located at (Street' 1na.i ca r . ne rofi , cross stl ec L �- N,unici.p -ality /1,42 �ee30J” _ Watershed. C7692 _ - -- SOIL FERCOI'1'1'1 �`" ,��;� p r� , „ �, �, ,, -�,�,� ,_, ,•,, I 01 _ % R. al�F'�_D I O B_, t�.,: ! .1li'�) i i, `, T tl:TC•'� .1 (O .. hole Number CLOCK TIi ;"; DEPTH 611 -1211 2411 TI's:.YY PIT DIVI'A RRQUIT6"l) 'J'O F1,1,; APPL-WAT"VON OP f-'),ML') IT11 110ix, 1\10. 11OLE, .3oll 4211 48 54 -10 .,0(y 60" 66" .7211 78 ti 8411 4e� e,-0 Ck IS FT-,jCr�-T:,T A 1-1 C I ; U I '-D No,? e- T AT W:HIC11 11ROU'r"D 1-i�ATER TER.:- INDICATE, L]tZ'k,ET B�,JJ%TG E,7CIT, ;�,ITERTED A10-le 111,"DICATE LEVE"L TO 1-[EICH I -,'I T E, 1EVEL RISES A TER TESTS MLALDE BYAr =7 Y? Vat e 7t I 1 4-1 -D If -R a te 'Use j S.D. .D., Usable Area Dr,v ideci + No. of Dedroom.s 06W Septic Tank Capacity / Gals. Type r%-y-0 n Area Provided By -i trench.�- .Absorptio. 3_3 L F. x24 —widt! Other 7 2-8 Sp. A , >r / 2- " Z)Ao,^ A Vl'- -,VESSIO .Address R.D. 6, Box 353 Camel, NY 10512 01 THIS SPACE FOR USE LAY IM-IM'IT DEP RTIIIE,d' -e Approved Sq. Ft/Cal. C Soil Rat Date F. d m , ?J nn3a t�lait+ in �� U8 /Arai a3aiN - r � 161 3(] aw oil mss_ r $ — Ptf ate: . �0. '13 i'rt ry 6• LT s. f - 1 ti. V _" 4_ a a j _} 1 _ I ASS 00" f " 1 Not to". } i i P .i -T Ain >_ RAWb o x VII a j _} 1 _ I ASS 00" f " 1 Not to". } i i P ■ .i -T Ain RAWb o x t Own ■ .i -T .. RAWb o x