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HomeMy WebLinkAbout1792DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -2 BOX 16 01792 'am f am F T 1 T . `E.'. . ; '' '. '. 1 ii .s ad �'J6. 1 01792 -AP1 - Y Dliisrof FCERTIFICATE :OF CONSTR.UCTION;.0 r Located Mat matto`ad - Own. -Patri ca & WZ l l ldlYl Pera9 Separate Sewe ► age; System,. built(iDy con ialni:of. 1000 Oal -5e1 Other requiremants 'NQnP Water SUPP y Public Supply From } Y t { 'Privatez $upPIY kD ill Address Log;:_Dwelling Building Type Has Erosion Control Been Completed? >,. certify that the systems) asjistedservj LL of which are. attached] ;''and in - accordance",wi putiiam county. .Departmeet'Of Elealtih -oats 9'I : �l�l v .19R9� h t r� Address Any person occupying premises served by "the conditions - resulting from :wch usage:, Apprc -6vallable and ahe.4pproval' of the'. private Ovate subject 'to modNi�ation or ehangalwhen in SAM COUNTY DEPA -R-- ErdT :OF HEALTH= rf Enwronmenta/ Heall'h Serwcea, Carmel, N -Y 10512 Per�it,4 �r3n8 2,00).... IRLIANCE FOR SEWAG`'_`bli SAL SYSTEM - r "'Patterson: , Town of Village - F = j 04 3, x 'Block ;•� � � u Tax 'Map Lot # 4 8 r,Sbd 1 rZot -# ` n AddresrRnX �n 6rc�.rct2r 24 �� ach wide 1_ateral s z k a 1 r R S y 3 P F Re , s nnc ; z' a , Br. ewster . ,N Y. 10509 i No .of Bedrooms TWn* Date Permit Issuod *design is for 3 bedroom the above premises were conatructe3 essentially as shown on`the- planarof the completed work;( copies _ the standards rules and regulations, do >'accordanc@ with the filed plan and the permit issued by she t C ` CerLfted Dy P E. R,A ,' s 29206= ° r ' 1 27 ,: Licenq No : E rve;system(s) shall promptly; take such action of may tie necessary W_ secure the eorreetIon' bf any unanitsoy of the: separate sewerage systsm_shall become nulFnd void assoon.as �;publk sinitary awer,.beeomes . �pply_sh all , become null and` woiq_ when a public ii wpply_, becomes avallabN. Such- ,approvals..are judgment'of the Com of .Health, such ev lion, modification or cAange Is necessary { 1. 1 Rev 9 -81 NGOr ENVIRONMENTAL S °ERVl�CES,._INC - Uf &NT STREET `ROUTE?376 P-0 BOX 1'0 4 (iAE B } -LL - !JUNCTION NEW YORK 12533 r s-a (914) 22x1 2485 .� .� z _ %s _ Y .} `UT4J?• i V+?". i Y „{d' s'°" ' ? ' f �� Q.s4Vy { -t.. F i' k FCC #1l[1i" �`, A"M 7f�t l l f a �. Pg gxr°� a r► NI E l l''3 - SAMPLING POINT exs3oxr` tatnam Cou ty TREATMENT CHLORINATED 0( PPM) SQFTENED ❑ OTHER ❑ x s SOURCE DRINKING'1NATER, AST.EWATEA EF FL, UE OTHER yL COLLECTED BY. C'li•�nt £ TIME :•:ern PM:..; YDATE° $Z ❑ APARTMENT COMPLEX ❑INSTITUTION x� RIVATE RESIDENCE ❑ SWIMPOOL- z k ❑ BEACH � � ❑; MUNICIPAL gw 16 RESTAURANT' ❑TEMPORARY Ftffl& '"`fi`£: ❑ CAMP D,.NURSING':HOME SCHOOL ❑ T RAILER PARK v 0 " r ❑'FARM LABOR CAMP :'.. ❑PRIVATE COMPANRY . ` ❑`SEWAGE TREATMENT PLANT ❑ OTIiER — TOTAL GOLIFORM.COUNT M F T PER 100 M L ❑ TOTAL COLIF.ORM COUNT M P. INC., r > X PER 100 M L OUT'F T CLM C O ❑ PER 100 ,.ECAL M COLIFORM COUNT M PN� y PER.100'M L e •DESSERT PLATT 'COUNT " ❑FROZEN �- < x'' ❑ AGAR PLATE' C NT, OU LABORATORY TECHNICIAN DATE FTEPOI 7"MBCFA'l Ti" f HA S k F 4 p� '"'Y � � � ',•,N& _ a (1�'F�•-5 "�. 6 ✓ x t - f + 3{ /lei{ `}� ;Qt`�y��(f}. w ®EPT `0F DEALT Tt� ��c f # Z i ' �*t J's> 3 Y 'S .�v� +Z s, -• .i,+^„" r+' i�+� *r.. *j s � ",.q '+ .3 DiL����p�� " � � 'c' c '< _. � ,5.�. ""�� � y ",tki•"d-s�"c t �.j, t 'Y �� : £aW �� ®65IE" U " e' • J. 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 County Health Department together with laboratory report of �-- _- ---- _���-- �=ariaJysis -of- water = sample- indicatingwafier -is of satisfactorybacteriat -quality`�fo7`e�ertlfi�ate'of ctinstnictrb'tti c6i�tprti�'n'c8is issuea: - -- - °-� - REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION /X V� ­__� NAME ADDRESS OWNER William & Pat Peragine R.O. BOX .150, Brewster, NY.10509 LOCATION (No--.a Street) (Town) (Lot Number) OF WELL old Rd., Brewster, NY BUSINESS © ❑ ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ ❑ CONDITIONING (Specify) DRILLING COMPRESSED CABLE ® ROTARY ❑ AIR El ❑ EQUIPMENT PERCUSSION PERCUSSION (specify) CASING LENGTH. (feet) DIAMETER (Inches) WEIGHT PER FOOT 1.19 ® ® DD I S OE El CASING j T 7 2YES DETAILS 41, 61t lbs o . THREADED WELDED DYES NO LJ NO YIELD TEST ❑ ❑ HOURS G.P.M. BAILED X ❑ YIELD (G.P.M.) PUMPED COMPRESSED AIR 6 40 40 WATER MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well LEVEL 151 in feet below land surface: 105, MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET to FEET two permanent landmarks. Drilling in overburden` 26 clay and boulders Hit rock at 26 •feet Drilling in rock, set 26 41 casingi grouted. -- - 41 105 Drilling in rock granite. JUL �r`J If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE. OF REPORT WELL DRILLER (Signature) 6282 72082 /X V� ­__� F Patricia & William D. Peragine p $D Ow`rye' r or Purchaser of Building o Section Building Constructed by Block Mayt Road Location - Street T. Patterson Municipality 4 -9 Lot Old Wall Fstatpc Subdivision Name Log Dwelling 8 Building Type Subdv. Lot # GUARANTEE 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 guarantee to the owner, his success- ors, 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 determin _ a tion_ o.f. the'. Dire ;cto =r : of he _Divisi:on._ of . Environmental Health Services of the Putnam County Department of Health as to whether or not the -fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Q Dated this 91 day of ,lulu 19$2_ Signature &n4-z� Title n, new and spouse of contract_ R is ` Corporation Name if Corp. JUL 2 € 1!',`,.,, th �,t Address DEPT. OF HEM,:, " ^? ' THEE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE C &TIFICATE OF COMPLETION WILL BE ISSUED. C LIRANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. D i-iision of Environmental Health Services, Putnam County Department of Health rYVYbj�Qf �-t�Crbt (`CHfq��G ,i4 iliaw�,r/ fee A.+, i a za�ccs »a^'. +tom i . i I-�J t3UIL{ U.41A.: _- - 4 3 ' _ _ _ . 1 -ature & . _ 7 Structure located from survey by surveyor noted below Date C: . Well located by: Surveyors survey.- _ - 0- Well drillers report mesurements. - - -7— — - -- 11 bur, "-t' Tank, boxes, pits, galleries & ioterois located by: Contractor(p Engineer: 1. Healthda pt: � 0 t - - - -- nn Field inspection by: Health dept o date Eng.Ineer date :?!_��12$ NOTES: q) $�{�c �qht tpoo Gql. Peecm,;t Cc,�c.wr,e . 3 "1!llA M' (%UA.? - &e Rrtment of Hea*b Division of Environmental Health Serpioes Approved as noted for conformance with p oa le hales ano,)Regulations of the: A _ g _- - 4 3 ' _ _ _ . 1 -ature & . 1, e Date C: . A - E `-- 38 - ---B - E -- - - - - -- 8. n P J ' - - -`== - -B - J `- -- "-` -._ _ _ J&L 2 7 1982 A - K ^=_ _ _B - K 9 DEPT.iIQF -HE- A,,-:;, ANITARY SYSTEM DESIGN "AS BU U`T" OWNER: - LOCATION Street:, Town: -- County:!cLSi_ Stole SUBDIVISION:_Q21- Gr/ofL slq�FL -� 9- E "!�Ho ��8 Map: -/;a4 Block.. 7 _- _ LOT N% 5; WBull der:_ .SLW�rx_ S u r Ye y or Drawn: -Job N4- o.2e o Y _ t JOHN H P R E N T I S S PE Dwg. 4 CONSULTING ENGINEER RD '7, F..,,z o r:, CARMEL NV 10512 —Iqt4 1 RTp_CJ7n ate: Notes:..: :1) Te`ts to.be repeated at same depth until aD roximately 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. ;� TEST PIT DATA REQUIRED TO- BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS` RNE�OUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO_. 11ai1]e .. •u =.ss iaa... ;: i �: ; t. i a S D � . � . 5]. �' Address NY Wip THIS SPACE FOR - USE" BY - HEALTH DEPARTMENT ON. Se Soil Rate. A .. Hproved Sq. Ft /Cal. Date frHES .� To ��/