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01794
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01794
„rar�ry `r'S v ci f yN T, Tl- 4 t'i3 u- „r rat .r p ,•r .fiwrr-r"..s -.
H 3 EALTH � z i S�- ` y `
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*UTNAM COUNTY DPA RTMENT OF
`Rev 3/86
� � r � r f � ivlsion of Environmental Health Se {rvtcei, Catmel, N Y 10512' -�- � � � �+,. �' `
O Engtoeer Mast Provide
�z P C:H D Permit N
ht y -wr
- r
Ai
CERTIF14•A TRUC�7flN CO1 wa ” ,�} "�
?Town or ViliBge
Snbdii leion Neme d P'�Ad 1. �i t3hbdv L}of p
Owner /applicant Name
MaWag
P
Y
Separateseweroge System built by •� f�A;A y I h. �j c� t^9 �.o�.A
r x r_ L
Consieting of 4 `Ono Gallon Septic Tank and N� ` }7-�1 Y� iA1Gi'1
r
Water Supply Putilic Supply From _ Addie`ss;
,or �� Private Supply DrWed by� Address �i��11 T G7` �% l/1
r.. .ra T..
Building Type` �r� tVr�t..�� Ae�— Has Erosion +Control'Been CompletedY
Nam6ee of Bedrooms Has Gaaibsge Grinder Been LaetaDedY
,'Other Regtdrements ' t a
wi certify thet "tifia syetem(s) as 1•isted servinq•,the above. premises were constructed'eseentia'1 y as s on, a pia te of the compfeted"w ri ( copies
of which`ara attached) and n accordance,with the standards rules and r t , dance w th s an and the permi ed by the
;Putnam County Dapa� ��t2 Of �� ` r � �` � �
Dats ' J ' Certifbd by P E R.A.
_ `, ,r � w Add ►e33 '� � 7 ,� � ��. �{ '�..{ u a _. e y T LICeflN NO
Any son occuPy4 4mises served by 3the above4ystem('sj fsliali pr'omptlywtake such action of may be.nedssny to iic re the coFrectbn of any unsanitary
`conaitns:rresyltirp from : - such u "sage4 ApDrovalofths epante sswsrags system shall become null:aeW void as soon Dubt.: sanlU►y tevver becomes
MV -and the 'approvsl, of the :private water supply shalt become null and ;v "oid -wyhsn a public vvata- supD1Y „1P!r av approvals are
..
subject to 'M040lutiow or change whenG; in tthe /judgment of the t ommissiorar Health such rsvocbt{on` modifkatbn or chin ge Is nicyiory.
-Date
I I L
O;wn(e(r$or Purchaser o Building
_
`Building Constructed by
0 A.,-C-r- e,_�)
Location - Street
Municipality
8 �
Se�r-
2
Block _
Lot
m /LD
Subdivision Name
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-
ation -of the Director -of-the Division 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
Dated this_''fs day of aj 196 Signature�-J�
i
Title
¢�t901 Lk?N"j C (3 t4 5r C t- . i rll
Corporation Name (if corp.
-E�P_ i M
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
v ro�amei�tli Hea) h 8s r�c�e
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WWI WFAUPIIT71^1
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GAHE� PRCUS IOM
►rT•'+� —= r !
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BREWSTEWIL ABORA TORIES..-..._��..:_..,._.._._v_
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
— WATER ANALYSIS REPORT —
SAMPLE NO. 6333
SOURCE: Angelo Bonavenia
Old Road
Brewster, NY
COLLECTED: October 2, 1986
BY: P.F.Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
hose bibb - well
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
ctober 4, 1986
Lk-
Roy (Bickwit P.E.
Director
7`r`!.l%F
" � fi `�` � 'RUTNA�M CUUNTY�:DE'PA'RaTMENT OF SHEALTH '- ��-�, �ENGINErE_R TO PROVIDE,�PERMIT'�
�1 ON CERT�,FI _ P NCE,
w �; � ;� � �� # ��'° Division�ofEnwrorimentalLHeakh Services �Carmel,�}N ?Y� 105 }12� EaPERM�I.T,#� ' — ` ` '
3j r fs . �,_. � if z.,�t .�A -.- r �-�' �k r �, } .� � � �.e'�,� aL'`� �.�. d(1�" ��C,F? �' yst�` 4r a 'ti''.r �. `�� .. � �p a rr `� "-� _, ti, a its � �'�- y •`� '., Nt ar�� .
CONSTSR,UCTION PERMITr "FOR SEWAGE DISPOSAL SY$T4EM f ��'J n= s v
z Town or law
fL�,o a ed :ai /!� '� �, cD..rt ra. .•=..Q ..�..— _�..y+c.,�- n.m7s r.:o 1 aX >.u.a p� ', o s ffltc ;'g t °.v9a.r` exriy'Dterti il�.a+.. - ,..,,.,.:.
11 T 'xT a l F
Subdivision 0 LD �hl.r. r� 1 �� -Subd �'LOt`"'q 's Renewal s, t Revision r r
r RN CyE.LO +.4YNK.3`
5• r } , j. ,, � +,� a- '` c.n ✓1
owner /Address RES7�FOX LI�NE� F3R�STE/Q N nt /0504 h � *Date Of�Previous Approval �� "' ��°'�� '�''� '�-G ;,�,
i s-r7 E 1`7T1 IOcL n j, '-
�"1 -S Fill Section Onl ❑ _- ^' y
Building'T,ype Lot Area Z Y > Y
sV ' Q P C H: D Notification Re ued
Number of Bedrooms Design Flow G /P /D 4�z v�
Separate =;Sewerage System -tor consist ,of OQv t 'Gal Sept c Tank antl,, 3 J LiN FT ®6�� �t IN .td
To be constructed"
' by }' ti l Address § x_
4F,., •`.rkf iF .i 1 � � f } . ! : ? Y S ( Z `+. ✓ - 2
VYatery5upply PUbI1C Supply From - _
:' , ✓ Pnvate Supply to be 'dnlletl by� D
Address
OtherRequirements*
UHF q s szr { y 61:
1�epresent that t:amiwholly_antl completely responsible for the design 5nd location Hof the proposed 3system(s) 1)_ that the saparoe sewage disposal "system
rabove descrrbetl, will be constructed "as shown••on theLapproved amentlment there -LO antl iriaccor'anee with the standartls, rules an regu a tuns o e °: u nam
a:
County IDepartment of Health, and that on eompletron thereof a* Certificate of Construction Compliahce satsfactory,to the Commis ;loner of Mealfhwill
tiatisubmitted to the Depatmentbnd a wrrtteh guarantee`wrll be ,furnished the owner his successors heirs or. assigns by the builder that said builder will OR
plM! rn'goodzoperotrng xcofd�t�ori'any,,part ofsa�d ksewage ":disposal system duringAdhe following the date oithe issu-
ance 3of +the approval, of It;he Cer6licatea ofraConstruct�on Compliance ofa the or- inali`system of any :reps the reoo 2)�ttipt the dr�lletl well .,q above
wiil'be located as:'stiown n;;the app cued plan >antl that said well will bey installed accords ,'wit Sthe '' arils rules, and regu a 1�T 1ons •of the'; Putnam
COUntY Departm t of Health
R:A.
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APPROVED FOR CONSTRUCT�hONhaThrSapprovah -exprres.one�yearrfromthe,�date issued uniessconsfruct�on of the - budding has been undertaken. and is
, •c.,i °�•'- ' — - '— "> a _zF•r'x •o.n.•rc. •, -^-'k ".-.r, =4.-.. --J _ r .
evocable fop causesor may be amended o %modrf�etlxwhen s`idere necessary bythe' m goner .of!Health ^Any change or alteration of construction
re�gwres a_:fnew permd Appro ed for drsposal ofs dome ic` mt y se Brand /or rrvate ater supply 'only: � •�
a r - a 3v �_ •*
Rua >v.f.. /ASt.._...- _. -•___ r 't _ A r. t" -.l �.i•, �.�.._ _.�.__... .,._�. .. - " -'
n'
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iPUTN`AM c,6,u, fi' 'DEPARTMENT OF HEALTH Y rmit a � G:
Environmental' ,Health: Services ,Carmel +N -'Y 105;12
c
G�TM tiCONSTIRUCT19N sPER11AIT ,FOR SEWAGE DISPOSAL `SYcSTEM 3F �
Village
Z.- ! ?P "� 1 ax -... J a x e+ x •i' tom. r .- ' s yam.,,, e. ? r �?" e�' °�,.. :.fir- a x°' .c.
oaf. •.`,,. r .K t+e Z �+ra s '� ; 71 a - "d
•Srs','$ bdivisio?I -� °� subd Eot # :_ Renewalsx�0t
�r }- Ol+ner /Addres Date'iOfPrevious
}+..
i!�Buldi yType _ Lot Area - ° -y �.•+ sFill sect3onron3y,� -_ '°~
Number of;Bedrgomsi 'i Design P1owaG /PJ,D� �4 s_ Yy�T? `H= D�otd'ficationf,!Requed`� _ `� _;
,,,,��.. -� e ;.� �_ r' �... '��y�� -?' �r� � " _ �;..�. �' - `°r -.'�"� 1 4 r�_.�,•+st���5�4F� ': -� � '�` a`..�r 'mot A/':,�i�
Separ�Ite l 0
Gal Septic Tank antl 7
Al
s ,' a •t-s -."`F ` -_s_, ra -^-x , ,r•- -" y "'.. 'S'c'...y5,fi - e., �',+jF'S+w'r d�, 4 .a r�yf- +v���''' r }
um
?to be,co-nauctetl
�°s'��` ,.1 >� e �. s�� :es ra, a , fir' ��rx a,� q „ - aa�,•,�A ,, � vv, ;t ta•� ^ �i- -�c� r
WateiuPP1Y 3ubliC SuPPIY {From
Prwate. S.uPD1Y. ito be ydr�lled b.Y. *.. ,' " ^s' %•a 1 ! -T,.�
" Address s _ spa _ = k!
x
e Other'�`Ft'e i'
7? "'�,"` .� ,! ? .v x•R± 't h" - v� �` sue!' f`,�s�"'r'.:.
s
��j -
. .~.3�i s..� .f -_%• •— V; k� r+ Yr -}c.. ;r..:a "..'" .,�-�. YF -,! .-... $.;:�`
fi 1 .. k ' Y :a•rp �.". v zap - sy, '�-•' "�o-..: y 4 �,_
;y, sa epresent that 1;am�whctlly antl epmpletel r!r'espp sLbletor_thedeslgn . a d -loc lon of -the §proposed(sYStem ( ss),:_ ld),3that thei,saps:,ate, sewage d sposal- `sysfe "mi°
above:gescribeg willibe constructedias,shownponftti`eap -r.b -v '.amef^i`d'men'L�the�e'�to and�linJacCO ►tlD`nCe w LH1tRe`�itantla►d5�3iuJeian 'f u a ions:0
ON
• County4 iDepar£rrient of<<;Health bnd that on complet�on,(theeof a Gerirfiwfo' of Cgristruefion?.Comp)iance': sattsfacto►yx;to fhe tCoinm�ssioner o_t,';Healthwilr
be submitted La theme Deparfinent, and to iwrl4in)4WarantiE . will {t e;_fur�ished. She, owns ..his!successors,iheirs�o► assigns by sthe,bu'ilder, tfiat sa��d.fbuilder'vv111.�
"ood,.gpf.atin "; 'on = ' , - - r . -r. - t €- t :'_ _
P 9 _ P. 9; c` ditwh.fany� part of, sand sewage disposal- system "<duringrithe pe sio`d�of twot( +2) years immediately followmgithedate of the issu ==
x. sneer of Ithe approval Uf;{the C_ertifacate of "Constryct�on Compliafice of sthe!onginai iystempo -`r, an re ,�rs.tiereto 2 that tAe?dYilled' well descrA6e$ above`
_ Y Pa ) _ a _
will Lbe located aststiownkon? the apprgved plan�and thaf sa{�d. well will be;hnstalled' in accordance with the stanggcl "s r es S M1 ►egula ions "o-nof the•` Putnam
County D,epartmentt of ZF,fealth x s ��
.X tYd
'3,,,�a Date" is �. a s - - 1. �,. Shgnetl �-�.. ,Q — s r '.7' P E-f"$`
/�zi� _
�s "Address: y a icense'No
_ s r.. __ i. �: ^� ro > ,. rn�n
r a _
»APPROVED ,FOR,!CONS�,RU'C_- -T N: ThlrapproJal expires ^,one year from the: datef:!issued vinlesss,cunst►ucti n >ofuthe building; h8s been Wndertglcen antl' is
rz 3� Ly - r_ >Fr ti
{.ocaYrle_ for cause orrtmaybe amended or.imodif etlryGhe ered;ecessary: Lby ,they Co er oJ% H lthti ,A'nyCtiange'Or - alteraflo'n o ��constructioh {c3a
k +� requues amino permit PPProv;' for di posalzoftdom sire sa �t - i e„ and %or p vale via r siif?p1Y oril
FC 3` s-
7 "i
V. ..Re -�9�81° ;` k � ;: < . . �... - �'�' �. '� ..+� ._ :. -:: .. ^� r r � :. ` -� _T ...,,; � �. � �"�-�x ,.;� _er•�5� �l �. ` ��,d.�` ��,`''�'' °': � �,. -r r �r:_
f�5. 1F S'yt" fu'n' .� V,. �.� v. 'e'&` � i3: _ i ,f •W.',y.C+i"' K1 'iE.� � y,�.44 �h l�t!.�' -L �.Wk � "''%
��`" .? �aa: -.. �^'>k.tk4' ;!". '+,_- `�''�,��., - -.. ,,n�nyt,'. +Pp fd' N°`'SF s _ 2- ,� ,5' -;'•k �.=�:ytr'� ye�,`,�.''�"'i` ie. +���. `� r"�` .� c aft! �y.� '-
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES:
, =COUNTY - OFFICE. BUILDING, CARMEL,
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner , (. L Address l%
0(, 10 till k L— O5
Located at (Street Sec: Block Lot (9
indicatlenearest ss street)
Municipality 04TTG"�?- Scat., Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Wems - -Water Level
'No. Time From.Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
( 1
Z
4,0 20 20 19 zZ �•%
5 0- Z/
1
2
3
,
Notes: 1) Tests to be repeated at same depth until approximately 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.
0-Z0
?0
/% ZD
I 2
D - Z /
2/
i� 70
�
;7
5
O
20
3
0060
Z
4,0 20 20 19 zZ �•%
5 0- Z/
1
2
3
,
Notes: 1) Tests to be repeated at same depth until approximately 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 ENCOUNTERED IN TEST HOLES
DEPTH IiOI NO sa _�. HOLE NO..�
G.L. 7 �prG
12"
1811
3011 -
3611 _
4211 i
48" -
54 11 �yiceJ� ��111ki° GC4wt_K4a0w
60" t i
66" r�
7211
_
781► , r
8411
INDICATE LEVEL AT WHICH GROUND WATER -IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATE LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MFiDE' -BY
- Lr�alury jAre-K t - r Soil Ra te Used�MirVl "Drop: S.D. Usable �e�'q No. of Bedrooms Septic Tank Capacity /pUD Absorption Area Provided By 3� L.F.x24 �jb" w - ,,n
Address
Lgnature
SEAL A�
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
1 represent ,_that I am wholly and completely responsible
above described will`besconstructed:;tas shown o, ni,the app
County .:l]epa►tment ,of : Pealth`4hd that on completi(
be submitted to.'the Department 'antl a written guar
place in. good -operating condition' any part of said
ance of the approval of the-certificate., of Construct
will be located as shown on the approved an and that s
County :Department of Health `,
Dire / 9�
.s s.
APPROVED irOR'- CONSTRUCTION This approval:6
revocable fortcaus.e or may be amended or-modrfied wh
regres, a new permd Approved_, disposal of d
w o
Date B
„ 4
Wrthe design-and location of . the proposed system(s),r;l) that, the separate:,sewage. disposal system
ved amendment there - to and ,in accordance with the standards, rules an :regula _ons o ! e u nam
thereof a "Certificate'. of Conitruc Compliance satisfactory to the 'Commissioner of•!Healthwill
tee. -Will be- furnished.the'o' rs, heirs:or assigns by thetibilder .that said.builderwill
ebx i
vage. disposal system dur' per'o ),year immediately follow�ng'the,date'of the issu -.
Compliance of the' _ ol y irs thereto,2)ithat the.,drilletl. well tlescribetl above
I well will be installed, ac i �fi st ndarcls ,rules antl regula i—f o s` of the Putnam
S�9h- ' P E R A
X ' License No.
r
res=one year from the, t is ction, of Ahe building 4has been undertaken and is
Idered 'necessary b� h si edlth, ' Any change•or alteration. of construction'
..
y
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Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
a' 1 fi .
Re: Property of
Located at
(T) Section Block Lot
Subdivision of ,9- Mk&
Subdv. Lot #
Filed Map # Date
Gentlemen:
This letter is to authorize. AA . lwk
a duly licensed professional:"p inter or registered architect��
•' of Indicate
to apply for a 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
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
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
b
Signed
Counter signe ,,� e o op ty
P.E. R..A , #. Address
U )IL(ee CA�
Address Town
j/
6(O6) Telephone
Telephone
kv
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t, a 3 ti Cis. r�r�
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Putnam County Department or Realtor
Jivision of Environmental Health Services
ipproved as noted for conformance with
ipplioable Hulse and Regulations of the
A'
Putnam County Health Department..
Signature TItle "JAt.
TMS IS TO C V111 IP1' TFIA'i' 'Ci l[i JB'C"AC;ii lli5Pi)ti.'.7_ SYSTIiIt WAS � ( � to
CON7RUCUD AS 1 NDICATIU) ON THIS t'LAN AND I HAT 'fill:
S`'S" E14 WAS INSPPC['ED BY NIL 11IT M: IT WAS COV ERM OVL•R. r
TILE SYSTrAt WAS CONS "IRUC.`I -}ill IN A('(- 0RDANCE WITI-I ALL
'1111 RULES AND REGULATIONS Oi?' Tiilf, iur.\AI`I COUN'f -,
D:;PAR'I'MENT OF I- IEALTIi.
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Signature TItle "JAt.
TMS IS TO C V111 IP1' TFIA'i' 'Ci l[i JB'C"AC;ii lli5Pi)ti.'.7_ SYSTIiIt WAS � ( � to
CON7RUCUD AS 1 NDICATIU) ON THIS t'LAN AND I HAT 'fill:
S`'S" E14 WAS INSPPC['ED BY NIL 11IT M: IT WAS COV ERM OVL•R. r
TILE SYSTrAt WAS CONS "IRUC.`I -}ill IN A('(- 0RDANCE WITI-I ALL
'1111 RULES AND REGULATIONS Oi?' Tiilf, iur.\AI`I COUN'f -,
D:;PAR'I'MENT OF I- IEALTIi.
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