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Home My WebLink About1818DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -39 BOX 16 . .! .,m i 77 r t r i� 6. iZ7 - �- 3 PUTNAM COUNTY DERTME PA NT OF HEALTH . Division of Environr»ental Heath Services, biia el, ,N Y_- CERTIFICATE., Of'.COIVST.RUC3ION;- COMIP,I_. LANCE :.:FOR`..SEWAG,E.DISPOSAL. -!S STFK-- h'e& "QF' /" r7i _5 "ca✓ .•: Town or Village Located at LL ! ¢ifs Ser.�4tf � � Block Owner t �. lGs LotS 9Z,,9 2 Job ��%j "n, E -LCIS7 �$2 Separate .Sewerage System built by _1�d�� " ®A/ NOR- Aid drP" 6 � TAB ••� Consisting of �p�Gal. Septic Tank 7/! lineal ,Feet X width trench. Other requirements Water Supply: Public Supply From - e / Private Supply Drilled B.y Address Building Type - r� 1- No. of Bedrooms, Date Permit Issued , Has Erosion Control Been Completed? I certify that the system(s), as listed serving the abo O were 'co n sential y,as shown on the .plans of the completed work (copies of which are attached), and in accordance with the standards g ,� regutatu�risM1 , a he permit issu by e .. t Putnam County Department of Health. Date �', �lfL�fLL--L- -P E: R.A. i J Address License No. Any person occupying premises served by the abo t,FY a such action as may tie necessary to secure the correction of any unsanitary conditions resulting from. such usage. 'Approvala��k1'e stem shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water suppl I- of -1h, I when. a public water su becomes available. Such approvals are subject to •.modification or change when, in the judgme i ~loner Health, such rev ocaY n, odification or change is ne essary. Date By Title q h ! ROBERT O' C O N N 0 R J WELL COMPLETION REPORT � PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CAr1MEL, NEW YORK This report Is to, be completed by Well driller and cui r,Iitted to County Health Department together with laboratory report of analysis of Htate'r sample indicating µr'atei is-'64 , safisfuclory bacterial quality before certificate'of Construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ROBERT O'CONNOR IBALLYHACK ADDRESS ROAD, BREWSTER, NEW YORK LOCATION OF WELL (No, d Street) BALLYHACK ROAD, BREWSTER9 NEW YORK (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT r] SUPPLY ❑ INDUSTRIAL ❑ FARM L_J CONDITIONING ❑ TEST WELL ❑ (Spe (Specify) DRILLING EQUIPMENT COMPRESSED ® ROTARY ❑ AIR. PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) DIAMEY ER(inches) WEIGHT PER FOOT 1�3 THREADED ❑ WELDED I DRIVES OE EYES ❑ NO WAS CASING GROUTED? ? a YES ❑ NO YIELD TEST HOURS ❑ BAILED ❑ PUMPED ® COMPRESSED AIR five G.P.M. 12 YIELD (G.P.M.) 12 GPM Sl1 ATEP. LEVEL MEASURE FROM LAND SURFACE— STATIC(Specityfeaf) 26 ft DURING YIELD TEST f loaf) Depth of Completed Well �sL�t ° 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. 0 6 Drilling in overburden- earth Hit solid rock at 6 ft. -6 . ..: _ ..21_ Drilling in rock - setting casing-grouted 21 105 Drilling in rock - granite If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 3/11/74 DATE OF REPORT 9/3/74 I �oe>Pk E f 0f C DA);%j 0 9-- owner or Tljxchaser of building �T Municipality App. - I _ a C _.......n& Building Constructed by r d„ �4A Location - Street Block -2 ,rte Building Type 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 succe.ssors,, 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 occupant of the building utilizing t'ho evci -om The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Mealth 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 day of OCT 19_3. Signature _zl � ,.. Title OWA)64.4- (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 BREWSTER LABORATORIES Box 2a4 - BREWSTER, N. Y. SAMPLE NO. 3845 SOURCE: Robert E. O'Connor - faucet - well supply Ballyhack Road Brewster, New York COLLECTED: March 31, 1977 B%: R,F,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. April 2, 1977 0 per 100 ml. ANON lk IL ) A s > his TAR •i p t _ t �pFt 1' �7• - i 2!0 - r. 7'yG.. //��.. yY.� C. I _ 1 _ i S 1 • /.'rL ./ y . -. 1x { y� •'4 ;:(�'• G <L.4Ff �'R L.,"1^f- ,:•'hL'Grk:w' "I X8.3 foi .. r �,..f.. , x °. : i �. > 1. 5. Fh !-wPi .i' �aG.QiitiJJTr i �' f,> 'k [ 3 C - SrJ yy1�,, � J) •/. �Y..GM !�I(•:i(Y 1 'sF r _ 'A � r A x '- � '.k '� A:.•F� 4.I �Li t • � t , } 1p .... ". w�jr,g 7 -t. I ,�A - .�.J� � � :. q.f.♦ �Yri k ugly; r ":- ti ,. K ..� .:i: S,4 v p�,t••: r ..:' t^'l i 4� „ y, s + -yi ...,�. ..... � .,.�. ..,... yr 5' r" t�. S' .>s' " •t.. AJ. r�ki F �f,�i. ��'�� fjoh h. a to *1';,x4 r•w Ix ,, HOW 1. ,... .,. ��,zy 4 ♦4'., 4. „A. .. .:., N.. .,�� _..,A "- .. 1 '.�P �.!•^ ' * 1 .c ;r,s v. •:. a.ot:'. -n ,In. .:pp.. a... �.{�� -.. •::� C 7z .. � .'. a..,�. - . -, ,:. � -.. ,.,.,. - ) .e:. a.. .. ,.. ,: ..:, .. t;. -. - r7, .. :•. _;., -., .,. .�� t, .�L� / /�(fi ray �/�: -: ;- -3:%ti: ..:5{�g`� si_3�: d''a�.. . -.',.. `,� .:M _ a•r. .t:' f.' '.:L ,).l1r ,:,.r +•n's.t. .: :. r. •. -.. <. .. ,. r ,e t .. a, - - - L1..K�/Cr :. 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AJ. r�ki F �f,�i. ��'�� fjoh h. a to *1';,x4 r•w Ix ,, HOW 1. ,... .,. ��,zy 4 ♦4'., 4. „A. .. .:., N.. .,�� _..,A "- .. 1 '.�P �.!•^ ' * 1 .c ;r,s v. •:. a.ot:'. -n ,In. .:pp.. a... �.{�� -.. •::� C 7z .. � .'. a..,�. - . -, ,:. � -.. ,.,.,. - ) .e:. a.. .. ,.. ,: ..:, .. t;. -. - r7, .. :•. _;., -., .,. .�� t, .�L� / /�(fi ray �/�: -: ;- -3:%ti: ..:5{�g`� si_3�: d''a�.. . -.',.. `,� .:M _ a•r. .t:' f.' '.:L ,).l1r ,:,.r +•n's.t. .: :. r. •. -.. <. .. ,. r ,e t .. a, - - - L1..K�/Cr :. L.�� '- /_',.f�.t. ,}�, ��.+r:M1✓ .,n. t ? t h ?'�.„ �r. t".vkt�r.."., n "'-.{ :.. ,:;, !. ::...,: x ::j •Ny' E R . DIVYSittl. OF 1 1 ., , - ,�r�- d, 'X: fit• �:, .. ;� w �rlr `i i,,c� r�-� ?•� r h� tU.'. uL1itA1'HE711:TM�9!,AVI['B' -s r t I PUTar S will be located as shownaon the approved p th t be!� 1 in corc , Date r h c N 7 t ` 7 Addresses — APPROVEO:�FOR CONSTRUCTIOK This approvaT� Par from the date tssu 7 revocablerfor'°dause or may be amended or modified' , en con ;ideretl r►ecessary by +the C i requires a new permd Approved for tlIsposal of do es�ticjsa�taage anC /or pi P[JTNAM COUNTY DEPARTMENT OF HEALTH -" DIVISION''OF E- 4VIRONMENTAL HEALTH SERVICES COUNTY. OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. OwnerWbecrR`r EF. "`d osje.io __ Address Ao Aud vjffw AV15 Located at (Street .tY�IACL �D Ondicate Block �' Lot 2 nearest cross s r Municipality' PATTEp-rep Watershed 17A S T 8&9a SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to.Va-Eer Water Level No. Time From Ground Surface in Inches 'Soil.Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 91'57 flol-r 17 2 �//4 9;33 i% J 5 - - 1 .. 2 3 4 0 Notes: 1) Te'gts to be repeated at same depth until approximatelyY 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 HOLE N0. Ci HOLE N0. HOLE N0.E%' -% G G.L. ! Yq r 6" 10 t3A/D �i4itrp S�.UO r' rr if _ 1811 i . rl �t rl 2411 30" 36" 42" 48" J if 6011 72�� °c 8411 No ,� INDICATE LEVEL AT WHICH GROUND -WATER IS .ENCOUNTERED �' WATE INDICATE- -LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED `'PESTS .. MADE BY .%, `•L AAt ,p e— Date .. _ _ . DESIGN Soil Rate Used % " Mi* 4/l "Drop: S.D. Usable Area ' Provided 3 47 fr No. of Bedrooms Septic Tank Capacity Gals. Type_ *�wel Absorption Area Provided By /7 7 L.F.x2411 ✓ width trench. 0 her � ��10*4, A r Name A O i Address BOX 267 AK :;� THIS SPACE FOR '� ,. LTH DEPAR_. �O o Soil Rate Approved Sq. Ft /Ca ®� �° by Date