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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -2 -60 BOX 20 02274 4 t . j �C PUTIVAM, CO�UN�TY� yDEPARTMENTmOF HEALTH �� >� � � t sion of EnvironmenfalS Healh Services �Caime% N Y �f0512 a> I ,EOMP LBANCEtOR ,SEWAGE- DISPOSQ►L rtSY &TEM._ —� Wks... . t''J�*AR+1Z�`� �- =Owner rar -;Rurc _aser. of Building. jam` aJ�-p t� d C_ -° .'. Bui ding Constructed by �. Location - Street Building Type LA-st•j op rV#JAM VALLCE -4 -p . Municipality Block Lot GUARANTY OF SEPARATE SEIJAGE 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, hairs 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 Environrnenual Health Ser- vices of the Putnam County Department of .Health as to whether or not the :. failuro.- of the-system- to operate was caused - by.,..the - wil.lfuh _or- negligent act of the occupant of ' the building utilizing° the ` T s. em Dated this ---�- day of flLb 19-1-3 Signa,tu .Title aL'JPJg/L If corporation, give narie and address) THREE (3) COPIES ARE.REQUIRED.WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COYIK ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Heal th,.Services, Putnam County Department of Health u x YORUM MEDICAL LAKORATORY INC. Yorl;toevn Fleights, N. T. 10598 P.O. Box 99 321 Kear Street RESULTS OF EXAMINATION OF WATER OW : ER - 1 7TT T j P; N -$1T ��T `, PJI)'T CITY, VILLAGE, TOWN VOR NAMt OF SUPPLY . ARBUTUS RD. RO RING BROOK RD. FUTNAM VA:-','LEY VAMPLING POINT LL BACTERIA PER ML. (Agar plate count at 350 C). COLIFORM.GROUP'(Most• probable No. /1 r7 LESS THAN 2.2 1 DETERGEN TS - ppm NITRATES (as N) = ppm " ,t FLOURIDE (F) - mg. /1. DATE RI N.Y. IRON, 9936A 2-13-7 IS, TOTAL rAL - ppm 245 -3203 of a satisfactory sanitary quality when the a, ple was col ed. �, f A. H. PADOVANi, M. T. (ASCP) x YORUM MEDICAL LAKORATORY INC. Yorl;toevn Fleights, N. T. 10598 P.O. Box 99 321 Kear Street RESULTS OF EXAMINATION OF WATER OW : ER - 1 7TT T j P; N -$1T ��T `, PJI)'T CITY, VILLAGE, TOWN VOR NAMt OF SUPPLY . ARBUTUS RD. RO RING BROOK RD. FUTNAM VA:-','LEY VAMPLING POINT LL BACTERIA PER ML. (Agar plate count at 350 C). COLIFORM.GROUP'(Most• probable No. /1 r7 LESS THAN 2.2 1 DETERGEN TS - ppm NITRATES (as N) = ppm " ,t FLOURIDE (F) - mg. /1. DATE RI N.Y. IRON, 9936A 2-13-7 IS, TOTAL rAL - ppm 245 -3203 of a satisfactory sanitary quality when the a, ple was col ed. �, f A. H. PADOVANi, M. T. (ASCP) I- Lj j ojt% IV 1 ,,00 1 V I Y L.J. r- 1-0 k Ili I ',;I L..l'q I .L.)I- I1I:P,L-! 301 Division of Env',oi1n1t?;)^,,!! IfVoili- Services COUNTY 01'HCEBUILDING CAIVAE'L, NEW 'Yoll This report is to-be completed by ::ell, driller and submitted to County Health Department together with labormory report of analysis of Watef ssrnplc indicating viater,is of satisfactory bacterial qup!ity before certii . icate of construct;on compliance is irsued. BE SUBP4f7TED jr�ltVH I N �30. DAYS. OF WELL CO PLE t [6Nw.., OWNFR LO-ATION OF W E L I NAME (No. G Street) (Town) (Let Number) IPROPOSI'D 12, USIC OF WELL, DOMESTIC ESTAGLtStiMENT CI FARM TEST WELL AIR OTHER 11 SUPPLY El INDUSTRIAL El CONDITIONING (Specify) DRIEtING EQUIPMENT F-1 COMPRESSED CABLE OTHER ROTARY AIR' PERCUSSION 0 PERCUSSION El (Specify) C A S I N G DETAILS eot) 0 PER FOOT DRIVE SHOE ED. THREADED L I VJfLDED I/N-4.YES J N": WAS CASING (',TZP.UiEE:? Lxj YES NO • Y15LD TES! Houps G.P.M. El •AILED PUMPED COMPRESSED AM 1 -2 It YIELD (G.P.14.) WATER LEVEL MEASUPE rR(,)M LAND SURFACE —STATIC (Specily lopt)i DURING YIELD TEST fleet) Depth of Cornpleled Well in feel below Land surface: 7-) MAKE Lf.NGTH OPEN TO AQUIFER (loel) DETAILS SLUT SIZE. 1, M E I E R (Inches) IF GRAVEL . 'V I PACKED: Diameter of well including gravel pack (inches) GRAVEL . AVEL SIZE (inches) FRO (feet) 10 (tool) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at lonst two permanent landmarks. FEET I. FEET _7 If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPI TED C)ATE Of- REPORT WCLL Q7RI LLR (S' ture) I - avvva uoau �u _u �rn� u a. a u _ wa F•y v_. :_ _ .. .. ;: •o T ; .County, ._Department of yFiealth.and that on completion t rig a -V` on c n Compliance tsit! 'be submitted<to; the Department, -antl a"written:guarant` wil be wn :successors heirsor :place in good;operat�ng-'condition any -part of. said * sews dis g' he': rind of two (2) year. (+ ,ance of 'the - approval of: Phe Certificate _of Constructwn'C the' sy or any;iepairsaher l will •be located as,shown de the approved plan and that said weI I Q (' e` -with the staid and I County Department of Health 7 a r Data $� rte' Signed - s k i Y C' 4 0,., `ice •`k. Y - : ,�" :Address Af/fLt✓' ..._ Y t 1 ;APPROVED F,OR' CONST�RUCT_I.ON This;approva expires'one year fr6m;the date- issued unless construction -:i L revocableyfor•.cause or nay ,b amended or:modrfied =when considered necessary by tte;Commiss of Flealth. t' regwres a new `permd lop roved fors disposal of dormestic ;A, .l ge a or wale' er s_upply only tory to the Commissioner of Health will jns by the builder, that sa d, builder will riediately :following, the date of they issu -. = 2j that the drilled v4ell described above Iles and regulations of. ::the -Putnam PE �` RA License No 2 - %ZO ie building has +been undertaken'and pis iych5nge.or alteration of_consteuction ` 5 1 PUTNAM COUNTY DEPARTMENT HEALTH ._OF Dwisfon of Environmental HealiFh Services Carmel N Y 10512 i j CONSTRUCTION PERMIT FOR SEWAGE :DISPOSAL SYSTEM 'GR" �� ��iTjs!i/��1 �/¢LL . �. Town or village : » LoCai d* `K t - Subr�ivision /G 2 � :t S� I�y• Address s Bwlding ^TYpe :Qtsl1� .T /rs� - Lot Area_ - r fVUmber -of' Bedrooms /"� Total Habitable Space _ GY!�'t�0 - Square Feet' 1( �Sewerage System toy, consi Separate st � `}•eye":. a Septic Tank •� lineal feet 'X - ��'' width trencfi' � } # To be cohstructed by f � %'.� Address - t Water Supply Public Supply From ` s✓ v Private Suppl be drilled by 1✓ t :to - e... .. 9� lo� L i Address: Other Regwrements - �� I - avvva uoau �u _u �rn� u a. a u _ wa F•y v_. :_ _ .. .. ;: •o T ; .County, ._Department of yFiealth.and that on completion t rig a -V` on c n Compliance tsit! 'be submitted<to; the Department, -antl a"written:guarant` wil be wn :successors heirsor :place in good;operat�ng-'condition any -part of. said * sews dis g' he': rind of two (2) year. (+ ,ance of 'the - approval of: Phe Certificate _of Constructwn'C the' sy or any;iepairsaher l will •be located as,shown de the approved plan and that said weI I Q (' e` -with the staid and I County Department of Health 7 a r Data $� rte' Signed - s k i Y C' 4 0,., `ice •`k. Y - : ,�" :Address Af/fLt✓' ..._ Y t 1 ;APPROVED F,OR' CONST�RUCT_I.ON This;approva expires'one year fr6m;the date- issued unless construction -:i L revocableyfor•.cause or nay ,b amended or:modrfied =when considered necessary by tte;Commiss of Flealth. t' regwres a new `permd lop roved fors disposal of dormestic ;A, .l ge a or wale' er s_upply only tory to the Commissioner of Health will jns by the builder, that sa d, builder will riediately :following, the date of they issu -. = 2j that the drilled v4ell described above Iles and regulations of. ::the -Putnam PE �` RA License No 2 - %ZO ie building has +been undertaken'and pis iych5nge.or alteration of_consteuction ` 5 - , 11 . , I - , I �1, . , - � .� *'�ll " - , � � " , " -�-,,,�y, 74', �,� - - !�, . ,- i?�y , �, I - , C �;3,� . 1)� , --, - , �.,. �� . - - , Y, -� - -- I i I - � - ,� -.-,�- ' I 1� ":� �i - - V-'% � , -- ,"�'.� - - -,�, - , ,- - I - . . - , - , V � - 'I .- - I - , � _ -, ,�, .. , C+ , - �� -, ., - " , --� . - � - I I I F A. a lllj�,--?� " ,;k- - -,:�-�,� ?!e . , � , .�'-. , I�F�. -- 4, ,f. 1�'. - ." --� k -- , � �,, 1 Ox "", �- -1 I , - '.. �- lj�-, I � .j� -:1-- "", : " �.. , �, - 1, "' - , �o�'';*i gv� , A',w-"!-� , �, *,- 6, MA , -.;r- - - 'i .. � - - - --� - - — � -- . - - A�- Z-.' 1, �� � . -- - , � . , - , - , - � ? 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I -1 ,� -- - - - - - , - . , , � - . !,�, PUT \'_a i COU` TY .DE ?'.D" cL T OF '.LTN- _. -.._:. VZR 'S `�`. -;k '�r��. DESIGN. DATA SHEET - SEPAR.1TE SE ,.AGE D I S QSAL SYSTE_-' FILE N0 .. Owner G�sIci,��q 5 e&,, ',oOP ��' Address ?lam tr 2 �3 = 13�0�/� �• Located at (Street).?�b��i'u�s %2cr ._ Block / Lot Z�• (Indicate nearest cross street) Municipality 10 of !'aia��J'i !/s� — / t9atershed�cf�GG --�— SOIL PEPCOLATION TEST DATA FEOU I RE D TO BE SL'S' T,17ED ['ITH APPLICATION . Hole ' Number CLOCK ME PE ROOT ATION PERCOL_1 T IO` Run Elapse Dep _ o Pater S aLer Level No. Time From. Ground Sur = =,-2 in Inches Soil Rate. Start Stop `in. Start Stop~ Drop in �1in/in.drop Inches Inches Inches 2 ll 5 1 _ 2 3 5 Notes: 1) Tests to be repeated at same depth a -itil approxi -_t-el .. equal soil rates are ob- tained at each percolation test hole. Alh:data to be submitted for review. � 2) Depth measurements to be made from top of hole.. 36" 42" 48 S 4' 6 0" 6 6.-.' T.. . 72: 78" 8 4., �I I.NDICA•TF,..LF,VcL AT. PTHICH GROUND WATER IS ENCOU \TEP.ED 1NDIC.ATE LEE TO WTHICH t;1TER LEVEL RIS =S AFTER BEI ?.G ENCOUNTERED TESTS:. LADE BY Date DE 6 _ \ Soil Rage Used Ab M,in /1" Drop: S. D. Usa:Dle Area Provided So \'o. of 5edroo s Septic. Ta:�'.c Cap�c'- �y /Z ©� Gals. Zip /I&I.V. i Absorption area Provided By 3& L. F.x2''.' 36'' V/ a:idtn. trench: Other , Name STANLEY Address BO; I r ; 1 �_ . , PUTNAM COUNTY DE?ARTLli1NT OF HEnLTR%- Soil Rate Approved .Sq. Ft. /Gal. "ki �-' Chec Date °l ai . -.... -.. -.. -.. - .-..,•_ _ „_,_ - - -: -''�� --. � � �v _ _ ,- - s ��' _ - �- c�VJt.i Q�” P<,ii'�3A�t�s1 �./A1:.t,.i�*F',•. c. o;- 1tJt_�a1EwtJG.tt�:E c+ Ja. E:if, t, :t��2'.