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02811
3 PUTNAM .COUNTY DEPARTMENT.:OF HEALTH
Divisio Sewices, ; Carmel N Y ,10512
CERTIFICATE. OF CONSTRUCTION COMPLIANCE FOR SEWAGE.DISPOSAL SYSTEM .
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Located At Oscawana- Lake Road Tex' Map 60 1 -j9 Bloc,
Owner R Lot i [`}i'arc3 MPS Pr 9..�
- • � Job,
Separate 'Sewerage System built by Rudolph MrA 7-e: Address Oscawana 7:ake A6
C1
Consisting of I Q00 Gal. septic Tanlc_: and 400 L df 2" O" wide trenches i
'Other requirements
Water Supply: Public Supply from
* Private Supply Drilled By Norman Anderson
.,.
,Address R?rs r Sf PW-na' -Al. 3 e�y 4--V, 10579 -
Building Type 011P f ri _ � iTrPSirlimnQP - No of ,Bedrooms 3` :Date Permit Issued 10�Z�i,L7� .
Has Erosion Control Been Com'pleted?
I certify that the systems) as, listed servmo.the above premises were, constructed essentially,:a 's shown. the plans of tKi— completed work (copies,of .which are
attached), and in accordance with: the stardards, rules antl „regulaUOn's plans filed and the perms sued by the , utnam County Department of, Health.
Date 10/22/80.
Certified by _ P:E R;A:.*
Address License No. l l 65 F,
Any person occupying premises,served by °the above.system(s) shall prompt , t e•su action as maybe necessary to re the correction of any unsanitary
conditions resulting' from such wage ,.'Approval -:of the separate sewerage`, a shall become nulGand void as soon as a public sanitary Sewer - 'becomes
available and the appioval of the prrvate`water supply Shall? become null and- ,void when a public water supply becomes' available. ' ' ' Such, approvals are
subject to modification or change `when, -in the judgment -of the Commissioner of Health, such revocation, modification or change is .necessary.
F
Date ��� —�� BY a Title
I.
,
Yee
Owner or Fur6haser of Building Municipality
pu�lding Constructed by Section
i,ocat.on - Street Block
1-u-ir T TIE T e 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
sposal 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-
_,.. the Director of the Divi.a.ian,___r'�ri.rozenral,. Health Ser-
vies ° or" tiie` ru 'i;ri$m- 'CounLy�De�ar'tinenc"oi' Haitc€is'�to�wYletner ° "or riot "th "e "'' -_�_
failure of the system to operate was caused by the willfAl or neg igent
act of the occupant of the building utilizing the syst
OWNER -�S
Dated this day of �� p 19 x Signature
Title
corporation, give name
and address)
X GON7aa CTofL - owmE- L-
- - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED_WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS .REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
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Md'pLU1011 F(1,,f'k?RT 111TNA j COUNTY DEPARTMENT Op
3/71 Dlviclon of E;nvirpnrnontul Health fatvlorta
�oulvTY UFrlct F3UiIJANQ • 'AHWL., NEW YQnK
This repPrt iq to t�Q complotod by wolf driller and s b tcd t r ! *.:� It! eF»� * •t^:it! a t ^'� J repatc of
t; mix q 0 In H 1• IllQnt [� Brh r. ! Ufa^ «w,•
`9ilhij 4i Ga''V� `r+i'itimN iiii is "Atin j Dieter Is of satisfactory bacterial quality before cortiticate of construction compliprlc@ IA I;IWW,
DEPORT FOUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMI
T'ION
'LE]
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t )htisg
ADDRESS
IOC Of�
rla. a�btraat /' / ?tka j491 &Mull
�'pOPASt p
j '` BUSINESS
IQ! 9UM�S1i IG El EATAWSNMI NT F] FAR64 t..-I WIFF WEth
PUCLIC AIR OTHER
SUPPiIf L.J INRUSTRIAI L_ I CANDITIONINQ �1 (bpgc!fy)
?`;p$JUINa
'. QU!PMENT
jam}_ Q COMPpE55ED I""j CABLE OTHER
�=J E'QTARY AIR PERCUSSION L _ J PERCU551014 ❑ Opocifri
P$TAII�
Lt;NQTIj floefj
oIAM.$TER( /nCAoe)
�j it
WEIgIiT PEN (OOT (-'�
i --t THREADED Q WELDED
0
� No
C'ASTtT
YES
L.J NO
TM
''�
EI DAILW
HOURS G.P.(�,
rumpEn COMPRESSED AIR
YI[;lD (A.P,Qt.1
WAT[R
Egy[k
f;EpSUftC; Et phR i�flQ at1RFALk— iT�T1G(SP @4(lr loot)
PURINA 1'tELO TEST fact)
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Depth of Complated Well +
in foot ftolow land turfacet
' ECRCEtp
LCN4TN Q ?4N TO A(TUIi`ER (Ftl
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QE1AIt� .
StG i�
RIAhtETER (laghps)
iF GRAVEI,
PACt.EDt
Rlpmotar of well including
gravel pock (Inchoa).,
GRAY ti ii12E (lnchop!
FROtit
TO (Inti"'�
tr.O>e 1—T: 9e -ACE
f )RMATION DESCRIPTION
Sketch exact location of well with distances, to at fgagl
two pormgngnt lanamarka,
FEET to ftET
If ylold wet tested at diffsrant doptht during drilling, lift bolow
FELT
GALLONS PER MINUTE
i'rttt lfif
uAre OF 09PQ11
syrt_t. pRl Fa f51pt but
°"RESULTS OF-EXAMINATION OF WATER
�5
�Y OWNER
Richard Meyer
h7 CITY, VILLAGE, TOWN VOR NAME OF SUPPLY
Oscawana Lake Road, Box 289 A, Putnam Vall
} SAMPLING POINT
Well
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9/17/80 '- 7:00 P.M.
9/19/80 2:00 p.m.
sIDATE REPORTED
9/222/80
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BACTERIA PER ML. (Agar plate count at 35 C).
3
COLIFORM GROUP (Most probable. No ;,'100ml.),
0 (MFT) ,
TOTAL - ppm
DETERGENTS- mg /L
NITRATES (as N) - mg/L
i
IRON, TOTAL - mg /L
AMMONIA, FREE (as N) -mg /L
pH=
CHORIDES - (mg /L)
?p These results. indicate that the water was YES of a satisfactory sanitary quality'whery the sample was collected.
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4F A. H. PADOVANI, . T. (ASCP)
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PUTNAM COUNTY DEPARTM W T OF HEALTH
1V 's. _- N---OF 1 'Trno 'T,A%:' `AL H`MSERVICES
Re: Property of_. Richard Meyer
Located at Oscawana Lake Road +Putnam Valley, N.Y.
Tax Map
x_�o -i -59 Block Lot Gentlemen : '
This letter is to authorize Joel Greenberg
a duly licensed professional.engineer or registered architect
( Indicate)
to apply fo.r a%Construction Permit fora separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated 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^supervis - ._construction. of said---
``system or systems in conformity with the provisions of Article 145 or
147, Education Law,,Lbejublic,Health Law, and the Putnam County Sani-
tary Code.
Countersigned
P *E., R.A.,
a,14-628-66-1-3--
�S's E0
Gj Rf-NCE
Ot
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-:
Very trul yo xis,
Signed
Owner of Propert
1 460
Address
212 -TY2 -1172
Telephone
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Notes:-!) Te`:�ts to be repoated 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.
Rio e
Number ..._:_..... CLOCK....TIME
PERCOLATION ..
' .PERCOLATION
Run J4Uapse
No...- ..::::.... -. .._....,`;:. :.;:..° Time
Start-Stop Min.
_._.. ......_...: .......:............
I36pth to Vdter
From. Ground Surface
Start Stop
Inches. Inches
Water Level
Inches....:.:_
Drop in
Inches .
Soil
Min. /in
Rate
drop
'in
i
1 A
3
� _
In
2.:1- 0:31 -1I i 01 '30
.16.
19
3
30/3 =
10
_. 3.11:.0.2- 11:::32 30
16
19
3.1
30/3'=
10
#2 " .,1:1.0:.:..05 =i0.:: 5�:; :.: -30...
16L.
19
3 ... .. :. -.
30%3; —
10
5 :.
1
Notes:-!) Te`:�ts to be repoated 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 NO. 1
HOLE
NO. 2 HOLE NO.
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�...- .....,.._Top>
.Soil.�.. <...�.......�._- .. Top .,Soil
6..
. 5,and & C1 ay Sand & Clay Sand & C1a
1211 ..
igna
Address'RR#8,-'*M1A8Co6t North
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THIS SPACE TOR''USE'BY,"fMLTH DEPARTMT ONLY:
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Soil Rate Approved- ....;. Sq. Ft /Cal.
Checked by
Date .
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