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BOX 31
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IN
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No
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IN
04070
" PUT,NAM COUNTY DEPARTMENT: OF HEALTH
r
D /Vision ' of EnGironmenta/ Health 5er,'vices, Carme %• N Y ,.10512
GERIClFICAE_QF :CONSTRUCTION CQMPLIAN_CE FOR SEWAGE DISPOSAL SYSTEM TOw� COt =yNaM
�-aj( "TovOn or'Village' °�:l.rcY*
t MAP 1:1 'Z • .
Located. at �� W A iV�l LAit'� {—'C O °AD Block
Owner `T'I1[�h1 -ikSl Ji Id1eLIIJID Q ,�A n��.� -AAi ToX s Job'
11 /i-�o ES C�Q�9 . R. .
Separate'• Sewerag C 'C"r . ;' / =G4i1"
3 ..
e':System bwlt: by Address .fl'E 13IG 1,fV. .. 1�4E'VlJ YE�iZ%
_ --7 .
t
Consisting .of z O Gal; Septic Tank �4 lineal Feet X 3 r t —width trench
Other, re uirements / t b r, •� 0 ' EL ' ► w` O So_11 GC>
isIr N� �aE'1 -l.
VJaterSupply.`•'• Publicr.Supply _From. '-
' Private Supply- Drilled =By �j t' Api SON'
Address
Bwldmg TYpe.: ,� AIJIIIrYEu 1`�E�iC' No of Bedrooms Date Permit Issued —
;.. ;y .
Has' Erosion Control Been Completed?
OF ���tttnra��
)V E
t ,zcertrfy -that the- system(s) as listed serving the above premiseswere constructed, e�► � tlw� L�e.pla' f the c ted,w (copies of .which are.,
attached), and.in accordance with the standards;; rules and •regulations plaris� led ,�a y- a put Cou m D r'tmerit of Health.
A ~Date H V C- r.�`JT l 19 MU ceri Hie.
t ';;, Address .'�� • • �� License No.
; �-
,Any, person occupying premise`s served by the above systems) shall ,promptly suol�r/� ctio may,l� gecessary to secure'the correction of any unsanitary
conditions resulting -from, such 'usage. _Approvaf.of the 'separ`ate, sewerage s�9ty�•R,b�•Au•yIZ_.� void as soon as, a public sanitary sewer becomes
�� ` available and: the `approval of the: private'water•supply shall become null and Jo'kj� •a�. "^tom °' supply becomes available. Such approvals are f
subiect.•,to modification or change when,:,in the Judgment of the Corrimissfoner_6% e�UP *44ocation, modification, or change is necessary.
Oate �' I / �/. / BY 1. ddr Title -P, .�• ,.
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L C C__,
A
A
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NA �.:C UNTY DEPARTIM , E E4LTH
E,LL 5COMPLET1,6N �-RIII OUT M NY .,O�
.'of - E nvirori'meni
:,,,I?ivision til Hialtt' .Services
COUNTY OFFICE-..BUILDING� CARMEL, NEW YORK
'drillor.'and �s6b ify kq_�:report of
�T C' �-H,4it be�ei'�'trrIent ts*tei. v6t� lab��ri'
analysi's.of �Hkers'ample.indicating water is of ikisfacto=al, q"uJaIity-,4qf ore cehifidate of.constructidn-coniplii'n"c6'is Issued.
-t,.'BE1WBMfT lb�
Tt NVIT"HIIN, 30 DAYS. DF t'WE LIL COMPLETION
Cr
I N A- �M E,-
DDRESS
_OWNER
gg
(Town),
(No� St t)
. ,,, ., z : =, " pber
5
�L, P-5
,'OF4
/ x
a�",Iuyielcl ivas:tesied at different depths d6ring drill"
.1MI
kit.
7�
DATE.OF REPORT WELL.DRILL R (Signat
-Z
FARM- [YfEST WELL
6T4R
CO3NDITIdI4INd-':,- El (speciify�
CAI
S
P
—DRIVE S ��CASING:QzRg TED?,
I READED��
HE LID415,
7� 'NO'
;YIELD
G.P,M
�ipeo h -of,
Complete e
�,A, n4v
FI'_ N'
BUSINESS
D"ESTABLISHMENT' El
PROPOSED. -�;XD6MESTIC
0
W
PUBLIC,
INDUSTRIAL
'F71 ,_.,gtOMP.RESSEDt
�41PMENT-.;,11
LiLl` ROTARY.—.:.,
'AIR _PjkCUgj ON
-"LENGT'.
(fe ',,.I
DIAMETER (Inthes'),JWPIGHT
PER 'FOOT-,'-"
�-�`XASING
_7
.YIELD,'
19,'�,�CqMff
LE15
1 SED,�Alk
PUMFED, F��, � 77
WATER
MEASURE FROM LAND. SURFACE STATIC (specify fed
DURING YIELD
MAKE.-
JCRI
SLOVSIZE
,DIAMETER 'Inches)
_IVGRAVE
DETAILS
DOTN416A LAND SURFAd
FORMATION DESCRIPTION
FEET, to FEET
t
99 7,
�47
7
j;
%
a�",Iuyielcl ivas:tesied at different depths d6ring drill"
.1MI
kit.
7�
DATE.OF REPORT WELL.DRILL R (Signat
-Z
FARM- [YfEST WELL
6T4R
CO3NDITIdI4INd-':,- El (speciify�
CAI
S
P
—DRIVE S ��CASING:QzRg TED?,
I READED��
HE LID415,
7� 'NO'
;YIELD
G.P,M
�ipeo h -of,
Complete e
�,A, n4v
FI'_ N'
1 4 ) I
0
Ilk
1 4 ) I
:: P, rbd ox •be . . o . i :i: �,..� <_ .ya,.: f w:;
L °_�® ass ®(� ? V_r,W k.M 4ALLF-I
Owner or Purchaser of Building. Municipality
Building Constructed by. `r-A,x iL-i• P-
LIP
Location Street Block
Building Type �.yy Lo" .
GUARANTY OF SEPARAT J _T
SI_ SYSTEi.7
C.
I represent that'I am wholly and com�letel responsible for the
location, workmanship, material, cor_struction and drainage of the 'sewage
disposal system serving the above descrioed p »operty,, and that it.has'been
constructed as shown on the . approved, plan: or . -:p_p_ owed a_m!endm_ent thereto,
and in accordance with the standards, rules arK r- ulations of the Putnam
Courity Department of Health; and hereoy.guararty to the owner, his succes-
sors, .heirs or ass? gns, to place in good opera ing condition ar_y part of
said system constructed by me` which fails to open ate for a period of two
years immediately following the date.of initial use of the sewage disoosal'
system, or any repairs made by. me to such syste-_, 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 acceot as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health 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 thlie system.
Dated this 5 T• day of � V C aU-51- 19 -7 D Signature f
Title 5sw.�s�b
If corporation, give name a
and address) e, 4 G OrMrz®m w
- - - - - -- - - - - - - - - - - - - - - - - ----
THREE (3) COPIES. ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF CONPLETION.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.l
rZ
vo
4
Pi
All?
LIG
A '17 1971
DIRO or
1"C'um �mfcu
a
AS CONSTRUCTED
SEPARATE SEWAGE DISPOSAL;,SYSTEM
TOWN OF
COUNTY. NEW. YORK
DATER SCALE,-P-•---EO j J013 NO. 70— I-9jC
SULLIVAN THIED&,
GALLON SEPTIC TANK
•
CONSULTING ENGINEERS
2417-mLF X B6 ABS. TRENCH
CLARK PLACE t2AM7PAr— NEW YORK
�l -- --- - - ---� \
`
4e
lk
1 �
\ 1
r
�' I O � � Q � , 1 1 I ' \ j .SY,$TE.M /- i0_.✓.C'O.G �yS TO /�.CG �!/C�S
' J ;0 I � W� I , 1 1 1 i �:y .. - -. �i _ �` .�EGr/ <Arioi✓s GF TyE P� >/vv/.7
-
� � � (r� Q b � 0 i ' � -- — - - - - � - - - - -- - - - -- -- —�` —� LL \ems c o i� Tr !FP�.E Tn�Ei✓T o.� .Y�A.0 T.✓
I �� � 1 ,� � I 1 � � x � � �, F • � S�.0 ✓ /GG � OF ` �� ✓ /,CO.Nw9�NTi�.G //69 {9i✓
1 I � / � � l T� MAP NO, /I,P B,G oG.0 /✓o, � TqX .COT Nd, $
\, o G say- �,yT'- -.c—ts �IC,c/ rv.Y /° E• AS CONSTRUCTED
a 1 I 1 >~ 2i2•�'� A �.-; r• S- , :cic. NO. Rf �SaS
I \ SEPARATE SEWAGE DISPOSAL SYSTEM
-4 y� rJEt //Y0,4+ /✓J. Ootr ,�i✓
1 \ o\\ .COT o,�,9n/. `.•�' ,.S 'M1f'yy osc.vr✓,w� /.q <,v.CEr .�o,vo
I hie
TOWN OF ��/%%o..� ✓,oc.c eY
osGA
��r�✓AM COUNTY. NEW.YORK
DATE 8 -/0 - �i SCALE .va../orEp JOB NO.
"ti %200 GALLON SEPTIC TANK I •, Nv���'3$'ngp� 4-` SULLIVAN - THIEDE
LF K36 ABS. TRENCH ' Z -dF ..... CONSULTING ENGINEERS
CLARK v+ nrF mawrmer ■ — rood
PUTNAM GOUNT.Y DE�A�tTMENT: OFD HEALTH
Division of Environmental 'Hea ;lth Serv." "ices Carmel 'AN Y 10512;
CONSTRUCTION PERMIT _FOR: SEWAGE DISPOSAL SY$TEM• Tc WN' - nt= - Mk", %/A t".. I.- 9E
1 r i 'Town or 'Villdge.
l CT �aCA L KE. oAD,.> _ c t
"Located aY sect ,on Block
Si�oarvtision 9c%C.CS� iC C i �a`E CY d Lotr- , Job
tt 'owner yoi►d' As ! D o LAcU �` d,E Lt �l'P A Apt . Qb� Aki Address
r .
Bwlding Type Lot Area
(Number of Bedrooms - -8,t:'D -� -odd - Total Habitable•S.pace I �Od + Square Feet
:. —�
�a�o
Separate Sewerage 'System to - consist of,:_ , Gal Septic Tank 6 lineal feet' X 3 +. width 'trench
cTo'tie constructed by;__ . 4 Address
1 ,•i , -
Water ;$upply. ; Public 'Supplyom
v Private. Supply to be 'drilled by.
,
r Address
1 Other'Regwrements" 'V ✓�i+? _CAE c`O 2� 6" ; O G' ✓C'�:'. /.C: To/°Se.14
} I represent that.li am wholly and-completely responsible for the design and +location :of the proposed, system(' °h) that the -separate' sewage disposal system
-above described 'will b6% constructed.asshown on the appro4ed .mendment ;there to and ,n accordance`•witFi the standards, rules an regulations o 't e u 'n
am
Department of Health; and that on completion thereof a "'_Certificate of,. Construction Compliance" satisfactory to the Commissioner of Healthwill
F tibe submitted to _the Department, and a':.writ_ten',gu„arantee will tie: furri'ish�ed the,owneriis suceessort, heir'sI,or, srsjgns!byr,Xpe _ builder,,that said builder will
place in gootl operating condition any •part of, said• sewage disposal system during the of two (2) y rrefedWoylq�lowing the date of the issu-
ance` of the approval of the,Certificate.'of Construction' Compllance3of the original system or any,repair,%% 0 'tpa�thl�j ' led well described above
i willd6ie cated asshown on the,approved, plan and that said well wilhbe, installed in. accordance with,,;t st�tr�? db! p�bCdg�d'r ons of the 'Putnam
County Department of Health. ' JoScrlik 'F-;. SvC.ttlil`. ^ .��E SG
9 r I ; ". y * e �G • e :+.E. R.A.
(� Dat Signe
e
d
J
v i a
.,ST a is u t Lti t ra a i. A
4 ;;Address Pr6,SO> :ACS$ hA+ti s>PAL r*.� r en e: - 2g $
.. ,'
SDK
' .,' ' �. is s 1�.. --. �i b
i
APPROVED FOR CONSTRUCTION This approval expires one year m;the date:' issued-un less' `•consttu on ,of the uilding.� on undertaken and is
:revocable for cause or may be amended oc; modified when consider ecessary by the Commiss oner. 'o .r% da y ch,tt�0a,�r� ration of construction
requires, a'' a rmit :Approved for disposal of domestic sa sewage ater pplsirr _ hFe:eeee�Go'0 ° °�wv� _
Data
-31 :.: A fF� NP�ty
BY :N. RN
fi i�u� rr
r,- -
PUTNAM COUNTY DEPARTMENT OF -HEALTH '
DIVISION OF ENVIRONMENTAL.HEALTH,'SERVICES
DESIGN DATA SHEET - .SEPARATE SEWAGE DISPOSAL. SYSTEM .. FILE N0. .
Owner +���.,�oj\ ,A., o Address
Located'
at. (Street) gn), :taoAp Sec . :.. Block : Lot
.
.(Indicate -,neare.st' cross- .:.street.)
' Municipality
--rcw..� of ;�>T�,::. 6Vatershed, �-Ac PcEksKiLi_.,:as AwGO►
\V A LL .e'7 E',1�
SOIL PERCOLATION TEST. DATA' REQUTRED TO `:BE' SUBMITTED WITH .APPLICATION , .;
79, -So, 1 1G rt F �oc�t `:i cc-r= c> C"i
MAP
�:
c7F t:A'itE . PEEtCS1��LL
Hole
Number
CLOCK TIME PERCOLATION ...,,PERCOLATION'.
Run
Elapsev, Depth to Water Water.Level.
No.
.. Time.--::. From. Ground ,,Surface " in :Inches Soil Rate ;
Start Stop Min. Start Stop. Drop in Min/in.drop.1
Inches Inches Inches
1
9:3o g 4s
2
9; 4-9 io 06
3
zC) z3 3
4'
S,
Z 1 4;3d. 9 :41
2
9::`47 io:o5 is 19 .22 3 '. 6
2 3
io_r) to C1:: z2, 3
5
T'CuT^v PERFCSit ► -ACO Foy; �vu�L vak - "ivs e o e
2
p
C_- .o l NG C �C, V.')eE R S
4:
Notes:
1) Tests
to be repeated at-same depth until-.approximately; equal soil rates are ob-
:,tained at each percolation te!:_t hole.'All data to be submitted for review.
2) Depth
measurements .to be made. from top of hole.-
Name Jos ePri FRAsactiS s��� +vAy, �,�, Signatures
- -.. v- o�r OF Ew oo�
AddressO"D z,TO Z. 8u L t-.a +s�n .c�arz PL. o 000000°. °.Y09��
o "g�' oo pNCls •j.0,
p., o,. Box ?�0.8�, M A H o..P ,. �. -y. `.i .. 0541 0 ° : FR J'G s
9 Gala- 8Z:z -T: * oy� l %off=
01 z°
PUTNAM COUNTY DEPARTMENT OF HEALTH
b 00
Soil Rate 'Approved Sq. _ Ft. /Gal Check D —.01- Date
����/ HESS
TEST PIT�DATASREOUIRED TO BE' SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
PERG TEST. Pr=izc, TsST DEEP TEuT.
DEPTH
HOLE N0. t ,HOLE' NO.2 HOLE-:NO.,-Z;3
G.L.
611
dirsati
1 L.
T
121?
1811
24"
S Ac y c Ay:'_
A.
S.A a y :`. ciL.. Ax
l,.', a A nt''.
1 o M ..
G'
3.01?
36!?
4211
rd �+'� v✓c l`t a�
l
4811
S 4'.T
6 0'1
. 66TT
.:
78'f .
8411:.'
INDICATE
LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
5A"), C_
INDICATE
LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .-
TESTS MADE BY' 5,-, L.Liv A� --Date JA,vzu _v
Soil 'Rate
DESIGN
Used Min/1" 'Drop :.. S. D. Usable Area Provided �5. o00
No.' of Bedrooms
¢ Septic Tank Capacity �; z ,5 o Gals. Type M A
Absorption
Area Provided By _z 3 6 L. F.x24T1 3'611 X width trench. Other
Name Jos ePri FRAsactiS s��� +vAy, �,�, Signatures
- -.. v- o�r OF Ew oo�
AddressO"D z,TO Z. 8u L t-.a +s�n .c�arz PL. o 000000°. °.Y09��
o "g�' oo pNCls •j.0,
p., o,. Box ?�0.8�, M A H o..P ,. �. -y. `.i .. 0541 0 ° : FR J'G s
9 Gala- 8Z:z -T: * oy� l %off=
01 z°
PUTNAM COUNTY DEPARTMENT OF HEALTH
b 00
Soil Rate 'Approved Sq. _ Ft. /Gal Check D —.01- Date
����/ HESS
ESTABLISH ELEVATION OF HOUSE TO PROVIDE DRAINAGE OF LOWEST FIXTURE
TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL
SYSTEM TO REMAIN UNDISTURBED.ALL CONSTRUCTION TO CONFORM TO STATE
AND LOCAL STANDARDS AND REGULATIONS .........
0 rr 1- .>7�°f .PO. ✓. F� /N G.P/!OE /,,250 GEt. SE/°TiG T9iY.r
0 - ��n =3 r,_ - F/ eL o s _ -� _- - -` .O ;I S�✓l:� D� APP13
C9,t� i.eoN P ?E
N`I-F, �I — �/�NC.ie.v Box I� � �•+'/•ysa s�r,�c-,e�
`FEB4 1971
PUTN UNTV- EA I; •o /f't E
\ ti D C,,Na IVI Of I i
`
ENVIRONMENTAL�HEALTH SERVI ES `I 1
98- - -__ _. _ C__ ;.2 sn ca9<• SEPi_iC��>•,9 -v`K }y j- ._ , I.., e. eo
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` 97-- -
E
0 T,•r /s SEV✓.9 G6' o /S.�oS9.G SYS YEM f-�i✓O /°� /Y�7rE
f 1
9 / ✓. -- .A l ,. S
7 9, 50 � � '1 % 0/�
•.� � ice. .`. .. \ I � it � - /v✓ /pN • 1\\ /.V CCN,�'o.�Mi9NCG� r✓i T.r' h'<.c .Pu <_6s .9�✓O
i N I 29•�. it \, t /e'er /on,n0 B i f \ ` � APE GI/�C .9 Y /oNS OF 7.YE �U T�✓`flM co UNTY
1 99, So \ \ 4 d8 „/E � , ... - - ClC'.'o.9iG Ti�1ENT O,� //G'.9.L%/y_ '•
2qi 1 I 1 1 \ , t �n 6"'" - `� '.,21 >ifE /fo�SE sEt✓Eie S,y.9.["L BE E." c.95T
....- Td ..-� � / /'• \I I �MiN M,. y, MiN, ' V '� _ /.E'oN P /PG: ;:
�.��y,+� /s' �'9GL Se'r✓.9 GE o /S,do S'9.C" re ENCNES S/.''9•[..c.
//?� /� 1 I,o°ee51 I ;on'- •+,.v. In.sr -a. E_. _ � _ ``7, _. _ _`( ... BE Co�v
. J/ I 1��// I � I.va- i t \ 'I. _ ___ 4 1 `�._.. �R ` Sri uc 7E.o P.y �'�9.G .0 EG TO . E- Y /ST /�✓ r; .
` I I I rES/.I 1 I' `I 5cr✓fiGE wo %SPoSfcG � t 'I�� 1 \l`` GON TO U.Q .S '9 N0 E/�C.y OTi%E'P 'rJ /I � SHi9�C,L
`SE r✓� G E I 1 1 I 1 I i I -9 1 `\ � �` U i BE Si°.9 CELT 9 T .Q MiN /M !/N/ OF q'
of S/a0 S/J.C_ I I ; I I � �! CENfEi2 To C�/✓7"Eie '
9ir� t.^9 '• `+G' 1 1 4" T/G �'>' � f C' y1 ` ` 1 � I {: Q 0-- Hi✓ /YvE�29GE` OG .Z'- 6^' o.� �U.'✓ OF C?/y / ✓,C
roiN I, 500o i L.. ✓0 1 I 1 I i � t\ 1 % D I Yl v
I 1 1 I 1 1 � \ 1 DID � ti..e.VYe"<. F / <L S/1i9L .G .BE �•G9 GEO /N' TiYE
o �. ' f �� ; 2 i ! i 1i, - _,/uN� 9B.So; 60�. j \ � N1�'1 O /s /6NATEO sL 1✓�9rE O /SP._+S�G�L. .9.e?E" -q ',.
2 -6' �✓ aF 1 I I � '{ � I I 1 �1 /�D � P.e /o.@ TO 3YS7 EM /�✓S >�9t,G 9Ti'o�! I
/ ��� ,eEOO I 9' ' I9',,,y_9' � I a,4 � .� U�°G'^' CoM/°.S,E> /oX o.�' sEr✓�•9GE = cvs.�o6�.G
/ I � Ir..si.v ryl /.✓, tM� I I t � � /' �,, sY5 >B%+� fJ.✓ ✓E.2�96B of !" o.c 'TCf'Sn /.G
1 1 ' 1 1 3 - i r�J /,�}'-`� Gl -ri ✓�.�2 3'.'/.•DL L BE P.G .v cc0 /.V �/ sPo S�9d_ .9.EE�i9.
301 �/� _- ::f
2.%�1� o ; " vor-v.r �'.s- s'i✓c /s' �'U.c.c /✓A�✓ RE. PROPOSED
2 1
SEPARATE SEWAGE DISPOSAL " SYSTEM
I / I i ., 7"/lo MHS (/. y`' ME"G /i✓OF/ ^7 � DOG.:+ /�
�' � Z o I� �,C OT .•�.G�9X < .•.` "•� "�`i(• OSC/JI�/.9N9 ,c.v.r� .eo.9o'1:
,- � , fJ DOTS �✓O. 72 7y 74 7S 76 77 7�' 79 B � 69
�' t i ^ ; }•.'�hFY•C;J �,•. y'f 'A B,CoGK No, /� .3-EG T /oN
79" of M9F o.0
TOWN OF oUTi✓�M ✓9GG E Y
\ SC /a° r�.POf�o SE.o �ON"r o/�.e = .dUTi ✓�9M COUNT,Y. NEW.YORK
�` O "�`'F' -• 1.. 9cUy \;? DATE / -/4 -7/ SCALE.vsNo E� JOB-NO. 70 -/92
=DEEPE LATION RATE �OCS /6N,. .� .MIN IN i2SO '; °,•• ..••-'•t"• SULLIVAN - THIEDE
GALLON SEPTIC TANK '• y`7!lSSIOp °gyp'`
�✓o «"oQ' 6' 'Coc.`c CONSULTING ENGINEERS,
6e.oc a rrfl rEC yr 3 • -o236 LF X 36 AE1S. TRENCH "'•'
CLARK PLACE tlANC9AC, NEC7 YORK
•
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