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I __•. :.� <- PUTNAIVI COUNTY DEPARTMENT OF ;IEAL'TH ,.
-_ D`i'vision of -Env✓ronmentai Health Setvices, Cahmei N. Y. ` 10512,
CERTIFICATE OF - CONSTRUCTION, COMPLIANCE- FOR "SEWAGE DISPOSAL SYSTEM - Pdtt21"SOn
l z Town or''_Village•.-
Route" 292 @- Mooney Hx"l l
Located at - Section V Block
3.. Owner ::
Tava�noc.Bu�lders `Inc Lot. ` 2 Job 1,
• :.
SO1 b4 Dwg No ::2.
Separate Sewerage- Syste built eY Art Burd��ek f Address Brewster, NY
m A r : h
Consistmg of 1000 ,Gal. Septic Tank 3.T6 lineal Feet .X 24 1 nCh. width, -a
-3.7
'. Other requirements None
Water Supply Public Supply From
�X
Pi Sons , , Inc
l f iwate- ;Supply'Dh el d By,
_..
Brewster, NY
- �- - - 10509 -
+ Flddress
'Building Type Frame . No., of Bedrooms
liras Date Permit Issued 89/77
i Has Erosion Control Been: completed?
Yes
I, certify: th'atD the system(d). as listed. serving; the above pre mises.were.constructetl essentially as shown -on the plans of the completed work, (copes of which are
attached), and in accord ance -with the standards .idles,and'regulations; plans filed; and ,the permit issued -tiy. the" Putnam County •Department of'1=lealtfi.
21 September 1�9Z,8 X" 11 o
Date "' ertified by w i R
C
FaIr St ee Carme1> NY':1 1•Z. PE 29206.A -
Address ! ! _ ! License No•
:Any - person .occupying premises served by .the above systems)'shall promptly take such action *as may be necessary to secure the eorrection of any unsanitary_
conditions :re'sulting from such usage , Approva,i .of the separate•' sewerage system; shall become. null and void- :as:,soon as a qublic sanitary sewer becomes
{ available and 'the approval`of the`pnvate water upply shalltiecome null anal' 'when a public water supply Omes'available # Such ;:approvals are
Subject to „modification or %change when;, in the judgmen't`;of .the Commiss' ner o` ealth, Suc revocation, dificat�on or' change: is ne essary: „
- qi.
Date: gy dl
"
;T
J
' r �
Tavift Builders, Inc.
Owner or Purchaser oT Building
Owner
Building Constructs by
N.Y.S. Rte. 292 (@ Mooney Hill Rd.)
Location - Street
Frame
Building Type
Patterson
Municipality
Fair Acres Subd.
Section
Block
#2
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 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-
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 the system.
Dated this 21St day of September 1978 Signature
Title
f c6rporation, give name
and address)
THREE (3) COPIES. ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Divi -sion of Environmental Health Services, Putnam County Department of Health
Wfikk WbIP(ATION RgPQRT PyTNAM CO.UPJTY DEPARTMENT Qf . ".RAC �
3l7i Division of Envirpnmental Health Servlcgo
. COUNTY OFFICE 8U.10INQ CAHMEL, NEW YPFIK .
This fopprt to Rw b.9 pornplatecl by wall driller and submltteq to County Health Department together with laboratory report of
$n ®R> {I i§ 91 4M�tQr bAmpla indicating water Is of satisfactory bacterial quality before certificate of construction pAmPliyRCq jp jgjgW,
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWN90
Tavi.no B i ers .mac „�
ADDRESS
Deans Corners Brewster NY 10 0
60CATIOtj
of y:eR
Nvay (tt►rn
Corner.;Rte "'2 '2 & Cross Rd., .Patterson,
g
(tRf lyllmoot
NY
FROPOSan
PSI of
WE 14
Qt1SINES9, �'''j
FARM
§uPPLT .: 1,.,J 1NPUSTRIAL L__I CONDITIONIN4
(�j
t„-! f €§T V'EL;
Q (OBE r)
DRILLING
G{TUIPh1FldR
_ Q COMPRESSED j", CABLE
R.Q TAW AIR PERCUSSION I..J PERCUS�IOW
j"""j OTHER
LJ (SPPcifV)
f„Afilfdt
p -T�lfL
jf h!Tlj ftRRf1
Q r.
D1All9RTER(lnChca)
61i
WEIGI{T PtiR FOOT
1 lbs •
THREADER Q 1NELD11)
S
YES
NO
WA5
Y03
.
j,
LJ �IA
YIELD
TE f
L I aAILlr$
HOURS
L;y1 pump co 0 COMPRESSED AIR 6
6.P-M, ' .
8Q
YIELD (a.151,1
8
l•'JATC�
Ik1fE$
Wg ,ka ..149 FROM L¢.trla SURf(�SE- Sif�TIC(Spoq! /y (eel)
0 r •
DURING YIELD TEAT fact)
f
Depth of Complot ®d Well
In feet below Land eurNoel 3101
' BC4:ELrT9
1Ffjf{E.
LEPfGTH OPEN TO 6{sulf9.R ((jet!
QETRfL§ SIAt I7§ pIA>JtETER (inghRtt) IF GRAVEf, Aipmoter of well includtnp �RAYE4 �JZ( (tnt?hos) FROM ((qvy Yp (fa9tf
PACKEDr grovel pock (Inches):
N-FTH FFOM LAND SURFACE Sketch exact location of well wlfh oletanoos, to of (ga ;f
FEET to FEET " FORMATIOAI DESCR1FT10N two parmancnt lanamarka,
0
2
Drilling.in..overburden
..
. . ?�^reve�rs;�:e^z.
Hit '.rock at 2 feet
2
30
Drilling in rock —set
0
.
Drillin
If ytsfd was lasted at different depth$ during drilling, list below
FEET
GALLONS PER MINUTE
�Ty ll CQNit'i.l:T�� ... � .. ..•�
T3H�' 4F/ f4Ef'ART 4�'gL.i• Pf�ILLER Islgna
m: 1 2 8
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. L,•2 7 r;
SOURCE: Tavino 7,uilc?ers i'a.ucet- �rvell
Fairview nacres Lot 2
Cross Roact, Patterson
i
COLLECTED: Torch 20,1.97
BY: P. Beal. & Sons , Inc .
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This rtrult ixdicater the rourct of the ramplt war
of ratirfactory raxitary quality whtx thif ramph war colbcttd.
0 per 100 ml.
March 27 , 1 -?70, Bickwit P. E.
Director