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PUTNAM COUNTY DEPARTMENT OF HEALTH 5017$5
108 DiviowHel Se
CERTIFICATE .0F GONSTRUCTIQ COMPLIADJCE FOR -SEWAGE DISPOSAL- SYSTEM P?titt�r�a.n
L 9 Town or Village
Cross Road
Located at � � � �- > - c -,� xTax Map• _ slock�
Owne► Tavno'Buder_.s .inc: fi Tax'.Map �t 3uba °(c' -3-
v
_.: Arthur ,:gurd�ck Brewster, N
Separate ;Sewerage Sys-,am built -by Address
1000 500„ L F x 24" wide trench
COnilsting .of Gal Septic Tank and
Othei requirements
Water Supply Public. SUPPIy F.eom
X P` F Beal'and Sons
Prwate supply Dniled By
Address Brewster, NYF,
frame. r' Three`'" n $77 ti
Building.Type No._ of Bedrooms —_—� bate Permit Issued
YeS
m ,.
FIas�Erosion contiol 138ej Copleted? }
certify thatethe syatwals) as „istedservinq the abova':prem: essentially as, shown on the p];ana ofed
ises were constructed ahe complet work (copies.-;
of which' are attached), ;and "in`accordance.with the'-standards, rules an3 regulations,.in accordance wfth`the filed plan 'and th' p.pfiit Ti sued'by, the
Putnam County:Depaztment:.Of Health
Z.
9 November_ 1978.: , < PE X R A.
Date Cert,fUed by
R D 9 Fai r S r: Carmel >, NY 1r0 2= �i
'Address s tense No L 29206 x a
L1ny person occupying premises ,;eryed by the apove, systems) shall :prgmptly take sucl+ a�tiori as maybe necgssary tq secU►e the corredton of any unsanitaiy
�-
conditipns resulting from wch'usage.,,',Approval of the separate'sewer'a`gesyftam'shall become. null °and:void;as soon)as a pucsariitary sewer becomes
available' and the `approval of the'.prrvate'water supply shall become,'null and void .when a .pubIi `.water ply beegmes available Such 'approvals are
subject,to moditi Lion of change When 'in the, judgmeni.;,ot the Comm _ r ner ot" Health such re cstion modification or :change'i ;.necessary`
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1044k"MTFATIM R9PQFIT
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e"TNAM COUNTY DEPARTMENT 00: J?RA�
W71
_
Division of Envirpnmental. Haolth Sefillooa
COUNTY OFFICE BUILDINQ - CARMEL, NEW :YORK .
Th111 rappr8 14 14 00 pornplated by Woll driller and submitted to County Health Department together with lghoratory report of
$nQjV §1q A? Wqi�QT tiampie indicating water is of satisfactory bacterial quality before certificate of construction ggrr pliRncg.jq Illygd,
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL CQMPLETION
6Ah1A
ADDRk33
DvON
Tavino Builders, Inc. IDeans
Corners,. Brewster;.:NY..,1.0509 ...
6OCATIOtJ
.. "04A . trasU
l 4tYn (tat NymOer
of VVIVA
Cross Rd, , Pataerson, . NY
3
PROPOSIR
f1USikE$S
t ;J �0+4�1=?iiS r ;iTA t ISHMEhI>
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11 Q COMPRESSED
R.QTARV
CABLE OTHER
❑
EAUIPME.NT
LXi AIR PERCUSSION
?ERCUS$IOt4 (Specify)
CASINO
(,4119TH (tofu ' ."
DIA?arTER(Inchga)
WE1QtIT rEti Foor
(�
TyREADEDr ❑
YE$
t30
INq
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1 lb S .
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WATER
(�pkpo.R FRO)A I414A eiU 44C - ST411C($PP40y foot)
OURINQ: YIELO TEST [tool)
f
Depth of Completed Well
l
20 9
in feet tyelow Land aurfpcq� .2151
LI;NOTd QPE N TO BAUI(i s ((9911
- sctass;d '
psTAlt$ ?4AT 0174. pIA*CTER (InQhf; �
IP GRAVEI,
08AyEt &iZE (ncttoa) FROkt ((gvI) iP (foffl
pipmetor of well inclvdlnp
PACKED1
gravel pock (Inches):
OffTH FEOm LAND SURFACE "
fORMATIQI�I RESCRIMPN
Sketch exact fOCPUon Of well wlth Q /sfsnt es, l0 6.1 1914f 1
two permangnt landmarks,
FEET to FE @T
Dril1 3L in :.overburden
-
0
10 .
E
4
:.
ck at '10 feet
Drilling.. i•n..rock -.set
Ca sing U outed.
t
__._....__ .. __. _.._.. _ ".... -- -- " - ._ __
30
Dr 11 i an:'rock- schist ..
-------- - - -.." ..... "_. - -...
_ _
8:
BREWSTER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 4.279
SOURCE: Tavino Builders hose Bibb -well
:Fairview Acres ;_,ot 3
Cross Rd. Patterson, Fj,Y.
COLLECTED: April 2 ,1 9 7 9,
BY: P . n . Bea?. & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This rrtult indicates thr source of thr rample wai
of ratirfactery sanitary quality when thi sample war collected.
0 per 100 ml.
April 6, 1 9 7 9, Bickwit P. E.
Director
PUTNAM COUNTY DEPARTMENT ,OF HEALTH_
Division of Enwronmental. Health Services Carmel `N._ Y 10512
CONSTR_UCTIO PERMIT FOR SE1lVAGE :DISPOSAL SYSTEW ..Patterson
r Town or Village
i
Cross ross Road T
C axLmap z Block 1
i Fair -Acres 3 fob SA `1765 it
Subdiv ision Lot
Owner
Raynor zenecker. Address Crass
dad
Frame 5038 Sd_ Ft P` tterson NY
Building Type Lot Area - }
Three 600:G61 Da 1512
Number of Bedrooms Deslgn Flow y Total' Habitable Space' Square Feet
_ .
1A00 1,14 .1 T
. Separate Sewerage`System to consist of Gal Septic, Tank = and : 500, 1; Fi'_II'.W1 de •.Trench _t
To be constructed by Address _
water Supply." Public Supply .From
i
> X Private 7SuPPIY to be drilled by
;,.
1 Address
Other R60,urements °
. a
. - -
I'ripr6siiniAhit-I am wholly and completelY`iesponsitile -for the design and location of the proposed, system(s) l) that the separate sewage 'disposal system j
"above descr�bed`will be constructed as shown on the approved amendment thereao and in accordance with the'standards, rules an regulations o t he u Hain
a.H
County Department of Health, and that on eonipie4�on.tnereof a Cert�ficafe of Construction" Compliance satisfactory to the`Commis "sinner of .Healthwill
be subm�tt'ed' to the ",Department,. and a written''guarantee will be furnished, the owner his successors, hejrs or'assignsby the builder'ahat said builder will F
} place m good operating'condition' any ;part of -said sewage disposal system dunng' the Per iod'of two (2 'art immediately fo_flowing thedate'of the issu '
ante of 'the, approval.-of the Certificate,of" Construction Compliance of`,fl e`originalsystern or 'any repairs tnereto 2) thatthe,.Willed well described`;above
will be located as shown on the approved plan:and that said well will be Installed 'm accordance with the' stand s rules and reguiaa ons of the Putnam
County _Dep4rtment.of Health.
Date 3August 1977:: Signed
P:E._ .R A
Address -RD6: BOX 353. Cdr ' Y 1051 :' L6nse l'vo. 2g-
A00R6VED FOR CONSTRUCTION This approvaL_expires one. y m fhe date issued .u�les construction 'of the building has been undertaken and' is-
revocable for cause, or may be amended or modified when consid_ necessary by the`Commi o er, of Healthc Any change'oc alteration of construction
requires `a; new perms Approve .for disposal of domest�e, ita s age antl nvat w d pply only.
Date
By' Titl e
ie
PUTNAM COUNTY DEPARTMENT OF I RIALTH
DIVISION. OF ENVIROWYEDITAL 111,ALTII SERVICES
COUNTY OFFICE PUTLDING, CARIM ?L,, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO.
Owner rv�� r Address
?**_AA
Located at (Street Z� Block Lot�,r off° 9J
n i.ca -e nearest cross s r e
Watershed G_.0'G�
Municipality. �dl'�,/s or► ..
SOIL PERCOLATION TEST DATA REOUIRED TO BE SUBMITTED WITH APPLICATIONS
3 JIM / ?A /9 L� /
Notes: 1) Tests to be repeated at same depth'u.ntil ap.Proximatel 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.
o e
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
No..
Start -Stop
Elapse
Time
Min.
Depth. to va ter
From Ground Surface
Start Stop
Inches Inches
Water ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
2 /0 NZ
l
4 /wf
5
1,7,0
ao
¢ /Z
2
3 JIM / ?A /9 L� /
Notes: 1) Tests to be repeated at same depth'u.ntil ap.Proximatel 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 DE SU13MITTED 1419'}{ APPL.ICA`.I'ION
DESCRIMON 01 SO1"L:0' IN '' EST HOI � S
DEPTH HOLE. NO. � HOLE N0. `,, HOLE NO.
G.L. of
6" �� 4'hits
12"
18u L /.
24"
30, G�It
361
4211—
48��
54
66
72„
78,;
84" Lec.7,c,E
. • INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED /1Io�P
INDICATE .LEVEL TO. WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Alo.;e
TESTS 14ADE BY PmA f��?T�L�P f�� .e. (✓.tee.) Date �j >>
�� DESIGN
Soil Rate Used�Min/l Drop: S.D.' UsaUle Area Provided lDOeu
No. of Bedrooms 7;�~ Septic Tank Capacity OG O Gals. Type.
Absorption Area Provided By L. F. x24" A 3b width trenc
Other Non e
ame i;na ure
Address R.N 6,00X 353 sio
�. ti .�'y .1.� N PREVp������
THIS SPACE FOR USE BY BEAD.PH DEPARTKEAT 014
Soil Rate Approved Sq. Ft /Cal.
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