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00054
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Patterson
Town or Village
Located at Norte Street Section Block
Owner William Romeo Formerly, M. Dwyer Lot Job
Separate Sewerage System built byJose_ph Plew D &M Excavator Address E, Fis kil- . N.Y.
Consisting of 900 Gal. Septic Tank 236 lineal Feet X 36t1 width trench
Other requirements Fill Section - 21 avg. depth, and sewage pump.
Water Supply: Public Supply From
Private Supply Drilled By
P. F. Beal & Sons, Inc
Address Brewster- N.Y
Building Type H1 Ranch Residence No, of Bedrooms three Date Permit Issued e
Has Erosion Control Been Completed? Yes
I certify that the system(s) as listed serving the above premises were constructed essenti y as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed d the permit issued y the Putnam County Department of Health.
Date 1Vry,17J 3 Certified b P.EX R.A.
Address Dykeman. Road, Carmel, N.Y. License No. 043880
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private 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 theJacl issioner of Health, such revocation, modification or change is necessary.
Date Title iL. 1_,! r
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �f�T"TG'RS -
,�/ Town or Village
Located at 1/0 RT
• Section Block
Subdivision �J Q Lot Job
Owner — LI Address NO�TTy `S7
Building Type X-4tiG06� Lot Area
Number of Bedrooms 3 Total Habitable Space Square Feet
�r f14/_ S4!5C_ .✓
Separate Sewerage System to consist of / Gal. Septic Tank lineal feet X width trench
To be constructed �by.� � `) S4� dET2fi�IVO6 f0 Address
Water Supply: — CPU is Supply From
Private Supply to be drilled by
' Address
Other Requirements �'4 /— AEG T /O/✓ %p d5l!5—
r ?04.1 /N -5E7"7-1- EO 1-141- To G�`lEi?f'/ /�tJ� ,�4NI T 40' Z�U-
1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the on system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed cco rdance with the standards, rules and regu aTions of the Putnam
County Department of Health.
Date Signed P.E, y R.A.
Address License No.
APPROVED FOR CONSTRUCTION: This avloloval expires one year from the date issued unle construction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanity sewage, and /or private water supply only.
Date Ii'he.�s /�' �/� By /�'i�tiTr�— ^�! E �� itle
SAMPLING POINT
ATT IJ n-DTT.T. -Wn I.m T.T..
BACTERIA PER ML. (Agar plate count, at 350 C).
COLIFORWGROUP (Most probable No, /100m1.)
HARDNESS'. TOTAL': ppni ;=
DETERGENTS - ppm.. ' ...,. r _.
NITRATES (as N) =. ppm.
IRON, TOTAL pPm._ i
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING = CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
MERROL INDUSTRIES
ADDRESS
ROUTE FISHKILL NEW YORK
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
STREET, PATTERSON, NEW YORK POP
PROPOSED
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ESTABLISHMENT ❑ FARM ❑ TEST WELL
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING OTHER
❑ )
DRILLING
EQUIPMENT
OTHER
® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH (feet)
0
DIAMETER (inches)
S •
WEIGHT PER FOOT
1
THREADED 1:1 WELDED
DRIVE SHOE
,QYES [—]NO
W S CASING (MUTED?
OYES LJ NO
YIELD
TEST
n HOURS G.P.M.
❑ BAILED ❑ PUMPED L.J COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST fleet)
Depth of Completed Well
in feet below Land surface: t
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
80
Drilling in overburden -
Hit solid rock at 80 ft.
80
90
Drilling in rock - setting
90
225
Drilling in rock -
granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
9/21/73
DATE OF REPORT
11/5/73
WELL DRILLER (Signature) ° ° °
.r o
William Romeo
Owner or Purchaser of Building
Kerrol Industries
Building Constructed by
North Street
Location*- Street
3 Br. Hi -Ranch Frame Dxellim
Building Type
PatterROn
Municipality
Section
Block
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 -30 day of &0%vb?4 1971J Signature
Title
If orp (5r ton, lve name
and address) a
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMK ETION 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
a
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.D#MR DIVISION:
INVIROMMENTM HEALTH $f"lw,.
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PUTNAM COUNTY DEPARTMENT OF HEALTH
.S
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0,
Owner b yF-� Addre s s ' Al O�frl, 5; 1047 TER�s ®�✓ ..
Located at (Strbet� . A1gRTf1 6-77 Sec Block Lot
(Ind c3� nearer cross street)..
Municipality /MKT T�/QS0A1 Watershed
SOIL PERCOLATION. TEST DATA REQUIRED TO BE SUBMITTED WITH :APPLICATIONS
Number CLOCK TIME PERCOLATION PERCOLATION
apse p o a er ---Water ve
No. Time From Ground. Surface in Inches. Soil Rate
Start -Stop Min. Start Stop Drog..in Min. /in drop .
Notes:. 1) 'Te':�ts to - -be repeated at same depth. until approximately equal'soil
rates are obtained at each percolation test hole. All data to be submitted.
for review.
2) Depth measurements to be made from top of hole.
Inches
Inches
Inches
q S
5
-tr
2
3
Cana vy o w�►
rE A
T 3
.4
2
3
.
5
...
Notes:. 1) 'Te':�ts to - -be repeated at same depth. until approximately equal'soil
rates are obtained at each percolation test hole. All data to be submitted.
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION`
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH- HOLE NO. HOLE NO. HOLE NO.
G. L(.
6" :..: .
12"
18"
24
301".-..,
36"
7211
7$"
8411
INDICATE LEVEL AT WHICH GROUND WATER.IS•ENCOUNTERED 3
.INDICATE`IML TO-WBI ATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY � f/ 7 Date
DESIGN
Soil --Rate Use d;L/!�- Min/1 "Drop:- Drop." S.D. Usable Area Provided
No:,.of'Bedrooins "Septic Tank Capacity oa Gals.
Absorption Area Prov ded- By - --L-.F.x2411 3 '— �.�`� i 1 r r}c. .
f�LL SECTO/\%-
Address ..
eARMEL N -Y
THIS SPACE FOR USE BY HEALTH DEPARTMENT.ONLY:
PE 04. Z..-
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1�fl/#11t1l1t%i\\
Soil Rate Approved Sq. Ft /Gal. Checked by., Date
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