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HomeMy WebLinkAbout0266DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -40 BOX 3 00075 . . .. 106 f I L 16L . 4 i hull 00075 ((( PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Division of Environmental Heahh •-Servfces, Carmel, N. Y, 10512 CERTIFICATE.OF.CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM wA) Of- /�/;T7E/�SoN Town'or Village j/j ?; Located at /�C %� /'� i,L L M0 A P Fa�O/►'�+P %4� � .� T Tax Map Block Owner ilpHy 4 6eye, �FFA CNei.e -i 1 t Lot Job Separate Sewerage System built by Address Consisting of Gal. Septic Tank and LI&CAA /CFT ©/' 7t F /G'LO Other requirements. Water Supply: Public Supply From _ Private Supply Drilled BY - Address Building Type ��� No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? N� " G�RAi'S X; & AL,4 r .,D 1 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of whit are attached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued by the Putnam. County Department of :Health -.,: Date �V1L Certified by P.E. ' . R Ai /.►r.,rsee r.,rr B� vy /�d .. �/ $ a 2 3 Address /fit �✓�L= �« License No. 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 d as soon as a public sanitary sewer :becomes available and the approval of the private water supply shall become null void when a public wat s a ply becomes available. Such" approvals are subject to modification or change when in the judgment of the Co issio a of. H such rev ca n, modification or change is necessary. i ate BY Title j Ij V i 0 ti.�t e� raffr �n 9 fare rtw o NTNIAM. POUM V WART y Q(2a,1iVTY OFFICE PUILOIN)Q - C A6MV19i;,. jogip Vj91IK Thls rep-oft 10 g9 to pa9mPletoo by well driller and smbmitteg to Comntir "ealth Ve. portment t4 ther with l@ re4a;V Nl lit ;Pf nitl�t�l>a A$ $.r;4. pie indicetinq water Is of satisfactgrit bacterial quality bef+are c4rti #icata of �srnstr4tetion C�Dd�IQPI to ISEPLlt3T MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION 9 � J John Agnelli b1dt1zot $$@Ct2 i g B t �_ -. r -5 .. Mp. $ . tlaetl _- .- �--- t'��n) $.At o1Ne3$Bri"a`� 4'pAPQS;P,D G G99APP14P I-t.,.! EATAIB�ISHAt�Id� L r 7 FA44 i 1 Y F?� Pl 0 0014V 4J INDUSTRIAL t_-) CPND TIO S$8 i El QlllLalld® ( ((^� COMPRESSED CARIE �"'j OTHER CASINO ; T -�- iIC�UStS . i 12 f. -ftPrcc TA,�t+t-,.1000 GAI %ron8oz',"7 PiAcrs J ION C QC7J{ /L A . r A-% BUttT LAYnUT PleOPE,PTY OF JRNiv �GE.4:> /F./sA AGn'ECG1 APPROVED TOWN GF PA7TE.P SOJY COU NTY QF P�TiJAM , JUL 1 K' rn 9 y KEPIM' • `'�'1POMIRRTAE d!ffi'LN 1� %yr1 �5 /o C: a +,tom•• 7 -ir ;-He-�fw<�4L D <svcsAt Srsrc..,W.+s!'nNJ�.enCSF <j �NAfpp<a.eo.aNppftl./rN .4�,. .P�aes ,PC,- WAT,,:�,r ✓r /:e P. T,�. �• v�r..,'% % /['nt TN ✓LOT 7,1A, %+ h/N :' /Tae lNJFY'C TAO L'� !YIC UfF'a2f !7 %✓AS yeZ f0..,� ' ���� ��j�•• gyp• VETR • 08023. • •._ . • • , i O P-1 ;4;�., : L/C IRrc r4 h t � S76 °79 ?JI "E p7 117oE 4 is 2 F }A A- eeseRvew 13. N /O• /9'00 "f 99.f7•! 10AL A, *WNYIIkpft~,Vr • e• Bi cN /�it c e.,AO ��oP6�P7i'/OF ✓GNN �GEi+!0 ✓E�i'A.f)i6�AElCI... �` iW../. -- - %ww OF PA 2TERSoN CcuN7YO <'LtJ TN!!M RPROV L. L0eAnoe/ 1+14P 'f%ouSE SANITht�/�¢/UT/FS JULB WTN • Q�FFS310� •• • pETR� ��••, 3 O • *802'a • ' O. PtneutiEUO,R t... BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. .WATER ANALYSIS REPORT SAMPLE NO. 4088 r SouRcE: John F. Agnelli,Jr. faucet well Lot # 2 No. Birch Hill Rd.i Patterson, N.Y. r COLLECTED: July 17, 1978 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 Der 100 ml. This result indicates the source 'of the samplo was of satisfactory tanitary quality when the sample was collected. a, t e. Qp�e.h o JP 4"( A rue_ l l Owner or Purchaser—of Bu lding Building C structed by t 4i1% RA N �I Location - Street 13 ; �n_ Building Type 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 ha.s_ 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 succe.s 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 followir_g 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-1. 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 sy;- ") Dated this A day of w 19 $ Signature " JA ?� Title ` If corporation, give name and address) 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 PUTNAM COUT TY Dr.PafiTIN r1T of Trr�;r�Tx DItTIS10N OF E C IL . �A1 SERTICEA S - " "COUNTY OFFICE'BUILDING9 CA T RN N. Y.: 10512 y .fir .. yDESIGN DATA SF'T= SEFARATE SdAGE DISPOSAL SYSTEM �d{/4y 1'i-,4 Address :�.� � r �/ ,= a� t� ! ��� r �•s + � �' �` }Located at See.:- Block Lot. 1n lca e nearest, cross street) Mwdcipal ty Watershed SOIL PFRGOLATIOrJ TEST DATA RE UIFt.D TO flE SUi�' IiTED,_'rJITH_._11FP:.LICA` I'O S o e: ' Number CLOCK TIC PERCOIA T ION ": PERCOLAT 0,N` 1 Run Elapse Depth to .va .er ester Level "h �s No. s Time;, From Ground - Surface.' xri Irc So7.l Fats Start Step, Min. Start Stop Drop , n �tilin..�`in ,drop- Inches Inches Inches ., 2 3 5 q. i 2 Al 5 Tests to be repeated at same depth until a . proximatelyy equni .so.t] rates are obtained at each. percolation test l A I data to be si&,,iittoci for review. " 2) Dopth measurements to�be i-aade from top of hole. , . f4 �rAL Alt NS W. Woe bs ko ir sa af r vs YV e - 01-14 ^Vo�l 1E E Z,6 V -r &Aar& 0 z z RA