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HomeMy WebLinkAbout0780DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -88 BOX 9 j , II 1 1% IN ` I_ r ri 11 I � 1 Yom. �. • `PUTNAM,COUNTT,VDEPARTM ,� Dtvlakin;ot Pwlronmeotal Health Servl �ATE:OF +CONSTRUCTION COM UMCE:FOR SEWAI , -, i SS ` Owfiei /appllnrit Mailer Addmu 5 d�Gl rr< Feet.Enclosed, AmountpU,= __ Carmel, N Y 10512 �`,,•��, ` 5 [ a g •e y a Towrn or ,+DlaQe o� Tai Map "� x "Block =_Lot SabdlvieMe:Name/ ?� H n� Suldy Date Permit Issued ,� , ,;( Consistblg of / U Galion Si.iik anh 7� •� �bs or,P ��t ; .7t`7; °ter c and Watei Sapplyr ,t Ppblic SaPPl3 From f Address' - r on Private Sappy Drlli{ed by Addeees o �- �" fit, • .. Dwaus- IPCJS; �,�n����_(JLot _. Size ✓ ` Has Erosio Na i W of Bodroome Garbage�Grinder Been InetalledY ' +' 4` a 1 � e � Ofbit'Requir'eOlentY I cartify ,that' the -eyetes(B)'ae liatedteerving the above premi ea Vera :constrtictgd`eesantially.;al ehown.on ihe;'planc of ,the coapleted york_( copies of which are 'attachedj, end in,;accordanca with: the standards rules and i aiione in accordance witA a led plan and the permit i sued by the pumas County Department of Health :} 4 �: Oats Z r CatiflW by p E: RA._ _ Addrasr� �� ` Lken" Any pawn occupylnp.prontas'.Nrvad by tars such salon as may bi naoutiry t0 iituri tM corr, caWo of,iny UnUrl tonditbns rawldnp from lush urge APprovsl Of tM, pi►at0 'wwaap� syrta ► iliall b null arw vold'as won is b pupti Ynita►Y, www boo evallibli anal "0 approval of tM privati watts fupply3fha avallib'M. Suth approvals wbi!ct to if katbri o► ebinpa whin; in he, judprtlN►t of tM;Commlaibt of c/ R `loth ravotatlon;: modHkatbn or; eMn4a ta' naeaw ►y.. 3/89 Oat BY Tnla`_1 ti y. as iwl PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENIAL HEALTH SERVICES %n cl Owner or Purchaser of Building Section Block Lot Building Constructed by Location Street 1,42 #z? Municipality P J_, I AlC 4, Building Type Subdivi ion Name 6-4 � I Subdivision Lot # GUARANIES OF SUBSURFACE SEWAGE DISPOSAL 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, rule's and regulations of. t''utna[n Cr�Urity Deparlwent of H a.Td .hereby guarantee to the owner, his successors, 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 iamediately following the date of approval of the "Certificate of Construction. Compliance" for 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 occupant.of the building utilizing the system. The'undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the tern to operate was caused by the willful or negligent act of the occupant of th ild* utilizing the system b . /J A day of 19_ IL Signature 0, L,� Contractor (Owner) - Corporation Name (if Corp.) Title ture ,III T P't1 11 - ccM44r _4_1c, Corporation Name (if Corp.) dye- Address P lobo `) rev. 9/85 mk 114145- eel ess I `r�M ro T.TCT T rnMDT PTTnM PPPnPT Jam. ►Y 1JLL VVaai LLJi iVL DEPARTMENT OF HEALTH.. Division Of Environmental Health, Services'-- PUTNAM COUNTY DEPARTMENT OF HEALTH ��t# Office Use Only ``:- Q ." WELL LOCATION STREET AOURESS: .-TDWN/V1LLACVCJ1y TAX GRID Num8a-'.1., " Im Rd WELL OWNER NAME: v5 5 4C./9�J ; :.?S� wit :L,t% Qc1}on /C • J(/i`%�. . O PU S. BLIC USE OF WELL 1- primary 2 - secondary eRESIDENTIAL O PUBLIC SUPPLY . O AIR /COND. /HEAT•PUMP O ABANDONED ' ":`. ':: ❑ BUSINESS O FARM ❑ .TEST /OBSERVATION O OTHER (specify) • - O INDUSTRIAL ❑ INSTITUTIONAL ' `0-STAND -BY : ' . ; . ° O MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED % EST. OF DAILY USAGE 600 gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY '... 'O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3�� fL STATIC WATER LEVEL �� tt DATE MEASURED S S DRILLING EQUIPMENT O ROTARY COMPRESSED AIR PERCUSSION O DUG ❑ WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASINQ OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH ;a ft MATERIALS: KSTEEL O PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE 70 tL JOINTS: O WELDED eTHREADED O OTHER DIAMETER in. SEAL- ❑ CEMENT GROUT BENTONITE p OTHER WEIGHT PER FOOT /7 lb. /fL DRIVE SHOE.-VTYES O NO UNER:O YES eNO SCREEN DETAILS OIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (f t) DMOP07 FIRS YEs ONO OURS ECONO Gqo�l GRAVEL PACK YES O NO v SIZE: Top OF PACK _.�•h DEPTH !L II TTDat DEPTH tL WELL YIELD TEST It detailed pumping M 00: O PUMPED tests were done is in- � COMPRESSED ATR , formation attached? ❑ BAILED ❑ OTHER i ❑ YES ❑ NO WELL LOG it more detailed tormition descriptions or sieve analyses are available. please attach. DEPTH FROM I suRFAcE Watu our- ing Wen Du- meter in FORfdA710N DESCRIPTION p0E tL It. WELL DEPTH It. DURATION hr. min. DRAW GOWN It YIELD 99M_ s rl;ct /45 O Q '39s, 6 ao 5 7 70 Ro WATER IdCLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAL. WWh TEHYATT & SONS, INC. DATE 10113 ADDRESS Well Drilling SIGiAMRE Rte. 311 R. R. 2 Box 171A PATTLRSON, NEW YORK 12563 41. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP r , t f It J t J. " r for ��L �. • / ' I r � -r!i •TiE�� � •ti•� j � S.'' : t��s'..':�1�`���t� �'' t. !a't;�Y•1r�' '� .:fta�� S, :i$ 7 .A•+. ,. {� ;• i �'7,3•�•. s�r,[ ^�1��.�1' L �± ,it•. L* 4,ti r.. r:F�� ii'Y'r S�{..(y -(""�y Y- 11[ w BREWSTER�.LABORATORIES ;; Box 224 }BREWSTER, N:Y..' _ r_: ,. r S 1{I...•� \�. •h 1•tMr 4 EE [�f :i r.{ .: �... �.. I eh 1•. Ct 1' l�.� � . ,l 1�•.,y ~' ,�' % ' %{'�,,� ..}'. / Sr f,.i� , l ^• S,[�,i,L.i: .a• 914 t: r �j 279= 4945 :t - } ..w 1 r:f S ' >h t ti +� 7 r J' eirk' _ I RC Y• " i. r 't• � t .�f .y �.. .l - > ) •v ti•, 'r. .•r �' � � t y L iy TER (ANALYSIS REPORT - Iw.•` ..,iP ••,r:. J• `Y '4.77 :J:' +: %.'rt°ir1 "a . :'r•' .. °$% n•• �` 4 a •4� .� , Krn•" - yy L _ l r - �. :SAME LE'N' 74 "82 ��. :,:� • ,; ;:_ "r` ` :�' • .,., �,:,�::; � • .; . r:•.. •�.. WELI�'� •LOT 1 '4 .�: .�• - .�:'� h'a c• �� Big Elm- Rd'. s.r Ross:;,A�lan: � ,.� :,a,�;•,.Y�... ,.. 25 ` B ram Lake Rd ', Arm , :.ice'•: lr. K :; •Y i[ _ ri l J.. . This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. . , homas Me Director ' S Dl�iflw at�rfrrrilai 6ai1�lae.len. � rmar cos �swnas n�o�w►i sra� � � - , . , AMROVEO ROft; CONiTRUCT1pNiT1iM + F flla�� h T l�Sl? CMMMAWdr-CO r _ rtrt e 1w: I) -that tM N tilpN 'Nw0 0 fll OYI fyitNl� N fta�efarAt,._IYNt ah ff/Y O �11�� ." satisfactory to the CommhNofw of.MSlthwlll, Ilk ! r!oM v aMsnvMnMtret�Y t Mtttw%s."."Mdw. aw »WIal NM ,wIM the INUfoilowie th•fit•'of It the drw" wtr11 doweed aiona i s 09 s Sf the:'PiAMm .tbh • of ,tha abuiWi" undorUkiWi aml is INK113 'Any. Ntaiyi_`oi'fiKafitlon ot•fotMtrYCtlon r M i to S>3bdPPv, {��si^^on,:Apn ovE DTJ i r •���;�rr �I' F wflb; p . :� raarunt Mt 1 ant whouy;,aM eanolatfat //0fi MtaiaO will N fleert►uet}e of Mow = Owneir _Oaok� of Oslo. a" tA.t M wlMw Rtr. th tM ONMtMitt. aM a _ Mfoa haw ;few:.N.ftM awitAeNii.,+�. r r MOO 'N 3M .MMOwI w the CA tlotate f : ^ irlll.N'.boNaa as Mm "Iw th ,- ii-6 it f!t cdwa.y OGWallaltt of ►IMItA. ` coo _ 4 . , AMROVEO ROft; CONiTRUCT1pNiT1iM + F flla�� h T l�Sl? CMMMAWdr-CO r _ rtrt e 1w: I) -that tM N tilpN 'Nw0 0 fll OYI fyitNl� N fta�efarAt,._IYNt ah ff/Y O �11�� ." satisfactory to the CommhNofw of.MSlthwlll, Ilk ! r!oM v aMsnvMnMtret�Y t Mtttw%s."."Mdw. aw »WIal NM ,wIM the INUfoilowie th•fit•'of It the drw" wtr11 doweed aiona i s 09 s Sf the:'PiAMm .tbh • of ,tha abuiWi" undorUkiWi aml is INK113 'Any. Ntaiyi_`oi'fiKafitlon ot•fotMtrYCtlon r M i �<,. . -.K ....a:.�+ .,. ..e. r - ....a ,, • +r.,^a -.; ix;r, -"a :�srr!- 6iT"'. 'fir- — 'wn �.._`_;µ: ,' DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT: ## - 7/ WELL LOCATION Street Address To Villa a Cit Tax Grid Number 61 �Sa�' N4_ _ q I WELL OWNER -Name OSS Mailing Address � 6162 -L AD Q?m /z rvate _. O Public E OF WELL - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY D ABANDONED O OTHER (specify O AMOUNT OF USE pp� YIELD SOUGHT gpm/ # PEOPLE SERVED , S /EST. OF DAILY USAGE bgal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION D. ADDITIONAL SUPPLY &M SUPPLY 4NEW DWELLING ) 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ODRILLED O DRIVEN ODUG [:]GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 0/E Lot No. WATER WELL CONTRACTOR: Name Z2 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N//�- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH &,SOURCES OF CONTAMINATION PROVIDE 8ON SEPARATE SHEET (date) ignature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applican t any and all water or waste products from such well property and in such /a manner as not to degrade o Date of Issue: Z 19 -/,+/�/J /�/ Date of Expiration (� 19 -(=:2 Permit is Non - Transferrable 3/89 shall take appropriate action to assure that dri operations be contained on.this r o e wise contaminate surface or groundwater. it Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller ITNAM COUNTY DEPAP.01151 N OF HEAL D 1 OF ENVIRC HFALT$ S S Y DESIGN DATA SHEET- SUSSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.' owner Boss 4 G AIV Address 2 S ;B i�'A/''/ C � �E `. /�� .A�Pi"I.O,Vk MY le s'o ¢ ao �D 9T Located at (Street) Ae /,. Z 2 � 1116 ,EZM RogD- Sec-(0) 9 Block Lot 7• Z� (indicate nearest cross street) Municipality Watershed CRd T o -,V SOIL PERCOLATION TEST DATA REOU IRED TO BE SUBMITTED WITH APPLIMICNS Date of Pre - Soaking 7 .�/ 8 Date of Percolation Test 3 7 I 8 HOLE .. ML ffl t C= TIME P-rRCOLATICN PEROO TION . Run Elapse Depth to Water Frcm, Water Level. No. Time Ground Surface In Inches Soil Rate G o 7-t Start ,Stop Min. Start Stop. Drop In Min/In Drop Inches Inches Inches 2. 2 /o, -c 9- /o: 3 9: 4. 10:69 -So ..2 /0,V0 4 5 1 � ' K rev. 9/85 4 TEST PIT DATa RDA DES -:;.)N OF SO G.L. 21 31 41. 51 61, 71 81 go 10, I�4 AMY 101202MM: TES ENCOUNTERED IN TE HOLE NO. si�ry lo Iva /?0 C & 0 W4 TEf HOLE NO. 121 13' 141 INDICATE IZV7fM AT WHIM GROUNDPZATER IS EN00UNTERED A/4 A45' INDICATE LEVEL TO WHICH WATER IMEL RISES AFM BEING DEEP HOLE, OBSERVATIONS MADE BY: Aj/ rc C C'Ar DATE: 7/? �8 DESIGN Soil Rate Used Z' /- Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type CcAIC- Absorption Area Provided By 6 7 L.P. x 24" width trench bf NEW*-% Other OR SAZIT Name Z,4 I)Xl—rW r IU/6 1.A1.CEPV6 AS30C.,,PCSignature Address 73 tr'41'Rf'1',5z1P- Ple SEAL 0 0 0.6451 THIS SPACE FOR USE -BY.HEUM DEPARDOM ONLY: Soil Rate I Approved sq.f%/gal. checked by Date I >`?UTNAM COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: %ASS A Ali ,� S �Y��4•ri -, � EKE` l'�'�4 �7 2. Name of Project: �/e0P4SE-D sspS 3. _. Locationo/v /C: a 4TTneQ eIJ 4. Project Engineer: Gv i0 LS OIL 5. Address: 7J OAIleF_L�(.D T)7—. tV7- M& SS6c �C License Number:. .Jc& f"I" Phone:';Z�7e- ivy 0 6. Tv0e of P o ect: Private /Residential Food-Service = Commercial Apartments Institutional Mobile Home Park Office Building, Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status.(Check One) Type I... Exempt Type II. Unlisted. "8. Is a Draft._Environmental, Impact. Statement (DEIS)_requi,red? ............. ADD 9. Has DEIS been completed and found acceptable by Lead Agency ?............ A)P 10. Name of Lead Agency dA 11. Is this project in.an area under the control of -local planning, zoning, or other officials, ordinances? .......... ............................... A)� 12. If so "have -plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? AA14 Date Granted: C. 14. Type of Sewage Disposal. System Discharge...... Surface Water i�•Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 14 16. Waters index number ( surface ).......... ................ AU A 17. Is project located near a public water supply system? .................. A% 0 18. If yes, name of water supply A)lA Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 100 20. Name of sewage system A)lk Distance to sewage system �21. Date observed: �i -�� ��1 23. Name of Health Inspector:. G1�71�in J� 24. Project design flow (gallons per day) ...... ............................... (gam (✓ l� ^j •, �' 1 'j i 2 • 25. Is State Pollutant Discharge -E,1Jm !nartJon System ( SPDES) Permit required ?.. A20 26. Has SPDES Applications =been submritt9dr A' to local-DEC Office? ............... A i, . >., . s 27. Is any portion of this project located within a designated Town or State wetland? ........:......................... ............................... /00 28. Wetland ID Number ........................ ............................... AJ 29. Is Wetland Permit- required? .......... /IIiD ............. . .................... Has application been made to Town or Local DEC Office? .................. l� 30. Does project require a.DEC Stream Disturbance Permit? .................... �O 7. 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops; solid or hazardous waste disposal; landfilling, sludge application or industrial activity? ........ YES or NO /%)0 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, ill, -sludge disposal site or .landf any other potential known source of contamination? ..............YES or NO A) 0 DESCRIBE: y�S 33. Is there a'local master plan or file with the Town or Village? ..... ...... .. 34. Are community water, sewer facilities planned to be developed within 15 years? A) 0 35. Are any sewage disposal areas in excess of 15% slope? ........................ A) 0 36. Tax Map ID Number ............................................................ °� �•� �' �� 37. Approved Plans are to be returned to: ................ Applicant K Engineer rf the application is signed by_a person other than the applicant shown.in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: �G2us►�.l P: _M c.0U N, 17 Y cH: 3 :a i E N T CF i=_, LM - DIT.%_SIC.N CF �-vi-cCN��"=r, �. =r,l _1 S` -�: SUPPLY & SUES'U_R AC SD?C D =SP�� S :SE'S J14A4 Lie- loll LF 2 _nch : rovide3 60 =t. r. ! 0 0 ex-J. i 1' I " I i I I F I L C r5z j: S cl_vter_ _ =r 10 fill rot=s P.ew s:r- -c. decal Ca" ^es I' 100 vr. flood rev. I 200 f res=_ vo i r, etc. I 50 fz. trot Lo.: -tic^ ) NO a1 U%•- .S Permit zol i cation Corr-rate Rasoluticn A Plans - Three sets EncLisiars zathori zsticn resign Data iDDS ) I. De-o Cole ? rC Res'' is P_=c col°_ Deotiq s/S S7 -- - .sSICN (3) i_ -- _iE_ House Plans - Two sets- Nell lette �7zi-• G�ce - �_ .Y.� :J Legal SubC1v_S_on Subdivision A-pproval Chec e1 Ketiand r. Data On DDS Pl`'s/�� &7 'Permit Sa -me R:QU?R� J� .� 1 1 ON i Sewage S j s ail Plan - ( nor _1 arrow) D or J Di s . j Sep-tic Tank - S_zia, T'cY;l We11 Detail, S ry ice Line i = over C-Cns`'_c icn NOSes (v=1:1Cer rate) Tesign Wita: _r!";. andJaeeo r=-s--,' .s Driveway & S_oc =.s ='CCU? i�Gatze'",C:ux'`.., in Drains Pero & =_eo rAleS L✓ w= _ =ter Se :ii :tipe OF pr_r— 2'la et_c'- -c:? Ex7,nsion Aie_=;si :O+v??;yrcv_Cy rlav,s-- =. s_ze Ii Fr' Pit & D Ecx Showm & House - Nb. Of ?e3_ro i .s Wells & SSDS' C w1in 200 i =. of P.-o c-c�. _= 5 er-5 Pro nerty Pe es & rOl_se Set.rC{ Necessary (-1' -7 :it lot) House Sewer - 1/4"/.ft. 4'10; Type p No Be^-as; Max. Be ;.s 45° w /cleanout S_aaRA'TION DIST .N=E S=­T= ON P_iN Fields 10 to P.L. , D_ i ve =Y, Large Tres, r'-_ C _ i 1 i . 20' to Foun��.ticn S•;=' 15 1001 to Well ; 200' in D.L•.O.D, 1501 nit- 100, to steam, Watercourse, L=_}:e (_- .. _\ w.n) 15' to Dr =_-r 371to catch 10'. to Water Lire (o; cs -20') - - -- 50' irta-T_tt°nt coo -'se S =tic Tams 10' Fran F ocncatio ; 501 to well 13' Well to ?r 0 AS- f5UILT DIMENSION CHART N° A 8 1 32 28. g 2 28.3 .10. 3 3 32 4-i . 7 4 360 5 5 4f.I 54.3 G 47.7 7 50.5 8 76-co 30, 1 77 . ca 34 10 78•Cc 38.0 1 1 80.0 43. ro 12 s1.7 48.0 l 3 bqt• 2 151-3.0 14 (3.Z D2,.0 ' 15 47.7 D5, o Icv 54.2 100.0 17 55.5 103.0 ► 8 �0 5 .7 1 OP). O I°J 71.5 11 1•b THI5 IS V CrKT►r-'f THAT TH5- SEWA &E L?160✓AI.. 5Y5TEM WA5 wW5TKUCT5P AS INPtC-ATe-:P ON THIS FLAN AND THAT THf: SYSTEM WAS KGMC -r�,:P PY M>; IT WAS covEKE�p 47VM . THI: s'f5TEM WAS caNSTK- UCTI✓P IN ACGOK.PANCr WIT[4 ALL STAKPA►2D K.ULE5 Af >O K ULATIOt�Is Dr THf' f UTNAM GDuwr -( Pi5-rAr.TMEN1' OP NtALTH AND TH6 Nirvd `tDKK GTATI✓ PEfAKTMf!5-W -r O>= 'NEALTH NOT11 HOUe,EE AWP W5-LA- LOCATION TAKt'Kl ;:--K.OM SUKVE5Y OF PKvMKTY , rr-E, kP P FDK, JOHN A . JL)PI A. GI KOCG© - LO-r 1 IKEVI52Ep DATE 5F PT. fKE. PAKgD r3Y TERRY WUAWS, L.s. I Vj�l L. _I OROJECT CL;ENT r:IA-T7�K-'54 I C)RAWING AS- 13UILT' Pon, jivision of Environmen 'a, Health Service :7 rg with C, 0 0 ec'Tr m e ,I, p io of the applicable le jules _ d ggu.lat . ns )utnam County Health Department. :P�