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BOX 15
01652
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01652
AIIr. & Mrs..Richard W. McGlasson
Owner or Purchaser of.building
Building Constructed by
I Bullet Hole Road
Location - Street
Frame
Building Type
Patterson
Municipality
Section
GUARANTY OF.SEPARATE SEWAGE SYSTEM
I represent that lam 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 tlie\,standards,
rules and regulations of the Putnam County Department of Health, and hereby" guaranty
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 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 occupant of the building utilizing
he _sv's.Lem.
. The undersigned further agrees to accept as conclusive the determination
of the Director of the Division of Environmental Health Services 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._- _.r.._. u _._ __.... �' w_ _ _.
Dated this 10th day of March 19 75 Signa
Title
ss;
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
r
nR- !. CT�eTT`nr '. DEPP-7 T T- i �
•i.na•a'. v'v vl� i i' L' LI'ntli i•�v . ��:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner • e�i�1o� . IQe' i �rsr✓ . AtkqAa4e s s l',A �@
Located at ( Street Agbw. 77 Block ® Lot 6aicate nearest cross street)
Municipality j0W1W ,0%,A, Watershed Cie -eb..
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run apse Depth to Water a Fe-r— I FV_ e
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
2 Z8
2
101-
1
2
.,5
Notes: 1) TeAts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REWIRED-W ]�E. SJUBMIT T F . ITH
Soil Rate Used jLYdrVl "Drop:
_gfS.D. Usable Area Provided
Y
Septic Tank Capacity Gals. Type
No. of Bedrooms 95!-P! )� z8M &4 @ ;—T, 0 e t,:: e
Absorption Area Provided By_A;jg_L.F.x24 5b"- Aoo- width trench.
AV% , Other 4".0
LJ-L r:,l Ica, U U-L
Nil- Hi. prehtis-
Address
P
Ga-,"el Neu,-,; Yprk 109,12 Ali&
THIS SPACE FOR USE BY HEALTH DEPARVENT ONLY:
Soil Rate Approved Sq. Ft/Cal. Ch b
0. 29,ju,
09
E S191-
Date
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