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BOX 17
01854
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bPUTNAK_C6 Ugvv 'bty U
ZTM T
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visi,
of nvironmen61-Health ;,&P&kes,- Caf
10942,
..CF.RTI F NSTR 'IANCt':.FOR'.-,q E-WAG t POSAL.SYISTE
Patterson.
'
cATE--OP�CO M.
Town or village
L dkle':E� f 'Drive
P_ s 1 6; n Block-
Located at
�
-
Owner FbrForrester Forrester Builders '
Job sUb lot #20=
Separate sewerage ,Sy er.-but,.by
iUt_Burdick: ' 'York: rews,
Z --conc.
Consisting. of Gal:: S 8 p ic.
Tank Feit-
'
, Idthrt rihch.
��Z4� All
o 'h4 --..r 4U 4 ent . S.
re
4U
Supp I y: Public Supply From,_'
,
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clan fi S
e �j
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rme N
:1,
Address
-Ae ` & -1
fenc
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bu lid ing., TypW 'N 5 P
4,nii
Issued
'V V�
_Mas rosip ' n ' Contr�ol,B_ een .f .,Cqq'p
, - - . � I "
104
X R certify ,Ihatjhe iysteh(s)asjisted serving ifie-ib64h Oremk6s�were.cbhstru�t� n
rs ;Ine.,UcomplqtedA w.
or'k -(c
O-P!es of
".attached), and in accord r66 with `the lstandards ruies-ano r lati plans U1.n County Department
- of -Health.,
Date Certified b
P.E.
•
L 7
r, Atld�ess
unsanitary
-
rvea- by, the above systems) .shall, promptly takes -a to secure the correction "of, any,
Any person occupying -premises se
s res . ulting rom,' ' 'usage pr v ate sewerigoi_�system sanitary, ewer. becomes,
condition f'^ --su-6hz 'L . Ap" 0 al -of.the s�epar I s 'soon a public
:SUp-Ply L ly.. becomes available.:- 5uc, jp are
av'ailable and the-appioyal_�8f .the � -:Pi i Vat e 'Wate r shall become,null -arid viol
jLfdqment';of_,the Co s§ _ner� catl a
ub�eet to. -mbdiiicatibn �6-r -�cnan4li-.�Wheh; 'in, the onI,,mq.4ifi ori or change. - necessary.
Ti
D*ate'— !le
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"BACTERIOLOGY -;7PAR-ASITOLOGY qY -4
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PL
rANTIBIOTIC_USED ,
U k REQUEST =bake
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Negative 7
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YSIP
RfRT �O.C,;ZU5�,,-jiEMOLYTIC
Proteus
-in
Psq6do_r`hd'hif_I
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,oxadil,
i in
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0 N' a
-Penicillin
D: He4iaph�lrs
T
Tetracycline -.
_T
_VBfgCyt_ 515. SMEAR TUBERCULOSIS,
Triacetylole�a
gcidFast Not
foiAdd f4
�k Mpj'Cjllijj
�t
!0 04 j ast Fq4dd, -
0" C;ujtUrjjS 0 A, For
No Cdlofdrm B a C' 113 13 1 1 soldtlld: from spe c iman - subMi tted'.'L
P.I _TNAM. COUNTY. DF-,iP.ARTMENT OF HEALTH
M. x 5eprarate Sewerage System i-3
r. R"LI CZpa .ity
3 STRUCT IO:N '' P ERMI T
=' ocated- atANp rAec�W_,njl4IN ?w Vi Section Block
u sion MO A00 VZ5 Lot Job �55' T
c+
ter1 0- �IieiJ Address`i -T- AIIJ G, �=tS Lot Area
ia3lding
o. of'Bedrooms t-° Total Habitable Space j'' sq.ft.
e arst`® Sewe'ra�e 'System to consist' of 1100 Gal. Septic Tank .� lineal feet
sue,.. ..�. -�...
4
q th trench
be constructed by Address
"ter. B, 1" .'. Public. Supply. from
L4rivate Suppy to be drilled by
K Address
-ho r Requirements
x�opresent that' -I am wholly and colipletely responsible .f.o-r the. design
: lop tiar of the proposed systeia'ys) : 1') -that -..the - se -ara'te '96. G - d s -.
I atem_ above described will be constructed as shown on't e approved
axz OV, pp oved amendment thereto f.nd in accordance with the standards,
re'gulatians of the Putnam County Department of Health, and that
,completion:, thereof _a "Certificat:,i of Construction Compliance" sat-is -,
.
dory tothe.Commissioner of Heal'--h will be submitted to the Department,
y` a written guarantee will be furze ;shed the owner,. his successors, heirs
nor :assign61,by the builder, that said builder will place in good operating
.an }sang 'part of said sewage disposal system during tho period of two
years imediately following the _date of the issurance of the approve.'.
V o :the Certificate of Construction �'ompliance of the- original system or
: Yp
kh rex�si�rs -,thereto; y 2; that the dr Llled well descri es abdve will be
,s-cated-.as -shown on the approved pia i and tit sa. sfa l' w"l . be installed
' in 'accordance with the standards, ru -Les and regua c4�ns a� �h ;Putnam County
r ..'
`$}epa.rtent of ealth.
yc
y T yfr <f -ice rg I
r,
1 _Date Sl: ;n r
AFPROUID FOR C TRUCTION: This a, proval e.xpi f1spn.p�o,ar�; ;; : the (fate.
f, �.
issued unless construction of the a :gilding hasiec�b- an is r
vocable': for ::cause or may be amended are modified w� = %ex� .a;,�� �'c��� �d neu .��, :�.xv
Y. the :^omtr ` ssicner of Hea? th. Any change or alterat > >,oY2 �c3f co�ns.t ruction
7^ ud3' 3, a w permit. Approved f �r disposa of dorr�estic son' ;s:ry sewage.
-Dates By
S� r
d
Forrester Builders
Owner or Purchaser or Building
Forrester Builders
Building Constructed by
Lakespring Drive
Location - Street
Residence
Building Type
Patterson
Municipality
Section
Block
Sublot #20
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 systggm- �
Dated this day of
19 Signature
at Goldens Bridge, New York Title
11, 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
V
MCOUNTY OF WESTCHESTER DEPARTMENT OF HEALTH-Division of Environmental Sanitation `y
DESIGN"DATA SHEET - SEPARATE SEWAGE SYSTEM FILE NO.
Awer S'i Address jJ®PE �.I�A(46;r 96tV 401
Located At (Street) JAr Af?
Indicate nearest cross street
Municipality PW 7r F 6p S o Al Watershed__ if W Y®
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole r
a'
'
1
Number'
e
' PERCOLATION
'PERCOLATION
'Run'
'Elapse
'Depth to Water Water Level'
.!Vo.
' Time-
'FromGround Surface in Inches
'Soil Rate ,
' t
.-
Start Stop ' Min.
'Start Stop Drop in
'Min /in..drop
t. t
t
'Inches Inches Inches
'
�p r r
t
V
MCOUNTY OF WESTCHESTER DEPARTMENT OF HEALTH-Division of Environmental Sanitation `y
DESIGN"DATA SHEET - SEPARATE SEWAGE SYSTEM FILE NO.
Awer S'i Address jJ®PE �.I�A(46;r 96tV 401
Located At (Street) JAr Af?
Indicate nearest cross street
Municipality PW 7r F 6p S o Al Watershed__ if W Y®
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole r
a'
r
,
Number'
CLOCK TIME
' PERCOLATION
'PERCOLATION
'Run'
'Elapse
'Depth to Water Water Level'
.!Vo.
' Time-
'FromGround Surface in Inches
'Soil Rate ,
' t
.-
Start Stop ' Min.
'Start Stop Drop in
'Min /in..drop
t. t
t
'Inches Inches Inches
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Notes: ,
1) Tests 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 mado from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS -ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLENO. HOLE NO. HOLE NO.
t
X 800115MEM -
INDICATE LEVEL AT WHICH-GROUND,WATER IS ENCOUNTERED
INDICATE LE
�
ER.LEVEL RISES AFTER BEING COUNTERED
1
V%fi3W
TESTS; MADE 8 13'WAg SOCIATE ENCOUNTERED
CONSULTING ENGINEERS
GOLDENS BRIDGE, WEAIGN
Soil Rate Used n/1 Drop: S.D. Usable Area Provided Go. #r- r
Septic Lr.s
No of Bedrooms C Tank Capacity --a N Gd s.
Absorption Area Provided By±L.F. 20ax*�61 a c r
Name BIBBO ASSOCIATES sighatur,
CONSULTING 5NGINEERU-- 7z
Address GOLDENS BRIDGE, K. YA SEAL
OFMW
Westchester County Health Department
Soil Rate Approved___--.-Sq. Ft./,Gal.
S.D. 27.6 (Rev. 5-24-66)
Checked by----,--.,-�at*-
32—
32 - - - --
32 ' Go
32- t
BIBBO ASSOCIATES
CONSULTING ENGINEERS
p GO—DENS SPIDGIF.. N. Ya
C\
w IL
AS BUILT SEWAGE DISPOSAL SYSTEM
CD
APPROVE,
................ . ........... uiu
FIELDS.
FIELDS INSTA'' z
M IN. WDE:MEN.��
-D BY, m
t> t: i IZ-k SYSTEM INSTi.'LE
3
. LOFfl-00'
OF, HOOP
DATE--
SCAI L' la-M
AV
32—
32 - - - --
32 ' Go
32- t
BIBBO ASSOCIATES
CONSULTING ENGINEERS
p GO—DENS SPIDGIF.. N. Ya
C\
w IL
AS BUILT SEWAGE DISPOSAL SYSTEM
CD
APPROVE,
................ . ........... uiu
FIELDS.
FIELDS INSTA'' z
M IN. WDE:MEN.��
-D BY, m
t> t: i IZ-k SYSTEM INSTi.'LE
3
. LOFfl-00'
OF, HOOP
DATE--
SCAI L' la-M