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PUTNAM COUNTY DEPARITAENT OF
En
CATE: I OF-CONSTRUCTION COMfPUAN& F . OR SEWAGE ]DISPOSAL SYSTEM .-T'. ,Rutnam Val,16V.
265)
Malung Address 154 -Noith Street zip 10960 Date Permit Issued 8/9.85
Peekskill. NY
Separate Sewerage System,bflt 4� Greg Xac&lusol Address Mi I I t own -Road, H6 1�k! s , VY 12531
&,,Iitwg of 1000 Gallon Septic Tank and
Water Supply: public Supply From Address
. or: ------- j I L-.�.— I Priva . te::Supply Drilled by Boyd Arteplan' wallAddress Rte.. 52, Carmel, NY 10512
Number, of Bedrooms Thrpp Has Garbage Grinder Been Inistalled? n 0
I dertify -that' )6 An
'tlie system(s A lAtte '� Q ab, %WV0nb44M'bissntially as shown on the plans of the completed work ( copies
of which are attached), and in I accordance I with the standards, rul!q and reg . *ations, in accordan�c . yith the filed plan, and the permit issued by the
Putnam County Depirtmieht of Health.: -U :,Ap -,,I
Certqljd by
Address k1l 9-Fair St. -.0,Armel, NY 10512 License No.— 29206
Any person occupying promises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any ununitary
'ndit ons resulting from such usage. Approval of the 'Separate 50104411196'Wftin shall become null and void as open as
11 "� tne approval of the. private water suppi 'j-' ' "' jl' d voidi "an a. 1j,ub-lic Vat i supply becomes available.* Such approvals are
available an y hall become nu - an ff.
subject to" modification 'or ihangi when, in the judgment of the Commissioner of ealth n, modification or change Is necesury.
Date 7 qap- By, Title
----- '-' -------------------'-----------'----' --'---------------- -- -----
. PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROlZMAL HEALTH SERVICES
Owner or Purchaser of-Building
Building Constructed by
Buil ing Type
7
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARANTEE 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, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the
�ownr h is successors, heirs or assigns, to place in good
operating conditi the
system constructed by me which fails to
operate for a period ears said
following the date of approval of the
"Certificate of Construon Compliance" for the sewage disposal system;, or any
repairs made by me to such system, except where' th6-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 system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this day of - QnG19 '(� Signature
Title
Gener 1 Contractor Signature r'� -=
t'` ^ \h Corporation Name (if Co o)
V _ _ 4 anon (� c
(if eft.)
�\.�z-v..
�., � t rLS2.;
Address
K)A
rev. 9/85
mk
PUTNAM COUYEY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Gayle & William O'Donnell TM 5 1 7
Owner or Purchaser of Building Section Block Lot
owners
Building Constructed by
Pudding Street
Location - Street
T. Putnam Vallpy
Municipality
Modulate
Building Type
0
Subdivision Name
Q 42265)
ivision Lot #k
.L. GUARANI'EE 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, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any a t of said system constructed by me which fails to
operate for a period of ears irmediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
ze - irs made me to such s stein except': where- `tti f
by" Y p e ailure to operate. properly
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 system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this 4th day of June 19 86 Signature
General Contractor (Owner) - Signature
Gayle & William n'DnnnPl1
Corporation Name (if Corp.)
154 North Street, Peekskill, NY 10560
Address
rev. 9/85
mk
Title
Installer
Greg Macaluso
Corporation Name (if Corp.)
Milltown Road. 1
Addre
Gayle & William O'Donnell
Owner or urc aser of Building
owners
Pudding Street
Location - Street
T. Putnam Valley
Municipality
TM 5
Section
1
7
Lot
Subdivision Name
Modular (S-n. domq,)
Building Type Subdvo Lot #
GUARANTEE 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 guarantee to the owner, his su
ors, heirs or assigns, to place in good operating condition any par of
said system constructed by me which fails to operate for a period f ��Y�
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
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 determin-
ation of the.Dir-ector...of the Division of Environmental Health Services
of the 'utriam - County - DepaYtment of Health' as to whethe� ' or ' riot -tine -.fail ..
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the sys
Dated this 4th day of T „ne 1986 Signature
Title
Corporation Name (if Corp
NY f101
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
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEA:
Division of Environno its Nealth Bfsrdon
COUNTY OFFICE BUILDING • CARMEL, NEW Y(
- This reports o_ _• c6mpleted by.weil r era nd s ub.mitted to County Health Oepartment,together with leboratoryroport of.
anaiysils of water simple indlcstinp't+veter IS of iatisfecfory E ts'cterlif quality twfoie °cenificm of oonifructlon corllpliarlcili isiued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
NAME ADDRESS
OWNnl Robert Falk R. D. 1 Box 129 Holmes, N.Y. 12531
LOCATION o. rat own ( Number)
OF WELL Pudding Street Putnam Valley
PtoFosEO ® DOMESTIC
use OF
WILL Q PUBLIC
SUPPLY
DRILLING 17 EQUIPMENT ❑ NARY AIR ERCUSSION ❑ PERCUSSION ❑ (Specify)
CASINO LENGTH (Ieet) AM (Inch") WEIGHT PER F RIM 3"()13 ,
DETAILS 21 6 . 19 ®THREADED ❑WELDED YES NO TES trO
TEST ❑ ❑ POURS O
YIELD
ME COMPlSSEYIELD 2 6 NAILED AIR
MEASURE FROM LAND SURFACE— STATIC(apecityt"t) DURING YIELD TEST lhet)
WLML '35 otal draVdown i °r ;, Lw w,�, 300
LENGTH OPEN TO Afi IP . . fie
$CN N
DETAILS IF GRAVEL Dlasnehr of we" indud(ns no Bet
FACKEDs • grovel pack (Inchn):
DEPTH FROM LAND SURFACE Sketch met loeatlon of well with dhtenoes, to of hgat
FEET to FEET WRMATION fJlSCRIRION two permanent landmerb.
0 3• Overburden
3 300
❑BUSINESS
ESTABLISHMENT
❑ INDUSTRIAL
❑ FARM
❑AIR
CONDITIONINO
❑ Test WELL
awl
Gneiss &"quart!9•
It yield was tested of different depths daring drilling, RN below
FEET GALLONS PER MINUTE
' -Boyd Artesian Well Co., Inc..
Rt. 52 Carmel, N.Y. 10512
DATE wee LVmraeleD DATE OF E RT WELL DRILLER (Signature)
12 -19 -85 2- 26 -�Eo / AV
25 -3196
o.
y®rkt®wn Medical Laboratory, Ina
321 Kear Street
Yorktown Heights, N. Y. 10598
Director: Albert N. 1'aefovano M. T (A3CP)
y- """j], W jh'o� -1
L
LAB pi,__ 306- 922
Collection Station Used:
Carmel Peekskill
.. Apt . K i o _ Z...:.,N.e 4i_ .0 i s-:yn. < ..
Date Taken:
5 Id,
Date Received: 3-31
Date Reported:,
Collected By:
.Referred By:
Sample Source,
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
Standard Plate Count per 100 ml
(Agar plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform per 100 ml
Fecal Coliform per 100 ml
Fecal Streptococcus per 100 ml
MOST PROBABLE NUMBER TECHNIA.UF (MPN)
j,
Total Coliform: -VPN-Index ner 100 ml -
Fecal Coliform:
OTHER ANALYSES
MPN. Index per 100 ml.
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WAS NOT) (NOT. APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDING T HE NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Albert H. Padovani. M.T. (ASCP), Director
LEGEND
RDS = Recommend Disinfect-
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
f All
AM HEALTH Permit s `r,20-85
�OIUNTY��:DEPART_ MEN,'
PV-
PUT A��
?�hh-Sivi -,"C'''
F Divisibh'bf EfiW 68S
RUC
n T
,CONST ey
T-5-win --- 6F-79.7iilage,
-�7
5, �`,J�6
Pudding wStreet " Bloi�k;.:�
jarce! :,�-T,
.7� z 7
0-
',Subdivisi- ,'Sukid'. Lot I ew
Revision
on
tz
Cky.'-f-& Vi -!,D6hne1,1`-,,, I54 -Nd Approval
5,�
&4nii/Addrei f
T,
r SeC94?n, PnIy
' Lot
Aodiltat
0.
`A6inberaof 1ped;rpkij �,-._Thr�e 1% 0,
A Des ofifibatib Req�ui, •Bedrooms igniFlo�f'G/P/n I'A!� N �i
P_ �q
on ist_ Gal .-' T n a n s c-
ge .Sewerage System C' s Oj
a r
ga
To 6e . cdristrudbil' ti)i Address x
Vllater u Public 1"'
p, Ic Supply iorn L I
,ti q,
-X
i%
w
Ad res
'Ad res
71�._
d'
"S `D'�'!' tei'
Curtain .
6
ConditioriallX
dihir_":;Aequi emen Deep n v e _Approve
Drain_
M,
�V
!I represent t�haf�l a;n, wholly dn6 c'o'm�-pi-"e'teiy'�riSponiitil6 fdr,6 sad -1i
e:,dq�jqq A,!�d !�cation`of that t he,� sdiiaiat6 sewage .disposal. system
above: descnbed will be; constructed P9!
C accordance with theVa and regulatlo"s _oT_711,�-u na�T
as'ii`iov�n,61n itili ap;-��,�;vdd',Amdn*dment-�th6r"t�'�'i'o.an in ndiiis. iuiiil
en Health .rand that o6 completion rf'iii6i� �:6f'C_ artnii i t to ihe torrirni.sioner of,HealthWill
pun y,* ep ietibr thereot`a�k-`-,ite onstructign Cornj
.' b submitted to the,Dsoartirrievit,' 'and .. a *riiienAilarintee .--.wjll pe y.q3,ish . I h-�`successor eirs or, aiiigns.y-,t6e�buil"r, that sild,�buijder-461
owner I S,;
"I* io' 0 '0
-place good ti ' _.��diti6n-, 64 "d i - syiierij' oWing thedate'ofthe ssu-.
An operating .4 saj -sewaje,'� . sppSa. during the two irij'�i�fiqdiatiiily� foli,
Certificate ornpliancii%dUltie aLs ste or " an , lm x % d ki�thereto ;: tfiatlh�e drilled . well described abd4e
.,-'an5e, of the.'a0proval'of the . er i of Construction
1_,;vIII',be-Ioeate'd as shown on the -7approved plan and tiiatliid i;;eII'-wiII'be:InstaII I with the itl and,,'re on$ 0 the utnam
�g f
z z
�'Augu
D X R.A.,
Date 98
NY' 105: 18 -29206"'
RO. q aA'�- fi, t N
.'Add No.
e
7
T-1k,",
APPROVED FOR CONSTRUCTION 'This approval f
expires e.� -is:
,!res, n ,.,r romthe',Aatejs4,U�d�'4! been undikakew and
may iier I ation o construction
i
T- . I ._x, "
0 bi cause m difi6d when 'necessary, by Co o io66-. Any� chi'
"qe ar- a
Zsai of domestic Ifai and or: ph atply only
Date u ires. z!, new P4 Appro
"Y.
7
. fr,,S-;
B
•
A
.......... .
1PU NAM COUNTY DEPARTMENT O1F HEALTH Permit a
i, Division of Environmental Health Services, Carmel .IV. Y. 10512
To be constructed by ? Address
Water Supply: Public Supply From
X _ Private Supply to be drilled by ?
Address
Other Requirements Curtain Drain -W Deep x 2G0' -t'
- and 12" R-o -B Over S.D. Area
.(Conditionally Approved 12 August 1�7E)
I 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 ana regulations of e Putnam
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 the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original 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 in accordance with the standards, rules and regulations of the Putnam
Coun
Date
APPF
revoc
req u i
Date
Rev.
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Putnam Valley
Town or Village
Located at~uGClrig Street
Tax Map Block 'l Lot Parcel 7
Subdivision
Subd. Lot q
Renewal _� Revision _�� (]y ;2(
owner /Address Kent & Ylarilyn Negersmith
RD
2, Pudding
Streellate Of Previous Approval
„ i Carriel,
Building Type l:Odtl.atr
IVY 10512
Lot Area
1.012 A.
Fill section only ❑
lhree
Number of Bedrooms Design Flow G /P /D yV�
P.C. H. D. Notification Required
1000
Separate Sewerage System to consist of
Gal. Septic
Tank and
To be constructed by ? Address
Water Supply: Public Supply From
X _ Private Supply to be drilled by ?
Address
Other Requirements Curtain Drain -W Deep x 2G0' -t'
- and 12" R-o -B Over S.D. Area
.(Conditionally Approved 12 August 1�7E)
I 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 ana regulations of e Putnam
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 the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original 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 in accordance with the standards, rules and regulations of the Putnam
Coun
Date
APPF
revoc
req u i
Date
Rev.
PUTNAM COUNTY DEPARTMENT OF HEALTH
b
HEALTH SERVICES
DIVISION OF ENVIRON��IkAi; E
Date July 29, 1985
Re: Property of Gayle & William O'Donnell
Located at Pudding Street
Putnam Section TM 5 Block I Lot 7
Subdivision of
V 1.
Sub4v.* 'Lot # Filed Map # Date
This letter is to authorize John H. Prentiss
a duly licensed professional eng'inqpr x or registered architect
(indicate T—.
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards,' rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign"611-necessary papers on my behalf in
connection with this matter and to supervise the construction of said
i4
System. in-cgn.f ormity--.w-Lth.,t,li-,e--proyisions�.9f�-Ar:ki.cll.ik - 5-9r.
147, Education Law,
tary Code.
the Public Health Law, and the Putnam County Sani-
4K
60 �n kte �rs i g n. e �i
C A . A h
Very tr yy s-,
Signed
Owner of Property
Address
JOHN H. PRENTISS, P.E.
RD9 FAIR ST 914-878-6170
CARMEL. NEW YORK 10612
Telephone
154.Njorth Street
Address
Peekskill, NY 10566
Town
914-73775876
.Telephone
0
PUTNAM COUNTY DEPARMW OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE' DISPOSAL SYSTEMS
- -
DATE:
SP. BY. -
DA
t
(Name of Owner) (Stree tion)
INITIAL SITE INSPECTION YES. NO COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .......................
Will driveway need cut ..............................
Must trees be removed - note these.. ..............
Deep holes representative of entire SDS area......
Additional deep holes needed..... ........:.....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics............................
D.H. 1 Lot
Depth to G.W.
Depth to rock
Soil DescriDtic
0 ft.
3 ft.
6 ft.
9 ft.
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil Descriptia
0 ft.
3 ft.
6 ft.
9 ft.
D.H. - Deep Hole
G.W. - Groundwater
D.H. 3 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
Soil
DATE: -r -
FINAL SITE INSPECTION INSP.BY:
YES
NO
COMMENTS
House SSDS located per approved plan............
Length of trench measured U
i
Width of trench average '2
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
i/
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ............................
10 ft. maintained from property line.and
20 ft. from house .............. :.......... ....
Distance well to SSDS (ft.) ............... .... ....
✓"
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench ................
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Boxesproperly set.......... ...................
✓
LI
Could surface runoff from.driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.....
,, -._�1 --
FINAL GRADNG OF SITE ACCEPTABLE.. ... ..
/I17mA...n Ial., n /
-11 6,6
(5c-t,(
T-74
A
A 3 7 43
lu" cv�
/y
MAI
M-W it
4 .2 a6
0
. PU_TNAM COUNUY_DEPARTMI,, T OF HEALTH
1
DIVISION OF EgVTr?0Wf4E1',1TAL 11D- LTH SERVICES
.:
10.
"M Oi�'FICE" BU tLDTPIG;' GA�EJ;_; N -: _y : Q512
DESIGN DATA- SHEET- SEPARATE.SEWAGE DISPOSAL SYSTEM. FILE NO.
Owner /�►f� /t9ar. -� /Jn s.►,:Z_Address e .57�• _
TaXPlarp .
Located at ( Street �e i c e . to:TS-ss / Block _Lot
a e II r cr-reet
p/. of Tn. L.nt
Municipality Pirt�e�a, �l���eii Watershed "L� '
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
o1.e ..
Number CLOCK TIf,7-, . PERCOLATION PERCOLATION
Run Elapse.. - Depth later Water LeveT
No. Time From Ground Surface in-Inches Soil Fate
Start -Stop Mina Start Stop Drop in Min. /in drop
Inches Inches Inches
Dec . oit� s' LR
2 ;; o
', ti's'• �c.:�`.: � • ,\` .�. ' ,�, 1,:a:, ;' l � c-.,
• { �._ �� tr � r_
:::, ::'.`.• '' Cdr �;IIf,�. fir" ;``
Notes: . 1 Tests tore' e .ted.4a '+same depth until a r0xilk'p tee,y "jp ual , soil
rates are obtained at-"--'e4-6,h . eri .Kation test hole. All data to,Rbe,,Pubmitted
for review.
2.) Depth measurements 'to be made from top of hole.
TEST PIT DATA .I I JIIIisD TO BE SULK -11 I`1 "1EM l•JITTI APPLIC/1`.E'ION
DESCRIPTION OF' �0]:LS iIICC ?J:rI`i'4?P,EU !',I TEST MOLES
DEPTH P`OLF,I .: VO...:: HQLL, N0. HOLD' N0.
G.L. -_
12_"
1811 F9 �`D��•
.241'
3611�/��
,
4211
4811- �✓
5411
v
.6011
66" -
7211
!�_JE, rac&
8411
INTDICATE LEVEL AT Va --ICH GROUND WATER IS ENCOUNTERED �� �6p¢
___ZNnICAT)rJ.L�J I�..T21r�LT '11 WATE.R.:J.�k1i r .RTSES AFTEh .B.EING_E COUNTER. / " k 0.,O�r•
TESTS MADE BY ,� Date &AI-X12K
DESIGN
Soil Rate Used/ 4-)o Mirvi "Drop: S.D. Usable Area Provided ',0
No.. of Bedrooms 77 ®p( Septic Tank Capacity /000 Gals. Type ®�v��_.
Absorption Area Provided By�_L.F.x2411 �' ��"` width trench.
Other.
� #1 ,�y'�ri of -- 0 . ♦ � o w IB to .. � .� _ r. .A
C o J
dame
- s
Address R 9 -- t� 5
Carmel, f 1 i ('.r I '
THIS SPACE FOR USE BY EE, ALTH DEPARTI' �,1 T .ON
Soil Rate Approved Sq. Ft /Gala G c
MA
Date .
e
I
"AS _QATA.
Structure located trorn survey by surveyor not 6,d betowVS-
Weil located by: Surveyors survey-
-Well drillers report J11-
Engineers- rnepufie Merl
Tanis, Doses, pith, galleries a lotefolls located l),y.CAorifroclnr--
Engineer"
Heallhdqpt:
Fidid inspeCt;on by: -Hecilh dept 1
Engineer a. f
NOTES: A- f, n -Zee)' Li�ci
WC4 t eAf):;�,O V -1
�j PEED 11 D I M E_N SION S
Putnam County Department Of Health
Division of Environmental Health Services A B roe I q�) - 13 0 lur- -A C
_q If
Cori .;applicable Rules and Re JA4 a C 3-3-7-e
'Approved as noted for conformance with A 0 D
Regulations of the
Putnam tounV Health Department. A
D ujzr4l). E F
A F _(0_.4 a F
.dr,
A G Z-== - 6 G
4A
flsQ nature 4
9r. If A
H �, Date
j
_B j
A K K
This is to certify that the sewage '1
1disposal system was constructed as I z4-j0,1 0,-V16_-Z7 A6 A!,10 P.C-,4a,
i.fndicated on this ,plan :and that: the
--41 syiiti�i wag inspected:by.'ine�'.befori. 9
Iwas.covered over. ��stem
'DESIGN ".AS BUILT
with a -A IT- -R`K--_S-'� A-S BU I LT
ordance
"constructed in geld
SX:N A' E
Istandard rules and regulations
-
P.C.H.D. & the N. Y"S.D.H.
LOCATION S treat
H VA U ei C 0 u n I y 7
d
SUBDI.V1 S ION:
M 0 P FQ 4x
LOT Nt
Block: -Z
4
Builder.
7)965 = A at ve or
Sur -22EO
y
Drawn: X--;o,L 2 2
QN
ftn- J 0 H N H P FIT N T I S S WE