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BOX 20
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02343
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` vORKT0INN MEDICAL LABORATORY INC.
` Kear Street
P 0 Box 99 321 4
;YGrk� Hlas,'I� Y0593� -
245 3Z0 ;
DATE`,COLL'•ECTED :-
;. RESULTS OF EXAMINATION OF,WATERr
DAT EIVED
Z�1TAR(�A,• , c/ o . "MON`F- A(3NA.�tTILi��EBS... ' ,.'� Y
.. -_1 v2 ,
CITY,; VILLAGE, TOWN & /QR NAMir OF SUPPLY
DATE REPORTED
P'UDDIPIG ST. CARNlEL,� NE'W Y08K
1/<5
,
$AMPLING,POINT
AL ppm;
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' E Y0MW11v 0��MC CWA-K, New v".;-�
.1's xanvor. Is to ba cov "'!9tedtv mound DecaF�aAm T0qet'-0*-,f kh tokzwwovj fa0v-? al
anslysix. *1 water ample is f0 pwvi-,-�L-t�J J--13flt cf w439ruclian vgMMi&.Mg ;!s ihw&.4.
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014'M
MrUR Montawna Builders
Pudding St Carmel N.Y.
Pudding St. Putnam Valley N.Y. Lot 2
M 6UMMEB V
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W11SE fop
gat MaUt
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cor4ftMED c
EIWTMY M, AIR 61MCUSROM
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20 GhT TEP MOT 'R ,
DEMO 1,'nf�p .,_ --- , �yC5
6 vvi 4r
IS cDj4M;SM AW 8 15, 15
5: 7
cpv!
12. Total drawdown Wow LOT.-A V.Y-Iww. 265
ZPEM 70
5CRM
MARIA
12PTA MOM k-ILM) PJAPAcc to JU o"ar,
,M
PUS ta
3, over-burden
a 265 ledge
85
-Tr vgv, COMAISID TF2 OF well
Boyd Artesian
b�2 ��i S /� /�� R. D. 5 - Route 52
Carmel, NA 100512
(Ir:ner or 1Lrchasc�� oL' t�u�l �.n�; Mu>>ici�,,�l:ity -----------`.
13uildilig Constructed by Section
,ocatio - Moe �13lock
3uildi1i Type
Lot
GUARANTY OF SEPAR'WE SDIAGE SYSTEM ;
I represent that I am wholly and completely responsible for the location,.
rorkmanship, material, construction and .drainage of the sea:a e disposal syst=em
serving the above described property, and that it has been 'constructed as shown on
:he approved plan or approved amendment thereto, and in accordance With the standards,
,ales and regulations of the Putnam County Department of Health, and hereby guaranty
:o the owner, his successors, heirs or assigns, to place in good oporatino condition .
my part of said system constructed by me Which fails to operate for a period of two
rears immediately following the date of initial use of the sewage disposal system, or
;ny.repairs made by me to such system, except Where the failure to operate properly
t li
.ti CnUSeU .,U,,' LIIe W1111U1 UJ° l O::ii,uia- vi L. ,.i: ✓u.,..r.......,,b ......��..�.- -.•b -
The undersigned further agrees to-accept as conclusive the determination
,f the Director of the Division of Environmental }Iealth Services of the Putnam County
1epartmc-n-t•--o-f- 14calth- -,as,.-•to",ivh -ether -or- not - the = failure of. the system to� open Otte was
aused by the willful or negligent act of the occupant of the building utilizing the
ystem.
rated this ZZ day of e,, 19 2o"O Signature
Title
(if corporation, give name and adores:
HREE (3) COPIES ARE REQUIfiED WIT11 THREE (3) COPIES OF FINAL PLANS* BEFORE CERTIFICATE
F COMPLETION WILL BE ISSUED.
LIHANITOR IS RFOUIREM TO. FILE NOTICE OF DATE OF •FIRST USE OF - SYSTEM.
_
------------------------------ ----------
ivision of Environmental Health Services, Putnam. County Department of Health
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.t. .,. -., a -. ... .. .... - ... _ .- _. .. _ ... ...
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DLVTST��. CP: F`s! (. ^; tf= .t- rz?lrC .S"-.:::..:; .•- - _. _ �__
Re: Property of J`f NA C_
Located at i rz�o 0
Date_ -67
fL Ls- L
Section Block Lot 54
Gentlemen:
This letter is to authorize j:x R1
a''duly licensed professional engineer or registered architect
(Indicate)
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 all necessary papers on my behalf in
connection with this matter and to supervise the construction -of said -
system or systems in conformity with the provisions of Article 145 or
147,- -Education_ Law, the Public.-Health La=w; and the Putnam County Sani-
tary Code.
Counters
P.E., R.,
Very truly yours
J
gned
Owner of Property �
Address
► ve- Telephone
Address is w Yb P Y.,
Telephone
I,
PUTPIAM CO1JTlq'Y Dr PART 4FNT OI I,T ALT11
i
DNISION OI'' L;i VIROI-TNM, ITAL I-TEAI,TH SERVICES
CARP, � J, Y.� 10512
DESIGN DATA SI-IEET- -SEPARATE SEWAGE, DISPOSAL SYSTEM FILE N0. 5.7�66��b9S�
Owner ��c �9Q -C�►_ �-- Address i = iV1��r����
Located at ( Street - U C::0 0-k N C-h SfP • Sec.. Block 1 Lot S Lj Q 2 -
�l iIjr,, e earo•st cross s -reef
Municipality �u�N�.a�, �1 !�� Lei Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUEiiITTED WITI-I APPLICATI:OiTS
Hole
Number CLOCK
TI^`
PERCOLATION
PERCOLATION
Run
a,', app F, D--p n to
,Ia er
eater Levei , `
No.
Time From Ground Surface
in Inches Soil Rate
Start -Stop
Mint; Start
Stop
Drop in Min. /in drop
Inches
Inches
Inches
1 `�' -�11
`� �T L4 e &.T C- D
7- o k
3
2
Notes: 1) Tests 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..
i
TEST PIT DATA REQUIR.i D TO BE STJRt%'- 1._T9'ED 14 191T APPL,TCATION
DESCRTPTTON OF', SO]'L` ;?t,COUt!'.i' }t;I,tfi ItV
DEPTH HOLE NO. HOLE NO. HOLE NO.
_ _
6"
,
�
12" � S
1811.
24"
. 30 1 1
3611
42"
f' 48"
54 ;
60"
66"
721.1 .
7Q It
a� 1U
8411
INDICATE L AT 1, II:CH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL �[HICH 14ATER LEVEL RISE AFTER BEING EI'aCCUNTERED
TESTS MADE BY 9 LL., Y�.� of 1Le p_0 *Q-vjL Date �j^ ��-
'`w: DESIGN
Soil Rate Used `� Yliin/l "Drop: S.D. Usable Area Provided
No. _ of Bedrooms Septic Tank Capacity Gals. Type tV'\ q-
Absorption Area Provided By 2�0 L.F.x24" b ✓ width trench.
_ _ �� . ► (� Other
Address
TIiIS SPACE FOR USE BY HEALTH DEPARTME -Iff ONLY.:
Soil Rate Approved Sq. Ft /Gal. Checked by Date