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BOX 21
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PUTNAM COUNTY DEPARTMENT OF HEALTH
` Division of Environmental Health Services, Carmel, N. Y. 10512
/ Putnam Valle T
..... .CERTLFICATE...OF_.CONSTRUCTION COMPLIANCE FOR SEWAGE. DISPOSAL SYSTEM.... _._.._ . Y � J
Town or Village ^
Bell Hollow Road 23 4
Located at Section Block
Owner Gary Gamache Lot 1 Job
Separate Sewerage System built by Tony Cesarini Address Old Peekskill Hollow Road P.V.
Consisting of 1200 Gal. Septic Tank 337 lineal Feet X 3611 width trench
Other requirements Domestic Use Only
Water Supply: Public Supply From
X Anderson Well Drillers
Private Supply Drilled By
Barger Street Putnam Valley, N.Y.
Address
Raised Ranch . &00°41 •
No, of Bedrooms q��g q�o ermit Issued
Building Type �� �`NN�p
Has Erosion Control Been Completed? Yes ® ® '
4f �
I certify that the system(s), as listed serving the above premises were constructed essentially n h of g,Ccknpleted work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, an the it is a P*nsrn County Department of Health.
October 15, 1977 • A p,E. X R.A.
Date Certified by
1 Northridge Road &kski l . 278$ 6 e° License No. 027846
Address nn[ �u(���
Any person occupying premises served by the above system(s) shall promptly take such action as ing b� Us`s�ryRo secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become nu I rftlN>,Pi as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water sup becomes available. Such approvals are
subject to modification or change when, in the judgment of the Co toner Health, such revocati modification or change is necessary,
Date Title
PUTNAM COUNTY DEPARTMENT OF HEALTH V E�
;} Division of En vironmental.Health Services, Carmel, N. Y. 10512
•DNSTRUGTl0U_PERIIAIT_FOR SEWAGE bISPOSAL •SYSTEM
Tpa�C Town or i lags
cated at � LG �{vGGo�.✓ e� -�Jt�O - 9ectisti z 3 Block �% 4-
.�/ 4/Lot —k'4 0L l,3 Job
�: .; ubdivision •
s .Owner
777,46 ZfgKEs ritLG . Address 377 %(/EST�f 5?�!� 1�.C- TGff6}51E�lGy
Building Type iDE�n� Lot Area f
lr
Number of Bedrooms Total Habitable Space d U T Square Feet
Separate Sewerage System to consist of TO C' Gal. Septic Tank 23 lineal feet X 3Cd width trench
To be constructed by U ytw Address
Water Supply: / Public.Supply From `
Private Supply to be drilled by �i Q k 00 W tA )
r
Address
Other Requirements t71�1 Ai /�l� EG�►J tN:)y C: A.:
Fv v_'Tti a ca>c>iL. VE plB�E= �'C'E� GUQ �.p•t!J O2/�1 !��1 IJ`jT1�L L 6�
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 staagdtjFli ,� ditpC regulations o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction ComOiance'\���ac ry�%i�F1e,Commissioner of Health will
be submitted to the Departmeht, and a written guarantee will be furnished the owner, his successors, iir ass 'lsy, h dilder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two�o) yak§ iMrfl ely.• � ing the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any rOaOrs4t `eto; 2)'tha%* ril&d' well described above
will be. located as shown on the approved plan and that said well will be Installed in accordan w he ul a ns of .the Putnam
County Depart ure t of ealth.
/I - z
Date Signed • •P,E. R.A.
Address P -NA -A. OP AG IEK 7 e2e br- , i r9- 4 ;F
APPROVED FOR CONSTRUCTION:. This approval expires one year from the date issued unless constru1 #•bf.ttle•bviN. '�7�s been undertaken and Is
revocable for cause or may be amended or modified when consid n "essab Comm i ner of H6111, iFfss° ��>�gtElcbr alteration of construction requires a n w ermit. Approved for disposal of domestic n' r se ivat ater supply onr�ftit „el,���
Date
By xi, //J Title +�
i ..
Scated at �
k
bdivirlon
77-
ilding Type x���' ��L'h LOt Area
irn
ber of Bedrooms = M
r
parate Sewerage System to copsist 120
of +
� r
be 'constructed
rter; Supply Public _Supply From
Private Supply'`
Address x
her Requirements '
3present that I am wholly and.completel
ive.descnbed`wilI be constructed as sho_y
unty Department of- Health, ;and than
cond
9 z-
4 .
ED FOR CONSTRUCTI
for cause or maybe am 11-1
e
r _
I.
responsible for'the design,
on'the approved amendm4
n completion thereof a ,6
nt,gn guarantee will'tie f
t of said sewage disposal
Construction3-:Compliancl
i and that said well wilt be ",
4, v a
s
.. ..:.�:.,.. 5.. _
rn �ervrces c,arme/ N Y 10512
r
Town or Village.'
Section ' '_ �` r- '.•Block
Lot J ob
Br N Y 10662
W
Total it
Space 15'Qt� `Q Square Feet
c
pt c Tank 320 Imeal feet X 36it
w width tren
' ch
i Address X15 he tt�u� Rod
h r "h =Lake >Peekslsi119;..:IVY
�t�1 ia71' millers „ 7 , p
i-
tnai�'Uallag9
.-
proposedysystemO ®� ' e Sewage :d isposal_.system
re to and m accordance with h h
0
0 11 tioqs o,. ; t e % .0 n7
to of Construction Compliance A r issionec,of Hea'IE'fi Will
d the'ovrner, +hi'successors; her' b it rkhat said builder will
r during the period of two (2 im Ilo ng tl�edate cq the -issu
ie original system or any repai to; 4 rill d'aisell,;described. above
d in,raccordance with the stag r ulat •of :,;the r Putnam
t
�EI o
ssued unle s construction of .thb ���lSg has been undertaken 'and is
Y Y° issi r• of,Health Any change; -or alteration of ;construction
,a or pr ate r .supply,,only - t
a - Titl
a
CTERIA PER ML. (Agar plate'caurit _ 35 -C).
C'OL- I °f.`RM.GROUP.- (!Rost.- F:obable rlo. /ICO n1:)-
ARD NESS TO TAt .- pp--r-- :.
TERGENTS - pPm
NITRA TES (as N) - pprri
IRON, .TOTAL` 'ppm
PEEKSKILL MEDICAL LABORATORY
,_..••. ,.
1879 Crompotid Rd. Barc liy Plazii' Bldg
Peekskill, 'New
•
York -: 0566
PE 7:8777'
t
DATE 'COL LECTED
RESULTS OF EXAMINATION OF WATER
L '
NER
DATE RECEIVED "
!'Y,' '.VILLAGE, TOWN 6 /OR NAME OF SUPPLY',,'
DATE REPORTED ..,
.1..�
�4-:�.'l,
r
APLING' POINT
CTERIA PER ML. (Agar plate'caurit _ 35 -C).
C'OL- I °f.`RM.GROUP.- (!Rost.- F:obable rlo. /ICO n1:)-
ARD NESS TO TAt .- pp--r-- :.
TERGENTS - pPm
NITRA TES (as N) - pprri
IRON, .TOTAL` 'ppm
;•, it -. = � -,'{ .
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICESi
COUNTY OFFICE BUILDING,• CARMEL, N. Y. 10512
DESIGN DATA.SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM
Owner Gary Gamaehe
Address
FILE NO.
1915 Hunt Avenue Bronx9 N.Y. 10462.
Located at (Street) Bell Hollow Road Sec. 23. Block 4 Lot 1
(Indicate nearer cross street)
Municipality. Putnam Vall ®y (T) Watershed ?eokskill
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
2
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
apse
Depth to,Water
Water ve
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
(1) 1
4:32 4:59
27
16,5
19.5
3.00
9.00
2
5:04 5:34
30
16,25
19.25
3.00
10.00
3
5:38 6 :08
30
16,25
19.00
2.75
10.91
4
5
C2) l 408 5:06 28 17.25 20025 3.00. 9.33
2 5.:12 5:42 30 1700 20,5.0.:.. ' 3.00..._ 10,00 _ .._.
3.. 5 :45 6 :15 30 17.00 20,00 3.00 10.00
4
1
2
3
4
5
Notes: 1) Tuts 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 made.from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION`
DESCRIPTION OF SOILS,ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. 3
6" saz0y,, boney &oam sandy,, bony loam shady bonny loam
1211 some silt some silt some silt
1811,
24"
3011
3611
42"
4811
54
60"
66"
7
78•'
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY John S. Romeo Date May 49, 1976
.. `- - -4 _- _ - • - -• . __ -1115
Soil Rate Used Mir l "Drop: . S.D< (Usable Area Provide, �5000 SF +
00 rae
. 0 0 —t run.. o�_
No. of Bedrooms 4 SQptic Tan��Capacityl,�: 1200 Gals, o psc"
Absorption Area Provided By 320 L.F.x241' - 36 x ®.
o °
y
Name Johta S Romeo Signature .�
Address 1 Northridge Road
ee s SEAL A �� 278x6
P°
N.Y. 000' of His ����
• s°
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. R /Gal. Checked by Date
_........�-
`71 -140-
P(3TNAiI COUti TY DLi .?l:L�T OF. 'r_= : =.LTH
•
DIVISIJWi__07 E�7IR�Cirti :aL`HFA;'iE{�'R'VC ✓.S.k:-
-as.
DESIGV .DA,TA SCl%ET - SEPA_aTE, SE;_aGE DIS'J J�aL SYSTL:I FILE NO
Gagner �iVO oG 77fs G.vle .Tiln-
Address 7� k/�sr`c/ 57 AvE }
.Al
-TAx
Located
at (Street). 9EGC, I %Uoco ;Po,
-SEE Block o4
Lot.., of
(Indicate nearest
cross stree L)
hlunicipalit
1.1atershed C',givv�ovs C�2u&�.�
SOIL PERC-OLyTION TEST DATA RE0UIRED TO BE SL'E'iI "ID -TI TL PPLIC TIO-NT .
Hole
1\' urber
CLOCK TIM
PERCOLATION'
PEP.COLATIOv
Run
Elapse
Dept:: to U:ater (iater Level
No.
Time
Fro.:, Ground Sur---e in Inches
Soil Rate
Start Stop Min.
Start Stop Drop in
Min/in.drop
Inches Inches Inches .
Q i
/o,
Zo Z-:3 ;
/Z
2
to
3.
/lr' ¢Z !Z; !B 3(v .
•zv • . 2 z 3
<z
4
5
. 1
/0'3- /0.'// 3CP
To Z 3 3 .
iZ • .
�. 2
/�•' // ®4•' �7 Flo
�° 23 3
i2
3(o
2� 2�•. 3
iZ
2
3
5
..
Notes
1) Tests
. to be repeated at same depth L ^:tll approxi - =- e- 1 r equal soil
rates are ob-
tained
each percolation -es-,
hole. All data to be submitted for
review.
2) Depth
,a.t
meas,-,.re-irents to be. -made from top of hole.
6r�
12'-
18. w /es i- Ay
241 .
3 0"
3fi"
42"
481'
54"
6 0"
78''
84"
INDICATE" LE, TEL AT S,MICH GROUND WATER IS. E \COU\"TERED
INDICATE LEVEL TO WHICH MATER LEIFEL RISES AFTER BEING ENCOUNTERED"
TESTS MLA DE BY iv4io- 7�icnvF co ��'ytt►��- Date ..lo-Z&
i-^� 1j or' �t �� 7'C ^'�l Area '1
Soil Rates s� /Z ,ir /1• Dro-O S.D. _ �e _1_ "_�
da 000
z'ro�=i�_d S
No. "of Bedrooms .S Septic Tank CapECi ty 900 Gals.
Type 10A5ow/2y
Ansor "lion area Provided By 23/ L. F.x2- - �6. "�ci`k�ib '
Ocher
- . V Uor� v E2 D�o�� ES�S -c0 gE " NW.� � — °E A , ab�° of t�q�ncn.
;
C>Z A,% N :tS 1 At 1 big
I
Name bs IV Sim ature o o
Address.. SULLIVAN - THIEDE SEAT*
b ^
z
CLARK PLACE..
O..Box 308
MAHOPAU, NEW YORK 111541
PU TNaL%I COUNTY DE PARTL 9:,N T OF HE LTFI
Soil" Pate" Aoproved Sa. rt./'Gal
Checked b%
°'bb6bbN °
Date
OWNE
SITE
MAIL
PERSI
LWUI= Q i o, CL .iV11C711 -LV %L.C, UW11CL, L=XUJV -, eW. 1 .
DATE TYPE FACILITY
PROPOSED INSTALLM S4A/ 401' . jg 1/1 PHONE
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original.sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
Proposal approved __,21 r Proposal Disapproved
Z2
Datd
'roposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submisgion of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep
drywells surrounded by one foot + gravel). It
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, s gamer or reported gent of owner agree to the above conditions.
3IGI�+iTURE TITLE
MM: V&te (PAD); YeUcw (fin HE); Pink Lbgija nt)
DATE /6
�A/
_TOWN_ OF P
_ _ U_TNAM VALLEY
W.:..LT, y?JRILT.,rRS : f:. AND REPORT
WELL COMPLETION REPORT
This repr:rt is to be completed by well driller and submitted to
Bldg. department, together with laboratory report of analysis of
water sample indicating water is of satisfactory bacterial quality.
Well Locati
Tax Map
Well Owne
Well Drillexi2
Name
Street
Mailing Address
Mailin�ress
Sec. Bl. Lot
City or Town
Tel. #
City or Town
CASING DETAILS ! YIELD TES WATER LEVEL. I SCREEN DETAILS
Bailcd , : (P:ca�,��re
from and surface
Length Ft . or
Puinl�ed Ii.rs. Statics Ft. Makes
a ,� When Bailed Slot
Diameter-.O/ Inches lYield: S GPM or Pumped Ft,, Length Ft.Size
Kindsq s Diameter In.
TOTAL DEPTH OF WELL J? �' F eC, C
WT?LL LOG
Depth from Give description mf formations penetrated, such
Ground Surface ass neat, sand, gravel, clay, hardpan,
shale;arclstone _ :gr'ai�ite.; etc; Inc3ude ..size
gravel (diameter) and sand (fine, medium, coarse),
color of material, structure, (Loose, packed,
cemented, soft, hard). For examples 0 ft. to
27 .ft. finc, pac:ced, yellow sari; 27 ft.. to
134 ft. g_-ay grans ±e.
Feet to Feel
Formation Desc:::iRtion
Date Well Completed_�� Date of Report
Well Driller ' � •-
Signature
BZS 1 -77
Gary Gemache Putnam Valley (T)
Owner or urc aser of ul ing Municipality,
u ng o struot -a by Section.
Bell Hollow Road
Location - Street B16ok
Raised Ranch 1
u ng 'Type Lot _
GUARANTY OF SEPARATE SEWAGE SYSTE14
I represent that I am wholly and completely responsible for the
location, wort nanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has beean
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 farther 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 o.f .the.1yotem to operate was :.caused.by :the willful or negligent.
act o.f the ooQupant of the buatlding� utilising the sy.ste
:... Dat'ed "t'iis °12" ciay of VOct 19 ~ '7 Signature'
.._=
Title2/_aa
ir eprporation, give name
and address)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - r ..
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS RE UIR D TO FILM QT C , RATS 0 F FFST USE OF SYSTEM.
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Division of Environmental Health Services, Putnam County Department of Health
PUTNAM COUNTY DEPARTNIt:W' OF 1ILALT11
DIVISION OF FNWRONMIMAL HEALT}[ SERVICES.
Date
a Property of 4e
Fe
P y%'�
a. •' Located at
Section Block Lots
Gentlemen: 7
This letter is to authorize John •S; Romeo
a duly licensed professional engineer x or registered architect
(Indicate)
to apply fora Construction Permit for 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
4- -Ort'fipf- l• i rin w•1 17h 1-his mw41-17H•r- "TNi. i -n R11ryP1'`li FP rhLn r?nnci-r1.lr+ ri nn nt caSri
system or systems in conformity with the provisions of Article 145 or,
147, Education Law,. the Public Health.Law, and the Putnam County Sani-
�ary Code.
Very truly yours,
Signed hew�.
Own of Property
Countersigned: i �.' ,;4
Address
4?/�
1 Northridge Road . Tel phone
ddress ..'.000�o,opoo
Peekskill No;Y 1056E �° I E�►�' r ° °o'
737 a 1056. o.
Telephone R. �.
0 2z ;
f
REVIEW CHECK S - T
Meets Std.*' Remarks
es i No
DOCUME -kS
House plans 0. K.
Design data sheet
Peres presoaked? i
Min., 30" perc test depth
Cont. results for 3 runs t I
D. Hole log 0. K.
Corporate Affidavit for other than individual
Authorization for engineer I I
Letter from Mater Supply if applicable i
If variance requested -such noted on plans &apps.°
DETAILS
if charge is proposed,
Existing contours shown ( A.
new contours) r--- --
Slopes"for driveway cuts, etc. shown
Water service line location
Footing.drain, etc. location I i
Top slope, bottom slope of fill i
Percolation tests and deep test pit location I
Septic tank size and conformance to std.
3. B. R. house .minimum F. .
House setback shown � U
iiiiLl'J l +l.it..!.l +!1.
Li.1.1. WaLE:t' vil-61iiii. 50 11�e U1. jj aL1VW11 j +
=- -_- ..Plan and. profile SDS .. �..�_ .__�._ ..'_:..h.:: j i ....... (:...... .:._....
A11 other wells anct ADS closer 200'
shown or reference made rf
Property boundaries (metes and bounds- clearly shown i
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P.L. i
20' to Foundation walls
100' to Nearest well
'50' to stream, march, lake, etc . incl .expansion
15' to Curtain drain i
10' to water lire (pits -20' ) I
15' to storm drain V IM
10' to large trees
10' from foundation to septic tank A
5 t pipe from leader drain & footing drain
.0
00 11-alp. by:
'b
0
U-11111AL F)PTT", Y(.'.,4 No Commoiitci
.P..r(), or. ty -;'L j; 1,10 3.--.Ckr-,C: o rnr-,r.3, Xburnd-
.,an estj.Twat-� hou,;c location . 0 0 0 a 0 0 0 0
rlill drivowtV nzecd cut . o o . . . o
14w;t trees b-- re moved -note thl-130 C? . 0 0 0 0 .0
Is (Icep hole r0p,,E.—"ent-ative of entire ST)S area
I,Oditio.nal do--T) iiolcs n'codod. *. a . 0 a a 0 0 0
;01'1.J.cieiit SM area available* consideril1r,
driveway cut, house . location.Scparation 0 0
dista]jr-CS., etc o 0 0 .0 a 0 0 a 0 0 6. 0 0 .0.
)IP BOLE IlArIP11
�Pth:
Nater elevation:
}lock elevation:
Soils on -�4
*'Is descri--oj
Date,
'IRAL SITE, PISPECTION Insp. by:
buse located where shown on approved plan
C., L, 0. 4 a .,..a -a 0
M lo rt'ed'vhere approved
a 0
lope of tile, ine'and' trench table . . .
oom all o,,,,ed, for expansion trenches .
VC-3? 50 ft. frcm si•;arn), %.,,,atercourse . a 0 0 a
atural soil not stri-=6d or SDS area
unnecessarily graded o ..o.
from pro_ ..1in- and
0 0 a a 0 0 0 o
.-Taration of trench from house., well
etc. follows plan 0 0 0 0 0. 0 a 0
umber of bedrooms checks 0 *0 0 0 0 0 a 0 6
tcnQs, brush., stumps, rubble., etc. greater
--
than 15 ft. from nearest: trench
-3 PL. of --- -ohoral soil hori-o "*a-"y from
trench e o 9 0 0*'Q .' 0 a 0 a 0 0 0 0 0 0 a 0 0
inct1on boxes properly set
)Uld surface run off from drivewav, roads,
ground surface., etc . charanel no-ar SDS
area 0 a 0..0-0 0 0. 0 0 .0 •a 0 0 a a 0.
16t drainac-- at)rcn- r 0.1'
in area of SDS
1114L GRADING OF SITE, ACCEPTA=-
a
O
PUTi�ArI COU?iT DEP- �T!.,E- OF LT
DIVISTOa Or y`J �; - Rv. ?�•`_;TL - - 1T.
a. S E_P•_VIC ES
Date
Re : Property of �wn . oF�77fE L., c
Located at Moz-49kv ; eo
Sazttem z3 Block 64- Lot o l
Gentlemen: E F, k-�
This letter is to authorize �"vGGiviy,v' -.rEfr ��
a .duly licensed p_ = '^.re3S10?'3� or _'a7l s�Ie e ?rC_ ^_? teCt
( Indira -e)
to apply for a Ccrstructior ��r; _= .or a sepa ==ae _e:;e.^ s--s,ten; to
serve the abgve ncta i �rooe »;'J a,,cord- 7 C e _ h �'e standards; rules
or reulwtior:s as promul_a ted b-r Co „ =iss Ion er o_ tre Putnam County
,L r
Departm nt^ o” _ eal -' , and to si =1_. .1 ,ne�essar- pYoe. ys o, mfr behalf In-.
con_necti on Frith t._i s r-a*tter ar_d to gL;n'r se . `_:e construction o: said.
syste^i or systems .n confor:�i ty `r- t h th- DMv:..io_ s of :_rti 1•a' 1L5 or
1lt7, Education. La:r, the Public Heal th La:r, Ord the Putnam County Sari-
,tary Code.
Very tnu19. moo, rs
A-
S ;;ad' f WF-� -A
Qr;'r Oi = = operl
�7 c TEg_ P•t�e
Cotinters igned:. Addr =Ss rli P .E., R.A. ), �Fo�';ANCIS �•,��', !�® 9 elephone
�� • ( Seal' )
;fie:. •
Telephone