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HomeMy WebLinkAbout2639DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -36 BOX 22 ME J • I j f L L I - ` `I 02639 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING ... CA ML N. Y... 1051.2 y DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner j�,;�' Address % �G���G sow_:,��,;� f9 Located at (Street J ��; ��,j'j jf/ sec. .s Block .._J Lot _;�% '4- � :-,�. ndica e neares cross streety Municipality ex -k,,7 �111e- Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to a e Water revel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 4 3,40 V Notes: 1) Te'�ts 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. Vs� 4 3,40 V Notes: 1) Te'�ts 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 41 G. L. 611 ip F 1211 1811 24" J 30 n � 3611 4211 4811 5411 60" 6611 72„ 7811 HGLE NO. HOLE NO., 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED zNDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED - ✓ TESTS. MADE - -BY— ' '" �� ,� `, �/ ; v Date a . DESIGN Soil Rate Used / Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms - 'G�✓ Septic Tank Capacity .%C Gals. Type Absorption Area —Prov— By.5e L. F. x2411 width trench.' Z �Qther � F P�FW �°oi►� VI-I'1 .i Address gnature O THIS SPACE FOR USE 13Y HEALTH DEPARTPENT ONLY: X0'6 °• 948 ' % . e Soil Rate Approved_ Sq. Ft /Cal. c� -MAR 12 1984 PUTNAM CC U-Nl iV OPT. of HEA�TIH y .tp�'�' Checked by �,.c�ti Date 1 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 . (914) 225 -0310 Mr. Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: August 25, 1989 Re: Compliance - Forte Peekskill Hollow Road (T) Putnam Valley Permit # PV -10 -84 Review of plans and other supporting documents submitted at this time relative to the above-captioned project has been completed. Comments are offered as follows: ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director "As Built" plans must include a legend., which reads as follows: "This is to certify that the _sewage. disposa.l...system was-constructed _, ,._.. ..._.... ...... "as:`.ind.mcai;ed• -on= tr�is plan-and that--the - syste'm was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and. regulations of the Putnam County Department of Health and the New York.State Department of Health." Upon receipt of a submission, revised to reflect the above comments, this application will be considered. further. Very truly yours, (( J� Lawrence C. Werper LCWLjr Assistant Public Health Engineer Acidity GENERAL BACTERIA Alkalinity Yorktown Medical Laboratory, Inc. LAB N Standard Plate Count 321 Kcar Street Date Taken: 7/31/ 9 Time: Yorktown Heights, N. Y. 10598 Date Rc' d: �T7— Time: (914).245- 2800,- _ _ Date. ReporL.ed - ector: Albert H Padovani M. T. (ASCI�J Collected By: rapasso Referred By _ Fecal Coliform ' T- , Sample Location: Kitcnen Tap PHILIP TRAPASSO Forte Residence:FeeKsKill,floilow P, 0: BOX 57 15utnam Valley,NY. SOML;RS,NY, lOr (9) Phone N - �, L r � J %� Phone N Repeat � eat Test? Sample Type: (check each) Potable LABORATORY REPORT ON THE QUALITY OF WATER i Non- potable INORGANIC NON- METALS 'm L ) MICROBIOLOGICAL CPU /100mL STP INF Acidity GENERAL BACTERIA Alkalinity 1+ °C Chloride Standard Plate Count ` Detergents, MBAS _ (CFU /1.OmL) _ Hardness, Total GE 12 _ Nitrogen, Ammonia MEMBRANE FILTRATION TECHNIQUE Nitrogen, Nitrate f r Phosphate, Total Total Coliform Sulfate Sulfide _ Fecal Coliform Sulfite _ Fecal Streptococcus METALS (mg/L) MOST PROBABLE NUMBER TECHNIQUE Copper Iron Total Coliform Index Lead _.. Mangs.nese .. _ F.eo.al. Co.li-f.ar.m. Index Sodium KEY FOR TERMINOLOGY -- Z i 1!C CFU = Colony Formi no' Units ,MISCELLANEOUS pH (units) Color (units) Odor (TON) Turbidity (NTU) CON = Confluent (q.v. TNTC) LT = < = Less Than - GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (For Lab Use) _ STP EFF Other: Sample Status: (check each) Outgoing HNO3 _ HC1 _ H2SOh NaOH ZnOAc Na2S203 Other: LE i+ °C GT 1+ °C _ pH LE 2 pH GE 9 pH GE 12 Other: ELAP No. 10323 TH ESE RESULTS INDICATE THAT THE WATER SAMPLE ((Was ) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TME OF SAMPLE COL TION. -1HESE RESULTS 1NDICATE.THAT THE WATER SAMPLE (Did) (Didn't) (N /A). MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC RIN NG WATER CODES, FOR T/HE-,PAR A�(E ERS TESTED, AT THE. TIME OF SAMPLE COLLECTI0 . Albert H. Padovani, M.T. (ASCP , Director 2 /86(Rvsd7 /87)RWE �9 WILL. (VM1'LJ1'E1uly 1c -hruAl Office Use Only a .t DEPARTMENT OF HEALTH _ Division Of Environmental Health Services }DEPARTMENT�OF PUTNAM COUNTY HEALTH STREET AU RESS: YIN7YIL / ITY TAX GRIO NUMBER: WELL LOCATION PEEKSKILL HOLLOW ROAD WELL OWNER AOORESS: P6iVATE N "bRTE PUBLIC. USE OF WELL )Q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS 0-'FARM ❑ TEST /OBSERVATION O OTHER (specify) 2 - secondary Q INDUSTRIAL 0-. INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _.- 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR AM NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION DRILLING O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH _32Q ft. STATIC WATER LEVEL QV DATE.MEASURED ' DRILLING XQ ROTARY O COMPRESSED AIR PERCUSSION ❑ DUG I' EQUIPMENT ❑ WELL POINT . 0 CABLE PERCUSSION ❑OTHER (specify): WELL TYPE 0 SCREENED- - f OPEN „END CASK,- O OPEN HOLE IN BEDROCK ❑ OTHER TAL LENGTH=, - 2 MATERIALS. STEEL ❑. PLaSTIC� D OTHER • CASING - "LENGTR-48LOW GRADE � a.. � •,fit _ 4 JOINTS; ❑ WELDED MTHREADED 0' OTHER I, , rA, DETAILS:., :' ___...._ - ..,..... _ ------ _._ ;., CEMENT ❑ BENTO NIT E g3OTHEDIAMETER _ :,.... WEIGHT PER FOOT Ibaft J! °- DRIVE..SHOE._Q.YES ,01. NO_ LINER OYES) N0. DIAMETER (►n) '"SLOT SIZE LENGTH (fQ,- DEPTH TO SCREEN. (ft) ,...- ,...DEVELO.PED7 SCREEN ... FIRST O YES ONO ;DETAILS :.Novas GRAVEL PACK C1. YES .... staAVEt ,.. 'DIAMETER -.. TOP - .......,.. -.... ...Qorroht._..,. a. ` ....:._...- . - ._. • .:_ - O NO SIZE: OF PACK in. DEPTH n oEPTH. WELL; YIELD TEST I( detail 6d pumping )f more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. METHOO:h O PUMPED +. tests Were done is in- , DEPTH FROM Water Well C] COMPRESSED AIR , ,formation ,attached? SURFACE Bear- , FORMATION FORMATION, DESCRIPTION Cook ft. it. ' YES 0 N0 O BAILED :. 0 OTHER ,. in meter In WELL DEPTH DURATION DRAWOOWN,: + YIELD Lana Surla e t ... fk ,: hr.. min... ft. 9Cm. . `320:, ,7+ 10 +Ga 1, ;, ER c TEM r-W'A tOUDY tOLORED ANALYZED? .,0 YES 7 'O NO . YSIS ATTACFIEDONO - T: S- T.C±RAGf TANK TYPE CAP..AGITY . .. ...... -... RMATION._:.. ._. TYPE' CAPACITY WELL DRILLER NAME NORMAN "A.NDERSON INC' DATE 7/ ”- /89 MAKER DEPTH ADDRESS SIGNATURE - ; 152 Barger ST _ 5 MODEL VOLTAGE HP Putnam valley , ny. • 1'05 I W11- PUTNAM 0CXW'Y DEPARTMENT OF HEALTH DIVISION OF ENVIROWINrAL HEALTH SERVICES ✓ � ;Jr 3 �v Owner or Purchaser of Building Section Block Lot Building Constructed by P� /� /.Y //V //G * / - /-f d, Location - Street Municipality Building Type Subdivision -Name Subdivision Lot # GUARANTM 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 part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Constructs on.. Compl fiance" for the sewage disposal systan; _ _. . repairs made -by me --io-suchf systOff; exceptwfiere the 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 E:nvironinental 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 (�f �� y 19 Signature Title 151 pgi - Signature Address Address rev. 9/85 mk y� STREET ICCATION 1/C c �. Il� < � MJ / L4 -R „L 7 PERMIT 4 ^� �/ . •- t� f Lm a OR Su7EiDIWSICN LC7I' I I] IV. V. vi. 'l- YES NO SAGE DISPOSAL AREA - a. SDS a=ea located as r aporove3 let' -s b_ Fill section - Date of plac-aient 2:1 barrier - I=- WID'IR AVG.DPTH c_ Natural soil not stripped I d. Stone, brush, etc-, crate_- than 15' fran SDS area. e. 100 ft. fran water course /wetlands. I I Ste.f E DISPOSALL SYSTEM a. Septic tank size - 1,00 1,250 b. Seotis tank inst- 1 level c. 10' minim= fran fcur_ca t:--,Lcn 1� I d_ No 90° bends, cleanout within 10 ft_ of 450 bend e_ DISTRIBUTION BOX 1. All outlets at saz el eva-tion - water testea I I 2. Protects belcw f_cst I I I 3. Ntinim= 2 ft _ oriciral soil bebwee i box and tr= mc-:es ( I I f. JUNCTION BOX - properly set I I 1 TRENCBES 1. 1,ength remir-ed -- 3 a Ie ^. `h instal-led 3 ey d I 2. Distance to watercourse ft. I I I 3. Installed ac rrdinq to plan I 4. Distance center to c--n c 61 1 1 1 5. Slorz of trench acc=t =-ble 1/16 - 1/32 "/foot. 41:7-- 1 1 6. 10 fit from prccr `)r line - 20 feet - foun t? cns 4 aZ 7. D -..pth of t_ e hcn < 30 inches f-an surface 8. Roan a-l-a4 d for eY•can-sion, 50% 1 9. Size of travel 3/4 - li" dia*net_- 10. Depth of crravel in trench 12" m nimmm 1 C' L. • Pipe ends C"-'pped h. PUMP OR DOSE SYSTEY-S 1. Size of v= chamber . -2.-- Vver-.EIcw '-jj. ... .. . - 1. 3. Alain, vi-mm-1 /audio ( ( I 4 PL= easTiv ac^essible nanhole to e--aae I 1 5. First bcx baf=Zed I ( I 6. Cwcle witnesse-d by Heal th Dew Lment 1 ( I estimated flow Per Cycle a. Eduse looted ver a:=raved plans. b. Number of bedrocws I I I a. Well lcc--at-----d as r,--*- a =roved plans ( ` b. Distanca frcm SDS ar`= zr= ur - -ft.- c. Casing 18" above trade_ I I d. Surface d_- airace a-ound well accentable. (� I OVERALW .�� • * a. Boxes prowl crrcut= b. All pipes rar -aaLy baccill e3 I I - c. All.pipes f?u--h with inside of box d. Backfill material contains stones < 4" in diameter � e_ drain installed accordinq to plan I I _Oi*tain f. C-rtai.n drain cutf-al I urotectea & di.r.to exi st_watecourse 1 I g. Footing drains dischzrce away from SDS area ( I h. Surface water- orot_-Llcn adeouate i. erosion on=o proved- on sloces areata- than 15 %. 'l- DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 :-APPLICATION TO CONSTRUCT< -1�' WAfiEI2' WELL PCHD PERMIT #Aiq-'5�' WELL LOCATION Street address Town/Village/City Tax Grid Number z6 WELL OWNER --N e ®%a Mailig Address / %G�/�v.f' Ur/�'�%r /�'' rivate .O Public USE OF WELL 1 - primary 2 - secondary ff RESI:DENTIAL ® BUSI:NESS ® INDUSTRIAL 0PUBLIC SUPPLY O FARM U INSTITUTIONAL OAIR /COND/ _AT PUMP O TEST /OBSERVATION O STAND -BY 0ABANDONED O OTHER (specify, AMOUNT OF USE YIELD SOUGHT___f _gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE60Gl gal REASON FOR DRILLING PIEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE jkPRILL8D ODRIVEN ODUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES 1,'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: --- Lot No. f ` WATER WELL CONTRACTOR: Name /�A�s''%D �r �� ® -Address: va e/ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: ""' TOWN /VIL /CITY - - -- DISTANCE °TO- - PROPERTY - ROM.' NEARESsi ' WATER- MAIN : ` LOCATION SKETCH & SOURCES OF CONTAMINATION _ []ON REAR OF THIS APPLICATION (da e) PROVIDED ..__._�_ — ON S PARATE SHE (si at ' - " PERMIT TO CONSTRUCT A WATER WELL -This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect: the well in accordance with the County Health Department attached to this 3. Submit a Well Completion Report on a form Health Department. Date of Issue: 7 _iq'�O Date of Expiration: `Z 19 requirements of the Putnam permit. p i oyi ded by the Putnam County Permit Issuing Offl-eiaq Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange COW: W011 T)ri 11 Pr JOSEPH F. SULLIVAN, P.E. eonsuL'Etny �.�.gtnut 2972 FERNCREST DRIVE Y(jRKTOWN HEIGHTS, N. Y. 10598 (914) 962 -4248 J, the 13, 1.988 Putnam C'ouhty Health Department 110 Old Route 6 Carmel N.Y.. 10512 R,&z Proposed sewage disposl system property of John Forte on Peekskill Hollow Road in the town of Putnam Valley N*Yo (35 -3 »P /0 4) . Gentlemen 8, . From a field inspection of the above lot there have been no changes to adversely affect the proposed sewage disposal system or location of the proposed drilled well, Very trul�yj yours Joseph F. Sullivan P,E, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .... : _ ...... Date � +��'✓� ��� ��Re: Property of - ' ° ✓�'7 .�� F Located at �j G0 r! (T) -/ � 'ea Section, g Block 3 Lot "Vlo Subdivision ofc'C�! /G%i' Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 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 "'' sy'stem"or ~systems I -.n conformity with the provisions of Article 145 or 147, Education Law, the Pub Health Law, and the Putnam County Sani- tary Code. � ®'V0000ame" . INAI 1 7 g �ery truly yours, t Of ��rh °r�,r POW 114 C <� S pbaoso• d' °p n 8t , pp s o N " _ ®p �FC� O er of Property Countersig P.E., �j Address Address Town o Telephone Telephone i , a . PHILLIP CERADINI ARCHITECT A.I.A. 1 Babbitt Rd. BEDFORD HILLS, NEW YORK 10507 (914) 666.0547 TO L-A {` cr�i�M �L N [LIE"TTEa of T"MUSEDUML DATE JOB NO, ATTENTION RE: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION `T .I ' THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted M-/For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 .REMARKS COPY • Resubmit copies.. for approval • Submit copies for distribution • Return corrected prints 0 PRINTS RETURNED AFTER LOAN TO US SIGNED: -318 k CERTIFICATE OF C( Located PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide P.C.H.D. Permit k ( s-2 . - 3 - ,;fk COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village Tax Map Block 3 Lot --,P/—<, Owner /applicant Name. -Tb 11 IF. Ir _Formerly, _ Subdivision Name Subdv. Lot M Mailing Address 6 W I3 o c• cA Zip I O Date Permit Issued n h a-r� I;� �C 1J • �� � _ _ Separate Sewerage System built by �' YY]!, ddress Consisting of (i �• Gallon Septic Tank and F 2A r e- vtv`t,�s Water Supply: Public Supply From Address or: Private Supply Drilled by A-11 A- ew'S V-7 Address a ✓ e er- �`� �. i/• I.i. �1. Building Type 9 G 3 ., Ae44 C e- Has Erosion Control Been Completed? Number of Bedrooms 3 Has Garbage Grinder Been In -cIE^ a Other Requirements I certify that the system(s) as listed serving the above premises were of which are attached), and in accordance with the standards, rules and Putnam County Department Of Health. — Date _ r , Al Certified by_ Al at Addrett 1 on the plans of the completed work ( copies the filed plan, and the permit issued by the P.E. R.A. License No. 21 y1"LS Any person occupying premises served by the Bove system(s) shall promptly take su bs necessary to secure the correction of any unsanitary conditions resulting from such usage. App oval of the separate sewerage system shall b e null and void as soon as a pub,'.-- sanitary sewer becomes av a liable and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modificatio/n'n or change when, in the judgment of the Commissioner of Health, such revocation, modification Or Change If necessary. Data / / B— ��� Title PUTNAM COUNTY DEPARTMENT OF HEALTH Permit s �I�V 1V Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM s � Town or 4illage Located at .9' r�•t�r. + I r L° 6�• � Tax Map - -� Block ,, Lot Subdivision JF r 7. 1 �r t' /r/ ��<� %""r' Subd. Lot a _ ? Renewal _� Revision Building Type A Lot Area Number of Bedrooms Design Flow G /P /D Separate Sewerage System to consist of d� Gal. Septic Tank To be constructed by Water Supply: Other Requirements Public Supply From Private Supply to be drilled by Address Date Of Previous Approval Fill Section only ❑- P.C. H. D. Notification Required and Address 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 an regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction ComplitnfeYtut% ctory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his succer -O.- I PrsAl 4-dj%tely by the builtler, that said builder will place in good operating condition any part of said sewage disposal system during the periodof4t4MO (a2.jdbHD({�i following thedate of the issu" ante of the approval of the Certificate of Construction Compliance of the original system oy �,;��h�3 the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance with bh@ standards,yfyPes ant regu ads of the Putnam w County Department of Health �°��• .� / \ Date ! I? " Signed . l ;J ! / /,� .i 5 . P.E. 4 R.A. r l/ �- 5 .l'M n +L ✓� `—. Address • Rtt{�eense No. APPROVED FOR CONSTRUCTION: his approval expir s one year from the date issued unies '„construction ofithr uY�iIng has been undertaken and is revocable for cause or may be amended or modified when o idered necessary by the s ionerz of FfealLfi'Aiji n' a eration of construction requires a qw permit. prov for disposal of dome is ni ry se ge, antl /or rivat wat iDate /� % PUTNAM COUNTY DEPARTMENT OF HEALTH (9 / Divlslon 4 Environmental Realth Serwlem Carm®1. N.Y. 10512 weer. to Provide Pamh.d on CERTIFICATE OF COMPUAKE CONSTRUCTI PEST FOR SEWAGE DISPOSAL SYSTEM Pellsmh p ®. / % ` /J Located of / / / / �/ Fs off �% vet e� /� own or VMaS. Suhdivlslon Piame C_ , E/' � mbd. I.at # Tax Map �® Block 3 Lot � J t�0/7i7 /!J% Renewal_ Revlslon 0 Owner/Applicant Name Date of Previous Approval f - ��' LZ Mwft Addreoa�0 4✓ ���� Town _ Tdp Bnlidimg Ty pe %.eye Lot Area Fill section Only Depth —Volume — Number of Bedrooms Design Flow G P D C/ PCHD Pioti®cadon Is Required When Fill is completed Separate Sewerage System to corselet of : 4 Go on Septic Took and —3 •, ' To be constructed by Address Water Suppb,. , /Public Supply From Address or: y Private Supply Drilled by ---Add— Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of the propo em t separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accord .� i ,� an regu a ions o a u nom County Department of Health, and that on completion thereof a "Certificate of Constructs Co to he Commissioner of Health will be submitted to the Depaithieni,'and a written guarantee will be fur,niilied the owner, hi " t h ass y t builder, that said builder will piece in good operating condition, any part of said sewage disposal system during the tl o ) r m tely allowing the date of the isw- once of the approval of the Certificate of Construction Compliance. of the original syste '� re 2) t drilled well described above will Do located as shown on the approved plan and that said well will be Installed in ac toJ an w' the : r les d u a ens of_ the Putnam County Depart ant of Health. V Date igned P.E. _ R.A. ._....w...__ Address:l / iT ✓'/7.•% /f� �. canoe No a�� /— APPROVED FOR CONSTRUCTION: This approval expires tw .years from the date issued unt ss pvi6 ilding has been un rtaken and is ►avOCaD18 for G a8 Or may be amended, or mOdifiedwhen c dared f�BCefsary by Commissions change or alter lW onstruction requires a w permit. Q7(�yp oved for disposal of dome itary wage, / private water s Y. tom/ Rev. Z !J. V 1/87 Date -- fff --- 8y Title : ly a • 3 : A MAR fd ` . { d, �, � �� t 2., aF• y � x . N v}'r t �S' 3 '^" "4s � y�. .,.� S _ ...a ... � o .'s '�� Ok -:4 r. ax- sl,>n+- Y ti�..irti � + '��. ,y a�i'r _. x .tea w�.: .c. `,e.'•e% ....:�n.........s�.- •;N�v. .. r •���. YF y : t t � � _ ..iy ij t r S �hsy® ce ic�itied on tbi s Ply `c ��e7�ed awe �8 aonatruoted ed bs 'before g u 9LU;st d.: °� �onstruced fn $acor Runty De °i 1. ,y wee and iee8n?nti orio$ e' D „ filth " sew SOX st `s �,� 4 •:t: ..sF t "¢ Yr w;n ; ;..'�+S'y Ffi t,.. F n+'r '• E y'�d s, `' i n';.� ' - AROMgyg10� : i � 1 � '�k}} ��� Y E. i.: 4 •{•b; yy..%,• '� �* v�,�M k L , 4 . f � ? ,v ' I Mum „uOunty, Uejl IROVIIi ;��w• ' " z nr � ;� r "iLvleliori 0!•rEnwl2roACt9Atal Health 3eivice a t�� � ..�i m ' ? •� r 'ApDroped u tioted��OrrSo,itto;'aance kith �,�:; r X � ___.. ..._ ..,., .�.......�...� .� _.._ ..,.. _.. .... e ip11Ca31e Hu2e8 sad RegUlationS _ of r s�,r, y Putnam CotiaZY Health D partment .ti �� {t p, ;k t. I,y 9 IK t d JyI �'^• c 4 .va �•E;� r � 5:.., ��y :4 r t��.,�"' t � `+ � w .,. s t } �.� t � C� .•e :' r. �� a � ,rF ° ;` t y, ` � '( .��r r u f�, "°R cyst °� '" � �"�' 4 ��;w �� , "° � t ,.s- ,y;_�,„. �a;....,_ .h-- �:.�: „✓.— •�..:;;�r*.��^^"*' l t a. , €v";% +. ,, "r '4'r.' :p ''� `'Cf Y WIC s -+ .�•'"`yt•9Y ^a^d tty s F tern d 0ee1;0 1 Qq w '. d "I . 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