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Home My WebLink About2712DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 61. -2 -24.2 BOX 23 j NJ Is L IN .I L 1 'II T 0 e4 - Fi I I IN MIN I'FJ ' T ' , WLr 't - I ` • I 02712 77 . 7. ,.. f PUTNAM ' COUNTY DEPARTMENT. OF HEALTH ENO I NO R `,MUST 10 \�� ( _ PROVIDE. Division of Environments/ Health Services,' Carmel, N Y 1QSf2 . PERMIT CERT ATE OF CONSTRUCTION COMPLIANCE., FOR' SEWAGE . D'ISPOSAL SYSTEM ccUTt�1M Town or Villags -:�.. .5.- ..:.:4 •a.. .; :'. .�.�,•^. - � : :..wa" .. ,:r= _. :.'w. .. � .i' � ay ter'. .. . rV �.,,r,,.,.x.�.,:_w. a Located at lC- �i -tl_i 1�1�D '�O 1p -1 i UTI�(i�•iM , ��l . LE xax reap ' , elock , D L( - LPL f g> tin e. /Formerly Tax map Lot e�2 23 Subd. Lot N NIA. Owner 22::42. Separate Sewerage System built by NAARoup LyOhlS Address GOLQ JQ�" \n� 1 1' Consisting of I00� Gal. Septic Tank and 4'(09 4-1"EAP_ FEET of; .24 TQEt�1GN Other requirements _. Water Supply: �/ Public Supply From .X Private Supply Drilled ayCE� \CKS�i�1w � /P- oTHE2S Address.CUI. -7 Building Type S\In�L_s- 1'`n\ No, of Badrooms �- Date Permit♦ �I,sssu1ued 2 -.23 �� Has Erosion Control seen Completed? Has garbage grinder been installed? NV I certify that the system (a) as listed serving the above premises were. constructed essentially as-ahown on "a plans of the completed work ( copies of which are attached), and in accordance with the. standards, rules' and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date Ad 1 188 Certified,, b - •' P.E. R.A. Address •UPPESZ. �T'P�'Tlot�1.1Di GAQ215o►"l may.. license No. 0%979 Any -person occupying premises served' by the above systems) shall promptly take such actlonAs may be necessary to secure the correction of any unsanitary conditions resulting from .such usage. Approval of the - separate sevrerage'system sh' 'I come null and ,Void as soon as a public sanitary sewer becomes; available and the approval of the "prlvate,Water, Supply shall becbme.null"iiid void whip a'public Water supply becomes available. Such approvals are subjecl;to modification or change When, In the Judgment of the Commissloner of Halth; such revocation, modification or change Is necessary. Date /d �� .B Title " __Rev_. 6/.85 c, ... :.. „�. r,s PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser o�fq �Building Building Constructed by /7 �16W44R>'D D Location - Street Municipality JJo Lz� Building Type 4 _ 5 2. 2.E Section Block Lot Subdivision Mme - A�)A Subdivision Lot # GUARMJTEE 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 theretoy 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 imnediately following the date of approval of the "Certi ft rate of C:onstxilction. Compliance" for the sewage disposal systan, or any _ . _..- - repairs "" made "Dj� fCte� t0 SiiCh `SysL66, ,_ t':tCegL "vr"rii u a ial iiiE to ijaiate proiciZY 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 Environmental 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 Z-22 day of 19Y Signature Title General Contractor (Own ) - Signature AOI- -OZ-p d yo„ s �o�S Corporation ITame (if Corp.) Corporation Name (if Corp) Address rev. 9/85 mk WELL UUMeLb* 1UN KtrUtAI Office Use Only DEPARTMENT OF HEALTH I, of.F« fey c .,tal Health SeviriC?5- li O PUTNAM COUNTY DEPARTMENT: OF HEALTH STREET AODRESS: 7 TAX GRIO NUMBER: WELL LOCATION (� �j 2�� S' --Z,Z WELL OWNER NA V ADDRESS: WBIVATE 0 PUBLIC USE OF WELL 0 primary 2 - secondary R RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑ NIDUNT OF USE ' YIELD SOUGHT e5 9pm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE SOU gal.. REASON FOR DRILLING 5 NEW. SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TESTIOBSERVATION 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3 _40- O ! ft. STATIC WATER LEVEL eft. DATE MEASURED DRILLING EQUIPMENT 15YROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 14 OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH / ft MATERIALS: ;STEEL ❑ PLASTIC 0' OTHER CASING DETAILS LENGTH.BELOW GRADE ft. JOINTS: 0 WELDED THREADED 0 OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT 0 BENTONITE I.OTHER WEIGHT PER FOOT 1b./ft. DRIVE SHOE-154ES ❑ NO LINER: 0 YES '@ NO SCREEN 0ETAII .S DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST . "' ❑ i'E� G! ND HOURS SECONO a GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK in TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping.�LL 00: O PUMPED 1 tests were done is in- MPRESSED AIR , formation attached? ;�O BAILED O OTHER i ❑ YES 0 NO LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- in9 Welt Dia- m e ter FORMATION DESCRIPTION cooeO ft ft WELL DEPTH ft. DURATION hr. min. DRAWOOWN it. YIELD Surface �oV WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO ( STORAGE TANK: TYPE CAPACITY. GAL. /1-0. PUMP INFOR ATIOH TYPE CAPACITY MAKER DEPTH �O MODEL SIP 11 ° 7- --'— VOLTAGE X-30 HP � WEL RI LER NAME � DATEnp/ d'd AOER & SIGtr3{TtTRE �'�� _ � �• % WFY k ikv C� PUTNAM COUNTY DEPARTMENT OF HEALTH RE /85 . Division of Environmental Health Services, Carmel, N.Y. 1051? Engineer to Provide Permit A on CERTIFICAT�.(1F�0� NE CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit Located at 17 - Town -or ll.la rStibdivlsloni Name Subd. Lot # Tea: Map BlockLot JZ. Owner /Applicant Name_ ® JVE.t? ,V T le, Renewal— Revlatoti ❑ a Date of Previous Approval e-7-7-87 Mailing Address Town , 7 ZI!__ Building Type L21A r L: E fA�,/ /G ✓�E5 Let Area i • I 4G Fill Section Only Depth Wolume Number of Bedrooms - Design Flow G /P /D �� t7 PCHD Notification is Repaired When Fill is completed Separate Sewerage System to consist of ! �o Gallon Septic Tank and — G • 2 To be constructed by q"GZ2_ ti/df>5 Ad,>,�a S I�i9C D S�iPiNro _ Water Supply: Pdbpc Supply From �p Address or: ✓ Private Supply Drilled by G�-lG J07V i sddre8s L✓i1 '� /SO.t� A-)- Y��r Other Requirements - h cnOL (.f V rr-epresent that I am wholly and completely responsible for the sign and location of the proposed syste ); 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 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 furnislied 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 thedate of the issu- ance of the approval of the Certificate of Construction Compliance of 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 i alletl in ac ordan with the =ta, r ules and regu aTiions Of the Putnam County Department 9f Heal . pA� Date Signed P.E.-Z RR.A %.G_ AdtlrettZ License No • ✓ ` V APPROVED FOR CONSTRUCTION: This approval expires o rom the date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when c ecessa►y by the Commissioner of Health. Any Change or alteration of construction requires a n'ew ermit. pproved for disposal of dom is sewage, an priv to water supply only.�� Date gy Title m 6A I ,� 4- 'PUT COIINTY DEPABTIYPENT OF BIEAI 1H f ; r Dtvlelen of Environmental Health Servk+eS Carmel. NrY 10511 N Eaglneer to Provide Permit q, oa CERTIFICATE.OF COMPLIAN( i 5 Z d 1' 4 Y- Y. .. ;EONS_ U EgMiT.FOR'SEWAGE;DISPOSAL SYSTEAf L y+ � .L it /YYI C� Town or eA® - - 6�I„ . I r i Saba. Lot q Sabdivlston Name az � rat_ ,� +t } r t h �. y t... h • n t Renew®14 ❑' Revision = o iM Owner /Appllcaat Name I Date of vious'Approvaf �° �'.Addreee K` t t r r 00� Town �i��l✓`11/V� l�' Zlp ADS .. �gw � o t t d ApC Banding _Type iAt Aees" 2 l'` Flll Section only Depth i volume_ r Number of Bedrooms Design Flow G P DM ��D PCHD NotiBcatlon is Required When FW le completed �' Separate Sewerage,Syetem to consist of ' '_ Gallon Se C Tack ana� e �r ` Zi LL,x.(. u %31�k ,.To be constructed by 6�,�OL j] L�/D a Address O �1 Water Sappli: Y blic Supply From `Address or:Prlvate SaPPIy C , h :' c� -� � berReoairements I, reDresent -thaC l am wtiolly antl completely respons(ble loith design" location of tfie proposed° systems) _1) :that tfie %sepa a sew a tlispofal'system - above described willbe constructed as shown on the`approvedlamendMini there ?to and :in accordance with tliestanaartls rules an cegu. a rons o e u nam: i - n.... - .- Gounty., Department of Hsalth,? and that,On co-mpletion thereof a Certificate of Construct�On Compliance satic}actory to'the Comm�ssioeer of;Health;w�ll ) =" be <submitted, -to the Department and a wntten guarantee:,wil1 De /urn�shetl the owner his successors 'hens or assigns Dy, 4he builGer thatusaid.bWider. lil o eratin' ,conddion any;, part of -said sewage disposal system Wdring the pe►iod :of two (2) years Jmmed�ately following thetlate of the asw` place;, m`gOOd, D _ g ae.rz' n .., :,am �,__:.'. r..s _.. ;. £,.•: M r t:. a,:t ,. ..- f once`; of •ttia ^,approval',of the',CertAicate Of }Constcuct�on Compliance oftheforigmal system or.,any repa,�rs thereto 2) that_,the,Crilled well described,.above w will,.be lOeated;as shawn_on the approved plan and that seed well will be inst n accordan a with the ri r les and: regu a"TiToos of -ahe Putnam .. County "bepartment.ot "'Health ;` � � `=` � '` +.' � s Date• %lid "'�_�':_ _r t - Signed'. 9 P E R A - r Address License No aj �'.- AVPROVEO FOR �CONSTRUCTiON Th�sapproval.; xpnes t`w , t arss�trom the dateuissued unl8ssfconriruct on,o/ -the budding as been undertaken and :is, r z x revocable for cause or may be amendetl or,mod�fied wh.i7— ns�de dnecessaiy,;by thecComm� ;sinner of Health `Any. Change or alteration of. construction' 59 � zy, requires�a new permit Droved for disposal o, domeriic a "sewage "and pnvate�wdter'wpp)y only -' •`� - � 87. ' Date '� 7 �f / gy Tale 44 fr vet b _ f.. J. -T- x- , t 1 WX -Si CONSTRUCTION 'POWIT,:F.. Subdivision Owner -�� Building �)[.Q„ Number of Bedrooms Separate. Sewerage System, to To 'be constructed by PUTNAM , COUNTY DEPARTMENT OF HEALTH Division of EnVi onmenral Health Services Carme% N. Y • 10512 OR'.SLWAGE' ISPOSAL SYSTEM. Town niage - Addre$$ �`�1 ��0.'3 0� 6� \ 1• `ot Areas�--11 3 @4 ��' jw Design Flow �'y,.0 Total Habitable Space ' Square Feet :onsist of Gal 'Septic .Tank °and •�� • ,�'V .14 Ma v• ,R'!! _ 424 [^ 4fh' 'a i-• ' 5 Address'. Water. Supply: Public Supply From Private Supply to be drilled by. Address —Glaf ' Other Requirements I represent that 1 am wholly and completely responsible fo[ he design and location of `the proposed systems ;•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.siandaids, rulesan regu a ions o e Putnam County - Department `of Health, and that on completion thereof a "�CerUficate of Construction Compliance"''satisfactory to the'Commissioner of'Healthwill be submitted to the Department, and a written guarantee will'be ,furnished ti he owner hissuccessors, 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''th'e'originai system "'or any #epairs ihereto ,'2) that the drilled well described above will be, located as'shown on the approved plan and that said well wilfbe in 8 in: accordance with'. the standards, rules .and; regula�ns' —of the. Putnam County :Department of�He_altth. Date r' 2 ,_! Signed P:E. Z R.A. . Address C�� 3 \�' lV .J G`°t Litense•NO: V"i�, <• l� APPROVED FOR CONSTRUCTION: This approval expires one yea[ from the- date. issued •unless''co uction of the building has been undertaken and is revocable for, cause or may be amended or modified when considered °necessary by the, Commission f Health. Any change or alteration of construction requires a new' permit .Approved for disposal of domestic e e a ri Y r supply o Date ^ • '�� BY Title -- r PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 , a Division of Environmental Health Services. Carmel, N.Y. 10511 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM En&eer to provide Permit q on permit # CA Om10 —% I Permit q V j Subdivision Name Nome Sabd. Lot q -� ry Tax Map &? Bioci< C�� °'� �� —$ ` Renewal_ Revision 1 %r1i�4D7Q Owner /Applicant Name 61 C� 4d19. ADM. ® -A 1 Date of N vlous Approval g Mailing Address � e g c t� � _C o _- _ Town Zip 1 D IZA Building Type ! ®� � cal Lot Area _24-L '% s FiD Section Only Depth Volume Number of Bedrooms-4 / Deslgn Flow G/P /D � PCHD Notiflcad n Is )Regnirod When Flll is completed Separate Sewerage System to consist of Gallon Septic Tank and To be constructed by Address Water Supply: 74 Supply From Address or: Drilled Other Requirements C.* / e 10 9 y v >..J s 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 07 P. 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 syste 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 a or 1 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 inst led in a ord�nc wit he stands s, ru regu a suns of the Putnam County Department of ealth. Date S' ned 11 P.E. R.A. _ Address b �v� License No 040970 ✓ APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless constructs n of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new p rmit .�AAppproved/fordisppoossaall of domestic sanitary sewage and rvate water s ply only. DatdG�,L Title ! r/ G� \€ ell, fO i (Perini ttee') w J . r y + �4 _ ._. r " Thin is, a` o :advise? the),Putna - -,County -.� . Health <E).epartmen:5, th f ,fi'11` has keen placed on t the below tap- ioned`,prcperty (Street drown). ell, fO i (Perini ttee') w .PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES .y.: iM -. .1>..b:..:i'/<Y.'v • " <:[*aA�iM '.zr> s46czM Y._Nti.R.' ^P .'Li .. � —c-- -- .`... ..o. -.. r..• Re Gentlemen: Property of Date /-.�a'.2ni's S w.)r -f- 11_1,6-01 Located at %q %�� Po�dj %all�a 1 D Section 3 -Block .J Lot 2 2 s 2.23 �_ k o This letter is to authorize r -� a C' Dr'�l�c a duly licensed professional engineer V 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 d:UJIJWC LiU11 w.L t n Litib ma L Lev anti to. supervise jhe coIlstrue Lion of said system or systems in conformity with the provisions of Article 145 or .._. _l47,.._Education Law, the Public He'alth_Law;. and_. the Putnam` County Sani- tary Code. Very truly yours, Signed -- ner of Property Countersigned: P .E ., R.A ., # 64 I'M9 fia& 9 07rr'o0'f /V, Y, 105`24 Address 424 38-4 9 Telephone Addre`s`s Telephone &v _5 pu� -1130 DEC 8 1998 Pu`r NAM C(DUNTY DEPT. OF HEALTH PUTNAM COUNTY.DEPARTMENT OF HEALTH DIVISIONQ OF ENVIRONMENTAL .HEALTH SERVICES- COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN-DATA SHEET= TEST PIT DATA REQUIRED TO BE SUBMITTED.WITH APPLICATION 8411 DESCRIPTION OF'.SOILS ENC,OUNTERED.IN TEST HOLES _.D _8PTN .. __._HOLE _ _NO . G.L. _ t' a�n�t. of �� in�c kir . Or 611 No.* of" Bedrooms Septic Tank Capacity 10 00 Gals: Type kkaton&r 12 rr /10-)&7 _ l' . ,�pa �►'1 : ��o? �03 h'1 18" 24" 30 ". 36rr 42" 8" 5411 . 8411 INDICATE. LEVEL. AT WHICH, GROUND. WATER_ IS ENCOUNTERED. nort2 .. INDICATE LEVEL TO WHICH WATER LEVE RISES AFTER BEING ENCOUNTE _ ._..� TESTS- MADE BY _ ._a horn -ia 4�....,a . -�: - - Date... �'/g /__. DESIGN Soil Rate Used k-20 Min/l "Drop: S.D. Usable Area Provided 5000 No.* of" Bedrooms Septic Tank Capacity 10 00 Gals: Type kkaton&r Absorption, Area Pr.o�.. By4 29 . L.F. x2411 .. . ' b� '''-' width Trench. Other Name G igna ure C Address ;.9 SEAL THIS SPACE FOR'USE BY HEALTH DEPARTIMT ONLY: Soil Rate Approved i ?:: Sq. Ft /Gal. Checked by Late .,., .r . PU`1 MM 000MEY DEPAR'IMENr OF HEAIJIH DIVISION OF ENVIRCNMENTAL HEALTH SERVICES MACE a A•liYll`...►iVLi►7LMVt� v.i.} S.i ... �, ._ —.... ..r �^• ;mot.- �l.v� � ' f- � './—. 1 ' ':' Owner 0/1 v @,- ��1 i�� F, Address phi I; p5,e Located at (Street) a,?fAle-y,d �� Sec. �3 Block S Lot 2.22 (indiciLte nearest cross street) HOLE NUMBE R CLOCK TIME • PERCOLATION - -- -- k'.L-TMi��TTGD] Run No. Elapse Time Start -Stop Min. DeE�th to Water' Fran Water Leti,-,�. Ground Surface In Inches Start Stop Drop In Inches Inches Inches _ - Soil Bate Pdr,i /7n .Drop P], 1 Il '3 -1/ 40 �O min. ° .�4 ;Z7 . 2 Il- 4z�- /�. 4� m��. 2� 27 '' Z 3 /l� 4�- /153 7r)"n, 4 5 r, ,1.. �..,� ✓J- �.�Q..�Y G i iii /%7 . 24 f 2 11. 5� -1217 211�;ln lu 27 3 4 5 1 2 3 4 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 made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED ITV TEST HOLES DEPTH HOLE ` NOo e _ -- _ IiOLr; Two G. L. 1° 2! 3' 4° 5° 6! MA- INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER. BEING Et00UNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: " - .. .. - _ . -1 DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 1000 gals. Type 1t1,q5&7 r1/ Absorption Area Provided By 2" L.F. x 24'° width trench Other ��rrr'�- ir.-�. p��,r rJ/ e— Name r� � I" l� C_flrrna�� `�m�� eE, Signature _ ... Address Ste' JDS THIS SPACE FOR USE BY HEALTH DEPARIMENP ONLY: Soil Rate Approved .ft al. Checked by Date .7° �n go 10° _ 12' MA- INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER. BEING Et00UNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: " - .. .. - _ . -1 DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 1000 gals. Type 1t1,q5&7 r1/ Absorption Area Provided By 2" L.F. x 24'° width trench Other ��rrr'�- ir.-�. p��,r rJ/ e— Name r� � I" l� C_flrrna�� `�m�� eE, Signature _ ... Address Ste' JDS THIS SPACE FOR USE BY HEALTH DEPARIMENP ONLY: Soil Rate Approved .ft al. Checked by Date IT L 1.) I'T N. 70" 33 ' O9 "W, A do EP. //01 ES 429,.1,1-- Of ith Yi s6vi N F ILL Iv y uNO at c es p p'a.111i Gull uy ld' t Lt le Dd t 14,fkp Z. ....... .. .. 3 Bedroawl Me- h.. Y) am VCS I I v 1 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME bop INS Orig. Routine ADDRESS P/1// C f WON TM 140. MAILING ADDRESS P.O. Box Post Office Zip Code PERSON IN CHARGE OR INTERVIEWED Name and Title :DATE a S., TYPE FACILITY 310 TIME ARRIVED I a FINDINGS: TIME LEFT •L4-5 . Orig. Complain Orig. Request Ccmpliance Ccmplaint Comp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain Signature and Title '11DC- PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: k*_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re ss Property of L&E:a BC' PZAIF7 Located at H' (T) A%j Section 2 Block Lot 2, 22 i 2.23 Subdivision of Subdv. Lot # Filed Map # Date, Gentlemen: 0 This letter is, to authorize 9044W.30 a duly licensed professional engineer.., o ere a��_� (Indicate to apply for a Construction Permit for a separate sewage systems 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 Z f.. _.a.a J,d' system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Codb. Very truly yours, Signed j (I 6 \' • - 1 o ""ersignedJ wner of Property rVk L Address own 17 Telephone I .. / i �I II ►000 GAL, N. 70 0 33,09 11w, 4DI A &-eiO //Oz ES 0 pl-,xv04Ar1oA1 La 2,22� 2,23. 3 Bearvoyll J- ve.-r T3odi n e- le PLC+yl � y y`( �cb' n pc�ry /V. 7,00 33109' w. A AC EP / /ol ES , aV 0' I 1 �� _`t�- loci 5� 2 _.,.. Lot 2.2 4 2..2.3 3 L3edrvcm �•r- I� G CD i:i der_ 13�?da »e. na.m %. ( ley, I�• . Y fo Q) 1000, GAL. SEPTIC -.TAJJX 757 33' 09 11w, A BEEP //Oz ES .0 p--l-vow'ArloAl 11,, ..1:.5 im ......... . PZ Tax..M.Qp 23 3 {ock.5 41-,,2.22 e 2.23 3 Bedroom, L C. e JJer aodl.me- tj -y-