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HomeMy WebLinkAbout2719DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -2 -34 BOX 23 02719 ,. !7- ri ki rr . -� P. A11 rl 02719 DL ; PUTNAM COUNTY DEPARTMENT WHEALTH Division of Environmental Haleith Services, Carmel, N. Y. 10612 ?eerrmie a y CERTIFICA OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley V D a Town or Village :;�-. tiN�. .._�[7`�- �pY- '� +r��I.C- R�+..L. .. ,:s- c_. -s.. -... .-a•. ,...,. ._ ..- -�°.. ........_:'.i..':��•:'cx•.. 31. ...•e.:.:.',.a..�.. �.�•u:. ,. «::,. Block . ownerMr . & Mrs . M. SwanserY Formerly Tax Hap Lot fl' 10 Subd. Lot N Separate Sewerage System built by Don Heady Address Canopus Hollow Rd, Put. Val. ,.NY Consisting of 1000 pal. Septic Tank and Other requirements Precast Concrete Leaching Basins Water Supply: Public Supply From XXX Private Supply Drilled By Norman Anderson Address Barger Street,Putriam Valley,-NY 10579 Building Type one Family Residence No. of Bedrooms 3 Date Permit issued 11/21/84 Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as own on the pl of which are attached), and in accordance with the standards, rules and regulations, in accordant ith the filed Putnam County Department Of Health. Date 3/24/86 Certified by_ AddressMuscoot No, RFD #2 8 M o ac NY. 1054 the completed work ( copies and the'-permit issued by the P E R.A. XX 110 5 6 W,fYO. Any person occupying premises served by the above system(s) shall promptly to we actlo as may be necessary to 4ecure the orrection of any unsanitary conditions resulting from such usage. Approval of the separate sewerage syste all be e null and void as wonIas a pu iki sanitary Sewer becomes available and the approval of the; private water supply shall become li and void when ay0lic water supply becomes avallable. Such • approvals are subject to modification or change when, In the judgment of the Jmissigflor of FliatCfl, such revocation, modification or change is necesury: JJJJJJ 'VV�� ,! / 51 •. Rev. 9 -81 WELL COMPLETION REPORT' 0. PUTNAM COUNTY DEPARTMENT OF HEALTH 3)71 pivision of PenvlPonn ,tjj Heatth Savit»s COUNTY OFFICE IsUIf DING - CARMEL. NEW YORK, This..r�t+9rt _is w be cem_ plvtett by wei(I tier and submitted to County Health ®epartmanti- together With laborattxy report of analysis of water sample indicati ._., �' `'� K y ng water Is Of satisfactory beet ".IiriaT quality before Geri i caiLl ; i`cafl truetiu�r tic. Qi1Q :.Z M ',ss la REPORT MUST BE .,W MITTE® WITHIN, 30 DAYS OF WELL COMPLETION ADDRESS 9WHEe LOCATION t OF WELL O' a; j2 BUSINESS DOMESTIC C� ESTABLISHMENT . ❑ FARM ICJ TEST WEl6 IR0 $11D ►C7 7 NSE OF WEId SUPPLY ❑ INDUSTRIAL CO ❑OTHER ❑ CONDITIONING (specify) � ❑ CABLE OTHER EQUIPMENT A PERCUSSION PE RCUSSION ROTARY r) CASIW LENOTH'( loot) DIAMETER(Inches) WEIGHT PER FOOT � 'WELDED N O DES NO ®ETAfdS HREADE❑ _... _ v _ _....... _ .:..._...._, HOURS : (G P Mi `.: , : ❑ ❑ YIELD; ( :PcM,1 TEfT BAILED PUMPED Z::"" COMPRESSED AIR 'WATER. MEASURE FROM LAND SURFACE- STATI6_(SPecItytoo1) DURING YIELD TEST (lent) D•p f' V,. d I. Ilawd Wrfogt LlfNE6 in fait below MAKE _ AQUIPER'(l® 00, SCREEN LL"TO .DHTAILS SL SIZE DIAMETER (IneAoa)' IF GRAVEL Diameter of well including, 1" NoQ TO Uo+ +) FACMi gravel pock (inches). DIFTH From LAt40 SURFACQ sketch ou"t looeflon.01 Well with diatoms". to at, tow t' �PEEY FORMATION DESCRIPTION ; . two porm"ont 4601**. go FEET lf:yi ®Id was tested. at. different �ept!4 during drillina, list below FEET GALLONS ►ER'.MINUTE DATE E C // / IEIE[ /� ( DATE OF REPORT WELL R (Signet rp) .. J j d! 0 `y� �yREnce ORecy,� 3 Or Ott ry . 3 'rSS� a p r - O O Ft. cu 'PHALT ^ ^�� __.. ^ Z r F D E N U e -� G`q N p pU5 --R, . . R4 ti. Zj•37'e. z z a ROpK """ THIS IS To CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WA: ,CON- �s3n �,� STRUCTEA .AS INDICATED ON THIS PLAN- AND THAT THE SYSTEM WAS INSPECTED B)' ME BEFO[iE IT WAS-COVERED OVER. THE SYSTEM -WAS P��FMEN7 CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES •AND'REGU— o LATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND}-THE 5SU S (Al. sulur) NEW YORK STATE DEPARTMENT OF HEALTH. No GAR -QAGr� �aY- lh+r7�2- �;' - of f` {'. -• r , t " A B ' • a 0 rANK 1 411041 15� (o" i -- - -ROAD -- ` s lv oz'w T - -R41L 130.00• 4+r w( 2 46' -9" tt ;y,-o a , (,¢'e. ¢w �; Z M' OLD aiN • G.OL xT 0 - w zm '0 Q ° W -i a a'o'mx ' tV6W ; /ic'u.`wsr come. LWJOaG LLI V l N U ZF >o w . 1 WOO 4A& 'rANY Q ,1 'J - = 00.4 . A e� wwo ai 5 4'cr i Q 0 s �2 JT y FiP9iJlE. of }Sea_th i - .. //oulB • tm�nt R t9 'Spar i onID ent ,a{h Servi409 a :• 1 C.",, ti to Division Oi / //Envi witb t ; _ i a � ormance a n or oo 1 :o =b Bi -00• j` _ and ReBulatiOna 6PProved ul a Plicable Re Health P�°at• �� l :F. :4 03 _- Z Cp a N �► 1' w Z gigoature „O > J j d! 0 `y� �yREnce ORecy,� 3 Or Ott ry . 3 'rSS� a p r - O O Ft. cu 'PHALT ^ ^�� __.. ^ Z r F D E N U e -� G`q N p pU5 --R, . . R4 ti. Zj•37'e. z z a ROpK """ THIS IS To CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WA: ,CON- �s3n �,� STRUCTEA .AS INDICATED ON THIS PLAN- AND THAT THE SYSTEM WAS INSPECTED B)' ME BEFO[iE IT WAS-COVERED OVER. THE SYSTEM -WAS P��FMEN7 CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES •AND'REGU— o LATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND}-THE 5SU S (Al. sulur) NEW YORK STATE DEPARTMENT OF HEALTH. No GAR -QAGr� �aY- lh+r7�2- �;' - of f` {'. -• r , t " eorktown Medical Laboratory, Inc. LAB N 2511-524 321 Kear Street Yorktown Heights, N. Y. 10598 Collection Station Used: Carmel. Peekskill..._. .Director: Albert N. Padovani M. T. (ASCP) Mt . K'i'sc o _ Hev City_ Date' Taken: 2, uo Date Received: •., , o�; ifrj Date. Reported: Collected By: Referred By: L ���� v` L� J Sample Sourc e A/ ' 7�2_ LABORATORY REPORT ON BACTERIOLOGICAL QUALITy Y OF WATER GENERAL BACTERIA L_--l-'standard Plate Count per 100 ml (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Ll--Total Coliform Der 100 ml V Fecal Coliform per 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Fecal Coliform: OTHER ANALYSES MPN Index rer 100. m1_- MPN Index per 100 ml THESE RESULTS INDICATE THAT THE WATER SAMPLE OF A SATISFACTORY SANITARY QUALITY ACCORDINGI WATER STANDARDS FOR THE PARAMETERS TESTED, A Albert H. Padovani. M.T. (ASCP), Director a V(WAS NOT) (NOT APPLICABLE) E NEW YORK STATE DRINKING E TIME OF COLLECTION. LEGEND RDS = Recommend Disinfect- . ing Water Source < = less than TNTC = Too Numerous Too Count 4 . Mr. &_Mrs. Michael Swansen Town: of Putnam Valley Owner -or ,Purchaser of Building.. 1Iunicipality :. Dori. Heady 2 3 Building Constructed, pt Section Canopus Hallow Road 2. , Location Street Block 0 e•Family Residence. 10. _ Building Type Lat. GUARAIITY OF SEPARATE SE AGE SYSTEI••i I represent that I aim ,rholly and col-1, letely responsible for th- location,. worksnanshio, material, construction_ and drainage of the se,•iao-@ disposal system serving-the above described property, and tha't.it has been constructed as sho;m on the approved plan or appro =ed W-1- -ndment thereto, and in accordance with the standards,. rules and re=7 -,lations of the Putnam JOLi21t` Dv w _ O1 LVa J L, and __ y u az -- ne .OiV ^S, Succes- sors, _ ^_ei s or ass =zis•, to: place I__ z o o d o_nera"_nZ Bondi Lion an �_ea-, -t of said system constructed �y r =e :r ^�i„__ fails to ooer e for a period of °ar3. ii"L?edi ately tool l owing the da .e of I iti ' u5.e Of �iie Sew i 1 3�: C�_3p0S^ sys eri, or any 1 e -ja-i rs made by ma to Sac i sy v °~ e_.oeo where_ JaV faillure to operate properly is caused by t _e Willful or nezrl -gent act of 1' ocu- pant of _tie h,�i l dingy uti� ; 4;nQ the sys t.e' - 1 -.7. .c undersigned further ac-rees to accept as .conclusive. the de- The on of the Director of the Division of Er l ronraensal He th Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system_ to operate was caused by the :•:illful or negligent act of the occupant of the building utilizing the system. Dated this 24 day of March 19. 86 Signature, TitlJae If corporation, give name and address) THREE (3) COPIES ARE. REQUIR=E WITH T� -FREE i3) COPIES OF. FINAL PLAINS BEFORE CERTIFICATE OF. COv�LETI013 WILL BE ISSUED. GUARANTOR IS ?REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF . SYSTEM. Division of Enviro=.L -ntal Health Services, Putnam County Department of Health TN 8M. COUNTY 5. Di f Envim nta! vision oT _`CONSTRU N PERMIT:TOR SLWAGE_-,D1SPOL S, ' Located at U "'�'�J'2.1 aw i oacl - Subdivision ,N /A Subd `iz V. ...Owner /aadressM -,, SWanSOn" SunriV Br.00k, Pitt AVc x %Building; Type cx, Fam ' ReS Lot Area, 00, �,Numbbr of BFedrooms ' - c Design •Flow c /P /D 60'0 r 1`t 1000 Separate,+Sewerage SystemFtoSCOnsist of To be constructed by Don Heady '' T Water' Supply ?Public Supply - -From r { t e Private 'Supply to be drilled by' N4 Al ;Addres °s Barger '.5t ,;:Putman Other - Requirements C'- 4 I represent tliatl:"am wholly and completely responsible or, the des\gri above; described' will be constructed,ai shown on'the.approyed ame fame County Department of Health',,and that on completioh.the'reof a 'CE be submitted to the Department, and 'a written guarantee will De fi place in good.operatmg! condition any.,pirt of ;said sewage disp4o'sal :ranee of ,the approval `f _'the Certificate of Corlst►uetlon;eo nce .,:Will ,be located ;ai shown on the approved plan and that said well,wrll be County - Department of Health 1� 2 /, Oate , . � Signed Andres :MlaSCnnt Nn' -rt-h jR•F APPROVED FOR CONSTRUCTION This approval expires, one year;.I ,,revocable for cause or:may be,amendeC ormotl�fiedwhen' " ideretl�'_ requires •a new, permit Ap „proved i r disposal of dourest sa ar Date c ry Rev 9 -81 e r EPARTMENT OF HEALTH' Permit » glib Services, Carme! N' Y 10512 j Tow or Village t 1'ax -Map 2 3 � � Renewal ^ �❑ ”' Revision -'❑ - - ��10�579 ' � r �_ Date ;Of Previous Appioval .q n Section.Only ❑y "" - ,� P C R D i No -1 fication Required' �p (4) `8ftDiam .x6ft.deep leacha,ncr Se tic Tanks antl' t r ,.,. r C 4 2 y ?aL 1 n � � Add ►BSS Canot]llc.ar'rH0 ,� OW .ROad< . x i 5 ` Pu`tnam=.�Val`1eyNY 10.5 7 9. 1 A. f y M� cation of. -.the l jre;to'arid ;in.aCi stems },1) that -.the separate sewage disposal system Ih the standirds rules an regu a ions o e' u nam lance satisfactory to the Commissioner -of Healthwill s heirs-. r, ssign s.by'the, builder, that said builder will o (2) yeprs immediately following thedafe of the issu pairs fliereto 2j.th t- We drilled well described ' aboie -, . standards rules d k, u a ons ' of the Putnam ' PE RAXX'. kk.r10541 11056 •TTV " Llcens• No struUOn c;of the $wltlirig h s'been`undeitakin and iB of Health. Any change ;•or - ,alteration of; construction �PPIy only ,Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Mr. & Mrs. Michael Swanson Located at Canopus Hollow Road (T) 23 Section - - - - - -- -Block 2 Subdivision of Subdv. Lot # Gentlemen: Lot 10 Filed Map # Date This letter is to authorize Joel Greenberg . a duly licensed professional engineer or registered architect XX (Indicate to apply fora 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 •�---._....._.- .._w.t,:.�+ #:gm �,r,. ; ��r_ a- t° C? :�-- �.I2�C- !Ji:�fJ'i�:m�.�.�'• wl-{;�,l:f:,'ti�p' rnV.L.�Ty��ii� .(S,' f�;;,; 4; Y `f'�.i`.�'e..'�_�.�...,,o�,' :.. _ :.._...... 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Muscoot North,RFD #2,Bx 488 Address Mahopac,N.Y. 10541 (914) 628 - 6613 Telephone Very tru yours, Signed Owner of Property Address K,� '.� , Il a Town 2fg - � �-- 7o2a y Telephone r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ �. .. � n .. -. .rep •:� - •.'. :.•n.a- •ti •�•.Pr� ry r- 1- ���'v�.�.::.�w.•`. ...w .. - ..'.�.sn... r.r r i� �� .�COUl`ITY :'OFFICEr BUILDING. CARMEL; N Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Michael Swanson AddressSunny Brook,Put.Val.,NY 10579 TM_ Located at (Street )C n us Hilo Rd # 23 Block 2 Lot 10.: Indicate nearest cross . street) :,.,, .. ...:...:..:... Municipality :.:,T. w ' of Putnam- Vaii&v Watershed Hud`9on...Ri.Ver.. SOIL PERCOLATION TEST . DATA REQUIRED TO BE SUBMITTED .WITH ` A PPLICATIONS -Hole Number .CLOCK_TIME PERCOLATION PERCOLATION 1Zun Elapse 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 qugT :.18 :5.8 -9 :.0.4... 6 15 1/2 16 1/2 1 6/1 29 :05 -A ;11 ti 15 1/2 16 1/2 1 6/1 =6 6 15-1/2 16 1/2 1' A/1 =A :19 -9:25 6 15 1/2 16 1/2 1 6/1 =6. 5 1 9 4 5 Notes: 1) Tdsts to be repeated at same depth until approximatelyy equal soi'i. rates are obtained at each percolation test hole. All data to be submitte(:: 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. DTH #1 ' HOLE N0. - DTH #2.'. p- ' Sol, 1T :_....r.. RTop Soil.. 84" 1'201 INDICATE LEVEL.AT WHICH GROUND WATER IS ENCOUNTERED NONE INDICATE LEVEL-10-WHICH WATER LEVEL RISES AFTER BEING ENCOUNTEREENone TESTS MADE BY Joel Greenberg - ,. DESIGN Soil Rate Used 6 -3 Min/l "Drop: S. D. Usable Area Provided 5 ; 000 SF No. -of Bedrooms 3 Septic Tank Capacity 1,000,* Gals. Ty ast Cog. Absorption Area Pry By L.F.x24 11 1 5b" — wi �c °E .(4) 8ft.-Diam.x6ft.beeo Precast Conc. Leachina Basins V'ame Joel Greenberg Signature Address RFD #2 -, Bx 488 Muscoot North SEAL 1 Mahooac.N.Y. 10541 1 f. A. j� THIS SPACE.. FOR USE BY'-HEALTH DEPARTMENT ONLY: 0 I Soil Rate Approved Sq. Ft/Gal. Checked by Date a a1 _,- BRUCE R: FOLEY- __ -..: .. Pttb17 'Health birector Mike Swansen Old Road Trail .Putnam Valley NY 10579 Dear Mr. Swansen: Y : L ORET.TA- _MCILINARI Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)'278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678' Fax (914) 278 - 6085 September 14, 1999 Re: Addition- Swansen- Old Road Trail No Increases in Number of Bedrooms (T) Putnam Valley Tax # 61 =2 -34 I have received and reviewed the plans for the proposed addition.to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated September 14, 1999 The addition is approved with the following conditions: Pi 3 The total. number.of bedrooms mus± remain atJee hr without prior approval by- ._ � - fhi's depar[m`eiit: _,_... .. _ ., .. _. � _ _. .� _..._.. _ ..... ._ _... _ �... The area of the existing sewage disposal system, and its expansion area, must be maintained. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges WH:kg Senior Public Health Sanitarian cc: BI d a, DEPARTMENT OF BEEALTH Division of Environmental Health Services 4 Genev Brewster, New Tel. (914) 278-6130 a Road York 10509 Fax (914) 278 -7921 BRUCE—R... FOLE -K - f�ublic Health Director PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLYI STREET OIL �( `. _ TOWNP, TX MAP # NAME;,��rr n� o�,� PHONE ? PCHD # .' MAILING ADDRESS —4' /c2, 71, DESCRIPTION OF ADDITION;: NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS., 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code..., Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all Having area including abasement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non- professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label:all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 6 d a •. DEPARTMENT OF HEALTH Division , Of Environmental Health Services 4 Geneva' Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: BRUCE R. FOLEY, R.S. Acting Public .Health Director Re: 7w It— S -e-VN y45� �ex qr- Residence Tax Map Town According to records maintained by the Town, the above noted dwelling IS V IS NOT in compliance with ToNNm code and the total number of bedrooms on record is 3 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Building Inspector a" ENT OF HEALTH of Environrrientvl Health Serviosis, Cormal, N.. Y 10512 pest CERT601 g or- '.CONS'TRUC'TION COMPLIANCE FOR SEWAGE'< ®oSPOSAL. SYSTEM .-Putnam Va ley r Town OP Village Located at Canopus Hollow Road Tax MAP 23 Slack 2 OwnePe°d ° Se • Mirs ® me Smansert/ ro-ly Tax Map Lot,k In Subd. Lot 8: V Separate Sewerage system built by �n "Heady Addre� Canopus Hollow' Rd p put a Y41"" PITY Consisting "or, 1000, Gal. Septic' Tank and —_.. 10579, 1 Omer requirements Precast " Concrete Leachincr Basins I �W84e►.Supplyc Public;SuPPIy From Private- Supply Drilled By NJormari, Anderson e Barger:StreetrPutnam Valley,NY '*5,79 Address: Bunding Type ® Famil_V Resid.Ante No. of Bedrooms 3 Date Permit issued g��G?�,LSa4 P asj Erosion, Control Boon Completed? I oertify,that the syatesa(s) as listed serving "the above premises were constructed.essentially ` as hewn on the plans or ifie,completeq.gdrk (copies ok :whiah are attached), at�d`in accordance .with the standards, .toles and regulations, in accordsn a with the filed p ;'and the permit`isauad by th�a+ .Yisfiam County .Depaztment'Of:Bealth. a; + e Da4o 2/8� Certified by %� `� E R.A. . e ACidrezueC04t ATO RFD #2 $ 4 6 M— O trance loo .�L Any porsom' occupying pvomisses served by the above system(a) shall promptly 4a o su octlo- as May bo n ©eoes?aPy to s�euro Sh eovrot4iofl o4:any ,uncenl4aPy conditions r®sul4ing:from such usage. Approval of the separsta' isworage sy m all bocomo null and void 'as soon as o p blic :sanitary mviir bioornos } available end..the.approbal'of the, private water supply shall beeodle ull and vo when's obits water supply becomes oval blo.. Such. appt®gels aro subject to modiflga4lon or cpango vsrhen, In Oho judgment. 04 Ohs missl nor of ch revocation. modification or change to noccomry. r OaY® B GD .`tC7 t - Y' TWO . 1. tic3tl ' 981 )jr I t er'.01 LOY'Ll "dry OQ IIA 6b ro ell r 7 .' PUTNAM COUNTY DEPARTMENT HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS Ah Signature &TItIe to } l i v. PUTNAM COUNTY DEPARTMENT OF HEALTR + HOUSE PLANS APPROVED FOR BEDIR,001,11 COUNT ONLY; EDROOKS w �s oe J6' 3' ►r 3 y IPUTNAM -COUNTY DEP. OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS Signature &Title Date 4' !3' 3' 7K- Ig- 'S'tvj,/5 el PIC- rj IJfj S-C p" ) p CA FJ Ft I Sq t 1-� --� 7 q y. 0 _ — R O 9�9 ��' — — 5 �7.OZ' W. — RAIL — 130:00' OLO A PIN I �� s.tdoo-ZOw. potE 4G� 9" � 0*. Sc -Al (� qg� -0" 4. 41 � O" 5 , i \ Pv "- ;y v 114-0" •i�o' -�" N i S� Lou.:ty Department of Health A 8 s pz JT y F�q�ilE ✓Np�R SON /J 89.00' W c- O d' 0 4C d1 0 0) 'o, vwc %T au= 'O, �'°�� O O K PNAIT�'�•. ZI - •- ROA 5SO5' (A-. 0 r P °t nI _PAVEMENT . Z CJ 7 a tv Q 111 a Z p Z } J W E K 01 O b a: Cr W ew WZ to Z o ZQ ° W J e W G. ; o Cr an LL I uj a Y UO a« ZF to U� JW = J= osp WU 0 0 c Vi' -tea 22 :s s3;, 11 N . 2. 1t0?6 O� � p Z Fo Eby N� T: 1 THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS'CON- ��3n STRUCTEP AS INDICATED ON THIS PLAN_AND_THAT THE SYSTEM; -,WAS u INSPECTED B1' ME-BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RUGES•AND REGU- LATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE Fe NEW YORK STATE DEPARTMENT OF HEALTH. 4 ,.. ;• ii t ' A i, I �� � s• ��� rANK 4G� 9" t' 0*. Sc [41'0 qg� -0" 4. 41 � O" 5 �j!,5" 59� D ": � 114-0" •i�o' -�" i S� Lou.:ty Department of Health -am i Div�iop of ronm tal Health Services ; i ItOd for 'Conformance with r t- Approved as gpplic.able Hules and Regulations of the Health D•P�ment. �P„t„am Ijl�`1IVVII��11\V�IANN�nVV1�� C( sigmtm-e & itl Date b a: Cr W ew WZ to Z o ZQ ° W J e W G. ; o Cr an LL I uj a Y UO a« ZF to U� JW = J= osp WU 0 0 c Vi' -tea 22 :s s3;, 11 N . 2. 1t0?6 O� � p Z Fo Eby N� T: 1 THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS'CON- ��3n STRUCTEP AS INDICATED ON THIS PLAN_AND_THAT THE SYSTEM; -,WAS u INSPECTED B1' ME-BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RUGES•AND REGU- LATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE Fe NEW YORK STATE DEPARTMENT OF HEALTH. 4 ,.. ;• ii t ' A B I �� � s• ��� 2 4G� 9" ZG� -Ou 3 QO' -0" qg� -0" 4. 41 � O" 5 �j!,5" 59� D ": � 114-0" •i�o' -�" b a: Cr W ew WZ to Z o ZQ ° W J e W G. ; o Cr an LL I uj a Y UO a« ZF to U� JW = J= osp WU 0 0 c Vi' -tea 22 :s s3;, 11 N . 2. 1t0?6 O� � p Z Fo Eby N� T: 1 THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS'CON- ��3n STRUCTEP AS INDICATED ON THIS PLAN_AND_THAT THE SYSTEM; -,WAS u INSPECTED B1' ME-BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RUGES•AND REGU- LATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE Fe NEW YORK STATE DEPARTMENT OF HEALTH. 4 ,.. ;• ii t '