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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -30 BOX 23 a IN I,yS. r ' ppr 4 !� '' • .I ' IT s� ti I ' r I 111. � ' g, 1 �L is - - `.I'� ` ti . 02764 �.CERTIFIC 7 Located.,a ck"er' 4" Buildlnq' Type - '.ErdsloW�6n�ir, I 'cbr.tify th at,*tfib -of' which jare attac ,iu'tnim 66'Unij D6pa 'Ploc Subd zz 'Lot ft the plans of.the.completed work (,c9pies "7.04 and 6i.. permit issued by the of ony,unungary iry sewer 'becomei, uci, oopr6441i, are y. Owner dt Purchaser of Building Section Building C'ons'iructea Location tion Street Lot at Municipality Subdivision Name Building Type Subdva Lot # GUARANTEE OF SEPARATE SEWAGE 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 success - ors., 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 further agrees to accept as conclusive the determin- at- i-on.- o ,:.the Director -.of:. the, Dlvis ion ; o- £---Env.irox.cnen.tal Health_.Servi.ces..- of the Putnam County Department .of. Healt�i as to w`Fiether 'or "not the -t'ail = "- ure 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 of 1L 19 Signature �— Title Corporation Name if corp.) Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL.BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health x Building IT ype Cot A,fei.t Number -of Bedrooms Design Flow G /P /D Separate 4 Sewerage System tci(,consist Ao' ,be.t: cdiistrkiiid _ ;,water` Supply Public Supply 'rom p,ivA"tA Supply .to be drilled ,d by Other Requirements A represent, that I am wholly.,and completely resporisjble jorjhi ' desig �1.�j6dve •'dii& i6ed will be-c9instNcted at sho:Wn on the' approved'arOrn'4i +,Cqunty., 6eOiitmfint'.,i FHejltA; _ * —.,,- on completion thereof a. ", ;6e submitted the 64paftmentj and ia'r ,wr' lttdn' guarantee will b i .10 ace, y:, N i rt o, saig"se#0 ',.arfce.,of the ,.approval 6t.,the Certificate of Constru4ji&h.•,CbmpIIar will betldcat6d.as shown on the approved plan a nd•that said well will t ,County- Department of Health.: -,. Address 1. APPROVED j.'FOR .�CONSTRUCTION This'a-pprova i'�ex,pref' one ,:i N reipcable for cause pr may . e4 amended or-modified cohsIde requires.a new permit proved isposal o domestic I AO�r4 V., a t 46at I loi ifwi: to ff',OF-HEALTH Pe it.*:Ig rM .',Town- or village .7 . . .... phiq.,o �UA Approval _ Fill action Only ❑ Notification d Address _,,6 proposed 1) that- th'a� separate '.sewage Alt 9 oral system icco�rdance I with t 'he., s1ta'n'dirds; `ru'les egulations of The FUR—am led in 6cSRtq#.nce it ii R, �kdv..P 7 thii�i'diii"Usi ed�- i'i. conuruct n OT It the: comm4sioner of.kea It h will ;thiii sa ' DIoth* builder Id builder will". iately J611lowing the date •of. the issu -' Ithat -the. drilled well 4described above ilte' nd reguTaTr3—ns0f the Putnarn *E.,11 L'%44- R�X` cense No ,* V40ding ]has lieen'undertakeA and Is �60brige or alteration ol"cohstructi.on silo ;} _01—K , "I 11 MICOUNT �TUTP�A, Division I on ,o _jqVWonrhenI x Building IT ype Cot A,fei.t Number -of Bedrooms Design Flow G /P /D Separate 4 Sewerage System tci(,consist Ao' ,be.t: cdiistrkiiid _ ;,water` Supply Public Supply 'rom p,ivA"tA Supply .to be drilled ,d by Other Requirements A represent, that I am wholly.,and completely resporisjble jorjhi ' desig �1.�j6dve •'dii& i6ed will be-c9instNcted at sho:Wn on the' approved'arOrn'4i +,Cqunty., 6eOiitmfint'.,i FHejltA; _ * —.,,- on completion thereof a. ", ;6e submitted the 64paftmentj and ia'r ,wr' lttdn' guarantee will b i .10 ace, y:, N i rt o, saig"se#0 ',.arfce.,of the ,.approval 6t.,the Certificate of Constru4ji&h.•,CbmpIIar will betldcat6d.as shown on the approved plan a nd•that said well will t ,County- Department of Health.: -,. Address 1. APPROVED j.'FOR .�CONSTRUCTION This'a-pprova i'�ex,pref' one ,:i N reipcable for cause pr may . e4 amended or-modified cohsIde requires.a new permit proved isposal o domestic I AO�r4 V., a t 46at I loi ifwi: to ff',OF-HEALTH Pe it.*:Ig rM .',Town- or village .7 . . .... phiq.,o �UA Approval _ Fill action Only ❑ Notification d Address _,,6 proposed 1) that- th'a� separate '.sewage Alt 9 oral system icco�rdance I with t 'he., s1ta'n'dirds; `ru'les egulations of The FUR—am led in 6cSRtq#.nce it ii R, �kdv..P 7 thii�i'diii"Usi ed�- i'i. conuruct n OT It the: comm4sioner of.kea It h will ;thiii sa ' DIoth* builder Id builder will". iately J611lowing the date •of. the issu -' Ithat -the. drilled well 4described above ilte' nd reguTaTr3—ns0f the Putnarn *E.,11 L'%44- R�X` cense No ,* V40ding ]has lieen'undertakeA and Is �60brige or alteration ol"cohstructi.on silo ;} _01—K , "I 11 7 RMNAM Crl",'Tv n;,l "A P '7' % -r -P ()r HrArjlf _Dl VTSTnN or :. � T Date /,_ Re o Property o Tr Plil, -7 Located -at Bloc k �L_ Lot Sectiontl Gentlemen: This letter is to authorize ............ > "duly licensed professional engineer 4 or . registered architect Vnic'aT7 ). to apply for a Construction Permitd- for e a separate sewacre system; to C3 serve the above noted property in accordance with the standards, rules or regulations as Promulag _,ated by the Commiss* loner of the Putnam County -Department of Health, and to sign all necessary papers on 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 t aha fflPutnam County Sani- tary Code. - P.E., R.A.9 0 Tr 2, _d c f �re ss . eT V Telephone Very truly yours, Signed aq Or, Of of Property rre/ gg'o Addre'sb Telephone '7? 2 P PUTNAP�- Ni 3, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �,OuiV15c- 'OF'��E'"�u��II�i�; °L >A -���� z.l�.�„•.��,.a�,,•��.�.�1b�:... ::.� �:,., �....,:-: �:.., �.. q..-. ,.>,�;•..�.:e..���_,..,,._.�... DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ,1&5 14 /4 » Cv/L Address Located at (Street Rdicate , � '• ����d Sec. 39L- /- )SBlock J.a/ ' Lot nearest cross street) Municipality.____ 11P44,140?>1 }' r. e_-Z Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 4rrRa I�' 9 P r9�' Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches j 1 lD,f v - 3 /4' ?Z;w �3 - 5 4 - . 5 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. 4rrRa I�' 9 P r9�' Y- 3 NTY 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 IN,TEST HOLES DEPTH HOLE NO. F HOLE HOLE NO. G.L. 611 1211 1811 2411 30" 3611 4211 48" 5411 6011 66 7211 7811 8 if 4 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED e- ,;NDICr&TE_ 1Zt- M- 'WfUCH-WATER '1Zv`EL- RISES_AFTER-. T-KING, ETCQUTNTER M-11 TESTS MADE BY Date DESIGN Soil Rate Used a--J b4ixV1 "Drop: S.D. Usable Area Provided--/-5-6/,,-1 No. of Bedrooms 3 septic Tank capacity Gals. Type Absorption Area Provided By _2,-fV L.F.x2411 width Trent Other Name Signature --------------- Address I tw THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by Z. Date C DEPARTMENT 01 HEALTH yw v N.Y .9- 1 Eli MtProvide Cer us J _7 _2 CERTMC-,4TE OF C.ONSTRUCnON COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P�" or a er Loicated AS j ex-Map . �3 clock Lot 4ipkmmit Naiiiii 17 fibdivisinii' am soW,. Lot p ..... ..... .-.jjp, 0, Address 9 Addiiss� A 1,77 s0i"SSewerage . .Systeir bqfit Septic ' Gallon WmAer-Suppbrs ��Publlc"S4pij Frqm'�, Address '/_7 Addre" 'Eroil6ii Control Byg TYO. .Bftn "Too"? 75,/ 'Nuximfiirof Bed66 Has Gikba& Gd"dii S�6- Other Rin III 'i 6,plans--of I"rtif'y lth'&-�- 'i m(s),iksAiiii&d serving ,'ihe:above tfie,c6kpleteq wrk ( copies of and. i��,a�6ordance w tn the standards 81 reg�l , ations, i filed plan, and the permit issued by the which are attached) �l : . . .— ..., .11 i46ii County Dejart�nt'bu Hke'alti�. P.E. R.A. License No.— Addr Any Wign C�ccMI)Vlng:pr4pTisle!'-.Wv,0:6y Ach OCUO secure the, correction of any unsanitary congitbns 'system reluftli4jrOm _such �,.ussqe_ Approval �6f, thi. sy Sm shaW,64k n Si i pubt': Unitary "Wer becomes j4jdmej avallibli. Such I approvals are "available an of the!'Oilvit6 caster supply nut - -V 06bl d the -approval. mod ikin wh�i 'in the.ju-ilornint of . IM Co nvadificsilon o►.chanom is necessary, Dare subject to 1 1:10 7� 7q, Y, Title • UTNAM COUNTY e Of Eovfromm '.11 -�r% st DEPARTMENT OF HEALTH Division of Envirorxmntal Health Servkes 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 DAi__ o� TG : -ax CuvEEE SHEET -,( 3J �l r - D •1 J visicn of _^ �- cane^ _= == -.. Services � - 4 Geneva :;oac. Brewster. NEW Ycr'< '0509 -j IZX Nit '-) •i•m�Fr or pages �c -ransmit`ed A — inc.c�c=rc_ccv� °r S yeas'; -. - _. - -- Asa P ARELL V. PE. US. PYWC ""IQI Dw=tw 4 CL;R Erg:: NUMBER I5 ?ld-278-6085 "cn c; '? i J ties c ; e =.s2 T _ 'e e!en � O rns�SS cn/r:cSc_ . a - ccntiac: cur of ;ice. 914- 278 -6130 6 DEPARTMENT OF HEALTH Division of Envirorxmntal Health Servkes 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 DAi__ o� TG : -ax CuvEEE SHEET -,( 3J �l r - D •1 J visicn of _^ �- cane^ _= == -.. Services � - 4 Geneva :;oac. Brewster. NEW Ycr'< '0509 -j IZX Nit '-) •i•m�Fr or pages �c -ransmit`ed A — inc.c�c=rc_ccv� °r S yeas'; -. - _. - -- Asa P ARELL V. PE. US. PYWC ""IQI Dw=tw 4 CL;R Erg:: NUMBER I5 ?ld-278-6085 "cn c; '? i J ties c ; e =.s2 T _ 'e e!en � O rns�SS cn/r:cSc_ . a - ccntiac: cur of ;ice. 914- 278 -6130 I. ; I p 1, !v;,,wz,*,v " M�, a. - M . . . , ,, , F ,4.k-�'--:"-,� ., 'w'n - _C, , '� 1---, *�lt �%: - -, _�, .- .. .,;. .5� . - - - — -tv 'P., , 1.-, g, -j.%j;wi , ..-. .�, . . Z'1_1' .wry ,j:I_f4�,"?.'z:..' VI..p. J�:?.&*.;;��*i."!,,. 411 I_16 A - l �'FY!t` $,,. ".. .,J.:, , '. , t�:, - ...-i, . 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'ka (�5.. .',.•idrr,!f! r K 1 1. ! � -� `f Gy .� ', ��4• �...� 3 tr6�y ���t R it v,'f"._i 1 -. . r v � y - •den qq t• J ty'1: .r \ F e .iC yl [ J ,y \by zf.ri� I �fyr �.• . { � '.c ?3 I •, � Z ti ✓.� � tr , rr �eti v. 3/86 PUTNAM COQfilY DEPARTMENT OF BZALTH Division of F.nvir mental Healtb Services, Carmel, N.Y. 10512 F,ISghaeer Mast Provide L2 r P.CJLD. Permit Town err TIb ' L CMW at 0,5 Go wa- 'V G/ a �7 L° ��OQ' L� -- 'i2 , 0 .. M.,. / a 3 U Ovne:/appuma Name /d•� ormedy swbdmd n Nsm 1 li✓ S•b &. Lot f _ Maw Aaa�.. d a s Ci ►✓A i-, �► z& RV zip Dxft Peemlt bawd Loor Al V Separate Sewerage System b M by 3 i'lk' rrd A W Ar Ki mss ram 4'tyJ r!! Consisting of Zs Gallon Septic Tank and /dV L d0fr Water Supplys PobHe Supply From Adr>keas on i'-' Mate Supply Drilled by i 3 �n! Addsren Building TA- %f e -5 / d Has Eroslon Control Been Completed! Number of Bedrooms Has Garbage Grinder Been Installed! Other Requirements I certify that the system(s) as listed serving the above premises were constructed essen the plans of the coopleted work ( copies of which are attached), and in accordance with the standards, rules and regulations, filed plan. sad the permit issued by the Putnam County Departmat Of Health. Oats O /lL� / 9L Ca if led by 4 P.E. A.A. Addre Any person occupying premises served by the above system(s) shall promptly take such actb secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage stem shall Dn as a pub':: Unitary awer becomes available and the approval of the private water supply shall become null v id when a public: boeomas avafrsbls. Such approvals are subject to modif 7 tIo n�fr ehahgs when, In the Judgment of the Co of Health, mo6Mkatlon or charW Is necessary. Data y ` By �%�VV✓ TKM' "�� Lv, �P, 7-. pt IV, "al n 1r.A S91 QW 0-1 I 7-y Aw I /�1, '� 1A 77,i ' A vj 1� ?"M f ICT r" t5 Nw SKP Ae Vk t7" I,:; .su N C3, ...... . . . . . . . . . . �A.Al V* 1.11, '4 ! lVes -64f 'm^ I is J lo: ORK '0W, Rx, J Y', - $gif"e 'S -. C-At A. ffim .% t - t v4 AIV -1 MMW; hz, P'. Q?k `l ll.� 4e i.,", 4,t J 'e'l, w is ON It 4 Y!, r:z Y'. 70 , W, 77 "ty , ;76 iYl� qv t v t t % 'j. R*'%:: ,',i" T�4 7ml Wrt`r ' PUMM Nr{IN OWAOM Vi /YAWS BMd mdM *40meNd6sdibtwo.C1 "N.T.ISM � COlQ1JAIK= J ap 11 lO�l' roe UWAIM syS Ptls • - ..y�_•4-�•�+s. f'V•b.•1.� +'.•n• ....vM�.'t ....��..y.�. �� /.•.w. .. V+l:.._.Tn� ��, ._..�._.. ._ ��n •.' r . =.�w.r jv�,P1... �sb•w Nasal ✓ /` /-� /�.y r mow! �rra_ I/i ' TM Delp- .. • • "" k m _ ..::� e s.f' a.- d *""'d o bads. 0 f Deb d Peevlw. A�pewa . '� �l�r^iI lea / Usilks Adia le 14670-a-1- .1�11 157y1-11 e/ Taw,. �k - %% %GS79 bliq 1yPs ��� i`� '� �. I�t A... 'z • , rri3 FE Sedkm o* Dwa ' vd� Nr•Ywr aI biaaaa '1 Daalp Flow G P D D b PC® NalSis� Y WM� F1 !, aaaptaiad SSPN@b Sawaw w east d 7 v S.ptle Tads �l7lJ Z4%�)/✓/ G� U ho, b e9j4-la e-r AdiErea wow S bL�PdWk Sf* Pty._ at ✓ *� Stiwb Ddbd oem b�.rssalla `� 1 raorarnt'.that 1 am wholly and completely responsible for the design and location of the proposed system(s)t 1) that the seperate enrage disposal system above do willed will be constructed as shown on the approved anwWment there to and in accordance with the standards, rules a rpu s o County Department of Waalth. and that on canpletsen thereof a "Certificate of Constructlon Cymplla"!" satisfactory to the CommisNOnar of MeaKhwlll be sabmOM to the Dopeetnprlt. and a written plrarentee will be furnW" ten owner, hi ••�ut�eeaBi4441is Or ass"s by the builder, that NW builder will place in geed .ewratllg coodillon. any hart of sail sews" disposal system during the {�irlgd t�s.,�,O� biers Immediately following the date of ten Nsu- eace of the approval of ten Certificate of Conetructlon Coeipiarloa of ten original sy�tem %1.t1wkil, 2) that ten drilled will described above will be located as dussrn am ten apprOwN Man and that said well will be' I h the_ ` 4,,rules and regulations of the Putnam Coolly DeplytWOM 0) "Unis, Dow S oop A v Y, ..:...I� `• Ave., •', ApMkovzo Ron CONSTRUCTION° approval erlpir two the date i ebil u g of` ten building has been undertaken and is revocable for or may be or modified when ry by the o rrii °7 f'f�eaRX- Any chape or alteration Of construction fa♦eNee a n w K. Apar"" for disposal of domestic o► t a�iFSauptiip;. ly• Rev.. 10/88 oa. By Title PUTNAM COUNTY DEPARTMENT OF HEALTH ...... _ .... __ �._..... _..___ _..__.... __..___a±i YS.7sw� va . aaa�vaswas-aa.rvacaw._a•• ,•-• •ia; aJi+LlCbLiia7 .. �� .;us��— YL' —n-M. �r.M.aa ._•'�in� "OaY.aW� .. IF. a.6- .�C�_s. •Zr-rA✓+ai�r. vN�tV _... _-..irt_�, y ��� .r h...<a._ V -vim... ...rc•. b.� -: %Me owner or chaser of Building Building Constructed by Location - Street � R— micipality Building Type e�� 3"_-j Section Block Lot Subdivision Name 3 Subdivision Lot GUARANTEE 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 _ _:s rf -ate of Construction - Compliance" for the sewage_ disposal system, or any repairs made by me to sid& sytte-4n, °except'wher tlne= as e to-= op�r�.te LoYcr y -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 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 7 day o Ale P' 19 C/_ 2- Signature Title e a Contractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Address rev. 9/85 mk Address e �n- PUT.'' : :': ? COUNTY DEPARTMENT OF HEAWH CR �XI S�» (r I - CA�e rrArAGE n:.TY• S AM �1 /6�¢Z ExrS�; n G �ASFIYI El�/� 5,, �. 1 ' :. Date ' i ' N Y FX►s �nG DFFicE. -30 y'� �,otPph � d_- lo_hce>Zfg._C9�d %n9�1e .. cISC�w.9n4 4 -4tePbad A' J( i ' N Y FX►s �nG DFFicE. -30 y'� % '7 R. A;?": -04 00, L r Department `( Fu nam. County Of ErkPito Approved' as rioted for-*.00nfo: Rules a D I Y d applia bI LN ti. t NA ".4 io"O„r 4" 4, P. . ...... rf 7; 4,77.. x ........ . . r T�� 4 f� 4-` '7- -Y I .. ;Ont.,— �� . ?RS BI�ILKT:SEs��. QD1 _7 jf q .1 o- SU8 T7, N0 Of At ek " JOSEPH Y BIN'- ORKI k I