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HomeMy WebLinkAbout3158DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -14 BOX 26 t� 1�.�. ■ A . r i . . -tik '- .� ; ME IL •. 03158 4 SHERLITA AMLER, P4P, MS,, FAAP "' Cotri»iisstotier of ltleafth LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 11, 2005 Iry Sevelowitz, Building Inspector Putnam Valley.Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 Re: Addition — Berk 78 Indian Lake Road TM# 75 -1 -2.14 Dear Mr. Sevelowitz: y ROBERT J. BONOI County Executive This Department has been made aware of some concerns with the above referenced parcel, specifically that the owner is applying with the Town of Putnam Putnam Valley to install a garbage grinder. Since a Certificate of Compliance and Certificate of Occupancy have already been issued, this Department has no jurisdiction concerning the garbage grinder installation at his time. However, it is highly recommended that if a garbage grinder is to be installed, the size of the septic tank h� l: cil, d... ncrease d:: An .add��__a_25_*g: :lWr."...'-..fca L�J�. rds,Le _s,iare:feet:of.:�u.faL� are are required for a garbage grinder. A gas deflection baffle or other acceptable outlet modification (e.g., gas baffles) and a dual compartment tank or two tanks in series must also be. provided. If the garbage grinder is installed without these above modifications, there is a good.chance that SSTS failure will occur sooner. If it is decided by the owner to change the .tank, a repair permit from this Department is required. If you have any further questions, please do not hesitate to contact us. JSP:cj cc: Dr. Berk Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 279 - 6648 June 25, 2004 Berk 78 Indian Lake Rd. Putnam Valley, NY 10579 Re: Addition - Berk, Indian Lake Rd. No Increase in Number of Bedrooms (T) Putnam Valley, TM#75-1-2.14 Dear Dr. Berk: ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed addition to the above-7mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated June 25, 2004. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. 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. Sincerely, Nfichael Luke Public Health Sanitarian ML: Im cc:BI (T) Putnam Valley LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 June 18, 2004 Berk 78 Indian Lake Road Putnam Valley, NY 10579 Re: Addition — Berk, Indian Lk. Rd. (T) Putnam Valley, TM #75 -1 -2.14 Dear Mr. Berk: ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed addition at the above- mentioned residence. The plans indicate that the proposed addition will consist of the following: Expanding the kitchen. Based on the information submitted, the above - mentioned addition cannot be approved for the 1. The den (cat room) and second floor storage room are considered potential bedrooms. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is five. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML: hn Sincerely, Michael Luke Public Health Sanitarian 9RUCE R. FOLEY Public Health Director CD 7 LORETTA. MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONL)) STREET It78 .HOC" KCk TOWNS vq6 TX MAP975 — NAvIE �ZZVICL ° PHONE S—n���y �CPC c3'O MAILING ADDRESS u a Vc._Ote DESCRIPTION OF ADDITION e Vi \T .-NIGER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) przp�red by a.Prpfessienal 1ngtr,�er :ar- Registered: utect in accordance��vi*i applicable �ecfgs: o tlie: Putnam County Sanitary .Code...._., . ,.... c Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money o -rdei for $100.00`/ 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, With name, street, and tax map. 9) *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. EoPy ofCeri. �f Occupancy m Town or Certification from Building Dept. with legal bedroom count of we ing. OFF7CE USE Comments Feb98 BFhouseguidelines r. Z;,jte February 2. 19 81 TOWN OF P U T N A M VA E Zone District R-3 N28l- 5612 PERMIT RECORD v Application is hereby . made for—, bUlldinq Permit Work to start Tmmeci Description 1— Family 7. I Location of Premises—Street or Road Indian k,6 goad Eaat SEC. —___A_ BLOCK LOT 3 FRONTAGE Depth— Rear ACRES (other description) or number of square feet 3*318-acres SUBDIVISION NAME Powhatan Estates TEL.--5-2_8-4688 This application must be accompanied by a copy of surveyor's map and complete plans specifications and all information required by the Zoning Ordinance and Sanitary Code of the Town of Putnam Valley when requested by inspector. Fee $. 297900 —Building Estimated $ , 15.00 Sanitary- Total Livable Area cost$ _ 55.000 $ 18.00 Plum - bing Date Zoning Board Approval ["15 COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. Plumbing Permit ZBA Approval Well Well Permit ABACA Approval 3 ' - S - 1-77 .�­ .-,- _. k A 0 M pPgrO - . .y PUTNAM COUmN M?ARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; 3 BEDROOMS ' Sutu"""re & Title `� Da4e `a rno Bu,t, °.�R - Kk v tZa°`„1 PUTNAM COUNTY DEPARTMENT Of HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDROOMS F Signature I Title Date gym. LM - KITCHEN / DINING SCALE: V4" • I' -0" WINDOW SCHEDULE WINDOW MANUF. MODEL • ROI OPENINCs QUANTITY LOCATION REMARKS A ANDERSEN G65 6'-0"W. x 5' -0" H. 7 KITCHEN 6F �- WALL TNB)AMBS FOR B VELUX FS 606 44 314" W x'46 3 /9' H. (FRAME) 3 KITCHEN FIXED SKYLIGHTS C ANDERSEN C14 7'-0 5/8' W. x 4' -0 1/1" H. I MASTER BAt"'I, TO BE INSTALLED R Y WA L. rWI TO BE INSTALLED D NE EXIST. TNIC104:b6 .. "... LIGIAT O O wly O % NEW FLOO� TO BE OFFICE NEW (3) 2xb 22 4 POST DOWN TO % EXIST. SILL - —� _ - NEW (3) 2xfp PROVIDE NEU) HANDRAIL TO �.: �— .. rLITCW -- EOl SEE DETAILED KITCHEN STEEL ME, I bKYtI I NEW CABINETIRT 4 =4 aid �Oj ,III - iGl i / - / CA1511LIT UP EXISTW. SOLID EXPOSED G1 FOYER ABOVE, TO REMAIN 1/1 A50YE HALL - KITCHEN / DINING SCALE: V4" • I' -0" WINDOW SCHEDULE WINDOW MANUF. MODEL • ROI OPENINCs QUANTITY LOCATION REMARKS A ANDERSEN G65 6'-0"W. x 5' -0" H. 7 KITCHEN 6F �- WALL TNB)AMBS FOR B VELUX FS 606 44 314" W x'46 3 /9' H. (FRAME) 3 KITCHEN FIXED SKYLIGHTS C ANDERSEN C14 7'-0 5/8' W. x 4' -0 1/1" H. I MASTER BAt"'I, TO BE INSTALLED R Y WA L. rWI TO BE INSTALLED D NE EXIST. TNIC104:b6 ANDERSEN WINDOW NOTES: I. GLIDING WINDOWS TO BE ANDERSEN, 400 SERIES, CLAD WINDOWS WITH SCREENS (OR APPROVED EQUAL) 7. EXTERIOR COLOR TO BE- TERRATONE. 3. INTERIOR FINISH TO BE CLEAR PINE. 4, HARDWARE STYLE 4 FINISH TO BE SELECTED BY WA R S. GLAZING TO BE 'HIGH- PEFIFOFC"IANCE LOW -E" VELUX SKYLIGHT NOTES: L SKYLIGHTS TO BE VELUX (OR APPROVED EQUAL) 7. HARDWARE STYLE 4 FINISH TO BE SELECTED BY OWNER 3. GLAZMG.TO BE STANDARD INSULATED 'COMFORT GLASS" 1. DAZE. MAh'CH 31, 7004 ALIT- CD3- F'I:ANS REV!SIONS. I I' VO E I <z 4. Za Q <o <Z c ~U J m d Y v +ry I� II� � 'Al ALTERNATE -ilou-r A L A 7r— LoCATIOti.-MAP'­ it?.ij I LT )'(054 . . .. 51i'. '71 " I VIN a I v TAHK 111-T, eo L _.,Op TIZENCN ss 4v as VIA PUTNAM COUNTY DEPARTMENT OF HEALTH FV 3 Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM PUTNAM VALLEY . .. ._ ..._ . _._•.._.,/,�I�- . __ /1_ 910Si Tax Map -J5-1 "Zrl Block.. e r ._.. Located at � S®° 19`x' A Subdivision 14CENZY i' AURO Lot Job LU 81BEQS e Address DIAAI% LAk-E F—D rH1S)T� Owner WM. naafi r 1C.IC ® Area 3, 518 �T �-�5 �ID/1 [ (JT N Al A V A �y 7 LLF_ � /y ,' . JO S79 Building TYpe _() Lot Number of Bedrooms 3 Design Flow 60y G Ti Total Habitable Space 'j2 oo Square Feet Separate Sewerage System to consist of H -000 Gal. Septic Tank and -3Oo :-F oF= 11 wtp-E ��%�i To be constructed by N 01 SEL Address Water Supply: Public Supply From Private Supply to be drilled by NOT '515=L' -e-TEV Address Other Requirements 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 t e u nam 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 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 the original syste r 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 in Iced in accordanc ith the standards, rules and regula i� ons of the Putnam County Department of Health. Date `'Z �- eI Signed P.E. R.A. Address b� C, s License No. 1/056 APPROVED FOR CONSTRUCTION: This approval expires one year fro the date issued unl s construction of the building has been undertaken and is revocable for cause or may be amended or modified when consider scary by the Com' ioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic s itar se ag wAte-sapQty. 6nfy Date �— S By ' Title 77 FJ T NA M COUiN,--_y DEPARTiNIENT Ott _-H.U`ILTIT. _I­­_WVISI0N -OF, E-N-VIRONYMENTAL HEALTH SERVICES Date NoV e rmnb e r 14 1280 Re Pr Pertv c f . o Loc'ated at indi n Lake 1t6ad East' T. M. x '75-1-2.1 Block Lot Gentlemen: This letter is to authorize Joel Greenber a duly licensed professional engineer or registered architect ' (Indicate) to apply for a. Construction Permit for a separate se-viage system; to Serve the above noted p-_rope,tv in &:_°eardance with the standards,, rules ®r 1egulat.:'-_ons as promiulagated by the Commis, S20-112'r of the aitnam, County D-epartment of Health, and to sign all necessary papers on my behalf j, P, v,uinv-_,v L lui i W j. Lil L i a L L tz L, 4,u 1: n 0 C, . V, . _I va 0 systerzi or systems in c.o-_nfcniiity witi-I tIa- -provis'I'Lons of Article 145 or .147, .Education Law, the Public -Health Law, -and the..1,Pu�n.am County Sani- C) N E il Countersr* ned. F 6 SS Very truly �Ourrv� Signed (XI --e f Property UVol if Church Road Putnam- Valley R N.Y. Address 528-3833 Telephony Telephone - !SION �q F E-N-, A 7�- �T-j --T;7, TCES kf7i R, C-N 7. —A T- T D! -1 OUIT."P71 0_77FI ,Cl'-,7 TLJ) T,,;7f' C E,-, 17 FiI.R NO. DEST G-jwj J)�-TAI R.A.-IIATE SE: .G"E Di 311"SAL FCS, M p nam %7. y Addrlss Church Ro cid a m LLub b e-r--, Indian Lake' T. M. R,,lock Lot Loc,'E) ted at (StrEiet neal--Ost� C.-rosS s �re;-, P Watershe, a , SOIL PERCOLATION, TE-123T DIATIA FTQUIR-D To BE SUBMITTED WITH APPLICATIONS CL(-'/ "'K TI? rE7 FEIRCOILATION PERIC OLAI rl, 1 1 ON ter Levei -u c, i,7ate-- Wa --cur r -,"e Soil Ra + e T in Tnches TJ 1--ie C! ic, Sl - n Dron -,n Purn �i n d -o Swop Tr2 lo S T n c,, =.g inche.s 3 E 5 4 -1.1._ 05 18 3 1:12-11:30 18, 16 19 3 18/3 = 6 4 fog review. 2) Dapth Ln e -a VV s' ho .'rcr. IL -I r - 1,0 -f h c1 _3-6 i9 !�3 18 3 310:53-11:11 1-6 16 _ 19 3 18/3 1:12-11:30 18, 16 19 3 18/3 = 6 4 fog review. 2) Dapth Ln e -a VV s' ho .'rcr. IL -I r - 1,0 -f h c1 3011 11 36". 6.'.: , �. ..fl 51L 1" ro .11 6617 al 7211 1 13 0l M ig Ij it to Qa MICH GROUND WATER IS ENCOUNF1 RED None IT17DTI` EE 2`�.T '1:77VEL AT I 2 1 �D _'[C ` TE -.ice TEL TO 1w7_11 CH LEVEL RISES AFTER BEING E11CODITTERED N/A 111P,ST` R'L` T Late AE)E BY 10-e-j- Greeabera _9,Z]_U8nLa_Q/_3_V_P n DESIGY SOil * Ram t e Used 6 -7 Milvi "Drop: S. D. Usable Area Provided 4 000 S; F. =M No. of Bedrooms 3 Septic Tank Capacity Ga == ffe pre- Absorption Area _Pr­6`v7_ —ded By F. x24 a— E, Sigriature -j,T e I Gree era Address R -8- Muscoot North York THIS SPACE FOR USE BY IM A11TH DE r-.ARTMF,,K ONLY oi I T ate Appro ved Sq. Pt /Gala Checked by e Tl:: JS T OTT _T!, RE" RcD 7T-- T T)- 1; TO- EEE EK�;BMITT_�� q LCI HIS"T SCR,I.?T-i0N 0--,4 SDI' ENCC)T:T.,`11ERTD 1N T-1--1.1 H C.; S3 2, DEPTH Hb_T,:Hi m e 3 HOLE : DT0 .2� HOJE, T%T0 ._3 Tnn Rni I 611 Some Clay an So= C, 1a .1211 3011 11 36". 6.'.: , �. ..fl 51L 1" ro .11 6617 al 7211 1 13 0l M ig Ij it to Qa MICH GROUND WATER IS ENCOUNF1 RED None IT17DTI` EE 2`�.T '1:77VEL AT I 2 1 �D _'[C ` TE -.ice TEL TO 1w7_11 CH LEVEL RISES AFTER BEING E11CODITTERED N/A 111P,ST` R'L` T Late AE)E BY 10-e-j- Greeabera _9,Z]_U8nLa_Q/_3_V_P n DESIGY SOil * Ram t e Used 6 -7 Milvi "Drop: S. D. Usable Area Provided 4 000 S; F. =M No. of Bedrooms 3 Septic Tank Capacity Ga == ffe pre- Absorption Area _Pr­6`v7_ —ded By F. x24 a— E, Sigriature -j,T e I Gree era Address R -8- Muscoot North York THIS SPACE FOR USE BY IM A11TH DE r-.ARTMF,,K ONLY oi I T ate Appro ved Sq. Pt /Gala Checked by lei J, VVI COUNTY DEPARTMENT DF HEALTH Division of ,Environmentah Health,. Services, Came% N Y 10512 CERTIFI_CAT OF_.CONSTRUCTION, COMPL-IANIC FOR SEWAGE, DISPOSAL SYSTEM c1:TN/4M 7,7 T -ow,n Located. at V 1+1 N ' `LAKE 1�%Y W15 Tax Map , + Block Owner -Lot' Job v� elS� Separate Sewerage' System bwit by;W ` Lua�z� ass Address 1fily�1AN Lk 1DO 3ta� L ei Consisting of Gal. Septic Tank and Other- requirements Water Sub ,ply: Public Stipp y,•From Private Supply Drilled By, �p l ii Address . A I.L .l Building Type �I� ,Q%1a� ' ; �' No, of Bedroomk Date Permit Issued Has . Erosion.'Control eeeri Completed ? , I certify, that the system (s) as listed serving the above:premises;were constructed,essentially as sho non the plans_of the ,completed work (copies of which. ,are Y attached);.and iiq' a& ''dance :' ih the standards;, rules and._regulations pla s ed arid the �t;•issued 'bY' 3Fie' Putnam County Department of Heal4h. `D�/ 6 Date FFFFF j , Certified b Address: �� License No ©� Any person occupying premises served by. the above system(sj shall prom ake su' action as may tie necessary to secure the correction of anyl unspnitary conditions resulting from such upage Approval of. the Separate sewerage system shall become nullcanC void 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 su ply becomes available. Such approvals are _ + subject Ito modification or change, when in the Judgment of the Com of Health; such, r cation, dification or.'change is necessary. :r - Date ... �j . BY Title fORKTOW I MEt?�ICAL'LABORATORY INC. F.0 99 Kear�Stre�t LOCATI30NS .Box _321 `eCk�Qn 321 KEAR ST YORKTOWN HEIGHTS N Y:' 10598 245 3203 °HeE�I��s+ N a,10592f), PEEKSK)LL sUTTONWOJD AVE N.Y 10566 7378777 -3203 24J 495 59 666.335 ❑ ' STONELEIGH AVE (NEARHOSPITALI CARMEL, N.Y: 10512 2789330 = DATE COLLECT F RESULTS OF XAMIWATION OF WATER D OWNER DATE RE -EI ED CITY .VI LAGS; TOWN" 6 /OR -NAME OF SUPPLY DATE REPORTED" eyiaw, SAMPLING POINT BACTERIA. PER'ML (Agar plate" count .at 35 C). ' _. COLT ORM GROUP. COL FOR" ROUP L - ppm. . MFT /100,n MPN /100m1 ". DETERGENTS - ':frig /L ;'. NITRATES "(as'N) - mg /L IRON;`TOTAL= mg /L AMMONIA, FREE (as N) =mg /L pH= CHLORIDES - (mg /L) These results indicate that the water was of a satisfactory sanitary quality when the sample was collected. A. H. PADOVANI, M. T. (ASCP) . NEW YORK STATE APPROVED LABORATORY WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. _ REPORT MUST BE SUBMITTED WITHINv31l `UAA:S OPVELI: 66M LET'IQ{nf OWNER NAME ADDRESS LOCATION OF WELL (No. roe (Town) (Lot, Number) PROPOSED USE OF WELL DOMESTIC ❑ E TABLISHMENT ❑ FARM ❑TEST WELL F] SUPP Y El INDUSTRIAL ❑ CONDITIONING D O(Specify) DRILLING EQUIPMENT ❑ COMPRESSED E] CABLE D OTHER ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING DETAILS LENGTH (lest) ) DIAMETER (inches) �j ( WEIGHT PER FOOT Jt'� jj �- ��I`THREADED El WELDED DRIVE SHOE 21YES El G YES NO YIELD TEST ❑ BAILED 11 PUMPED COMPRESSED AIR HOURS G.P.M. f) YIELD (G.P.M.) y WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) Depth of Completed Well 7 / in feet below Land surface: S>Y .0 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (Inches) FROM (feet) TO (loot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET R, i'_, r 'Y l� A DEPT. OV HEALIIP:,.: If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL OMPLE ED DATE OF REPORT I WEL ILLER ( lure a .,., -or. ::.:'.r. :_ ..�•. : -_. 'v �,, - rY. I(' W /J Owner or Purchaser of Building Municipality Building Constructed by Section hvw 4gN L A Kr,- "Q 15 ASS Location - Street MZ�• Building Type Block Lot GUARANTY 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 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 systerm,.except where the failure to operate properly is caused by the willful or negligent act of the'oecu- pant of the building utilizing the system. The undersigned further 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 .a- s_:to•..whe�her- b' r= rich `the" _. pure of'lthe system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this /9 day of 0Q.`T 1981 Signature��� Title Q If corporation, give name and 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 Envir Services, Putnam County Department of Health 3 „� . �,!' i' 0 Ti E IA L' LL d