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03237
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' PUTNAM COUNTY DEPARTMENT F HEALTH
Division of Environmental Health Services, Carmel, N. Y. 1 M 12
Cl= R71FIGATE OF CO�f1iS7'RUCTION CbMPL1AIVCE FOR SEWAGE DISP054L SYSTEM
Town or Village
Located at-� L� ' tt•....—�q"' `� Section Block
Owner Lot Job
Separate Sewerage System built by ``
Address --
Consisting of Gal. Septic rr Tank ZZ q lineal Feet X -Z W width trench
WLEF-
' Other requirements
Water Supply: Public Supply From
Private Supply Drilled By
Building Type No. of Bedrooms Date Permit Issued-
Has Erosion Control Been Completed? "may of NEV, y G,Q�
A. KF
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I certify that the system(s). as listed serving the above premises were constructed esse tial a^ n la r t ompleted work (copies of.which are
attached), and in accordance with the standards, rules and regulations, plans fil an i is th am County Department of Health.
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Date - � � Certified by __ P. E. K•A•
Address �S "'3 K&" License No. � �1
�F N 421 r
Any person occupying premises setved by the above system(s) shall promptly take such ac secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall be ` ivf i"gsfll6) soon as a public sanitary sewer becomes
availableland the approval of the private water supply shall become null and void when a pub comes available. Such approva, l!, re
subject to modification or change hen, in the judgment of the Com er o ealth, such revocati mo ification or change is necessary.Q_ t
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Date r By Title
PEEKSKILL MEDICAL;I;ABORATORY
1879 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1
Peekskill, New York 10566 41988 PE 7-8777
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RESULTS OF EXAMINATION OF WATER I. _. 7/31/7+
Stanwood Builders, Church Rd.,Putnam Valley
, VILLAGE, TOWN & /OR NAME OF SUPPLY
DATE
SAMPLING POINT
Well
BACTERIA PER ML. (Agar plate count at 351C). COLIFORM GROUP (Most probable No, /100m1.) RDNESS, TOTAL - ppm
less than 2.2
DETERGENTS - ppm NITRATES (as N) - ppm IRON, TOTAL -ppm
These results indicate that the water was yes of a satisfactory sanitary quality when the sample was collected.
/, -- 1H:1P.!ADoVANI, M. T. (ASCP)
Own or Purc aser ui Municipality
Building Constructed by Section
Location - Street Block
Building Type 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 shourn 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-
od operating condition any part,
-4" heirs or assigns, to p a,,e in go .
said system constructed by me whwcn d' Ls to open -Q ,.� f, rya rer�C; - 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 de-
termination of the Director of the Division of Environmen-ral Health 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 wi.11f'ul or negl' ent
act of the occupant of t building utilizing the s tem.
Dated this day of 19� 1 Signatur
Title Nna
I orpora i.on, gi
an a ress )'
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THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP.TTETION WILL BE ISSUED.
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GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health