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HomeMy WebLinkAbout3277DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -97 BOX 26 I.yL '1" L �' rr ti' r 1' .IN L . T I� JIN , J y IF ' '� z . I. - 1 I L � 1� IN 1 �' ., P �'. 03277 ys z'ti,., e, 'i Zr c .�,�"C .. '�'. •.� f; A:^a4,;"'hv +,�.xl..� b3a" %`:� `ear.i,`` ?r.tnrz.:<^�cc'S m A �'Y -,� a fr �. �:5 ta.+, tY �. �,, ,. .: a .. •3°--x "6�'ti: L 'r. "':'us,,� < � .; q� � {� �1m. �4��Y lges• 3/ �'6 a PUTNAM COUNTY DEPART KENT -.01 Division of Environmental Health Services, Carmel, N Y 10512 fi c • z fif �6r H D yy a y .•�' .. ,; ,, '} ` y t 2 PC Pe` r • s 4t 4 .s e X$TEMr� .�"i�SrE=r LL yoL L o t�.� .� ,4� Tai.gar 'o sloe ° 7 D ^/ 61eAM S /�O.idE f� say Owner /appllcint Name bdivlsion Nerve Sabdv. Lot p L'Ait.,P..�i✓� As Form ' //I!�✓/��G Mailiog'Addrese �� Dste Penmlt:'Issned 3/ ..�9L �rifliQ .G�o,�/�' atrof/, N•�/.. /oS.3G ,Separate; Sewerage Consisting of O Gallon<Septic Tank and` 8 0 ;'G F y �1 GLE�E'Y� 71, _ Water',Sapply: ^ c Supply From`` Address or: Private Supply ;D illed by y % %T Address -_� -f� 7i�� fG�✓ _ p /1�� Ba1lding Type %'t� fi�'1� Has Erosion Control Been CompletedY yS i Number of Bedrooms 3 Has Garbage Gunder Been lnstalledY O Other Requirements I certify that ge system(s) as listed,eeriinq the above premises were coneiructed essentially ae shrnm on ;the plpria of the completed work (copies: " of which are "attached) and in accordance -with the etandardsk rules and regulations i accordance ,with the filed :plan aiid ttie peiinit issued by the Putnam County D per prat :Of Health u :Oats 1�� • r PE'�R ;A � • ,_ • Address �funse No i Any person oeeupying'pnmises served by ttiexabove ystem(s) fishallYp►omptly take sueh:aetion as may W ^nepiw►y t0 sacra tM correction of any unYnitary . conditigns reiultir�g from such usages Approval of,thel seDaiite sewerage system ihail beeoma nuH antl voitl as sc4i as, avpubt anitiry gwar`?:baeomes ivailabie `,and the% approval of ,the'pr{vate water suDP�Y shallsbecome null and "void when a pu01k watts supply ,bet:Omas iva{IabN. Such approvals arts° subject to modifie�t {on change when in the Judgment of the CommissiO4 ar of ►lellth '4ueh revoc�tbn, modifleat166:6i- change Is'neeeaa►y w oats � WELL UUFirLLTLU1N rczruAl DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only �STREET ADDRESS: WNW TAX GRID NUMBER: WELL LOCATION WELL OWNER NAME: ADDRESS: 9 PBIVATE T 0 31 Alm a r- ILAil e Kal �-Q A 11- 10 PUBLIC hA - USE OF WELL 1 - primary 2 - secondary IdRESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 0 BUSINESS 0 FARM ' 0 TEST/OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL .0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT 25 - gpm./NO. PEOPLE SERVED * —1 EST. OF DAILY USAGE 1!2– gal. EASON FOR DRILLING TEST/OBSC NEW SUPPLY ❑ PROVIDE ADDITIONAL. SUPPLY E3 TEST /OBSERVATION o REPLACE EXISTING'SUPPLY 0 DEEPEN EXISTING . WELL DEPTH DATA WELL DEPTH —ft. STATIC WATER LEVEL . ft DATE MEASURED DRILLING EQUIPMENT O ROTARY 9COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING. eOPEN HOLE IN BEDROCK .0 OTHER CASING , TOTAL LENGTH tL MATERIALS:' STEEL 0 PLASTIC 0 OTHER. LENGTH .BELOW GRADE (51 tL JOINTS: OWELDED YTHREADED DOTHER DETAILS DIAMETER Z—. in. SEAL: O CEMENT GROUT IYBENTONITE ❑OTHER WEIGHT PER FOOT 9 1b./It. DRIVE SHOE. YES ONO U ER:OYES NO SCREEN tDETA.S DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? -FIRST - SECOND �O YES --- 0 NO—.: HOURS GRAVEL . PACK ❑ YES 0 NO GRAVEL SIZE. DIAMETER OF PACK In. TOP OEM —fl- BOTTOM DEPTH — ft. WELL YIELD TEST I If detailed pumping MVHOO: ❑ PUMPED tests were done is in- 0 COMPRESSED AIR formation attached? O BAILED 0 OTHER ❑ YES 0 NO it more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- r ing 1�1�1 0.. peter ter FORMATION DESCRIPTION C00E. WELL OEM ft. DURATION hr, min. DRAWOOWN ft. YIELD gpm. Lurid Surlace n C/ ¢, ALe, CL &I red An Cle a FO 64-1 6ran 6C WATEP YCLEAR TEMP.- QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES ONO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL I CAPACITY DEPTH VOLTAGE HP kt@tfftLLN.NWATT & SONS, INC. DATE ADDRESS Well Drilling 3101ATURE Rte. 311 R. R. 2 Box 171A PATTERSON, NEW YORK 12563 Atzk" I w e _ if � � � •.. a \ 11 11 `' P O Bo�c 99, 321 �Kear Street p Yorktown Heights, New�York 1059:8 v'' y� .... — _ _ _ ". ..� � - a• - �Z� auta,� "+ar4'Axa+'�•±Fw V`4 Cr"+Y'. •�a• t +�?.:: •f51 '..ate« F LAB # E� NAME; t'�f}rlSyyt �,YlC� ADDRESS Four Prof.e -s.'s ona.] 5ervi.ce's s 'x Z.,. OFt s:RE�UL.PS � r`P7ease� ca1,1'= ONLY:: b weekday ' To` recei`ze results -over the ph :t'he 1 ab: reference " wnumber 1i-s`ted a't the` t NO :RESULTS o i nformat bn may' bed :gi ven `o 37 ab reference number P1 eas e; be sure tha �lt'ime quoted , to, you $has e1 apsed b� =fore :ca result -s :may = not:.be. ready a,t _the time ,of OFFICE HOURS Monday Friday`, 9AM t TEtE °PFVONE (w914), 245 2800 WV ween 3PM &5PM5 e= .:you`MUST ,'gi ve o f this form witho -ut the an;aal'ysqs.. ?.n9, ea`Se � .w, u-r. -ca 1 -1 b k K a^.` 00 1650 i Yorktown Medical Laboratory, Inc. LAB # 321 Kear Street Date Taken:- 10/5/89 Time ; 32;30p: �� = >'arksai=, °rh¢s �:. ` ' G� .: _. =. r ...::�: _ rDe�+ ®• Sc ::' . (914) 245 -2800 Date Collected By: Reported: cans on • O 1989 , �w Director: Albert H. Padovani M. T. (ASCP) Referred By Sample Location: C e a ANDREW CRANSTON JR. Peekskill Hollow —RU R.R.. 2,-. BOX 1394' Putnam Valiey, .l HOLMES,NY. 12533 Phone # - Phone # I Sample Type: L J Repeat Test? _ (check each) LABORAT.ORY-.� REPORV'* ON THE QUALITY OF WATER INORGANI,C..NON- METALS mg/L) MICROBIOLOGICAL CFU' /100mL _ Acidity. GENERAL BACTERIA _ Alkalinity < Chloride Standard Plate Count _ Detergents:; MBAS _ (CFU /1.OmL) Har;dne;ss`''Total Not _ Nitrogen, Ammonia MEMBRANE FILTRATION TECHNIQUE Nitrogen, Nitrate Attached TNTC= _ Phosphate, Total Total Coliform, Sulfate: Sulfide: Fecal Coliform Sulfite METALS.(mg /L) _...Fecal Streptococcus MOST PROBABLE NUMBER TECHNIQUE Copper Iron- Total Coliform Index Manganese _ Fecal Coliform Index _ Mercury Sodium KEY FOR TERMINOLOGY — Zinc CFU = Colony Forming Units MISCELLANEOUS pH (units) Color (units) Odor (TON) Turbidity (NTU) CON = Confluent (q.v. TNTC) LT = < = Less Than GT = > = Greater Than N/A = Not Applicable S/A = See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (For Lab Use) Potable Non -- potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgolu HNO -S _ HC1- _ H2SO4 NaOH ZnOAc Na O'S 203 Other: Incomir.T LE 4 °C GT 4 °C _ pH LE 2 _ pH GE 9 _ pH GE 12 _ _ Other: ELAP No. 10323 THESE RESULTS INDICATE THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TK NEW ARK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THEM-9'E OF SAMPLE ODRL ION. THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) �NG ET THE SATISFACTORY CgN CACA UALITY STANDARDS OF THE NEW YORK PUBLI WATER .CODES, FOR THY PA RS TESTED, AT THE TIME OF SAMPLE COLLE X/ \_4 X1bA) 2 /86(Rvsd7 /87)RWE PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - ,,......._. _ ...__ SIOi __..._......__ ,, ._,., ---- - - - -_- _.AFa HFAT,TH•�SE'&iZIf:E$._ --_- .. L/ 61-ZEN z - 41j-o eiif fe Owner or Purchaser of Building Gam}u,ee1ye �IsjoCif 7�s Building Constructed by h/oG G ow . Location -Street 60 C5�o - 1 Section Block Lot it/�i9 Subdivision Name Municipality Subdivision Lot # ,ees i ale.✓ /, �,� - We d � F.e�9�' Building Type GUARANTM OF SUBSURFACE SENAGE 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 .�ti lcat . bf :_Cr tx�xctaor�.,Cc+mpI -, cep,:. € t -- "se*�a�ge ~�clisphsa °syste��; .or. y repairs made by me to such system, except where the failure to operate properly 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 Director of the Division of Environinental Health Services o Department of Health as to whether or not the failure of the caused by the willful or negligent act of the occupant of the the system. Dated this ,S day of 19,90 General Contractor (Owner) - Signature /✓�i4 Corporation Name (if Corp.) 2/ AL Address �'fJs'ow,Asl, �✓, y . � 0 �3 G rev. 9/85 mk the determination of f the Putnam County system to operate was building utilizing e -ten Corporation Name (if Corp.) 3i 4.i ;w4e ��✓�. Address r uvt` -j, Jl': t 1tN�:iP= -ION Date spar b sT LOCATION Ao� �� 6 c,. � CWN=.R cur rA716 PHIM?T a V`� �I �(` �1 'IM , OR SJSDIVISION TCT m II IV. V. vi. T YFS NO tea_.- -SDS area. located as plans ans b. Fill section - Date of placenent 2.1 barrie~_ LGTS W -I= AVG_DPtH A t rogiw4 'rw' gar c_ Natural soil not st_ri=ed I d. Stone, brush, etc., greater than 15' fran SDS area. 1 }z 1 e. 100 ft. fran Ovate_*- coot wetlands _ 1 1 Srfr;7-lr- DISPOSAL SYSTR4 a. Septic tank size - 1,00 1,250 /—eel b. Sentic tank ins -; 1 I I I c. 10' mininnnu from foundation 1 d_ No 90° bends, cle?nowt within 10 ft_ of 45° bend e_ DISTRIBUTION BOX 1. All outlets at same eievation - water tested I I 2- Protected below fres t 3. Minimum 2 ft_ oriai n:soil betwrizn box and trenches f . JUNCTION BOX - prqpe—rily se} g. TREN= gth Lznyt1h insta? l ed gyred : ft. 2. Distance to watercourse 1 1 3. Lns =`a Ued a =-rdinq to Dlan . 1 I 1 4. Distance cent-_- to 5. Slore of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from prcoe --t-r line - 20 feet - fourdaticrs 7. Depth of < 30 inches fran surface IIR I5Z� lyz, I I 1 1 8. Roam allowed for e_r`arsion, 50% 9. Size of gravel 3/4 - 1i" diameter 10. Depth of gravel in trench 12" mi nimnm L. • Pine ends cpped I_ h. PUMP OR DOSE SYSTEMS 1. Size of vuam char 3. Alain, visua /audio 4. Pump easil y accessible manhole to grade 1 1 5. First box=aed 1 1 6. Cvcle witnessed by H =.mil th De a unent estimated flow per cv_ cle 1 ( 1 HCUME a. House located paper approved vlans. I b. Number of bedrecirs I I w-rzlr I a. Well located as per approved plans I I b. Distance from SDS area ne---sure i c. Casing 18" above grade_ d- Surface drainage around well acceptable. ( f ( I OVERALL WORK,%-S=' I, a. Bcxes propearly grouted b. A-U pines , -Ially bogie? led C. All pipes flush with inside of box x. 1 d. Backfill material contains stones < 4" in diameter e. Curtain drain insta Ued accordinq to plan i 1 f. Cirtain drain outfall yrote✓ted & dir.to exist_wate_rcours� g. Footing drains disczarge away tram SDS area 1 h. Surface.water Drot_ection adecuate i. zosion c--n=61 provided on slcoes areatar than 15$_ 1 t1� X PLTTNAM COUNTY 6ii'"TIAENT OF FtEALTH ­'­­�- A , Enalneer 'Y. 10512 rivvirtlni�emal 11MIh SeMcex; Carmel. N. ljlvlxlo� of E 'on CERTIFICATE OF COMP CONS QN;FAMITIOR SEWAGE DISPOSAL ,SYSTEM 771, mim or VWage Sobdlvlsloa Nime -Subd. Lot # Tax Mp BIGC'k Lot J Renew aL 0", rX kppficaini_NV�Ueh�'VMCxe Date oFVriy1otia Apjr6y%.I 1.05f,5. To" Y,04"JVA ZIP Mailing Addrisi 1450/ QW.-F-199 O q Biffldlzig Type. Lot, Men I'_Flow G/P/D tw__.4 DesIgn' en Fill Is completed Iquinber of Bedrooiiia- Z i A) 4 Wort S E '-d* T _,y, 4�7 to' SeW-4--ge System ep c SID oq �-'j To be A/ T1 c Aidiress— 4 ma Supp J­"� U C_ Water' zi I till Addre o ;L./ A ;iaree, sunup; i 1�L TAY or: Private U Other Regolremente oi' tn�- p'; r - 000 . r -Wage -d;ipo sal's;/stem he . a�jkqn d..,-Sysiern(s)::1).that, the j� represent that I a;;'wholiy1 tons mehdinaht there to and ln'accordance witn.!tie standards, . '!ytat,i &_nJ,r_e­M the. Tuinsin quia igns of Above;iiikri6ed'w-' pli& rice satisfactory . , 6nii'o !'f4ealthwill Department of Constructiom, pl-i n to the COMMis * il, I t , 0 .1 . the ep . said -builder will Diaee in Co HF:be fuirsishi'd-thi"tivvner ­ f .". , - years immediately follow(ng he date,-of the lsw- be �of, j�6�(iy om, lip, YS!�T',or..,any,fopairs,there.g;: _th6.:drllled,ivill-dekrlb*d above c 11 ce'-3�of'thW ginaFs -A . an th approval' ol i A fi� i�A —will be l6caied W. I wel 16 iinii I .%rules and regula,tions '1116, Putnam as s Mo _d �Cou6lly. Department P.E.— R.A. t ALi -2 7 0 License No-S _2 -Y%ar 060IC61,15TRUCT �;rri date issued unless cons,ruci on OT�140'19" fia"S bien undertikmn and is APPROVED om revocable 116 'ciu.i or may.,be amen h necessary by the- Commlisiokier'oU Hoofih . Any change or.alterition of eohstructlon ;spqipi- n a view Omni domestic ary "wage, and /or private supply, o' li: require W Approved for ornes Data p APPENDIX J 000NI"i DCp�1IZ7MCNx .0�' `fIEAIA'ti ' T ,,. L1V101V1/ OF E Ji�Vlrlu+►�1[fLI':iICtLJiil,.� 1m r' OE$I(3N4 DATA. $UBSUFACE SEWAGE: DISPOSAL ZYST M FiL.E + LAID. PiMNId�.�; f'TATCI.�! NoKEs _ _ oam4r �: FtFa+ N � I A dzi ��. P " � a �T - Located at (Street) Eh me a -L, - 0-1,ow gccA r3 sec. Lot 2 v ',( nd cate, nearest cross street) . Municipality " o r . Au.(. E Watershed Q Ek'S KI l,. 14 ,oiz-,w #A o SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMiTIW WITH APPLICATIONS Date. of Pre- Soaking" 3- 2 3. 8i F to of Percolation Test 3- 23 7 HOLE NUMM -: C OM TIME _. •PERODLATION. • PERCOLATION Run - Elapse Depth to Water F'rcm Water Level.. No. Time Ground Surface In Inches Soil Rate Start -stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 2 JS 5 ' 34 *47 23 4 f t r NOTESs 1. Tests to be ro" pe�►tedat 'a t e depth•_until. ap�raocimately; •equal soil rates are obta16ed atjeaChperool$tion test hole. All data to be suhnitted for reviet4..' 20 Depth measurements to .be made fram top of hole. rev, 9/.85 ' r _., ........... 17 !. mk - .•_ — A TEST PIT DAT11' RApUIREU T0. BE' SUBM Tbm ;�WiTH J►PPL1C1�TION , mcumIP'I'10N `OF SOILS ENC'Dwi'm-m1' 1N mE5T> HOLES " Name S� G �fnl _ . Si rA � �� .J D 2 - g E Address THIS SPACE EUR USE BY 11EALTtl DE:PAR'IMERr CHLY: Soil_Rate Approved sq.ft/gal. ;.. Date DE[''PH HOLE [�. /�' BOLE _.1M rt,1 KMJrr it =ro.H�Fr .I`KJ•t lJ E4 7c'c �•- ask r, •w '. - .a•:.;- `' w.. .:,. -s•� -b :..: . • ,: .. . i- '•v'Nr+sv: s -- '.`r 5-t C"`_ .s. _ 'ti' Y t Q e,_a ' .21 h I1 a 3' v v Lv1 81 } t r 10I i E. N 1 , li 11 I •12.' s 13' ,_.. :.. - _.c_ v->.,- ..-. . .- .- .....,. ... -... -11��� /1 L• ��� 111- ►'L71\.I� VRWL`IJI.A1Gi\ 1S �7�[V:i/ .. - - %� ©Y � =Y}�•�� INDICATE LEVEt, TO WHICH WATER. LEVEL. RISES AFTER BEING MUNTERED .: • DF.� ,HOLE .OBSERVATIONS MADE BY:_ .S:. 1,,g IV o E 2 DATE:. - ? 3-- �3L Soil Rate Used Min/1"' IOSPSSJ'1�m�1.7 ' DESIGN, Drop: S.D. Usable Area Provided idv, of Bedroams Septic -Tank Capacity - /DF>.n 94 ls.' Type AecM T Absorption Area Provided By L.F. x 24" width trench Other .9,0 Lr' .Fr.._ w e 4 DE &P Be r, -C"ry acAF_M _-?A aepf Name S� G �fnl _ . Si rA � �� .J D 2 - g E Address THIS SPACE EUR USE BY 11EALTtl DE:PAR'IMERr CHLY: Soil_Rate Approved sq.ft/gal. ;.. Date • .�iT , 7 APPENDIX J :'PiflRVAM 100U1+T1'Y DEPARZME* OF HEALTH } `; . DIVISION OF. ENVIRWMEN.M. HEALTH SERVICES DESIGN. DATA SHEEN- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILENO. Row .t�LopMENf G Address �Soi �ANfP�cj2f��s /�4�Tpad ./*lLrflJ N�r Located at (Street) F /GG 4404d �o.0 Sec. l.: �o,. .. Block / •.. Lot Zo. (n�.nearest cross street). Munci lit Watershed Pa Y %w.J o pch-�/,�r� LC,F N �E,�KS u /c //a�c SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED.WITH APPLICATIONS.. Date of Pre.- Soaking mate of Percolation Test i .., . HOLE _ NUMBER.. .CLOCK TIME PERCOLATION :`.PERCOLATION Run Elapse Depth to Water From Water Level, „, No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop ” Inches Inches 'Inches., 2 r _. .- • 3 . 4 1 3 3 5 ' + NO'T'ES :' 16 Testa to be repeated at -same intil apprcvdmatel:y. equal` soil rates are obtained at.'each percolation test hole. All'data to be submitted C. for review. a; 2. Depth measurements to'.be,,made `,from top of hole. rev. 9/85 17 mk TEST PIT DATA UIRED TO BE'SUBMITIM,WITH APPLICATION nnn�nr'vnr�� . nn _ nnT* n T1Y mnrrm ttnr neq .-DEPTH HOLE NO. / tP _ HOLE NO: �? HOLE ND. ' T j;. ; ri 21, ,.. 4' 77 6' . + ":, S7-0 'f / �'c Aar C� 1.rrtat 8' 9' 10' N t 14' INDICATE LEVEL AT WHICH GROUNDWATER IS .ENCOUNTERED . L._..... __ . INDICATE LEVEL TO•WHICH WATER LEVEL. RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS. MADE BY: Jr 111406 � .. _ ....:- , :.. DATES , -- t _ DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No..of Bedrooms. Septic Tank capacity gals. Type Absorption Area Provided By L.F. x 24 width trench Other Name ._ Address Soil Rate Approved sq.ft/ DEPARTMENT OF HEALTH • Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ..-.-APPLICAT.I.ON TO CONSTRUCT A WATER, WE-LL PCHD PERMIT WELL, LOCATION Street Address it Li. Hoi.L<3 POAD -Tax Grid Number Town /Village Cit 4otHov to Pa.,ic i o ZL) 0 -i WELL OWNER Name Vi"WAC-:.w 5�AT� 140HE.5 ,-. y - i„,� Address Private 13 Public USE OF WELL - primar 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ INDUSTRIAL U INSTITUTIONAL ❑ STAND -BY ❑ ABANDONED ❑ OTHER (specify ❑ AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 5 n gal REASON FOR DRILLING ANEW SUPPLY ❑ REPLACE EXISTING SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O DEEPEN EXISTING WELL ❑ TEST /OBSERVATION DETAILED REASON FOR DRILLING Sis Ft 6P E WELL TYPE ODRILLED ®DRIVEN E]DUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A Lot No. / WATER WELL CONTRACTOR: Name j�jp�a,r -i�g�► �iP;� s,ra;.; Address: PorpAo I0,, "EY. U' l, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _V--"`NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY _. DISTANCE..:T,O_ P.RORERT - FROM - NEARF.ST..WATER:.MAIt�l :... LOCATION SKETCH & SOURCES OF CONTAMINATION. PROVIDED ®ON REAR OF THIS APPLICATION 30N SE TE SHEE fJ c74 (date) (signatu PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue``; 19 '�--^ Date of Expiration Permit Issuing `Offici.ah Permit is Non - Transferrable QiQr% PUTNAM COUNTY DEPARTMENT OF HEALTH APPENDIX K DIVISION OF ENVIRONMENTAL HEALTH SERVICES • .. _.... a - , . .s .](�•. +Y_^+....' t 7 _. ..r a - � ... ,. - .'�� ' ~. r .. 1. _.v� � . }�s ''.- ,;.� � s .. ,... a .. :. date Re,: Property of Pi N"dSoc i- 5TATEi -4 Honk -- �y^i..p �cL ; XNC Lo c a t e d a t P� E i�G-S Z-i Li.' H'.o LL _J Y'V R 0 4V d 0 W n ► -O f- P0rA) APJ_ (T) Section C,1- Block 1 Lot - Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: �. This letter is to authorize LE J. A N oeliz a duly licensed professional engineer !/ 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 connection with this matter and to supervise the construction of said _. _ r Sys teu�> a n: coal o:r. -mitt' tiristh...�the�....pro_uisaoiis ro.f.::Ar..t 147, Education Law, the Public Health.Law, and the Putnam County Sani -i tary Code Countersi P.E., Address �q3 26� Telephone tery truly yours, ;igne Own of FU7operty ��ai a,�pF /12E C.i�ok.T Address Tr��ZlL7a w.l,�/ � i � ff7T ,�1 •� T wn Telephone ~- ' ~ � �� =_ , M-a r ~ ----------------------------------------------------- ---------------'---- i C �� t .,/u��'1 LL IL IA J�. ' t k _s ft,f r �� a• 5 ,-a` PU'MAM COUNTY DFP�RTMfNi.OF IIFALiEI ° ��� 1 Rev. 386 Divhlon of Envlronmentr) IIrrI1h Servlrer Grmel, N,Y JOSil FnRlneer le PreYlda P�rtnl! A M C COM AN r i � n CER IEl A'I'L PIJ r CB�� k e 1 OF Y " Y CONSTRUCI70N PERM t FOR SEWAGE DISPOSAL SYSTEM rOYYNt OF'�iAl•4/`7 lr�4L�Ey r�� Il.— r/�.i/�/:.� � /GiL�O� O./4i�.�,.,..4,,. ;r.:•- +- ,••. —�� -•w= -� -t"'_ A1S�n � `YUieg t i.. �-� — u_.:_...._.... SobtUYlrloB Nrme Srhd Lo! A Tr: �� BlockLot 20 MrP Rene frid- Revlelon -�.: p Ovreer /AppUeault Nrroe� /NNAGL�.�Ti�rOHESp�E�2�OpN i)��✓� , ; `� _ bete of Prevlogt! App►o�n) — - -- MIUDQ'AddenSo /MP�iRE`ouRT Town �QS 1BolldtoR lyjre tP�S /QEA%T /AL Loa Aree '? Cd ��'F FIII Secllen Onl Y bepth Volosne• Napsber ot,Bedroomi Deelgn E Io.r CYP,LD 6 p8 f't� tVotlOeidon Is Regidiid tiVheo EUl is eompleltet Seprt>,te Seferrge System b ceesbl of CGV Cdton Septic Tw+k rnd_O Lt�1J .f r X ONC L j� i t To be Conducted by �iiSfLK`r ••an/f Z'„� AddressurAJA/"J �e%�t /✓�" qp Weser Supply: - Pdblle Srpph > rom Address Iyn Prl rte Sappl It ie ��TUiriif Y oti;er.Reg90die l>i YrvDfesenl lhlt 1 em wholly yf t he dltign and lotttion ol,the p►ODOfed fyfNm(f)i 1) that thf;feparite fewaq�,difPOUI fritam 1boW tleferlbed will`pe tout PuInsin County' t��0atlnen('ol -, _ l 1 1 e °'�ertlliiale of Conftiuetlon [empllanc�' utislaelery to IMtommltflenir 01 Hultnwill bi wbinittad to (he -De i n i ..$ 11 -0i IurnGhed IM Owner hit fueNtfert; MUt oiisslgnt by tM Duilile►� that /ilA bUildw will pl +cs In good operilinq ;,, on se, Ispofal system duNnq` the posted el tvftrlQ) yurl,ImmedlNttlq loltowlrq !hedite'of the Hw- �ny of j1i� eDOrovai el e ; artily to o Il nee of `Ins Iglii f tV'II4 er eny ►spa f lhsietoi 2), Il+it the dialled well di" i6ed' above wail be i0ralud et shown o 1 pple fit wel Ul De Install ., iCf Gfden 1�th t ndn f, fYle1 end fin Il oRt of .1h1 Putnam Count -� y Oepartrhsnt ignd r t P E �R A. �y 7 /ppaad -yfKaa llcenfe No -32Z 0 APpROVEO FOR CONSTRUCT a va ief��MM/Y IYdlh the d {la Ifrued unleft tonstivelteri el tha butldlnq has been undertaken Ind if 4vYV 66 a' /or puss 07 may Orimen "` en confitteied neiiiiiry by. the Cor+rmhtlefnr, ,e/ Hoiltn. Any cMnge.el; 'il4iiii". / tonftruttton repuhas j 'new permit APtiiovad -/o dIspofal o/ tlornestte fanifiiy tevriye and /or-,prlvite •water .supply only, Oils ,::: < ..:., BY ," •r` • •T4fle �• ,4,*r ST' ^f �y z..L.. x c� """" **r�� 1 1y- ... �/ t -m ^f*i �i`4`+'y -' .c3' f s '"y'3 h i4 7. ,7 ` FC�t� { ti ` S8 �' S 5 � "- �~ /lirlrl �.ff�l./� fC }{ 1; Y Ti Y "tk'0^iF 4 Y �'viR,i N5-✓11{x� � {' PUTNAM COUNTY DFPARTMFNTOF HEALTH 1 �fi lif3Y. 3 86 Olvlllon el Div lronmental ll�ahli Servlrea. Carmelr N Y. IOSiJ 1'nal ^q!'r le Prevlda Prtmii A t r en CERIIEICATE bF.COMPUAN CE `CONSTRUCTION PERMIT F08 SEWAGE DISPOSAL SYSTEM w= t x i��IK/4LidLGfJ .4' To Ior VU)m e B1ork;%NLot 1 P 2 t7 Reoevral -�' �O '•y Reylefon' [] Ovrner /AppWApl NnmePINNAC4�SrAl2eL Dlte of N40iin4 ApprorsJ r os MiIWD Addrera50�i[iRE�OI dQ7` Tom �'ORKIbWN fiE /GNTS ,tijP /y, /Qlr I BulldleQ �Pe .PES /Q�d%7 /%iL —lol Me! R�'§ `` flit Secllon Onil De th Volaere Nomber ot:Besiroetn� ` DeBign, flow G /P /D YCHD;NotlDndoo le Regolred Whee fUl at _ d0� r Septttrle Sewerltge• Srokm fe eeeebC s[ OOv Grlllon _Sepde fairft and L �4J.' y X GNC• L { " ' %beeoeotrnctlbbl�� �wtlLK � :,fin/ .7•,� Aa�ire.r �tJrl/A/'? we �V � r✓•1 � Wafer 3apPllt _ • l'ebUe So 1 From r_ � Address I PP 1 :, ortPrlbate Sappl b SO A dreea >L � Other Regttlremet►b yFl �aprssant ;tMt 1 $m who11Y . s Y )Iffy f' ha deign and local {on of the proposed fystemtt)r 1) (Ml.tha reps sts sewage IiPOiat .system sx : - .... 1` `n ni s r u a om$bow wn e. Putnam i hn rill County Oep$rtment, of t 1 _i Lortllicile o1 Construction Complt&nce. satisfactory to thus Comrr+lssloner of Healthwitl ? S Submitted urnl ned the owner hir:rueeessbit, ha {rr er asslgnl by lhe,0uildn, that:.a$IS. buildar wllh pi$a in good opentingk ors fe` Ispos$I syftem durihq the perled of iv<O1�P) ys$rt tmmedlalely (ollowtrq IhiAnls of the Inu• into of iha eppr0v�l "el i" arlll,f lo o Iliince of ;lhe^ igina1 systsm'or any rtAentol 2) IhH tfii dfillad, well'described.$bovs will bs locale0 es shown- . ( i ppie aril w�l 'ill be Insulted Ito gene Ih :Ihi" At cuter and rpuns of Ih� Putnam County Oep$rlmen[ of N t P E _r R.A. x at N /f LK cense No 3 Z O APPROVED PO' CONSTRUCT s va ` res /YTIV the date ,Issued unlest cerittruetlom of Iha building has been undertaken and H .Mh.,, :..,, . revocable ''tor Nutl.07 may qe $men hen tonsldered netestary by;�'ahe COnimiss' r Of NYllh.:' Arly'thanye'.os alter$lbn " -or ConsltucUon r64uk�i a: navr.perm(l - f >ppreved Uo► disposal of domeslle'an {lacy revvi9e and %or prlvale- wDDly 'only O$le �By, 7/tle n PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services APPENDIX L AFFIDAVIT - CORPORATE OWNER APPLICATION z..-._.. ..P.ev . -.1. -. ;�ee� -.. .:Ra -•- }orn .�iae ..a. <u..�_. ��:a .uci o+- « .... .. ., m-._ .�. ..1 _... - -. _a. _..a -+ti e�.....re+> « >:.: -,: �...��.: a e.. .w.�.� «.z._ .. -_ FOR PE%41T APPLICATION SUBMITTED TO PUTNM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: I, J u n , TH F, LAP ,4 PP-'e C- L that I am an officer or employee of the corpdration and am authorized to act for Pi Aj i.r,�t eft _ r-- _ �t A..i'lo L Y •4o M A S 1 i.'E L UOM E N T °�j G (Name of'Corporation) having offices at 8SD1 (f"AM F-;pE: 0/L r Whose officers are: President: d02) 1-6 LA POLC.r4 RP '�'3 MIi- . Pic"ViyI P00JAM ��ff (Name and Address) Vice - President; L� Lam '. C- .7..cii, .55al._. 4a1P�.tR�Cb.u2T (Name and Address) `Secretary; Ale e AQ/ .(Name and Address) Treasurer: (Name and Address) and that I.am and will be individually responsible.for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this Y day Signed: of 19 a Title Notary Public STE ART M. Gi.A;:3 N tery PUNIC, sale Ot Now Yak we�icnener County, qo. �st»se Co`r'psicate -Seal• 8/84 r / PETER C. ALEXANDERSON County Executive _..._......._...._ . .. ..T.._.... ;:rte -...�: _,___'�_ .r; <•._..,. ;. �..�: _. JOHN SIMMONS, M.D. Deputy Commissioner DEPARTMENT OF HEALTH JOHN KARELL, Jr., P.E. Director Division Of Environmental Health Services 1 t June 16, 198710 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Stanley Lander, P. E. Box L Amawalk, New York 10501 RE: Proposed SSDS Pinnacie Stately Homes Dev. Inc. Peekskill Hollow Road (T) P. V. TM 60 -1 -20 Dear Mr. Lander: Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: Additional deep test holes are needed, one in the expansion area and one in the proposed SSDS area. Well detail not provided on plan. Design data, i. e. , deep test holes afia"percolatiori `test results not noted on plan. Gallery detail notes aggregate to be covered wit as halt felt. This is to be corrected to untreated build�n a er r V g P P 2 inches of salt hay. With 3 bedroom home the minimum required linear feet of 4x4 galleries is 75 feet. Plans note 72 foot of galleries to be ou used. I Proposed SSDS is to be split, maximum length of any part. of the system is to be 60 feet. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Y' v`er truly, r Environmental Health Technician RM:pt cc:RM JK File • APPENDIX J ..PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET SUBSUFACE,.SEWAGE.- DISPOSAL SYSTEM_ _ _ _FILE: NO.:.. - .:Jr..... Y...r .r. - ...... ...... _.:•.....w. «n......y.Y- .,� "�.: :. .. -'u . .. .... .c., fr.-trr+ _ ter- � r .1 .- enl.....a --... CE Owner DCye. &v pmt Address 39--I C4VPFJPf G"v�> � 1'��� �w�� �r�.t�rs��c ►y Located at ( Street) �e E; s u i i. } , i.uGw Pa,�- n Sec. a Block % Lot e> (indicate nearest cross street) Municipality �� a '� Watershed s iCi t.L }a;,�,��i.,3 . k oo�C ,� i 9 P3 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 9- 23- date of Percolation Test J_ 2.3 ­6 HOLE A1r1MAT4M Orf)r'V TT V 'nvnMr Tm7rw T%r%nr nr RMY^V? Run No. Start -Stop -Elapse Time Min. Depth to taster Fran~ Ground Surface Water Level In Inches Drop In Inches Soil Rate Min /In Drop Start Stop Inches Inches IP/ l Z�v 145 93 �� 4,7 2 Z'46 3 .0/ 1. �34 �' /� 3 ..5e a 3 .4 ;J3 2,'lb « 4 5 IF 3 9 ;a 9 ;i f. /¢ .34- 3z 3 4 5 1 2: 3 2:P' 2 �I /o /� 62 s^ 3..'/3 3.-30 ' /�� ��3f 3 s- 4 5 NOTES: 1. Tests to'be repeated at 'same depth.until.appreacimately equal soil rates are obta ned;at each percolation test hole.- All data to be submitted for review. 2. Depth measurements to. be made fran top of hole. rev. 9/85 17 mk TEST PIT -DATA REQUIRED TO BE SUBMITTED WITH APPLICATION .N IN TEST HOLES DEPTH H HOLE. NO _ _ -' - 4' 5' 6' 71 H e� - u a] L. 9 c - 10' ,l N .. -. _ ca,. 3 -ri 12° +' 13' 14' ` 41 INDICATE LEVEL AT WHIM GROUNDWATER IS ENOOUNTERED 1/lfa.m/? INDICATE`LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED �I ` DEEP HOLE OBSERVATIONS MADE BY: , S- J /A ofO c /21 DATE: 3-1917 DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided, - No. of Bedrocros Septic Tank Capacity c> gals,, Type Absorption Area Provided By L.F. x 24" width trench / e Other 7Z L i A) , FT 4J r _01 n Names Address BOX ONLY: Soil Rate Approved sq. f t/gal. y sTfr.V �' - u a] L. 9 c - 10' ,l N .. -. _ ca,. 3 -ri 12° +' 13' 14' ` 41 INDICATE LEVEL AT WHIM GROUNDWATER IS ENOOUNTERED 1/lfa.m/? INDICATE`LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED �I ` DEEP HOLE OBSERVATIONS MADE BY: , S- J /A ofO c /21 DATE: 3-1917 DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided, - No. of Bedrocros Septic Tank Capacity c> gals,, Type Absorption Area Provided By L.F. x 24" width trench / e Other 7Z L i A) , FT 4J r _01 n Names Address BOX ONLY: Soil Rate Approved sq. f t/gal. y sTfr.V �' e >- w PUTNAM 6O6& HEALTH DEPARrb� DIVISION OF ENVIRONMENTAL HEALTH SERVICES- John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME '- 1NNWGLe STAr& &L tyolk65 D6-V, ZN� _ Orig. Routine Orig. ADDRESS HbL,,,A1,u 7 P Orig. Request No. Street `m No. Compliance MAILING ADDRESS 350) MMPF-/95-, PVr y01ZK7V Af :Ny 105J,V _ Complaint Canp Final P.O. Box Post Office Zip d�— Group Illness Construction TELEPHONE _ PERSON IN CHARGE OR INTERVIEWED NAI G U 1 A AA4D 11145 SC kE &%- Name and Title (_N e1 6 DATE -� 18 TYPE FACILITY %5 TIME ARRIVED FINDINGS: TIME LEFT S 3 0 Reinspection Field, Sampling Only Field Conference Other Explain Q_ �I % �� � I11� _Jim - _ —_ .� �� • ♦ � v Signature ana Title f WA-t � -A46 PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: HOC DEEP HOLE PROFILES N, Date: 9 9d D.H. - Deep Hole G.W. -Gr D.H .Lot D.H. hot }� -Groundwater le Depth to G.W. t Depth to 6:W. Depth to rock g' /a Depth to rock �— Depth to rock';'= 0 ft. Soil Descri tion ft. 0 ft. �� �- P +�'"c 3 ft. 3 ft. 6 ft'.� 12 ft. 6 ft. Sr 6 Re 9 9 ft. e- 12 9 ft. 12 ft. 12 ft. D.H.T Lot Depth to G.W. Depth to rock • 1y' Soil Descriotioz 0 ft. 3 ft. 6 ft. 9 ft. 2- -ft Soil Descri tion D.H. 0 Lot Lt Lc- Depth to G.W. Depth to rock A ` 0 ft. 3 ft. ft. 6 ft. 9 ft. 3 IC) Stsw�¢ 12 ft. D.H. (@ Lot O?_j)_Jb1.C- Depth to G.W. Depth to rock �— Soil Description 0 ft. 3 ft. Le,Am lsvyc I m6cs a 6 ft. 7 9 ft. 12 ft. Soil Description �SaI L LoAvo S°y,-a d 3 0 D.H. Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. Soil D.H. 0 Lot Depth to G.W. Depth to ,rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft D.H. Lot _ Depth to G.W. Depth to rock_ Soil Descr 0 _ft. 3 ft. 6 ft. 9 ft. 12 ft. f .a a la Soil Descri to on 0. .- ft. awn 3 ft./ Stsw�¢ �m Sr 6 ft. 9 ft. 12 ft.. / D.H. 0 Lot Depth to G.W. Depth to ,rock 0 ft. 3 ft. 6 ft. 9 ft. 12 ft D.H. Lot _ Depth to G.W. Depth to rock_ Soil Descr 0 _ft. 3 ft. 6 ft. 9 ft. 12 ft. f .a a la Ti COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL %= SUPPLY & SUBSURFACE SE%%GE DISPOSAL SYSTEMS 2J REVIEW SHEET CONSTRUCTION PERMIT '4J DATE RTr BY 1J AC 10 t ('Street Location)' (Name of Owner) COMMENTS YES//' NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Depth cd House PL �e/is Two sets Well V permit; PWS letter Variance Request LF trench provided required 60 ft. max. Par lel to contours 'J GENERAL --Legal Subdivision R-ibdivision Approval Checked Ex-approval SSDS Adj. Lots Checked Wetland (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) -...Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench/Gallery; Pump'.pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two-Foot Contours Existing & Proposed .--Driveway,., &- Slopes Cut- Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size . If Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells &.SSDS's w/in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1/4"/ft. 4'10; Type pipe No Bends; Max. Bends 45* w/cleanout SEPARATION DISTANCES SPECIFIED ON PLAN 1 Fids� 101 to P.L., Driveway, Large TreesiTop of fiL. 201 to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 1501 pits 1001 to Stream, Watercourse, lake (inc. expan', 151 to Drains• Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse; 101 to Water Line (pits-20') . 501 intermittent drainage course Septic Tanks 101 fran Foundation; 501 to well 151 Well to PL 9 10 APPENDIX L PUTNAM COUNTY DEPARTMENT OF HEALTH D VISION OF ,M— NMOM TAL ,-TH DATE: i17.2 / RE: Property of �TO��✓ Located at (T). Subdivision of Subdv. Lot # W Section . . 6 y Block / Lot .70 Filed Map '# Date M�if Gentlemen: This letter is to authorize �NG�n/ �• 7 -%,*Al Oq- e �'• . a duly licensed.professional' engineer_( or registered architect - (indicate) to apply.for a.Construction Permit for a §eparate sewage system, to serve the above.noted property in accordance with the standards, rules or regulations as promulagated by the C¢�nissioner of the Putnam County Department of Health, and to aY sign all necessary papers on my 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 147, Education Law, the Public Health Law, and the Putnam County Sani Countersigned P.E. , R.A. , # �ador �S `5 -/ /�:•�� �� � Telephone very truly yours, Property, Town �i - 1:�.9 -1 - Telephone 19 APPLICATIC.I FOR PUBLIC ACCESS TO RECORDS ..,......... -•I0; 'itE'CTRDS-�.CC�.��S T��„ "i'�"� ,.�'. ,.:w. ... ._. =l�rn_. _ _ � ., ..._.,. .. _. _ . __ ... PUTN" COUNTY Na -me QfZrl? �tal Health Services JOSEPH L- Pz-LOSO, JR., PUBLIC 120 Old Rt 6 Ctr -Bldg 3 • INFORMATION OFFICE R Carmel, NY 10512 Address I EF ?.=BY APPLY TO INSPECT THE FOLLO:•-=yG RECORD: b3_ilinc A_c p s= P= P OTTED — D=.:1 = E D Record of t_i? s accZcv 1s Lacal Custodian cannot- be found. Recozd is not by t --is Agency &4/1 7- L.e Ti t.! e_ Da- e_ NO = :CE - YOU HAVE= _= A R_G -T TO P?: _= L A DENT aL C; THIS APPLIC :'"ION TO THE PC;:ti:_•? COQ_ ;T,. Fa=;CUr'T�r= - Ne:-= 'Business Fccr.ess O MUST FULL`! F: {FL;�_T`i F yS F.= ?.SD'.`;S FAR SuC "r. DF`1 = =.L IV tv:.ITT:`it .SFVEN DAYS C. 'YZCFT?T• OF F`7 F ?P= "L- I S' cnatu.e Czto t _