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73.08 -134
BOX 27
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03390
�; v i x� ���� 4`s`� � Via Y � x ��ry'V'i -1 «-�:
t1 : J �: v E -46,,t EEWi . MUST-,`,
COUNTY DEPARTMENT''OF HEALTH
Dfvisfon of Environments! Here /dr. Servrcea, Carmel, N Y 10512 PERM ^I T'#
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CERTIFIC , S E' OF .CONSTRUCTION. COMPLIANCE FQR'`.SEWAGE .OISPOSAL ;SYSTEMr }
�1'
Tow, or. Vf�ga.- �:.,.,
Located ate Tax Maps+ ~'Block
Owner
7 ✓inJ'J' %x'19 fj / Formeily Map Lot N Subd Lot I
.i. Tex 4 t
Separate Sewerage 5 stye :built' by "� "���'fl
((%% Address
Con ;l6tfn _Oa,l. Septic Tank and � ea
other requirements'.
Water Supply. 'Public Supply, From
Y Private Supply Driiled wv Gir /1 ir✓ i�C
Address �f J
7f J m No. of Bedrooms `Date Permit Isiued �V �J o
pe
Building Ty a °
Has -Erosion CohtrotBeen Completed? `
_ � 4 " Has garbage grinder been installed?
/V
I certify that the syetem(s) se;listed serving the abovepremises, were constructed esaen..rtssrj�ipealtfewnaon the plans of the completed work (copies
of which are attached), .and in accordance with the standards rules and regulations ip+ecc wi the filed'.plan, and the' permit issued by the
Putnam County Department Of Health
'� '�,�,,, il•, °rC a '.
�.
Date rtif ietl bY.
P.E. R
- ' 'Address
• L tense No
Any person occupying premises'servetl by the bove systems) shalt promptly take w n' nepssi secure the correction; of any unsanitary
conditions resulting from• wch' usage Approval ..oi the .separate sewerage ystem sh M u oL n ai a public uun)tiry sewer becomes
availible -and the: approval of the private vatir` —, ly shilf'become fiul Id wfi'a liC' r ecorries availat►le Sueh eDDrovals are
sub] actl to modlf.ieatlon or change when„ in the;. Judgment: of the mmissio r of H odNI ilon or change As neceftary.
Date ' , V B T I t le
-- ,Rev_6 /.85 v:.,__..._'- :-__..___� ..:_._.....�_.._.._._.'..• ._...._.. ...._.... .....__.___._...
M
_ _ _ _
PLF1'NAM COUNTY
DEP.AR OF . HEALTH .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-h0, ,.1 � ti O�,44,4 S1 AJ40 V
Owner or Purchaser of Building
P. a.M. C3c- c, C, -S
:Building Constructed by
C +EiVC '
Location - Street
Pu-rru p-,L( VA`Le y
Municipality 6f ZUNI -4 P 3:
) S-roP.y PZkA E-
Building Type
Section Block Lot
Z75i-;4T1E-5 - See- �ro�c! 3
Subdivision Name
,- 07-*`- 4S'
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. -fs er"a of -.two .years iinn�4tely following -the_ c- to f .approval of the
"Certificate of Construction Compliance" for 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 occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of. the Division of Environinental 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 day of 1927
General tractor (Owner) - Signature
Corporation Name (if Corp.)
-
Address i�urN .4 V�3 ��c J AU,�-f , ( Qs79
rev. 9/85
mk.
��Etlo - —
Title
Corporation Name (if Corp.)
k04;W V1 ,--Z,j
ess
-3,Z).
mAH o Pp e, ,
:I .
I V.
I I.
X.
TION'�
APPENDIX C
FINAL SITE INSPECTION Date
)Inspected b --'
�RT.S.VAiJI.V,I:S:J.�Jiv: LOT,
�:..i .•i- T.•�.�? -... __. �. .. _. •.7s!! : f. .. . .. «,�
10
NO
COMMENTS
SEWAGE DISPOSAL AREA `
a. SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier_ LGTH WIDTH AVG.DPTH
c. Natural soil not stripped .
d. Stone, brush,' etc., greater than 15' fran SDS area.
e. 100 ft. fran water course /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Se tic tank size - 1,000 1, 250/16-4j
�
b. Septic tack installed level
c. 10' minimum from foundation f a "2
d. No 90° bends, cleanout within 10 ft. of 45° be_*d
(�
w 1Q. - -e is
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
IV
f. JUNCTION BOX --properly set
-'
g. TENCHES
1. Length reouire3 - () Length installed,�6Q
( _
2. Distance to watercourse measured_ ft.
---
3. Installed according to plan
4. Distance center to center
d� ,,,•
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feet from property line - 20 feet - foundations
7. Depth of trench < 30 inches from surface
.8. Roan allowed for expansion, 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11: Pi ends capped
h. PUMP OR DOSE.SYSTEMS
1: 'Si:ze -cif
2. Overflow tank
3. Alann, visual /audio
4. Pum p easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health De t
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrooms
WELL .
a. Well located as per approved plans
`yJ
b. Distance fran SDS area measured ft.
c. Casin 18" above grade.
d. Surface drainage around well acceptable.
OVER az WOREMAS='
a. Boxes properly grouted
b. All pipes partially backfilled
c. All 2ipes flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. , Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to exist.watercours
l
g. Footing drains dischar a away fray SDS area
h. Surface water protection ad to
i. Errosion control provided on slopes greater than 15 %.
10
PUTNAM COUNTY DEPARTMENT OF HEALTH
3/86 Division of Environmental Health Services. Carmel, N.Y. 10512 Englneer to Provide Permit #
on CERTIFICATE OF COMFLIAN / /� +�
C TRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit N �f
Tower or
Subdivision Name �' E� Solid. Lot # Tax Map mock � Lot
Owner /Applicant Name Renewal_❑ Revisioa
Date of Previous Approval
Mailing Address - °� °" �� a Town is �trvT9 Zip -_ C.- 5-.7z
Building. Type �'� Lot Area d� Fill Section Only
Number of Bedrooms ��?3 Design Flow G /P /D �� PCHD Notl0cation IIs,
Separate Sewerage System ofironslgt of f" is' Gallo. Sepdc Tanta and
To be constructed by Address
Water Supply; Pabllc Supply From Address
or: Private Supply Drilled by Ea Address
Depth volume
tettulred When Fill is completed
G�7
Other Requirements °cf
1 represent that I am wholly and completely responsible for the design and location of the tem(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and V06An standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of ctL9swGQra81i satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guararitee will be furnished th re m i �� pr assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system A ing td4� I od of t� y immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the i in stem ny r�epiao the to; 2) that the drilled well described above
will -be located as shown on the approved plan and that said well will be ins a an the fid j rules and regu a'ons of the Putnam
County Department of nth.
Date Signed : ?a: P.E._�"� R.A.
isi
k I'y® o�
Adtlress � '� f`' License No
a
APPROVED FOR CONSTRUCTION: is approval expires one year from the da I of the building has been undertaken and is
revocable for cause or may be amend or modilied when considered necessary by aairsf° f h. Any change or alteration of construction
requires a new `permit. Approved for disposal of domestic itary sewage' and /o only.
Date ` v1�tJfQ By Title tl
T
��J..; i` tl' k IOn
L� .� 0'n -M1I.2. ll -_! -.. ". . .....�w -s t.. y.." Y.- I.r h' r iF �••'•a ,,.d-1 ( i.t �ry �4�Jf'h q,. v 1 l.i. _r �f
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—. —, -- = �- �— ��- 1�3� `y':'`}.--- _.lJ'+z�__.- �.Ar_1V _ �— Q�- �Yl� - -- �• 21���Lt�[.- �..._.__�:.._._.__�_— _._.._._.
r 1 ! q 1
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
May 23, 1986
Frank Sullivan, P.E.
2972 Ferncrest Drive
Yorktown Heights, New York 10598
JOHN SIMMONS. M.D.
Deputy Commissioner
Re: Sinkov SDS Construction
Permit Revision
P..CHD Permit PV 39 -85
Boswell Rd, PV, TM 62 -9 -12
Boswell Estates Lot 48
Dear Mr. Sullivan:
Review ofAplans submitted at
this time relative to the above, - captioned project 'has been'
completed. Comments are offered as follows:
C:o.nst.r:uG ;tlon_p.prmi-t .tax ma.p nu- Jacking, .
... .L a .. y r. - • - -
n 2 Plans and permit indicate three bedroom, though house
plans indicate four. Design flows are adequate for
four bedroom design.
3. Trench length requires alternate design or dosing. It is
suggested that an alternate design be used which splits
the flow equally between two 300 l.f. fields.
4. JMinimum septic tank size is 1250 gallons for four bedrooms.
If n additional tank in series is proposed to accommodate the
increase capacity, three six•inch horizontal pipes located 18
inches b low the liquid level must be provided. A vent pipe at
least fo r inches in diameter must also be placed at least four
inches a ove the liquid:level.
If he existing 900 gallon tank is a metal tank, it could not
be used nd specifications for abandonment will be required.
5. Plans must indicate that existing septic.tank must be
pumped.and system may not be used until issuance of the
Putnam County Health Department Certificate of Construction
Compliance.
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641
2'
6. Footing and gutter drain discharge points are not
shown.
7. Location of adjacent wells is lacking.
8. Length of proposed trench conflicts between design
data sheet (200), permit (600) and plans (300).
Upon receipt of.a submission; revised to reflect -the above
comments, this application will be considered further.
Very truly yours,
a,,mo,a
ames S. Hodgens
JSH:pt Asst:!'P'ub;lfic Health Engineer
cc..JK !
JH ,
File „
Mr. Sinko-v
- ` •� V r
PUTMM COUNTY DEPARTMM OF HEALTH - DIVISION OF ENVIRQffiWM, HEALTH SERVICES
INDIVIDUAL 6ATER SUPPLY & SUBSURFACE S DISPOSAL SYSTEMS
m; a ,.�,k r • : ., n .. 4. 4EEu�' S:�T-..:
1 DATE REVIEWED: -
_ 7 a� BY:
(Name of er) (Street Location)
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
'30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
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
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
... Representative of : Sewage & ..Expansion. Area
.._ aY s on-Area;'siio ;gravitk-±hi4;suff -s ze:,.•,�. °� -
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
.Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit.R & D)
Data On DDS Plans & Permit Same
B�
t '
�
SAM
mm
MM
y ► �� r , 95
. �r
DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
'30" Perc Hole
Other
House Plans - Two sets
If PWS - Letter
Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
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
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter Curtain Drains
Perc & Deep Holes Located
... Representative of : Sewage & ..Expansion. Area
.._ aY s on-Area;'siio ;gravitk-±hi4;suff -s ze:,.•,�. °� -
If Pumped Pit & D Box Shown & Detailed
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Curtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
.Septic Tanks
10' from Foundation
50' to Well
15' Well to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit.R & D)
Data On DDS Plans & Permit Same
j
RMIT F
Located at --d
Subdivision
7d
e Date Of Previous Approval
Building TypeA_ Z � Lot Area _,gu;�v
Number of 920---a—Design Flow G/P/
Separate Sewerage System to consist of Gal. Septic Tank
To be constructed by
Fill Section Only ❑ —
P.C. H. D. Notification Required
and
Address
Water Supply: Public Supply From.
Private Supply to be drilled by
Address
Other Requirements
I represent that I am wholly and completely resOnsible for the design and location of the proposed.. ntW; 14 he separate sewage disposal system
above described will be constructed as shown on the approved amendment there to'and in accordan he, tt4pqjardjrj s and regulations of �urnlm
County Department of Health, and that on completion thereof,a "Certificate of Construct.! fNo the Commissioner of Health will
be submitted to the Department, and -a Written guarantee.Will be furnished the owner, his Ce rs ors s by e builder, that said builder will
place In sewage disposal system during the pert 'of (2) ea s Im g"&a
good Operating condition any part of said t I following thedate of the issu-
e'
ance of the approval of the Certificate of Construction Compliance of the original system & r to-, a* t e drilled well described above
VV d
will be located as shown on the approved plan and that said well Will be Installed in accordance it A u a ons. of the Putnam
County Department of Health.
Date a r"r P.E. R.A.
Address
,,Xned
V "' Icense No.
APPROVED FOR CONSTRUCTION: Tn*approval expires one year from the-date d u I C uilding has been undertaken and Is
issued
r m a 166 0
revocable for cause or may be aniendecy r modified when co red bec�!s�ry by the Co :: s �166 o y Change or alteriti.on of construction
requires a new permit. Approved for disposal of domesticisin)1arl sewage, d/or p ivate w r supply only.
Date By Title.
—
Rev. 9-81
PUTNAM COUNTY DEPARTMENT OF
HEALTH
Permit #
Division of tnvironmental Health Services, Carmel, N. K 10,512
IR- SEWAGE DISPOSAL SYSTEM
Town or vlllag
Tax Map
I.P
,
10 t
Subd' Lot 4 Renewal
❑
Revision
7d
e Date Of Previous Approval
Building TypeA_ Z � Lot Area _,gu;�v
Number of 920---a—Design Flow G/P/
Separate Sewerage System to consist of Gal. Septic Tank
To be constructed by
Fill Section Only ❑ —
P.C. H. D. Notification Required
and
Address
Water Supply: Public Supply From.
Private Supply to be drilled by
Address
Other Requirements
I represent that I am wholly and completely resOnsible for the design and location of the proposed.. ntW; 14 he separate sewage disposal system
above described will be constructed as shown on the approved amendment there to'and in accordan he, tt4pqjardjrj s and regulations of �urnlm
County Department of Health, and that on completion thereof,a "Certificate of Construct.! fNo the Commissioner of Health will
be submitted to the Department, and -a Written guarantee.Will be furnished the owner, his Ce rs ors s by e builder, that said builder will
place In sewage disposal system during the pert 'of (2) ea s Im g"&a
good Operating condition any part of said t I following thedate of the issu-
e'
ance of the approval of the Certificate of Construction Compliance of the original system & r to-, a* t e drilled well described above
VV d
will be located as shown on the approved plan and that said well Will be Installed in accordance it A u a ons. of the Putnam
County Department of Health.
Date a r"r P.E. R.A.
Address
,,Xned
V "' Icense No.
APPROVED FOR CONSTRUCTION: Tn*approval expires one year from the-date d u I C uilding has been undertaken and Is
issued
r m a 166 0
revocable for cause or may be aniendecy r modified when co red bec�!s�ry by the Co :: s �166 o y Change or alteriti.on of construction
requires a new permit. Approved for disposal of domesticisin)1arl sewage, d/or p ivate w r supply only.
Date By Title.
—
Rev. 9-81
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property of
Located at
Date
�0, Section Block Lot
Subdivision of -13 o, 1° -// -1— -> A,
Subdv. Lot # 4 ,5�- Filed Map # Date
..
Gentlemen:
This letter is to authorize��� r
a duly licensed professional engineer t or registered architect
( Indicate -
to apply for 'a Construction Permit for alseparate sewage system, to
serve the above noted property in'accordarlce.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
�r5teun� aii..:_s_y_s.t. ems .:iza o.onf.:orrri':t w t:h ±1� -pr �r aaci '.c�,f _Art'FSI.e';:�:k5:..9 "x`. ..,
--
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned:
nu Aa'„ Q.
Very truly yours,
Signed ,
Owner /of Property
P e , 42-.A
Y_5���.
ME
Address
_ A,; °'�•
Telephone
R-D 3, Box �i9 , L3o5wELl- AND
Address
Town
�f
Telephone
J
pq� 15 2-0
_ ,-� -- ----- �= �'=---------- - /�S�_ -.Zip / �i1x
qtr .n
30b
aA-r
niLET 5-7
41fa* SAT H A. 0 u D.P-
-t- Tol
41- 3 4.
48R
20
. . .... ...
a-
ti
D001,71-ITS
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No
MAP L"e"on
rouse plans O.K.
Design data sheet
Peres presoaked? ;
Property lines or corners found . . . . . . .
Can ezt'in• ,to house.locat-ion . . . . . . . .
I
'J
1.2-n. 30" perc test depth
Const. results for 3 runs'1�
D. Hole log O.K.
-
,,yam GF
Corporate Affidavit for othcP than individual
!
Authorization for engineer
I -
Letter from Water Supply if applicable
If variance requested -such noted on plans apps. N. 0&
E ' EXPA 5 E
N£ D• -'
'"100ATVRE g SEAL PEA
D, :TAILS „
. FILL DEPTH j AREA' SHOi kJ( c i) MOT'S: - Pr.AN ro Bs- row,;,veb , �')
Existjng contours shown (show new contours) i
Slopes for driveway cuts, etc. shown
o
Xater service line location
,
Footing drain, etc. location
Top slope, bottom slope of fill AIPc
Pereolation. tests and deep test pit location I.
Septic tank size and conformance to std.
3 B.R. house minimum
House setback shown I
Distribution box ft T below frost
All water within W_§it. of: PL shown
1
i
f-
I uw�sA t Lem
I
WekL CASING 12" rj130VE GkADC
<,
-
Plan and profile SDS
All other wells ana.SDS closer 2 0' I
shown or reference made eK
Property boundaries (metes and bounds- clearly 0
;;,....
n is
BDIU iS IDb I .i
rEA Ar PeoV4L
•
Y SuNDi��Slgv
✓�
.
1Jater elevation:. :
ISEF1114TION DISTANCES SPECIFIED ON PLAN
'
I10' to P.L.
X20'* to Foundation walls
J0 to Nearest well
X•
House located ubere -shown on approved plan
400' to stream, march, la e, etc. inc :expansion
5' to Curtain drain
.•
—
SM located where approved . . . .. . . . .
0' to water line (pits -20
'length of trench measured
Width of trench average
slope of file line and tren— c . Ti acceptable . . .
Room allowed for expansion trenches . .
Over �Wft. from swamp, watercourse
15' to storm drain
10' • to large trees
0' from foundation to sel�tic tank
115' to pipe from leader drain &.1.00 tint drain.
'25 To .c4Tr_k CEASIr.,
I/
✓
,
✓
_
Natural soil not. stripped or SW area
iuviecessarily graded
10 h't. maintained from prop.line and .
�r
IS' WEk.L TO 11
EO' - %ePTtG TAr3k. •TU• %00L_L_
20 ft. from house . .
.
Z 1- r ac .S . F 1 cat il��Kaxx -3ti? 10+
ir, -20 RM Oru(d f>eigt+'t fr to-'15
6r $-f3
C • t ti A
FIJs'LD CITEC"K L:CST.
Date: r �
Insp.by: _
• _ .cam r r
INITIAL SITE INSPECTION "� f -
YCsl
No
',' Colronc:nts
Property lines or corners found . . . . . . .
Can ezt'in• ,to house.locat-ion . . . . . . . .
'J
Will'. driveway need cut . . . . . .
Must trees be removed -hote these
`ts
.
FFdnalt or,
Is deep hole representative of entire SDS area
Additional deep holes needed. . . . .
Sufficient SITS area available considering
,
driveway cut,house location, separation
distances, etc.
'
<,
-
RrA. WGLU, /%FPTILS
DEEP HOLE DATA
Dspth:
1Jater elevation:. :
Rock elevation:
Soils description:
Date:
FINAL SITE r•,SPECTIOPI (Insp. by:
House located ubere -shown on approved plan
—
SM located where approved . . . .. . . . .
'length of trench measured
Width of trench average
slope of file line and tren— c . Ti acceptable . . .
Room allowed for expansion trenches . .
Over �Wft. from swamp, watercourse
_
_
Natural soil not. stripped or SW area
iuviecessarily graded
10 h't. maintained from prop.line and .
20 ft. from house . .
Separation of trench from house, well
etc. - follows plan - -- - - - ..-- --
. . . . .
- -
-
--
'Nulnber of bedrooms checks . . .
Stones, brush, -sti=ps, rubble, etc'. greater
than 15 ft. from nearest trench .
y
15 Ft. of peripheral soil horizontally from
trench . . . . .
''•
Junction boxes properly set
Could surface rtuz off from driveway, roads,
•ground surface, etc. channel near SDS ,..
area . . . . .
Doers, lot dr't.. :e an dar O.K. in area of SD-S
FINAL GRADING OP SITE ACC.El "P11 IX
•
r,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION' OF-ENVIRONMENTAL HEALTH SERVICES.'..
`- COU'iTY`' OF'F10E 'B JiLDING; , CAR1MrZ;• N'. Y.' 10512
DESIGN
DATA- SHEET= SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0:`
Owfier . /./�i' .. _ ._ h /�` =� Address..
,Lotated. 'ate (Street)/_51;-', 01" 'f Sec Block Lot
(indicate nearest cross s ree
Municipality Jezprf� �Z ey Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS--...
_... 2._..:
Notes: 1). Tests to be repeated at same depth until approximatelyy 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.
Role
Number CLOCK TIME
PERCOLATION
PERCOLATION
apse .... ,...
.No. Time
"Start - Stop.- Min.
- Depth to . a er
From Ground Surface
Start Stop ,..Drop
Inches Inches
a er ve
in Inches
.in... , .
Inches
Soil Rate,
Min. /in drop
4
_... 2._..:
Notes: 1). Tests to be repeated at same depth until approximatelyy 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. HOLE NO.`S HOLE NOe
G.L.
6"
1211
24,1
.. 3611
42"
48"
5411
.6011
66'.'
. 72
7811
84"
INDICATE LEVEL AT WHICH. GROUND WATER IS ENCOUNTERED
IN7 IGATE I,EVEI, TO WHICH- WATER LEVEL
RISES -AFTER BEING ENCOUNTERED, _
7. `TEiS fMADIJ`SY - -�- - �\ cr' %i 11 " { :Ta�
t DESIGN
Soil Rate- Used�MirVl Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity,/, Gals. Type
Abso ption Area Provided By L. F. x24" '�°°oa,dth wrench..
�CY�
ame c i
igria
�'� oil_
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal.
Checked by
Date
JOSEPH F. SULLIVAN, P.E.
YORKTOWN'HEIGHTS, N. Y. 10598
(914) 962-4248
4?
Ael
0
�a x Located at
Owner
s . ,,,Separate Sewerage. SYstem �
Cbnsi sting:,df,,'
Other requirer
--Water Supply P
-P
Bull ng° ,, yp 1.
.-Has "Erosion.,Control
1,certify 'thit-ttid,
attar. e�i. )_anq. �a,�qq r .'An.5
Ion;— —
S_eci
....
_'RY
"E
sr
7
� ww
V If.
age:
width trench
k (copies of which are
Department of It h�.-.
40.,
PEEKSKILL MEDICAL'LABORATORY
1579 Crompond Rd. Barclay Plaza Bldg. A, Apt. 1 4
..- ,, VG nf:- .�if�f•: ..dr..n:rA.tl+•a•v «trd•.'al �w l�f �l N�Naur w, • .,.. _ y.4f �• C =1R t. l�.. P.VI � .y R. -N•r.�i F ,��a l,�i�n ��M:.�ar9�f f•TI:: is �./1`.Tlw~
"'Reks7ci1 New York 755 PE 7-8777
# 46524
DATE COLLECTED
RESULTS OF EXAMINATION OF WATER 5/14/76.
OWNER DATE RECEIVED
Lew Agostino, RD 19 Boswell Rdasputnam Valle V14/76
CITY, .VILLAGE,, TOWN VOR NAME OF SUPPLY DATE REPORTED
Lot .# 489 Boswell. Roads Putnam Valley 5/17/76
Well
BACTERIA PER ML. (Agar plate count at 35 C).
4
COLIFORM GROUP (Most probable . /looml.)
less than 2o2
HARDNESS, TOTAL -ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
IRON, TOTAL - ppnk
r LUUM11Jt; (r) - mg. /l.
These results indicate that the water was yes of a satisfactory sanitary quality when the sample was. collected.
6
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 ��� Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORKa
P °'I'itiis' report ^'rs r►'Ab ' TYiplete�z6y �I rePl" n1Tr31 and sunrt I ai9"f� o'untjr "Flealt}i "Departiffdr td'get e� with Tabor; y port f �'
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN'30 DAYS OF WELL COMPLETION
OWNER
NAME
ADDRESS
LOCATION
OF WELL
(No., A Street) (� (Town) (Lot N(u)mber)
kLd �CiA QLI. 6
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM TEST WELL
❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ (s(specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION El (Specify)
)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
1�7
( THREADED ❑ WELDED
O
YES N NO
YES
NO
YIELD
TEST
❑ BAILED ❑ PUMPED
HOURS G.P.M.
COMPRESSED AIR
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
(�
DURING YIELD TEST (feet)
�(j
Depth of Completed Well
in feet below Land surface:W, .
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (leef)'
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches) FROM (feet) TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
f�qq
`•"V�
. :,w w... ... .eY ^'r.�.••.��...�. Y• .�PG.vq ^N.. .�•. ....r.�...�� �._w.w.a. w.. �. .�•.
.b
1
1 '
i
{mow
h
. \•V �P-
•rw}.��..�J.P
.. �.atr -r`.: a'•« --{.. . +.._..p...
WiXYA
oy
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
` 11> 0
DATE OF REPORT
WELL DRILLER (Signature)
,�
a
Building Constructed by
Location - Street
Zi5AM &era .
Building Type
Section
Block
Ile
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 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 P the Division of__. vironmental. Health _Ser -.
y= Hepartrrh-rH of°- a3 rr�as ~to wtie°ther °o r° nct the °° _,�
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the sy t m.
Dated this day of 19f %� Signatu e
Title gEI A CONSIpbCTI, N (1�IC.
(If-corporation, give name
and address)
BUCKSHALLOW -n, R.F.D. #
- - - - - - - - - - - - - - - - - - - - - - - - - - - - LAKF M[+kDr ,ti. Y- I ft44'
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
LP&LA-4R'
Owner or
Purc aser o
Building
Municipality
Building Constructed by
Location - Street
Zi5AM &era .
Building Type
Section
Block
Ile
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 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 P the Division of__. vironmental. Health _Ser -.
y= Hepartrrh-rH of°- a3 rr�as ~to wtie°ther °o r° nct the °° _,�
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the sy t m.
Dated this day of 19f %� Signatu e
Title gEI A CONSIpbCTI, N (1�IC.
(If-corporation, give name
and address)
BUCKSHALLOW -n, R.F.D. #
- - - - - - - - - - - - - - - - - - - - - - - - - - - - LAKF M[+kDr ,ti. Y- I ft44'
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
r�„`+'ia•z`:'- tF.!ia- ,._ a �%r' ,'[. ti'°r.`5.;; .. .T.,. �� 5�--= +a`.- :z.v:— ,'-wit ;^n:� =`at :.:. .. iw. w.oaswa:�..;... ...,: �R: �iS"> N- w.- »:w'c•:�a-
i2 L.eepfy'
0 er or Purchaser of Building Municipality
Building Constructed by Section
A042Zg1_e_ 12e/f-,,
Location - Street Block C�
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 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-
soi-s, 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 ac.t of the occu-
pant of the building utilizing the system.
r
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
j� h G the' the.umy.0 Ity.e. a:r.mt -o- ltrs �
failure of of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this 90 day of MA 19 V Si t nature -
Title c�G
If corpora i
and addre s)
n,01,e name
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.
2
,pyv y -i1,.f X ycr s Y k c r -'�, r-7*•, F?
y -. \ "L i 4 .S
r-< y - i y t� f... i 4 k tfi• -'+- r,� \+y ..t. -KY V
^ ,
)w W r. 'ai
y"a,.. y� ify. iy,.
d-
n ���� �YJ 7'� _ Y'. ,,
u; ing C,Ons ruetE Section -�-,.°. e_
:x - _- - Block:,_
1
1 1 ,
pl
s
��.
But in T e
g Lot
yp �.
,
GUARANTY OF" SEPARATE SEWAGE-. SYSTER
Yr
I represent'." that I am who and' 'completely r.:esponsibe for the
ZocationY:. workmanship, material, :constru,ction and drair'ae: of tYe s'e:wage
disposal system serving '.t;he. above..desc_ribed property, and thatr` has been
constructed as shown on "the :approved plan or 'app rowed amendrrient thereto '
s
acrd in accordance' with. the standar:ds,- ;=rules and' regulations '-of the Putnam,L J`
County Department of'Health, and Yiereby guaranty to the: owner, his succes ;
rsors9, heirs o_r assign s, 'to: place in good operating : condition any part off'
s,aidsystem :_construct'ed bjr me`which fails to. operate for. a;perio'd of two
gears'immediately. follow n the dace of initial use: of the; "s,ewage disposal j
eyst:em, or .any' repairs made by: md ... to s`uch.'sys,tem9 except where the f �ilure ?r
. , to operate properly s caused :by 'the willful or., negl.lgent aca of the xaccu
pant of the: building :utrizing';the;; Sys. am.
Zt
�+
The unders'ignea `further agre'e.s to accept .`as cnciasive`' °the ;de
termination of the Director of :true'` Divi;sibn` of r' vironment.al. Health
vice`s of ;tithe;. Pu nom County. Department .�of Healthy as .: to whether or: not ;the Y
i �fgz;Iizre of the _syst `:eras_. ]:d :uaed.b.: �h�; wsll� �1 c -r rye 3 ��x
x 'arty of the_ occupant of The -- building .utilizing the system
.P
Dated this day of C 19 Signature`
If
corpora ion, g e name
and address
) r
S� �,yyl _ __ yi -
- -
'THREE (3) COPIES ARE REQUIRED WITH.THREE (3) COPIES OF'FINAL PLANS BEFORE
.
-CERTIFICATE. OF COMPj�ETION ' WILL BE ISSUED.
GUARA14TOR IS REQUIRED TO FILE" NOTICE OF DATE OF FIRST USE OF .SYSTEM
D3: ision of Environmental Health Services, Putnam County.'Department of FiaaZta� yz4
kyr L
5 . .• > )x 4t,. t ; s COL 7tha- yZayZ1�} .
4c-'
A ,�?
, t
4 Loaat on`, Streets
Block.,
1
ing
wild_ <:Typei r Lot
` 4 f
}
GUARANTY OF, ,SEPARATE., SEWAGE. =SYSTEM
•;
n
jc
3,IzKrepresent, that I am wYolly. =and,= completely responsible :fora
locat=ion, workmanship'; material, construction an :drainage of the s:ew
;;
d" aI' system srerving.,the above .desdr"ibed property, :`and:-that'"it' °has::
constructed as shown' on the approv.,ed, plan or app rovedamendment ;`there:#
and in accordance :with the 'standards, rule and' regizlat`ons of "the Pu't
y Department of Health, "and hereby, guaran_ y to the'. owner, This` s.0
sots,: heirs drtassigns, t6'place `in.go;od operating;'. "condition any par - -.t<
said ;system constructed b- mei which' fails, to:.operate fo;r a perlod,,:of t
years immedrately fol1614l,r_g:;the date=oi'; in tial uses: of ..the.: sewage .,.d i_r
Zi
syst`em, or any repairs made...by me to sueir sys.t`em, except ,where; the ,f
t'o erate properly is caused,:by the willful o:r negligent .ac.t: of the: e
pant ,of - ",thei building utilizing` the ;:syatem.,:
her a re`
The 'unders�:g`r�ed `•i'urt g es to accept as G:onclusive the d
fermi nation: "of .the Dl`rec vor of, the ,:;Division of .,r'vronmerit;al:;.Health.` Se
vices.: of :the.:Patriam County: Depar•tirznt 'of : Health. as :,to',whether ' not t
failure cif the system tto operate` T,�aa� caused: b�vtk�o;`vwzll,fu�. or:::riegligan
act of the occupant of the building utilizing the system
Dated this day. of 19 Signature
Title'
f If corpora ion, .g e. n
_ and addre s)_
THREE (.3.) COPIES ARE REQUIRRED WITH THREE (3) COPIES' .OF .FINAL PLANS BEF'
CERTIFTCATE OF COME-,ETION 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
Ril
-w
at �^^t �'4�S,�s. lA -9,Mi. y3 ' 6r '` 1 Y t A 3 r'D S 4• L w � L
�.l-`°` •�rds'•�1' t •y°"! -C •�'4r r j �' - 1 i i '`+ k t : , .I 5W2 7 A
M w h'- -y`j,•'T '�.'' '�\
,.'1 zk• r ,iytn+ xe t r '-r -• e t i <,. w'..
u 1+.Y'•t.,�'.a�z.
Ty -
1" sr i�(Vjsio�
1� CONSTRUCTLON PERMIT rFOR SEWA!
Located at
-
� 3 Subdivision ��Ci � OS'(.s�i
+Owner 4
} ,Burld
rn9;
TYPe Paz -,
:Number. ; of, Bedrooms £`
-' zxc, - '
Separate] =S ewerage,SSystern 0 consist'Pt IS
To be constructed by
3 c.. T - 4T'h
Water Supply �Publrc SpplyFroni
F Private Supply to ti
Date
. s �
APPROVED FOR CON:
rev
ocatilefor�c use or rrr
`requires :a r
Date c 7 t{
T1
d by be
PAR' TENT : OF 'IiEAL'I H
th Services kCai'mW/ N Y 1.0512
y.�p-s`t` bed � � <ec ache :. '�• ��.;' �• � ,�
T 7.1own or ;�finage .
a
t rE e,• �, "xws." x. #Block fxs r -
V.9
Address -
�r
t " Total Habitable5 ace �- °'� '�� - 'Square Feet
ll p z 4 r
iptrc Tahk s� ®� slrneal feet ,X ��. s width trench
'11,0W, Ir 2310
5
6
ationof thetpropo5ed system(s); t f }thr trtaiat�)b8.'age 3.posal system
re to,and ,in, accordance with the stan�aq?1 "rule ns o r he _.0 nam
the Certificate of Construction - Compliance '6f the original system or any repaus thereto' tai I�t�iP'dT ' Wb scnbed above
the ap&provedXplan and�tha sa d well will berinstalled irn accords ce?�wrthE the rstandards rule f f � t•he Putnam -
alth /( -/'�
}
PUTNAM.COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
i. �•. n• vn-:. ��+ cls.er- .'•uri.'s- .A�y.vH� "p�-i; r.. ::7iG".��M.a- v >�7= 'b>•t, -^�e•: ^v:.s�lertri+r7."�_ _. .. ✓v.n- r- v+.X,w�%e �+.n4in «..::(:�:= w�,:a -i. n "e'�.:a- .. t 'J.Lrn :: -..:�.
COUNTY OFFICE BUILDING, CARMEL, N.Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner l� /I(� 44 ®A Q20 1jC:VS'r1A.1j$ddress ;� 3 ,<t� C'41�&.y S7' �i4
Located at .(Street p G.! 41- Am Sec. Block Lot
ndlca e nearest cross s ree " 5'7;47/ 'gS
Municipality Cyw y /VU ;�AP14 V41,Lf yWatershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
\ 2 I&D
r 4+ l,2: /0 1,2
..c�2/ 3
W-A
16 .
5
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
Dep to
Water
Water Levei
No. Time
From Ground Surface
in Inches
Soil. Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
rl q"Os a1,,o
\ 2 I&D
r 4+ l,2: /0 1,2
..c�2/ 3
W-A
16 .
5
3 A'!2
21
2
3
4
5
Notes: 1) Tests to be repeated at same depth until aroximatelyy equal soil
rates are obtained at each percolation test hole. All pp 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 o
6 i
DEPTH . HOLE NO._ ! }p HOLE, N0. 'HOLE CVO.
�'S -•'T —r-�c _�Z:S ... .u:?iiL'ic:./! #_Y\ .Y.•AC..v4 ^'4 vm.. - ,.*s;. ..ono r'S �3'..e '�vr°W -cos �z>`^•s= zSn?'r ri....` OnSt�-. hnion,=e•.<aA_eciv+•:<.•�_� ",; .:;'v.s��.eo.•. .r>
_ -aQ•r
�e.ue
y
6"
12"
18"
2411,-
30"
r /Ne
3611,v✓
42"
irX�v�F
4811
5411
60 "1
66"
/) / C94
2"
7.
7811
8411 / C Vp
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE Date
DE�IG
Soil Rate Used_-90 _Min/1 "Drop: S.D. Usable Area Provided ft�t�llF%'
No. of Bedrooms _Septic Tank Capacity Gals. Typei1.
Absorption Area Provided By 110 L.F.x24" � -width trench.
Other 0-.,,.e«..._
Address Amjo
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved
Checked by
PUTNAM COUNTY DEPARTMENT OF HEALTH
W'.7.--p'--:.';!z2;
DTVIi HEALTH 'SERVICES
Date
j 7S
Re: Property of
Located at--
Section Block Lot
-Gentlemen:
This letter is to authorize--;.- tz'4 it) 0 t
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 M2ttC?V an.q to supervise the construction of said
system or.systems in.conformity with the provisions of Article 145'or
-na, P, -Lfnt' tsaml
`diic�iti-.* tM. -,.Pu.b ld.o Ho a1th
1,47,-.1- 1 51. FATI e. ;,t ip, C o y
t.ary -
Very truly
Signed
Owner _ f -operty
-ClU
Add
ress
7��4 -3 Yl Z
pdRK,-,1zO-PC1 _aao Telephone
Address
76
76 3 5 Oa 71
TelO'PhOne
..r e-":. y, ...� O. . . ):.. ... _.,:�^ -. a d .w .n �!1' _. �L:w�•'.',`.7 � n ...YJ ^.r.�..Y. rt7:..:. tC� .� "`T2i i . . "1. r. f C u iuZ �L °�is l ' ��L -.. . r . .. S..J'. :`
11
So
So+
c\,�� > ® Ste, •
it SC> ,
i
9110
t
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.EX 9 001 /�.�,.:5���
� gg9ltn
county Real
service-
Dog
01.4sion of En°iro th
as noged � Regulations � � �
Ba R A 'Do 1tD Dep-r t
gJAW
�ia �CX�zI+ /r�al�q ,r ►Ire. d �e p`c .O�CJ'asa
J 7l
tify that the sewage disposal eyeteM wag _
indicated on this plan and that the system
by me before it was covered over. The
structed in accordance with all standard L
itions of the Putnam Gcunty Depa.tment of ���Ae d;�
New York State Depart•,,ant of health." --- --
T��%> �" .._.� u //: ✓off f'.�