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BOX 27
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03421
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HEALTH
?-UTINAA-�.t
OUNTY'D A
J
'Division of -
Environmental :H 110/
A
ION 'PERMIT F0R,:SkWAGE-,PISP0SAL,-S pa
?Own or Village
7.
ey
7,
Lot.. Job
e— AM00 Address
,V-,�( S3
.ding Type Lot Are a
V L,/z Square,
Total Habitable Space -- Feet.
,Number of Bedrooms —
ic Tank lineal feet X width trench
1'.\Separate Sewerage system to consist of
—,.Gal. Sept
04
T
o be constructed by 4 AA.-*,Oi2 Address
Water Supply Public.Supply From
—L-'Private :Supply to be drilled by
•
Address
h . er Requirements Alri "no 1-/.,0
that the separate sewage disposal system
the proposed system(sj;'1)
nand location of
i,represent that I am wholly ind.eorn
•
ant there to and in accordance with the standards, rules and regulations of the Putham
above described will be constructea., Us . factory to the 'S
ertificate. of Construction compliance" satisfactory Commissioner of Health will .
a' el
County Odparimeni of Heaii*h** n; assigns by the builder, thaVsald bulldWwill'
urn !shed �the owner, his successors, heirs, or
�66, submitted to the, Depirtme ,w following thL,I' fn�
immediately edate'of the,�, ssu-.,,
nditi an Part d o I system during the period of two (2) years
place-.iq,,good operating co. th y repairs thereto; 2) `that the drilled well described 'alidve..�
of the C e.qreginpl system or an a
approval aT— ionsof the 'Puin"airn
ante df-ith'e' installed in 4cordance with the and reguT
shown on theipp 0 10 standards, rules
will belocated as
j,C6uniy'. Departlilent of Health. y
P.E. R.A.�
/V0. S ad.
Date . ........ f/Z P
p:ddre pxz/ License No.
AP . PROVED FOR CONSTRUCTION: This .approval x p crei one year from t date issued unless construction of the building has been undertaken, 'and '.!is',',
Commission of Health. Any change or alteration of construction
hen considered necessary by the Com
U
w
revocable for.cause or,m modified be emended or 6difled '
requires a nd ,ermit. A proved for disposal of domestic sirill or ate w pply only.
zz
_
By Title
Date L/
I
:r
PEEKSKILL MEDICAL LABORATORY 337
1879 Crompond Rd. Barclay=Plaza `B1,d
Peekskill, New York 10566 PE 7 -8777
RESULTS OF EXAMINATION OF WATER.
OWNER
- D i ,Y.dA
CITY, VILLAGE, TOWN & /OR NAM8 OF SUPPLY
Luo a I r, pj_/ (%a. ((_e t t, Aby.,
e[
DATE - COLLECTED
DATE RECEIVED
DATE REPORTED
BACTERIA PER ML. (Agar plate count at 35 C).
COLIFORM GROUP (Most probable N6.. /I00mI,:).
Les s -- j-/xL.,l
HARDNESS, TOTAL -ppm
DETERGENTS - ppm
NITRATES (as N) - ppm
ppm
FLOURIDE (F) - mg. /1.
These results indicate that the water was / �S of a satisfactory sanitary quality when the. sample was collected.
A. H. PADOVANI, M. T. (ASCP)
¢,
0
�
_ Putnam Couoty DeyartIDent °�
Division of Environmental Health $spates _
AM rave9 as natadand Hegulatlond oQ l
of the
li -agile
Put Co ty ile lth Department, � a2
..j- enatur & itln
iE d 63t tj x MV t*a
ft" Aim
alp t
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