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BOX 28
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03543
t PUTNAM COUNTY DEPARTMENT OF HEALTH I (A .. \
Rev. 31 6 Division of Environmental Health Services, Carmel, N.Y. 10512
11D_ Engineer Mast Provide P V 37-84
n, P.C.H.D. Permit p --
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �UT1M`-VALLEY '
Town or v e
BOSWELL ROAD
Located at Tax Map 6 2 11 stock .f0 Lot 6
Owner /applicant Name T. MINIERI Formerly ----'
Subdivision Nan,gBOSWELL r_Sabdv. Lot N 24
Melling Address 47 BATAVIA PL .HARRTSSON Zrip 1 f152R Date Permit Issued 7/17/84
Separate Sewerage System built by OWNER Address
Consisting of 000 Gallon Septic Tank and 48OLF Of LEACHING TRENCHES
Water Supply: Public Supply From Address
ors XXX Private Supply Droved by N _ ANDERSON Address BARGER ST,, PUTNAM VALLEY . NY
105:79
guffdlng Type one family r e s i den ilea Erosion Control Been Completed?
Number of Bedrooms 3 Has Garbage Grinder Been Installed? .
Other Requirements
I certify that the syatem(s) as listed serving the above premises were constructed
of which are attached), and in accordance with the standards, rules and ��99elation
Putnam County De rtment Of Health. 1�z
6/3786 Certified by
Date IV
Addre- MUSCOOT NO
4
NO
assentiAlly as shown on the plans of the completed work ( copies
, in ac rdance with tnq filed plan, and the permit issued by the
P.E. R.A. XX
541Icena No. 11056
Any person occupying premises served by the above systems) shall promptly ke such a f ion as may be necessary to sdl ure the correction of any unsanitary
conditions resuttin from such usage. Approval of the separate sewerage sm shall`Oeco null antl old as soon as a publ': sanitary sewer becomes
available and the pproval f the private water supply shall become null a Id wA a p is water DDIY becomes avatlabN. Such approvals are
sub)ect to di cation tt:apga when, in the Judgment of the Com n of alth ch rev n, m Iflcatloe! r ,hangs s necessary.
r/G7 /�/,(` /,/ 1 Title
Date By
COUNTY DEPARTMENT OF HEALTH Permit N
Division of Environmental Health Services, Carmel, N. Y. 10512 /
__CONSTRUCTION PEtllAlnT_yf.OR SEIMAGEMDISPOSAL SY.STEIfA. - `p� rLy`'.
Z/'o
Located at -fi�r °�' �w� �—✓ - rD Tax Map 4/ `° Block
Subd ivisi sum. Lot Renewal
0 r P- er/Addre IS A -rA /I A L -
pP
Date Of Previous Approval
Building TypeLU t -Fo9 i+A jl Lot Area 10 D O (4 Ca✓.
Number of Bedrooms -4 Design Flow G /P /D
Separate Sewerage System �toc^onsist of _ �� 1�^ Gal. Septic Tank
To be constructed by {� � _E% N G 7 LLIQ -TA'
Water Supply: Public Supply From
Private Supply to be drilled by
Fill Section Only ❑
P.C. H48 D. Nott��ific)atiionn Required / I1 C I
and l..J sr'f OF 1�����!/`s ��Sf -1�/
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,k_
above described will be constructed as shown on the approved amendment there to and in accordance. with the standards, rules an regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Halthwill
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„ system or 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 installed in accordance wi the standards, rules and regu aT{ions of the Putnam
County Department of Health.
Date 7� 9 1 DA r Signed P.E. R.A.
MUxo0T Nvar n ZZQS
Address ✓ e
License No.
- PROVED FOR CONSTRUCTION: This approval expires one year from tL#date issued unless construction of the building has been undertaken and Is
,-able for cause or may be amended or modified when c idere necessary by the ner of Health. Any change or Iteration of construction
a new permit. Approved for disposal of dome c ni ry s ag an ri a water supply only.
4
{u: 7= BY �^/v"`' Title
y�.
...J1
- 's,. f,;.•H_ t..:. ... '. yi+:ni .a <ts �a'i'.a � r.;'c- ,..n•a ..: e: ;a. r... -. -.
TO: COUNTY ENVIRONMENTAL
ATTN: ROBERT MORRIS
4 GENEVA ROAD
BREWSTER, NY 10509
FROM: FAUZI IBRAHIM
18 BOSWELL RD
PUTNAM VALLEY, NY 10579
Mr Ce I V E D
PUT,�.��
vcs
99? 'AU
REF: CONVERSION OF GARAGE TO FAMILY ROOM
DEAR MR MORRIS,
AS PER OUR TELEPHONE CONVERSATION, YOU RECOMMENDED THAT
I SEND YOU A COPY OF THE HOUSE LAYOUT AND THE PROPOSED PLANS
FOR THE CONVERSION OF THE GARAGE TO A FAMILY ROOM. ENCLOSED
YOU WILL FIND THE REQUESTED DOCUMENTS. PLEASE FEEL FREE TO
CONTACT ME IF ANY FURTHER ASSISTANCE.IS NEEDED AT (914) 528-
1697 HOME. I CAN ALSO BE REACHED IN THE DAY AT (212) 653-
� ...........:.. .r.. _ -. 2 7162.- THANK.. YOU -FOR---YOUR- TIME-. AND - HELP -. -- -
a
PETER C. ALEXANDERSON
County Executive
.. --.. - .s+i.• "!!PT•Mn.Y•M. �i ��RC •1.'M, .1, u . .- ° ., � - .. _ `5 - S r .. -F.-;
ENID L. CARRUTH. M.P.H.
Public Health Director
JOHN KARELL Jr. P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
' 9
110 Old, Route. Six Center, Carmel, New' York 10512
(914) 225 -0310 .
Dear
I have received and reviewed the plans for the proposed addition to the above
mentioned residence. /
The plans ire A'2
. I
Tl— survey indicates that sufficient area exists to expand or repair the sewage
di.posal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditions:
I L.
1 ?.
1 3.
The total number of bedrooms must remain at _ 3 ___ without prior approval
by this Department.
The area of the existing sewage disposal system, and its expansion area, must
be maintained.
All plumbing fixtures must be replaced or updated with water saving devices,
i. e., low flush toilets, restrictors for shower heads and faucets, etc.
-OVER-
S �,
0
CL.
0
'R -k
Cie
tu
-0
IL
NOTES,
ASVE AL-L-
A
1-1
A LL5
EXT ti
Approved as noted for confor mnee with
applicable Rules and RegulatibDs of the
nam County Health Depai-, me
cLIL,AJrS
Signature & Title
MT)
Pt
—3!-o
FA 0
i. •
i � t
NQ IL
Putnam County Department of.Health
Etl�'A Ib E
Division of Environmental Health Service
1-1
Approved as noted for confor mnee with
applicable Rules and RegulatibDs of the
nam County Health Depai-, me
C,&O ?
Signature & Title
MT)
—3!-o
FA 0
�/zorktown, Medical Laboratory, Into LA-B 0 22350.
321 Kcaa Street
��(orkcown Heights, N. Y. 10598 Collection arme Station Used:
_ • _ .(914,243.3 0 {Cy.��sr ®pe//l � Peekskill
c'.-- �» '6'��- .-- ^l1C!OZ0 ..y.1'' '�fe ?�.<•ca�ty,. .
Director: A1Gcrt H. Padoean M. T. (ASCP) _
7 Date Taken: 3/31/86 (6:30)
Date Received: 4/1/86 (12:30)
TOM MINIERI Date. Reported., /3/86
BOSWELL ROAD Collected By: MR. MINIERI
PUTNAM VALLEY, NY Referred By:. CROSSROADS PHARMACY
528 -6226 Sample Source: KITCHEN TAP:
L
LABORATORY REPORT. ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
,Standard Plate Count per 100 ml
(APar.plate @ 35 °C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
/To.tal Coliform Der 100 ml
Fecal Coliform per 100 ml
Fecal Streptococcus per 100 ml
MOST PROBABLE NUMBER TECHNIQUE (MPN)
.To.tal .Coliform
. .�?nPN- I•nd•e•x-- ne =r�•�1 m ._ ... �-
Fecal Coliform:
OTHER ANALYSES
MPN Index per 100 ml
THESE RESULTS INDICATE THAT THE MATER SAMPL (BIAS) (BIAS NOT) (NOT APPLICABLE)
OF A SATISFACTORY SANITARY QUALITY ACCORDIN NEW YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Albert H. Padoeani. IA.T. (ASCP)9 Director
LEGEND
RDS z Recommend Disinfect -
ing -Wait **r Source
C = less than
THTC = Too Numerous Too
Count
TOWN OF PUTNAM VALLEY
WELL DRILLERS LOG AND REPORT
-WF-LLF - COMPLETION REPORT—:
is report is to be completed by well driller and submitted t&
Bldg. Department, together with laboratory report.of analysis of
water sample indicating water is of satisfactory bacterial quality.
Well Locat
Well
Name Mailing Address
Well Driller .elc— ,
Name Mailing
City or Town
Tel..#
City or Town . Vo
4j-�
r'%
101JU, 1)EFun OF WELL eet
WELL LOG
Depth from ..Give description of formatioms penetrated, such
Ground Surface as: Peat, silt, sand, gravel, clay, hardpan,
shale, sandstone, granite, etc. Include size of
gravel (diameter) sand (.fine.,
:mater -161- -structure; Zoose; 1iao7ceci,'
cement, soft, hard). For example: O. -ft. to
- 27 ft. fine, packed, yellow sand; 27 ft. to
134 ft. arav aranite.
Feet
to
CASING DETAILS
YIELD TEST
WATER LEVEL
SCREEN DETAILS
Length Ft.
Bailed_
or
Pumped Hrs.
Measure from
Statics a Ft
land surface
Makes
Diameters Inches Yield:
GPM' 5
When Bailed
or Pum ed Ft
Slot
Length Ft. Size
Kind:
Diameter In.
101JU, 1)EFun OF WELL eet
WELL LOG
Depth from ..Give description of formatioms penetrated, such
Ground Surface as: Peat, silt, sand, gravel, clay, hardpan,
shale, sandstone, granite, etc. Include size of
gravel (diameter) sand (.fine.,
:mater -161- -structure; Zoose; 1iao7ceci,'
cement, soft, hard). For example: O. -ft. to
- 27 ft. fine, packed, yellow sand; 27 ft. to
134 ft. arav aranite.
Feet
to
Formation Description
Feet
%
Date Well Completed Z2 d'14 re Date of Report
Well Driller
Signature
BZS 1 -77
THOMAS MINIERI PUTNAM VALLEY
Owner or PurcFiaser of Building Municipality
THOMAS MINIERI
Building Constructs by
BOSWELL ROAD
Location - Street
ONE`,YFAMILY RESIDENCE
Building Type
62II
Section
10
Block
6
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-
=t :r. nation .of... :the...Directo.r .of -the D iv'is..on_.of...Env= ronmenual, Health.. :. -:-
�` vices of 'tie 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 sys m.
Dated this 23 day of JUNE 1986 Signatu
Title r�k,�_
(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 Environmental Health Services, Putnam County Department of Health
LVIU1t:%L1V11 w.LLn Lelia MaLLei• $llti to. supervise the cunstrucciun of said
system. or systems in conformity with the provisions of Article. 14S or
_
—14.7., Education Law the ,Public .Heal t_h :Law,: and. the.. Putnam. County Sane= -
tary Code.��
Countersigned:
P.E., R.A., #
Joel Greenberg >Architect
Muscoot No. /RFD 92 /Bx 48
Address Mahopec', NY 10541
Very truly rs, ,
Signed
Owner of Propertq
Telephone
14 V--1 S D lU b(f LolTelephone �aS
01
4a
w
Rev. 3186 PUTNAM COUNTY DEPARTMENT OF HEALTH
Division ofEristronmental HeAth Services, Camel,N.Y. 10512
"Milim""Mm"Feviti"PV 37--64
P.C.H.D. Permit
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PUTNA14 VALLEY
BOSWELL RMD Tonves " Vlll!n
6211
6
1,ocated itt T.Mp Blok_ Lot
Owner /appilemstNpme T. MINIERI _F.,ouay, S.1wilvist-N.9-0SWELL Sb&.Tt#
24 ,W
NY
Molitor, A&bves 47 'y3ATAVTA P',.. HARTZISCON,zip I nl;gFi Data permit Issued 7/1784
�irpmmte Sewerage System built by Cl 1NER —Addivess---
Corialsting of 1000 Gallop Septic Took and 48OLF of LEACHING RRENCHES
water Sopply:—Pubuc Supply From 'Address
X Address, BARGER ST. PUTNAM VALLEY
orr'.M Private Supply Drilled by 17 - ANDERSON
NV ;1'
111,111411.11TYPe one feirlily
Number Of Bedrooms 3 Has Garbage Grinder Been Installed? LO
Other 11equireartimb
--'-J ceFtify that the system(s) as listed serving the above premise, ware constructed essentially he show ce, the plans of thelcoapietad w I copies.:
of which at attached), and in accordance with the stsedards, tole, and yqual-ions, to *ccArdmc, with the filed plan, .aM t-: permit
- ad
Putnam t Of Health.
0.7 Certified Oy. P.E.—*R.A;—L
4:
NY 1
Add,*P—SCOOT NO, RFD41, i� 488 -f�MHOPAd,NY 1
Any Mass occupying Promises served by the above system(s) shall promptly lase such action as my be nocourspiry to tire the curroction,'Of, any uUnpn1!t r,
7
conditions resulting from 6 usage. Approval Of the separate "Grals) System ShAlI•OCA)mp null a d a, has a vor beest
arrallablo and the approval of the private water supply shall become null and, to Wha4 a public' "tam poly b�ocomcd avalbbb. �,:�.�Such -approval s5 are
ch rev ion, isissawri y.*..
n
wb)OCt to modification or' Chap" when, in the jUdgawmt of the Commissioner of H"Ith/M M
Data By T I
c.
f.
LOT # L 3
—5 7/ —>O' Zr--o
JEAMM P-
PP IV E LL'
i� M C)
'77
t000 GAL. PRE-CAI-1-
W k1c. SfPrllzC� TAN K, V) 01
4�
/]UNCTION
(5 OX E.15
7
7 7
V
r--Iy st
A S 6 L . F . 0 F 7 ' . , , , F"' I I
L6ACHIA.)4 TMAICHE5, 14
O)ZAINACE EASEME-1,1- NO CARBACE
FROM ROAD ABOVE GRINDER WAS
INSTALLED .
..,Y 71'
--a
r-,E -GE D(Src-)OSAL GY
LOT 25
(AS BUILT)
Ili .
rj
I I
:Y. s
FIRST FLOOR PLAN {,. - • ' - _z
f-
-.n3. -_r S
tj
_ 7
O N
1
j + 0 0L
— of
1
_ Cei
�. i i -- Y 2 °•b -- \ (W.2.ulS- \vj1 /V.F1 PCATB
IJ
` Mr I rxZz
t4 t" LIP 1.4F.
1;
o L.1v1NG rr`o.ctM
In
Ia a
30 1
1 I ♦ Y
I}.•'• Y1.o o
.
1 0 11
11 .1
° C 1 .
,1
i.
JEANN E
DRIVE
I Ih"
ra
le
J
Ld
3
LOT # Z 3
o \ /
IOAOGAL• P¢E -G1bt�
AN f
V
'60K2S
ZO/ -2`P
7
7
4Gi
/r APRA - 44-3 -56
-� 'I ' 7g= g o / 000 lqc..
480 L•f.OF
-� L5kGH1hwW TON Ea.
I\ NO GARBAGE
D�zq1NALE iASCMENr Gr°?I QMR WAS
ETOM RoAD AbDYE 1N.STALLED .
/Y 71 2o'
pe,vs..�ro�vv�
•b .SPA' /�Y�+ .
LOT # .25
5LWAGE DISPOSAL SYSTEM LAYOUT (AS BUILT) . SCALL 1 "_40'
17 I S `TANK WEb
9 10. II 12
$8'
!. _G�l... _(09!. ,'f�'_. _... 9.g' Ioa' 43'
59 Sa
40' AS 55' loll 33' 40' 45' 50' g$' 60, %Z'
• �° • •• g99T '!S TO- 6£ RT• IFY.-THAT.THE..SEWA�E.DZSg�SA?3 SYSTEP E�- CONSTfitlC4ED`.
ON THIS PLAN AND THAT THE SYSTEM WAS
INSPECTED BY 'M��LF`L7lTE ��S"CCY4EREfl'OVERc THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH, ALL STANDARD RULES AND REGULATIONS
OF THE PUTNAM COUNTY.DEPARTMENT OF HEALTH AND THE NEW YORK STATE.DEPARTMENT OF
HEALTH.
ioJ O Ooh
t
a Apped /�l �'Di� DeDyi t
Iiaab went m`?�t
Ie Ota of
rtri 8�ea a "Or 00 8aa1tb SQa1t�
S eat 8a 0 rpi0.
mat s ¢ T t1e t� Da �1k 01Co. tb ee
t
Oaloi (per
JOEL LAWRENCE GREEN,BERG ®..�.1...:
ARCHITECT'- TOWN PLANNER
mu0C00Y 100WTq '11po Oa. 801 000~ -
......e maw rowlc 101141
.�.p nuo�SEWAGC DIbPOSAL '11'4TLH LAYWT (AS iiDl1,T). �O -q e� 04.E
SD
10.1 "Q4 IAYAT P061
MI{NIFRI° wnLl
"IIR:AI'1R5.�'F�OC'IAS
a..�tiWP11 fZ4 , PIILNAM VALLEY � NEW .Y02 ___
A 34�
4.l!_
.-4 8'
777. .:
o. v
So' 29' 35'
B (00' (04'
(o$'
73'
76'
17 I S `TANK WEb
9 10. II 12
$8'
!. _G�l... _(09!. ,'f�'_. _... 9.g' Ioa' 43'
59 Sa
40' AS 55' loll 33' 40' 45' 50' g$' 60, %Z'
• �° • •• g99T '!S TO- 6£ RT• IFY.-THAT.THE..SEWA�E.DZSg�SA?3 SYSTEP E�- CONSTfitlC4ED`.
ON THIS PLAN AND THAT THE SYSTEM WAS
INSPECTED BY 'M��LF`L7lTE ��S"CCY4EREfl'OVERc THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH, ALL STANDARD RULES AND REGULATIONS
OF THE PUTNAM COUNTY.DEPARTMENT OF HEALTH AND THE NEW YORK STATE.DEPARTMENT OF
HEALTH.
ioJ O Ooh
t
a Apped /�l �'Di� DeDyi t
Iiaab went m`?�t
Ie Ota of
rtri 8�ea a "Or 00 8aa1tb SQa1t�
S eat 8a 0 rpi0.
mat s ¢ T t1e t� Da �1k 01Co. tb ee
t
Oaloi (per
JOEL LAWRENCE GREEN,BERG ®..�.1...:
ARCHITECT'- TOWN PLANNER
mu0C00Y 100WTq '11po Oa. 801 000~ -
......e maw rowlc 101141
.�.p nuo�SEWAGC DIbPOSAL '11'4TLH LAYWT (AS iiDl1,T). �O -q e� 04.E
SD
10.1 "Q4 IAYAT P061
MI{NIFRI° wnLl
"IIR:AI'1R5.�'F�OC'IAS
a..�tiWP11 fZ4 , PIILNAM VALLEY � NEW .Y02 ___
P.�
- PUTNAM COUNTY DEPARTMENT..OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE. BUILDING, CARMEL, __N..Y. 10512
4.i — .. - ... •.. . or...r�w.. .+roc.+ ^,....._.�- .nz...i. .,... ...... .-.. ..t .--. .. _.�. "r'j . +y , ', .
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
+i SATfl Vi-A PL
owner 1 l�l%V! �.I --Address �t�aD1�.0 My, /Q ,5�2,6
Located at ( Street LL ec • (0e 7L Block Lot
(Indicate e neare T. cross street)
Municipality OLcJ1� f1lT ' Watershed i Jr- 17
SOIL PERCOLATION TEST DATA REQU RED TO BE SUBMITTED.WITH APPLICATIONS
3 lC;r�Z -10, 2 'gip ire 0.4.
oh.
So
'Role
Number CLOCK TIME
PERCOLATION
PERCOLATION
Elapse
Depth
to Water
Water TFvel
So
4 . : 4)5)
No. Time
From Ground Surface
in Inches
Soil
Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in
drop
Inches
In7ch/es
Inches
��/ l �.•00 _ Cf: 3c �D
f �
t`1/ i Gp
4+ YJ
���J.� ""
� Tea a�
2 �-� ro i�:�a�p
3 lC;r�Z -10, 2 'gip ire 0.4.
oh.
2
3
4
5
Notes: 1) Tests to be repeated at same depth until approximately 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.
So
So
4 . : 4)5)
50
1
1 ?• Sg l- a�
5
1
2
3
4
5
Notes: 1) Tests to be repeated at same depth until approximately 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 ENCOUN'T'ERED IN TEST HOLES
DEPTH HOLE NO .Tn HOLE .NO.�T� HOLE NO.
ts-
•
6"
12",
18,.
24 }
30"
36" .
42��
54.11
60"
66"
72"
78 „.
8411 �
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL. TO WHICH WA ER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Ur= r= P-4:s Date
Soil Rate Used 16" Dff >,/1 "Drop: _.. S.D Usable Area Provided
No. of Bedrooms Septic Tank Capacit J606. Ga. aEp
Absorption Area Provided By 8® L.F.x24 —jb"– E .Rid
,� ,� G
eA 5-r
1Vame Joel Greenberg- Architect �,�� griatLtre
Muscoot No. /RFD #2 /8x 488
Address Mahopac, NY 10541 S $ >
6 ?�
THIS SPACE FOR. USE BY HEALTH DEPARTMENT ONLY: of NE`N
Soil Rate Approved Sq..Ft /Gal> Checked by Date