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04421
K v 3 86 PUTNAM COUNTY bEPARTMEINT OF HEALTH
DIvIsMd of Environmental Health Servketl, Carmel, N Y 10512 `
/Q, EngjSaeer 114nst Provide £ 6 � ,
D f+A TD AD flnmc D[Te -nnm f'AMDT I A ldrq[P WMB CTim A f+L+ nICDACAI CVC7R'i M.' / LLB �.E>.% / . �'• ��
a. _V4, 0
Located at °6 9` r7 Ta>< 1V1aP • 'Block Lot
.�
Ownerlppllcint Name For_m1erly- Sabslivlsloa Neme Subdv LoEq
Mallln8.Address ��� vr' C/J tf i Mp A0, Date'Permlt Issued 9. i 7
SePerate Sewsirage System btillt by � � Address � r'`�J �'✓
Coneteting of, �' Gallon Septic:Tank'and , .
Water Supply: ' . _'. Publlc Supply From Address
or: Private Supply Drilled by Address
.J3�n /.
Bulldin ' / / Ct' Ha a Erosion .Control Been Completed?
�Number of Bedraome Has Garbage Grin detn Installed?
W
Other Requleements W e F "IJ E
I certify that'the sysGem(s) as listed,' serving, the above premises war- a constructed [i' A js "a� a pima of the completed work f copies
of which are attached); "and .in pccordahce with the standards, rules and 'regulation in once 6h a led plan,:and' the permit issued by the
Putnaa Co /unty %.Departmenft OF Health „ , �• �Q� f• r
Gate'
�fCer lletl by p.E, Rf,A
Addis ') .l`! %// ��%. t r . license N0. y y
Any. person occupying premises served by the a ova systems) shall prompti y. eke wch s y be n' I y_`*,sacure the correction, of any unsanitary
conditions resulting from, wch usage Approval of the separate sewerage system shall. L�bB e} f0on as a_ publ::.senitary ewer becomes
�,
aivallibls;`and the approval of the' prlvate water supply shall'beeome' null and "'vofd'vvhen i,� ewy,,�becoma- available.. ',Such. approvals are
subject to modfficatlon,or change when,, In the ,judgment,..of, the Comma ns► of Health `ICTh'r06G modification. or change' Is necessary.
Date o :ells
C3
PUI'NAM COUNTY DEPARTMENT OF HEALTH
-- DIVISION � OF '°ENV7ROINMERFAL HEA ?' ,:.... , s
Owner or Purchaser of Building
Building Constructed by
a '- fey s "/ q,7' 6
Location - Street
Municipality
Building Type
Section Block Lot
Subdivision Name
/3
Subdivision Lot #
GUARANIPEE 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 for a-period of two years immediately_. £ ollaaing .the.,date::of.- approval..of the
"Cektificate"of Cons'truc ion- 'Compliance ""for the s "ewage"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 Director of the Division of Environinentai Health Services
Department of Health as to whether or not the failure of the
caused by the willful or negligent act of the-occupant of th e
the system.
Dated this 5� day of G'r. f. 19 RV Signature
Title
General Con actor (Owner) - Signature
Corporation Name (if Corp.)
rev. 9/85
mk
the determination of
of the Putnam County
system to operate was
building utilizing
/®5''� T
el'A COn
���• �,p� WLLL L.Ul1rLC.11V1V rcr•rVicl
ly .t DEPARTMENT OF HEALTH
Of -Environmenta.Healt- Servici .on ,
W Y PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
_
WELL LOCATION
STREET ADDRESS: N /VIL / 1 Y TAX'GRIO NUMBER
Lovers Lane, Putnam Valley, NY Lot #13
WELL OWNER
NAME: ADDRESS:_
Richard Pulcini of o t. Yktown Hts NY
® P81VATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND.IHEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
(3 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 305 it.
STATIC WATER LEVEL 30 ft.
DATE MEASURED 3/23/88
DRILLING
EQUIPMENT
0 ROTARY (3 COMPRESSED AIR PERCUSSION O DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. a OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH K_,? fit
MATERIALS: U STEEL ❑ PLASTIC ❑ OTHER
CASING
DETAILS
LENGTH.BELOW GRADE 5o ft.
JOINTS: O WELDED ® THREADED O OTHER
DIAMETER i; in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT
PER FOOT -1.9.
Ib. /ft.
DRIVESHOE:11YES ONO
I LINER :OYES LINO
SCREEN
=
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
0 YES ❑ No
SECOND
GRAVEL PACK
❑ YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH -ft.
BOTTOM
DEPTH It.
WELL YIELD TEST 1 If detailed pumping
I
METHOD: O PUMPED i tests were done is in-
® COMPRESSED AIR , formation attached?
O BAILED ❑ OTHER ; ❑ YES ❑ NO
1P1�LL LOG It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Dia-
.eter
FORMATION DESCRIPTION
G7oe
ft.
it.
WELL DEPTH
It.
DURATION
hr. min.
ORAWOOWN
ft.
YIELD
9Cm•
Surface
25
D
it
ing in overburden clay & bldr
.
T;
t Inck
at 251
305'
6
2851___
25
51
D
it
ing in rock,set casing,groute
.
0
illing
in rock granite.
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
wELLDRILLERNAME P.F. Beal & Sons AT1E0/4/88
ADDRESS PO Box B SIGHM
Brewster,NY 10509
I
32.019097
Yorktown Medical Laboratory, Inc. LAB # _ -- --
321 Kear Street Date Taken : Time:'
ime :
A:H69 -h _N�Yc %059.8 _ .: _,<,: ; = D a cFr' d
(914) 245.3203 Date t
lleced By: Reported .-
Director: Albert H. Padovav�i M. T. (ASCP) Co—.!� ,
Referred By:
T- Sample Location: IVa 11ua
Phone # (J
Phone # I Sample Type:
L y4%�' /�7Ou1,�/S/ Repeat Test? _ (check one)
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS (mg /L) MICROBIOLOGICAL (CFU /100mL)
_ Acidity
_ Alkalinity
Chloride
_Detergents, MBAS
Hardness, Total
_ Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
Sulfate
Sulfide
Sulfite
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
_ Total Coliform'
Fecal Coliform
_ Fecal Streptococcus
METALS (mg /L)
Copper
_ Iron
:_.Lead-.. a
_ Manganese
Mercury
_ Sodium
Zinc
MISCELLANEOUS
pH (units)
Color (units)
Odor (TON)
Turbidity (NTU)
MOST PROBABLE NUMBER TECHNIQUE
Total Coliform Index
Fecal Coliform Index -Y
KEY FOR TERMINOLOGY
CFU = Colony Forming Units
N/A = Not Applicable
LT = Less Than ( <)
GT = Greater Than ( >)
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
NR = Non - reactive
_Potable
_ Non- potable
_ STP INF
_ STP EFF
_
Other:
Sample Status.
(check each)
Outgoing
_ HNO3
_ HCl
_ H2SO4
_ NaOH
ZnOAc.
Na2S203
Other:
Incoming
LE
4 °C
_
_ GT
4 °C
_ pH
LE 2
_ pH
GE 9
_ pH
GE 12
Other:
REMARKS /COMMENTS (For Lab Use) IELA�P #10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE` A� (WASN °T) (N /A) OF A'
SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN °T) (N /A.) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE DRINKING WATER
CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
2 /86(Rvsd7 /87)RWE
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environments) Health Services. Carmel, N.Y. 10512 EnBlneer:to Provide Permit 0
on CERTIFICATE OF CONYLL41VCE � /J
CONSTRIICTION P FOR SEWAGE DISPOSAL SYSTEM / Permit # _,/
• Located str'e a �� !�' 01l _ - .. Town or VUlaB9_._�.
•'�'�'. _•.� . ._. _ :.� _ L.:zt _. r � j /J - e... - <s ...:, _ -s• :'. ".'.. y• '' -• ^�, ': s..:'s. �._.f ^._i: C ^. �•� ,
Subdivision Name 9� ���°'"F C• Sabd. Lot A J � Tax Map' 'Block Lot
Renewal— ❑ Revlelon ❑
Owner/ ApP Icant Name / ?I a,o !%
y _ Date of Previous Approval
Mailing Address Town Zip Q r�
s r—�
Budding Type d c Lot
Are +C ,4
Number of Bedrooms — Design Flow G P D G D
Separate Sewerage System to consist of cS� Gallon Septic Tank and 4-if _-d
Fill Section Only
PCHD Notill
Depth Volume
Is Required When Fill is completed
ae.6
To be constructed by Address
Water Supply: Public Supply From Address
Private Supply Drilled by-- Address
or:
j'✓'`d/ J e / y a
/
`` r ne A-l' /
Other Requirements y
1 represent that 1 am wholly and completely responsible for the design and location o the proposed
system(s); 1) that the' separate sewage disposal system
above described will be constructed as shown on the approved amendment there to, and in accordance
with the standards, rules an regulations o 0 Putnam
County Department of . Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successor
y the builder, that said builder will
place in good operating condition, any part of said sewage disposal system during the period of
2) ea
ly following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or a
0.4� N>;y a drilled well described above
�'
will be located as shown on the approved plan and that said well will be inst ccords ce wi
A r �� d u ads of the Putnam
County Department Of Health.
a
Date �Q�J�► /�' Signed
«. ' P.E.— R.A.
t
Address
tcens No
APPROVED FOR CONSTRUCTION: T �s approval expires two years from the to issued 1 9,
tri "( a bull di as been undertaken and Is
revocable for cause or may be amend or modified when considered necessary he C mis pl
A alteration of construction
requires a e permit. ed f isposal of domestic sanitary , sewag /or v ,a
,..o V.
t/87 Date By
au
eN fide
STREET ICCUATION
���
PERMIT # P V —(Q
III
IV.
M
VI.
FINAL SITE INSPECTION Date
OWNER
Inspected by (--L--)
_& i- C / III.) j
TM # OR SUBDIVISION LOT # / / q — 2 — /—Z
10 1
SEWAGE DISPOSAL AREA
a. SDS area located as approved plans
b. Fill section - Date of placement
2:1 barrier- ILTH WMTH AVG.DPTH
C. Natural soil not stripped
d. Stone, brush, etc., greater than 15' fran SDS —area.
e. 100 ft., from water course/wetlands,
SEWAGE DISPOSAL SYSTEM
. Septic tank size - 1,000 Y,25d
b. Septic tank installed level
c. 101 minim= fran foundation
d. No 90' bends, cleanout within 10 ft. of 450 bend
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
f. JUNCTION BOX - properly set
g. TRENCHES
1. Len qth required Length installed
2. Distance to watercourse measured- ft.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 1/32 "/foot.
6. 10 feet fran property line - 20 feet - foundations
7. Depth of trench < 30 inches fran surface
8. Roan allowed for expansion, 50%
9. Size of 2ravel 3/4 - 1 " diameter
10. Depth of qravel in trench 12" minimum
11., Pipe ends capped
h. PUMP OR DOSE SYSTEMS
2. Overflow tank
3. Alarm, visual/audio
4. PLzp easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Departnent
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Mmber of bedroans
WELL
a. Well located as per approved plans
b. Distance from SDS area measured
C. Casini 18" above grade.
d.* Surface drainage around well acceptable.
.OVERALL WOMMSHIP
a- Boxes properly grouted
I
b. All pipes partially backf illed
c. All pipes flush with inside of box
d. Backf ill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
E)A 6')
f. Curtain drain outfall rotected & dir.to exist.watercourse
9- Footing drains discharge away from SDS area
h. Surface water protection adeauate
i. Errosion controi provided on slopes gLELater than 15%.
10 1
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
_.. T'''= `APPLICATION' TO -COI kRUCT - "A� WATER WELL
PCHD PERMIT #J1L -Q`��
WELL' LOCATION
Street Addre
or-f-s
s Town Village Cit} Tax Grid Number
a e-
WELL OWNER
*RESIDIENTIAL
0 BUSINESS
0 INDUSTRIAL
Mailing Address
✓ /t. �S O�
❑ PUBLIC SUPPLY
O FARM
b INSTITUTIONAL
jOn i� '�
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
rivate
0Public
O ABANDONED
O OTHER (specify
O
USE OF WELL
1 - primary
2- secondary
AMOUNT OF USE
YIELD SOUGHT _3' gpm /# PEOPLE
SERVED G` /EST. OF DAILY USAGE 41& gal
REASON FOR
..DRILLING
MEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
OREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
O TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
ODUG
OGRAVEL
C]
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES R" NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No /3
WATER WELL CONTRACTOR: Name /d B /� R}�J �l��i/9� ®i,� Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES 6---'NO
NAME OF
PUBLIC WATER
SUPPLY: _
TOWN /VIL /CITY
DISTANCE
TO PROPERTY
FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION ON SEPARATE SHEET
/d /9 .0 %
(d at ! sig
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.
2.
3.
Date of
Date of
Pump the well until the water is clear.
Disinfect the well in accordance with the requirements
County Health Department attached to this permit.
Submit a Well Completion Report on a form provided by
Health Departme t./
Issue: / 19
Expiration: 19 It ssui
Permit is Non - Transferrable � COQ'' H.
Yellow copy: Building Inspector
Pink Copy: Owner
-��87 (lranrfo a nnv• W01 rlri l l cr
of the Putnam
unty
M
.� ��
- /
�1., 1
�� ti �Lti-�
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/ � (� �
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.. v :. .. _ _ - e .__.. a ..__ ... - - - ...
. _ . _ .. _ ... /- _..n.
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APPENDIX B
PUI'NAM COIIDii'Y DEP-ARTMFNP OF HEALTH - DIVISION OF ENVIROMMM HEALTH SERVICES
INDIVIDUAL TnMM SUPPLY SUBSURFACE SHVM DISPOSAL SYSTEMS
•..+%:V i••M•'.. i�i...- �•b3: :%n yr.�....`' "'�.o �y�C"`'.' ��•- �1- �;�1- Ltl:JUL1Vl`I.:P1:411'1t1J:• . ,li.. n. ✓..: �.: ". __w.�tYi.�••iT% '� s
�I A
DATE 'vA" iL7V 1C rLJ
BY: �
(Name of Owner) (Street Location)
o
i
4� xr,r
Kett
pp,
GG�
NM�
MM
NEI
trench ISF provided � "
=` =•
60
Parpl lel tc -. . 1
i�
AM
QA
.- ,...
ci
G�7
10=6&1 elev./
r
r�O
G�
�i
(0�4'r1.3
Permit Application
°Corporate Resolution
Plans - Three sets s/s
Engineers Authorization
Design Data Sheet (DDS) SUBDIVI N
Deep Hole Log
Consistent Perc Results (3) Fill 1
Perc Hole Depth
House P s - Two sets
Well permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Tcwn/DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAIL ON PLANS
Sewage System Plan - (north arrow)
wage System Hydraulic Profile - Gravity Flow
1 Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes (grinder notes)
Design eta: •- p®rc..and -deep •resi-
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area; shown; gravity flow,suff, size
If Pimped Pit & D Box Shown & Detailed
House - No, of Bedrooms
Wells & SSDS's w /in 200 ft, of Proposed Systems
Property Metes & Bounds .
House Setback Necessary (Tight lot)
House Seder - 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,Top of fill
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. e-xpan)
15' to Drains-Curtain, Leader, Footing
351to catch basin, stormdrain, piped watercourse
10' to Water Line (pits -201) .
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL
FU11VV4 CIAR11 "j' I if - PAIM4011 (:l FIFA.,'111
DIVISION OF L'NVII2CR�lLN- FAL IMALTH STMICES
DESIGN DATA SHEET- SUBSUFACE SBgAGE DISPOSAL SYSTEM FILE ND.
-_- .::
TOamer "aG N3dress3�`` ':G;.,�? `!tso'r7. =.
Located at (Street) 1—a yJ e Sec. Block Lot
(indicate nearest cross street)
Municipality Watershed
SOIL PERCX)LATICN TEST DATA TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking Jam`- �� Date of Percolation Test i ��
HOLE
NL14BM CLOCK TIME .
PERC0=0N
PERCOLATION
Run Elapse
Depth to
Water Frcm
bates Level
No. Time
Ground
Surface
In Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop In
Min /In Drop
Inches
Inches
Inches
123.
2-51
4
5
Vie'
3/l 2r
4
5
1
2
3
4
5
a
NOTES: 1. Tests to be repeated at same depth until approximately equal soil gates
are obtained at each percolation test hole. All data to'be submitted
for review.
2e Depth measurenents to be made from top of hole.
rev. 9/85
.1
TEST PIT MIA RHQUIREJ) M BE SUIMPITI-D W1111 APPLICATION
4• DESCRIPTION OF. SOUL FNCDUUrERED IN qEgr HOLES
DEPTH HOLE NO.' zHOLE NO. HOLE NO.
21
31 dc
41
51
61
71
81
91
10,
ill
12'
13'
141
INDICATE LEVEL-4,AT-V,UC[i--GROU-NEM,T--ER- IS. FliCL)UN-T-ERM.:--...*..-.4...:�4;,7..e..-..-.-
INDICATE LEVEL TO WHICH WATER -IEVM RISES AFTER BEING ENMUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:'
DESIGN
Soil Rate Used 57 Min/1" Drop: S.D. Usable Area Provided .--,!r70v
No. of Bedrodm Septic Tank Capacity gals. Type
Absorption Area Provided By 4.� d L.F. x 24" width trench
Other 5wole e71-,6i4-" rl
Signat
Address
209 %
THIS SP CE FOR USE BY HEALTH DEPARTMENT ONLY: !W4a *
Soil Rate Approved sq-ft/gal. Checked by Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
Date
Re: Property of1&44Pd /0_21? c ;,&p z�
Located at or
(T) Section Block Lot
Subdivision of
Subdv. Lot # 44 Filed Map # Date
Gentlemen:
This letter is to authorize 749 � 9--
a duly licensed professional engineer or registered architect
— T_
(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
tdAAo7ct-i:-oii-witl-,-,thi.9-niattier -and. to -supervise the .,coiff-st,rilct'l--Oii-'-bT -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-
tary Code.
P.E.
2- 7
Addre
XdL..9
I.,
Telephone
Very truly yours,
Signed�Z&YL�_
Owner of Property
Address
Town
Telephone
s k t �
t r/
_
ITT",
ir". ✓
..f 1
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is vow, v try+': 5� � �:``�'`{�ar
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