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<+ PUTNAM COUNTY DEPARTMENT OF:HEALTH
Rev. 3186 DMelon of Environmental Health Seivices; Carmel, N.Y. 10512-
r
t
PermlW
Engines
P C.H D _
R CATE,OF., CONSTRUCTION. COMPLIANCE FOR SEWAGE DISPOSAL, SYSTEM I0WRA `(J/i /•L¢ll i�SG! *V
v �� 'r Tai Map
To"
Blockr V —Lot
Located a ,,//jjam� ,/�' _ .
l�G Former) �,Snbdivle(on Name S Sabdv. Lot q
Owner /applicant Name Y
Ma Address ZIP Date Perm it
Wng Issued S?r-
XSeparate Sewerage Syatem ballt by �� ` Address
Consldtirig of d Gallon'Septic Tank and AIR:
lej �
lic
Water Supply: Pub Supply From Address s� /
or Private Supply Drilled 6 Add eB� ` l
pun Type 7Y4%dQ�y��� Has Eiosion'Contiol Been Completed?
/'Number of Bedrooms Has Garbage Grinder:Been Installed?
mente
Other .Regalre
I certify that the system(s) as.1isted.servinq the above - premises were constructed essentially as.'shown gn'.the plans of the completed work ( copies,
of which are attached), -and in accordance with the standards, rules and regulations, in accordance with the filed plan, and'the permit issued by the
Putnam Count Department Of Health.
�d E ? AYIy�E ?�(1Z /FLL G? a.A.
Date Ji� Certified by -
Address, _ /T!sl � ANkL:
Any person occupying premises sarvetl by the above - systems) shall promptly take.such action as may be necessaiy to secure the correction, of my unsanitary
conditions' resulting from weh ;usage. Approval of. the separate sewerbge system shall become null "and void is Won as a pub ; ?: sanitary sower becomes
iveilable'and the approval -of the,-.private water supply shalI-6ieome °null and- vokt••when -a pubilie -wife► wpolY.becomes available. Such -. .approvals are
subleet to modifiption or ehanys`whsn, in the iutlgment:of .the missidoor f. Health, such evocation, modification or change is neceasa►y.
soon
Oat�t�L�aiJ� 3.� /dta
Title
ce
u
W Y O
VILLL 1.V11riln i iun rczrur"
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
office Use Only
� WELL LOCATION
STREET AOURESS: WN /YIL Y TAX GRID NUMBER:
� I�� �` � r � � f "2.` -c s o ;r; -11
i
WELL OWNER
NAME: ADDRESS:
aoA_J I d A � ►° s/',
PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
YRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE y gal.
REASON FOR
DRILLING
9 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
` WELL DEPTH ft.
STATIC WATER LEVEL ____U� ft.
DATE MEASURED � /g 25
DRILLING
EQUIPMENT
❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. EVOPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH o. fL
MATERIALS: 9STEEL O PLASTIC ❑ OTHER
LENGTH.BELOW GRADE .dig! ft.
JOINTS: ❑ WELDED THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT 9fBENTONITE ❑ OTHER
WEIGHT
PER FOOT , lb./ft.
DRIVE SHOE- WYES ❑ NO
LINER: ❑ YES IKNO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST If detailed pumping
MFHOO: ❑ PUMPED i tests were done is in-
1 COMPRESSED AIR , formation attached?
❑ BAILED O OTHER :OYES ❑ NO
l ALL LOG more detailed formation descriptions or sieve analyses
are available, please attach. .
DEPTH FROM
SURFACE
Water
Bear.
Ing
We1l
Cia-
Deter
FORMATION DESCRIPTION
G70E.
tt.
tt.
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
ft.
YIELD
gpm.
Land
��
J}
J
t w / _s 1n / —
C
P
///
WATER (d CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? O YES ❑ NO
STORAGE TANK: TYP Ey _ �-
CAPACITY GAL.
PUMP INFFOROATION
TYPE v �
MAKER
MODEL 2
CAPACITY
DEPTH ��0�
voLTaGE /1i HP �
w oAILLER NAM oaTE
AIL��RT M. �IYATT St SONS, IPIG.
A 5101M RE
Well Drilling 5101RE
TTER6ON NEW YORK 12563 �
PA K
r��
Yorktown Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -3203
Director: Albert H. Padovani M. T. (ASCP)
r AKIN, DAVID Jr.
SOUTH QUAKER HILL
BOX ? ?6
PAWLING, NY. 12564
L
-1
J
C.A. 006459
LAB #
Date Taken: q/R /88 Time: •20am
Date Rc'd: � /'!z /88 Time:.10am
Date Reported: — MAR7071968
Collected By: Akin
Referred By:
Sample Location: Kitchen Tan
Birch Hill Rd.
a erson, ny.
Phone #
Phone N Sample Type:
Repeat Test? _ ((check one)
LABOt "A TORY REPORT ON ATHE Bi;Cs °E`RIULvGZCii: Q[JAL1T'Y OF WATER
GENERAL BACTERIA
X Standard Plate
(Agar Plate
MEMBRANE FILTRATION
X Total Coliform
Fecal Coliform
Fecal Streptoc
Count (CFU /i.OmL)
@ 35 °c)
TECHNIQUE (MFT)
(CFU /100mL)
(CFU /100mL)
Dccus (CFU /100mL)
MOST PROBABLE NUMBER TECHNIQUE (MPN
Total Coliform: MPN Index (per 100mL)
Fecal Coliform: MPN Index (per 100mL)
OTHER ANALYSES
REMARKS (For Laboratory Use)
11
X Potable
_ STP INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
Na2S.203
Incoming
X LE 4 °C
GT 4 °C
KEY FOR TERMINOLOGY
RDS = Recommend Disinfec-
tion of Source
TNTC= Too Numerous To Count
CON '= Confluent ( =TNTC)
LE = Less Than or Equal to
GT = Greater Than
N/A = Not Applicable
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAO) (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THENXFWYORK STATE DRINKING.
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
r
For Lab Use Only:
/X/ W
ei'.— H/C to
Albert H. Padovani, M.T. (ASCP), Director
PUTNAM COUWY DEPART OF HEALTH -
DIVISION OF ENVIROkIZ=AL HEALTH SERVICES
I— Q- 711
-7L 4J, U,,�X 0
Owner or Purchaser of Building Section Block Lot -
Bui ding Constructed
AKx F�;
Location - Street Subdivision Name
Municipality Subdivision Lot #
C,
Building Type
GUARAN= 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 following the date of 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 Environmental 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 3 day of -19_T2 16
Title
General Contractor (Owner) - Signature
Corporafion Name (if Corp.)
Corporation Name (if Corp.)
Address
Address
rev. 9/85
mk
p UTNW COUNTY 'DEPARTMENT: -01F AU
i
1-12
Division of -Envii6nimen-i'W Hialthi S&&6s, - 0-5
CONSTRUCTION PERMIT ,FOR -SEWAGE pigpc(sAL .SYSTEM
Located at tjzcji Allit C. ;-17 --f�Blobk—,4 -Act Revision s,
dA Subd
Subdivision iod: A. A0 A)i Lot # Renewal
Owns Datii,�of P s -Ap ;2,-
r/Address 0,62 AA&I.
Building Type �Mi 0327 ACP-cS F
Lot Area. - ill.s ion�on
Design Flow G/P�'D bi
Number of Bedrooms P.C� H: D. ..t' L -
Separate Sewerage System to consist of
Z 0 6;V- Gal. Septic Tank' and
To, be constructed by Olve Address
Water Supply: Public Supply From
Private Supply to bi drilled' by ON't-
Address
Other Requirements
7
t
on of the proposed -sy'Oeff system -
I represent that I am wholly and completely, responsible for the design and locki sepai�iii,�sevvaje';disppsaF
Ct the _ .
.,above described will be constructed as shown on a approved amendment theie: to and in accordance with 't';he standard's.'ruies and regulation.s- of -tn
County Oepartment of Health, and that on completion thereof a "Certificate of Coristruction'Compliakii;!, sit ij4ctoryap ; t`h4.-,Commissioner 7' of 'HealtKwill
be . submitted, to the Department,. and a. written guarantee will be furnished :the bowner,- hli-i6ccessiirij- heirs or assigns .by -the ,builder ,��that ,L�igid�builder Will'.
,place in good operating cond
ition'Lany part.*of said *sewage disposal system during tfie 0eiri " f fie'
od 0 twoJ2
ny repairs, e-
M -14're -we
ante of the approval L of the. Certificate of. Construction Compliance of the- original system i drillied: II described -above
...,,:will be located as shown on the approved Plan and that said well will be Installed in 'accordance with the' andardi.-. rules 'and riislulaTrons of: the ,Putnam
County Department of Health. ii
Pais Signed
Address Q License No
T
.APpROVED FOR CONSTRUCTION-. T_ his approval ear frcirn tfie7 t of-;the ein ti ken`and 1 i
I expi.res one' L date ls�sued unj"s,,onst!qpt* -,bUildlng-has b -Z
modified 'y th
revocable for cause or may,6e amended or modi I vvhenppri%We edn essary'l e C rr� Vissipher of. Health.: --Any c ange, or,alterat ion;of 'construct Ion -
D
ew 'Pownit. Zr Lvvsje a�lt, mterxw�
requires a n only.
f I of domest a priv t
Date By:7 Title _
Rev. 9-81
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRObBENTAL HEALTH SERVICES
INDIVIDUAL MTER SUPPLY /SUBSURFACE SE5ZE DISPOSAL SYSTEMS
FIELD INSPECTION REPORT
DATE:
�7 �/ / l `/ `% �''✓ �� INSP. BY:
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION 2 YES NO CORM' ENTS
Wetlands on /or proximate to property........... ..
Property lines or corners found ...................
Can estimate house location .......................
Will driveway need cut .............................
Must trees be removed - note these ................
Deep holes representative of entire SDS area... ..
Additional deep holes needed...........
Sufficient SDS area available considering•driv. ay
cut, house location, separation distances,etcl...
Adjacent wells/ septics ......................... I...
D.H. 1 Lot
Depth to G. W.
Depth to rock
Soil De.
0 ft.
3 ft.
6 ft.
9 ft.
12 ft.
D.H. 2 Lot
Depth to G.W
Depth to roc:
Soil D
0 ft. Fi
3 ft.
6 ft.
9 ft.
12 ft.
D.H. - Deep Hole
G.W.- Groundwater
D.H. 3 Lot
Depth to G. W.
Depth to rock
Soil
0
ft.
NO
3
ft.
x
6
f t.
X
9
ft.
12
ft.
1�
X
DATE: =?
FINAL SITE INSPECTION INSP.BY: i
NO
CCMMENTS
House SSDS located per approved pl .........
Length of trench measured Cd ��� -
Width of trench average
Slope of tile line and trench acceptable.........
Room allowed for expansion trenches ..............
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded .......... ....... .........
10 ft. maintained from property line and
20 ft. from house.. .....d
Distance well to SSDS (ft.) ...... . .........
Number of bedroans checks... o ....... o ......
Stones, brush, stumps, rubble, etc., greater•
than 15 ft. fran nearest trench.. ...........
15 ft. of peripheral soil horizontally
fran trench..
Boxes properly set ....�t <,u ..//V. � //, ,,a E %
:ould surface runoff fran driveway, roads,
ground surface, etc., channel near SDS ar /l
Does lot drainage appear OK in area of SDS.. .
FINAL GRADNG OF SITE ACCEPTABLE.. ..
x
X
1�
X
l r�
A`
�G G �
Y,
j.
�.
'V
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71T
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u
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N.Y. 10512
DESIGN DATA SHEET- SEPARATE SEWTAGE DISPOSAL SYSTEM FILE NO.
Owner �,¢ Ulli f�/, Y&I-11 Address ,Of4C11 /LC, ;e6 P
Located at (Street Sec. Block Lot
6dicate nearest cross street)
Municipality Z±-r 6 ") Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK
TIME
PERCOLATION
PERCOLATION
Run
No.
Start -Stop
apse Depth to Water
Time From Ground Surface
Min. Start Stop
Inches Inches
Water ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
AX;, 1
3.,24-
4-
30At Z4
30At-,Allw
.2
3 ; SS ^"
'Z 3-
30MiN Z 4
25'
/"
3�miAl/i,/
3
4t2 4f.Sc
3oMen/ 24
ZS
/"
3a•,►t..��i,J
No, Z 1 .3 2.4 /"-0' ..3 a ✓
2 3 ; SG - ¢:26 30,,,.,E Z4 ZS /" 3 40 „,,•JI /Al
7”" ¢;S7 3oANi,o 2 ¢ 25- �
4
5 ,LoT / SE 3 •�.aJ�N
e`°� Q�FESJfUNQ� F .
J �•
Notes: 1) Tests to be repeated at same depth until appppr"x' ua
rates are obtained at each percolation test hole. All �..0
for review. 4sr.-'`
2) Depth measurements to be made from top of hole.74,
r.
a
TEST PIT DATA REQUIRED TO BE SU]3MITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
611
12"
18"
24"
3011
3611
42"
5411
60'1
66t1
721f
7811
/rAAV/ SAA) ) / Z- 'M V
84" I
3(; " EA
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED i✓o�E
INDICATE LEVEL TO WHICH WATER LEVEL RISES.AFTER BEING ENCOUNTERED
TESTS MADE BY ./.1/E ✓� NE Date 917/S 3
DESIGN
Soil Rate Used .30 Min/1 "Drop : S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity Gals. Type
Absorption Area Provided By L.F.x24" 36" width trench.
Other
Name Signature
Address SEAL
THIS SPACE FOR USE BY HEALTH DEPARTPIMT ONLY:
Soil.Rate Approved Sq. Ft /Gal. Checked by Date.
18"
2411
3011
36"
.42"
48"
1,
60't
66"
72" SAKO ✓LOAM Vy172mc C c'Ay
7811 lfloc,e C4 tv ,
8411
S;W4 LAM w
174- Atr L'cAy
—
�n� e 6-16 "
174DICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 1-41A16
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS. MADE BY �/; DE v.�E, C: s', ►.J�ry cssEV 8,r M12, F, 4 y Date 2-11417B
DESIGN
Soil Rate Used ,9 Min/l "Drop: S.D. Usable Area Provided
No. of Bedrooms S Septic Tank Ca ty .yo v Gals. Type Alzee rkr,,u,Q v�'. ,�c�- .comet.
Absorption Area Provided By 70 L.F x24" �b"ytkith 'Erench.
Name �.g v/n r�z�zi�rl lgna ure e
Address SEAL
�✓vSa�u� �3� •
d a
THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by Date
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOIL
t,I"CaUTI`iE RFD IN ".VEST
HOLES
DE. H
HOLE NO. /
HOLE NO.
HOLE.NO. �
_ G.L.
1YIt;�; t3af�v.�
�nA
/3'IEV, t3�� .�.
J /o�.Sc![.
/✓QED f.3Rccy.V 75.-Soit.
61
To�Sest
/1iey..l�.�ccslad /JPSoit
^%. Uasw,tJTa.° 14
/y /LD ddr.y.J %C�Scit
12"
s. /��;�Lo. , ✓�.l�:+�eC',�r
,,� ,0YZ0AM wjT�fICEt.iAy
s���Lo�M w/T�E e«&
18"
2411
3011
36"
.42"
48"
1,
60't
66"
72" SAKO ✓LOAM Vy172mc C c'Ay
7811 lfloc,e C4 tv ,
8411
S;W4 LAM w
174- Atr L'cAy
—
�n� e 6-16 "
174DICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 1-41A16
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS. MADE BY �/; DE v.�E, C: s', ►.J�ry cssEV 8,r M12, F, 4 y Date 2-11417B
DESIGN
Soil Rate Used ,9 Min/l "Drop: S.D. Usable Area Provided
No. of Bedrooms S Septic Tank Ca ty .yo v Gals. Type Alzee rkr,,u,Q v�'. ,�c�- .comet.
Absorption Area Provided By 70 L.F x24" �b"ytkith 'Erench.
Name �.g v/n r�z�zi�rl lgna ure e
Address SEAL
�✓vSa�u� �3� •
d a
THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by Date
-----------
Frofa the of
: DAVID PETRUZIELLO, P.E.
CONSULTING ENGINEER
9131179
142c c—Asc avoacrce.)
A 3o' 8c 4a 0,a/6,,a4& C",pc (:!�)e p ry
V,
Z (9 6'Aao vr 9,r70o, eo?41r acea4a
Oki 6. 0!57
,eA,OC
>161,UR- C-OA11OCtVr-V AAVC 9lGCA1/W-0"4&ArC-& OW
45 A -r f '-xce,,r AL vemc-Apr Of S'ys-rcAv —A
do
coUNNTYi
c)F
PUTNAIM COUNTY DEPARTIN22:4T OF'11aUTH
DIVISION OF HEALTH SERVICES
COUNTY OFFICE BUIMING, CARPEL, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SMEIAGE DISPOSAL SYSTEM FITS NO.
Owner d),qRv,1 41lewg✓ '7-AN640,, Address
Located at (Street) S. Quqk-c,?_A4L Ro, Sec. Block Lot
(Indicate nearest cross street3
Municipality t9,- ?A 7-rees&, Al Watershed.
SOIL PERCOLATION TEST DATA REQUIRED. TO BE SUBMITTED WITH APPLICATIONS
hoie
Numb e r CLOCK TIME PERCOLATION PERCOLATION
Kan Eiapse Depth t . I- to Water Level
No. Time From Min Inches Soil Rate
Start-Stop Min. Start Stop Drop in Min./in drop
Inches Inches Inches
l
2
8
5
za) u(jr
ice /U
Z.
all
5
Tests to be repeated at same depth
until approximately
eq , ual soil
rates are
2 1.
lo.iz310.124
/,,v ,v
2
Depth nicasurements to be made from
v ,,v 6
2 MiAd,,v
2 cev-c
6
4
5
za) u(jr
ice /U
Z.
all
Notes: 1)
Tests to be repeated at same depth
until approximately
eq , ual soil
rates are
obtained at each percolation test hole. Al
for reviei,,,.
2)
Depth nicasurements to be made from
top of hole.
3zg
- JJ.ry l
fH5 4)U /L/
P vn
p,e•3� BcvC P.oe 8 9..,� ., ti �O -riE 7.4 v
N'fxi Gcpp Box
PRT74 iL -A
�u�(rw?]If.aer../ �. }_';) s- C.,a . "',l,' fir' _.Y �,'"!_ . _L.._. } %.r �i M&a Ml ^ek.- `k`a53✓Pi'�'Y�'W.'Vt 4w rti.nY. q%�S"- �iMS "Y ��L.e .y�•+'y�,�•.7
ruv= County, Depaitment of Rea lLq
Division of Environmental Health�Serviose
ipproved as noted for conformance: with
zppllcable Eules and EeralationS of tha
34itnem County Health Dep3rtmsnt`.-
' � •t anwturw Ti t7w' +e. •
�17�� /►tad.
WN
Lot 2, F.M. N°• 1958
N / F AKIN
28.66
E N
N 27 -42
00 �
LOT 1,Area= 2.0321=ac. p
Mop N° 1958 Filed
m
Filed Map N2. 1336
N well
/ %s W
2 /2 sty. 45.66.
p
3 m dw a . 0
O ` gar r
co
! \ a
132.9 �j�
Z
_
-24-4 W 173.51 r stone we //
to Rt. 22 B/R HILL R AD
David A. Akin, Jr & Linda A. Steeley
Pow.ling Savings 6onx
Commonwealth Land Title Ins. Co
for policy N'• 85- LRC —5651 :.
SURVEY PREPARED FOR
DAVID ALBERT AKIN, JR B LINDA A. STEELEY
SITUATE /N
OF PQ T TERS ON
COUNTY OF PUTNAM STATE OF NEW YORK
SCALE I = 1OOr JULY 15, 1985
JULY 16, 1985
-JULY 15, 1987
OCTOBER 22, 1987
JAMES K. DEVINE
LAND SURVEYOR
4 CHAS. COL MAN BLVD.
PAWLING , NEW YORK
12564
p /� 49045 �F
S O C7 I �H AND S�
J
- Guanntea er draf awn; htdlamd hereon slow
Oat MIS SteM n7s pMWW In eeoordanoe with the
eabting Code of Pawft for lend Surwya adopted by
IptFUNi04®A41ptIll10M9R A➢011lan 10
the New York 6hb Mmctation 01 Professional Land
MIS YAP A 8F.Cnt1N
Surveyor. tkdd Or tertiftcaticns shall run
T289 fL OF�t+�NBi8tA7i m1Y.e11711
{40L
only to the psro0 fbr When, the aurYe is ed;
and an his bdW to On title CompanYyGCVF� -��
Ma
agency and lending institution her_,,
gwny. t..d � cm0fred
,,.
the enejn fm It I
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eeniftc9tt0ns are not transferable tc x.. ...
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