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631- 589 -8100
13.-2-36
BOX 4
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00146
Di
,Located at,
Subdivision
7�7
M C i fi4tV "n'tPA R
_77
STEM
A PrkVhA
own or iTage
Tax Map L ,:Bioc
Lot 21-1 _h -.%,;O
per Raynor
'ie 6 ker
dress, Cross Road
Building, Type Frame -z Lot Area 1.4288. * PAttee 6'.
Three OQGaTs./Da YNUmbir of Bedroom snDesid n Flow
Habitable space 's qu Feet_,...
,
Separate Sewerage.,Systehi%eio coniist of -1000; 2501X24" - Wide- Trdhch+1 8 -ROBFi ill -, Sett.
Gal. Septic Tank, and
To' be constructed by
Addres
water Supply Public Supply From
'.'
.,r!va! 0 upp y to be Arilled,,by'�
Address
R' .,. L
.er eq,uurements,
f'represent that I am wholly, and.completely'responsibl6for, the dessigri and location of the proposed system(s); 1.) that thefsiiiparat4 isewag ei.A isobisal, system
a604e 'described Will 6iii constructed -as I h approved. amendni - i Inacc6�dinci-Wit t rules an re:ulat:o I _M,
_s o,�(n on��heas ent here to and h the standards, r , �d ions of-: the,.,Putpa.
County Department of _Heikh�,! and that bh,conni:iletlon tiiireoi a,'ii'iCertifii�ta ' of_c6rstruction Coilip1iiiii:e !"Saiiiis.ctory'to the C �h rp smon6r-.ofH"Ith'WIii
be subrriitted to the ,Depirtment -'and a" written guarantee -will ,be. �furnished "th6 Towner, fils-siuccessors, heirs or assigns by.thi builder, that said builder _wilt
place in,ggod-' of said ieWij'e.•disposaI syst�"rrf during thp,lieriod.6f i�N6�(2i:��aii:irrimediitiiy,fo!16�vI t of the issu-'
opera. qiq yRpd[jtiq�,"qp*, fi#t : " , ..4. , : , . 1_1. _,,pg toe:da
ance of Construction " '., c, original' - - ,, " ` i "' ,
of' - ompliance of origina System or repairs thereto 2) that,the drilled-well ',desdide d above
.will, be located as shown iip'theapprovqd plan and that said'weil Will be installed.. in - accordance with the i6hards ru es a Of the Putnar
County Department of. Health.' 3 Au us't 1977: igni) 'PM xv,
Date
No.
.0
r License',
.,,Address-.- -RD6 Box M, NY
7
29206.: 1
APPROVE-6 FOR "CONSTRUCTION.- ThIs:appriqyal;'exipires one yearfrorri'the''. date issued.Aihl nstruct*on'df the. building : has n.,arid -.1s
Ith Any change or alteraiion:gVed
revocable for. cause or maybe amended or- modified when,considere necessar b *th C mmlss*,.�e�`._O�'HZ
_SL Z. Ps"ction;
y Y.
requires a new permit A.Oprovedjqr iiipbijgI-,of-. aicirpeit!c sane Ory.
. 1 .1 . . �;� permit — >N a a17 only,
y
6 a ta' r ...
Title
a
21
�4
PUTNAM COUNTY DEPARTMEINT OF III ALTH
DIVISION. OF FNVTRONMN,lITAL WIRII SERVICES
COUNTY OFFICE, BUTLDTI`IG, CARMIUL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner , Address �O''OSS % 40-/Tf , rj0
xl°9�r
Located at Street �. 3- Block / Lot ��►,� 9)
Indicate nearestcross street)
Municipality /rs ®oP, Watershed �� -�h
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Notes: 1) Tests to be repeated at same depth'until aPProximatel equal soil
- rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth moa.surements to be made from top of hole.
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
No.'
Start -Stop
i apse
Time
Min.
Depth. to 1-.Ater
From Ground
Start
Inches
Surface
Stop
Inches
Water Level
in Inches
Drop in
Inches
Soil Rate
Min./in drop
2
or
Notes: 1) Tests to be repeated at same depth'until aPProximatel equal soil
- rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth moa.surements to be made from top of hole.
5
Notes: 1) Tests to be repeated at same depth'until aPProximatel equal soil
- rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth moa.surements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SMIP- 11:TT.IsD 141:9'11 APPLICATION
DESCRIPTION OI*,' SOIL:' .-�,1dCOU1\'.C1,T1?,D IN `'iT,',`) ' IiOI-JES
DEPTH HOLE. NO. /. HOLE NO.
HOLE NO.
G. L.
12"
18"
24"
3011
361 Amf 5,6
42"
48
5.41f
60"
66"
7211 ewlb ck
,r
78"
8411
•INDICATE LEVEL AT MUCH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO VIICH WATER LFV4 RISES AFTER BEING ENCOUNTERED !g;
TESTS I4ADE BY - o
Date
DESIGN
Soil fate Used_0�r M1n/l "Drop: S.D. Usable
Area Provided zOOO®
No of Bedrooms 9rPe Tanic Capacity /jo00
Gal s• Type o
_Septic
Absorption Area Provided By _A:AL— L.F.x24" b"
width trench.
/� �y A �+
%% Other
Address R._n_ 6. ox 353
Carmel. NY 10512
THIS SPACE FOR USE BY hEAI2H DEPARTP.iI,NT
Soil Rate'Approved Sq. Ft /Gal.
y
ri
4 ,43 2 -�
PUTNAM COUNTY DEPARTMENT _OF' - HEALTH
Division of; Environmental Health - Services Carmel N. Y 10512
CERTIFI6ATE_ -0F CONSTRUCTIO,N: COMPLIANCE FOR:.SEWAGE DIS 0", 7SYST:EM PdtteY'SOb
I
_ Town or Village
Cross: Road 10
Located at - -' Section _ Block -
tot . SO1 T;63 elzeOwner R aY or:Wnec Job
Separate- Sewerage System "built by ArtE�urx- Bu.rdl�cfc Add[e_ss B'i^ewster, NY 10.509
r _ -' 7000 - - _ � 255._ � ..
z- Consisting of; Gal. Sept�c,Tank V s (meal_ ^Feet x 24 - W1dtPi 7,rench width trench.
,
Other eeouiiements ec
' 811 ~ R 0 `Fhb `. Sth'on
IWater 'Supply_ Public Supply From
Mfl V Drt 11 Ong; Tnc
Private Supply Drilled By,
-69
Brews ter, V 6. 5
Address
Frame
=
ft ee 8/9/77:
Building Type No.. of Bedrooms T 1" Data Permit Issued
,t m
H a
s Erosion Control Been'.Copleted�
f 'I certify _that the systems) as listed 'serving the above.• :pr6mi,e., were constructed essentially as- sfiown•on the planf of the completed worR'-(coples.`of which are
°attached), and -in a Cccordance'vvitti the 'standards rules and`.regulations plans fil ,:and the permit - issued b he Putnam County Department of Health. i .
Date l- 5 Marc„ I <9/ 8 Certified b P,E R A
R :D a r tr t;,.Garmei , N 70512; - 29206
Address - �'s - tense No -
rr'
n
.. Y
-Any person .occupyin9 premises served liy.,fhe above;:system(;) shall promptly ,take such action as maybe necessary to secure the correction of any ,unsanitary
,conditions resulting from' - such.:usage. Approval kof the:.'separate sewerage system sfi'all become null a ' oid'as soon as `a. putilic sanitary sevuer becomes
' available and the':approyal'of ` ahe private water supply shall`become:riu nd :voi when a '.0 blic wa upply becomes :available: Such approvals are
subject to modification or. change when, • in the judgment -of the G mi of . " "u - catii dification or. change is: necessary.
I 'D•ate �`� •! " By Title K
so
i
BREWSTER LABORATORIES
Box 224 - BRG-WSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 3944
SOURCE: Raynord We izenecker — new well
Cross Road
Patterson., New York
couxcTED: Sept. 16, 1977
BY: Kill Drilling.. Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This rtsult indicates the source 'of At sample was
of satisfactery sanitary quality when thi sample was collected.
( L 1
Se t . 24 1977
p
oy B:ckwil: P. E.
Director
WELL -COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3)71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
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
NAME ADDRESS
OWNER Raynor Weizenecker Cross Road Patterson New York
LOCATION (No. 6 Street) (Town) (Lot Ni
OF WELL Cross Road Patterson
PROPOSED
0
DOMESTIC
[j
BUSINESS
ESTABLISHMENT
D
FARM
USE OF
CASING
LENGTH (feet)
DIAMETER (inches)
WbsiHT PER FOOT
R1
WELL
DETAILS
PUBLIC
❑
6
1
D
AIR
THREADED
YIELD
SUPPLY
D PUMPED � COMPRESSED
INDUSTRIAL
TEST
CONDITIONING
DRILLING
0
DAR
EQUIPMENT
ROTARY
PERCUSSION ❑
PERCUSSION
CASING
LENGTH (feet)
DIAMETER (inches)
WbsiHT PER FOOT
R1
❑ WELDED
DETAILS
21
6
19
THREADED
YIELD
D BAILED
D PUMPED � COMPRESSED
HOURS
TEST
AIR
4
WATER
MEASURE FROM
LAND SURFACE— STATIC (Specify feet)
DURING YIELD TEST (feet)
1
LEVEL
30
280
SCREEN
DETAILS
. I
DEPTH FROM LAND SURFACE
FEET to FEET
0 6
6 280
DTEST WELL
❑OTHER
(Specify)
❑OTHER
(Specify)
DRIVE SHOE C t
X YES CD NO x YES NO
T.P.M. YIELD (G.P.M.)
20 20
Depth of Completed Well
in feet below Land surface. 288
LENGTH OPEN TO AQUIFER (lest)
DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE ( Inches) rxum (feet) 70
PACKED: gravel pack (inches):
FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks.
Sandy topsoil.
Hard blue limestone
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
S�5
le 0 5 P, E?ra�L7
LI �
13 Z
C .1
JO , lY
DATE WELL COMPLETED DATE OF REPORT I WELL DRILLER (Signature)
9 -1G -77 9 -23 -77
MILL DRILLING, INc
r
E
02
PUTNAM COUNTY. DEPARTMENT OF HEALTH.
Drvrs/on of Environmental. Health Services Carmel N Y 10512
. ;
,'CONSTRUCTION PERMIT,.FOR StWAGE.DISPOSAL SYSTEM. Patterson
j " Town or Village
Located at :Mooney_ Hi 11 Rd &:Rte: 292, Tax `Map 10' Bock 1
iSubdivision Fair Acres Lot 2 Job SO: 1641
Owner
_ ross e oRaynor:We e Address ad -
Building Type Frame i s ,i Lot. Area 52877 Sq. Ft. Patterson " NY
,Number of Bedrooms Three} ', :Design Flow 60OGd1 S . /O.ay . Total- Habitable Space 177G` 'Square Feet ,
_. . „ 1 OOD o
^Separafe. Sewerage System: to- consist of Gal Septic Tank and ' VK ` F: -X 24 -' , Wide .:.Tr, ench
To be constructed' by Address
Water SuPply:, Public :SuPPIY. From
r ?. .
X
LA
Private SuPp1Y_to be-drilled by '
.>
Address -
Other -Requirements Nnne ,'. `. ,._ - - -
J represent that I am wholly :pnd completely responsiblefor.thetlesign:and location of t�.Nl� roposed system(s); 1) that _the'.separate: sewage 'disposal system
above described will, be constructed as shown on the approyetl amendment there to and in orda nce with the standards,`rules an 'regu a ions o, a u- nam
County Department of Health and that on completion,thereof a'" Certificate of Construction Compiience" satisfactory to the Commissioner- oUHealthwill
tie_-submitted to 'the Department, 'and a written
guarantee will be furnished the owner his successors, heirs or' assigns `by the`;builder „that said"bu"Ider will
place in .,good .operating' condition any part of` said sewage .;disposal. - system du ring the period of two "(2j years immediately following tliedate of the issu-
ance of the.ap'proval of- the Certificate 61 •Construction,Compliance of the.origirial'systerri. "or any repairsahereto; 2) that the drilled well described above
will be located as shown on the approv plan'apd tl said a vii Lire in 11 d 'in accp�d�nce with the - st nda s, rules antl •regul lion of /the Putnam
County. Department of Health: IM i na I � - -1 �e� ti �o�n: _Wel zen c er ontraC.t Ven8ee. Q
9 Y Y
Date 3 August :1977 5� neC X
:.
- Atldress R06 , BOx353 , 1, Y 10 12 E 29206.
' License No.
APPROVED :FOR CONSTRUCTION: This_approvai expires one year from the date issued unless_,coristruction of the building has been undertaken and is
revocable for cause or'may be amended or modified when considered necessary- Y the_:,Co issioner' ci Health.. Any change or alteration of construction _
requires a..new. permit pproved for disposal of domestic, ry` age .an or pr ate wately only
it 1
Date : n"� -E / e
s BY .. Title � .
m
a
PUTNAM COUNTY DEPARTMI T OF HEALTH
DIVISION OF E9VIRONMENTAL HEALTH SERVICES
Date 8�y�Z7
T
Re: Property of___, Ave ;,aft eche.-
Located at ,lo®(e 41W cG .d& . 292-, %; ,Ao.y
Block Loth_
Gentlemen;
This letter is to authorize
a duly licensed professional.engineer ✓ or registered architect
(Indicate)
to apply fora Construction Permit for a separate•sewerage system; to
serve the above noted property in accordance with the standardso rules
or regulations as promulgated 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
system Ior systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
,B ..1v6,, lt?i2�ti ce;+�i /ris �o.,`t wee-!/ei,�ee
Lary Code . . �Drj .i�q %I �%�c1 f /
Very tru ours,
Signed - - - - — L - - --
Propprty
e`.�rr t
A dress
914- 878 -6170
Telephone
Telephone
ONY DEPARTMf
,q
HEALTH PUTNAM T
Oivisfon of EnVironmenal Health ,
Services Carmel •lV Y '10512
CONSTRUCTION PERMIT FOR.;SEWAGE DISPOSAL SYSTEM= Pdtt2rSOn
j Town,.,
Village
a ' or
Located at Mooney HZ 11 Road: R te 292:
sect ,on Tax Map 10 : Block 1
�L r
su6divieion Fair ,Acres , Lot.Part; of 9. (Parcel ;2)db S01641_
.Owner 90hn C` Wei zenecker Addres�N 'Brewster Road
�., F 52877 sq ft. Brewster, New, York 10509
Bwlding Type tame " Lot Area
Number of Bedrooms Three 79�
Separate :Sewerage System to consist of 000 `.. Gal Septic Tank To2130Hab a spa
feet ;X width rtrench
ita b I
,. o
Address J6„
To be constructed by
Water ;Supply :, Public Supply, From
i'
X. Prrvate.Supply to be dulled by –
?.' Address
Other Requirements NOne'
I ,represent that I am ,wholly and .completely'responsible for the design and location of the proposed system(s); If that the separate sewage disposal system
above described wp'_be constructed as shown,on. the approved amendment there, to and .in accordance w�th'.tFie st indaidi, rules an regula wns o e u nam
.County Departnent, of Ffealth, -and that on completion thereof a ".'Certificate of -' Construction = Compliance" satisfactory to the Commissioner.:of Heaithwill
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
.-
Su-
place' •in good operating' condition any part of said sewage' disposal system during the period of two.(2) years immediately following thedate of'the'issu-
ance of: the approval of the'.Certificate..of Construction "Compliance ,of the original ey Ste Im or any repairs thereto-,-2) that the drilled well described above
wili. be located as showvn;on the approved plan'and that said.well will be Installed'-in accordance with ',t lards, rules and regula ons of the Putnam
County Department of Health' °,
ti P.E._ R.A.
Date 14 Apr' 1 7 976 Sign`
Address ''RD6 BOX 353 ar 1 'New York 5l2i�ense No: 29206
APPROVED FOR CONSTR_UCTION.. This approval expires one•year from the date :issued - unless construction of.the building has-been undertaken and is
revocable for .cause or may be amended or modified when considered necessary by the Commissioner' of Health.' Any change or, alteration 'of construction
requires -a new 'per /�%it :'Approved for disposal of domestic �t}a�ry�sewsj'�e, .ai or private water .supply only
Date `[/l �7i By.-. —� j Title
.y.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner _44,n %/e i xgr4 e r Address %/e e." P g At;
Located at (Street 1 I- ~, p Block
�InUica e nearest cross street) Lot
Municipality Pqg� -f, ,'a,02 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
No.
Start -Stop
Elapse
Time
Min.
Depth to Water
From Ground Surface
Start Stop
Inches Inches
a er ve
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
10853
0,02
6
,/
2
Ods3 Opo¢
3
M4 oft
/I-
,4
O9/6
L 1
d 8 f-9 0 8s7
2
Q PS7 D 9/0
13
3
V 9io O j L 3
/3
y4-
/
/ /- /f
4
11
2��
a
Notes: 1) Te':�ts to be repeated at same -deptti; . 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 fromtop of hole.
DEPTH
G.L.
6"
1211
18"
24"
3011
3611
42"
4811
5411
6011
66"
7211
7811
84"
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS.ENCOUNTERED IN TEST HOLES
HOLE NO.�_
.
INDICATE LEVEL Al Aff (M GROUND WATER IS ENC OUNTERED /lo n e
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Ne ,9e *q5e-#- ��/�'��•
TESTS MADE BY *,,= . (N .L. 7,-1 Dat e
DESIGN
Soil Rate Used //— Min/l "Drop: S.D. Usable Area Provided S. a
No. of Bedrooms_ /�c Septic Tank Capacity/600 Gals. Type
Absorption Area Provided By 2�0 L. F. x24" 3fi' —✓ width trenc
Other Mo w
name ,john H. Prentiss, P.E. bignature
�Ftsawr�,;�•
Address R.D. 6, Box 353 PRf;y-'s4�� NA.
Camel, New or
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Chec b �� Date
9� 40. 29Z
01, THE 31 /
REVIEtnT CHECK S =T
DOCUMENTS
House plans O.K.
Design data sheet
Peres presoaked?
Kin., 30" perc.test depth
Cont. results for 3 runs_
D. Hole log O.K.
Corporate Affidavit for other than individual
Authorization for engineer
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps.
E3. t3eN� sum, , A 0 11C
Meets Std.1 Remarks
l es 1 I,lo 1
DETAILS
if change is proposed,)
Exist ;_ng contours shown show new contours)
Slopes for driveway cuts, etc. shown
meter service line location �t
Footing drain, etc. location
Top slope, bottom slope of fill i
Percolation tests and deep test pit location
Septic tank size and conformance to std.
3 B.R. house minimum i
House setback shown i
Distribution box ftg. below frost_
All ti�a ter within 50 ft. -of PL shown
P
Plan and profile SDI ...... . -_... _........... ....................._......... _.......... _
All other wells and SDS closer 200'
'shown or reference made
Property boundaries (metes and bounds - clearly shown
SEPARATION DISTANCES SPECIFIED ON PLAN
10' to P.L.
20' to Foundation walls
0' to Nearest well
50' to stream, march, lake, e
15' to Curtain drain
10' to water line (pits -20' _
15' to storm drain
10' to large trees
l0' from foundation to septic
15' to pipe from leader drain
M
c. Tincl.expansion)
1 N,
tank
& foo iFig drain
•.• ,• • �V
X,J,T`1'711T, SL E-5 IT:SPIECTIO 1
Yes
To
Cc:r.!rents'
Proporty.lin es or corners fo.�nd �
Can estimate house. location ...
Will drive ray rce? c u L L,
Dust trees be rc:^oved -note these
w.a
✓
-
Is deep hole r. cpr : sentat_ive of ent ro SDS area
Addition--al deer) ncic- needed. .. . . . . . . .
SuS'ficient Sf;S a.r:;a available consider-'L:1
driveway cut, house location,.separation
•d.istances, etc.
D t'EP xi0 PA'Tr'1
Depth :. & :
Vater elevation: ._
Roc�ic eleve tion: ,vim .:n'
3.. /0....2_S deS .�._ p✓iof1• _ /z, � s'••�
Date:
FINAL SITE 'D1SF "EC TIO'1 . Insu. by
•House located where sho•Tn on approved plank
�.Zl:t�'�i�.t 'vi•• 1'•r'��C i (�''"-..G� l.{1"�C'st ... _ _:t _ ! -
Width of" trench a.ver"aC.e
Slope o?' t; le line and trench a cc:;ntable .
Room al-Io.'e d for e::cansi on Tenches . .- . . .
Over "50 l-t • fr cm swamp, T••atercovrse . . . . . _
.?natural soil not s t -i pned or SDS area
unnecessa_ i Iv Erzded o . •
10 It t . irrainta._r_e:, frog: prop. lin° and
20 ft. from house o o _
S pa.ration of tr 'erch -fr ot7 house, well
etc. folic-as ula.n . . . . . . ... . .
lumber of bedroci -s checks . . . • • . . . • • •
Stones . bra ;° ', Stu:-,Cs rubble, etc. °realer
t1mn 15 ft. from nearest trench . . . . . .
15 Ft • of peripheral soil horizortally from
trench • . . . . • •.
Junction boxes preoe_ly set
could surface. run, off from drive:•-ay, roads,
ground surface, etc . channel near SDS .
area • • . ': • • • • 0 0 •
Does 1 of dra4,=T;e avn,'ar 0. K. in area of SDS
FTI4'LL GRADING OF SIT" ACCEPTUILIE
•
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of J0 4n C.
Located at l *OS2er A// �/. . �Q �-���� ✓sue
f p Bloc k Lot���
Gentlemen:
i�ei1rce/
1�
This letter is to authorize John H. Pe6n_t l ss P.1r.
a duly licensed professional engineer or registered architect
(Indicate)
to apply fora 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 t1.:is matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 2.45 or
1.47, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
ountersign d:
P.E. R.A., # 29206
R.D. 6, Box 353
Address
Very truly yours,
Signed
Owner of Woperty
,V 29SCIO Q1,�*
Catme l New York: l 5 l 2
914--878-6170
Telephone
Address
Telephone'
ttiiiUUU fy A' 1 . ".
lsr Ali �F +.3kv ; �i � • 3 E" , t � r`` -
Y •.at r 1.- . rt — - r a if3AEtFtia;.
l F i•�7
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