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HomeMy WebLinkAbout0487DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 14. -1 -3 BOX 6 00296 0 oil . ,. Em r E1r am L 11 LA I 00296 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health December 21, 2005 Mr. and Mrs. Ed Clinton 172 Cornwall Hill Road Patterson, NY 12563 Dear Mr.' and Mrs. Clinton: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive Re: Addition - Approval - Clinton No Increase in Number of Bedrooms 172 Cornwall Hill Road (T) Patterson, T.M. 14. -1 -3 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the-approval stamp from the Department dated December 21, 2005. The addition is approved with the following conditions: 1.. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be. updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets etc.). 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke Public Health Sanitarian ML:cw cc: Building Inspector, (T) Patterson Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845).278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health December 21, 2005 Mr. and Mrs. Ed Clinton 172 Cornwall Hill Road Patterson, NY '12563 Dear Mr. and Mrs. Clinton: DEPARTMENT OF HEALTH 1 Geneva. Road, Brewster, New York 10509' ROBERT J, BONDI County Executive Re: Addition — Approval - Clinton No Increase in Number of Bedrooms 172 Cornwall Hill Road (T) Patterson, T.M. 14.4-3 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department dated December 21, 2005. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices (i.e. new low flush toilets, restrictors for shower heads and faucets etc.). 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours, ;'��/X Michael Luke Public Health Sanitarian ML: cw cc: Building Inspector, (T) Patterson Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 . Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 A5i SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH �. 1 Geneva Road, Brewster, New York 10509 r - - -�' QJ; 4e ADDITION APPLICATION RESIDENTIAL ONLY STREET ��c; L_ _GvsaC�� _TOWN Zao�2�; TAX MAP# // — / NAME e: ���� HONE PCHD# i 'MAILING o/ 3 3 4 — 0Z ADDRESS /U l� ✓' DESCRIPTION OF _ ADDITION NUMBER OF EXISTING BEDROOMS_?� PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845)278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Town Legal Bedroom Count Re: - (Owners Name) Tax Map #: Addre Town: Year l [-%U Glee --G . According to records maintained by the Town, the above noted dwelling, is in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Other: , Date V1�L I / N�N - / v Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 -���> s�3+�•'� �z�_ ��r�afaxh� `.iT�cn -.�;. �1� _:fit -•s� .y F 3 ,w, .�,•,t* -L-v ��?y -��.- � t, � �, ,�, � Ts s>*,��"$,f�iT•^�e,k �. .5"��ss�� '� �� . >.:,;� ,t � l u `a1+.- `1' � E<�r A a + t.� �i-r 7 Y�a �'- 0 h7 ..� ® � c��i ' , 0 , %�a�. � ^ �c•_a'� ° © r,.��` � r,�_���r�`s' {f�'`� .�'T.' � r;�f°�y��� g�'.�` .£.��. � s SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health November 9, 2005 Ed & Tami Clinton 172 Cornwall Hill Road Patterson, NY 12563 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Dear Mr. and Mrs. Clinton: ROBERT J. BONDI County Executive . Re: Addition — Clinton 172 Cornwall Hill Road (T) Patterson, T.M. 14. -1 -3 I have received and reviewed the plans for the proposed addition to the above- mentiop -"�:: residence. Based on the information submitted, the above mentioneduddtion cannot ; f approved for the following reasons: I 1. The sewing /laundry room is considered a potential bedroom. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is five. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer.. Please revise the proposed floor plan to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage .treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML: cw Very truly yours, Michael Luke Public Health Sanitarian Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 VAN LENT ARCHITECTS AND PLANNERS ROY VAN LENT AIA • PAUL VAN LENT RA 431 ROUTE 202, P.O. BOX 292, SOMERS, NEW YORK 10589 vanlentarch @aol.com P: (914) 277 -3195 F: (914) 277- 5733 LETTER OF TRANSMITTAL TO The Putnam County Heatth Department Environmental Health Services Geneva Road, Brewster, NY 10509 Attn: Michael Luke DATE: December 5, 2005 Revised Plans Clinton Residence RE (nrnmmll Hilt RA Patorcnn NY JOB NUMBER: 1781 WE ARE SENDING YOU: ® ATTACHED ❑ UNDER SEPARATE COVER VIA: ❑ SHOP DRAWINGS ❑ PRINTS ® PLANS ❑ COPY OF A LETTER ❑ SPECIFICATIONS ❑ CHANGE ORDER ❑ SAMPLES ❑ OTHER: CQPIES DALE__. N0 .,DESCF2IPTION 3 11/21/'05 1 P . Three 3 copies of Revised Second Floor Layout per BOH regulations. ® AS REQUESTED ❑ RESUBMIT COPIES FOR APPROVAL ® FOR REVIEW AND COMMENT ❑ SUBMIT COPIES FOR DISTRIBUTION ❑ APPROVED AS SUBMITTED ❑ RETURN CORRECTED PRINTS ❑ APPROVED AS NOTED ❑ FOR BIDS THESE ARE TRANSMITTED AS CHECKED BELOW: ❑ FOR APPROVAL ❑ RETURNED FOR CORRECTIONS ® FOR YOUR USE ❑ RETURNED AFTER LOAN TO US ® AS REQUESTED ❑ RESUBMIT COPIES FOR APPROVAL ® FOR REVIEW AND COMMENT ❑ SUBMIT COPIES FOR DISTRIBUTION ❑ APPROVED AS SUBMITTED ❑ RETURN CORRECTED PRINTS ❑ APPROVED AS NOTED ❑ FOR BIDS REMARKS: Dear Mike Thank you very much for reviewing the Clinton Project with me. I have enclosed three copies of the revised second floor layout showing the reduction in size of the Laundry sewing room area . In our last telephone conversation in which you gave approval to this revision I said that I would revise the working drawing sheets to conform to the revision. I will do this. I have enclosed three copies of the sketch plan of the revision with my Seal and Signature for your records and to furnish to the Paterson Building Official so that they may continue their review of the filed drawings. I have sent the signed and sealed sketch drawings in order that the process of review and approval may be expedited. If you have questions please call me. Thank you again, Roy van Lent R.A. AIA COPIES TO: Mike Grogan & Ed Clinton SIGNED: Roy van Lent, RA (by imd) PUTNAM COUNTY DEPARTMENT OF HEALDI HOUSE PLANS ''aPPi'JVcO FOR BEOR 0, m c�t u� "-i 0'w{: c�EDR0L �9S & Title.�� Date :RS Y �'��� •� NJ I "VV I6 .. c SOMERS, NEW YORK 10589 �l PUTNAM COUNTY DEPARTMENT `OF' HEALTH �• Division,,& Environmental Health Services; Carme% /V. Y. 10512 4STRUCTION PERMIT FOR.SEWAGE DISPOSAL SYSTEM. Town or 011059 Located at �D�h &<a Section Block kA /V %O Subdivision p o��/° Lot Job' Owner Mir /� �/ ©s�� %Ct't11/B S' Address j/b� �/r� 1/• .Building Type A Wdj 10- Lot :Area r6.•'0 GAO i °f7.r r, �B �" { Number of Bedrooms Total Habitable Space Square Feet i - Separate Sewerage' System to' cons'st- of � GaL .Septic .Tank lineal !feet X width trench To be constructed by Address Water Supply: Public - Supply From PCivate'Supply to be dnlled`tiy Dom` i Address 'L x , X 6a 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 above described will be constructed as shown on the approve 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„'_'Certiiicate 'of -.Construction Compliance" satisfactory to the Commissioner of Healthwill 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 thedate of the .issu- an'ce of the approval of ,t Fie Certificate of Construction Compliance of 'the original systerri'or any, repairs thereto) 2)'thatthe drilled well described above will be located as shown on the approved plan and that said well will be Installed .in_ accordance with the . standards,. rules and regulate ons of the Putnam i County `Department of. Health. Date _ Signed P, E. R.A. t yAddress �` License "No. 2=9)49 a* .,APPROVED FOR CONSTRUCTION. This:approval- expires one year from the date issued „unless of, the building has been undertaken and is ' revocable fo-r:cause or- rriaybe- amended or modified when considere essary by the mis over of Health. Any change or alteration of construction requires.a new permit. Approved,for' disposal of dbmest ,sanitary se ge a afer s pply` ly. Date ��–='.2Y BY jd-- �— BACTERIOLQGY = PARASITOLOGY VIROLOGY - 4 ANTIBIOTIC. USED...:, ... .:. .Mrs. Ciaydo -S 16:,:, Church ,Street Carmel New York. 10512- Will ,pick up or call: - =: PUTNAM DIAGNOSTIC LABORATORIES id STONELEIGH AVENUE - CARMEL, N. Y. SOURCE.OF MATERIAL p' -REQUEST-El [] Blood ❑ ;SMEAR " :: ULTURE, ❑. putum ❑;Routr ❑'Nose -D T•'B• ' ❑ Throat [],Diphtheria ❑ . pine Fluid Fun us. ❑ .Urine D :G. C. ❑ :: Feces D "' ❑,_Pus From: o Cher D D ' ❑:Ova an `Parasites- Q,Viral Studies •SE ITIVITY SE NS. RESIST. - STAPHLOCOCCUS E] Aerobacter Chlorainphenicol ", ": =' F ' Ell Non- Hemo.•Coag. To Follow '' : D Corgnebacterium Colistin Sulphate_, ❑. Hemolytic -Coag. To Follow ❑ Escherichia Declomycin Q'Coag. Poii fiver ❑ Klebsiella Dihydrostreptomycin ❑ 'Negative ❑ 'Paracolo. Batt. Eryt romycin Neomycin nto ` Nitrofuiain STREPTOCOCCUS; HEMOLYTIC . - Q 'Alpha ' 'p Beta p Gamma [I Eriterococcus ' ❑ Proteus 0. Pseudomonas- Enteric Pathogens Ozacillin :_ = w, ' :❑ Pneumococcus D Found , Panalba _ D Neisseria .z :. _❑ Not Found Penicillin- ❑ Hemophilis Tetracycline TUBERCULOSIS 5MEAR TUBERCULOSIS.CULTURE Triacetyloleandomycin:e D °Acid`Fast'- Not Found '❑ Neg. For Acid Fast Ainpicillin .N. ❑ "Acid Fait'- Found ❑ .Smears,, Routine :Neg• Pos:° ❑ O & P Not Found ❑ u L` &P Pste oures, r N-9 . o i orm, ac .- 3 isolated ;from - specimen '_ 1 �1 '1 ,7 DESIGN DAT` SHEET- SE 7 DT 7 --.n" S, T L , S FTLE. NO L 0 c t- d a t- See B. 10 C."K, Lot. rsil Mu, ic-;P,-li A 04 LE! h e d 7.7 7 D T r'�'T T r,) !01 P 7 7:1'�'-' T �q a P 7 0 LI T n n', T 1) B-,- T -i -4 D7 Hole NL Cr C,,-;� .�,TT PERCO' 0-'�k 7 El-mose L °0 t t 0 L NO Tiri-e rro... _Z:Z) So4l RE, . . . SIC: L L L - '.14n. - S�ar 0 L S L - Dro..) i 7 � 7, n 01 IrC. . ),00" A A!f- 3 je 4 S 2 3 s 4 4. Notes 1) Tests', to '�2 re�.Z= at are OD- a t sa�e d8-pt-'h un"il All data to ':--)e =0i r '11P r7i.-'�C3�P F71 0.71, '07) Of ) 1, P I. ?A -L-1 T,, �F-_� 7 '% -1 PL NAM CC'" T} DE T OF H rE."' F, Ti Soil Rate -Ap r o -v e A "- Sq. Ft. /Cal C', A -P 292( Or E SIN'to Date.. TEST PTT DATI-`i, RE OUT RED -0 Z Z, -T0`-[T'T--D 3 --77H -A ID-or T C -2 -11 O.\' 0' v-1-14014. DESC"DTPTTr. CE S C :1, S E C' E R D i HCLrS N o . , o L L;-"- Tan Ca p I L ca -I S . ZkIM T',y p ROWP9 Absorptio.-L I-H M E �'N H.0 -Nol. HOLE. -N- 0 Na; . C3 4o"In H. P-elltiszu, E.. Of E Sic re cu R —16, —j . -K - , . D 353 Address G.L. '-N! 61' 12? 1811 24" 30` 36`• 42' 49 S 4!* 0 'Ili 41 4 66'r -7 2- 84 -'IC.�-T-:, Cl, Ll--'-7k7LEL AT '0- 'D %A T E;R T C, OU E, lk !l. !N-DIC-ATEE L,EV✓LT, TO 'v:'-ITLCF ','7A--'' F, R I Z 7 A "TE.) Q -)U\ iS 7\*Cl, .'TF Rf-D" Tr STS "LA DE 3 - Date ?A -L-1 T,, �F-_� 7 '% -1 PL NAM CC'" T} DE T OF H rE."' F, Ti Soil Rate -Ap r o -v e A "- Sq. Ft. /Cal C', A -P 292( Or E SIN'to Date.. Soil Rat-n M,in/l` D co p S.D. 0' v-1-14014. N o . , o L L;-"- Tan Ca p I L ca -I S . ZkIM T',y p ROWP9 Absorptio.-L Area Provided B. L. F.x2'-"* 3.5 oll width trench. 0 -LI I r G:> Na; . C3 4o"In H. P-elltiszu, E.. Of E Sic re cu R —16, —j . -K - , . D 353 Address S Er, '-N! ?A -L-1 T,, �F-_� 7 '% -1 PL NAM CC'" T} DE T OF H rE."' F, Ti Soil Rate -Ap r o -v e A "- Sq. Ft. /Cal C', A -P 292( Or E SIN'to Date.. 7 -T1 -- -7' D-7 T 0 7 .-T.r7 , 7 TC Re: Prope�'t --y c= Located at. Sector Da'e Bloc':- Lot Tin i s 1 e s, z) 0 1' 1 Z --:,— J oh n -*Lf Prent I s's r C) :"n- a S I f 41`E� an:" 0 S I :�-1 en.� -Z - n C S a vv'-__'... :J_' Z' S IL7, Ed-,-,.c-=-*'t.-'_f on La,..r, t e P -a b La�-.--, and t-Ine t-ry Code. o viz i t e r s i 1 '-5 d R.D. 6, B. 353 Add vJs tarmel, M.Y, 10512 878-6170 Very t-l-r-uly yours, e'j e -;) he n e 000 F") 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 OWNER NAME J r� i � ADDRESS )� % LOCATION OF WELL (N (Y & Stre ) (Town) .(Lot wumber) vG PROPOSED USE OF WELL NESS ly ❑ DOMESTIC ❑ ESTAB ISHMENT ❑ FARM TEST WELL SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER ❑ ) DRILLING EQUIPMENT CASING DETAILS COMPRESSED CABLE OTHER ❑ROTARY ❑AIR PERCUSSION PERCUSSION ❑ (Specify) LENGTH (feet) r DIAMETE(t(/� �hes) WEIGHT PER FOOT D�RI) E S O j _ C SING D7 ( THREADED ❑ WELDED I .YES ❑NO r YES NO YIELD TEST HOURS G.P.M. BAILED ❑ PUMPED ❑ COMPRESSED AIR YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) 6 DURING YIELD TEST (feet) Depth of Completed Well S� in feet below land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL ,SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. to FEETtJ. FEET 3,2—, izir 3.2— X06- yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE '36 r ; � 4r ,t r ^4A-4'� �Sl DATE WELL COMPLETED DATE OF REP RT WELL DRILLER (Signature) t , ~ fil -' Municipality Section Block 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- termination of the Director of the Division of Environmental Health Ser- vices 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 day of , r; •,' .e 19 Signature' Title If corporate ' , give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 Owner or Purchaser of Bui di g �.J eue_ oil C' - 1. CX t� /`t C Bu li ding. / Constructed by e ��f1Uat /� H Il _(' Location - Street / 4�6L ( /eel . •S &� Building Type Municipality Section Block 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- termination of the Director of the Division of Environmental Health Ser- vices 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 day of , r; •,' .e 19 Signature' Title If corporate ' , give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 a � • 9 Owner or Purchaser of Buildin ,1- // C01 allI (L Building Constructed by r'r4 � % q I Location - Street Building Type . P/-" 1-s'a Municipality Section Block 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 :Wade 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 furth.er agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices 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 day of Signatur "a, XJ�t f Title � -0, Z -A_// ) Vii.. If orporat on, give name' and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 1. V Jo 5-e Owner or7Pur c aser o Building Building Cons tructE; d by ' C j 1-4 u/ eF f ( Loca 'on - Street Building Type P`` --/ 4-1J `S a Municipality Section Block 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- termination of the Director of the Division of Environmental Health Ser- vices 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 day of Z �. ^ _ 19 Signature f..,i�t� c a ��� -� �, Ti t 1 e If corporat on, 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 Zvi }� NX 1 t0.i' 7i 1 t e- g got —'- 'e p az{1 Lot, 2 �t 4 4t "'a...: * 'i ,r_�tjkt y+'4 ?7' i. };' Swill � rt c : �,.` •p,:c� ���'I.ti�I.�;N,`_,. .z' t =. mot« I a F 0 0 0 yn ?IL Qo I P s T✓ S r SAN elf + "� 3 S> L 1 '.� 0 AMOCO N - a q IV REM -Roo 1 y f ar NOW S AWAY, won