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BACT1rRIA;�PER ML (:Agar plate count at ;35 C)i
COLIFORM'GROUP (MI ost'probdble :No.71700 L)
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R bESS; TOTAL- =`ppm
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NITRATES (as •N) ppm
IRON; TOTAL
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APPROVED
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.9101 u•eiob # CAI 3 4�, Frty �.n 0 CT2.6 1973 .
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BUT &C(P)UN�fy TF E�H
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E _ gtREGTQR DIVI
t, is 401 - - - liIVIRONME-NTAL HEALTH SWIM
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X® EUTCH
owner-or Purchaser of Building
Building Constructed by
ll 10 1 .4- . !fie i fit. f s
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BuiR ng Type
_ VO PATTERSON
Municipality
2' &Y M.AP ;j I' s
Section
2'
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 syst
Dated this .7A day of T)V 19 2 Signature 6LAq4 d
W c COOPER
Title 1 -; C M_
If corporation, give name
rj and address)
. .
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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.
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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 N0.
Owner v ll u T - ik Address L - AC,--
. f Pg-OS �� G!" Ave . LAi Ue( A.i:) W . lit! 1�
Located at (Street RdIcate'nearest IN KLCpi(l LE: R�Sec. Block Lot �J �-
cro ss s ree
Municipality Y k j j ut. Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Felapse Depth to Water Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min.;. Start Stop Drop in Min. /in drop`
Inches Inches Inches,
1 d to
3
1
2
3
5 ..
1
2
3
5
Notes: 1) Te'gts to be repeated at same depth until apppproximatelyy equal soil
rates are obtained at each percolation test hole. All data to� e 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 ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO. ,
G.L.
12"
30
361
-v
42"
48"
0�
54 If o
60" rZo
6611 4.f
72„
f
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHIC WATER LEVEL RISES AFTER BEING ENCOUNTERED
. TESTS MADE BY _ A `1T ' C -: " j - j Date 6�44 1 _
DESIGN
Soil Rate Used Min/1 "Drop: S. D. Usable A :Provided c C)
No. of Bedrooms Septic Tank Capacity r,' Cal s. Type ti_��rc
Absorption Area Provided By L. F. x24 N( �.;, �. H ' width trench.
Q
Other
Name o+.� ar,2n /� _ �L Q I i,� �-- Cigna -;lire
Address - e_ SEAS,
THIS.SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Checked by
Date
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OF HEALTH.
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ENGINEER ANIJ TMF t OCAS HE At r O c �
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QUTNAM COUNTY OEPi, 0 HEALiN i A • AS � T�'D •
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