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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of
Located at� -�
(T) 60 Section Block 3 Lot
Ir
Subdivision of V �. 6
Subdv. Lot # Filed Map # Date
Centlemeu:
This letter is to authorize, 11/%}?i C f �/�: •
a duly licensed professional engineer
(Lndicate
to apDiy for a Construction Permit. moo: a separate selwage system. to
servo the above noted property in accordance with the � . �'O' arc3. , raI es
or regulations as promulagated by the Commissiorsr of the Putnam County
Depart=en.t of Health, and to siSn all necessary papers on my beha}_i in
CO=eetion wit;z this natter and to super Vise the construction of said
system or systems in-conformity with the provisions of Article 145 or
147, Education Law, the Public health Law, and the' Putnam County Sa .i-
terry Cade.
Couatersig~ned:
P.E. , �.�. , # 0 93
Address_
Telephone
Very truly yours,
Signed
V.
Cwner £ Property
Address
Town
4- -7.1 (S - 0'? -) `7
Telephone
TEST PIT DAM • M 1 •' 011 TO BE SUBMITZED WITH APPLICATION
DESCR=,ION OF • t LS ENCOUNMMED IN TEST HOLES
DEM HOLE NO. EOLE NO.
ROLEM..
G.L.
C t
2'
31
4'
5 r.
6'
71
8'
9r .
10'
J-o
S^N,oy Q RAV6-LLY
Lro t}M
1.1.'
12'
131 .
14'
INDICATE LEVEL* AT MICA GROUNDWA7M IS ENOOUNZ= tix,N E.
INDICATE LEVEL, TO WHSCH WATER .LEVEL RISES AFTER BEING ENMUNTE ED loo N C
DEEP HOLE OBSERVATIONS MADE BY: M. 8"dZi NsK1 cLARK :DATE: 11I 4) es
DESIGN
• Soil Rate Used ( 7 Min/1'1 Drop: S.D. Usable Area Provided 5 o 0 o -!&.F.
.
No. of Bedrooms - 3 Septic Tank Capacity i o 0 0 gals. Type `
Absorption Area Provided By 3 oo L.F. x. 24" width trench
Other
Name A►J fl o L. p l-�
Address -73, H A i R2 G t R L r-'> I7 i21 V e
�PA ?'Tr- ; V-.!!y I Z
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
../1f
SEAL
Z
t12, d Sr
Soil Rate Approved sq.ft/gal. Checked by
Date
SS /�j_ 41204L_ A/0 * ! .
PUTNAM COUDn Y DEPT OF HEALTH �r j� . G � > / Z
DIVISION OF ENVIRCNMENM HEALTH SERVICE'S
DESIGN DATA SMT- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner UA460 Address
Located at (street)�/✓j�- Sec. Block 3 Lot y
(indicate nearest cross street)
Municipality Watershed /v �
SOIL PERGOLA ON TEST DATA REQUIRED M BE SUBMI= WITH APPLICATIONS
Date of Pre- Soaking
- Date of Percolation Test
HOLE
NUMBER C= TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Fran
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min /In Drop
Inches Inches
Inches
1
2
3
4
5'
1 Q/(J�� ✓l�"L
2
5`O' /L S
3 /
4
1
2
NOTES: 1. Tests'to.be repeated
are obtained at each
for review.
2 Depth measurements tc
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to'be submitted
be made from top of hole.
?F,
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.
1'
2'
3'
4'
5'
61 1 M��
8'
10'
11'
12,
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
_ DESIGN
Soil Rate Used 7 Min /1" Drop: S.D. Usable Area Provided�Ot�T
No. of Bedroams 4 —_ Septic Tank Capacity ZL �j y _ gals. Type 661VC- .
Absorption Area Provided By L.F. x 24" width trench
Other
Name- �j�Ci�i� �'A?3i� %�GLs , pg . Signature
Address Lidgll SEAL
Y0447SwA) DTs A x
THIS SPACE FOR USE BY-HEALTH DEPARZMENNI' ONLY:
4(
9
051 a i
Soil Rate Approved sq.ft /gal. Checked by Date
FIA
pultm axmy DEPARRiENT OF HEALTH
• DIVISION OF RTMaZ01ML HEALTH SERVICES
DESIGN DATA S1=-S(JBSUMCE SERM, DISPOSAL SYSTEX FILE NO.
re
9 MAI u le-T7,GET
Owner LcmcmmAw 4- t+oxc_H Address pr_r=L,,5-
HAyiLAmT> 1=PZjVG AW11>
Located at (Street)*- P,;z i m-!5,ToAaC F+ %I-L. TZOAP Sec. 18 Block 3. Lot
(indicate nearest cross street)
Municipality TAT
TE Watershed C:jzoTo�
som PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking I zis-/ a Date of Percolation" Test i z t7 13
IrRCIlJCg TIME PERCOLATION PEizco=CN
Run -Elapse uepzn LO vydLer C.LCXU waxer i-eve ' _L
NO. Time Ground Surface In Inches. Soil Rate
start-Stop Min. Start stop Drop In: Min/In Drop
Inches Inches Inches
rl.9,,zS -Cp," ) 9
1 *1 1 29A5 - jo'06 Zo Z4 ?_
3 io,,o & - )o'�
Zo Z4. z
4
5
r 19,. zA 4. Z4 Z7
2 9,.45 I o,.crse- n
Z-7
-2
3 )oo(a c 3 P-1. 6-0
4
5
.L Tests to be repeated at same depth unt.D. appradmately equal soil rates
are'obtained at each percolation test hole. All data to* be submitt?3d
for review.
2. Depth measurements to be made from top of hole.
I certify thst the systan(s) -ai
of.which' are attached)\ and in:
.Putnam County DeperLnent:Of He
Date
re.' premises ,aeie constructed essentially'as shore on the plans'of the completed work.( copies
idarda rules and' ons in ac co ce.w e;.filed,.plan, and the. permit issued by the
Certif ied by 'd AL iR F t2.A.
AdtliesS _�d
lsss►f u►e the eorrbctlon: of -any unsanitary
>ld is as a pubt'- s+nlUry sewer. becomes
pplY es 'awllable "Such 'approvals are
n, tlon or.chinye ls'necarssa►y._
Tit i
O
�' i3� N'OVS -� IZSOpy.CeNG.
SBOrnc •raNK
/NST•4 -GL� S�zo t-�
�w.e�D yza �F
�— =A
�M°5i9o.4 4,7.o�.
9.00.5-
o
ti
so% E'reP. A-,eeq
s�xtrri� /9j
6 fH W �f
S l /
c �
AREA = D. AC-
L6 .30- 7-
O
0
\JI V� -I
Asphc/r c.. e3
4z87,9
QA NA /VD
"This is to certify that
the sewage disposal system was constructed as indicated on this plan and
that the system was inspected by me before it was covered over. The
system was constructed in accordance with all standard rules and
regulations of the Putnam County De_a=.r.tment of Health and the N2ca York 1
State Cup_rbTant of Health_"
Putnam County Department of Health
Division of Environmental Health Serviee8
`D Approved as noted for conformance with '
applicable Rules and Regulations of th
PutnAM Co ty alth Depar,. ent.
0y 6
,4 1gnature & Title Date -
S`PtEof �Iro?
9
05'1
A-s — LT
ss D 5
tip
�C�C�
�'I��S�t�
fAM-)
y0� /oYw
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH. -SERVICES.
jP
Owner or Purchaser of Building Section Block Lot
SAP--I-
Building Constructed by
. N o-, -k ,%- D �A
Location - Street
P.PFW
Hunicipality
Building Type
Subdivision Name
2
Subdivision Lot #
GUARANTM 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 Environinental 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. c p
Dated this t day of 191 Signature Y `�►
Title V t C.Q_ �C►`�S C�.s -�
V u 1 Cc.../L0-) "VM" L� S
General Contractor (Owner) - Signature
ak"
P�
rporation Nam (if Corp.)
Address
rev. 9/85
mk
tj gkACWC. -► 71,ucG4 fzc,. -s LA
Corporation Name (if Corp.)
7 Cc¢, .Q(Z �,C PeJ4 k-( C L
Adores d (Ovo�.
:
LL�rIYVJr1 V
.
Y
•9
FILL SITE INSPECTION
Date OY /1�20 /_ 9'
�� Zh1V6 - _- = ; . Inspected by _°
STR= IC'CAT_TQN CWNI FUR
/V�N�
Mw /CM10 7 I'-
PERMIT ? � ` �� SUBDIVISICN LOT
cn^m
I. SE' WAGE DISPOSAL AREA
a. SDS area located as per aonroved plans
✓I I /
a
b. Fill section - Date of placemnt
2:1 barrier. " LGTH W-= - VG.DPIH
I
lir Al
c. Natural soil not stripped
d_ Stone, brash, etc., greater than 15' fran SDS are-a.
e. 100 ft. fran wat°_r ccursz/wetlands,
r-) '
II. SrSLZA = DISPC✓AL SYSTEM
`
a. Septic tank size - 1,000
b. Septic tank installed level
I I
c. 10' minimuza fran fourdaticn
d. No 900 bE ^_as, tee=*scut within 10 fu. of 45° by -nd
I I
e. DISTRIBUTIC -N BOX
1. All. outlets at same elevation -'water tasted
2. Proteclted belcw frost
3 . Minirli-n 2 f _ original soil- be =w�� box and tr`-!c:-:es I i
=
f. JL=!CN BOX - properly set
I I -
g,�""- {
.
l.. Le- *:ctt-h reared - L- -ncch instaL�
2. Distance to watercourse ..ar lnea
.
3. Installed ac-c-ording to plan
-
4. Distance c`nte_r to c°'lte_r
I
5. Sloce or t-` ^_Ch acceptable 1f16 - 1/32 "/ =COt.
6. 10 fat frcn prcoerty line - 20 feet - fcundat; ors
7. Dep-Eh of t=ench < 30 inches fran surface
'
8. Room aLl cm-a3 for eYrznsicea.
9. Size of cra�-el..3 /._4 - 1" teeter
10. DeDt.*7 of c2avel in t:re ch 12" m]nim►nn
11. - Piree ends erred
h. PUP OR DOSE SYSMM.S
1. Size of v c2hamber
2. Ovierflcw tank
3. Alann, vi.-j a I /audio
I
4. Pumn easi? v accessible manhole to grade
i I
5. First bcx baffled
6. Cycle witnessed by Health Dermot rient
estimated flew per cvcl-e
I
IV. HOUSE
a. House 1pmted ver awroved
b. Number. of bedroans
V.. WELL .
a. Well looted as per amroved pians
I
b. Distance fran SDS area meeTarmd ft.
c. Casing 18" above grade.
d.' Surface drainace around well stable.
VI. OVERAII, WOPRAA=
a. Bones properly grouted
b. All pipes partially backfilled
75 z7
c. All ipes flush with inside vE bcx
d. Backfill material contains stases < 4" in diameter
I
e. Certain drain installed ac to plan
9LI:
�-
f. Curtain drain cutfall protectei & dir. to exist.watercoursd
g. Footing drains dischar a awn ftm SDS area
I
h_ Surface water,- nrotr -tion adeonte