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BOX 10
11:�
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 �►�.,�„� . / Address
ate, Lat
Located at (Street •� Sec. / B lock Lot
6dicate nearest cross street)
Municipality reb Watershed �oa
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
5 '
11137
2 / 242
r
3 / /Y49
m
1
5 �.
Notes: 1) Te' ts.to be. repeated at same depth 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 from top of hole.
Hole
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Elapse
Depth
to Water
Water le ve
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /iri drop
Inches
Inches
Inches
2 1141
5 '
11137
2 / 242
r
3 / /Y49
m
1
5 �.
Notes: 1) Te' ts.to be. repeated at same depth 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 from top of hole.
TEST PIT DATA REI
DESCRIPTION'
-10
q0-)
11R±15 TO' BE SUE,
WITH APPLICATION
TAT MVqM UnT VQ
DEPTH HOLE 'No. LF-'.1 HOLE NO.
G.L. 70;a sty'
1 d
611 4'07iC S
12"
1811
2411
3011
a
3611
4211
4811
5411 % A-
6011
6611
7211
7811
8411
INDICATE LEVEL AT WHICH GROUND WATER is ENCOUNTERED A16.1p
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Aldofp Atodeew 24116M
TESTS MADE BY - I Pjr -fj 2IF j . Aaw ZZY-AlDatO / &_ /„
. .
DE3iUN
Soil Rate Used__g!4-Min/1 ,11Drbp: S.D. Usable Area Provided f.
No. of Bedrooms Septic Tank Capacity /Oda Gals. Type AfCfx0#,,ey
Absorption Area Provided By_ZP_L.F-x2411 width trench.
Other
Name John - renti ss, F.T.
b1gnature A/- -
Address R. Q. 6. Box 353. PF?
"N,
Camel. New York 10512
THIS SPACE FOR USE BY HEALTH DEPARTIENT ONLY:.,'
Soil Rate Approved Sq. Ft/Gal. Chec y Date
r IN4 ►'A
Gentlemen:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 71�1173
Re: Property of
Located atgP
6-ra.� Lw
Section
Block Sxa, Ry 42 Lot -f 30 9
This letter is to authorize
a duly licensed.professional engineer X or registered architect_
(IndicaTFY'—
to apply for a Construction Permit for a separate sewerage system; to
John H. Prentiss, P. C,
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the Commissioner of the Putnam County
oCi2par , and to sigh all necet3sary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems.i..n conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
C un ersigned:
P.E. R.A., # K,
J
P.D. fie B. 35.1
Address
Camel ? New York 1 0512 �
914-878-6170
Very truly yours,
Signed
'/'
� '�-(� � '')
Own r of Property
Address
� PRF T 'rciy\
4
,o
No..292064� 14 `
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