HomeMy WebLinkAbout0992DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25.46 -1 -75
BOX 10
9
L
I IN 2
N161
'
.
rte'
r
i
loo ItIl.
el
lo
116
IL
el Ire!
7
i
,I Pla
me
00992
Other 'Requirements Xrtk' ti 1.n s
..,.
I represent that I' am wholly and, completely responsible for the design antl location of the p•roposetl• , L �Hl
above described :will be constructed as shown on the-a
f,
pprovetl amendment there to and in accordance iia� °d air
e,. rules
Counfy Department of .Health, and thafon completion thereof a "'Certrfrcate of Construction C i ce . sat fa tc -,Rory t
be submitted to the `Department,= and a written guarantee will bel furnished the owner his we sir heii�sl9n� bj!
place " in :.good operating condition any part of said sewage disposal system during the period fQ o (2)y�" ''s iijvrt�tliat
;ance of. the approval_of; the Certificate 'of Construction Compliance of the origi al system 0 r1 n epaiisiStl leto zthal
will belocated as shown on the approved plan and that said well will'be installed ac rdance, wdp ,t stagsla rule nd f
County Department of. Health
Address
APPROVED FOR CONSTRUCTION. This approval expires one�year from: the date issued. u constru io'n of the building
{ :revocable for .cause or !inay be amended or modrfIed when coin id ecessa►y by the Co issroner of ealth Any change r
L� ... ..;
t requires',a new , ermit ,. rov r t ispOSRI of domes6 y sew ri tow ply on`
bate'r G ^ gY Title
s
N
r alteration of- construction
� j
P-;-.
3
Gentlemen:
PUTNAM COUNTY DEPARTMENT .OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date %
Re: Property of
Located at
Section Block Lot 72 7 / -*772 741
This letter is to authorize R 111 M A IV
a duly licensed professional engineer or registered architect
(IndicaT j4
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgatel. by the Commissioner of the Putnam County
Departiiciit of nealtii, and to sign all necessary papers on my behalf• in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
Edu�at?..on_.Z,aThL�._.t. e._!l,b -i�c- Nealtl- maw,_• and - the•-- Patnam - -- County-- Sa- ni- _.
tary Code.
Very truly yours,
*' - cwna --bf • • -
Countersi
Address
•
y� Seal) Telephone
'
Address
q� t
Telephone ~�
_ PvTI�ii CCvivT L DEPARTMENT OF HEAI�TI
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET -SEPA TE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner a . (� Address .'' e....
Located at (Street Q_P 4._% f �> Sec. Block Lot
n ica e nearest cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to.Water a er ve
No. Time From 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 '
2
3
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.
-
DEPTH
G. L.
6"
12''
18"
24"
30"
36"
42"
48"
54
60"
66"
72"
78"
84"
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION.,,.___,_
'DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE �O., HOLE NO. HOLE NO.
V
INDICATE !MFEL -AT '-MUCH u•ROLrnYL TJATER IS EPICOL';;TLRED -
.INDICATE EL Ty H WEE I EL RISES AFTER BEING ENCOUNTERED
:. PTS ADEB Date
DESIGN
Soil Rate Used t Dan/, "Drop: S. D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity /60 Gals.
Absor 'on Area Provided By L.F.x24" e _
s
r
Address
SEAL
THIS SPACE FOR USE BY .HEALTH DEPARTIENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
to
It
t