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HomeMy WebLinkAbout1075DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -1 -25 BOX 11 WE III all r is, r I lu - ' - ■ 1■ 01075 L 7 �- RUTNAM COUNT Dtviston of Env�ronmem of k ' .CONSTRU I:ON PERMIT ;FOR $WAGE'; DISPOSALrxS •Lo cot ed, •at, o:od Subtlrvisfon Ste' .�' Owner /Address BdiIdln9 TYPe �� i't �Z7 L� Cot Area J -+ 'Number'of Bedrooms:' Design Flow G /P /D: �o °o• , t l .Separate seweri g"'S itb` to consist TofR //�]�O V • To be constructed by ° �4 Water Supply , Public Supply 'From { Prwate ^Supply: to be drilled by;.. 2 f Addres;, r °Other Requirements P 1-,represent that I•`am wholly and completely responsible,tor the desii above described will be constructed as'shown on e'approved amend Eounty :Depart men t of Health; .sand that on +compietion'thereof;a:' be submitted to ",the Department;- and a writton IgUirintee will i6i place in good operating= conddio'n any part of s--id sewage °aisO -ante oi.the' approval oi_;4he Ceitificite ,of Construction ,Complii ..'will.be located.as'shown on the approved plan and that said, well will'I County! Department of Health Date Y C3 tit f igne APPROVED FOk CONSTRUCTION This approva"I ezpiie{ one ye revocable for cause or may be'amended? PUTNAM COUNTY - DEPARTMENT OF HEALTH, DIVISION OF ENVIRONMENTAL HEALTH SERVICES. Date C� Re: Property o Located at (T) ection Block Lot Subdivision of 9�fT? UAL /'% Subdv. Lot Filed Map # Date. � ?ylvj Gentlemen: n This letter is to authorize c+ r ���i�44t' i a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary pap.ers.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 147, Education.Law, the Public Health Law, and the Putnam County Sani- tary Code. .Very truly 0 Countersign d: � G"/ er 9190 le i r.E., R.A., # Address.. X X. Address 4D Ci L�Q' 'G D(J Telephone Town. Telephone 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+��� 1 Located at ( Street 4ndicate 6�jl C 1496 Block Lot ?j L ")--3 � � n aces cross � street) ° Municipality, d N Watershed 4j� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole . Number. CLOCK TIME-t4- PERCOLATION PERCOLATION Run Elapse Depth to Water Va er Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2z= .12 i2 ,a ,. Z_ 4 Z 5 3L- ai 2 Notes: 1) Tests to be repeated at same rates are obtained at each percolation for review. 2) Depth measurements to be made depth until approximately equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION ... _...... .. _ :._... -..... .DESCRIPT•ION OF SOTLS ::ENCOUN` FRED IN -.T-EST —HOLES, DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. �^ c r� c9� � c� J 611 Lk 12" _ 18" 24 30" r 9► 42" 4811 I 11 .54" 6011 Iff 66" 72 8411- .r . INDICATE -LEVEL AT- WHICH GROUND WATER -IS ENCOUNTERED '� � F- INDICATE'LE"VEL T TO WHICH W TER LEVEL'RISES'AFTER BEING 'EN UN C `(' TESTS MADE BY- Date 1 Soil Rate Used( Min/l "Drop: DESIGN ` S.-D. Usable Area Provided 1 (l`34: a No. of Bedrooms Septic Tank Capacity Gals. e nf!' -C Absorption Area Proved By L.F. x24 "j '- e�- i P � ame lgna ure Address Se. SEAL � i;�� r p '0 84roo AA`��ESS THIS SPACE ONAN'�r4y� FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by Date I ' r o ;• n 1 � '. 1 \ \\ ` � 1 � - ,►•;pal � �` ;`4�� :.s�� � p�. l000 \ 5J� o►:L f, .� i� ,�i�l h \ r N.A N. rPr«:r�K. ✓o.,•1:J�a: toil T=4! j A !D SECTION I �