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25.63 -1 -8
BOX 12
01207
J
1 -
116
1
IN
01207
` PMNAM COU
V. x Division of Enwronn_
CONSTRUCTION PERMIT 'FOR - SMAGE"DISPOSAI
7-. ""y'_'• — •- y'.�. -T—r —.
IEPAR,T, , E °OFF,HEALTH
ealih Services I,armel .:N Y. 10512: • `
:M. t• ti ,
} Town or. Village
Glarrerl �, L'�ECOt Dr1v ^s H F i ed if
LocaYetl 'at L1 1 +Block
Putnam "Lake 4 ° ;�A550 5 Incl 50830 :.
Subdivision of Job —
Jam ce '& Carl Na�carato i 1�7 Kenwood::Road
9'' YP � � r � ress
Owner Add
Buildin T e .Frame , m Lot�Area BOOO ±'' ` Rutnam •Lake., 12564
.° ' :
;Number of Bedrooms Three Total Habitable Space 11'24 fin' 1,F1'Square I ?eet ;I
~ ,
Separate, Sewerage :System to consist of -'_ l OOO 3rGal Septic' Tank 26 lineal feet` 36 'i`•nch width trvinch I
.To be 'constructed by " Address
Water Supply Public Supply From
' > e l
X .t Pnvate'Supply`to be dulled, by
e �
Address +
;Fill Section 36' Deep x _48' �W de' x, 30' 'Long
Other,. Regwrements I' – i
1 represent that 1r am wholly and completely responsible forthe design and location 'of the proposed systems) 1) that the separate sewage disposal system -
atiove. described-will be constructed as shown on the approved amendment there to and in`accordance:withl the standards,.rules an regulations o e , u Putnam, '+
y P �, R p : Y ,will
Count De ailment -of Health and that on com lotion hereof a Certificate of •Construction Com Hance" satisfactor •to the Commissioner of'Health
be,-submitted'.to the, Department; and:- ^written guarantee will be- furn�shetl the owner his successors heirs,or• assigns by the•bwlder; that saiq builder'lwill
place - -in good;•operating condition any part .of said 'sewage disposal system du'r`ing the ,period of two (2).ye6 Srimmediately following the date of the issu
ante of`; the' approval of•,,the Certificate .of Construction: Compliance of the original system or any repairs'4hereto;'2,) that`.the drilled well described al)oye
- •* i es and regu a ons of .ahe `Putnam '
will be'located.as showmon the approved plan and that said.well will b`e Installed m accordance with the ards rul
County'Depahrnent of Health –►
Date 9�19/� i 'lt' + t Signed v P E R.A.
1
R 3 k 5
Address D '6 Box 53' G el Ne .�Xor 0 12 Wicense No ` 29206
I'
APPROVED FOR CONSTRUCTION This approval expire3 one year from the date issued ,unless construction of the bullding has been undertaken :s: ri
d is i
'revocable for,,cause or may be am nded or.niotlified when considered necessary by _tAe Corriin�ssioner °of 1 lealth Any change` or alteration of ,construction
'require; :a ew ;permnit. %Approved for difposal of domestic san�tary'se%wa'g�e� and /o`r private water :supply only ',
Datei BY i.- ,F'2�C/l �_:eoti.�..�` ° %�� /Tale
H
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T�I
F'TKk1N1..'COUNr171-: BE P PaNT -C)F--AL
DIVISION OF ENVIRONMENTAL `HEALTH SERVICES
COUNTY OFFICE BUILDING; CARMEL, N.- Y. 10512.
-DESIGN DATA SHEET-SEPARATE
SEWAGE DISPOSAL SYSTEM FILE VO.'
Ouiner*",
-ddre sq &
-Located at
(Street)
(Street.
�a
- 0
A s�c �R-F: ��ree
�OV;,
t 4
s'�
i c 6 �n e e r . I t��
Muhicipalit
Watershed
-'SOIL
PERCOLATION TEST
DATA REQUIRtb TO BE SUBMITTED WITH APPLICATIONS
Nurhber
CLOCK TIME
PERCOLATION PERCOLATION
Run
.4apse
Dep p-Water water lsbv"31;
iNo.
Time
From Ground Surface in Inches Soil Rat6'�,
Start 7Stbp 'Min.
start 71. stop -Drop in Mine /in drop
Inches;' Inches Inches
map
. .... ... . -
3 AQ
V AV e <
5
TEST PIT DATA
DEPTH HOLE NO.
G.L. A. ed
611
I . \
REQUIRED TO BE SUBMITTED WITH APPI
:.-Soy MCONT
09--'OPP , RPED - I-N:- TE TAE(
[CATION
HOLE..NO'.'
Silk
7:
PUTNA:W COUNTY DEPAR`rMhT4T OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
R4
e.
M
Gentlemen:
This letter is to authoriz-
a duly'1-1consed professional engineer X or registered architect
IndicaTe-j-
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 promulgated by the Commissioner of-the Putnam County
.0 TT_ - -1 J- I-
TI)V-partmelnt- C) I 11t:::U_L U 11Y aid to sign 41,1 9!eBsary papers on my behalf in
connection with.this matter and to supervise the constructioh:of-sAid
system, or systems in.conformity with the provisions of Article ;145 .or
_14.7-y_ Eduicat-ion - 1a,a-,---the-:"Pu'1blic :Health".`J_aw-, and -the-Putrz Co-
mt- Sani -
tary Code.
Very truly yours,
Address
-.Cakivl, New'yoft i 2
051
AF I
or S10
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