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01629
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PUTNAM' COUNTY 'DEPARTMENT OF
` Division of EnJi�onmenia/ Heath Services,.:Carmel; W. Y'. '10512
_. GERTIFIC/aTE.•OF CONSTRUCTION: 9OIV1PL.IANCE, FOR SEINA.G,E_DISPUSAL;SYSTEM:.: Patterson=
y
f Town •or Village
Located =at Hgh View Supn�r Acres Subd
ec o Block
Owner. ' Wm Rookwoo.d Lot; 26' Job
_ • , = - •' , ., � :, , •� 0512•' �
:Separate Sewerage System built,'
uilt by .,..Owner Address Mon-Ad. , •Carmel•-, NJ, l
s 1000
300 36 •finch 4i!idth irenoh i
Consisting ,of Gal. SepLc Tank lineal Feet
w c
I
Other. requirements .
water supply:` Public SuPPIy.,Frorh
X Boyd Weal Drillers
.Private SUppiy' Dr111ed'.By i
Address
L" ake, Carmel N Y.'105T2
Building :T.yPe Frame No of Bedrooms 'T -- Date Permit Issued "R 7 0171 i
Has 'Erosion Control Been Completed? None: Req -' d
o
i
I' certify'that the system(s) as listed serving the above premises were constructed essentially as'.shown:on the •plans of the completed work (copies of which are
attached), and` iir• accordance.with'.the'standards, :rules and'regulations plans fil ,_and the permit issued 'by t utnam County Department of Health.
Date
11./18/"71
Certified by P E X. R.A.
•Address6 License.No ZAZ
.Any person• occupying premises served by the above system(s) shall-'promptly take such action as m_ ay be neces to secure the correction of any unsanitary
conditions resulting from ` ;uch usage: :'Approval. of the ':separate sewerage system sh'atl. become null and v ai� soon as a public sanitary sewer `becomes
available and the approval of: the private water supply, shall•becorne null and n' a public ,water, ply. becomes available. Such approvals are . I
subject)to modification -or change when,'. in the Judgment of the ,CO sinner of a -rev cation'or change is necessary.
Title
Date By
0T•1__v- O -n 2-.an J :_h. O- Vii._ Ltn^ n�:_c1� , v _
- . O J
�s: (-
VRA e �oci�i �100� .
Bu , l d Cons -v Sac'
Lo Rio - 3 area
Block .
SO-23
TIn a - - - - - -- -
O. r ^-" J� J J :_- L'o Ora �-a 0.J ... e(.. �, 'J ^v .._, _�-._ ..� n ..�
Da .�� �^ lea a?�-
DzVi S,On O_ �� I? _'J _- 1, Lv9� _ S :_ - .: J'- ? . ,'a' :.Oi:�_
PUTNAM COUNT=Y DEPARTMENTa`OF HEALTH
Division of Environmental Health . Ser=vices, Carme% .'N Y. ' 10512
CONSTRUCTION P,E'RMIT: FOR `SEWAGE, DISPOSAL •SYSTEM
r kIla
o V
Town i ge
Located at /Tf "d� %�ls± ��� ✓Q Section�4q`� $lock
...
Subdivision kN' S ' L'ot�' Job
Owners ��ecsC4G a i Address
Lot Are . - o
Y /47 Building Type' a
�.. - ---• —, -
Number' of_ .BedroomsLi°� Total Habitable. Space Square Feet
Separate'. Sewerage System to consist of �� dd Gaf Septic Tank_ lineal feeC X 7G width trench
To be constructed- by 42k1- Q,1 Address
Water SuPPIyub'Iic. supply 'From
Private Supply to be 'drilled b Y.
I Address
Other Requirements 'd�e
I represent tha6, am wholly and lcompletely responsible for:the design and ylocation .of the.,lpropoied rsystem(s); -1), that the separate sewage disposal system
above describecl will be constructed as shown on the approved amendment there to and in accordance witti the standards, rules an regulations o e u nam
County . Department of - Health, and that on completion thereof a "Certificate' ;ofConstruction Compliance" satisfactory to the Commissioner of Healthwill
be submitted;,to the Department and ;a written :guarantee will be furnished the'owner,'his successors, .'heirsor assigns by the.builder, that said builder will
place: ii good operating condition any part: of Said sewage disposal system during theyperiod of. :two.(2j :y ears Immediately following the date of the issu-
ance.of the approval of the •Certificate..of Construction - Compliance :of.,theo(iginal system•or any.repairs,thereto;.2)`that the drilled well described above
will •be located as shown on the approved plan and that said well will be installed ,in 'accordance with the standards, rules and regula ions of the Putnam
County Department` of Health:_',
Date' . 71%nI 12/ ' Signed P.E. R.A.
Address �� i License No.' lee
APP.ROVED'FOR .CONSTRUCTION: -This approval expires one year front 66, date issu6cf. unless 'construction of the building has been undertaken and is
revocable_ for cause or lmay. be ,amended or modified when considered necessary by 'the.Co issioner of Health.- Any change or alteration of construction
requires a;: new permit: "Approved for,disposal.of domestic 5a " ewage;'a or pr'' a e w upply ,only.
Date_ !(i7 �- L� BY ) Title
2 / -'- 13djt A
4
5
5
v PUT \AiI C01�NTY DE�:._.s'-;'T OF :,� :LTH
DIVISION OF ENS °C` <��:�TAL HEALTH SE :ACES
•DESIGN DATA SHEET - SEPARATE SE, .4GE .DIS -;SAL SYSTEM FILE NO.
1
a rier ps, Address ale
Located at (street). P ,rr. Sec . Block
ip
Lots
(indicate nearest toss s greet)
Municipality Watershed (f
2
SOIL PERCOLATION TEST DATA REOUI.RED TO BE SUB'1ITTED PITH aPPLICaTION
x.
Hole
Number CLOCK TIME PERCOLATION
PERCOLATION,
Run Elapse Dept:. to dater .;titer Level', .
No. Time Frog, Ground Sur=ace in Inc::es
-Soil Rate
Start Stop Min. tart Stop.-. Drop in
Min/iri . dro.p
Inches. Inc ^es Inches*,
1 103 /
2 / -'- 13djt A
4
5
5
Notes.: '
1) 'Vests to be repeated at same depth until approxi- . = -tely euaaI soil rates are ob-
tained' at. each. percolation test hole . all data to be submitted for review .
2) Depth measure rents to be made from .tep of hole.
1
2
3:
Notes.: '
1) 'Vests to be repeated at same depth until approxi- . = -tely euaaI soil rates are ob-
tained' at. each. percolation test hole . all data to be submitted for review .
2) Depth measure rents to be made from .tep of hole.
IT
DESCRIPTION -RE 0_L'1PE _0 �1 � B.`i! TTED T'i'?i P LIC5:TI0 \` �✓� -
DESCRIPTION OF SOILS E\'- nUNTE QED IN TEST HOLES
DEPTH HOLE' NO'. ,HOLL No. HOLE 'N.O.
611
12"
18"
F1
24"
3 0"
36"
42"
0
54"
601 o
66" Q °
i 2 c. .
/8 .
INDICATE LEVEL AT WHHICH "GRbUND [1aTt,R'IE ENCOLNTER D
INDICATE LEVEL TO WHICH GIaTER LEITL RISES AFTER B'PING ENCOUNTERED
TESTSLaDE 3i' Date
t,�_ �.
Soil Rate Us Drop S.D. Usable `re Pi ov
B droo-a��_Sep', i s ?'?�' C __ i' z ®D Gals . Type
e a /�
No . of
Absorption area Provided By ®P .L.F.x2 -'` 36" (L' c,; idth trench.. Other
John H:- P.rentis's P.E.- C.E.C. Sign �pFESSI ro'(
Nape C, _ature
Address, . R. D. 6, B- 353 AL
Carmel, N.Y. 10512
PUTNTIAM COUNTY DEPART LENT OF HEALTH F� s- 6 �k,
Soil Rate approved Sq. Ft. /Gal. Checked by ry °Fr F Date
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