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01974
1ALTH . PUTNAM COUNTY . DEPART MEN OF
Division of Environmental.eartt Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
or village
Subdivision �` L4 Y—e Lot Job_ +� �. L9 —54s
Owner K -1:0 _ _ e� Address
Building Type"' Lot Area Sam �%
Number of Bedrooms Total Habitable Space C, Square Feet
/�
Separate Sewerage System to consist of O C:1; Gal. Septic Tank 2-4:0 lineal feet X width trench
To be constructed by Address
Water Supply: Public Supply From
Private Supply to be drilled by
Address `
Other Requirements 1 C4 ?)Af-A� P- V � �o. GO V e-A- SAL- l ,5 ✓. ZS
I represent that I am wholly and completely responsible for the design and Iodation of the proposed system(s); 1) that the separate sewage, disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee. will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance •of the original 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 standa"and — �of the Putnam
County Department of Healthf '
Date e.a Signed P.E^ R.A.
h Address MAP, NU License No. -
APPROVED 'OR CONSTRUCTION: This_approva expires one year from the date issued unless construction if the building has b e ' undertaken and is
revocable for .cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitap— sewage, and/or private water supply only. /
Date������ BY �ZiG2- �Zr±71e /�
PUTTNA�I COUNTY DE-Pi�RTMMT--*-GF-+E-A13TH-:'
DIVISION OF ENVIRONMENTAL'HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner
_(Lk i Address
k ti
Located at (Street� L_-AV_,ej�t>g,:j APL. Sec. 3C, Block ot is
Indicate n0arest cross street)
Municipality. Watershed ooq C:) r,)
SOIL PERCOLATION TEST-DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number CLOCK TIME PERCOLATION PERCOLATION
Thm. Elapse Depth to Va ter Water TFveT
No. Time From Ground Surface in Inches Soil Rate
Start-Stop Min. Start Stop Drop in Min./in drop
Inches Inches Inches
Ice
U
23:1-9 3.A] 17, t 3 14- 1 116
33'41 IS 3 A
4 12—
4
Notes: 1) Te,�ts to be repeated at same depth until ayyroximatel� equal soil
rates are obtained at each percolation test hole. A data to e submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REWIRED TO BE SUBMITTED_WITH.APPLI.CATION
DE9CRTPTfON" OF': SOIL" EREI7 "T1V T S't' llb E
DEPTH HOLE NO. I HOLE NO. HOLE NO.
G.L.
6"
12"
18"
2W1
30"
3611
11.2"
48"
5411
60"
66"
7811
81E"
............. INDICAT-E- LDTEL = =AT- WHICH - .GROUND -WATER IS ~ENCOUNTERED_
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date 4.. p c• r 1 �.'�� .
DESIGN
Soil Rate Used°, — Mirj/l "Drop: S. D. Usable Area Provided
• PQ �pFE
No. of Bedrooms] Septic Tank Gals. Typed .
Absorption Area Prov ded By 2� L. 11 �idth Trench.
Other
Name S1
Address 4 i L� r!
1 U, �\ F
THIS
SPACE FOR USE
BY HEALTH DEPARTPENT
ONLY:
Soil
Rate Approved
Sq. Ft /Gal.
Checked by Date
r
i-
_._ __ = PUTNAM° COUNTY' DEPARTMENT - -OF * HEALTH - - - -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Data
Re : Property of H I-_--16hCLS
Located at LAY.e--PCQ,,-1 PLAC-
Section_Block 3 Lot
Gentlemen:
This letter is to authorize 4OW-Ag-b J r+
a duly licensed professional engineer ✓ or registered architect
(IndicaTe-7-
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
' epari t Het11t11, and to sign all neueasary papers on my behalf in
Lc 1 tuicil� vi r
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=
tart' Code.
Very truly yours,
Signed
QROFESSIo
N
OwnbT7 Pr p r y
Countersigned:
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'• \e 18 "•30' BLDG. PAPER COVER
i. • r' . h�, . ''Q.t:A:lyQ- �: r4l rK';P.'}'t C. D OR HAY
P F R FOR ATED 9"
14 /• a. `�,_ �.l I e�'i PIPE
CLEAN GRAVEL OR
• J ' t �..1 ._ -�_- Qom, L.IJ C. A„! La � - 24 °MIH to �6" .{ CRUSHED ,STONE.
asc ?� \ --- iUr_�E.�z: ABSORPTION TRENCH
�' t. • o �? ° t I ,` L •. 4 f lit• DNSY97EAI :TO,BE CONSTRUCTED IN ACCORDANCE WITH T,HE RULES AND
APO, DEPARTMENr-
I REGUt ATiONS' OF THE fJ.y f N 4M GOUNiY
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OF HEALTH
yr c[ i SYSTEM $HALL NOT "gACKFILLED -U TIL INSPECTED. BY •DESIGN
ENOINESR�.AND ?ME LOCAL, HEALTH DEPARTMENT 1F•'REWIRED.
" ` + v •:.`'` �'- ` 3'i+AL.. 1 `,. +} �',CT.131972 •SYS; -6M T'.o.;coasrs'T OF,:A •� X00•. GALLON SfPT.IC'T'ANK
+ri as�r S:6g "o[ e?+s I`F /idWpj . AND'n*AO FT. 4F. _� FT. TRENCH -WITH A MFAXIMUV
i t'~ J ' 1 'PUT AM C.JnI ,.rl t HEALTY
e n PITCH OF I / IS : PER FOOT.
DISPOSAf` SYSTEM GRADES REFERENCED•TO FINISHED FIRST
I sr' cmmeorlrieiuHEU?yssrvlrr FLOOR' "EI EVAt'ION ,UNLESS OTHERWISE NOT'E0.
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.Scn,Lliy 'HOWARD A.-- ..KELLY, JR
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