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631- 589 -8100
36.40 -1 -10
BOX 18
1117. It '�- 1 I rr
96 Hj
LLb
02022
Y
e ! 5;�' Division o1
I
Yy
CONSTRUCTION- ?PERMIT FOR SEWAGE
Located at�ai�! °n' Vl�V
Subdivis , x "
Owner
Building `TYPe.
'Number of Bedrooms - ` Des+gn
- Separate Sewerage' System
in cohsist of_�
To be co;nstructe'd by
Water Supply Public .Supply From
Pnvate Supply to be dri
aAddress
a.
Other Requirements E _'tea 1�1 T
• k
1 represent that I��am wholly and ".completely `respons
above; des, ribed -will be constructed as shovrri on the;i
County Depart "meet of Health, :and'thatFoh comp(
be submitted to tfie Department" and a w'ritten;,g
w..
' ;place �m good :operating' - 'condition any part 4? sa,
ance of the approval of 'the Certificate 'of Constr,
Will- tie.iocated as shorvn on'the approved plan and tfii
County bepartment of 44ealth:
Date -
z k
Address
APPROVED FOR CONSTRUCTION This approval
- :revocable for cause�or may, e` amended or;modifid0
requves, a' new permit. ",ApproJed�fpor disposal of
Date C,
i
i
S
f
JTY DEPART T OPU COP N P HEALTH
•
DIVISION OP. -' ENVIRON'MENTAL HEALTH SERVICES
Date
•
Ras Property of
Located at
1
Section Block Lot i Oi ko2,
Gentlemen:
f.
This
letter -is to authorize_ 1�)F_Kj'.
j A,621_i Ar ;M i IR12.�,: �f
a duly licensed.professional engineer or registered architect t,-
(Indicate)
to apply for a
Construction Permit for a separate sewerage system; to
terve the above noted property in accordance with the standards, rules
.or regulations
as promulgated by the .Commissioner. of the Putnam County
De p artment of Health, and to si n all necessary papers on my behalf in
connection with this matter .and .to supervise the const-ruction of said:-
: - system or *s steins 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 yours,
Signed
Owner of roperty
k
Countersigned:
Address
F.Fk9$ R.A., #.
A �-
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°"t rNE ST Telephone
Address
B D
elephono
t� � e °yANI CS. J L 0
• p� °i. OF HEA i t-
'y PUTNAM COUNTY D4PARTMENT OF 1iEALTii
DTVISTON. OP ENVIRONMENTAL drALT2i 'SERVICE:D
,OOUNTY...OF'F'ICE SUZLDING; CARF.L � *. - -'Y'e
VATA . SHEET - SEPARATE SDXAGP; DISPOSAL. OYST M F X10
Ail
1�►r � -YY%i '�%ii�t��,1� %7���;� GIfY) Adc�r��a�
,.
Ind-
ca e n eras cross � rea
r 160 Watershed
r'
S011i - COLATION TEST TA RSUIRED TO VE SUBMITTED UITH . Ar S
�h • CLOCK TIME PERCOIATION
�d�o .• :.. .m� ►om Oro=d Sur 3' ce' in Inches . 5��:�. hate
Ot t -Step alp Start Stop •�pP in:' :, lie. /4n
Inch6s Irnche Inches..:
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QF • / t . ,Ih� It .. .. ... - ... �•J • T • `
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HEq
Hatema 1)' Tests to tie x°a atecl at saro.a de h' ll�n , �. a 03��6
f . tQI Q �.
®i aoa are obtnd ®�ua� O a �
or ra eu.
Wpth nionsuremexnto to be ,made • °sum tip . ��' e
1
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TE,ST P*rr 'I'D PX
C I.? J. I'll -1' G, I i OP .13011,, HOLPS
DEPTH HOLE, NO.� HOLE PLO. 11OLF, NO.
G.L.
'611 All"
.12
2}+"
3011
36„
.4211
4811
54 ff
6olf
6611
72 11 -4
781f
8411
-INDICATE LEVEL AT WHICIT GROIJIT) MATER 'Is EPTCOUIPITEm-7)
INDICATE LEVEL TO WI CI WATER LEVEL RISES AFTER BEING ENCOUNITXRED
TESTS MADE Bymm Date
DESIGN
Soil Rate Used j Min/1 "Drop : S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity Gals
Absorption. Area Provided By��Z,,---,QL.F.x24" j b"
e
Name -71-Aia S i g i i -a t u r e ✓
X.11
Address 114A—x'111 SEAL
5/d &94, ILI
THIS SPACE FOR USE BY hEAU.111i DEPARTME11NIT ONLY:
Soil Rate Approved Sq. Tt,/Gal. Checked >jy Date
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SITE 8k SYSTEM PLAN!
20 SCALE
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536°25 �30£ /0.00 �
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SURVEY OF P
PREPARED
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