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BOX 18
02046
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date A rZ
le
Re: Property of
Located at
A/a
Section Block Lot
Gentlemen:
This letter is to authorize George A. Haughney
a duly licensed professional engineer or registered architect
(Indica�_
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
Department of Healtlt-1,'..and to sign all necessary papers 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
1�+7, Education Law, the Public the' . PLithdb, CbUffY--Sbxff_
tary Code.
. I
Very truly yours,
Signed O/W 464�
e f If
OF ne o P r erty N Yp 6
.... . . ....
.Countersigned: 13A /V
e s s
M., R.A.,
3 V 7�
Dykman Boad Seat-) Teiephone
Address
Pe 4. b l
�
0 �1,
Camel.. Now York
CA5-9353
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Li Q v o R / Address -23C7 moo, B1_ P?5 , G�co.vx
Located at (Street Sec. -Z .9 Block �3 Lot -�
�Indicate neares cross street)
Municipality. %A7T1- ",yo.t) Watershed .t/%
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Role
Number
CLOCK TIME
PERCOLATION
PERCOLATION
apse
Depth to Water
Water
Levei
No.
Time
From Ground
Surface
in Inches;'
Soil Rate,
Start -Stop
Min.
Start
Stop Drop in
Min. /in drop
Inches
Inches
Inches
\7 o
2
a= /Y -? :2c
3
a:
9/4
4
2:sc .3 fG
as
9
2
3
5
Notes: 1) Teskts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT, . DATA _ REQUIRED TO BE . SUBMITTED_ WITH APPLICATION-
OF 'SOILS`
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
6"
12 ".
1811
24" o�Rk GoA�
30
3611
42" GRou vD k/4 7---,
4811
60"
66"
72"
78•'
84"
-. INDICATE LEVEL AT WHICH GROUND WATER.IS ENCOUNTERED
,INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
'TESTS MADE BY . G !-/ Date
-is C ` L
� /L n � r"'71viu
Soil Rate Used / /
Mi i Drop: S.D. Usable Area Provided
No: of Bedrooms .2 Septic Tank Capacity 7s Gals. Type
Absorption Area Provided By /8o L.F.x24" width trench.
tOther
Address SEA�a
c i ` �a. ; • ` c� r
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �
Soil Rate Approved Sq. Ft /Cal. Checked by `'��r,,,,,,t,�`` Date
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