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36.41 -1 -49
BOX 18
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LILL
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SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
OFFICIAL USE ONLY
PHONE
PERSON INTERVIEWED PCHD Complaint #
ame & Relationship i.e., owner, tenant, etc.
DATE TYPE FACILITY P -B-o
PROPOSED INSTALLER.4 , k jri AA PHONE
ADDRESS � y q
TION#
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location
may require submittal of proposal from licensed professional /engineer or registered architect.
I' I •;� _ 5 A i ^. -.. �+ A ri ' I Vii`'
- - -4.-as owner; . r :p e D ant of owner agree o the conditions stated on this form.
TITLE .� : L.,L't -, DATE d, ',
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name
b. Site Street Name, Town and Tax Map number.
C. Location of installed components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved
� Q
Inspector's Signature & Title �/DATE///
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
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Putnm Courdy Depaftent of HeWO
Division of Environmental Health Service
Approved as' noted for conformance with
;;pplicablle Rules and ReCiukiitions of the
u n
m�amGo�. �a
Signature & 71iFe
31
Putnm Courdy Depaftent of HeWO
Division of Environmental Health Service
Approved as' noted for conformance with
;;pplicablle Rules and ReCiukiitions of the
u n
m�amGo�. �a
Signature & 71iFe
4 WOLF 845 228 0735 06/04/04 05:06pm P. 002
-P&UN-2 -2004 09:2'4 FROM:PUTNAM COMITY HEALTH B45 -279 -3578 TO:92280735 P:10110
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PC/ rl`iA/i/ ' coUwr , NrLY YORK '
SCA� E / ,,.^ 30,
Sold . map fl lea, Mo'cA POD /931 os Mop N^ 149-A
I
JUN -4 -2004 FRI 16:59 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P_ P
a WOLF 84S 228 0785
June 4, 2004
FROM: Gregory & Teresa Wolf
FAX: (845) 228 -0735
TO: Mike Luke
Putnam County Health Dept
FAX: 278 -7921
No. of Pages including cover sheet: 2
06/04/04 05:06pm P. 001
i
VIA TELECOPIER
RE: Property Address: 510 Lake Shore Dr., Brewster (Town of Patterson)
Mike:
The following represents a copy of the survey on the above property. If
this copy is not legible, please give Ed BartDs a call as he may have a better copy.
I look forward to hearing from you. Please give me a call at 225 -7007 or
before 2 PM Monday through Friday at 621 -0600. 1 appreciate your time looking
into the septic issue. Thanks for your help.
Sincerely,;
Teresa Wolf
35 China Road
Carmel, NY 10512
,THN- 4 -2G_M4 FRT i F+: SR TFI : R4S- ?7R -74 ?1 NAME: PI ITNAM rni INTV nPP0PTMPNT f1P P 1
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Said map Iil5d March 20,1931 os Mop No? 149-A
1,damas C. Edgetf, Me surveyor who mo&- Certified to: Security rWe* 8 Guaranty Ca�mpclzv
V
;Ictc ar Id, 4967
PRr 27 -4 --
•PUTNAM COUNTY- DEPARTMENT OF HEALTH,-•
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner I CU Address it, or
Located at V61-7
(Stree sk o ,rp �d, .]L Block Lot G ' - 1l
� n—dica e nearest cross s ree - (Sq - 155
3
Municipality pa4-+ Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
Depth to Water
Water Level
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop
Inches Inches
Inches
1 )41 114'5: 4
yo
/
3
4
5
1
2 \
4
Notes: 1) Tets'.to.be repeated at same depth until ay ximatelyy equal soil
rates are at each percolation test hole. Al a to be submitted
for review.
2) Depth measurements to be made from top of hole.
FUT"AN! 0 71 Y
.D I V-r S I ONT 0 L7 -I
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DrE S I G N ATA -:31HEEZET SEPA-PuATEE SEIIA,�_E Dig_ L S Y. S T _7 FILE N 0
o,; -,or R i3,qc- A ,AA d Address- P-277
7/0
Loc a te "2 a t S t t� 2 t )._ V z v Zza& -Z14 OCR: L_"L_ 0 t
#z & Sec P_ 7
(In _CZELt C�'O SS s
4-ct
ic ipal it Y_ _Q�VA 2,E 7a I easay Lersh
ed
S 0 1 fj PE P. C' n_T_..A T 10 T*--'-qT E"",
RE.911IR:-
D_ pr 1C 2TT r.)V
SL: 2
Hole
tee_' CFC,-"
-TTn\-
PEIRCOUA
._.'-'i1 E I In 05c
Leo
0
NO. T i r,
Fr o Sroun�
S:_. a c e
_: -I C'. s
Soil 'Da-te
S t a S t Oo %14L-1
st;m �7
S t
In C,-.. s
In
Ir.c..es
4
5
2
3
s
3
4
s
No -es :
1) -Tests to he repeat-e' sa d_8D-t-'h
-nS+ '�10
a'- e=c, I
Lain2"' L L 0 -2 00 0-;l
Ail d-:, t a t0 :D e s i b m a. t 't e '21 -or :'e`. e
TEST _?EJ -0 K ;K,TTTEJ .._ _ = ,PPLICATION
DESC.P T ?T T 0'.; 0� ,n - 3T , -10LE3
DEPT[ HOLE \O. .HOL s No . HOLE N 0.
G.L.
121- r
'18 TT
_�y- .�o��,__._.__
2 4'.
30"
3 0' _
42'.
4-3
6 0"
6 6'f
r2"
/� 1
84.
I \DICATE L= �'c.L aT ,:HIC r G?� \D r,, , T �� TS E \C
_ l r OL N- Tom.. _
I* D1C��TE L rL�� TC� .��I (�;i (���'^J- L�.`� j'L SZiS AF!_.IR. .TJ'L,`Nh EEN T7 'TL's! -i.
TESTS "'LADE 3 Date
IJ
Soil. kate '_'�_ ._ =7 - - -- "i7 /1 DNo,. S.D. L :s_�1e�__ ri
No. 0-f, Ee •_'OC7 -.a _ Sep tic Tc _ti Cad ___L Gals. T�,
l'_ 9oc� v
Absorption- cirec P1'0v1Qd By L.F.x2': 37�t/ i'.'1r.Tt h trench. Other_
Sj..—.=-ture —
Address � L ,;,�,g ��E. _ SEAL
PUT`a' -I COi \iY DL?`._ °.i" .:'T OF r•T l. "�`
t L ��
Soil I,aTe �ppYove!' Sc- Ft -Aal. Checkedr h_, Date
-
TEST PIT DATA.REQUIRED.,TO BE SUBMITTED WITH APPLICATION
_._... _ .,.r.:...Nr DE CRIPTTON'OF 'SOILS' NCOUN`T'ERED IN TE5T'_VtiTt'�': ...
DEPTH HOLE NO. HOLE NO.
G.L.
6" •�
12"
18"
24"
30"
361
42"
48'►
54"
60"
66"
7211
7811
84"
INDICATE LEVEL TO
::`TESTS MADE BY
ry- TND--WATER IS- ENCOUNTERED
�H W I G UTERED O t F/a•�. ep
to
DESIGN
Soil Rate Used -MM Min/1 "Drop: S.D. Usable Area Provided
No. of Bedrooms Two Septic Tank Capacity. 00 Gals. Type
Absorption Area P ov ed By. )_L.F.x24" _width trench.
� ,' . _ e _ _ Other
DIML — wnn n. rrenzi ss , r.t oigna7mre a
Address R. D. 6 Box 353
Camel, New York 0�
� � r
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Chec Date
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