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02087
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02087
7
P -NA T,
UT -M COUNTY.,"D19PARTMEN, .',OF '.HEALTH
x. I�ia
,D idronm 1 12"
IRS, O�Mq
Division S�r'�k -:64 1i IV. Y. la
.d 6�ttR'UMONPE RM OR EWAGE DISPOS AL SYSTEM
P
a t t
erson
Jasper
' Town or
,village
T66d Tat PA a p
sion* L
6' Ernest- .4' .
An r Adbress U tnam,la A
Building rN, pe vLot Area
+
`k Brews NY' :10509
Three De—sign-
,
FI o 2% o . Bedecons , p Feet
7x
Separate Sewerage System to Trench -
consist j-
,
T
construed by
j
-Water.'Sup'ply:
lic - 5upply Frorri
Private Supply up ly to be clrilleid by
Address'
Re'O'uir
Other - her� Requirements None
S
I P M" n t ha t." I clesign,Ahcl location ,�,o Ahe, proposed �.systerr(i) 1) that the,sepai`M6 `se� 6ir,ld I ' 6 6 1 Sy
above �;O�,whoLlly-_41 . r
-W ' H ' I , be .46��*pj�jovbd a;m e n d rrii� ni there: -.to 'a nd: In accordance - With the itiridai' ,Ahe Putnam -
clekhtied' t4d,a.s'shown.ori . _ fIj the C6 L ' 9 j -, r ' -'- - . - I
cpnstr.u4 standards; rules and regUlations,of
py' - ' "' LL * '! t ;i� z f f, satisfactory Mi
niV�Diepiihrrient ; of ,Health,' and 6a n� completion ihereo4
"Certificate --d , Constiudtloh Zornpl ia nce!' , m S_1011_1
or I the owner' heirs 6r asiignS_6y-.ihe:bbIId6r -,th said 'I
place be Submitted to- the Department; and, a,',vy will be ftitniihk Successors,;: eirs, builder,wi
6 of the isiu.
in ;§ddd operating _ccIrIditioA any- part d: sewdge9:d6p'dSaCiyiiem d 4"1 late�ly'. f6l 16W ing`,�ihe te
uring he period,of--two (2) yea(.s imm6di.
'-iince ,.of-. the approval of th-ii certificate o -..Construction Compliance -6i ihe'oilginal system or any repairs thereto that-the drilled WellAiiscritied atiovi)l
Will be t ih
Ions _
"t 16 he -standards'%.- rules �apd'_' �qf,
_,Will'be l6cated'as.sho*,ri on 3 iii�pto�6d, plan- aindjfik sifiii:wel'i lnst�,qe -jin accordance u e Putnam
,.,,,.'.:..
L- j of PC rec
Date M
6ounty-, Depart en
7
-
S t; 9
A b A.
78:�
P
Z2 ""
E,
R.
-e License se No-'
2.92096-1:
C6 the
_ I I" '-,T I s:approvaVexoWd'
�IAPPROVED FOR ti. I - �
s one yea. rorn' date Issued un-lis _ construction" of the building has been undertaken and
A,_
revoca- he, o 0 1 ie w r e ' n co'
b rr, usii,� r may amended-ciirrn 'Iiflid h nsidered �y the -of-, nst ruct io n `
necespry b Fo,
,.'ngg:or alrt,era9t ion
utres a new'.per 'it. d for disposal A tai wag 'iriclj.' Nat 'r
15 IS; 9 1W , "
m r u y nay ppr
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Title.
PUTNAM COMINTY'VEPARTMENT OF HEALTH
DIVISION OF-ENVIRONMENTAL HEALTH SERVICES
Date— %B /7�
Re: Property of AXwe A-
Located at
Block Lot
Gentlemen:
This letter is to authorize John H. Prentiss, P.E.
a duly licensed professional engineer XX or registered architect
(Indicate).
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
DeDartme . ht of Health 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
147, Education,Law, the Public Health Law, and the Putnam County Sani-
tary Code.
RA 9. Fair .-Street
Camel.- MY insiP
014-�8`786_6170..
Telephone
!N&S-Wo
Very truly yours,
Signed .Z
Owner oF Proper
t�,'
Address
1).9 -
Telephone
1°'�w
PUTNAM COUNTY P IPARTMCNT OP HEALTH l
DIVISION. OP ENVIRONMENTAL II!WRIi 'SERVICES
COUNTY OFFICE - BUII DIMG ` CARMFI ,
'I4N DATA SHEFT- SI♦P,ARATE SEWAGE DISPUSAL, FTa NQ.
Address
oat d at St reef �,.�C'elf l�ri ✓e B1pok, _Lot, 1'';�
ride c� aft � arts ar�is$ a red
.. l P`r'_— �i� .� �y 11"• I `A Y�AI/IIYq�Iw1����t1
BOIL . COLATION TEST TA EMUTRM TO M SUBMIT UITH ®prB
Old
LOCK TAME FERCOI ATION
o va er a er ve ,
X.
Np. :, me Frain Qp
r .. �.. . • Creu .Nli,a.
i 6
rt -Stop St Drop n $ta �
Inches bsti qs I n c h ®a.
7.
�
• , .. II.Y I 1 111r1 ,I r I,P Plln I 1 ��IIRrlrlj 1 '1 �lir -. iMT�>•PI .
.. .....
ci ''I•%
N ®ter 1 Tests to be repeatiad at aa►ne depth' ur tia a p.�rc tell i� t I
r. or obtalneo At each p ®rcgl�tioni tQOZ hplap tee 1 ¢alb
Ili R/r /� S•I
OW
0 • , • 1
Mpth niQheuremente to be ,made•• frm Op . �f hiA.e,p : ':�•� ,
d ` >., .
DEPTH
TEST PIT DATA RHQIJIM;'J) '.V0 11',; 51M,7141)"I".1"I'M 1. 1,T]i APPLTONVION
DE13CRj*PTi01Tq 0Y., ;?01111111
H0I;L-,, NO. Hou,", 1":O.
611 4--V1Vie 5 "A
.1211
18"
' .
211 4
30"
3611
42"
4811
5411
6011
6611
7211
C-ow owl.? -w
78
841-1
INDICATE =T-EL AT WMICH GROUJ,'D WATER IS EY1C(,V.c,,)THTC---D
INDICATE =L TO MUCH WATER 12VEL RISES AFTER PEl"NG ENCOURTEREDA/age
TESTS MADE BYhee
j0Z78
f
DESIGN,
Soil Rate U[sed //-/fNin/l "Drop: S.D. Usable Area Provided--,�Oev
No. of Bedrooms 71vee Septic Tank Capacity 10ea, Gals. Type
Absorption- Area Provided By P�L.V.x24" ✓ b width trericoll.
Other-
Address R,Ll, 9, IF-air Street
-'arm..
THIS SPACE FOP, USE BY FEAUTH DEPARTMElff 0
Soil Rate Approved Sq. FL /Gal. - 26
OF THE ST
4
31M
Date
11
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