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BOX 19
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02132
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CONSTRUCTIOI
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Subdivisions
Owner��G
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. W f0 *2
PERMIT FOR SEWAGE DISPOSAL SYSTEM / !r/�a al .0-7-7 f?
7 Down or village
.,per,_ /I�CZ� .�!. �....•"- �... tl. ...,..- .�....:Tax.Il��51.:. -.... - �:�._.� .....�..__..,lalc+ck..__.�r ..__....,..._......._..._ ._.....
C / ✓�')C+.fT.@7 //_ i .. Lot Job
Address
Building Type . Lot Area�i
Number of Bedrooms .4e Design Flow �f Total Habitable Space /-y�C Square Feet
t�
Separate Sewerage System to consist of Gal. Septic Tank and
To be constructed by Address
Water Supply: Public Supply From
Private Supply to be drilled by
Address
i
Other Requirements
1 represent that 1 am wholly and completely responsible for the design and location 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" Pe Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, h Abs . ns ,nth uilder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two r6s d aLe®1 4p wing the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any re irs r a tp ed well described above
will be located as shown on the approved plan and that said well will be installed in accordance with theetar�das, rules ari.iaula , ons of the Putnam
County Departure t of He Ith. „r,�,'✓ �_ ; � , , ti� � , � a � /
Date Signed P.E. R.A.
Vyl
Address �✓' �i9 ly "t?ti l i ,�?, v #�o' Licers$Ib.2"�f��
a � a
APPROVED FOR CONSTRUCTION: This approval expires year from the date iss ed unless con thA�tfttildiri�s °been undertaken and is
revocable for, cause or may be amended or modified when nsi red a ommissioner of F01 ° °„l�r��Octreflgq�op.'alteration of construction
requires a new per t. Approved for disposal of dour �nita se f ge, d/ private water supply °!glyF'F cl>\� P
l _, Date 1 By •
!S
0
This letter is to authorize -4>'%
a duly licensed professional engineer Pell
or registered architect
(Indicate.) . .
to apply for a Construction Permit for .:a separate' .sewerage. system; to
serye.the.'above noted property in'accordance with the standards, rules .
or regulations as promulgated by the Commissioner of the. Putnam County
Department.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, tha'Public.Health Law, and the Putnam County Sani-
tary Code.
-- .... _ _
.......... ..
Very truly yours,
C/
Countersi'ned:
P.E., R.A., #
Ad ress
'eleplione
Signed
Owner oi' Property
A dress
7 S-14-1 Ys
a z Telephone
• '�+epnES3�'`.
1,7 17
PUTNAM COUNTY DEPARTMENT OF HEALTH
DNISIQ! OF ENVIRONMENTAL:HEALTH_SERVICES
:...... _... , _.., . - 00 UNTY'
DESIGN.DATA SHEET-SEPARATE SEW. GE DISPOSAL SYSTEM FILE NO.
Ownelf�rg��hn Address
Located at (Street CI Wn Sec � Block 1 Lot �-5 �
� � ica a nearest, cross .street)
Municipality �/�� _ / __...,..
SOIL PERCOLATION TEST DATA REG IRED TO.BE SUBMITTED-WITH-APPLICATIONS
Hole
Number_ CLOCK TIME ___... PERCLOLATION....,.. PERCOLATION
Run Elapse Depth to Water a er ve
No ... Time. From . Ground.. Surface, jn Incihe s Soil Rat
Start -Sto p Min. Start Stop j
P Min. in drop
_-Inches Inches...... ..Inches
�> 1/:37 / ..rte .. 1.
Notes: 1) Tents 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
DESCRIPTION,-OF -SOILS ENCOUNTERED. IN-..TEST HOLES.-,
G.L.
"COO,
6
1811 . _ ��1� :� mQ� -
2411
3o„
3611
4211
4811
54
DESIGN
Soil Rate Used 7- min/l"brop:- S.'D.' Usable Area Provided
No.'- - bf---B6drooms Septic Tank - Ca �a-qity -zc�'ci 0- 'Gals Type-
' 11 p
Absorption Area Provided By., �Cy, L.,F.x24 width Tr_e_nc_F.__
N-amb- Signat!!-F 'T 1
L/
Address Z9? 2 1:;W^ 0""0'+- V S E A Llf
V70
THIS SPACE FOR USE BY HEALTH DEPARTMENT -ONLY'
.Soil Rate Approved S q; FFt /Gal: Checked by Date
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