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02626
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02626
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PUTNAM COUNTY DEPARTMENT OF HEALTH
Rev. 3186` v \� Division of Environmental Health Services. Carmel, W.Y.10512 Engineer to Provide Permit q
- -- - .. on CERTIFI
TE OF COMPLIANCE
CONSTiiUCTION PERMIT FOR E DISPOSAL SYSTEM C
J tnam Valley
Located at Wi rrc[ppP Ron Town or Village
subdivision Name Wic=ee Estates II Subd, Lot # 5 Tai Map 19 Block 1 yet 16.5
Owner /Applicant Name
Wicco P ee Estates, Inc. Renewal_❑ Revision rX
.
Date of Previous Approval
Mailing Address 44 *North Central Avenue Town Elmsford ZIP 10523
Building Type 1 family residenceyat A. 7.676 ac + Fill Section Only Depth Volume
Number of Bedrooms 3 Design Flow G /P/D 60 gpd PCHD Notification is Required When Fill is completed
Separate Sewerage System to consist of 1000 Gallon Septic Tank and 429 L.F. X 21 wide trench
To be constructed by to be determined Address
Water Supply; Public Supply From Address
or: X Private Supply Drilled by to be determm
Other Requirements
represent t a I 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 and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
wilLbe located as shown on the approved plan and that said well will be installed in accordance with the standards, rule nd regu a� ohs of the Putnam
County Department of Health,
Date Z d i lb ' Signed P.E. X R.A. -
Address Cashin Assoc.. 37 Fair St. Caren .Y. 10512 License No 26008
APPROVED FO CO TRUCTION: This approval expires Ole yea from th date issued
revocable for se or a e amended or modified when cons tlere ecessary b the Cor
requires a n ermiiit proved for disposal of domestic it sewage, r r
Date �v By
of the building has been undertaken and is
of Health. Any change or alteration of construction
supply only.^���
Title �' •
PWIAM COMP 'DEPARnIDU OF. HEALTH
'DIVISION OF 'RMRUZZ9M HEALTH SERVICES
Date
Re: Property of � C�T�7 5> k--k_ -
Located at W� Q—�E�
M. -PL.5TQ4<,1--k VALUtq Section Block Lot
Subdivision of
Subdv. Lot # Field Map #
Gentlemen=:
IhU'* letter is to-authorize LAS � i &A
a duly.licexiw6d Profesiional Engineer X or. Registered Architect to
apply fora COMM=tion'.Permit for a separate sewiage system, to serve the above noted
pr6perty in accordance with the standards, -rules or regulations as promulgated by the
Co=issioner . of the Putnam Co%mty Department of Helath, and to sign all, necessavy papers
on my behalf -in connection with this patter and to supervise the. construction of said
system or system in conformity with the provisions of Article 145 or 147, Education Law,
the Public Health...TAV;, - - and .. the- Piitnizn-
Countersigned
6D R.A.
T
ess
Teepnone
Very truly. yours,
SIGNED,
Owner of Property
qq /oc
Address
2- P
TOM
Putnam County Department of Health
Division of- Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER- APPLTCATI.ON
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY 11EALTH DEPARTMENT
TO: Commissioner of Health - In the matter of application for
--- - - - - -- — — — — represent
that I am an officer or employee.of the corporation and am authori.Zed
to act for—(name—of corporaton)—
having offices at 44 A --------------------------- .
6_MSFbPr/ WEv4 Ypr_ /_- G15L'�j_ _ _ _ _ .whose officers are
President Or-, lAFE!i�, V-1 CS
?Name and Address) — _ — — —
Vice- President _ — — — — — — — — — — — _ _ _ _ _
— — (Name and Address) —
Secretary — — — — — — - -- --- — — —
(Name and Address)
Treasurer
(Name and Address)'
and that I am an will be individually responsible for any or all acts
of the corporate n ith resp ct to the approval. requested a d all sub-
sequent .rel t'ng then to
r to before this day Signed_ _' _ — — —
of 19 Title __s} ________ __
NO.
O
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A
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Corporate Seal
FUTNAM• JUNTY ,DEPARTMENT •OF HEALTH.
• DIVISION OF ENVIRONMENTAL HEALTH.SERVICES
COUNTY OFFICE BU-ILDING,-�; ARMEL,._N..Y. 10512
DESIGK .DATA::SHEET- SEPARATE. SEWAGE DISPOSAL.SYSTEM FILE ANO._
Owner icc0tP 1'�Ct I t C- ?Cddress,�f�i o�'g'6�..[.�+�Y� L. Ay..:,. �P�'S1F���G' PJY.
-� � 1os23
Located- at:...(Street re -e- l... Se -o. j Ct Block ._Lot:...
kindicate nearest cross -sTr-e--pTT
Ntunicipalityi .. puT•N A-(YL V 14L LE Y 1�latershed <
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED.WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Mpth to Water Wat6r ve ..:.
No. Time From Ground:,,Surface.in Inches Soil Rate
StartwStop. Mina Start Stop. I?T'oP.. ??. Nin. /in drop
Inches. Inches Inches
11/ -4216.. 3�0 1-7 /Z
l g
=r
xzl
0
Notes: 1) Tests to be repeated at same depth until,appr t y equal soil
rates are obtained at each percolation test hole. A11 tM the �ubmittod
Gor review. -+ Cr)
2) Depth measurements to be made from top of.holX —<
7
2d ..'
..3 �Zs
41 ._ y
s��
172
2yy2
1 115 .— :121:1 ...
<Sl
l�'
2 17
.
l g
=r
xzl
0
Notes: 1) Tests to be repeated at same depth until,appr t y equal soil
rates are obtained at each percolation test hole. A11 tM the �ubmittod
Gor review. -+ Cr)
2) Depth measurements to be made from top of.holX —<
TEST PIT; DATA �UIRED TO BE SUBMITTED.: WITH- ~'LI.CATI'ON
DESCRIPTION OF SOILS. ENCOUNTEM,4- N TEST • HOLES
No., of Bedriodttls.:::'' Septic Tank. Capacity, /Oo C91s.
Absorptior `li,ea Provided Byy24
tva►uc �/���•(LV ' /7� �C�C_I /t/ G� / :G., / Ui�yxs�uty . �-
Address rA 0, ST'- SEAL
T` No. 260
THIS SPACE .::�'09, USE 8Y HrALTH '. DEPARTMENT ONLY of THE ST
Soil Rate Approved Sq. Ft /Cal. Checked by, Dste
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