HomeMy WebLinkAbout2670DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
61. -1 -17
BOX 23
f ' loo I
is V:
oil
0 or
a
or
;1
02670
a
.1 iags
Block
06,
Square , Feet
low
iage ,cl i stip'sa I' 'System
Dns,o e, , Outnarn--
Won& of -Heal thwlil
that said builder• will .,,
ithaida'taoi tha-Issu
Ov I.A;sc '-
I O'l 'ilbed'
r—Of the-, Kitn,im,
n,,,u ndertaken;. and 1s;-
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date /
Re: Property of
Located at �iCi/? e,,,/�11 -.0 e�✓ 1,�� G'�
v
(T) z 222KL-22 4�6e-- Section 6-7—Block Lot �-
Subdivision of
Subdva Lot # Filed Map # Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer ;11�or reg:
(Indicate
to apply fora Construction Permit for a separate
serve the above noted property in accordance with
��/�' ✓dam
Lstered architect
sewage system, to
the standards, rules
or regulations as promulagated 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" - syst'6ars- -in conformity with" the 'provisions' of Article 145 or` `
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
;'X... o. Signed
OF REP mo Owner of Property
Countersigns boo,00,�o do o .
P e E ° , R. A ° � � �
�' A,ddddress~s�
� �., '' a a ✓ ��/ /'ice% 1 G' <.G��
Add e s s Igr, :•q4 Town
L C
Telephon-
TeIlephone OCT 8 1982
PUTNAM COUNTY
DEPT, ®E HEALTH
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING,. CARMEL, , N. Y. 10512 r
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner�61/ Address 0�' Il�
Located at (Street zV,,v Sec. J-7 Block -01 Lot
n lc e. nearest. cross s ree
Municipality. 1,17l E Watershed
SOIL PERCOLATION TEST DATA - REQUIRED TO BE SUBMITTED WITH APPLICATIONS
oe
Number. CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to a er a er Level
No. Time From Ground Surface.in Inches Soil Rate'
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
2
5 ..,
5
Notes: 1) Tots 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.
G.L.
611
1211
1811
2411
3011
,3611
4211
4811
5411
6011
6611
7211
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN.TEST- HOLES
--jib " NO HOLE NO HOLE N0 .-
'(811
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
e-.
INDICATE....LEVEL TO WHICH ATER LEVEL RISES AFTER_ BEING
ENCOUNTERED
TESTS MADE BY
:I)at6 p j0`
Soil Rate Used
DESIGN
Min/1"Drop: S.D. Usable Area Provided
No. of Bedrooms
Septic Tank Capacity /000
Gals. Type
Absorption Area Provided
By Apo L.F.x2411
width trench.
Other
ame 3 o
na I
D'I yra, Signature,
OF E
Address
yor if .+-a
w �+5t
THIS SPA FOR USE
BY H EALTH DEPARTMENT ONLY :
Soil Rate Approved
Sq. Ft/Gal. Checked by
4,, ZZ
Ak 0 246
. 0 ate
RECEIVEK,41
OCT 8 19,,Q9
PUTNAM COUNTY
DEPT
, QF HEALTH
112,17 /1"0.02 A(
ji
60
i 4q
19
ti