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HomeMy WebLinkAbout2751DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -15 BOX 23 02751 I,yti � ' � r 4 -A jjK T 02751 iPQ!l�IAY oomrrlr DSAD'1f�lf!' DF � . ohm= mmod Bad& som6m ctia" xT. lun 4= OPCOMPILLAM rounko 3 COWnMM Purer M UWAU Drlo.AL U� pA . � .. s. - - •�- - .i .y ov - s . i . �-- C�:-�� - .. �� ii`+rii'' �t ��i�--- r-�'.� ...,.�.r.._, . _ ...... Pia -JId11IL I.t f lk TAIZ N&AP 51 3 '� 'M Ofser /A�tdatK� LGJ.I 2I7 ���� Rwawd_❑ b.ldaa ❑ Data d�erN�a A!la�r Yay AdioM / /A� `t � � � nP Fee En os d I++rs syPa�G�J► Dt LI ALA Sat Asea � ���.,,1 �G pB oidy LJ D.& Vdr llallliar d Mia�a_ Datdgl Plow G P D ��� PCBD Nalmtlan b Rogdmd W� M Y eaa�MM/ 5"Mr a Swaaap S7om is am" of OH � =— Sept Tuk i1 To WOMWN*W.IW wow sgpl! : Pie Sq* 1kin � Adhou Sop* DOW otyr 1fa�aYa.a.ta 1 represent that I am wholly ane completaly responsible for the desion and location of the proposed Wdem(gs 11 that the M crate Ywa • dls oYl s slam Some described will be cond►uded as Shown M the approved amendment there to and in accordance with the standards, rules in raps Ona O a Oawlty Deportment W Numb. and that M complatlon thereof a - ,c"ficato of Constructlen CompeanM" Satisfactory to the COmmlaalmler of NeaNhMll M nlbamud to the D"WWAIW. aM a written OWWAOS will b• furnished the ownw, his waaessora. hers Or asagns by the 6UNW, tent uq buNew will pros in one .dparaltnp O0"R$M, any part Of Yq sewapa dkOOYl System du►kla the period of two (2) s bnnimutely follewinil the date M the New MM Of the eppevat Of the Certificate of Construction COmplbnee of the Original system or any rep ) that the drNIM we descrbM above well M gaatJN�as if1aM11 M the applOred plea and that Yid well will be Instal �inrwa A the Ies and rq�Ons $f the pYtnam e wdy 'J � 1 Date liignad ►.E.�� 11.A. _ License NO APPROVED FOR CONSTAtICTIOaI: Then aWWMI expires bovo years from the date issued unless construction oft bulgblg has been undertaken and is mv* Mlo for Cities or my be ameaded Or modified when eonsldwed nec ry by the Commissioner Of Health. y Nhanga Or ahe►atlen Of construction tomwim a now parmN.. Apialwasil for disposal of domestic unitary sawap. and/or prlvete water wisely only. DEPARTMENT. OF HEALTH Division of Environmental Health Services 10512 (914) 225 -0310. 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Addr ss Town Village C ty Tax Grid Number WELL OWNER Name 121 Mailing Add ess a-Private -' 0 Public USE OF WELL 1 - primary 2 - secondary "SIDENTIAL ® BUSINESS INDUSTRIAL ® PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, U INSTITUTIONAL 0 STAND -BY AMOUNT OF USE YIELD SOUGHT 1J— gpm /# PEOPLE SERVED /V /EST. ® REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION M&W S PLY (NW DWELLING)- ® DEEPEN EXISTING WELL OF DAILY USAGE.$13�al D ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED ®DRIVEN ®DUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT'TO FLOODING? YES L/"NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:,'��= Lot 'No. a_ WATER WELL CONTRACTOR: Name -'�� �r17 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE.: YES I,-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM - NEAREST WATER MAIN: LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a.form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 4eo 199 Date of Expiration 19 Permit Issuing Official -� Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located a t e::5jS f1'r— L LL (T _?± Block 3 Lot Subdivision of �J' 1�►i�T���t`1 _____ Subdv. Lot # - -Filed Map # Z 12 0 Date TZ 18 Vr Gentlemen.- T. MICHAEL DALY, P.E. CONSULTING ENGINEER This letter is to authorize P. 0.6©X,243 s 87 a duly licensed professional engineer V/ or registered architect (Indicat e to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with'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 syetems "in conformity with the provisions' "of' A`rticl'e 145'0r' - 147, Education Law,.the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, S fined�G. Countersig d: Gl%G� Owner of Property P.E., R . A . , # �/T Z AuV1r���ier /fl�lw/� Address T. MICHAEL DALY, P.E. CON9111 Teaar Address Town P. ®. BOX 243 SRENOROCK, N. Y. 1 0587 94- 4 7.2 '3.2'9V 9/-0 - Telephone Telephone 7 77 0dw RMINOW9,61111196. 7 i "WesenCtitat I afn fa�'ii�6d"n and socation of the Propotdd systomms 11 that the separate. so . w"0 dimagol";St abbe daavnj®d �jjjl be 6o.Wjjrud4d as i4o,�PnIiiwi the jppqlmgid a"ndIn Countit bopoirtimeint . of "ft- R-h- and iornilwiciihomf a I IC in -milmmiadio"t" 08m) 60,964d opoiatb* CMdRlOW,&nV,,plot di o90 arm of tho :ap p rows I of tk'@.'C or tificitq; oftconstiuction- 64066c an be COL-tr ctto .3 1:-Q 9 - - � - - Address- aPPR6VEIDFiOlICONSTPL4CT,OOM:Ttbisalwqcii4ii. pl!"!!.",10•0!15, nVOC6610 for cauee Or Imy 64 ii or ivimifiiiii , conikiored i mQuirso a raw OR it Awovea.-for disgoealof domodicun" Rev. to and in accordance trim the it duriM. the Period Of WO (2) VQ "ingl* i br ally reW1751M ulactory to tho c6mmiswonev Of mealthtjill imigno.0by *0 bulidw.,that tabs bvimw Will 18taiv volt"ing tho.dato of.tfto IM11- 2 that It 01106d Wall de=M" 060vo on no t e Fwmrn P.M. - M.0- fAl., e No 4h® date isn4ad unless (onstruction of tho budding .has bcon, undortatten, and in ary by live Commissioner of Health. Any Chonip Or alteration of construction water ou"Ov only. T1200 r a PUTNAM COUNTY DEPARTMENT OF HEALTH Date Re: Property of Located at Block Lot � Subdivision of Subdv. Lot Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSUILTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOROCK. N. Y. 10SR7 a duly licensed professional engineer or registered architect_ (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with 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 I._r._ .__.... eonnecti7am -- i h- mutter GTLd to supervise tie construction of - z aid 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. Very truly yours, r fined , Countersign e � Owner of P operty P . E . , R . A . , # ' oC Address x � G�A�S'DAG� Al /0 ,S83 Address Town Telephone Telephone `. PUTNAA4 COII1vTY DEPARTMEPIT OF HEALTH R V . 3186 Division of Enyhoamentab Health Services Carmel 'N.Y. 1051? on CE STRUCTION PERMIT FOR,SEWAGE,DISPOSAL SYSTEM ee to provide Pernilf iY Baildbng. Type t� u A� Lot Aream' 1' 6i F111 Section Only Depth dolnme eted 1Vamber'of Bedrooms Design Flow G/P /D i0:(7d I�CHD'Pletl/Oca�itloni� Reaali<od When Fill is'compl Separate Sewerage System .to consist of Gallon Sa ptic Tealt ane i,9 L G 1(� To be construc by U c� ��' Addeees ted - woter. Supply. Mflc SaWy From Addee®s or: '� Private SgPpIY 1)10 ed by - �ddeese Other; Requirements I represent that 1 am wholly and completely responsible for the design and location Of the proposed systems) 1) ,that the separa a sewage disposal System above describes will be constr "ucted asahown on theapproveq amendment there to and in'sccordance with the standards,,►ules an regu a ions o e u nam County Department of Health, .antl thah.,on completion thereof a Cerbf�cate of ConstrueGOn Compliance satisfsitory to the Commissioner of, Health will be submitted to the ;Department, and a written guarantee wmll be furnishedWtha owner; his successors, heirs or assigns by the builder; that said builder will place' n good' `operating condition any'p5rt of .fa id sewage disposal - system;. luringIthe perio0.of two,(2) yearsim diately1011owirg ; thedate Of the issu- agce of the approval of the Certify cafe' of Construction Compliance of the grigmal system or;any repair theret the the drilled well described above will be located as iharirn on the approved plan that, said well will De; install o` ce ;wl the„ ` Bar"06 regu aeons of the Putnam County Depart ent f •Health P E. R. Date�'� 5�9netl . UUU R. ... Address License No APPROVED FOR CONSTRUCTION This,approvai expuei; , yearfrom the..-date issued unless construction ,the building has been- undertaken and is revocable for cause or, may be amen tledI-or modified when considered necessary,..by the.. Commissioner of Healt Any change or alteration of construction requires a permit. �A proved' for, d' 0 1 f domeiti sanitary ago -and/ a water .supply only. Date °� BY Title a WELL LOCATION Street Addres n Town /V 11a age Tax Grid Number W ELL OWNER =ZW= ing v %I? _rivate O Public USE OF-WELL 1 - primary 2- secondary XRESIDENTIAL 0 BUSINESS 13 INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL OAIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY 0ABANDONEp O OTHER (specify D AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE] j�gal REASON FOR DRILLING EW SUPPLY OREPLACE EXI OPROVIDE ADDITIONAL SUPPLY Q3TEST OBSERVATION TING SUPPLY ODEEPEN FXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES �Y__NO IF WELL IS LO rAT E IN JAL TY SUBDIVISION, NAME OF SUBDIVISION: L Q A- Lot No. WATER WELL CONTRACTOR: Name (3e CtIT il. Yj' tjh ,4 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION WN SEPARA E SHEET 1d- , /1. (afite) (si. ature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until.the water is clear. 2. Disinfect the well in accordance with the requirements of the' Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a fo:iermit m9bing nam County Health De artmen . Date of Issue: .Z� 19 e Date of Expiration: .lylg c a Permit is Non - Tra nsferrable copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: owner Orange copy: Well Driller i 77, 01 ' ENGINE # PUTNA COUNTY ®EPARTMENT ��k-LT�✓: ER TO PROVIDE PERMIT ON CERT)IFIC .E , COMPLIAN ' - Division of Environmental Health Services, Carmel, N. Y ,10512 PERMI1f CONSTRUCYIOPI PERfiNIT FOR;. SEWAGE DISPOSAL: SYSTEM 1 - Town or Villagb Located at Subdivision Owner /Address subd. Lot H Renewal _[]_Revision, ` ❑ Approval Building Type Lot �].�'G6V r 1�lt Fill Section Only Y ❑ Number of Bedrooms Design Flow G /P /D- COO O- H. D. Notification Required Separate Sewerage System to consist of `��L— Gal. Septic Tank and 4 Z LF� To be constructed by -T71 19111-D. Address Water Supply: Public Supply From �'� j�( •-� Private Supply to be r drilled by '5 t" ' Address Other Requirements I represent that 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 o Putnam u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the commissioner of Heaithwill be submitted do 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 i lately following thedate of the issu- ance of the approval of the Certificate of Construction. Compliance of the original system: or any repairs t, o; 2) that the drilled, well described above will be lo'Wted as shown on the approved plan and that said well will be installed in a col c witn a sta r s, rul s a egua i�'ons of the Putnam County Departm nt of Health. - DateS 5 gned P.E��.a_ _ R.A. Address O h License No. APPROVED FOR CONSTRUCTION: This approval expires.one year from the date issued unless construction o the building has been undertaken and is revocable for cause or may be amended or modified .when- considered'necessary by the •ommissioner of Health. Any change or alteration of construction requires a new penrrmit. Approved for disposal of domestic Sah ary sewage, a d/o riv a water supply only. �!�� Date?' By / Title A pit L�' Rev. 6/85 T P !!TS A sure plans 0. K. -r :sign data sheet_. :res presoaked? !n. 30" pert test; depth snit. results for; 3 runs 2C. 1 f . Hole log O.K._'' >rporate Affidav it-for or Mr than individ ual • lthorization for :engineer :tter from Water Supply iT app czo e variance reques ;ed -such noted on plans & apps.* rR Q6 rA L,CNN . %4 f.'rn 0 EYPAK%,g i AREA Q 1-9 IGf.iHTURE � b"L - OrJ P�A!�S -TAILS 5 LL Dr.p," RtiEA SNOT =ANC �y� �', <PLAN TO Be, rRW=n ED, Xisting contours;�hown (shoe new contours) lopes -for driveway cuts, etc. shown iter service line location )oting drain, et(","'. location 1 A )p slope, bottom•slope of Pill I 1 ,rcolation tests and deep test pit location I I :Dtic tank size 4,:: conformance to std. ! I B.R. housa rininjun / 1 )use setback sh&wi istribution box J' �. below frost hi ► l 'j`�`ft. ll water - with In of. PL shown - - ct.t_•CASIAG P,CSOVE' GRADC' - "- Plan and G r in SDS �....... pr1 ofil ....... ........ .. .... All other wells f and SDS closer 200, 1 shown or refe.- ,-ence made _ Property boundaries (metes and bounds- clearly shown ) 1 _ �CJ - Grllzit AP P0- AL ReQLTy SJRDiJIs�p�, TARATION DISTANCI4S SPECIFIED' ON PLOUI ' to P. L. ne to Foundation }?al s o to Nearest welr U' to stream, mar`.rh, aka, etc. inc :expans on - .� �'.. to Curtain drain ' to water line, :pits -2 _' to storm drain, 1' • to lnrfe trees= ;/ l' from foundation: Lo soptic t ln: i' to Pipe Prow Tf;adcr dl pin &.1'do Iit; . ralfl 5 To .CATCt► CbASlfa S� WEL.L TD jt ;o' .�.EPttC TANU TG • wEf..L_ ^ RU�7-. 4&1 Fetj 18f I - 7C1 r � Date: In3p.by: t INITJAL SITE I11 SPi 6TION r � Yc3- No Colnllcnta Property lines or coYher3 found . . . . . . . Can ca im6to house location . . . . . . . . . _ Ifill- driv6n ay need cut . . . . . . . • . . Ihust tree:!.. be removed -hote these Is deep hcl:a representative of ontiro SIX; area• Additional -Joel) holes needed. . . . . . . 11 • Suf1'icieni SM area available considering drivewa�.!cut,house location, separation . . . -. istancs, etc. d e ku. .d6tL1 �b4PTK s -- --_- -- DEA:r Hou ,,'DwA Dapith: Water eYovation• Rock ele ration: Soils description: ter - _ • FINAL S.11A, n3PECTION IIns b -- ]louse located vbera 'slioun on approved plan - SDS located where approved . . . • • . • . • 'longlh of trench mcasurcd 1•lidtn of trench average Slope of the line and trenc .acceptable . . . Room all.oi -; bd for expansion trenches . . . . . Over ft :. from st.amp,vatercourse Natural uoiq not.stripped or SDS area _. iuulecess.3r:ily graded 10 let. maintained 'from prop.line and 20 ft. from house . Selmrat-ion of trench from bouso,•well _ etc, follows plan . .- - -- -•-- ..... __.._. .._.._.___._ -. • • • Mullber of `iedroom3 CIlCCks . Stol -Iov., brvrh, • etul::ps, rubble, etc: 63 eater Up 15 i't. Prow nearest t-ronch . 15 I='t. of periphcral soil horizontally from . trolich Jiniction boxos properly set Coill.d sm: ^eco ijut oi'f from driveway, roads, • groulid z;r.rihce, etc. charuiel near SDS . area DaC:l lot. e.rnln.•i ;c nllic:il' O.K. in area of SDS FINAL GRADING OF SITE ACCE1" ABLD : A, < C. l i 1 1 s PUTNAM COLWY DEPAR'IlH&V OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT _ BY: (Name of Owner) (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Ex- oansion AreajsiivEnL -,- -g zc << L .y Ow,-sufF. maize If Pumped'Pit & D Box Shown& Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fram Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same MEM .!_1.. M EM ENEM 0� Ms ©ME ©EM ME® NMMM@MM1 MEM M� MIMM MEM M.M. FA ®EM NMMIMMMI MOME MMI EM M_ME MEM E _■ DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Ex- oansion AreajsiivEnL -,- -g zc << L .y Ow,-sufF. maize If Pumped'Pit & D Box Shown& Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fram Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of f. i. Located at (T) Q Section_,_-51 Block -5- Lot Subdivision of Subdv. Lot # Filed Map # 0 Date i9 rj Gentlemen: This letter is to authorize a duly,licensed professional engineer o rregistered arch i4ct (IndicateT— to apply for a Construction Permit for a separate sewage system, to. serve the above noted property in accordance with the standards, rules or regulations as promulaga.ted 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 -&—c-ta %. . -*.-n . - - rr- - t.11- the- .5Yst-1,,-m,-. or,. confz, i 147, Education Law, the Public Health Law, and the Putnam County Sani-- tart' Code. 'Countersig'"d. R.A.., �Lo � Address 7 L Telephone ; Very -trtAy yours, Signed I 40e4rkoMr�oer�ty�� 4k"Ot r-ko 0 1 Ao ar- Address Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _y n� C�mr akrikm - - DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. - zZM!!b I - Owner M N Address Located at (Street . Block 25 Lot P=031'cate neares t cross S re Muni cipalityFO-T tJ4N, Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION.* PERCOLATION Run Elapse 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 1c)46_ �O -t 2 4 5 1.10., 2o - Oe 62. �a 24 2(o 11 4 5 Notes: 1) Tests to be repeated at same depth until approximatel� equal soil rates are obtained at each percolation test hole. All data to e submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DEPTH HOLE NO.- l HOLE NO. HOLE NO. G.L. 611 .1211 1811 .2411 30 3611 no 4 it 2 .4811 54 6011 66 78 84 -IT AT 1.05e v -1 TE - TS -N. E. A M, =T M1-1,3H;,G:_R0UND WA R --ENC-QU ZE -TO.- T VEL RIsEs A nER i�IWG_- EM1'0UrTTEFMD- TESTS MADE BY Date DESIGN Soil Rate Used_6-20tn/l Drop: S.D. Usable Area Provid ls. Septic T nk Capacity No. of Bedrooms )000 Gals. Absorption Area Provided F-X2411 re 0 o 0 gle 1-04m- Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved . Sq. Ft/Gal. Checked by \'0A 04846::, Date