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A �D� PUTNAM COUNTY-DEPARTMENT OF HEALTH
REV . 3/ 86(�, \ Divleion_of Enviroumenfsl Hesdth Se vices. Carmel, N:Y.10512 Engineer` to Pmvlde Permit N "
q�� on CERTIFICATE COMP CE
g CONSTRUCTION PERMiT FO ., S _ WAGE DISPOSAL SYSTEM t #�
Si u v__ S[ _ .�S(/�' �D ' wn or i e
- Located at _ /
-Subdivision Name %2uA/d0 Sabd: Lot # f 4 JTuF Map: Block G►.ty _ ~
Renewal._ ❑ Bevlsion ❑
Owner /Applicant Namo/'AA t]
Mailing Address .,� f Datevlo� Appro � �.i ✓ /ii./ ,a '
Building Type 71
Number of Bedroo
Design Flow G /P /D
Separate Sewerage System to consist of ��Gallen Sepdc Tank and
Ti, be constructed by 4. !/1 o/A a i �1 C� Address _
Water Sappy. Publlc,Sapply From /'Address
or _ Private Supply Drllled b � 41- �k '"-Address
Other Requirements
represent that '1 am wholly, and completely responsible for the tlesignand location. of..the proposed system(s); 1) that the separate `sewage Aisposal system
above.described will be constructed as shown on tne.approved amendmee rules an regu,a ions o e u nam r
County Department of Hiilth,— and fhat.on completion thereof a °Ceitificate of Construction CoMpliance "satisfactory to the'Commissioner.of. Health will'
be submitted 'to the Oepartmerit, and a- .wrdten�'guarsntee will be.furnished: the owner, his successors, heirsoi assigns by the builder,. that said builder will
place in good operating condition .any part of: said sewage""Gisposal system during the period of two (2l.years immediately following thed4ta-of: the issu-
once of, the approval of the. Certificate of ConstcucUOn <COmpliance,.of the,origi ` ,system or any repairs thereto; 2) that the Grilled well described above
will be located as 'shown On 'the approved plan and that said well will be installed .i` ordance with the s rtls, rul and regulations of,' the Putnam
County Departmen of Healtb.
Date . (j ', Signed P E./t� R�.A.� —i��1
Address License No • L4 -`./
h
APPROVED FOR CONSTRUCTION:' This approval: expires +one y rfro the issued unles const ction of the building has been undertaken and is
revocable for -taus or mdy o amendetl:oc,modified , whon con =1 . scary., : t C m is ' n Health: Any change or alt atiOn of ruction
rerauires a new rmit. A r for disposal of - domestic sa , r age; n k" e - a pply only.
Date BY .. - Title . .
In
D'AQUINO and DONAHUE
CONSULTING ENGINEERS
Cl John V. D'Aquino
RD 2 Box 17
Put. Valley, N.Y. 10579
526 -2039
01 Daniel J. Donahue
Breckencidge Road
Mahcpac, N.Y. 10541
628 -7576
wTTEnT10» n -
RE:
,S-IDS
P/- rrAl/% /-7 1/%iLLE
WE ARE SENDING YOU , ❑ Attached ❑ Under separate cover via the following items:
❑ Shop drawings
0( Prints
❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter
❑ Change order
❑
COPIES
AT
DA
DESCRIPTION
- below:
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JNo.
1
❑ Approved as submitted
❑ Resubmit
copies for approval
❑ For your use
A !//i7 /i,
�/i /.r _• �I0 'j I?
I /rn mac- t 6,44 t/rr%G G/7 U / ,j Ci:'�
- ❑ As requested
❑ Returned for corrections
❑ Return
corrected prints
❑ For review $and comment
Cl
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19
❑ PRINTS RETURNED
AFTER LOAN TO US
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L5 O OJ-� S`t
G p P
REMARKS -
!/ I X/6
COPY TO
7-/ D r7 _,- G
SIGNED:
enclosures are not as noted. kindly notify us at once.
1011
THESE ARE TRANSMITTED as checked
- below:
For approval
❑ Approved as submitted
❑ Resubmit
copies for approval
❑ For your use
❑ Approved as noted
❑ Submit
copies for distribution
- ❑ As requested
❑ Returned for corrections
❑ Return
corrected prints
❑ For review $and comment
Cl
-❑ FOR BIDS DUE
19
❑ PRINTS RETURNED
AFTER LOAN TO US
`
%
REMARKS -
!/ I X/6
COPY TO
7-/ D r7 _,- G
SIGNED:
enclosures are not as noted. kindly notify us at once.
1011
PUTNAM COUNTY DEPARTMENT OF HEALTH —DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVIEW SHEET - CONSTRUCTION PERMIT
DATEE
BY:
(Name of Owner) (Street Location)
COMMENTS YES NO
Permit Application
rate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results (3)
30" Perc Hole
Other
ouse Plans - Two sets
PWS - Letter
Variance Request
n REQU DETAILS ON PLANS
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
Expansion Area;shown ;rgravity,flow,suff. size
• •..•ii -1i` 'Lib. & Li 1- /�J11' VlilJAll ti 1J<i 1..C[i'i Rim.• .•.
House - No. of Bedrocros
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 (i.nc. expan)
15' to Drains- Ciirtain,Storm,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from 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
..: MTH 3;.� -- a
DIN. RM. KITCHEN MDRNING RM.
IIU x1216 10.1 xI2.w II1x12I9
LIV. RN
I82x12t
1st Floor
FOYER . `. .
91x91
FAM. RM.
f61.1219
WAKEFIELD 27' x 48'
0a.
o:.
i 801 BR�4 BATH I WALK -IN
92.12
2 I I1 x 9 2 CLOSET
-ry R...�.. -HALL
O
-' OPEN TO BR 1
04 BELAY 161 x 16 @
Ate. fZ' BR *2 r
cl 151x126? - .........
e STUDY
121x54 \
�+
0 2nd Floor
Im ! PENN LYON HOMES INC.
Old Trail Road. Selinsgrove Pa. 17870
Telephone (717) 743 -0111
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date ��1D 7. ���Gv .•,. .
Re:' Property of F71 -04,' De- Al;r -d6
Located at osc d yyoga Lo.Ze Roo d
(T) P1j e Section Block Lot
Subdivision of t7 p ^ jvtm Jge,- dglh
Subdv. Lot # % Filed Map # Date
Gentlemen:.
This letter is to authorize DQhi�e, r oh y hkt-f
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
connection with this matter and to supervise the. construction of said
�........., ._._.a_jj4 ±EFC:� Ci- r:'.•j'•"�... .°r^-.a°ia'-":' il' °'vi'i�iv -'%-it$ v i2" 1:' `J1allliPS "lJi 'NY'G ".iC'iC` -1 O�'• .•• •..'.•• � .•_
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
"I gn eG
Owner of Property
Countersigned:
P.E. , R.A. , # 64g4el A3
d1d re s
re[..re� r iii -C DCO
Address V
/77,0ie 1,6
Telephone
Town 3p��
93
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL-HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
bESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Fr6'1 k DC dl, r d d Address /L ,p0 "2,
Located at (Street QS�G4�G�� ea Sec Block Lot
indicate neares cross street)
Municipality 11! / / • Watershed f�- �O- Pj�,�if''
SOIL PERCOLATION TEST DAT REQUIRED TO BE SUBMITTED WITH APPLICATIONS
nvly
-
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
Eiapse
Depth to Water
Water ve
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start Stop
Drop in
Min./in drop
Inches Inches
Inches
47,2
,
21�ys Id.
2 /.1f� f 02 46
x+/73 f7
5
1
2
3
4
5 ,
f�>
Notes: 1) -Tests`_to-- e` repeated at same depth until approximatelyy equal soil,
rates are obtained at.ea.cY- percolation test hole. All data to be submitted
for review. ".
2) Depth measurements to be made from top of hole.
T= PIT DATA REQVZi= TO BE SUE=ED W A2PLICATION
DESCRIPTION OF SOILS RICOUNTMED IN TEST —HOLES
DEP'T'H -BOL-7. N04 HOLE No� HOLF NO.
G.L.
61•
240
30"
36,
42"
48"
54"
6011
66"
72"
78"
=ICA.TE, IZM AT WELCH GR=M WAM IS ENCOUWERED
MICATE LEVEL FOR WEZCHWATM LVM RISES AFTER BEING ENCOUNTERED
TE-n3 MADE Ff J),A* 4r DOE A16
DESIGN
Soil Elate Used Min/I" Drop: S.D. Usable Area Provided
F
No. of Bedrooms Septic Tank Capacity Gals. Masonry Metal
Absorption Area Provided by 4 36
44.IP.x 24 .
Name) 9 d li / ,az- , -1 ,Z)
/J 7— /V
PU Tg tj Cc=tir Health Department
Signature
Sm
So:-1 Rate Approved sq.Ft./Gal. Checked by
Date
er .0
4 LMP!4801-e-,)O��