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BOX 26
03205
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PUTNAM COUNTY DEPARTMENT OF HEALTH
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e r . D/V/S!O/1 ofy ftm ronmengl Health_ Services Carme% N. Y 10512
�IEtRT1F.id:A9fF OF COWSTRUCTIgN;DQMPL- tAN,G�9 F0 R °SELVAGE DISPOSAL: SYSTEM �ict%n) �� Uin C.C.
� a._.s.. .+...„x �3 � A wr^•v +����^ �r'"� y- R�'�°" '`..�,.�.. '�",..,.:'^s.�..�.."�'."^!"{ .c. .c"^T� `�OWn Of �/ Ila�e ..— �S °P^T�u� -.}.v
Located at PIA O � a �� � Tax 'Map Block
Owner
`t Job'
)Th)AN'1£ii"�•5 G Address /�14 C�Pf1 C • %V �/.
Separate Sewerage 'System :built by T—
Consisting ofd Gal. Septic Tank and:% `'�"
Other,'. regwremen ts - 3
t r
Water SupPIY bhc Supply FromZ
��
Private Supply Drilled ,By
1 x 1
Bu�ldin9 TYPe�5 p`� No } -of Bedrooms Date Permit Issued K
' =
Has, Erosion Control Been' Compl,eted� " "?
t' ertify that thesystem(s)_as hstedserv�ng the ab a v�re ~essenU ly as shown on the plans of a completed work (copies of =which are
attached); and in. accordance wdh `fhe standard" regulate led d the permit is d b th utnam County Department :of Health
R A t
Date " ' .it � 'bY _. , _.• P E t ,
Address 1� ' License No 1'
"19 ats t�
Any person occupying premises served by the ve'_ ' tly V e such action_as may be necessa ►y to °secure the correction of any unsanitary
:conditions-'5r, esulting from `such ;usage `Appro4 o� araf stemsnall become null`and void 5s soon as a public sanita►y sewer becomes
_available and -the approvals: of the ,pri waters :
mOwner or Turbtiaser obi ding Municipality
Pj l-ies = c' `77
Building Constructed by 7-A-:*- MA-P
rte... q?,t9.4 r_> -'
Location - Street Block
Building Type Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the - Division of Environmental Health Ser-
vic _.,,Qfth.._,Pu.tnam . County Department of , Heal -tai .mss; -t o- hethex�.�:r:.:no.:th_e
_.
f ut � of t''ci sy st;e -gin °to "'op-era'uo i a's "c iis�cT "' y t ie"wi1 ul-or "negligent ~�
act of the occupant of the building utilizing the system.
Dated this V day of P a✓ 1,9 6
40M_e�.s ;E�C, Aos7hj- >AD
Signature
Title
If corporation, give name
and address)
P tj_y_
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP1,ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
PUTI`UIM COUN`T'Y DEPARTMLPIT OF }1r-ALTII
DIVISION OF ENVfRO1'NMEPTITAL }I -UJIi SERVICES
COUNTY OFFICE BUILDING, CARPIEL, N.. Y. 10.512
DESIGN DATA SIUE T-- SEPARATE, SEWAGE DISPOSAL SYSTEM FILE NO.
2k, Owner jr04� Q 'F Address_ -71P -6xv -to 100 �:�y_�� .
Located at ( street)S c, -. cr
GA �YCo� 9 sec. r - Block Lot .Z3
n ica e near.-oss s reef
Munj cipality P,.� -t j i� y fir\ 4� Watershed P 15 t
TION TEST DATA R-EOUIRED TO BE SUBMITTED WITH APPLICATIONS
hole'
Number CLOCK TIbm PERCO-1-ATION PERCOLATION
Run apse -p, to tva er water Levei
No. Time nom Ground Surface in Iriches Soil Rate.
Start -Stop Min. Start Stop Drop in Min. /in drop
1 Inches Inches Inches
2.
j!� .. 1. _...
5 2-a► -
2 1D S�, lfi , �� li % Lo'
4
5 .
2
3
5
-Notes :. l) Tests 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 SUBMITTIM 1•1I:TH APPLICATION
DESCRIPTION OF SO= Ej- ,'CCUN'j.T,RI D II`I TEST MOLES
DEPTH HOLE NO. HOLE, NO. HOLE NO.
G..L.
r
6
12" ...
24" .o N d
30"
36"
42"
x+81
54"
.60". ��1C� S.
-.6611
72" Ste, Sa6 N &S .
8"
INTICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEI EL TO WHICH WATER LEVEL RISES {��iA,FTER BEING ENCOUNTERED
TESTS I�1A.DE- BY V���E �hN de _qe�vcJ�b�JF` Dote
DESIGN
Soil Rate Used 7-0 Min/1 "Drop: S.D. Usable.Area Provided So��
No. of Bedrooms Septic Tank Capacity b Gals Type j!1�,5
Absorption Area Provided By` L o L.F.x24" 3F- trench.
er
7K
Address e Q; .. SE j �,� �F NI'V I 1r
THIS SPACE FOR USE BY FEALIPH DEPARTM 1N T ONL'Y:
Soil Rate Approved Sq. Ft /Cal. Chocked.' -� Date.
...._ _ _...._ .._ __..... . . . ...... .. .. .. -._.. -° _. -.. _ - . _ -,. v - _ -: - _ :.. _ ..... _ _ ..:.•.mil..,.. ": -_._. - ..._ .. -. . _. -. _ - .� -_
4
-PUTNAW COUNT;
Division Of fnlarormen.
CONSTRUCTION, PERMITr FQR SEWAGE ;DISPOSAL. S`
Owner f7O14!i'fi/�f4° t�A! CA
Building T.yPel�c� tiif /f} L. Lot Area
Number of Bedrooms Design Flow
separate "Sewerage- System';to consist of
To be constructed'"
Water Supply Publi c Supply From
vale Supply to, be diilled by,
Other Regwrements
uy
W
_ /
�of,,fhe proposed aystem(sp' i)�that` =•,Elie separate sewage_dispo al isystem
Town or, Villag e7 - - --
Lot J-
Address
Total Habitable Space d� Square Feet
I Septic Tank;
and , ���;`.� /�/•./�f -� �� ��/(d4C ^`7/
Address����'�
a
r
�of,,fhe proposed aystem(sp' i)�that` =•,Elie separate sewage_dispo al isystem
PUTNAM cor,\_ry J)r;iimo',M-N'r or HFAulf
'ALT11 SERV'rCrS
DTVTSTnN OP. F.NvrRo,-,':•:FNTAT, IT
%
-- V& 7c;,
a
C-0 VJ6� Date A
Re: % Property of A' \X 444 W ___jkQ ml
Located at
Section Vlt-4�CJt- Block Lot ;!P7
Gentlemen: �x H.*.p T/
ILEY I. -
This letter is to authorize STAM LANDER
i*duly licensed professional engineer or registered architect
C2
(Indicate)
to apply for a Consttuction 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,flealth, 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, the Public Health Law, and the Putnam-County Sani-
Very truly yours,
Signed
of Property
Count sianed:
Address
P.E*., . Rte, J
ss
. BOX 267
AMAWALM", - W. Y.* 10501
e ca u casw u
iKN4
Telephone
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was 1 horie
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PUTNAM COUNTY DEPARTMENT OF HEALTH-
DIVISWN OF- .ENVIRONMENTA j3F_jTH..S R..VT1QZS.._
.COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner4rH,))e,4 J._�I#gRolv RclvclV Address. -!5-17
- i TAr- jlkp, VE
Located at (Street 7-7 Block Lot
=n 1ca7e nearest c ss s5e�t)
Municipality. ,,Zfw,,-' Watershed J11OR 0 C/;r- /ge
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
//vZ 11,2
z 7 c4,
—2— S
3
2 1122
/9
21
-3
5
2
45
3
11:37
22-
4
5
2
3
4
5
Notes:
rates
for
1) Tuts to be repeated at same depth until a Poximatel�
are obtained at each percolation test hole. Affdata to
review.
2) Depth measurements to be made from top of hole.
equal soil
e submitted
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE IV0 .. .�.%.. HOLE 1V0*. VH�LE NO �VF.
G.L. /o PS.7JGpsv�
6"a
1211
18" c� a
24" 61—uele.
3011 =i
3611
42"
4811
5411
H
JAW d Lz,E'.g cry L
N
H
N
6011
6611 "
7211 h
7811 K
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED i�-
-• I.NDIC.ATE LEVEL T0- WHICu .WA_TER� -LEVEL RISES AFTER BFI? ?r. ENCOUNTERED,.
'1t�S`T'S} 1�1A11E BY. .. ,
DE IGN i
Soil Rate Used�Min/l "Drop: S.D. Usable Area Provided Sr/
No. of Bedrooms 3 Septic Tank Capacity ��'D Gals. Type ''ic�cl& -r �Ve_-
Absorption Area Provided By_L.F. x24" width rent .
• r1.•r �i� P ������'.� i Other
. 6 va z �w�,. v .,
Name• °t�Signature
U
Address Alt' r Y_ 105 �ff L.
245-2645 &i®
THIS SPACE FOR USE BY HEALTH DEPARTP v�
Soil Rake Approved Sq. Ft Date
i'
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