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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE _OF COMPLIANCE FOR SEWAGE DISPOSAL.. SYSTEM .. P>" - r-i1J. r-�X jY-1
Located at Tax Map Block
Owner �A r� f' VV f`) cc>L'D ,(� (�� 1 i._ p C (� S Lot r Job
Separate Sewerage System built by H • r i G Address I--- �") C_7 G F'I F- t-•L -E
Consisting of IZOO Gal. Septic Tank and
Other requirements fY
Water Supply: Public Supply From
Private SuPPIY Drilled By
/`'v ► G I�Q 1-4 / =>1 T N R IN) hL i_L E- '`� �, I �i T "~
Address
Building Type Fk- 4�1 h-- � No. of Bedrooms Date Permit Issued
Has Erosion Control Been Completed?
1 certify that the system(s) as listed serving the above premises were constructed es ntia 1 5 shown o e plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans fit , an permit ssued j by the Putnam County Department of Health.:' ,
Date /7 A Y 19 %& Certified by A P.E.)9!!LR.A
Address 2 a--3 kATb R i Ave. i" -rV ij 4P icense No. 1T 1 83 ` eY3i
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanita ,?
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becorr,
available and the approval of the brivate water supply shall become null and void when a public water supply becomes available. Such approvals
subject to modification or change when, in the judgment of the ion or change Is necessary.
c Date�e/ ! By s Z��. C's;�`�t"�• = ",5
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
0 ,
�. '. Division of Environmental Health Services, Carmel, N. Y. 10512
4 '
j
16ONSTROGT-10!w kW14 SEWAGE bispOSA- SYSTEM
Located . at
Subdivision. -- / dw-4-
VT' ST 1 s--+ -3 -::2 c=wr- / 1'MIN
Owner Sri
yoc,A o �Ir, Il.L,J'>�I7..S'.
Building Type
Lot Area '+ ' A['Ae
Number of Bedrooms
��%�A
Separate Sewerage System to consist of �® �% Gal. Septic Tank
6
A. � �
Tq tie constructed by
[ j►
Water Supply:��
Public.Supply From
v
Private Supply to be drilled by cS
Other Requirements
Address
0VWC—:
or
Section
Block
Lot 2- a- Job
Address
Total Habitable Space
h 11
L 00 lineal feet X
Address
f 'G A— IL1.1�i�
Feet
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 of t e-- u_nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthgyill;'
be submitted to the Department, and. a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bulderwill
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the is`su
once of the approval of the Certificate of Construction Compliance of the ri in system or any repairs thereto; 2) that the drilled well described
Will be located as shown on the approved plan and that said well will be Installed i rdance the standards, rules an. of the . Putnam; tt
County Department of Health..
Date Signed P. E. R.A. -a.
Address K&:11A)A A N License No. -7
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and'is-•
revocable for.cause or may be amended or modified when considered necessary by the Commi o er of Health. Any change or alteration of construction
requires a new permit.. Approved for disposal of domestic prs� e g e, at w ppty only. Date �6 ` � y� By J Title �+ v►
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. Y 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner l woOQ�t���O�e"fL,
Address _147-60b%" J�lll�e`1.
Located at ( Street L yGENr LAND sec. Block Lot izz
indicate nearest cross street)
Municipality ?sa o*.,m V Nu,, " y, Watershed '4wjcsIcJCL
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH.APPLICATIONS
Hole
3••14 .:
to
1A...
4: Z
Number CLOCK TIME
'%'•L 4 t o
PERCOLATION
ZZ.
PERCOLATION
Run Elapse
Depth to
Water
Water Level
Z. S
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Z sg
Inches
Inches
Inches
1 to % c to.. Z3
2 Ia. t3 t�'• 9 Ito
310: 101 loY.19 1e 1
3
cp
3 V:o
3••14 .:
to
1A...
4: Z
4
'%'•L 4 t o
ZZ.
7. S
5 • :Z4
.3 �34` l0
2z
Z4
Z. S
1 3'• 3 4.
3 :qr S• . 12.
1 °I
Z 1
UL C.
2 3.4k.
3: 7. I t
21
Z-3
Z sg
3
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES vQ
DEPTH HOLE NO, HOLE NO. HOLE NO.
6"
12"
18" u�
24"
30"
3611
`F2"
48 it
54 if
6o"
66"
7211
78ft
8411
INDICATE LEVEL-,AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED A)QOJC
TESTS MADE BY Date 2• /!• 74; 4� °!2 °'�
Soil Rate Use d_�Min/1 "Drop: S.D. Usable Area Provided 66
No. of .Bedrooms Septic Tank Capacity «O Gals. Type k%
ded
Absorption Area Prov Bye L.F.x24"
- width trench.
nOther
bignature
Address (L CAA (P-t,_ SEAL
THIS
SPACE FOR USE
BY HEAIfPH DEPARTMENT
ONLY:
Soil
Rate Approved
Sq. Ft /Cal.
Checked by Date
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