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73.20 -1 -4
BOX 28
I lom IN
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opm. �` , •-
,, L . s
PLJTNA�M x C(
I' Division of Envirc
4 "z`Iei"3L�y
division
ler •C7lJi ti -W 1 ��i:.l?Z21�7- 1 t
ding Lot Area
hber of Bedrooms
1 t^
crate Sewerage _Syste'm to cOnsistJ
ti e cons tructed �by
"b
.cx I
i4 t , t.: '
er Sup,ply Public Supply From
6
Y 1 .Private Supply tsx*ket drilled by
�, 11
Address +
' e
1 1 1
eri Requirementsr i ;\
�resent,that I am wholly .andrtcompletelyresponsiblefor thetlesigri
. Rt..• eta
ve described .will;be constructed_;as shown;on`the;approved ameridm
County CDepar m
ment' f Healtl \
�
Z
r• By
n
rfi
� S8C1
Lot
Ad
1 tY
is Tank
z, t .:G
1.( Q �
F HEALTH I
\
10512
f� '� „'"".� y �,� 1 }� h r. vat k t a� 1 , •+, �. . ,. t
"-Town ,of Vil�lave
Block d
JOb
YI
l
-labitibI- Space _ % � + Square Feet
{ I�neal. feet X+ts�v f74 width-'11- rench) tit
i t
sed_,system(s) tai') that `the; separateµsew6ge „disposal ystem a
nce with: tFie staridards,,rules an regula ons o e,:' u nam
Compliance satisfactory to the Commissioner ofzHealthwll
xessors'.heirs or,assigns't y the:6uiider that said builder will..;
ofti two (2)iyears immed�ately,following.thi. of the,issu
any,regairsfthereto 2):that the:driiled,-well described above
it h the standards • rules• and .regula Putn
onv,\of 'the :am +,
2
l PE �R'A
Llcense No yc
ss construction of the bLfldin¢'has been undertaken and is-
eer, of,. Health: ,.Any..change or, alteration of construction c,
r supply only `„ T
m
Gentlemen:
PUTNAM COUNTY DEPARTMEN T OF HEALTH
0: F TiT '* .i RofIN D. I Al'.r T, r
v
i Date -- ii%�1771
Re: Property of10_\'1)\"13
Located at
Section 0 Block Lot 3
This letter is to authorize
a duly licensed professional engineer or registered architect
(Indicate)
to apply fo.r a. Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations-as promulgated 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
.`- •�.LvI -$J�Yry e'er- ., v: i.j -� _ -c-o t u'i =Yrii .i;y'.With 'ttYP `irovi'slons` Article 1l5 or M
147, Education ,aw,'the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
�p
AM.-
W. S i gne d
Owner 6f ProRNIty
Countersigned: 9 Address
P.Eo, R*A*9 555- 5 1st
Telephone
(Seal)
Address
Telephone
DEPTH
4., -4
'611
I
Soil Rate Approved Sq. Pt/Cal.
12"
1811
2411
3011
3611
42"
mS
5411
6oll
7211
I
TEPST PIT DATA 11.,0 px wl"PIT APP.L-CATION
ITOLI
HOLE, NO. EOLE, T%'O- HOLIP, NO.
INDICATE- LEVEL AT ITE11CH GROU7,rD (WATER IS EPTMJ.r1TE1U----D A/06ZOKD W#Tcl--
INDICATE =L TO WHICH WATE'R T,,LV-F,,L RISES AFTER L'.L'-;L'NG ENCOUTMRED
TESTS MADE BY Date
Soil Rate Used* 5-"' P'-1in/l'tDrop:. S.D. Usable Area Provided
No. of Bedrooms— Septic Tank Capacity 51V Gals. Type
a)_C
Absorption. Area Pr-d'-Vi ed By
_33 3 L. P. x241 za_h trench.
dtl- 1p,
J41
Addres�
iYAL
4
Checked ray Date