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HomeMy WebLinkAbout3480DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.20 -1 -4 BOX 28 I lom IN - ■ . a 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