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����% Title -yd'
ea
. PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMCNTAL nrtALT• SERVICES\
Date 7s)91
Re: Property of
Lo ca t e'd.-,-.d t'
.-(T) Section Bloc k L o
Subdivision of P- cVtS`'
' '
Subdv.. Lot Filed Map Date J/ 5
Gdntl6men.:
This letter is to authorize
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*pr*o P 'e±-ty in accordance with-the standards, rules
or .-re-gulat.ions as-promulagate.d by the Commissioner of the Putnam County
bepartme'nt'of Health, and to sign all necessary papers on my behalf.i-Ti
connection with thisimatter and to supervise the construction of said
sysvem or systems in conformity with the provisions. of Article 145 or
14•,.,Education Law, -the Public Health Law, and the Putnam County Sani-
tary Code.
I
Very truly
Signed
Counters . igned: Owner of Property_,.
Address
Address
Town Q
1051(
Telephone
Telephone
t PUIMM COUNTY DEPARTMMr Or HEALTH
';,DIVISION] OF ENVIRORMUAL HEALTH SERVICES
�`- •.. -,F.Y ... _'". 3 'T" {,k r cf.�C-s ev.�c -�_ dn�r`:...;s'� .a ....�_ a. =-a.: ..' -a• :,.� .. z:,i ".;-i ...,:ii;:.n:::,- t- +c- .ru. -s«. oiw.`::.:ra� .1
DESIGN DATA S=— SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.'
1.! Owner •'�•. �`c.�:t�1 Address
Located' at (Street) e,�.r,,, 1� -esa� Sec. Block 3 ^ Lot _
rp(indicate nearest. cross street)
�F=- dcipality. 'Watershed' G�•o�z
SOIL PERCOLATION TEST
Date of Pre- Soaking
�- 4 Date of Percolation Test
TEOLE
Nam m CIS 1
TIME
PERC0=0N
PERCOLATION'
Run.
No.
Start-Stop.
Elapse
Tine
Min .''
Depth to Water Fran
Ground Surface
Start Stop
Inches Inches
Water Level
In Inches
Drop In
Inches
Soil Rate
Min /In Drop
27
3
2
1z 7
r 3
;26
-Z%4 2,
. 3
�' ?
Z 2 Z 3 $
Z: 3 2 .Zy 77 -. 3. 9D
Z. 4 17 Zy 27 3 91-0
5
NOTES: 1. Tests to. be repeated at - same depth until appro -i tely equal. soil rates
are obtained at each percolation * test hole. All data. -to- be submitted
for review...
2.. Depth measurements to be made fray top.of hole.
rev. 9/85'
a DEPTH
G
TEST PIT DATA REQUIRED To BE SUBMITTED WITH APPLICATION 4
DESCRIPTION OF SOILS ELXX)UN`1 t .IN TEST HOLES
a
HOLE NO. HOLE M.. ;z_ HOLE NO.
9
LJ
Cz
4 m
ZCC
5
68
71
88
91
10
12
13
14
Mac imm i;T°Wa —moutiaw s JENMUNT
INDICATE I= TO WHICH MATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE 'OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rdte Used ': -W Min/I" Drop: S.D. Usable Area Provided &00 -1 -V
No. of Bedrocms 2 Septic 'rank Capacity gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other
Name
Address
Signature
SEAL
A
THIS SPACE MR USE BY HEALTH DEPARTMFRr ONLY; ",�°ROFESSWN�
Soil Rate Approved sq.ft/gal. Checked by Date
33
Ary, .,portion of the existing
septic system within 1.001 . of
the-'-existing well must be
located_ and ins
pecteel- pr•ror
to the issuance of construction
compliance or certificate of occupancy
tD
Of
rn
BATA
to water
to impervious
to water
to impervious
3T'.
e -io min /in
ptic tank
0
N
N
P.
WD
e.,y � ~gag :51s
µ g6_53—ZO
W
W
5�_q0 0
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I
h
l
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U
l
AREA: 1.226
n
acres -
:I
1
35
4 rows of
c. .. �..,....._. L
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e \ 0
7
e.isting ssds
i
6/i5/60
400 fin, ft.
s ned Proposed SSCS y
pool
b: w
0
QGCA ��
propos�+d `b��
existing 3 goroge 8
Cdrm. dwelbng 2 bdrm.
Oddit:on
w
ex:4 I I
l6
Z
01 R :50.00
L =5807'
I
n
z
n�
LO [i �wl proposed
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