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03596
PUTNAN JNTY ADEPARTMENT.' OF ; HEALTH
�a3 Division of rmenta/ Health rServic ;Garme% N Y: 10512 �b '
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CONSTRUCTION P:ERMIT;'FORE SEWAGE' DISPOSAL SYSTEM
' Town or Village
/� Block --
Subdivision!GQ dl��al. f%G.2 •5' Lot Job
' Owner OiWQ 1/1, !' /,7G�2 //✓�
j - Address ' �'i9E/Yro /./7'
i Building•Type Lot,Area '_� A
I ;Number of Bedrooms Total Habitable Space ���� Square Feet
f Separate Sewerage System to .`consist of Gal. „Septic. Tank lineal feet "X width trench
lobe constructed by,- Andress
G'v
} Water Supply Pubhc:Supply From �-/� �� �S,v,� //✓as. /v- �
J9 iV
i
` .�jL
Private ..'Supply to be dulled
Address r
Other Requirements C'r'.eTAini ;M4,401Ar” /N.5TA4G��" 4 cSl,low,Oy O/V �L_4AI
I represent that l ,am wholly and completely responsible for the design and'tocation of the proposed system(sj 1) 'that' the separate ,Qj posal system .
above described will.be constructed as shown on the approved amendment there to ,and in accordance'with the standards, rules an ons o e� u nam
County, `Department- of Health,- and, that 'on;;completion thereof a "Certificate of.,C,onstruction Compliance" satisfactory to r�ihsstoner,of, kl Ithwill
..
2 be= sulim�tted.to "the Department, and. a,wr,ittemguarantee will: be furriistied the "owner, 'his successors heirsor' assign by a,p�ili!4r1'tAat'said,byil ar will
place in good operating condition any' part of said sewage disposal system during the :period of two.(2)':years.immedia 1�(3f9t1o�1V ' the#dete;of thei�issu-
erica of'the approval of the 'Certificate. 'of Const ►uction,.Compliance of; tfie original system or any repairs- Ch"er'eto;2)'t fh �rmadd'�w IC;dejcA qd ayygq5ove
wUl•be' located as shown on the approved plan an"d "that said well will be installed in accordance vMh'the standards, :rules egu .�qn� of t e�'P trlam
County Department of ,Health.: f'+ v- °bb
gn f t �IP E e';
Si ed R.
Addresso7a: SA
id a N,o.
revocable for,ca se o may be; amended or modified whe ,con idea necessary t Co n of the bu'il git�9�s� eenp (i)1 e�Ce rid is
APPROVED FOR CONSTRUCTION This approval expire ne ear om the date•' ed unless constructeo
Ith Any Chang :41opr�a uctfon
requires''a, a -per it, a•.A proved for•:disposal of d , e nitary sewage n prniate r' ply. only
I Date B ;Title
...*L,
COUNTY OF DZ1?M -f ZNT OF HEALTH Divi s ion of Savi
DESIGN DATA SHAT 1111P `,SEPAATZ SEHtIAGH: SYSTEM 7IILZ ZD e
Oe i @r �a�✓o i;�f�La/ / 'iets /AIC . Address ,�,0�i►�a'N1' �s�D
located At (Street) �c�Ti�i2/�[;� ,L/��v� Sec. 6'rj
(Xnndlicate. nneagebt cross street)
ronn®meuntal Health Services
L�All, * . 5 owJ•16 s, Al
Block J�ot .9
Dbnicipalit Watershed— ,����Ki � z-
SOM PERCOLATION TEST ; DADA REQUIRED TO BE SUBMITTED VITH APPLICATION
Hole
Number' CLOCK TINE
PERCOLATION
'PERCOLATION
°Hiun'
° Elapse
'Depth to Water
Water Level
°
° Time'.
Ground Surface
in Inches
'Soil hate
Start Stop.
° Min.
.'From
'Start Stop
Drop in
°Fin /inedrop
0 0
°
°inches Inches
Inches
°
p
z /�4 t
°
L/
0 0 0 o E o
0 o 0 0 A o o A
0 0 e o e o
0 5 0 0 o e o 0 0
Notes:
1) Tests to be repeated at same depth until approximately equal soil rates are
obtained at each percolation test hole. All data to be.subimitted for review.
2) Depth.measurements to be made from top of hole. .
-'
°
3
° J `¢o °
.y_' mss' °
/S °
7—e /1 0
°
21,
/ °
/.� /9�•n/ I `'
o
e o
o
a
°
5
° 9
8
i
°o
E
9
l
9.
2-
- --
0°
0
0
0
0
0
0
0
0
o
g
o o
a
o
0
a
o
Notes:
1) Tests to be repeated at same depth until approximately equal soil rates are
obtained at each percolation test hole. All data to be.subimitted for review.
2) Depth.measurements to be made from top of hole. .
,
TEST. _PIT DATA . REQUIRED 1i0 BE SU9MITTEA WI'L'�i APYLICATI01�1 _•..•.....
.. ... _� ... ... --.:,r UESC :KTi *T 10
4"00- S01.1
DEPTH HOLE NO. HOLE NO. HOLE. NO HOLE YO.
r
r
6"
12" ,�.eo�.v/ i9iuoj�. Zcr- --17 WI,7 " �' /3CEts' C e,9"A5
24" •
30"
36"
42" "
48" �,�aw.✓ Lair. -.
54" `
60" •,
66"
72" y A-2-A -0,455
84"
INDICATE LEVEL AT WHICH GROUND WA17ER IS ENCOUNTERED
INDICATE LEVEL FOR WHICH WAnR LEVEL RISES AFTER BEING ENCOU=RED
TESTS MADE BY /���%' [`'E^'�� C�6.DATE to -
DESIGN
Soil Rate Used /�" Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity Gals. Masonry Metal
Absorption Area Provided By= ,L.F.x24 "36" #-' width trench. Other
C -,o- 7-A, / Z%Q ",ovz; /9 ni -- f/d e- -,y .00 9G9ZG
Name_ ✓, ,yc.s >,t L ifiu✓En �f��'� Signature. .i.�v►-►� {���%�
Address 0 �7v � -_' �l.c -4 ,� �E� �o. SEAL aE OF ti`4v
T.: ' , PUTN,kM. County Health Department
Soil Rate Approved 1•.5' Sq.Ft. /Gal.
Checked by,, 3�
�"%�3 ,�NGIN�•�'a
'FU T n AIM County Departwnt of Health
_ Divi e�q.on of Env rvnnantal Health SarA ces .
AFFIDAVIT CORPORATE WER APPLICATION
FOR PF21:T REQUIRED BY PUTNAM
COU TY. SANITARY CODE
(Plemae type or print in ink)
TO': Comicstoner of Health -.In the matter of application for
p
1"0 ant
that I am authorised to act for the
U J y+
os mo m .® oe m, m ® ea o
taw of Corporation? m
- f
having ofPicen at ® '��a t�.o gj) --- — ® — — m — —7
whose officers are
A"fddent fi+�o�l Nk r•�f3 1
litl<sYrxk'9: �1t .ri,cixues eu�t�a �
Pi P" s 6 ,
°� Tffei 9 ��� ��d���8=
Treas.
TVS4 I RodAi A3OilViS7
by Resolution adopted - - �. 19
w.
with respect to the appro m. requested and all
rubasquent acts relating thereto,
.Worn to bef ore me this, clay
of 19 0
Signed m
Title
a
PUTNAM COUNTY DEPARTMENT OF HEALTH
f, DIVISION OF ENVIRONMENTAL HEALTH SERVICES !
DATE:
RE: P R O P E R "r Y OF. %40 AA0 G11 i.J IQCCe- a/ AIL'.
". A
.
LOCATED T
SECT ION BLOCK LOT .9
kNTLEME'N
- .TM''IS LETTER, IS TO.AUTHORIZE �,�E, F rr►»2/,LO�Z
1. DULY LICENSED P'ROFESSIONAL.ENGINEER_ -O.R REGISTERED ARCHITECT
INDICATE I
'O,APPLY''FOR A CONSTRUCTION PERMIT FOR A SEPARATE SEWERAGE SYSTEM TO
!ERVE//THE ABOVE NOTED, PROPERTY IN ACCORDANCE WITH THE-STANDARDS, RULES
IR R,EGULATIONS AS PROMULGATED BY THE COMMISSIONER OF THE PUTNAM':.OUNTY
)EpARTNENT OF HEALTH, AND T-0 .SIGN•ALL NECESSARY PAPERS ON MY BEKA,.F IN
TONNE- CTIOW'WITH THIS MATTER';AND TO SUPERVISE THE CONSTRUCTION Or SAID
TELEPHONE
ADDRESS ��70 Steak/ /h.'ei- Zz SEAL)
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PARCEL SHOWN`MEREON KNOWN'AS LOT No 9;
ON SUBOIVIS10N MAP: ENTITLED "AMENDED ?
PORTION OF POND VIEW ACRES FILED ON a .e
DEC 1973 d §MAPI No . ��
4'y ++ SURVEY „OF PROPERTY FOR
P,ON,Q,VI EW aGRES, I3N'G
SiTt W '
J HENRY. CARPENTE�2 & CO.-, PUTN' ' VALLEY
`CfVIL`' ENGINEERS & L'AN,D SURVEYORS;
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YORKTOWN HEIGHTS N 'Y p -UTNAM COUNTY N Y
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