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HomeMy WebLinkAbout3621DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.11 -2 -11 BOX 29 03621 1 1.6 r r 'f ■ ■ 03621 a,_... PUTNAM COUNTY DEPARTMENT OF HEALTH L > Separate Sewerage System _ ;': j Municipality / CONSTRUCTION PERMIT Located at ! Sewn Block Subdivision Lot Job Owner ;% (_ Address.: °✓ i VILot Area "f ilding Type /' ; - Bedrooms Tot Y Habitable Space sq.ft. Separate Sewerage System to consist of*";, Gal. Septic Tank �.:'.� lineal feet width trench <4:� To be constructed by �_ s -j _ Address . Water Supply Public Supply from Private Supply to be. , s- Addre s Other Requirements I_represent, that .I am wholly and completely responsible.- for.the design: Ana "location` of the "proposed system ` "s 1 "that "'the 'separate seUrage dis- posal s stem above described will be constructed as shown on'the approved plan or approved amendment thereto and in accordance with the standards, .rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satis- factory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder,. that said builder will place in good operating condition any part of.said sewage disposal system during the period of two (2) years immediately following the date of the issurance of the approval of the Certificate of Constr, }. pliance of the original system or p re an y airs thereto• 2) t1j, d well described above will be located as shown on the a,pp ; d—V-6 that said well will be installed ..in accordance with the S:- 'Cra:r ;,,rum nd regulations bf the Putnam County Department of Heal th.'''� Date n ! i APPROVED FOR CONSTRUCTION : �c �O' al expires one year from the date issued unless construction o_ ding has been undertaken and is re- vocable for cause or may be amen ed..or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposa f domestic sanitary sewage. Date ��O /'o By 001 loor j l PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISiON`�OF E'NVTROi l�'1.�TTAL 'HEAL'I'H SEtt`v iCF;S` Gentlemen: Date Re: Property of y1/a4F)1r1'n- A111N 65 1 Located at 4- c0 Z /Ili` A; of 141; 1061=7 rrzL.r�! Block . Lot 3 This letter is to authorize STANLEY 1. LANDER a duly licensed professional engineer t" or registered architect (Indicate) to apply for 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 system or systems in conformity with the - provisions -o -Article 145 or- 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly�% yours, Signed ` V G�� ���i� ,�/�°�j`� `G•�f�' r ,y Owner o P7perty Countersigned: / Address P.E., Telephone A ( Seal) e�GFE8$� BOX 267 N. AMAWAtKy .1. `r 245-2645 `. Teleph:;::, 32�Ix V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTHISERVICES. DESIGN.)A TA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO. Owner Addressu��� © arl� /�c ✓,. . Located at (Street) ae.cpif 1 /4:U ('' Block �?' Lot (Indicate nearest cross street) Municipality, owll L %r SOIL PERCOLATION TEST DATA RE TIRED TO BE SUBMITTED WITH APPLICATION Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Level No. Time :`. From Ground Surface in Inches Soil Rate Start Stop Min. Start Stop Drop in Min/in.'drop Inches Inches Inches Pd r 2 4,- 00 �' �� �° z 3 16 3 /-� m .5 . 2. 4 5 1 2 3 4 5. t Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are ob- tained at each percolation.test hole. All data to be submitted for review. 2) Depth measurements to be made from'top of-hole. 8 411 , INDICATE LEVEL AT. WHICH GROUND WATER IS ENCOUNTERED' r INDICATE LEVEL TO WHICH: WATER LEVEL RISES AFTER BEING. ENCOUNTERED TESTS MADE BY tiS �,,��� Date 7. 27- -7 ° oil Rate Used ;C> Min/l" UC, JI 131N Drop S.D,- Usable. Area Provided G� ' 1. s e P tic Tank Capacity7,) '- Gals. TyP t-, /s7 f � -, re/ c_ - Absorption Area Provided By. , °�j L.F.x2411 36" W'� trench. Ot.er_�_ TEST PIT DATA REQUIRED TO -BE SUBMITTED.WITH APPLICATION, DESCRIPTION OF. c�ILS- �T'PICCUI�.TEF,ED IN TEST- r:QLES DEPTH HOLE NO. j�/, -.7 ,HOLE NO. '1 HOLE NO. �—V'W�W AL ur _ G.L. .. wyi /sic —S�l .. �o /� mi7L.. / ✓��cJ Jc. `G/ . — 67? 1211 C` %, ,PCe . CJ 18 TT Fr t 2411 � ....... _ � ... .. ti 3011 3611 �r . 42't 48T1 . 5 4TT 6 OTT 66" cr 72t1 _. ... `7.8,11- 8 411 , INDICATE LEVEL AT. WHICH GROUND WATER IS ENCOUNTERED' r INDICATE LEVEL TO WHICH: WATER LEVEL RISES AFTER BEING. ENCOUNTERED TESTS MADE BY tiS �,,��� Date 7. 27- -7 ° oil Rate Used ;C> Min/l" UC, JI 131N Drop S.D,- Usable. Area Provided G� ' 1. s e P tic Tank Capacity7,) '- Gals. TyP t-, /s7 f � -, re/ c_ - Absorption Area Provided By. , °�j L.F.x2411 36" W'� trench. Ot.er_�_ c �� '_ r Name STANLEY I �ANDE � ���f� Address Q �—V'W�W AL ur _ PUTNAM COUNTY DEPARTMENT OF HEA •- =;,� -fir Soil Rate Approved Sq.. Ft. �� do y Date -