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PUTNAM COUNTY DEPARTMENT OF HEALTH a-
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
!/r)Cf< / / A \A'1G M4IJ own or ;Ilage .• -,
Located at 'M
{� LO ('!t Mak' /cY7 i7C 2E.s Lot
Subdivision ob' J
• owner e 1 i (I Address _ de" Lot / Lot Area '� 6a u_ °` _
• Building TYPa'/� y" s/
Number of Bedrooms Total Habitable Space —(J L_ /5-00 -
Gal. Septic Tank 1 i7 lineal feat X /v Squa e`F t
separate Sewerage System to__/ccoonsist ��aof / / /���tttww��^ ///1 f� -
To be constructed by `� V � 'le Atltlress / =e/ 1 VR' h
Water Su PD Y+ 1 Public Supply From
Private Supply to be drilled by O
A /l /V. _
1 Address 3 ' -
Other Requirements
1 represent That 1 am wholly and comp �i a design and location of the proposed sYSSam(S); l) that the Separate sawd90 disposal m
above described will be constructed a endment theta to and in accordance with the standards, rules an raga a tons o e. -. m
County De Partment of Health, in I "Cerliikata of Construction Compliance" satisfactory to th9 Commisslo r f Health W it
be Submitted to the Oepartman arks a furnished the owner• his Successors, hairs or assigns by theshuildar, lh t sate of.t ill
place in good operating c.nditi as of 1 jjQQ sal system during the period of two (2) Years immediately Aollowin9 the eat of th s
ante of the approval of the to �Qll C , nc0 of the inal system or any repairs thereto; 2) that the drilled well d sc ib tl't
will be IoWted as shown on the a ro a Dl thD {nrtrra�igwel a Installetl atcordanc with t lantlartls, rules and rn!1ulas f the ..Put m
County Department of Health.
Date _ / / Tom• '� n Si ea n! g ��
APPROVED FOR CONSTRUCTION: prf�i M and year from the data Issued unless construction of the buildili9 has been nde taken ne si'; t
revocable for cease or may be amentl0d or r14 considered cessary the Co mmi�r of Health. Any cMnge or all ratio 'tract
requires a now permit. Approvetl for tlisposal of o astic m a �IWS =prior Ater wpP1Y only
Data v Title
I
• PUTNAM COUNTY DEPARTMENT OF HEALTH
- Division of Environmental Health Services, Carmel, N. Y. 10512 'n
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM`'
.vu ✓ C
Town or Village _ �
v ' t —BR I.044
a — ass c Tit /`94p
Located
Owner : //�C'e�fy ri %� / / /ft' Bloeka -`..
Lot Job
Separate Sewerage System built by�–rJ�'NTtc S /fjM( if-/V'G Address /[/Jgd ofAe CL < A.%(�
Consisting of s Gal. Septic Tank 'Z 7,7 lineal Feet X 7~^ 's'`
width
tfe_nehF
Other requirements
Water Supply: Public Supply From -
,1 Private Supply Drilled By
3`
r . Address iat/rt//!rl �FGCi I/r .''
i 3-
Building Type f NO. of Bedrooms � Date Pumit I—ad
Has Erosion Control Been Completed,
d r "
I certify that the system('
as With serving t a aP a nitr jed. i Ily as shown on the plans the completed work (copies of of He
% [[ached), and in attoraance with [ha Stan rule s, p led, d the Permit Issu by M Putnam Coumy Department .oiHealth: -r..
,1 Data ad .✓ Jt
P.E. R.A — _
. – Adds ° / '72
License No. Any person occupying premises served by the abo Sim(jI�ll pt1Y take Such action as may be necessary to secure the S ectl n of any u115anild Y
conditions resulting from Such usage. Approval of erage system shall become null and void as Soon as a public sanitary se r DBCOmes
available and the approval of the private water Supply shall become null and void When a public water SUPPlY becomes available. Such apP ValS S
subject to modification hangs when, in the judgment of the C er o Health, Such revoritlon,.m �ication or •fMnge is necessary.
f� `7/ ., .
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Owner or Furctiaser of Building Municipality
Building Constructed by
D/Z /oAG s�l�Td+> .CocrrLr' 3
Locat on.- .Street
Block
1��3i.00wTiAc !. /
Building Type Lot
GUARANTY OF .SEPARATE SEWAGE SYSTEM
I represent that .I am wholly and comple.tely,responsible'for the
location, worlamnship, material, construction and drainage of the, sewage disposal system serving the above described property, and that it has been
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 hereby guaranty to, the owner, his succes
sors' heirs or .assigns, to place in good. operating condition any part of
said system constructed by me which fails to operate for a period _of two
years.immediately following the date of initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu
pant of the building utilizing the system.
i
The undersigned further agrees'to accept as conclusive the de-
termination of the Director of the Division .of ° Environmental. Health Ser-
vices of the Putnam County Department of Health as to whether or not the f
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing tie system,
Dated this _ day of JAL *, 19 %i Signature
Title
f corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS.BEFORE'
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR .IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department.of Health
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Pre t2.E5
PUTNAM COUNTY DEPARTMIN T OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
t Date. / "(Q kehl my
Re: Propej�tye of elo III �2s
-TX
LocaM ted at y e7•. [
Saco 6� Block` Lot O .
Gentlemen
+'This letter is to authorize
STANLEY 1. LANDER
a duly licdnsed professional engineer or registered architect
(Indicate)
to apply for a Construction Permit.for a.. separate sewerage system; to
serve the+abcve noted property in accordance with the standards, rules
or.regulatsons as promulgated by the Commissioner of the Putnam County .
Departmen•t!.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 of Article 145 or
147, Education:Law, the Public Health Law,. and the Putnam County Sani-
tary Code.q
Very trul yours,
Si ed y
�j✓ wn r of Prb ert� , •
Courite si6ned.�/ AddrIess
F . E . , A-4-71 # �. O �
RpFESSIO,yA Telephone
C7�n�1 N 1 1 AhDER (Se � �
BOX 267
Te ep one ;F �L15 Egli OF NEW�� °�� .
n
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5
5
1
2
4 !;
Notes:
1) Pests 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:
Lo fs .
PUTNAM COUNTY DEPARTMENT OF HEALTH.
DIVISION OF ENVIRONMENTAL HEALTH :SERVICES
DESIGN :'DATA SHEET -. SEPARATE SEWAGE, DISPOSAL SYSTEM FILLE/NO.
/
Owner TO S "j5,-j4 / ` / /LAS Address 133 rsq eY . �i . / GITYIG� Gvj
l�Cl /�_e / /.
Located at (Street) k-"iA �Gi7Gt CY u Block
y
Lot'
(Indicate nearest cross street)..:
Municipality.., ld Alp 'a Watershed IM YG COY ,EJ
/�u:cr
SOIL PERCOLATION TEST DATA REQUIRED 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
2 � = 43 �
3
5
5
1
2
4 !;
Notes:
1) Pests 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:
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE N0.
HOLE F0. ' �y
.�,..
HOLE NO. �� GE
k;
G.L.
12"
Rte'<
q�bJ /inc£: CL�ii
�bruo�R _^y may¢: r� F
14
24"
a
30"
N
h
^
36"
h
42„
48"
rf
54r
60"
66"
72"
ti
78"
84 ".
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED _
TESTS MADE BY Date 7°
DESIGN n-
Soil Rate Used--L j D Min/1" Drop:. S.D. Usable Area Provided /,T—
No. of Bedrooms S Septic Tank Capacity � Gals . Type ,,,, Lorc;
Absorption Area..-Provided By�_L.F.x24" 3 " L,"'-width trench. Other.
Name SIANIH 1 I ANDER �.
Address BOX 267
A
t,^
PUTNAM COUNTY DEPARTMENT OF HEALT}�l
ar
Soil Rate Approved Sq. Ft. /Gal. -- — ed by Date
I
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770`
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+ PUT A I _ • F HEALTH - - -
.. . '. SIGN OF- ..
Jcr1Lr�'
ENVI NTAL HEALTH';SERVICF$ -
C
PR�/y/ /rS�S Ss�ON/N H�R�ON BE /NG
L 4T S, AS c IVOWiV ON "r_SUBO/ ✓/S /On(
iYfAP of <secJ' /aN F�" GLOC�9iy/0.4RF�
ACRES, "" SF� /O iY1RP F /GE1J /N Tfii�
GUTNF�/Y/ fOUNTy CLERKS CFA /CE
oT s N sUR1/Ey OF �RDP�� %J'
S hh �o /A/
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75 "
Al 52°410 .' ZO° W
263.
NE`V
YORK
/N'AIRCI -1 /.5, 1971
SURVEYED: PREPARED. BY
t
BUMNEY ASSOCIATES
"-;vl crrdfivations lvreon are rMid ;or
the ma.p us d copies
e'rt i5!:e <ai;y cert e +ad t`u'
,ftei7 >nryeY.
vna aegsn:d ;< tcn rda +ete wish the
.
ENGINEERS & SURVEYORS
tkicrtvq only iP said trap or
gear Fhe irtipnyacd
Cad,' Or tn;;Mics -W Und .
20 WOODSBRIDGE ROAD
*en1 of tie- sarvev!u' wbw signature
appears bervoo."
5arovs adont±!d by the New ywh States
0.adMet;On c! fgf�s9lgnfl Laced Gury'pra!r
KATONAH. NEW YORK 10836
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