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Home My WebLink About3634DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -11 BOX 29 -' �- IN z Ht .:. LL , 03634 W6idtfi -se X. Town- or' Wy ag Age Lot wner ress er-of Bedrooms abitable Soate Square Feet, triinch Private gup*,l corriplolgly'Aip-priMbli-f or, the d A-the Putnam'-1 yn,901 s_ 'bdir airs Date _j I ONS ob ice e edW6eh:c_ons_ it ' services �1; 01; fF at ti Width, trench 4atersupply ..From BuildinG ZZ57,77, 7.7 XN tjj�llyas-,shown,,onxne plans f Which are attached), an d iin,accardance bd,necetsary to -s( of any, ujisanitary mure An pe so wer'beromes Such approvals are 0 6i 'c'hancife when, c��'7��'f _ E�� E =5 � ��J Q� .•��P.�1�2Z ' d�.�iC.LtS'� Owner or Purchaser o Building Municipality _t©sz: e'll "ur "ee's Building Constructed by Location - Street a Sin Block Building Type Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, 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 disposa-1 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. The undersigned further agrees to.accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- - prices- of • trre Putnam •Goon -ty D.epartmer'�t 'of.'Hb'alth a -s to tiahether• or not -the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the._s.y_ M. Dated this day of 56el' 19 Signature -" Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP�TETION 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 r�'a- .- r-- ..rs.�'x- A-ear... ay. -.. .. C +.�:,r.. b ^•r _._ _ _ '.. _ - DiVIS IAN OF ERVIC;ES Date t Re i Property of Je2_sd -'W/ -/ Located at S ?oG .O/It f1G'" �l/l� .92C 3 49 131 oak Lot o 1 Gentl.erden s This letter is to authorize TAY J o %AR _, ... . a duly licoxSed professional engineer X or registered arch3ttdt, (Indicate) ' . to apply fok. a Construction Permit for a separate sewerage: Systems. 0 serge the above noted property in .ac.e:ordanoe with the standards# r -uleo. or regulations as promulgated by the Commissioner of the Put nom.tdunty Department "of Healtlis and 'to sign all necessary papers on my iaei.half oaru3e:i.cn::rith _thsr: aM% ;te. �up�arseI� c'onstruct-fvn of sid system of systems in conformity' with the provisions of Artid le 145-pr g. L. 1479 'Education Law, the Public Hbalth Laws, and the Puma County. 8ani tart' C ode Very. tsuy Sfgn ed / . er of nte Pr6per y ress c _ �� •� ��3 �� c ,r i'�tlphone PUT \'AEI COUNTY DE.'�?1_'LNT OF r� -.LTH- �_..,....,...._ ,. DLVISIO'N OF HEALTH S DICES. DESIGN DATA SHEET`- SEPARATE SE:';a%E DIS OSaL SYSTrE FILE N0. :Address O%O5C-.0 .sue'. xUwl,� Us GCc �1 Located at (Street) SM ._ �° Block --3 _ Lot (Indicate nearest .cross .street) Municipality��v _ 11,1144 . atershed SOIL_ PERCOLATION TEST" DATA REQUIRED TO BE SUB"I'I'iTED PATH APPLICATION Hole okiriber CLOCK TIME PERC OUT IO \' PERCOLITIC` Run No. Start Elaose Time Stop L"Iin . Dept to t� ate'r From Ground Surface Star = Stop Inches Inches 4 i7ater. Level in .Inches Drop ir, Irc: ^.es Soil Rate Min/in. drop 2 L fb 3 19.1.3/ _3C. /% '/K 4 S ®Z 1 9/30 91 "6Z / / Ig 14 / /Y f.4 2 J.'aZ 9 °13 z / 31d 17 / //,e z� 3 5' 33 `c�.'v'a %(�z/ 1716 ' v fir, 5 . 1 2 Notes 1) Tests to be repeated at same depth un't-11 aDproxi'.'_t'el equal soil rates are ob tained at each percolation test hole. all data to be subnitted.for reviec,.. 2) Depth mews Xemnents to be made from too of hole. TEST PIT DATA ?�OUIREu _0 -2 SUBMITTED r:IT I APPLICATION HOLE- DESCRIPTION OF SOILS E\ - C' \TERED I`: ='EST HOLE- DEPTH HOLE N0. �� .H_OL N0. wL HOLE \O' /64� G.L. /d411. -SO/ Z, 7W 6't 121 �S%i!.�7cr1�1._ SArI/o. -cc4y 1$ iS rr �� - 2 4'; .3 0': a 36T _ 42' 49 N 54" '0" ar a 2 =. 8411 INDICATE LFtTL AT 6:HICH GROUND W A= IS. E4, 1 \TERr.' a INDICATE LEVEL TO WHICH :dATER LEVEL RISES _AFTER BEING E\COUNTERyD � ~� TESTS ^LADE BY Date •e-ZI -'/ Soil. Rate Used 3-0 Min /1' Drop:, - S: D. Us e. Area. Sbyc . No. :o Bed: oo-7s v Septic Tank Cap _� lty. Sara Gals. Absorption reaovided BY -ffA L.F.x2''1 u:idth trench. Other Name STAU V ..�oM�� Sid: �'� �� 'i, Address SOX 267 �q AAA ®p{ t 1Ln __ r •h[M _ 0.9 ®� PUTNAM COUNTY DEPAR TL, 9:, N T OF HEALTH � ®� N�1 � Gni 1 Pate onroved Sa. Ft. /Gal . Checked b Date � S T ANT G7 sTRrt b?, 7 � G6 T�b v �� {O ..•. y