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PUTNAM COUNTY DEPARTMENT OF HEALTH S F�
D1111slon of Environmental Health Services, Carmel_ N. Y. 10512 Nt 1 LEA
CONSTRUCTION-,PERPAT FOR SEWAGE DISPOSAL SYSTEM ova-
Town or Sseeion Villa
�i�f9�!/IC � Svc �_ BIOr,JC9
.. , . r, . • _ - - (�'•' •..� _,., dam- -- e
Located at C
Subdivision Ga�eSG/��ISd.C/� �L.°it'ty ✓er�_� Lot ® Job
�/�SFiJ Address.
Owner _
Building Type 4;T /AG Lot Area SZZ
Number of Bedrooms Total Habitable Space abL %C�GA °
Square Feet f'
r� a �
Separate Sewerage System to clorisist of 9L5p Gal. Septic Tank w_, lineal feet X �1— � width trench
If If . To be constructed by 'S f ��� O3gr - ��G Address /�1C,224U y�444X
Water Supply: Public.Supply From
Private Supply to be drilled by% -�a�
if
z
Address
Other Requirements Of
I represent that I am wholly and completely responsible for the design and to t s): 1) that the separate. sewage disposal ARM stem
above described will be constructed as shown on the approved amendment th ac f nce tandards, rules an regu a ions o the -
County Department of Health, and that on completion thereof a "Certifi e.r C pli, satisfactory to the Commissioner of Healthwill." a
be submitted to the Department, and a written guarantee will be furnis d t e o �+> ors, Wi or assigns by the builder, that said build erwill
place in
r - »'�
good operating condition any part of said sewage disposal sy riri ��i_ 1,o wo 2) ears immediately following the date of the issu
ante of the approval of the Certificate of Construction Compliance of. e o 'gi i y re � r hereto; 2) that the drill dwell described above
o.:
will be located as shown on the approved plan and that said well will be instal in th st ds, rules and regu) . ions of the Putnam F, -
County Department of Health. C ZO W.
d No. 31 'b
Date c/lloi C- .d �fCf'�� Signed �� 0� Lam. R.A.
Address ��.✓ �Pi!/ f9i50;� f License No. 327Zm
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and'.,s''
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construct ion`.•! *v,
requires "a new permit. Approved for disposal of domestic sanitary se age, and/o • W water supply only.
Date —7 _�J By Title
f:
`. ..... PUTNAM COUNTY DEPARTMENT.. OF. HEALTH -
__
Division of Environmental Health Services, Carmel, N. Y. 10512^
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM iFxi�ilr eir" �ily�A t/AClEy -'
Town or Village
Located at 58ctien Block 2 -
Owner `� � ^114 Lot ��' ��c: Job
Separate Sewerage System built by �'����f /C �S'frTE.S ` Address
%Ln� s p a
Consisting of Gal. Septic Tank 6 30 lineal Feet X width trench ='
Other requirements
Water Supply: Public Supply From A
Private Supply Drilled BY �•�Rs.�E4?sv,w✓ p�lLCfflJds
Address
Building Type ��' '� C aFEU U of Bedrooms Date Permit Issued
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving th bo pre tru sentially as shown on the plans of the completed work (copies of which -are=
attached), and in accordance with the stand ules M' p1 s , and permit issued by th `Putnam County Department of Health
Date �i 2' r ill y P.E. .R.A. f
Address �j9r C, �O' 32 Z �'� '✓ (o License No.�
Any person occupying premises served by the above sY mptly take such action as may be necessary to secure the correction of any unsanitary' i
conditions resulting from such usage. Approval of the separate .sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water sup comes available. Such approvals
subject to modification or cha ge when, in the judgment of the Com issioner of Health, such revocati m ification or change is necessary,
Date By Title
C1
W
Owner or Purchaser of Building Municipality
'/0'S C ".-El /w/ G z s
Building Constructed by
Location - Street
Building Type
M:0wenn
Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
�o
'7
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 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.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Eny 4 ronmenrual.. Health;. Ser-
f- -
P�dtra��- Co -u itT-Departmen't of Health as to whether 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 em.
Dated this 6' day of 0C-/' 19 Signat
(If corporation,..give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION 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 ' I
„y.
+i
Gentleman:
This letter is to authorize '' STANLEY, i LANDER
a duly licensed professional enF_ �sr : ✓ or _- vi'sce "re? .arc^_tact
.(Indicate)
t0 ,a:pp1y .for a Construct.on for ".G. Jepar Le "s -3war SySt °'_� t:7
'�
serve 'L e n re noted »L._ s v�^'�"1 a t''1 the r ' -al as
S 1 v Uh .abo.% not 'd p oD l'�._.". Ci .7 _...��._ i'.. . _ u._ a e S r G J
i • .,,, .-••� ^a L- the ^ . i ; ^- ^ `1-- Putnal,: COt�:'
or reau_a vio .s as _ o_:.�._�� . b r __ ;,o _ _ SS _ v1 va_
.... '�1 P rro , t :�n.. L . 4 i JT'1 .�.�.� -v_ ^v _ .�� ._ C�..r ' viral
D.,part. eL o� n a �., d :,o s_� a_ . ss D D s on_ ._y b
cOnnZCt10T' t•17 tC1 thi S 2i13tt�:' °i?d tv 'SUD' -,� +i �° conSt.rl:Cv�O ? o 8a-:d
system "or" systems i n confor"'i ty pro : _:z_ons of Article "1L Or "
1L;7, Education Law, the' Public Health .La , " and the Putnam Countyy. San. -
tary Code.
Very t al yours,
Sied�
r_ o. :�rope^ty
8I IWO
Counter si d � � � ddres
A.
P.E., R.A. T 3 l•i; T ,/ �. C
y, Tel eanone
:QTAAII CV I �'AAf'nClC9 <, Aa` ° • -
DUA. LP®
�MAWAI K N , Y
24x5 -2645
DESIGN DATA .:SHEET = SEPARATE :�E,.,.A DLL 0 AL SYSTt:'' FILE ?0
Owner -A'A54-2'11 W140 Address —51/ ear ��ar wy t441 -c
Located. at
"Street). �,�our .1�2t�✓G' boa .Block Lot ✓�
(Indicate nearest cross street)
Municipality �Gvti o% �diT/1/�:
�'.tershed���,
SOIL PERCOLATION TEST DATA PEOUIRED
TO BE' SUE: I'="?E
t;ITH
_APPLICATION
PERCOLATION
Role
�Lmber
CLOCK
TIME
PERCOLATION
- -.
PERCOL_1TION
Run
Elapse
Dept:: to Cates
.,rater Level
No'.
Time'
From, Ground Sur' =ce
in Inches
Soil Rate
Start
Stop
Min.
Start Stop
Drop in
'iin/in.dr.op
Inches Inc-e=
Inches
1
�i c3�s'cs
O
�cS
/g(, -14f
2��
boy
.��
i�® �/�
157
17
4
p� 1 S.'9,7
22!6b
.4 -
S
• l '
2
4
5
- -.
Notes
1) Tests to be repeated at same depth until approxi- .ate1 equal soi 1, rates tare ob-
tained a.t e =ch percola = ion test hole. All data to be submitted for revie:o.
2) Depth meas:,.re -eats to be Trade from toa of hole .
DEPTH
HOLE; NO. /0/ 7
H 0 LE 7 N 0.
HOLE N 0
G.L.
'561C
61'
0 -, -.04
Af
12t.
18."
24'.
301-
41
36"
42"
48
5 4"
60" let
.66
2
78
84
INDICATE LEVEL AT ti-HICH GROUND JA T EL R IS ENC-OUNTEREli A
OU RE
11N.- D1 CATE LEVEL TO WHICH WATER LEVEL RIS-E3 AFTER BEING EN C ITE L D
.TESTS �IADE B.v, z 41190vld2c:�
Soil Rate TUs e d Drop S. D.- 1: s 1 e Area 12r d i d d L5Zva
No. -o of Bedrao-s: 3 -Septic Tank, Capacity 7a4:,.. 'Gals.; IIYPP
Absorption Area e a Provided By L. F.(2
GFEW t,id -h rich. Other
LtMIULIV-.
Nafie bi-ANUT J.
Address :t$,UA Zt) I
%I!- I
t
A
Y. wou Wfi AWn - .
PUTNAM COUNTY DEPARTL%9-NT OF HEALTH
Soil Rate `approved Sq. Ft./ Gal
Checked 1-p?
•
Date
,S
.f
I
_ ,,.�� I %' � F ills is tc �a,;'1'y s`•ai tie sewage
i / ' disposal Syste„ .yes r._.; : ;'iad as ia-
1 r t \,� i dirated an tide!: system
us inspected by iti
o>iar. The systul
� j 1 occordaaee mith all the r s al i rezii
/ '1 Of
G� fc,t � v. , iP, f � ;' tpatiOy�yS (I� flit rOtOafil �GSFity ttapt.
"u f � IlealUL
r �'rF -= �l:_i.r.�o _S,:r � !/•5 ,� f :9S dc,.r'r.a G/ �C: %'?rgcf:,r% Jr..t.:._ ,....;�'Gi.
.. t� � ' `� ' �� • N r , � .. / � %._.,. � {YJ.7 v `j `• Jar "- !
�' `�'� ,V `i v;l•.t�{ �� �r:,�j � 3 "� "'�'�& 1(�E`S` ,' � ,'•- r:,✓ /li' / ?{+,..t.',pi. f�a1 /i�.
r
�Q, ��
.
•'t � �3ti � � tea_ '��4!`•
1971
' ty P1: OF HE.�EiH jp } f /1.,. 'uz ( .-- �/ r2- •.c
Pup P.F.' I": .:.: R1.'Lh 4s/ lr' -_.� Ei� *- r ^'.:✓r rf r 4' /'C
BY�.O , DIVlS10N OF '
4 0 ERETH SERVH7P$. •�° ! c'cw's: .61r.�i1.t} - 'r' ✓C, /r'.c.:d; t;s.•.Y �,,.tf+ ,r3f �f /
1 ENV R iPl H r '.t'