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BOX 29
03677
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03677
3PUTNAM CCIUNTYn DEPARTMENT „OF HEALTH
L�yy �,...� .� Driisron of Enwronmental Health Services; Carmel N Y 10512
Z� u
COIUSTRUCTION PERMIT ,FOR SEWAGE _DISPO
r
?KDL€�� ,Town or v_ ill
a9e t
Located at `�Q G? 7 r Block 1
�” ,� �.. s ,. Sri j `f/�.. ' . `•
Subd+vis+on
! Owner A/.,ro,
3J
4 a8uild+n9TYPe
t
Number of Bedrooms ` 3 J Total Hab+table ;Space Square F. e)
$ •z � ,
�j V
Separate.iSewera9e System to cons +st of Gal Septic Tanks I+neai feet Xr width:trenc
To be constructed
Water S4_ QP,Y Ubi+c SUPPIY From s 3 x a S s a. k {ilif
§ k� Prwate Supply�tio be�drilled�by�; ,� F -� � � `=•
Other. Requ+renients °'_
=1•represent that -1 am wholly and :completely oj�t locat+on�of the p posed systems) l)�that 'the sep rate se*age disposal - -system
t,."aboveaescr bed' "wdl be constructed show roved�,a here to and;in accorpance with the'sfandards °rules'an regulations o... :t, e u nam
County ';Department of Heaith,,and tha I- - a ` to of ConstructionaCompliance sat+sfactory to the Commss+oner,of. Healthviitl
:6e.submitted�to' the Department, _and a - -' a �b -s >ed`the ownerx hissuecessors he+rso►ass+gns by the'bu�lde; that sa+d'bwlder "aiv,ilf
'.place in_good °operat+ng =condition any: P �� osa, rrl duZ�m iod of two (2) years+ mrried+ately'foilowing�.thedate of-.! "e.issu-
ance of- ,the::.approval of :ahe Certificate "f o 'sit" nc of he "or'`or any epairs theret" )-_that hii drilled, described ;above
will be located as ;harvn On the approved, d f Ibe ast ed in rw+th the andard ule "s and regulations of .;f Fie Putnam
County'Department of Healthu ^f'
late .� NO 32'91 ` P.yE RSA
Address nJ ; f %>►�� (. a License No
r COVED FOR CONST;RUC,TION #This approval a _e year from;th'e da, issued uhless construction of the bu+ldmg: has been underfaken and is
l`ble for cause or. may be amended or.`mod+f+ed when'cons+d ere l necessary by the Commiss+oner of Healtt! Any change, or altera't+on of construction:,,
s ,a new permit Approv8d for3disposal 4of- domestic sanitary sev�yge d or pnvatexwater'r' ply only ra y 4 4
c /yr
.r� y - ,�, ,}, wi•`"i i ' ] '��' w- at'e. tit `tip < �' t N
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l PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of
Located at Z7— '
Alk -
44— Block ,P Lot 14-
Gentlemen:
This letter is. to authorize
STAN EV L DER
a duly licensed professional engineer �.-'� o
(Indica r registered architect
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
'h...... _.. .l TT. '1 J- L. - .7 �- .. ' �• l r.. n n .v� - +�v+'r.r�v�r� nv� »ner l�nti+n l f ^ n
.UG�JCL 1.•t iLG114 lJl 11GQ.1411, -a11a L. .�%_L CL 1._ 1_Pivvu"`ar �L,:,,Nli_ .. ::ii :i� L.v.�.u,i..
connection with this matter and to. supervise the c,onstructi:on of said
system or systems in conformity with the provisions of Article. 145 or,
.
147, Educutznn -Law, - .tha- -rublic -Health Law, and the Putnam - County Sarin -.
tary.Code..
Very truly yours,
Signed
Owner bf Property
Counter igned �-e-
- —
( j..DER. (Seal) ; e ep one
A� re s s
BOX 2s% ��,%� . _
10501
W. .0 Y 7.
5 -2645 f' , -
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24�.� mss,_
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
j. COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
ESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner w°
• J�i�;d: �ir�.� f Address �?� , r //-V e , /I/ .%
:Located at (Street _ o�%� ��� �S Gam- Block Lot 14--
ndica.e nearest cross street)
MunicipalitY'r�a�� �`P Watershedf
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
. - rloie
s >;Number CLOCK TIME PERCOLATION PERCOLATION
tZun
Elapse
- -Depti to Water
Water Level
/ g
No.
` j
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
•Inches
Inches
Inches
ax11If
2
2
,/o
r?
HER
3
/p °-IS l ° =f�f
3a
5
r
!(
N
otes: 1) Tests to be repeated at same depth until approximatelyy equal soil i
Pates are obtained at each percolation test hole. All data to be submitted
'for review.
2; Depth measurements to be made from top of hole.
//I
/ g
ref j
` j
2
4
ax11If
2
f,UTINIANI ✓
r?
HER
5
r
!(
otes: 1) Tests to be repeated at same depth until approximatelyy equal soil i
Pates are obtained at each percolation test hole. All data to be submitted
'for review.
2; Depth measurements to be made from top of hole.
i
1
11
TDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
MICATE LEVEL TO WHICH WATE1 LEVEL RISES AFTER BEING ENCOUNTERED
]STS MADE BY. 'Date
DESIGN
)il Rate Used b
Min/l"Drop: S.D. Usable Area Provided
S Gals. _----,Type
of Bedrooms Septic Tank Capacity 1?0
)sorption Area PrVo
36 width trench.
Ot4er
sTAHLE- Qo�
'me
AMAWALKY .N. Y. 'LuJuJ-
Aress
[IS SPACE FOR USE BY HEALTH DEPA
,il Rate Approved
Sq. R/Gal.
Checked by Date
CM
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH
APPLICATION
c�
DESCRIPTION OF
SOILS ENCOUNTERED IN.TEST HOLES
EPTH
HOLE NO.
HOLE. NO.— R 2.-
HOLE NO.Pe7-�,
r 11
311
V
Mel, 4266�e__-
311
It
i
1
11
TDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
MICATE LEVEL TO WHICH WATE1 LEVEL RISES AFTER BEING ENCOUNTERED
]STS MADE BY. 'Date
DESIGN
)il Rate Used b
Min/l"Drop: S.D. Usable Area Provided
S Gals. _----,Type
of Bedrooms Septic Tank Capacity 1?0
)sorption Area PrVo
36 width trench.
Ot4er
sTAHLE- Qo�
'me
AMAWALKY .N. Y. 'LuJuJ-
Aress
[IS SPACE FOR USE BY HEALTH DEPA
,il Rate Approved
Sq. R/Gal.
Checked by Date
CM
err
c�
JIr
311
r 11
311
i
1
11
TDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
MICATE LEVEL TO WHICH WATE1 LEVEL RISES AFTER BEING ENCOUNTERED
]STS MADE BY. 'Date
DESIGN
)il Rate Used b
Min/l"Drop: S.D. Usable Area Provided
S Gals. _----,Type
of Bedrooms Septic Tank Capacity 1?0
)sorption Area PrVo
36 width trench.
Ot4er
sTAHLE- Qo�
'me
AMAWALKY .N. Y. 'LuJuJ-
Aress
[IS SPACE FOR USE BY HEALTH DEPA
,il Rate Approved
Sq. R/Gal.
Checked by Date
CM