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HomeMy WebLinkAbout4474DOCUMENT CONVERSION SERVICES PROVIDED BY . IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -32 BOX 34 04474 16 T I ` r ' `p I -. 'L - .� 1 04474 tEl'F PUTNAM COUNTY DEPARTMENT QF HEALTH \Diwsion of. Environme »te/ Heis h � permit ICATE OF �MNSTRUCTION COMPLIANCE FOR SEWAGE. DisposAL .SYSTEM H� p � � `. - Town or�Villaya Sax Map %. Block w. Owner y �� ormer ly Tax Map Lot . Separate Sewerage System 'built by Address Consisting of.,- L —Qal. Septic Tank and Other requirements Water Sup Public Supply c ► ^�*+ Private Supply Drilled BY Address /^ Building Type No. of Bedrooms Date Permit Issued Imo" Has Erosion Control Been Completed? I certify that the system(s) as•listed'serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached),.and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. 'zZe Date Certi ied by I'd P.E. R,A: - Address / Q ✓ License No.1° y �� or Any person 'occupying. Premises served by th ove systems) shall 'promptly take such action as may necessary to secure the correction of any unsanitary conditions resulting from such usage. AP royal of the seperafe sewerage system shall become null and void as soon as a public sanitary, sewer. - becomes available and the approval of the pilvate water. supply shall become. null and volt when a public supply. becomes available. Such approvals are subject to modification or change when, In. the Judgment of the Isslroner of Health, suc revoce on, modification or change is no Date r, CJ ^ I BY TKN _Rev. 9 -81_.- -- -- -- — -- - - -- - - - r .. ... � ... ♦. .. � ... .� .- � _. � ...rs. ��♦ - ...-. . -. ._ ..�. .�� ..�A... . .G. � ,♦ �Jr- •fY ! .. .p , . -... v+ _ .. y f � .. _.. .� ♦ ..r ....� - ._ ...� . ,.A... ,.C' � w -IS. 1 j Own r or urc aser of Building il - Bui:l"dink: ..�.. a..1a� Y' m -„� wT ..�.f .. ... 1 ... �.. .. ,.. v,: .- .- � � o �. .. �_ :. _. c .�..�.. .�..e -.� .�G.� i�- .t, +w.e E� .. ... _ a� o..... -y ..... q-. ... .:. � r.. .� .. r. �.�.... ._ •�'. • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ft=, Property of Located at "'�eA4 �A (T) �P' 6y21 Section 1,721 Block Lot 2�le Subdivision of /HIV l elelal / "4;q' ', -Subdv,. Lot 40- Filed Map # Date Gentlemen: This letter is to authorize���/ a duly licensed professional engineer /vim or registered architect (Indicate to apply for a Construction Permit for. a. separate sewage system, to serve the above noted property in accordance with the standards,.rules or regulations as promulagated 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 ., :....:_;.sy- s- z- em--or -sys•t-•ems -the - p-r�o- i�i:ons --of - ►!-ti-c;lew:, 145` 147, Education.Law,.the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, IMF Signed Countersigned: � `� Owner of Property P.E. , R.A. , # d, . amp Address Address a;v�� „�o�° Town ""ECEIVED e� aoeeco43$�y J Sy q l Telephone Tegeph ne tV 191984 P Dkil f . OF Hi AL M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY' OFFICE BUILDING; 'CARMEL, - N Y. 10512`~ DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner i ;;/ e �s � Address `. Zol Located at (Street ZV:4;�� Sec. / Block Lot . n ica a neares cross street) Municipality. 7all;�702yv o' � Watershed SOIL,PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME _... PERCOLATION , . PERCOLATION; No. apse Time Start -Stop Min. Depth to Water From Ground Surface Start -Stop Inches Inches Water Level in Inches Drop in Inches Soil Rate,,_. Min. /in drop 2�� ®�;/ 3/0,01 &IV :301 5 _ -....m .. ...wn.o �. Z.f a/P f���/ �✓ ....`� y,s- ... � ...e e.i +. /tee .. ..�.. ��^' -..M.• rUl+. t. �.�. .f ...._ _ .. .. .. ..a. i... .- a. 4 1 4 5 DEDr AM C, IU,,, Notes: 1) T&Rts to be repeated at same depth until approximatelyy equal soil rates are obtained 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 - DESCR--P'I'ION OF SOILS ENCOUNTERED IN TEST,HOLES ...+.� �`a�C a. _ .ia.. . ;aw.,: .OVb. n .: i!• v _ �...ryry.. .- �� _ s . V '•��n�•.+fM1d�w '.Z i'i•iT�-1S'LrT •� "p "N ,_N,� DEPTH HOLE NO. HOLE NO. t!� HOLE-NO. G.L. 6" 12" 18" 211•" 30" 7811. 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED : °3NDICATL LEVEL PTO WHICH WATER -LEVEE,= =RSSES 11FTER> BEING= ENCOUNTE TESTS MADE BY cT -'=� f.,, ,) i .r'rii. .. Date'Y� e DESIGN " Soil Rate Used I/ Min/1 "Drop: S.D. Usable Area Provided,® cc,- r No. of Bedrooms Sept' c Tank Capacity ,_,Z Gals. Type_ro.� r _ Absorption Area Prov ded By L. F. x2�+" "— ��-!Iti trench. t,... - a° Elw( -ro flame K . gna• ; u>re;'= p Address ;� ` k' i, -• �moma0e THIS SPACE FOR USE BY HEALTH DEPARTMENT.-ONLY aacna° Soil Rate Approved Sq. Ft /Gal ;. f -> Checked by Date _ jo MINIM G ayplio le Pu Uou two, A ZI/ 7Z e2' jo MINIM G ayplio le Pu Uou two, A ZI/ 7Z