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JCT,ION PERMIT :FORSWAGE:
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lumber of Bedrooms ! Design F1owa G 'P /El
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.rr'kz sT -.—Oi at rte.
eparste 'Sewerage System � to consist of,i,s
later Supply xPubl�ci Supply rtFrom r
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tSi4: `ti � ,�g' ?� r �,.
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E 9 Ry s"a e
NTY �aDEPARTMENTy OF HEALTH � >�«= � Permit Y 4-[Jc
�entalHealih Services Carmel N Y 105, A
^et x �=� °s�,y+, ,.n`,t � aex,. r a. % �", � ° 3 rxE•- d� t a t 4 a f ti
1 5r 4,y a "f s^ a a x
SYSTEM" �4 rWL v--,- �.. t G
vii i
`, � r ' r- Town r illage >. ��; •
J �..}t. - n;•r..c -F ,..m` -n J �IL}iep -i$►F K,., ';EIo k` - - ", irJ �'. o t�� x' s -It \1 . q..
i
�� ' "` �' F111 Section Only ❑ '' `a � - � � S
�'� � x�•+,. tL P C '`H DrNotification`Required
`�'� Galal 5eptit gTank�� antlM�
F ����� ti s L '+t „� 'Y V `'. .145'1h~. •i7. 1 J 3 t M � j
�� �^*� sy��'� �. �' t U1 �s �r.s ri �; Y � ""� xfi� � Lr` �, r,"�..'�+�s?��s"+�`'Sks � �' '�",.,'� r �• '' y4
X r 2 yy N f 1 x x
ies�gn pnd IocdUon of the proposetl systems) 1') that the separate ,Sewage „disposal ,system
endment' there to and in accortlance wdh the stantlartls rules an regu a ions o -.the,,,,, u nam
a 4 to b. '•.. '°yXr a 1
rya "
Cart if �teoi CoostructioGompl�ance i atisfactorywto the Commissioner of Health will v 1
II ibe',furnnished -the owner his successors° heirs of „ass�g�s by the ^Builder that saidFtiuilderwill
isposal systeff . dunng the period of two "(2) years immediately'following tfietlate'o the iisu- f
pl�ance�of5the onginal systemoi any repaus Yeto 2) that the'dnlled well tlescribed above
v�ll be installed �n act ante ith the a d ds rules and regulations f the Putnam
D.
'� �*� s� � mow' ,�y, • � .�, ' � ^:, ti i'
Ign n_ aS r isP`e RA4rr4, E
yearfrom the date issued unless construction of th tiuildmg hat been Lntlertaken antl'is i
le►ed'(y ce essaryby �theCo 'siioner o ^Health A�yehange oralterstwn of construction
1�da'r {sews e ' antl /or xp'n t itte�supPtY only{ °x «
¢l
ti-
11D p� A pIr -� �t fit/ 1Cpy A p�7CA��+ 1C �[,7��^
`M 0 i ✓ ', - PUT rh�1vIl ®V lv� ll;' z ®1L:1C/9I�1vYJL1V ll ®Jl' r �n�lr�-�L �� r }'`"� ','.Permit
C' Division of. Enwronmeh&1 IWa ltti Services Carmel N..-' _Y 10512
i
4
'C ®RiST�BlJCT80f� PERibil� .FOR .S�NNAGE ®BSPOS� SVSTERA,. ,
a Town or. age
,
Map Block Lot . . 'I
�o.atog :
a2 T,, Tax
- Renewal Revision
Subdivision
S11kxi L'ot A
❑ 0.
ti s'
.Owner /Addieis Date 'Of Previous. Approval
Builtlmg Type Lot Aree r ° Fill Section only ❑ x ° �` _ Y {
Se crate,; f Bedrooms Design Flow G /P /D,� P C N _ n Requir
Number o
D Notificatio
p Sewerage` System o cools �o x Gel Septic Tank antl -
rTo be constructed by 4 w Address ' ~
;Water Supply Public Supply F m ; P.
�
Private Supply to De drilled by
Other Requirements
�,�
4 _ i
d; represent that I am wholly and tompie tefyresponsible for the design and location of the proposed system(s), "1') that the separate seWage disposal system
'`above deser�bed will be constructed as shown on el 'approved amendelent thereto and in accordance with the startGards, rules an regu a ions o e u nam
Count `De artment of Health °stand that.on com'let�oh thereof a Certificates of Co�nstructiortrCompiiance satisfactory to th ®'Commissioner of Healthvill
1, �. „..;,n� m xp•:." fir„ °. :"r"+w^+�^?y . ,;:., .er^'' f._ <^-
be submitted to -the Department, -and a written guarantee" wilt be;.furnisheC the owner his ;uicesson_ hers or assigns.:Dy the`.,bu�lder that said budder will
'place m',good operating conddion any part of.,said swage disposal system during the period of two'(2) years immediately followingA4heda4o . of 4h® issu=
:ante of `the appigval of ,the Certificeta sot- Construct,on Compliance of the".original; system or any repairs there4o 2j ;the drilled vveli desci_ibed above
will be located as shoyvn onthe approved plan and that said well will be'Installetl' �n accordance wrath the standags r s aJ d regu a—T oiT ns 04 the;, Putnam y
County Department of Health
t a .
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y,
}
Date ,
5,
- v. Sgn
x
. tense No
APPROVED FOR` =CONSTRUCTION This''a
£ pprovel expires :one year from the date issued L s constiuctior, `of, the bu�ldmg: has been' ande ► taken and is r
;revocable; for "cause or may be amended or modified when considered necessary_ Dy the - -Co missy ner o4. Ho&Ith': Any change or %'alteration of cdnstruction:
regwres a• new permit ` Approv 'for dispos l of domesti and rpr ate wpply only`
Deter e� -� •� ,.�; '� #` : B ��" _ _..t„�,a" -- �- �Y'141® "'��'- ^�"'�T '{
.Rev. 9-81
M
IE
• PUTNAM COUVTY DEPARTMIlV T OF HEALTH
�T ♦FTR ♦ ♦A AAATTT••ffAAA T�py T�Ty'A ['N .�_..
• •D'�,Y..��i3Oii.._ Vi. _�. /�FJ:'- r- A.`.��:•h Ui.SI +�'�1U4i�'i'iS�����.. ��. �.:N.....L....��. . s ''r.a:: �•.!•uw
Gentlemen
This. letter. is to authorize T.. - Michael Daly, ^.r.
a duly Ticensed professional enginee or registered architect
(.Indicate)
to apply for a Construction, Permit- for .a separate sewerage system;. to
serve the above noted property in accordance with- t.he_st.andards,-- -rules
or regulations as promulgated by the Com, issioner. of the Putnam. County
Department of Health.,,and to sign all necessary papers on my behalf ink
connection with this matter and to sup* ervise._. tkie _.ccanstruction -o:f:- Tsai °d: -;.
system or systems in conformity with the provisions of Article 145 or
147,. Education Law, the y, ealth Law, and the Putnam County Sani-
tary. Code. -
MAR �- 01983 Very truly yours,
COUNV
pEPT. O� HEALTH Signed.
Owner of Property
Countersigned: Address
P.E., R.A..e, #' 4846Q
Box 243- Shenorock (Seal)
Address
N.•Y. , 10587
248 -7022
Telephone .
Telephone
r
`PUTNAM :COUNTY DEPARTMENT OF HEALTH..;:;;,'.':
DIVISION -OF ENVIRONMENTAL' HEALTH SERVICES-
_.___.- ._.._. -. COUNTY OFFICE 'BUILDING; -CARMEL, N. Y.. .710512-
10512:
.DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner
Address I.
Located at (Street )
Sec. Block Lot
('Indicate
nekrest cross "'s ree -
Municipality _
_,__ _ . -- .-- Watershed
- "' -TSOIL PERCOLATION TEST
TA REQUIRED TO HE SUBMITTED WITH APPhICATIONS
"Number �j, "CLOCK TIME
°" -" PERCOLATION "`` PERCOLATION
Run' Eiapse.
.Dep : __ o. a er . , a er ve
Time
_F,r,om ":Ground -Surface jnri Inches `. oil -.Rate
Start Stop Min.
Start Stop Drop in Mtn. in drop
,,yyam�
Ap
-2�
';r
-
z;
11 c
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to 1e made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED.WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DTH,. HOLE NO. HOLE NO_ s HOLE NO. }_
. c m .. ., • rc -ey n �sir .. ,;,y to ;: .-c; � :TM � a1
G.L.
n.
. _ r op. ., _ 007 Soil�RateUsed Mirl "Dr b, AF�
z
No -of,• Bedrooms.
Sept ' c_ .Tank Capacit Gals•.._ -�_ _..Type
Absorption Area- Provided y 33 L.F.x24" X '- width trench.
her
- 2
.Name igna ure 1.
,