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04821
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04821
PUTNAM COUNTY DEPARTMENT . OF HEALTH
OF E
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"DIVISION•' NVIRONANTAL ICE LTH SERVICES
Date` /- 7
Re: Property . of
Z1 0
° Located at (;c),t/ Vii✓�t
lock Lot
Gentlemen:
This letter is to authorize STANl�. J. LAME
a duly licensed professional engineer 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
system or systems in conformity with the provisions of Article 145 or
t w; cPubli 4Haltfi..= ` :`alid= �tlaa'4PuanlCotiit-:Sr�- x-
.y _... «. _ ... ...... -..
c Law. 4.. GC�
tary Code.
Very truly yours,
Signed
Owner of--"Property
�SC�Es� A7C{ �ig1�G
Wo 190
Address A,'fiA,,4i A,,, pe,E.. -eels A
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ear °, `��'4A', -71r � � �
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH_ SERVICES.....
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COUNTY OFFICE BUILDING,�CARMEL, N. Y. 10512
i
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner 5A7t ta, tn�U) , &,. • .� t� . Addre s s ���� p�'� ZA144 4'--! f &I Alw //,4 4416
'( /lave AP TJ
Located at (Street Block Lot
6_d1cate nearest s ree
Municipality_40t'.'d,1 Z)/-' Watershed Ed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
apse Depth to Water Water Mvel.
No. Time From Ground Surface.in Inches Soil Rate
Start =Stop Min. Start Stop Drop in. Miri. /in drop
Inches Inches Inches
2 `'. /v 613), j®.
4
5
5
2
3
5
Notes: .1) TdAts 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 be made from top of hole.
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TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO.
HOLE NO . 19-1-
G.L.
6"
122 11
�f
p
181t
N
24
30!1
"4W _�t LVA�f
47V
J4
3611
4211
4811
5411
6011
6611
HOLE N0. Pe.
fir, O>
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vi
7 ,
w
w
N
A
>a
7211
.. ... . -_ - .- - ._. .. -..< .. _... .. . . ..r, v - .ter• . c - •.
8411 N
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED "�+ %✓�
INDICATE,LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date - /2-27C
DESIGN
Soil Rate- Used Min/l "Drop: S.D. Usable Area Provided
2 -r
No. of Bedrooms J Septic Tank Capacity e� Gals. Type �^� C -I , 6,j
L..
Absorption Area 'Provided By L. F. x24" width trench.
TANLEY I LANDER Other _
A
Address AMAWA(_K,. N. Y. 10501
THIS SPACE FOR USE BY HEALTH
Soil : Rate Approved Sq. Ft�y�oC�y Date