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BOX 2
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PUTNAM COUNTY DEPARTMEN T OF HEALTH
•DIVISION OF ENVIRONM =4TAL HEALTH SERVICES
- Date /0 y
Re: Property of
WOO,.. _
Located at
- Section Block Lot
ti
Gentlemen:
This .letter is to authorize �D�yJ_ ®rPri� its
a duly licensed professional, engineer ✓ or registered architect
(Indicate.)
to apply fora 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 Co- rumissioner 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
147, Education Law, the Public Health Law, . and the Putnam County Sani-
tary Code. ►
Very tr ly ours,
Signed
wr? .r of Property
AIX
Co ersigned: Address
E R.A. ,
Telephone.
ASl (Se N;
Address
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Telephone
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN .'DATA. SHEET -.SEPARATE SEWAGE'. DISPOSAL SYSTEM. FILE N0 .
Owner AddresS�sd /C S
r-
Loc aced at (St reet) `D- �iw . Sec Block .Lot
(Indicate nearest cross, street)
0
@i*S Watershed
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SOIL PERCOLATION TEST-DATA. REQUIRED TO BE SUBMITTED WITH:APPLICATION
.Hole
Number CLOCK.TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Water Level
No. 'Dime: From Ground Surface in Inches Soil Rate
Start Stop Min.. Start Stop Drop in Min/in.drop
Inches- Inches Inches
2
OF I
3
-4 -- -
5 `
Notes:
1) Tests to be repeated at same depth until approximately equal soil rates are ob -.
tained at each percolation test hole. All data. to be* submitted for review.
2):Depth measurements to be made from top of hole.
Name S.
Address Q/. B 3 S"3
Ca Amy-1, Al,
o
PUTNAM COUNTY DEPARTMENT. OF HEALTH
.Soil Rate Approved Sq. Ft. /Gal.. Checked by .Date