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place in 'good operating _conddion any ;part of said sewage disposal: s
ante of -the approval of the'Certifi' a of Construction Gbmpliarice q
will be,.located as shown on the approved plan antl that said well will be, ins,
County •Department of Health
tt
12/4%73
Date Signed
: D.. 6' Box;,_ 353 `Ca
::_Address f �<<
i
APPROVED F.OR 'CONSTRUCTION This: approval,expiresione year -froi
revocable for cause or may be amended or modified .when co'ns�deredanecE
requires a new / .perm t. Approved for disposal of dourest rotary se'
Date 31 gY —�
:ti
n tluring' -the period of two (2) years immediately following thedate `of the
e original'system ' or any ieparrs.thereto 2) that tFiearilled` well- described. above -:
d in accordance „wdh the standards rules and regula i0 ofd the v Putnam
E'X` R A
NY' 1 0512 L e N29206'
r � � icnse o
ie date _issued unless construction of the bwldmg -has been and rta�en avid is. '
y sby Cthe' Commissioner`'of Health Any, change, _. alteration f coris�rucfion'�.
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and /or, a water supply only
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Title °
I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re Property of Amei
' Located atyg►�'�s• ® ®�
Section Block Lot
Gentlemen:
This letter is to authorize
a.duly licensed professional engineer L---OO,or' registered architect
(Indicate)
to apply.for a Construction Permit for a separate sewage system; to
serve the above no property in accordance with the standards, rules
4
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
1.47, Education, Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,'
Signed
Owner of Property
ou tersign d:
P.E. R.A.,
Address
Address
Telephone
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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 / ,,iS��� g.�ee I�% Address Sk ®�q ter /5/i �® al
r
Located at (Street � Zfi• )eu Sec. Block Lot
Indicate neares cross street)
Municipality % 2ft�!W�10 t,, Watershed 47eb-6b f
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
o e
Number CLOCK TIME PERCOLATION PERCOLATION.
Run
apse Depth to Water water ve
No. Time From Ground Surface in Inches. Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
2
31W lArd-
Notes: 1) Te'�ts 't.o• be repeated at same
rates are obtained at_.,.each 'percolation
for review.
2) Depth measurements to be made
depth until aroximately equal soil
test hole. A11 pp data to be submitted
from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. �_ HOLE N0.
G.L.
6" B
1211 COX& 4 a-v,
18"
.2411
3011
36.. e
42" '
48"
54 it
.6011
66"
72
7811
8)+"
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED fV60g!
INDICATE L� RISES AFTER BEING TRE
� -TETS MADE Y A ow T , 7/ 0 )5? /�� 1J.1P PDa eQ /Ae /9-?
Soil Rate Used AnrMin/1 "Drop: S.D. Usable Area Provided 046 YL
No. of Bedrooms Septic Tank Capacity /00 ® Gals. Type
Absorption Area Provided By - ® L. F. x24" o� width trench.
Other Alam"
Address • 6 Rox 353 a P
N•
Camel, My. .
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
G
Soil Rate Approved Sq. Ft /Gal. Che by
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