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BOX 3
00020
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00020
PUTNAM COUNTY s
* 'D/V/S1 if, 6f Environments/
CONSTRUCTION PERMIT -FOR SEWAGE - .:DISPOSAL SYST
Located at B`� rCh ;H I I .I -Rd
' Subdivision - -
Owner At711[ R.-
-t,FOSter
Building Type Frame Lot Area' I 38':
Number of Bedrooms Three -;:
I, Separate Sewerage System` '-to consist of 1000 Gal
r
` To be °constructed by z
h' Water Supply Public Supply From '
EPrwate Supply to be drilled by t
Address- '
Other Requirements None
I represent that f am wholly. and completely responsible for the design an
above described will be constructed,a's shown on the approved amendmen
t County' Department of - Health,'ind- -that on cornpletion thereof a �'Cert
be submitted to the Department; and. a', written guarantee :will be,fur
place in good operating. - condition any -part of sal sewage disposal
a.nce of the approval of the Certificate of ' Constructwn. Compliance
will
be located as shown onrtheap roved' -Ian and'thafiiid well-Will 'be.in
i C_ ounty - Department of Health
9 Q t D I X74`'
DEPARTMENT ,OF HEALT
Healtih Services,, ;Carme% N Y ;1Q51
r
Tax Mai 0
Lot` •08.
'Atldress
A Patterson
Total Habitable Space
Septic Tank 230 lineal f
a � R
A'dd"ress
tl location of 'the proposed system(s); 1)
t there. to .and in accordance with•the "stanch
ificate of= Construction Compiiance -satisf
Wished the owner, his successors hens or a
S
dunng` the period of two (2)'years l
of the or�g�nal system. or any repans theret
stalled accordance' with the.�stand64V
i
s Date C O elf Signed ` :� f
f + Add'r "ess 6 O 353 x "
APPROVED FOR' CONSTRUCTION This approval expires one year from the date issued unless constructio
revocable for cause or may - be a'rriended of modified-,when considered. necessary by -the Commissioner. of Heal
requires a" new,!permit Approved for disposal of, domestic nrtary sewage; and /or' private water "supply
A% ` BY
Z_
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0
Patterson
Town= oK Village
5 - .Block -02
Job ' S0151
Rcl
N1^ 12563
1- -1.96 Square Feet
eet x' 36 finch width trench '.
that the' separate sewage disposal, systerri
rtls, rules.an regu a ions.o e u nam
actory,to - the Commissioner of. Health will
ssrgrisrby. the .- b'uilder, that saidrbuilderwill '
mmetliateiy following :the date of the issu
0 2) =that the' drilled well 'described. above
rules and regulations of ,the Putnam
a•� P E V
License No0S '
the burldig has been undertaken grid rs '
Any change =or alteration; of constructidn
c
Tit le -
'2� ,a
11 "g e !6/
/1 3a'.f .
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 Axe,,., Address
Located at (Street) 7n/ �p Block p� Lot 48
dica e neares cross s re
Municipality IS 79evy-009 Watershed CAC -6®,.,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
5
Number CLOCK TIME
PERCOLATION
1
PERCOLATION
Run
Elapse
p
o a er
Water Level
No.
Time
From Ground Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Mini. /in drop
Inches
Inches
Inches
® 1 D470/ '2
2
/1-
�
�•/
rn
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5
Notes: 1) Tuts to be repeated at same depttl until approximately equal soil .
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
5
1
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5
Notes: 1) Tuts to be repeated at same depttl until approximately equal soil .
rates are obtained at each percolation test hole. A11 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
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.
G.L.
6"
12"
18"
24"
30"
36"
42"
48"
5411
6o"
66"
72'
78"
84"
INDICATE LEVEE KT-V=H GRO77ND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTE
TESTS MADE BY /� dj�,o Date �jo - //%
LLJ1lr1V
Soil Rate Used_j/-/Miri/1 1tDrop: S.D. Usable Area Provided
No. of Bedrooms /e Septic Tank Capacity ZM Gals. Type' ®®yy�0
Absorption Area Provided By j&0 L.F.x24" 5b d/ width trench.
Other
lva,mtj �'
Y-xnEn-r - =T� bigna Address
RfV-i, s
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: c 4
0
Soil Rate Approved Sq. Ft /Cal. Chec y +! Date
��op EHE SSN,
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