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13. -1 -30
BOX 4
PL
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00101
a PU -NAM - ,COUNTY DEPARTMENT OF HEALTH_..
r
Division of Environments/ `Health 'Services, Carme/ NY 105:12
CONSTRUCTION PERMIT. FOR SEWAGE DISPOSAL SYSTEM PdtterSOn } _.,
Town or Village =-
`, Bat dau1n Road _ .
Located_ at. Section, Block
.
a.
Subdivision Mooney. Nfil1 Lot 24 ion 01`549
.
_ S
owner : ��Mr & Mrs. ��Jos = Prl�mavera _ Address Bk: Wtn =Road
e. ��`
Building Type Frame- got Area • 2 Patterson, NY 1% 12563
Tree : 221 O
Number.',of Betlrooms Total `Habitable Space Square Feet
G p
Separate Sewerage System - to . cohsist of 144Q GaI Septic Tank �QQ hneaQ feet X < °- 3V Z�ri`C.11 • width tren_ ch
g To.: be coitstructed `by Address -
Water Supply: Public Supply From
}
Pr vi, Supply 'to: be, drilled by
' a
_ t:4
R: oT� x'11 .Sects' on "36" Aee� 6724
,Other Requirements 3
t I represent that i am wholly, and completely.rasponsible for;the design and location,.of the proposed • system(s) '1)'that the separate- sewage disposal system
i
above described will?be constructed?as shown %on the approved amehdment there to and `in accordance'with_ the standard s, ..rules an regulations :o -the. u nam, .
j ;County Department of Health, - and,that'.on•completionthereof al'Certificate of.Construction Cornpllance" satisfactory ,to theiCornmisdioner of Health will.;
-be submitted to the Department-:4and ,a written`gu`arantee will tie furnishedahe'owher his successors;heirsor'rassighs by the;buiider' that a�tlauiider will.
place- in good operating coi►diti(ih any part of said sewage 'disposal system during; the period `of two_( 2) ;years immediately following the date of "the'issu-
i
'ance of the approval of'the "Certificate °of Gonstruct�oni'Compliance. of "the original system or any repairs thereto 2) V41: -the drilled well described above•
i will be located as shown on the approved plan,and that said well will be installed in accordance with the standards rules ;5nd regula ions of the Putnait
County Department of Health
Y 14 sarluar 1975= X
Date' Signed P E• R A
� k
Address • 6. Sox .3 a NY 051 `' 4 License. No, 29206
APPROVED FOR .CONSTRUCTION: This:epproval expaes one from the'' date,issued 'unless construction of the building has been undertaken and 'is
revocable :for .cause or may :be. amended or modified when considered_necessary',by the „Commission Health ^>.; Any:change o% alteration of construction
requires a new permit pproved for disposal of domest�c;sa age`:andJo ' prwate ; 1 only
a Gate r 8Y. Title
777 "Y
R
su
Gentlemen
PUTNA,I COUNTY I)EPAUMFNT OF HEALTH
DIVISION OF ENVIRONMENTAL HFALTH SF.,RVICF.3
Date ,- 'Amlyew New
Re: Property of f �•� .�ras Aye"Wyer4W
Located at AIVA 0A, 0W. .T•'
CYP Blo k
Lot
This letter is to authorize John H. Prentiss, P.E.
a duly licensed professional engineer X 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
-147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yours,
Signed
Owner of Property
Vd-
C a
Address
29206
Ws
R. D. 6. Box 353 Telephone
Address
Carmel, NY 10512
914- 878 -6170
Telephone
L ff,
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.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
ME apse
No. Time
Start -Stop Min.
Depth to a
From Ground
Start
Inches
er
Surface
Stop
Inches
a er Levei
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
3
4 If 4T
5
or, 2V
Notes: 1)
rates are
for review
2
�1
Te':�ts to be repeated at same depth until approximately e
obtained at each percolation test hole. All data to be
Depth measurements to be made from top of hole.
soil
tted
DEPTH
G.L.
6►'
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO.---_
12"
18'►
24 't
3011
36"
42►►
48"
5411
6011
66"
7211
78►►
84"
INDICATE
INDICATE LEVE.
►PESTS MA nw.. RV
WATER IS ENCOUNTERED Z`3 °`fie
LP�ti71lI1V
Soil Rate Used/- Min/1 "Drop: S.D. Usable Area Provided /®4D®® e4f -it
No. of Bedrooms Septic Tank Capacity /gg" Gals. Type �alg®�
Absorption Area Provided BY-ftg2 L.F.x24" jb" ✓ width trench.
Other
, , ....
Address P f,.a.
,,, ., .., . �.
THIS SPACE FOR USE BY HEALTH DEPARVENT ONLY: ,
Soil Rate Approved Sq. Ft /Cal. Che
S' 11
f
FTHE SINJO Y�
Date
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