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BOX 6
00249
7.
PUTN'AM :COUNTY 'DEPARTMENT OF = HEALTH
Division of Environmental Health Services ,'Carme% N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE_ DISPOSAL .SYSTEM Patt21"SOn
Town or:' illage
Located at_ . Rte': 311 Tax Map. 1 Block 7 •
Subdivision Lot °b S01.516
Owner ',Mary L . & ;06nald RE_►1nQK' Address "Brtck .HQIJ$e }�d
Building Type: MOdUl aY' Lot Area 1 • 03 A. Patterson � 1� 1256
Number of Bedrooms Two' (Three fQ1" �E�qn� Total Habitable Space 9 50 s quare Feet
•Separate. Sewerage System to .consist of 100V'.. Gal. Septic Tank 300 lineal feet`'X 36 "1►LC�l' width trench
.To be constructed by Address 1
Water Supply Public Supply From
Y
Private Supply to be drilled by
Address
'Other .Requirements .'None
I represent that_I am w6,olly and completely responsible for the design and location of the .proposed eystem(s); .1), that the, separate sewage disposal system
above described'4ill be constructed asshown on the approved amendment there to'and in accordance.with thestandards, rules and regulations o e, u nam
-County Department of Health, and'that on completion thereof a 1!Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted .to the Department, and a written guarantee.will be' furnished the owner, his successors, heirs or assigns by the builder, that said builder will
:place in good operating condition .any part• of said sewage' disposal system during the period of t46.(2) years immediately'following the date of the issu-
ance of the approval, of the Certificate of Construction Compliance of` the original 'system' or any repairs thereto; 2) `that the drilled well described .above
-'wi,ll:beL located as shown on the approved plan and 'that said well will be installed in accordance with the ' standards, rules and regu a ons of the Putnam
County Departriment ,of Health.
Date -30 October 1974 Signed P.E.X- R.A.
Address 'R. O. '6, Box . :353;' - Cannel , ' Ni 1812 License No:29206
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for cause -or may be ameniJed or modified when considered necessary by the. Commissioner of Health. Any change or alteration 'of construction'
requires' a new permit. Approved for disposal'_of domes/t'iic' san itir y.. / Yss%omeew- a e, .and oy r Priv water supply ° nl y.
Date By. Title
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 &., ,fe Z. Address
r-k�ir
Located at (Street — -S@8. p
.t Block __7 Lot �9
ndica e
nearest cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
RM Elapse Depth to Water a er ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
.z 1 al 12-3 a- 3 2:4 4r f
2 /4,31- /"7 r 2 2�c /
3 /14 ) IX
5
2 12f J_
r.
3/100 1318- /B /
4 4�16
5
2
{.
Notes: 1) Tests 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.
DEPTH
G. L.
6"
12"
18"
24"
30"
36"
42"
48"
5411
60"
66"
7211
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE
78►► s
8411 N�
INDICA LEVEL AT WHICH GROUM719AT IS ENCOUNTERED
/Vow e
INDICATE LEVEL TO WHICH WATE WEL RISES AFTER BEING E COUNTE
TESTS MADE BY f1.c 7- /o 7 Date /oly
DE IGN
Soil Rate Used /00 Min/l "Drop : S.D. Usable Area Provided 0 0 o ' f
<74, -ee /w- -,j 1�
No. of Bedrooms -7w�o Septic Ta k Capacity 1,0,o D Gals. Type
Absorption Area Provided By 300 L.F. x24" width trench.
Other &-Q07e
Address R. D. 6, Box 353 N. PRe,y�" �c
Camel. New York 105.12 ��, o�+' 'ss
THIS
SPACE FOR USE
BY HEALTH DEPARTYMT
ONLY:
Soil
Rate Approved
Sq. Ft /Cal.
c
Chec
°I Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Gentlemen:
This letter is to authorize JX� �zv - S3
a duly licensed professional engineer 1�c 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
1.47, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly y rs,
Signed
Owner 6f Property
# 2920E
R. D. E,, E3o:< 553
Address
Ca crib I , MY 10512
91.4- -878 -6 170
Telephone
GZ '
Rim@ jj'r
�eF,A IV, 29206 E
�FTHE ST�/
Address
.9 /f ®4079 A
Telephone
•
Dr�.t e.•
j ri � SITE j cr r.
110_. T1'-L ITISP�,CTIOid - �
Yes
1\o
Ccri'men.t 3
Pro crt�� l:� nes or corners fo,;nd
estimate ' Clouse location
Will driveway reed cut
must be removed -note these '.
.trees
Is deep hole r. cprosenta.tive of entire SDS area
Additional deep holes needed.
_
Sufficient SDS ail: -.a available cons deri:_
_
driveway cut,house location,.separation .
•distances, etc. ..
.«
DEEP 110 ,- PIA, TA
Depth
later elevation: �
Rock elevation.
'
•'
• Soils descriution: a,�,... ,
Date:
FINAL SITE 'I'_`1SPECTIO�T Insu. by:
House located where 'shown on .approved plan ...
_
.. it T . •. . ., .- J...., 1 _ 1 _.
Width of trench average :
Slope- of tfle line and trench acceptable
Room a]. owed for e:;+pansion trenches
Over 5C ft. frcm swam-o :•:atercourse _
Natural. soil not stripped or SDS area _
unnecessarily graded
:i0 r rrai�ltai r_ed fro�� _nron.line and
20 ft. from house .
Separation of tr`rlch iron house, Drell
etc. follows plain . . . . . .
Number of bedrocros checks . . .
Stones, brush, stumps, rubble, etc. o *"eater
tImn 15 ft. from nearest trencr
15 I`t . of peripheral soil horizont -ally from
trench ' . . . . . , , . . ...
Junction boxes - prep °_�1y set
Could surface run oi•f from driveway, roads, ,
gro .nd surface, etc.. channel near SDS • ,
area
Does lot drainage anrear 0. K. in area of SnS
FIl�'LL OftDING OF SITE ACCEPTAB.TE
RL'VIE -1 C1111,CK' SIT�`T
'Meets Std.
des 4o
)OCUMENTS
Y
louse plans O.K.
)esign data sheet
'eres presoaked?
!in. 30" perc test depth
!onst. results for 3 runs
). Hole log 0. K._
- orporate Affidavit for oth -.r than indivi
authorization for engineer
,etter from Water S, ,)-pply if applicable
f variance requested -such noted on plans
Remarks
)ETAILS
if charge is proposed*.,)
'xisting contours shown show new contours)
>lopes for driveZTay cuts, etc. shown
Eater service line location
'ooting_drain, etc. location I =
'op slope, bottom slope of fill �
'ercolation tests and deep test pit location
>ept:ic tank size and conformance to std.
B.R. house minimnu-o i I
Iouse setback shown I
)1. _
_L ilif. J_i�i1
.... ..... .
ill Wa sex' tlJ. Glllil >53 1'U U1 EL 611V W 11
Plan and profile SDS
All other wells and SDS closer 200' -
shown or' reference made
Property boundaries (metes and bounds- clearly shod
EPARATION DISTANCE'S SPECIFIED ON PLAN
0' to P.Z.
0' to Foundation malls _
0' to Nearest well
0' to stream, march, Zak
5' to Curtain drain
0' to. water lire (pits -2
5' to storm drain
0' to large trees
0' fr foundation to se
5' to pipe frog; leader d
etc. incl.expansion
c tan_L
n & fooLlng drain
i
6
s
2
I
f,
j
i
TdntL insidatength
Tnnk tnsIde ve.Ith
Ligaid to ve i y
.. �CtlDtltlty_ to p0
Reld R.regd - ---3c
i Width_- — -
Y N'loter@
1 N Goxes__
section
S t I Ga: Gn! /Sq
_4 Ft
wide
fl
} r
"!- -Ova to ifs....
• Ih. r - ll. g'' r '`t, ice. .. {A. / '/� � /i _ gip. !r �Ut7r �sJ
0 ct- 5.'d .S
r J N Y
APPROVE'
N.! •`60 -_ :L, r .W _.� 3 \ 3,. j �''. y� NOV 11974 - --
+UTNA G7UN Y U FF. OF NEALTh '—
R. DIVISION OF C W N k k
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