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HomeMy WebLinkAbout0501DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -10 BOX 6 00501 . IN -. ' J:J 1 ; 4 . 6 c: IN . �. .', ; V '. - - ML 00501 x-• S b ?` ' IV 4 1'''' '� `F h�`.� >! ? 4-'fV Y '�j 'f' S! .tk PUTNAM COUNTY `DEPARTMENT OF HEALTH "� , Division :oft EnwronmentahHealih Servrces, Carme% N Y :10512 ` CONSTRUCTION PERMIT FOR SEWAGE^ DISPOSAL SYSTEM` y �' y' own or.villa97 ! r Located at 42=4 SectEOn Block f ,. A {- Subdivision Lot ilob ^ - T Kip Owner �a • , Address /�ir�� frP!, w 1 a i ;'Building Type Co t Area ��7� Pa M , , ,..: :. a'Number of Bedrooms'`.` �n.P Total Habitable Spacex ��Square `Feet _` . , : , d OFF Separate. Sewerage• System to-'conssf :ofDB� Gal - Septic Tank '� lineal `feet X `—� ,. width trench . _. To be '`constructed by .� L5� ��% Address_LZaptln/' •' Water'Supplyc Public:Supply From " . _ 13e: f 1 p Private Supply to be :drilled by Address Other 'F2equirertiefits �/ta �� E I represent that,Vam wholly,and: completely responsible for;the design .-above described will'be'constructed.as shown on the approved amendrne County;_. Department . of -Health, and'that on co'mpletion`thereof`a "Ce •.be sulimitted'ao:'the- Department and a; writtep..guarantee will be fi place' in good operating condition L any •part of sa;d sewage dtspo;el rance of the approval 'of the, C()'rt fIcite' of Construction.iCompliante wil!-be;locate6 as'shown on the approved plan an`dAhat said well wilh;be, County„ Department of Health Date SignedS 1 Address APPROVED FOR CONSTRUCTION -This approval expires one yearn revocable for ca'use`or.may be amentled or dified when consldered;n requires a new; m perit. ,Approved for ,dimosposal'.of domestic sandary Date a ~' ,` .. 2 _ By in �r date issued u Dr va1��,ter t � t y , 7 systems) 1) that the separate,•sewage _ d, lsposal,system Pjth.the;stendards, rules an .regu a ons;o e u nam: piiance','�satisfactory to,the Commissioner of Hoalthwill )rs hems or assigns by the builder, that ,said bu!lder "will wo ( 2 ),years.Immediately..iol low ing thedite of the lssu re6aks`thereto;4) that•the,drilled well described above he standartlr ,rules and':reglu a ions of� ,4 he. ..-,Putnam P: it., RA' � Z License No. 7�C`' nstruction of,- f the building has. been undertaken :and is of Health Any c'Ra� or altelratiorr 0 Wc6 nstruciion supply only c a e / +J Title PUTNAM 'COUNTY DE?= _RTHENT 'OF Hz-.'.LTH:. DIVISION OF EN VIR 0N,'-NL'_' T A L HEALTH SERVICES DESIGN -DATA SHEET SEPARATE .. SE,-TAG -7, D 10 J A L SYSTEN FILE. NT 0 Octiner ..,,,Address Located at (Street) -L Sec. ock Lot L L indic ae' n.6 ares.t. cross.. stree Iv Municipality SOIL PERCOLATION TEST DATA RP-OUI-RZ-:)'TO BTE SUKII-1-TIVID WITH APPLICATION Hole Nu 0 e r CLOCK T IL 1 E PERCOLATION LA T I ON PE RCOLATIO'4 Run Elaose Dep to [a No. Time F r o m Ground S u rP=ce Soil.. Rate S t a r L Stop Mlin S t a r Stop Mi n /i n drop Inches Inc I -,es Inc'-,-s',. 2 3 1, 14 4 ' 5 Nile 2 3 14-n /A :kl: q.- 4 2 4 S No-f-es:, Tests- to be repeated at same dsoth until a p p r o x 17 a t e 1 %, equal- so_J'1 rates are ob- tained at each percolation Les-, hole. All.data to be sub-miLL 2) Depth meas .,.rements.to be made from top of hole. PUTNa`1 COi'NTY DEPARTMENT OF HEALTH \ '° Soil Rate approved Sq'. Ft./Gal. Checked by _ °FTHE sTFAt:0 Date TEST PIT DATA REQUIRED �0 3E '�UBi•iITTED.'.;ITH APPLICATION DESCRIPTION OF SOILS E C = �I':. TEST HOLES DEPTH HOLE r 4: \0'. ' `' .HOLE IN HOLE` N0. ,, i��� • • G.L. � ..t ' 6 }} .0®0� .y 12rr 24}r 3 01` y �� �EJ►Ms 36rr G MY- ov 42" 48 IL 5 41t 66" 2:. 4 %.O.r O a tP kk IL'D'ICAT� _•6LL :AT VFICH GROUKD TER I - rOUNTERE, INDICATE LEVEL TO idHICH WATER LEVEL 'RIB �, )AFTER BEING ENCOUNTERED YOW #IgW S TESTS "LADE B �'.JC��[i�.� ,��prj�,Date 'L.5_ SoL Used Tin /1." Drop: S.D. Usa -Ie Area of aA� _.1.. Ra �e -. o i _ . . No. of Bedrooms Septic Tan'; Cap= il�,' .b Gals.. Type -- . Absorption Ares..Provided By L.F.Y2' 36" cr:idth trench. Other • vp Na -me John H. Prent i•ss,. P. E.- C.E.C. Si-:,ature SSIONq� • Address R. D: 6, Carmel, 5 T� . , B 353 ss, FF� N.Y. 10512 PUTNa`1 COi'NTY DEPARTMENT OF HEALTH \ '° Soil Rate approved Sq'. Ft./Gal. Checked by _ °FTHE sTFAt:0 Date Loci I On IoW B! o cl�-- o c t i z z S -.5 Da M C E C) 71 r*,D 0 0 o -ur- 2 -r. - '�! Z ,. °r .,+'.L �s p Jt,'x•r•a 'C r! Jai py ?J �. 4S '.1' S -r rt i # Y.,,A •\� 1t 1'. t ♦ N, ; t~ ; �1 X. h 1'.v i Al F.. 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