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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
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