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BOX 6
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00513
PUT NAM WUNTlk.
X
bivi;6-of Environmental
4.1 .1( 7
';Located .-
. ea
Sub0ivision
A-116
Lot Area
°sNumber of Bedrooms" ,�j
7;-
s6para te sewerage System tb--Co;Sisf- :of ;;.�
c66strutc'ted*:bY
SUpplyi Public supply
fo, be -d led,: by
pri4z(tle� supply
Address
�j eq u it
%
I represent that i am: whdlly-Sni& completely. regoon :)kfor t6i,deslin
above described will lb6 co'nstruded-as shown on the P`OroveO!joeirdm
-County. Department of Health, and that oh,,cOimip' tion thereo f W
epartmidirit, andI.La �vrjften:.� arzinted �iiil' b6-.- i
bd submitted , to. the D d' .� -�r
61"--s I ie�wagd isposa
'Ac�eJn good,operating cond ' ition any part
,T, ance -.6f the approvAl, of the' Ckkflcafb,. , k ctiOin1darTipl!A`hc
71
Sun7iy� Department of keilfh.,
gig'S
�Address
approve wpv.i r1q. �eaf
APPROVED.-FtOk CONSTRUCTION; .-This 6xpires
,�-Yrdvocajbje The c�au'se& hiay.be amttndqd, or modified hen co bq'r'ed,,,.i
disposal f Ili
stp
eyuires ii, neW,:LOer1mit;`..AOprovqd for
'y
-- ------ 01
Wth SOW&
iLot,
Add
Adde
issued,
sed sysiei�( a e- sewage 'disposal system
— — - �,!, the, separate
ice ,with ,the ir Ules,an, d,regulatic?ns —oT—tE—ei—P—uTn—am
Compliance , satisfactory 40-:the Commissioner of Health will
alic
ssor iheirVdr" assigns by: -tfi6.bu'ilderj that said builder will
the date of the issu-
�any 'ibaiq
rf , . that the, drilled well,described above
h-, tfiw',stlirid'airds rules . 1.
land",,regM!ati9ns --Of. the
h t
,:S-ia ds,
R. A.
License. No. ao&,?Jz?
S, i;p*n§trudti6h, of Ahe, building his beefi.,undertakem and is
r7 of Health Any `-change_ or alteration Qf'construction
'17.T
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PUTNAM COUNTY DEPARTM T OF HEALTH
DIVISION OF..ENVIRONMENTAL. HEALTH SERVICES
Date ! 14 7?
Re Property of Edward T. Scrivani
Located at
Section Block Lot
Gentlemen:
This letter is to authorize George A. Haughney
a duly licensed professional engineer X. or registered architect
( Indicate')
to apply for a Construction Permit for a separate-sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated 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 9�t�
Owner of gat" 1. .
gat" �,� 1LJ & 3
PUTNAM COUNTY D PART E T OF, IiJ!A' LTH
DIVISION. OF FNVIRONf4FeVTAL HEALTH SERVICES
COUNTY OFFICE BUILDING; CARMEL,, N. Y. 105_12
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. .FILE NO.
Owner e'. Address ;%.11JAlb A04 L O K/
AX M
Located at (Street mac. Block Lot
6adicate nearest cross s ree
Municipality ,}'�s,✓, / y Watershed .x�./�G�.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS .
Hole
Number CLOCK.TIME PERCOLATION PERCOLATION
Run Elapse Depth. to VTater Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Tnnhes Inches Inches
Notes: 1) Tests to be repeated at same depi;h'until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review..
2) Depth moasurements to be made from top of hole.
CPS
CA4
5
-
3 /,?;PO - 12,2 D
lv
1
2
_ ..
3.
5
Notes: 1) Tests to be repeated at same depi;h'until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review..
2) Depth moasurements to be made from top of hole.
` TEST PIT DATl1 riI��IJIRLD TO 13L SU13P�11:T` 1- .W]:TI{ APPLICA`�IOIy
DESCRIP7'IU1J OI' :SO,TLS .� ,1vCOUl\'.['I,P,� n ':'Iry .`l'I,`��i''' HOL S `
DEPTH HOLE. N0. ., HOLF'NO....
HOLE'N0.
_... ;.
G. L.
if
12 "•
;.1811 '• .. " •..... �
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2 .41,
t
30„
1 1 A ii f lj'
3611
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42
L ii 14
c)1 11
6011
66
7211
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811 . , _
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R
INDICATE LEVEL AT WRTCH GROUNp WATE ZS
ENCOUNTERED'
INDICATE LEVEL TO WEIICH WATER LEVEL RISES AFTER )3EING ENCOUNTERED'
TESTS MADE BY
,? c: c�'� Dated; j 77
DESIGN
Soil Fate Used Minfl Drop:
S.D. Usable Area Provided
,No.' of Bedrooms / Septic Tank Capacc ty o a Gals. Type
-
Absorption Area-Provided By L. F. x24"
width trench
X.
er
Name o
r
Address t�1' • ...�- !'M�G:.:.y
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