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00673
1
00673
PUTNAM COUNTY DEPARTMENT OF HEALTH.
J_ �Dfwsion of..Enviroomental Health Services Carmel N Y 10512
CONST.•RVCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM >"' "�'T;� S,O, P:� C J
Town or illage
p, n ^y
Located at ��t y(% Section 1 r aI� $lock G
;Subdivision V'L� A'.I N V' E �S t� sl' I V, l�J Lot rO Job
Owner ' z '•r' S IlA yy� Aydd�ress.
Building Type'' L i ®
Area: •� 0. 1�` L tti d l� t I
Number of Bedrooms
Total Habitable Space Square'Feet
Separate Sewerage, System to consist of ®t� I�neal feet X
It,
width trench
Gal Septic Tank A
To be constructed by _'O k Address �`r P;
L
X
Water Supply: Public;Supply.t ` rom ~r.".'• ,
Private Supply to be drilled 4py '1' i �:'�9
w Address ��, ti E lw �� , 0�'. f A nn pu I
` other Re4uirements ®t` (Z 6: �N'� i3 d.e O e
f represent that I am wholl and'com letel V� '
y p y responsible for the design and location of the proposed system(s); 1) that the separate ,sewage disposal system
above,described will be'constructed�as shown' on'
n,the approved4aTendment there ,to and in accordance with the standards, rules an regu a ions,o e u nam
'County Department of.;Jiealth, and that on completion i6 eof a Certificate . of Construction Compliance" satisfactory to the Commissioner of'.Healthwill
be,,submitted.to '.the Department;` and a written;'guarantee,Will be furn;shed''the owner his.. `c'cessors;,.heirs - of assigns':by the builder,, that said builder. will ,
place in good operating:;condition any.'part of said sewage disposal . system during ;th '- period of, two (2) years imrrledietely following ahe date of the issu- J
ante of the *approval of •the'Certifieate of Construction G .original. system or any, re airs thereto; 2) That the drilled well described ,above
will be locatedasshawn on.the approved plan•and that said wellW,ll be,in ed. ;in accor8an'ce with t andards, rules and regulations of the 'Putnam
0 i
Oate t y Department of Health.. � ,
gC
igned
:.
P E:
Address L? '� L `l.iAi l 1, ..� �, a ®� O es3 '
License No. ' IJ
APPROVED FOR CONSTRUCTION: This: a6piovai expires one year from th$.dat 'issued ,u less, constructign of the building has been undertaken and is I
reVdcable for cause or may; be amended or.modified_ when edtisideretl necessary by the .Corti' missioner of. Health. Any. change or' alteration of construct;2n
requires a new permit Approved or disposal of dom R r ;sew ter supply only.
iz rDate¢��r".^y BY ifD l_ Title
j.
a
Re : . Property of S TEPI EAl t7 STi14IS04/- %WA'UCFS -1 co/r/F/-C,
Located at 'I & 4,A) ,� /AJ I2p, P4" Trp�so l�l
Section PW Block Lot h.
EUtiM RM ►ir
;t
Gentlemen:. OAS
This letter is to authorize x �
a duly.licensed professional engineer or registered architect --
(Indicate)
to .apply fora 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 Corrm-iissioner 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.
r
Cour_ rsigne
1 .10
.Very truly yours, `�
Signed 4� �' C'ay�. �d /7- 4
Owner of Property
A//
Address /
Telophone
f/ Separate Sewerage System
Municipality.
CONSTRUCTION PERMIT
Located at % " //1,1kLr'r�e ��Y� ��� -Se, t a Block C
Subdivision&,,, &,, Lot 9
Owner Address1 Lot Area iljcop'j
Building Type
No of Bedrooms Mlee Total. Habitable Space sq.ft.
Separate Sewerage System. to consist of %d00 Gal. Septic Tank-,LMlineal feet
width trench
To be constructed by__ 1�2r ep, Address
Water Supply Public-Supply-from
Private Supply to be drilled by
Address
Other Requirements
I represent that I am wholly and completely responsible.for the design.
and locatioh'of the proposed system(s): 1) that the separate sewage dis-
posal s stem above described will be constructed as shown on'the approved
plan or approved amendment thereto and in accordance with the standards,
rules and regulations of the Putnam County Department of Health, and that
on completion thereof a "Certificate of Construction Compliance" satis-
factory 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 two
(2) years immediately following the date of the assurance of the approval
of the Certificate of Construction Compliance of the original system or
any repairs thereto; 2) that the drilled well described above will be
located as shown on the approved plan and that said well will be installed
in accordance with the standards, rules ai.d regulations of the Putnam County
Department of Health.
Date 7`y�' %y „Sigee
APPROVED FOR CONSTRUCTION: This app pires one year from the date
issued unless construction of the buas been undertaken and is re-
vocable for cause or may be amended.or modified when considered necessary
by the Commissioner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sanita y sewage'.
Zug By _ L�1
,F DIVISION OF ENVIRONMENTAL HEALTli; SERVICES
DESIGN -DATA SHEET SEPARATE SEWAGE DISPOSAL. SYSTEM. - FILE NO.
Owner �4ge�r �Tg„f ` s Address N-�f h
/J Bi
Located at Street ZZ* 12 Lot .9_;
(Indicate nearest cross street)
Municipality f'g'fna�7 Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Water Level
No. Time: From Ground Surface in Inches Soil Rate
Start Stop Min.. Start Stop Drop in Min/in.drop.
Inches Inches Inches
Z l Z05:3 Af I --v
4
5.
2 1
4
5
1
2
3
4
S.
es : f
'Pests to be repeated at. same depth until approximately equal soil rates are ob-
,3in`d at each percolation test hole. All data to be submitted for review.
:::pth measurements to be.made from topaof hole.
TEST PIT DATA REQUIRED TO BE SUBMITTFD WITH APPLICATION
-DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. `° ,HOLE NO, HOLE NO
G.L.
6tt
12 tt
18 tt
2 4't
3 Ott
36tt
42 tt
48 tt
S 4"
60"
66tt
72"
78tt
1
/i/o l�/QZ'2sr.
8 Ott
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO -WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /Vc-7e
TESTS MADE BY �{ j(�n� ,�'rP„'s(i)NN „l Date 71(3'0170
DESIGN
Soil Rate Used - o . Min/1” Drop: S.D. Usable Area Provided �-'3-2)0
No. of Bedrooms Septic Tank Capacity O Gals. Ty pegs� <„
.Absorption Area Provided. By L,F.x24't 36't width trench. Other ie;
Name
Address 4 B3!Z3
PUTNAM COUNTY DEPARTMENT OF HEALTH
Soil Rate. Approved Sq. Ft. /Gal. �fCR�� @t y Date
: PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH ;SERVICES
DESIGN .DATA •SHEET . SEPARATE SEWAGE, DISPOSAL SYSTEM.. FILE NO:.. .
Owner 5TF P +(I R J l MSC N Address
nn )
Located at (Street) fL I'Cv4 - Sec . i .'.Block:'.'
Block Lot �v
.(IndicatL4 nearest cross street)- —
Municipality TT IZ�$ 0 C 1 Watershed a T 6 `- Ps)',
SOIL PERCOLATION TEST DATA REQUIRED.TO.BE SUBMITTED.WITH APPLICATION
Hole-
-'Number CLOCK TIME s PERCOLATION 'PERCOLATION
Run Elapse, .Depth to,Water. Water .:Level
No. Time. .'.'..From Ground Surface in,.Inches •:. Soil Rate
Start Stop. Min'... Start Stop Drop"in Min/indrop.
Inches Inches Inches
`37J"= � /f
4
D ..
3�
,�¢ �j01, 7f
3
5
Notes.
1) 'Pests to•be repeated
tained at each percolation
2) Depth measurements to
-
at same depth until:approximately equal soil rates are ob-
test hole. All data to; be submitted for review.
be made from .top of. hole.
DEPTH
G.L.
3011
36th
42 Tt
48 Tr
5 4" .
6 0't
66Tt
72"
781t
8 4't
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �- .t
INDICATE LEVEL -TO WHICH WAITER VEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY 0 6 F— 0 Z �c) F 1 A#. Z , In+ �- % Date
DESIGN
Soil Rate Used 30 Min/1't Drop: S. D.j; Usable Area Provided
No. of Bedrooms ,3 Septic Tank .Capacity q60 als . Type
Absorption Area Provided By. 3'7(D L.F.x24" 36" trench. Other
rr ... 1KLI!* ��Frrl� yy�� x5 Signature'
S L k a '
0WOWN-MAMHA N. Y,
PUTNAM COUNTY DEPARTMENT .OF HEALTH w,
Soil, Rate Approved Sq. Ft. /Gal. Checked y Date
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1.7 29'
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