HomeMy WebLinkAbout2920DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
62.15 -1 -59
BOX 24
L
1 ti� o I '
l T
r- 1 m r
r '
' I , Im - ■
02920
I represent that I am wholly and completely 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 the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
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 thedate 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
will be located as shown on the approved plan and that said well will be installed ccordance with the standards. rules and regulations of the Putnam
County Department of Health. o
Date v -� 71, 1 7 -7� Signed P.E. !L R.A.
Address License No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unle struction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered nets ry by he. Comm' Sion of Health. Any change or alteration of construction
requires a ne& permit. Approved for disposal of domestic sani ag an / r priva ` nly.
Date By Title 1 s
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM��T" �raLLEY
Town or Village
Located at L_ Section Block
Owner %,\. Lot 9 Job
Separate Sewerage System built by er11 -t% r t /Ad,.l Address
Consisting of — Gal. Septic Tank lineal Feet X width trench
Other requirements Pit q X +� t o t'�AT 12 X x G. = 4 $!e 0 1= �R-�. A
t
Water Supply: _X_ Public Supply From �IL_1,_ L-JA14R
Private Supply Drilled By
Address
Building Type 1UN. &C -A — AIL NvxAji400 No. of Bedrooms � Date Permit Issued
Has Erosion Control Been Completed? (ES
I certify that the system(s), as listed serving the above premises were constructed essential y as shown on the plans of the completed work (copies of which are
attached), a in accordance with the standards, rules and regulations, plans filed, the permit issued by t Putnam County Department of Health.
�at�
�y� �f ( Certified by P.E. R.A.
Address
T ChL�n/E. //ate 7�yG. /yrx License No. PC:)
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system' shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissions of Health, such ion, modification or change is necessary.
AA *A 1 �^ � ^ 'T) By Title �
,•.. _ . - ,' PUTNAM COUNTY
DEPARTMENT OF HEALTH
Division of Environmental
Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM IW 411.
l�fiL LG y
r
t-ocateu at i- !i- �Y_-- •- -- -� -- — -,
Town or Village
— Section i3socK _
n'►
Subdivision
Owner r /E�G�Z GoL-Q -STW 14-1
Lot
�q Address t - -SCA ✓/��(f/�
Job
Z'�T ��4'
Building Type Lot Area
Number of Bedrooms Total Habitable Space
Separate Sewerage System to consist of Gal. Septic Tank P T lineal feet X
Square Feet
�RE� width trench
To be constructed by C UA,5HHA A✓
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 location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
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 thedate 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
will be located as shown on the approved plan and that said well will be installed ccordance with the standards. rules and regulations of the Putnam
County Department of Health. o
Date v -� 71, 1 7 -7� Signed P.E. !L R.A.
Address License No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unle struction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered nets ry by he. Comm' Sion of Health. Any change or alteration of construction
requires a ne& permit. Approved for disposal of domestic sani ag an / r priva ` nly.
Date By Title 1 s
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM��T" �raLLEY
Town or Village
Located at L_ Section Block
Owner %,\. Lot 9 Job
Separate Sewerage System built by er11 -t% r t /Ad,.l Address
Consisting of — Gal. Septic Tank lineal Feet X width trench
Other requirements Pit q X +� t o t'�AT 12 X x G. = 4 $!e 0 1= �R-�. A
t
Water Supply: _X_ Public Supply From �IL_1,_ L-JA14R
Private Supply Drilled By
Address
Building Type 1UN. &C -A — AIL NvxAji400 No. of Bedrooms � Date Permit Issued
Has Erosion Control Been Completed? (ES
I certify that the system(s), as listed serving the above premises were constructed essential y as shown on the plans of the completed work (copies of which are
attached), a in accordance with the standards, rules and regulations, plans filed, the permit issued by t Putnam County Department of Health.
�at�
�y� �f ( Certified by P.E. R.A.
Address
T ChL�n/E. //ate 7�yG. /yrx License No. PC:)
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system' shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissions of Health, such ion, modification or change is necessary.
AA *A 1 �^ � ^ 'T) By Title �
Rr'Tup'N I it o w.g rzo �i ���% - —
^H y IVY.
PUTNAM OOUN'i3t HEALTH DEPARTMENP t ,
* DIVISION OF ENVIRONMEML HEALTH SERVICES
PROPOSAL POR SMan E DISPOSAL SY.IkM REPAIR
MUM'S NAME PHONE 67-�) N3
SITE LOCATION 3 0 5,n- . 4V -1
MAILING ADDRESS pvT / -q,9- r V 4 LLlrV , (4 (Y • f
PERSON INTERVIEWED PCHD Cauplaint #
Name & Relationship (i..e, owner,tenant, etc.)
DATE 111vF1f4 TYPE FACILITY C-5
PROPOSED INSTALLER uv �- 6 8-.; 6 r k r PHONE .5:�
REGISTRATION # e49'
Pro (include sketch locating all adjacent wells):
NOM: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
S'
i
Proposal:approv
Inspector's Signature & Title
ev eu 0441
Proposal Disapproved
Proposal approved with the followincx conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
�.. E� rat .� (� (� •�- 'ityt� �l f'
l2�
Date
(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
'
i
I, as owner, or reported agent of owner agree to the above conditions.n'
SIGNA TITLE' It %� DATE
1
?MS: WAte MCID); Ye]lccw 03kn SI); Pink (Ag icant)
. t.,.:.
_
O��a. o� - ?U_r^--�_se =' O.' D-:,_� d? _''lu ^_C1 2--T—
Bui lqi n Cons �, uc b� Sec ior_
I20.'
Lo•ca' ion - Stree� Block
C11 % %45,f= ._£KO -V"3 / /:,ni
BUJ I dingy Type L. o
GUA
cons —
disco J -__ �j __ J e
i
/CEO
aJ v Jam.+ as J �
C ..__ V~ J__. --,. �•J��. �... _� +__ J_ _/I -.�iu �_�- __. -_..r __.! J____..J \
nd _ -V' J _ J^ �✓ __ _ _. J. __ _
joant
v_ J_
Vices 0_
I- ure 1
_,. o_ ^ � 1 -- ^ J ^n J'^�Je - . a!,sed ^ - ^_v T� � �11_'u O_ _
S�J v: v� v -.J _ -
ac
Da tZ_s _ da- o /DEC 19� S =r' -U_
fT
r a 7� -- Z -_
an
TL___- _ % COPIES __. 1 _, S
IS REQUID 'S_
DiViSi0i1 O_^ 'lsi i -,O� S ? �?? L:: a7.�:1 Ste: --; r�3 ?li J`?=, m C0un. -17 L °�;3 w� „`� 'Of
i�`�•` ` i
�. .
IT
TA
� a ;
7
T
f DEC.
,I 7X71
.,«
y. .\
�
� � • IrH
�.� .. P r:
Of
::NTAL t; ,r,
EALTH SERVIC( `
■� + ,,```` �.
IL
Lu
:LLJ
� �) r�' 0430,.• C`C�' e�