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Home My WebLink About2921DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -61 BOX 24 02921 L� 12 IL . 16 7 LL I ti ' 1 46 02921 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental . Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or Village _ Located, at Subdivision— Owner Building Type 0Y6 1 I Number of Bedrooms Section Block Lot w Job ,...' ° -A-_ Address S CAVJ A'#3 A ?Q, 1201 NAVY, VAck_e�j _ 9Total Habitable Space , Z� Square Feet Separate Sewerage System to consist of �!�C1 J% / Septic Tank lineal feet X width trench To be constructed by Addresss I Water Supply: � Public.Supply From G Q ! `%T '��' �!G p' Private Supply to be drilled by Address Other Requirements . ,4 I represent that 1 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 oT t e . u nam 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 the date 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 in accordance with the stands ds, rules and regulati— o—' ns of the Putnam County Department f Hea h, Date / igned - U ` i Address License No, APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless co -on of the building has been undertaken and is revocable for .cause or may be amended or modified when considered necessary by the Commissio of H Ith. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sans se , vate only. Date �` i G By— d Title IF I PUTNAM COUNTY DEPARTMENT OF HEALTH ... __.�jtsjgjn.� - nf.. rvly/ Flrcjmanf3y.. Hea% f._:�Fi. ✓;C2c,.iCiar/19ef�_iV:. ___ _ _( CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ?UT NOAWv- V A1. L q Town or Village Locate Owner Separate Sewerage System built by �,v �A Q ft A(-J Consisting o Kt% 1k 94rz Septic Tank e7djS°l ' Water Supply Other requirements aL Y --k 'Public Supply From Section Block Lot . Job e yy�� y Address ?U Y ASK` OCUL_el • ./ ' d lineal Feet X. width trench Private Supply Drilled By Address Building Type �e V v 41 j O ►�+ No. 'of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s). as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed a d the permit issued by /,he Putnam I unty Department of Health. Date h Certified y� -� R.A. Address L L License 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 waters ecomes available. Such approvals are subject to modification or change when, in the judgment of the Corn of Health, such re tion, mod 'cation or change is necessary. Date By Title am'S NAME ITE L=TION PM PUNAM CTY 17NV HEALTH FAX N0. 19142787921 P, 1 � 2�� - go,�l IWO AK4� z4z, L--- . . _ ....... _ . IE�U�ci�if►i "t:C7UtY�Y rir.��t�i' � iJBFt�t�T� . .... _ y .. ^.. _ .. .... -- . - DIVISION Or MMRMIM*AL HEATH SERVICES ..i 62 e,, PlICNE .4`.Z i F- Z0593 zQt 'y 8 A ING ADDRESS je� i`�/�q !�l EG G � � /Y L/ l o•� ;�,9 - MSON imERvmE m PCED Cai ilti nt # Name & Aelationship U.0, owner tenant, etc.) !ATE l!> 9d 'TYPE FACILITY QED INSTALLER � �' c %r e d-�1�< Pxon 5s = 1;;KF/I EGISTRATION # Je C , Msal (include sketch locating all adjacent wells): =.- Repair must be in same location and of same type as original sewage disposal system. Lfferent location may require submittal of proposal from licensed professional engineer or !kgietered archItiact. .oposal approved Proposal Disapproved Inspector's Signature & Title Date - - -- i .-opos approved with the following conditions: . Procurement of any Town permit, if applicaEIe. :. 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 caaponents 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.g. house corners). three prwast 6' diem. x 61 deep . System repair to be performed in accordance with the above proposal and conditions. as clan or reported a en f owner agree to the above conditions. G �Z'U�tE ` TI`Y'LE G'� Can X�a // ems" OWNER'S NAME SITE LOCATION ADDRESS Q 07 )2,a,, '� A k4 o INTERVIEWED � � Y\ a h/ PCHD Camplaint � Name & Relationship U.e, owner ®tenant, etc.) �, X, I A (n TYPE FACILITY PROPOSED INSTALLER ('A N A REGISTRATION # L Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original Different location may require submittal of proposal fram licensed registered architect. & Proposal Disapproved Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Subnission of as built repair sketch in duplicate showing: a. owner's name. b. Site Street Name, Town and Tax Asap number. • sewage disposal system. professional engineer or A c. Location of installed camponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6° diam. x 6e deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent owner agree to the above conditions. SIGNATURE TITLE D 1^1'f\ �1y DATE NO )0 Imo: Tithe (PAID); Ye]loo (Tarn ffi)e Pink (kli,®nt) l e 4- 7' n, ocation cons -po.: Sr 77 dis- a sl s e r 7: n C.on 3 - 'D and ir ne c 7 s ac- , Te :13 .7 4- 0 0 VneL und-ze-rs-2-nef a Z '3 a •o, a - "sl" .0 t "In Z- -_ c Jam_ 0 -- . er- V-, CeS 0-rl -1- 7 n 0 S le :) �, 3 T.7i I I 37 s,:;:- to c p failur=5 o� S_ - 'is" a c olf occup-an., t e bulld z Dated ?_s d 1 9D Y'S - U" - AV rl it e co p 77 nCCD7-_nS OF 7D T. 7 Tl 7,S.,377' -..rT!,L- 3. 7- � -? �. CART OF C 0 L _'T _L U_,, I -7TO 17 G UAR a a J.-La Stet, -- I S Pu�nam COL;``? -VT ;_Je�o e Division. o., 7,1 V r o n a C /�Z/ A -- C). /3 n _ r '� , .A . � ., �,z.f� - t —bt OCT- 9796 WED 3:3.38 PM' PUNAM CTY ENV HEALTH PAX N0, 19142787921 P. 1 a PUIW 0170 M HEALTH DEPARU -Mn k k DIVISION OF MV1RONb4f' *AL HEALTH SEMCFS PROPOSAL FOR S3W=E DISPOSAL SYSTEM REPAIR tM I S NAME ii i ., f� -��' PHm ✓E"2 � "' „Za �.3 TE 10MTI0N -9' —dog �4/ J'it! 6zd&-14. lQt SL= ADDRESS A,' l ° .S'7 RSD`t INTmRviEVED PM c iivlaint # C�/ & Pz1ationship (.e, cwner,tenant, etc. ) M to /2z / (� TYPE FACILITY h �POe INSTAL' �z z!L OL y ��'•4/� � / c fr C a�t/� PHONE%!y -z5.s = rK� ,GISTRATION # Je - oposal -(include sketch locating all adjacent wells) : ms: Repair must be in same location and of same type. as original smmge disposal system. .fferent location may rewire submittal of proposal from licensed professional engineer or gistered architect. w I ,oposal approved Proposal Disapproved Inspector's Signature & Title Date i •opos1 approved with the following conditions: . Procurement of any Town permit, if applicab e. :. Submission of as built repair sketch in duplicate shoeing: a. owner's name. b. Site Street Nam, Town and Tax Map number. c. Iccation of installed carponents tied to two fixed points (e.g.,house oorflers). d. System description (e.g., 1250 gal. concrete septic tank, three precast 5' diam. x b' deep drywelis surrounded by one foot +• gravel). « e. 'installer's name and number'. System repair to be performed in accordance with the above proposal and conditions. as caner, or report agent of Omer agree to the above conditions. q GNATURE TITLE ® W/ E/' DATE /Of (O ` M: w1ite (MV);- YSUCW (fin BI); Pink (P}alimnt) 1 ..1 7 .. t'c.