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02922
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
.. .. _ _ .. ��� -�swn Cr Village -.
Located at
Owner S�l n �C i
Separate Sewerage System built by `; Q �',
k� • ice?
Consisting of Gal. Septic Tank
Section rs1
Lot a3 Job `�� ",`(�C?
Address Y O l N A DAL-( is �
lineal Feet X 6 width trench
Block
Other requirements j
Water Supply: Z Public Supply From 6L AA 4Q�
Private Supply Drilled By
Address
Building Type
NC3 VA , ( UJPI 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, and the permit�ed b the Putnam ounty Department o ' ealth.
Cc 1 / Certified b ` P E c;, R.A
Date �/
c' License No.
Address
Any person occupying premises served by the above system(s) shall promptly take such action as may be neee .r 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 Commissioner of Health, such revocation, ication or change is necessary,
Title
Date . By
M1
1
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE
DISPOSAL. SYSTEM",
� ~
- _ • _ ..
- - -
�
`Town or V �Ilage
Located a-t j
Section
Block —
Subdivision MAC. ,p r� /
�� EM) /�C AC t�GV
!�
`' h(`� � it
Lot ��^
tt`6�r
Owner T�� 6 l
r I
Address ��i`� -A
Job
1I��
Building Type } . KC(..)V, A:TCC)N3 Lot
Area ' Ir °� O S
l) (fLiARii
/3�
\1 E1'1
t
,i l `C
Number Of Bedrooms —
Total Habitable Space
1 y` ` - Square Feet
Separate Sewerage System to consist of
--- Gal. Septic Tank
i $e} lineal feet X
To be constructed by C C? S t4 M
lam!
Address 9 Q J /l!t-M
width trench
Water Supply: Public Supply From
�U210/�1Ai GAIezj r
3j�i
Private Supply to be drilled by
Address
Other. Requirements
I represent that I am wholly and completely responsible for the design and location of the proposed system($); 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 an regulations o e u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
place in god 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 in accordance with the stand�A, rules and regula ions of the utnam
County Department of Health.
bate %� ' y Signed
r (�
P. . ` R.AA..
Address * A 6 kA+ e s a License No, '�/ l
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless con ction of the building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary by the Commis ' of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sa / s?vage, and /or ri a e supply only.
Date
By .� t9��"°`" Title
The undersigned further agrees to accept as.-conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health`as to: whether or not. ."the
failure of'the system to operate was caused by the willful or negligent
act.of the occupant of the. building utilizing the system.
Dated this t day of - . 19)3 Signature -.
Title
If corporatzon,,•give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES.OF FINAL PLANS BEFORE
CERTIFICATE OF.COMP,ETION WILL BE ISSUED.
GUARANTOR IS. REQUIRED TO FILE NOTICE OF DATE OF FIRST" 'USE OF SYSTEM...
Division of Environmental Health Services, Putnam County Department.of Health
i
Purchaser o Building Owner o -.Municipality
t3v 6o L_ fI) S
Bull-ding Constructed by Section k
k
Location - Street,- Block
10 G XAZ i [j,'.J
BuiId.ing Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I re resent. that I'am wholl and coin letel responsible for the
P y P y:. P
location, workmanship; material, construction and drainage of the.: sewage' k
k
disposal system serving _the 'abovedescribed property, and 'that.it has been
constructed as shown on the7 approved plan,.or- approved amendment thereto, 4
and in accordance.with the standards, rules and regulations of'the Putnam
4
County Department of Health, and hereby guarar_ty to the owner,, his succes- t
t.
sors;, heirs or assigns,. to place., in good operating condition any,part.of
' said system: constructed by me which fails to operate for a period of two ?
?`
years immediately followir_g the date'of.initial. use of the sewage,disposal
system, or any repairs :Wade by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
.parrot of tiie bui'_ciin,? �_t.iliz rg.. the ��a JFI�
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