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HomeMy WebLinkAbout2923DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -63 BOX 24 Ill t-tirs I I 6 . , him 11 r: , Lo IIII f - L , IN L Lm" r r IN 02923 6,3 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM PC) -T VALL� J, Town or Villpgc -- •• - -- Section Block Subdivlsion A uai M e G 4L-I. o E S Owner /�1L�� -� G(_)L-n S 1 E \ 1j Building Type _el -A36 :1.4 c ty Lot Area YA•- t Number of Bedrooms Separate Sewerage System to consist of �ci I Gal. Septic Tank Lot Job S O `--1 t r Address (26 T1ijll 6A irk .( _ Total Habitable Space C Square Feet lineal feet X 7 7 width trench To be constructed by �t �nAddress 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 an regu a ions o 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 instal i accordance with the stands s, rules and regulations of the Putnam County Department of Health. Date igned P Address ` + +'(1 License N � ..-� APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless constru ion of the building has been undertaken and is revocable for .cause or may be amended or modified when considered necessary by the Commissi ealth. Any change or alteration of construction requires a new permit. Approved for disposal of domestic san• se su only. Date — l By Title NJ PUTN.ANi Ci�U'i� i Y I7E �1I2Tirgis � - 1 i�.L A.LTH:. Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ' U �ALLtj_ Town or Village Located at pp�� Section Block C Owner /�P\ r / �/ iJ�C �% AAA" i Lot Job 0 Separate Sewerage System CCbuilt by �e -�� A "�' Address � A Consisting of ti+ Gal. Septic Tank lineal Feet X 3 width trench Other requirements A� Water Supply: Public Supply From LLCJ� MAL 6AVb M S Private Supply Drilled By Address Building Type — &ZX0V 6z i ON) 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 issued by the Putnam County Department Health, Date Certifiec,�by s ^ ► i I I P.E. R.A. Address License No. 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 sup omes available. Such approvals are subject to modification or change when, in the Judgment of the Commis oner.of Health, such revocay6n, mod• cation or change is necessary, 4�'„__i_'ZI / RV X:�C "_" \ t4­1 V"*� Title Awk Owner on urc aser- Building Municipality - Building Construct6,d.by Section Location. Street Block C. Building Type Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am- wholly and completely, responsible for the location, workmanship,. material, construction,and•drair_age of the sewage disposal system serving the above'described property,, and that it has -been a constructed,as shown on the approved 'plan or approved amendment thereto, . and in accordance with the standards, rules and regulations of the Putnam County of Health,. and �iereby ,guarar_ty- to the owner, .his succes- ,Department sors. 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- following the date of initial 'use of the sewage disposal system, or any repairs -made by me to such system; except where the failure to operate properly is caused by the 'willful or negligent act of the occu- . �arit of the _building utiya.zing the system_ 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 riot .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 « day of IZIAAJ. 19 1I .Signature. . Title f corporation, :: give name. Wand address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) :COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION WILL BE ISSUED. GUAF.a...N70R ITS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. . Divisica of Environmental Health Services, Putnam County. Department of Health 44'- 21` 'S