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Home My WebLink About2924DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 62.15 -1 -64 BOX 24 No i ,. I i r r �. �. .. �. . . L �. ., 02924 VL L ,✓_. PUTNAM COUNTY DEPARTMENT OF HEALTH .. � Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM -[ M k" VA !� Town br Village Located at Section_..... -. -� . "yLUiii�ia101i .1�^•'•�'' '1�'Jr(�'�LY.'�✓r1'd..l../.5:6 Lot �! Job J+ st�-a ' Owner -�(:� � ✓1 i"1 Address &` ,1 (-.LL�i�'n Ao_ Building Type v c' Lot Area �A( 1✓ �t/l(/iAl1 ll�t�� :H Number of Bedrooms I S G Q'ri Total Habitable Space Square Feet j J Separate Sewerage System to consist of a .X�� 1 ll1s Gal. Septic Tank lineal feet X =7 _K110 .^ c i To be constructed b,.y/ l j A/� � Address �� r\oL � width trench .' I{, Water Supply: tl Public Supply From r o ik, i•� 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(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 cans .7 the Putnarn County Department of Health,' and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill l 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) Yhat 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 and regulaions of the Putnam County Department of Health. / ; Date � � l � � % Signed 1 0 Address License N IL APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction o e building'has been underta en and is revocable for cause or may be amended or modified when considered necessary by the Co missioner of Health. Any change or alteration of construction requires,a new permit. Approved for disposal of domestics r sewage, or ivat water supply only. , Date J'"T t BY �. Title . b PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Heath Services, Carmel, N. Y. 10512 1 -Town or Village Section Q Block Lot `l +Job Address Vt��iAvr1 `}cLAR, 4� lineal Feet X width trench',,. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Locate owner Separate Sewerage System built by S ..J- s:1A�� A1\J Consisting of Gal. Septic Tank Other requirements Water Supply: Public Supply From C Private Supply Drilled BY Address Building Type �t� tti t-% , ol- 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 t e permit issued by the Pu County Department of Health. ".,! ,%' % 1 522 Certified by P.E. R A. Date � Address License No. 3C Any person occupying premises served by the above systems shall promptly take such action as y be necessary o u e 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 s9221Y becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such rev tion, odification or change is necessary. Q OWNE SITE MAIL PERS, Name & Relationship (i.e, owner,tenant, etc.) DATE / TYPE FACILITY #,9A �i PROPOSED INSTALLER 0&/ G!G/,,3�l2 -�' PHONE 6-.2,y G Proposal (include sketch locating all adjacent wells): NOTE: 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. / i 2200 C�Z. 7,44-4— 4-- /neap / 15teLh4 t� Proposal approved Proposal Disapproved to 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 Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' 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 of owner agree to the above conditions. el 4. �' SIGNATCRE TITLE DATE tom' PIES: Wibe (PAD); YeUcw Mkin BI); Pink (Applicant) / Owner o Purchaser o `Building 'EuMding Constructed by Section Location - Street Block Aj -(t 1' i o: 3 Building Type 4 Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and.completely responsible for the location, workmanship, material, construction and drai.r_age of 'the sewage . disposal system serving the above described property, and that it has been 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 tereby guaranty to the owner, his succes- 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 imrlediately following the date of initial use of the sewage disposal system, or any repairs made by me to: such systen, except where- the failure to operate properly is caused by the willful or negligent act of.the..occu.- pant of the building, utilizing, the SY_C1t- -. The undersigned,further "agrees to accept as..conclusive the de- termination of the Director of the Division of &ivironmental Health Se"r 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 day of 191�L 3ignature Title ion, give � .1.."" If corporat 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 TE IVIL) (Fk.; Lr4 S T 1 i�4 A tZ ALe:'; bF