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HomeMy WebLinkAbout2925DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -41 -65 BOX 24 4 ' LET is EM .1Ll 150.f 02925 ti PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or VilI�4L T) a Section Block � Located at I ` C, -j(L) Owner - �11Q ri 0 AX lac � Separate Sewerage System built by Sc� Consisting of IS -Gal. Septic Tank Other requirements Water Supply: t From PUNIC SUPP Y Private Supply Drilled BY Lot Address lineal Feet X' width trench ddress �� No, of Bedrooms Date Permit Issued Building Type 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 �of* Health. 1° P.E. F A- �— A �? Certified by- oate License No. , Address 1 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secur 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 becomes available and the approval of the private water supply shall become null and void when a public waocat onplmodif cat on orlchange is necessary.vals are subject to modification or change when, in the judgment of the Commissioner of Health, Date By Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Ibis r w, n �-zN �. -W1z1V E� Subdivision Owner [n, Building Type � k Number of Bedrooms Separate Sewerage System to consist of Ie XI.S l i Al ii Gal. Septic Tank To be constructed by /— Water Supply: r'• Public Supply From Private Supply to be drilled by Address 4 f own or V iI lege �- Section Block f Lot Job Address 0 GA wA A..A Total Habitable Space IZ1010_4:� Square Feet i lineal feet X n width trench 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 u nam County Department of Health, and that on completion thereof a "Certificate of Construction,Comoliance',' satisfactory to the Commissioner of Healthwill be, submitted to the Department, and a written guarantee will be furnished the owner, his s ccessors, fieirs�.dr 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 (2j 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 standards, rules and regula i— oof the Putnam County Department of Health. Date _ ` 4 Signed P.E. R.A. Address `- License No v v APPROVED FOR CONSTRUCTION: This approval ex Tres one year from the date issued unless construction of the uilding has been undertaken and is revocable for .cause or may be amended or modified when considered necessary by the Commiss• ner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic Sa ag rivate er supply only. Date �® —� By Title AD Pl r � •® • A ' r Laic i o J •d_I � s7A�,VLob Tblk(. c��su��a� Nq r Laic i o J � s7A�,VLob Tblk(. c��su��a� Nq = = J;4IN 1��3 �1',�� } ` �i F tiEAlTt� X8995 ST r hiENTALMEALTH 'SERV{�E5'•, of Nti. ` }. ♦*i �, rr{{.eq..}} j`!t5 _�+,x �.,. I c. `.. -:_;.. .r ?t 1: 6 ¢' -a,1 1.. . , 8........ d _. .. ... <..,_ ..., .., r _ „_, ,, .<.a .. . 5iJ .I I rr t %��'. ���,5� -. StiSZ3 .,.(:a. ,�... _. .'! � .t9t , • ., . . +V� ��•+.}}p 1i�P� riY?ei� :i!PFCaI�iSi Sr fix'r� � �sNTS�':T. �4 �f J� �5. ',r 4th`}.. .. s. .. ,�_.� _., _ - ....:r ._ _. _... dt'. k..- �. >F;w....a.'S&.,:'si�.SS+x.G..n.