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02926
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR F.�OR� S_ EWA_G!_1E_DISPOSAL SYSTEM Pi.� � ANA �j
/ V ►. � �I Ca.00� � ILI � V -,Z .. i -vwri 3T Jiilaga _
Located at A n a 1 Section Block
Subdivision ` A/AA Pte-- r�Ctl�L�e' ,i S Lot Job o� � Z
Owner ` �J c-►`.� �° 1 1 Address
Building Type
Lot Area
Number of Bedrooms
Separate Sewerage System to consist of Ext5 1 i M Gal. Septic Tank
To be constructed by co P-5
Water Supply: Public Supply From
Private Supply to be drilled by
Address
Other Requirements
Total Habitable Space k'L-0 (' Square Feet
lineal feet X 3 width trench
Address 'PQ :J N
1 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 e regulations ions o t 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 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�'ons Putnam
County Department of Health.
Date / ~ v Signed. / P.E. R
Address License No
APPROVED FOR CONSTRUCTION: This approval expl s one year from the date issued unless construction of the b ilding has been undertaken and is
revocable for cause or may be amended or modified when consideretl,,LL��ecessary by the Co issioner f Health. Any change or alteration of construction
requires a new permit. Approve for disposal of domestge-eae�it ( sew e, a or p vate supply only.
Date BY. Title A-
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PV1 NA:M VA1_,L.1 --"1
Town or Village
Located at n EV E� Q `D-e i y C r` Section Block
Owner / _ is V �`- 6Z. �U �'� l I� Lot ,q�� Job S�O `1 F
Separate Sewerage System built by Co 9-C, N � A � Address ± V `l^ ��
Consisting of IT -Gal. Septic Tank lineal Feat X width trench
Other requirements
Water Supply: ♦r'_ Public Supply From
Private Supply Drilled By
Building Type
Has Erosion Control Been Completed?
No, of Bedrooms Date Permit Issued
1 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 alth.
Date Certifed' 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 se cu a the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void on as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water ply comes available. Such approvals are
subject to modification or change when, in the judgment of the Co a f` alt such revo do otlification or change is n/ec�essarAy.