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Home My WebLink About2930DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -70 BOX 24 IN IN IN No 'Jr IN 111- Nip V - f 16, Lj , 4 t , 02930 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 r.O:.l1.:iiJ ii✓4.iPi.'►:;��i�.E l'J�i �FrirditiGE`'�:lary:yri� �tJ1[.'iirly� F� `PIA Town or Village Located at I ° ► E IF- (Z IC) t Section Block -�� Owner °�. Lot Job Separate Sewerage System built by CU Address ANA J� � A1-i -e \f . IV Consisting of t)(154. Gal. Septic Tank '"^ lineal Feet X width trench Other requirements I htEYV Sei`' Q- E171 S Id" -KG1'Q0 ,ICS +fa oo., i. -y• Water Supply: t'' Public Supply From Private Supply Drilled By Address Building Type �F o ►) s� >`.t 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 Putna County Department of Health, Date l L Certified by �� P.E. R.YA -7 Address cuaizb C License No � Any person occupying premises;served by the above system(s) shall promptly to a 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 supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner 9,,f Health, such revocation, tion or change is necessary. Date �" BY F' G� Title - PUTNAM .COUNTY :DEPARTMENT OF HEALTH.. Divisior. ijf F_nviron -) tal Hwfdh S €rvice , Carmel, Al.. Y..'10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM 01m tax YA L1- E-Y + Town or Village Located at r " ` E V',ErL `� (Lj L) C+ Section Block Subdivision r� �V ( !� �'�� 6,A +38 S Kk Lot Job i �J1 Ci•�� .. � `�1 �lS•p1- a- iT51�1 ✓l Adtlress -�� 1- Owner rD 5 C'. ��► Building Type ICf?il �C� 1/t Lot Area f.�.AM .yLLr lJ1 Number of Bedrooms 1-' +�� Total Habitable Space , C, .} Square Feet Separate. Sewerage System to consist of .Gal. Septic Tank lineal .feet X width trench To be constructed by C' o g-s 1-1 AAA" A� � i A' ddre s � � � MA ^A VA Water Supply: �P.ublic Supply From �� '_ `�"� "' a rC' °S Private Supply to be drilled by Address !2 S Other, Requirements Va✓ I represent that.l 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 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 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) *that the drilled. well, described above will be located as shown on the approved plan and that said well will be installed i accordance with the standards, rules and regulati— ons . of the Putnam County Depar men of Health. /,/ 7 /Z- Signed P,E. f R.A. Date J -,,*� Address �'��^�" -[' 6Lo-e Ca License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date Issued unless construction f the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissi_opefo P.Health. Any change or alteration of construction requires a new pe/r�, it. /Approved or disposal of domestic sanit se�ge, and ate ly only. )�� n MEV�a_ 640L_0 S-7t11,0 Owner or Purchaser of Buillding Building Constructed by Location - Street k'Cti(OV' A jioIl' Building Type W AAA VALL04 Municipality . Section Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage 3f the sewage disposal system serving the above described property, and tzat it has been constructed as shown on the approved plan or approved amendment 'thereto, and in accordance with the. standards, rules and.r_egulations of-the Putnam County Department of Health, and hereby 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 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 pant ^cf ^the building ;.utilizing..the..syst.em. _. 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 Departmle4t 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 thi s day of 'mac_ 1911, Signature h Title If corporation, give.name. and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE,OF DATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - T - - - - - -.- - - - - Division of Environmental Health Services', Putnam County.Department of Health IBIS Vo iN - • . - i i.�'''" �,.2C t 5 �. i ►� C� ; . �;,pTI G . �",4n,1 � ��, . l__1 $ to sf ,�lt_ rA E,4 PITS F ' « , vy A - A ko I t� �a`� L. 1, x.13 + `(, . �5 C 13 ,4 i•1. . t Cam' APR 6: 1913. PUTN Of tli!;A Lej. 1 ®v !lust iu4e. DI DIVISION OF 61�1tlIRONMEId PIfALTH SEICiT� i�cti+lrx v' rr.eica : -��u;� L*t N aid iLii cf;: 0A k` titi.. Tu • � Z � . ' « , vy A - A ko I t� �a`� L. 1, x.13 + `(, . �5 C 13 ,4 i•1. . t Cam' APR 6: 1913. PUTN Of tli!;A Lej. 1 ®v !lust iu4e. DI DIVISION OF 61�1tlIRONMEId PIfALTH SEICiT� i�cti+lrx v' rr.eica : -��u;� L*t N aid iLii cf;: 0A k` titi..