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02932
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02932
CONSTRUCTION PERMIT F
Subdivision �1_ U
Owner . A^ `e4 t
{�`�� Q
Building Type e Nov P,
Number of Bedrooms
PUTNAM COUNTY - DEPARTMENT OF HEALTH
Division of Environmental.Health Services, Carmel, N. Y. 10512
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Town or Village .
SKt? u�iv� Lot Job
Sic (0 Address
=� ' { � � A f.A/ L 4 - -e V
Lot Area T Q ki�) J
Total Habitable Space t).f'd � ± Square Feet
R SEWAGE DISPOSAL SYSTEM
Separate Sewerage System to consist of �x(S' tAl _Ar2111_ Septic Tank lineal feet X width trench
To be constructed by Address
Water Supply: 11" Public.Supply From �t-EN +42 - 1�E>JS PJ116 4 Vk ALS_Cy
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 and regulations of the 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 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 in accordance with the standards, ru and regu ations of the Putnam
County Department of Health.
Date 'I P �Si ned P. E. R.A.
Address �� a r me,( 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 nec sary by the Com oner of Health. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic sa_pjtacy, s�nrage. and /qr Rriv a wa er supply only. _ 0 �
Date By �� �7 ���� Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM k)'("N &LA
I Town or Village s
Located at DC �� \l� i` Ei�
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Section
Block,
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Lot
Job. _,�) (
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Owner
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Addresc ( C
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iN IMP i -
Separate Sewerage System built by
Consisting of Gal. Septic Tank
lineal Feet X
width trench
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11)
LED 51
Other requirements -
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Water Supply: Supply From
r
Private Supply Drilled By
Address
Building Type 'Q E--K� 0 V A T 10 k�
6
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, nrd the permit issued by the Putnam Coun y Department of Health.
Date i C1 �-- Certified by – P.I_. R.A.
t
Address L� -�' t i �� License No.
Any person occupying premises served by the above systems) 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 ecomes available. Such approvals are
subject to modification orj change when, in the judgment of the Commissio o Health, such revocati , dio; cation or change is necessary. ��
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