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02935
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y, 10512
_.. : OF' :� ►.ate •1_ �1• 1 wNC %ti �. Ate= v�E.?.FyI-S i fy ..
icni"6wl�.iaTc .,r ;,:��i.�Ti;t;�Y30i., Cvi.'ti`�C..i\ .E . �P, : Egli z - .... - .` L :� S: Eta - _ 7t °Tip`
Located at
Owner - %0 V 1--+ C V
Separate Sewerage System built by
Consisting of Gal. Septic Tank
Other requirements
Water Supply: ✓ Public Supply From
Town or Village
r-Section Block
Lot 4 3 1 ,J�oi b �i��^0 ° _ y, /5
Address C/ CA�AOA L-�CE 0 ?l)-i VALUz_-Q
lineal'. Feet' X width trench
., eet
CIIFE' -o
Private Supply Drilled By
Address
Building Type 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 essenti y, all as shown'
hown`on -the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, and. -, a permit issued by the Putnam County Department of Health.
Date � `I ` d` Certified by��
Address �I`ICJL l�� License No. ' �Ir
Any person occupying premises,served by the above system(s) shall promptly take such action as may benecessary to secure the correction ofjan.Y un eei�fflr35
conditions resulting from such usage. Approval of the separate sewerage system shall become null and_ void as soon as a public sanitary �'/1er b are
available and the approval of the private water supply shall become null and. void when a .public water supply becomes available. A,,' such approvals
subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or chang'is necessary'
Date \ / By 4 Tile 14
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental. Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL 'SYjI tivi
Town or Village
Located at iev_ •'e_'
Section
Block
Subdivislo 6AA ',r d '
Lot
Job
Owner
Address
'�j
Building Type e PWQ'C LV vim- Lot Area s
'`
L1
Number of Bedrooms
Total Habitable Space
%ZQ`' t Square Feet
,�
Separate Sewerage System to consist ofS Lf^ Septic Tank
lineal feet X width trench
To be constructed by
Address
Water Supply: V/ Public. Supply From Q� ��
�f�ho`rr
I-.
`u,
Private Supply to be drilled by
Address �j{
�
Other Requirements 02 V\ew t1^ _e_' �0 5 �-- rQ V y `1 S a b 502 110
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 regu a ons o e 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 acc rdance with the standards, rules and r ns of *the
11 County Department of Health.
Date
e T� 1M..s� Si ned ��c�t. �¢ / 1 R.A.
Address 'e"01 � � � License Nd.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been,,, , Berta fen and is
revocable for .cause or may be amended or modified when considered necessary by the issioner of Health. Any change or alt9• 'f construction
requires a new �permit yq, Approved or disposal of domestic ar s , and /�re ater supply only, y,
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PUTNAM COUNTFY
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