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02936
PU NAM COUNTY DEPARTMENT OF HEALTH
Division of Envkonmental . Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Yu.-r QQ0% V% WIP'L4
Town or Village
Located at -� y v Section Block C
Subdivision > f C1 ta r V- Lot 1.4- Job 10-
l
Owner s B S TA Address 05C4WA0A,
Building Type ' Lot Area A G'-L' �� 1 /�Qr r-„t� @g 4
Number of Bedrooms Total Habitable Space 2 d U } Square Feet
Separate Sewerage System to consist of +G-Jr Septic Tank lineal feet X width trench
To be constructed by Address (�
Water Supply: Public. Supply From C'r
Private Supply to be drilled by
Other Requirements r%Nt+j c :P 6 A°— _ i:] KQ 'ctoo CjF Q^i an 30,r p itl0
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 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 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 r tions of the 'Putnam
County Department of ealth.
Date 060 a Signed E.R.A:
Address _34 ,f A e 4J License No
APPROVED FOR CONSTRUCTION: This approval a pires one year from the date issued unless construction of t e building has been undertaken and is
revocable for .cause or may be amended -or modified when considered qecessary bffthC missioner of Hea lth. Any change or alteration of construction
requires a new permit. Approved for disposal of domestic ar sew e, ao water supply only.
� BY � ;(,
Date
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
U i hl M L�
Town or Village —�
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
Located at p Aegcp_ " "`�L�{ — Section Block
Owner t`r \EY'a � }- Lot ._ 14- Job—
4n
Separate Sewerage System built by C� LIC�U)S � lIV - Address C �lVA'j`il� � " PU3.M&M VALLGJ
lineal Feet X width trench
Consisting of Gal. Septic Tank
Other requirements t/4
Water Supply: V Public Supply From �LlG 1.� t�Al2 �'"
Private Supply Drilled By
ress
Building Type "^ _x
Has Erosion Control Been Completed?
No. of Bedroomss Date Permit Issued__
I certify that the system(s) as listed serving the above premises were constructed
attached), and in accordance with the standards, rules and regulations, plans
Date Certified by
ill as shown on the plans of the completed work (copies of which are
the permit issued by th Putnam . ounty Department of Health.
P.E� R.A.
(('lrtn License Noy.
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 supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner of H Ith, such revocation, modification or change is necessary.
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k jNVIRONMENTAL HEALTH SERVICES J1)I�IC'Clol� $O�
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