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Home My WebLink About3221DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -6 BOX 26 03221 ' PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Located at C::: N V F_ c_ Owner Town or Village ^7 i Tax Map ! G— Block Lot -Job Separate Sewerage System built by cby Address 2 `- 6 _' Consisting of / Ze`Gal. Septic Tank and Z�a L- r- X 7 N� 1J vim' r E;, C & —M&NCM Other requirements Water Supply: Public Supply From j� Private Supply Drilled By N Address MATt-Jx M V AI-L _K y Building Type pV_J 05t""L^J liq C-1 No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? \l am ��L OF New `' ' yV, A. ��ccr0,s,,{ I certify that the system(s) as listed serving the above premises were constructed essenf w p bf a completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed; a t r i b e tnam County Department of Health. JS Date i Z 1 - Certified by P. E. R.A. Li: fty� tT. Address 2- 0 icense No. �` 1 V-3 Any person occupying premises served by the above system(s) shall promptly take suc secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall p soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and en a YF(FSM66 A beconi'es available. Such approvals are subject to modification or chan a when, in the judgment of the Com stoner ealth, s""lit� eafi n i r tion or change is necessary. Date L 4a. By Title I i I. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental. Health Services, Csrrilel; N. Y, 1051.2 i.GNSir1uC.11U_N YtRMi1 FOR SEWAGE_UiiiP0SAL SYSTEM 1 Town or Village Located at`^'`W `gyp Section Block Subdivision��A�� -, Owner— Building Types ` Lot Area ` Number of Bedrooms T Separate Sewerage System to consist of ` Gal. Septic Tank To be constructed by Q d � a�--`� Water Supply: Public. Supply From Private 'Supply Jo be drilled by Addre!: �JV- Other Requirements 0(J Lot (� — Job � �+r A Address 1 V MAl 'I Total Habitable Space zAQ0 Square Feet lineal feet X width trench Address V `QI I represent that 1 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 o t 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 the date of the issu- ance of the. approval of the Certificate of Construction Compliance of th '.ori final systemyezany repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Install d i cordance w' the standards, rules and regMa-fions of the Putnam Couny Department of Health. Date 91 Signe ��(►( P.E. 2R.Ai Address �✓,„ `�' -�` ec License No. � APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless con ction o the building has been undertaken and is revocable for cause or may be amended or modified when considere scar the Commissione of Health ny change or alteration of construc ' n requires a new pe mit Appro�{ f disposal of domestic sap ary se , an or riva at lye S Date r-- BY �� Title v r ...- ..+..• wrx z':..-r•..- :-._.a...,R �+ • —.�. :._: .-r :. �.+.. ..- .:a.rj .. ...: - n..._....�.s;w:��-�1 T..�. ...tea ". ..� r-• r -_.�• -• ..- m....«A .'r.- . ✓...• ..2a -..�.. r � .� .- ._� .�... R.w..— '^'.:^ • .ra ] "'.. Owneix� o- urc aser of Building Municipality ng constructea oy Location - Street Building Type Section Block Lot ; GUARANTY OF SEPARATE SEWAGE-SYSTEM Wf represent thatL4Cakewholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the.approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations 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 Mi which fails to operate for a period of two years immediately followir_g the date of initial use of the sewage disposal system, or any repairs made by"to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive. the de- termination of the Director of the Division of Environmental Health Ser- _..o.,f:�tr�c�: D p tme.nfi of 0,,' -"'_h r ... id}'tPt, %-1 °" ` >- �•c+.;he-.._......_. failure of the system to operate was caused by the willful or e iy t act of the occupant of the building utilizing th sys Dated this �3 _ day of 19 % Signatur� + X Title \\.it Ir 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. Division of Environmental Health Services, Putnam County Department of Health Ol 1 Ll iY 4N F�TRU ,K% MA tNERY, BUILDING MATERIIALS NOR EXCAVATED EARTH $HALL EE ':4 0 iN!= SEWAGE DISPOSAL AREA. CONSTRUCTION OF THE SYSTEM IS 'ro qL IN ACCORDANCE WITH THESE PLANS ANY REVISIONS THERETO AND THE• j� AND REGULATIONS OF THE PERMIT ISSUING GOVERNMENTAL AGENCY. Al r P. � I- , II, A7 0� It --. SF WERAGE DISPCIS.4L SYSTE, NAMIE STREET TOWN NEW -foRK LOT M. BLOCK _TAY MAP N',- %mmis" AS--i i I At BUILT LAN, su PUTNAM COUNTY DEPARTMENT OF HEALTH lir �t,Nii'1xiJNi�IE'N�'AL, Hr:[�Llri 'Ct`S Date Re : - Property of Located at !��WQQ_kx Qx�� Section Block Lot Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordane.e with the -standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or "t•(..i.li_a1:1vn LaN he 11-lLl..r_1 I-Iealth--La i_ _h�- �.lt71 "ai.t y;Gill"c_`'• tary Code. Very truly yours, SriQ,t OOOP a ce7�/ls i�vc f Or '; f. >.; Signed ,,. �,ee4 _ qefi6r of Property Countersigne Address 911, �s N OlGls Telephone Address Telephone J NO,TRUCKS MACHINERY,BUILDING MATERIALS NOREXCAVATED EARTH SHALL BE ALLOWED lf� TqE SEWAGE DISPOSAL AREA, CONSTRU,CT16N OF'THE.SYSTEM IS TO'BE IN ACCORDANCE WITH THESE-PLANS ANY REVISIONS THERETO AND,THE RULES AND REGULATIONS OF THE PERMIT- ISSUING GOVERNMENTAL AGENCY, 41 1200 a L. 4'9F=7 7r- 7A N 14 zoo e-v -Y -,3 d, A 8 S. 'r4e, 42—' ai RP 716 lli 42 - 0' Ak,?-w� F:' 16 A. 0 �: Af�� S EO JUL � 73 e UT NTY IVISION O • F W.MMMENTAL HEALTH SERVICH Peor-g 6 VA Dar A 10' V. I" D.W. Im J NO,TRUCKS MACHINERY,BUILDING MATERIALS NOREXCAVATED EARTH SHALL BE ALLOWED lf� TqE SEWAGE DISPOSAL AREA, CONSTRU,CT16N OF'THE.SYSTEM IS TO'BE IN ACCORDANCE WITH THESE-PLANS ANY REVISIONS THERETO AND,THE RULES AND REGULATIONS OF THE PERMIT- ISSUING GOVERNMENTAL AGENCY, 41 1200 a L. 4'9F=7 7r- 7A N 14 zoo e-v -Y -,3 d, A 8 S. 'r4e, 42—' ai RP 716 lli 42 - 0' Ak,?-w� F:' 16 A. 0 �: Af�� S EO JUL � 73 e UT NTY IVISION O • F W.MMMENTAL HEALTH SERVICH 4 a,( oO PUTNAM COUNTY DE ?ART iE N T OF LTF[ S%, S, ON LN ITR-G i N "TAP 4K -Z_ • j' ..il :� L� >l .i�tii Lff_ ie C.., ^L Jnb F..> DESIGN DATA SHEET' - SEPARATE SE ,, GE DI' ?OS 1L SYSTE' FILE NO... Address Located at (Stre.2t .;�,'�0 P�� Zt� Sec . Block Lot _ (indicate nearesc cress s treet) - rlunicipalityCS`�31�� .r7atershed '-- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUE ",T'I? 30" 36" 42' 48" S 4" 6 0" 66" C, 78 84 INDICATE. LEVEL AT WTHICH GROUND WATEIR IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEITL RIS=S AFTER 8EI?�G ENCOUNTERED TESTS `ADE .3,Y .FIuCZ� A, d''1toy0e .L Date% Soil Rate Used 3_ —Min/1" Drop: S.D. L'`0�, =r� �deaO No of Bedroo..s Septic Tank Cap ty Absorption Area Provided E p }.7 L.F. ;Y2 _ 35" t "'t xeno Othez_ s: 4, Name k)� M, atu No, a — Addres.s`k> kbZ_SQ-"4iW.J(--, SEAL PUTwAM COUNTY DEPARTMENT OF HEALTH Soil Rate Approved Sq. Ft. /Gal. Checked by Date