Loading...
HomeMy WebLinkAbout3712DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -52 BOX 29 ell 0 n 0: ' 6 home IN I We IN he . le'lorli r IF 011 A lm . 6.2 il 03712 �. ``�' PUTNAM COUN'I1Y DEPARTMENT -'OF HEALTH Division of Environmental HnIth Services, Carmel, N. Y. 10512 Permit # Y CERTIFICATE OF CONSTRSUCT16N COMPLIANCE FOR SEWAGE, DISPOSAL SYSTEM S"JO .VL Town or village Located �at Tax Map JLT •.'(Q•. Block Owner / Formerly Tax Map Lot # `— Subd. Lot # Separate Sewerage System built by Address Consisting of al. Septic Tank and Other requirements Water Supply: Public Supply From __]C Private Supply Drilled By C�i �TINC� -,a Address -IM Building Type)�a�s I No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? Y 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, in accordance with the file n, and the permit issued by the Putnam County Department Of Health. ' VC— Date I Certified by - P. E. R.A. Address r7 Z License No.ALg�2 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary ytocure the correction of any unsanitary conditions resulting from such usage.' Approval of the separate sewerage system shall become null and void as a public sanitary sewer becomes available and the approval of the private water supply shall become I and -void when a pub water pply becomes avalNbla. Such approvals are subject to modification or. change when, In the judgment of the MI of Health, pfiCh revocatl n, modification or change is necessary. Date —, By Title Rev. 9 -81 Owhet or urchas�er cif Building Building Constructed by ao� RA P'CV4E k s Location - Street VALL Municipality Building Type 346 Section . 3 Lot Subdivision Name Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly 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.regu.lations of the Putnam County Department of Health, and hereby guarantee to the owner, his success - o,rs, 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 of the building utilizing the system. The undersigned further agrees. "to accept as conclusive the determin- _, ration ,of the_- Director- of- tithe Div_ isi_ on of Environmental Health .Servi_ces. of the Putnam County Department _of Healrth as to whether`or not`the�fai' ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. n Dated this / / day of 19 9� Signature Title Corporation Name if Corp. 1. S A 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 �'l`1 G 61) -;7 7'DEEF' CURTA IN ORA11V V 4' C) n. ua co TUTNAM-_= 0 - '47 x -41 :J JNT F .-Pe # W" CONSTRUCTION STRjJCTION _.PERMIT :,FOR '.SEWAGE ,'b1S o _ Town - village aLx mock__ _-T Bull in 'T V V u er `bf edrooms.l. Design il G/ P/D ­F-- Se 'i6rige .Sqjtern to consist of A, we rage jo.-be-bonstruc -t ' a by ' o 7,4 Y -,Water. St , ippiy*.. :;• Public Supply From .— -:771 Prwate Supply to be dii4 z Address' Other equtrervjep s "A rqp!esqn t th a. am wholly-,Ind completely *,responsib,le, abo-ve-descri b ad will be constructed as show rt qktoe'a ppr� 'Couinfy­bepartrnerit' .of !1l841 and bi,'iubihitted A6 .1" e —, h , D lace - Do Der atind" � , con 61 iiK-ahv-Dah ,Wia,sAkf!m aunty Department of Health 77 7R; -41 :J JNT F .-Pe # W" _Health __ 7, olrs��f o _ Town - village aLx mock__ _-T Y r7l Section ❑ o 7,4 Y ','b.',`NStiLca Re iredj��_ P. 0h z Address "A Z z: J� n 4 des 2n ` proposed ; , .1 ) th 1 t. t" h e . se para t a, sewage disposal .riyste nr i I 6&rdance.wi t h the.s t andarck.4 leCa �reau a� so s o e,,Puxnam .w Any change. oi,'a" M -revocabile-fo "A Iteration o .,constr requires a° new pamit F•Ap roved f�sposal of domestic dart' s w e .a /or pnvatew supply r icaijid or maybe Rrpmlss 6W..Bf. Y T.. ........... Yz S" M P113 D CTIC;CK LIST. Date w �.v .,..:.c ur.: •..•.� -• •...:- ..:...n. ... o -.,-�- .ap. ..:r, -7:: c;oa:•. ai•3 .;ti.ae.-..s.4 i IN-I.T.TAL SITE INSPEC T TO ` yes. No Comments ,Property lines or dorners found : .. Can estimate house location .. ., . Will driveway need cut o . . . . . . . Must, trees be removed -note these - Is deep hole representative of entire SDS area Additional deep holes needed... Sufficlent SDS area*. available considering -- driveway cut, house location, separation , distances, etc. DEEP • HOLE DATA Depth: Water elevation: Rock elevation: Soils descri.Dt i on: Date . 10- L . -- FIX-AL SI7TE IN 1P ECTIGN Insp . by: Hou s- located where 'shoi,n on approved. plan SDS _located where approved . .. _ -- .'lerz.th of -trench measur -ed - -- W i.dth of trench average Slope of the line and trench.acceptable _ loom _al3:owed- •for -e� fiver 6 f;. from swan p,lrate'r` "course Natural soil not.stripped or SDS area - ivariecessarily graded .. . 10. rt. maintained from prop line and. - 20 ft. from house . Sep-"-ration of .trench from house.,. well '- -- etc.- follows--plan :---- :- __,__- ;-- ;�--- ,---- ,_- _o�_ - -- -------- .__- - - - - -- -- -� - - -- _ - - - - -- -- ------ - - - - -- - - - - -= -.. - - -- htunber of bedrooims checks Stone's., brush..' stlu: ps, rubble, etc-, greater than 15 ft. from nearest trench 15 PL.. of peripheral soil horizontally from _ trench. . • . . . . . . . . Junction boles properly set Coi -O.d surface run off from driveway, roads, C)x )c g • ground surface ., . etc. clhanniel near SDS , . , area. . . . . . . . . . . . . . . . Dae:s 7.ot. drain" I re a.pp_aj, 0. K. J.n area of SDS - FI.NAL GRhDING OF SITE ACCEPT -AM-B 4 1 �Xl� vc� �L•V + = t A' xA' xQ , ..xti61 i►1f�: 1- �0�€��: to Gt A1. x e Kw �t1 wz t _'% 4� S'GP!'P FMK ,v a Ie000 CrAv �A t�l�o+IZi C '�Ci�.'Ta.Sk ; ' OX v o F It CyFi14' — I' Iz C �15�1 �sro is a i b ��1 c. e. is �