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Home My WebLink About4377DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -35 BOX 33 04377 1' �titi "1 AM i so NJ IN ra NJ. 04377 _ „. -��- - FU'1'NAM "COUNTY "DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM A. � P-164,41 Town or V' lags Located at , �� 2. 0 Block Subdivision a Lot'. ..rt. 4r:•':' Job'... _ — _.-._- Owner E L lLL� G , I T�fI' IE' !=' ' Address /" Sr, y: McA0 / /iLG�� •I�— -4 1 Building Type p'l .4 c,_ --Sr . Lot Area Z' Number of Bedrooms �d��' = "� �� / Total Habitable Space %4 '!=? Feet Separate Sewerage System to consist of Septic Tank Square /l � � lineal feet X �9 � width trench To be constructed by E- ;6A` ( /LL j %�? �-G�.al- (� �, Address Water Supply: Public.Supply From Private Supply to be drilled by Address Other Requirements I represent that I am wholly and com Ix e t esign and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed h a dment there to and in accordance with the standards, rules an regu a ions .7 e u nom County Department of Health, a �f "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department ten ra a+ furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating conditI �I pa ge I system dur g the period of two (2) years 'mmediately following thedate of the'issu- ance of the approval of the Ce fica e o o pli ce of the or' i I system or any repairs t re1o; 2) "that the drilled well described above will be located as shown on the ap o pia 1 well ll a installed i ccordance wit the sta r s, rules and regula�ons of the Putnam County Department of Health. Y r Data (.� i 0 ,)1; S' ed '°� P.E. R.A. Address I / License No. APPROVED FOR CONSTRUCTION: This s one year from the d e issued + nless Construction of the building has been undertaken and is revocable for ause or may be amended or modified when considered necessary the Y Y Commissioner of Health. An e Y chap g or alteration of construction requires permit, epproved for disposal of domestics ' ary se a ,and /or pri ate water supply only. Date By Ti PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM + "F I �''TI�A�'1 Town or Village Locate Owner Separate Sewerage System built by Consisting of � Gal. Septic Tank Other requirements water Supply: Public Supply From Private Supply Drilled BY Address Building Type Has Erosion Control Been Completed? IA)x " 110 at BIOCk j tlon Lot Job Address f� " lineal Feet X 36 width trench i/, Igp ! /' teems 4P Jojo Date Permit issued I certify that the system(s) as listed serving the ruc entiall as shown on the plans of, the completed work (copies of which are attached), and in accordance with the standar ,-i les a Ian it , an �th'e permit iss d b a Putnam County Department of Health. ° P. E. R.A. Date Y 11 277. License No. �'��c Address Any person occupying premises served by the above sli�R�r y take such action as may be necessary to secure the correction of any unsanitary ' s= Fr,'• ?s resulting from such usage. Approval of the rage system shall become null and void as soon as a public sanitary sewer becomes and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are o modification or change when, in the Judgment of the Commissioner pf Health, such rev tion, modification or change Is necessary. f V ' . •- j ,•- � �! f �•�- l Title �/ By *11�i s e t B� /Lw 0 er or Pu c aser o Building' Building Cofistructed by _ 4, Location Street Building Type Municipality '-7-4 7. Block 12 Lot GUARANTY 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 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 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 de- termination of the Director of the Division of Environmental Health Ser- vices a of the Putnam Co=ty..D.epartment of Health as to whether or not the ' - failure of °the~ system to operate was caused by the willful or negligent . ` act of the occupant of the building utilizing the syste Dated this Z day of ,D V 19�. Signature Title . (If cor oratiorV,,give name and add ess) LC / -_ 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 A3otes . Tests to be repeated at same depth until approximately equal soil :rates are ob- tained at each; percolation test hole, All data to be submitted for review... 2) Depth measurements to be made from top of hole: , PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �.�i.u, �� :r''.�'. : t rf- _ i r .Nrr•• - J .- _. t.. .,, _ . e DESIGN.. :DATA. SHEET - SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO. - rA � Address � i�� l Located �� 7,-q n at '(:Stre.et) � L� ��"� '' Block.,.' Lot 2 (Indic ate:nearest,cross street) Municipality 0WIv lV . 9 #4& Watershed SOIL. PERCOLATION TEST DATA: REQUIRED_.TO:`BE SUBMITTED'. WITH- Hole Number CLOCK TIME PERCOLATION' PERCOLATION'. Run : ,. Elapse Ae P' th : to 6uater .. , Water. Lever No: Time From Ground Surface in :Inches, Soil Rate. Start Stop Mir-,. Start. Stop Drop.,in Min /in.drop;; '.Inches Inches Inches . : :. Per t. —? 3 3.� <<�' 7 7 C �J 2 3 ;1s, s 4 s 4 , A3otes . Tests to be repeated at same depth until approximately equal soil :rates are ob- tained at each; percolation test hole, All data to be submitted for review... 2) Depth measurements to be made from top of hole: Name jA Imi . .��rius�r� -.,�. is lK Address � 1 1� PUTNAM COUNTY DEPARTMENT OF HEA ..soil. Rate Approved Sq. Ft. /Gal. Checked by Date pl, Of OVIRONMOIA ❑CAITH SEE U' LL