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Home My WebLink About4470DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -27 BOX 34 - all ' At 1 me ` Be T " V . , , r.J . I r f., �I' ti 6 ` N El 04470 g� . .- PUTNAM COUNTY `DEPARTMENT: OF I=IEALTH t Division of Environmental Health Services Camel `/V Y 10512 a 1 GAS f(ECT�,OF ^E�T?Jt`�sc. L�'.'�1sr'.Ired = r >CsF3 5 l�s�5P:r` sF.i. �S't�s7'L -11�� I G. . .�.• G Town or Village Located at "- �/ _ Section Block -Owner ! '�%� Lot.- Z� r Job, 1j 1 Separate ..Sewe� age System built Consisting of Gal'YSept�c.Tank +Imeal Feet X i/17 width trench r i Water S upply PUblit'S'unely From `Private Supply Drrlled By - : Addre'ss s EiUij* .Type �G r 9C7 1 n` h No. of ,Bedrooms Date Parmit Issuetl a,4 iHas Erosion Control Been ComPtited� - £ I- certify: that the system(5); as listeq serving; the above premises were constructed essentially as sFiown o�9{ �pi`s�fjjrieP,ceompleted work (copes of which .are. attached),; and �n «accortlance with the steniiards 'rules antlSregulations plans firFed 'and thepgrmiepYa;�r @eVP.yl�tJfam COUnty'.Department of Health. y/ 'Date Certified by P E R A y y rya `� laicense �No eAny person occupying premises se►ved by the above systems% shat)., promptly take such action %` 4,y -be `tto secure �I�e _correction of any unsanitary .- ..conditio.ns resulting from `such usage q:pproVar i the separate. 'sewerageasystem•sshall beco ".a "Vol d, as soon;�d igTP,ublic sanitary'sewer b' ecomes aVailabid -and the.'approval of the,pnvate .water supply shall: become null and, void when a Zpub up7 g �e�ctPrp�at� Vailable ', Such ;`app ►ovals are %sublect�to modification or charige twhen _;an the judgment of the Commissioner `of Health- ysucif�eyD5lipp - ifit�µ9n or change ;is necessary R' Date Tale } - owifer or FurcHaser oT Building Municipality Building Constructed by Section ° Location,- Stre t Block r Building Type 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 aucces -. 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.oper..ate 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 Se.r .wesr -af ..the _ 'Dut.nam_ Coup.ty.;D.epartznent:,..' f._:.Heal.th ,as. .:to._ whether _or.::no-tt-.the:..: failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated thi s day of t:. 19� Signature Title If 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 PUTNAM COUNTY DEPT. '.. T P "F-P: f OF HEALTH Division of Environmental Health ` !_"rvP.7es, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or Village Located at ✓ _ °Tax Map 12— _ Fjl�ik•__:- _ e � " SuUdbti3iaii'- f'� >vc y �,.. Lot Job_ , Owner � f le C�d1�y r° .+ � Address .01 1117 Building Type C e,,7 Lot Area Number of Bedrooms Design Flow �� — Total Habitable Space ��i�'r� L� �/ I Square Feet Separate Sewerage System to consist of C,� � Gal. Septic Tank and �•-s /' CT� 2 �js hie To be constructed by 0 rY � � / _? J% � Address Water Supply: Public Supply From /y� {Ct /73 e`� Private Supply to be drilled by Address Other Requirements 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, the and regiu a ions of the 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 assjc_]W i'�'boy ler, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) year,,. ad el fl1 the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs the,Ft 21,AM. ri ell described above will be located as shown on the approved plan and that said well will be Installed in accordance with the standar i nsh of the Putnam County Depart ent of He Ith. e4� t ✓� o e o a Date Signed R.A ��I g.�E. K Address if �.' ! c ", N a 144 Z, �sy 4V APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless nstructicY...' gthe uilding ,has 0446,iindertaken and is revocable for cause or may be amended or modified when c idered necessary by the loner of Health.�1gara�g$r`�atetai3lon of construction requires a new permit. Approved for disposal of dome is i ry se /o water su .ly on Date�� s+— By RI NI"k`I Cf'('.NT)' D11W\j.'•7NT fir IIrArMI \T, !lF:aT,11-I SFR\ -M C'r;?' .a Date `% � Re : Property of Located ati Section 2,7-<W Block Lot Gentlemen: This letter is to authorize 71; 6 Ga 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 accordance with the standards, rules or regulations as prorrulagated 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 147, Education Law, ,the:. Public 444, t�- La��:= ktd...:t1ie 'autYfarii "Couii�ji �Sani- tary Code. Countersigned: P.E., R.A,,r s�ov�a ®o press A {�° Telephone Very truly yours, / � Signed Q ner of Property Address S2 4/51 Telephone 9 0 G y +a n A I.. FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTALHEALTH SERVICES C ��-OFFICi-b fb]Ncr, -.,bA N. 'OU DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner re �e_ co Address avre-e+ R V, v Located at (street Sec. 126? Block Lot indicate. nearestcross street) Municipality Watershed ..SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTEDVITH APPLICATIONS Hole 3 Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Wate-FIEVEeT No. Time Rrom Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches-- Inches 714 2230 5 2_1 2 2- 2 3 Notes: 1) Te'Rts to be repeated at same depth until approximately equal soil rates are obtained at-each percolation test hole. All data to be submitted for review. 2) Depth . measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED.IN TEST HOLES. _ J ^S %. �•1T�'. .. _. y; :'•.. y.; ,; .cn; 'rr�d/v �k1..�: �OLL�NOe ��, -��c.. :L'.:: ': X..aw vn.pdr - �%SxV:- .,- :.+= . -..wxw e - DI;FTIi •HbLE' ' 1�'�. � v�:�:= �._-: .�. > -. � � -� G.L. 6" 1211 30." 36" 42" 4811 5411 60" 66" 72' 781 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDLCATE LEVEL.TO WHICH WATER_ LEVEL.R SES AFTER - BEING_ENCOUNTE;, TESTS ` MADE°- . B)Y _ .,.i y, - - Date... DESIGN Soil Rate Used Min/v'Drop: S.D. Usable Area Provided No. of Bedrooms_ Septic Tank Capacity Oda 'Gals. Typeosc.� Absorption Area Provided By .4°d L.F.x2411 width Trent . Address Ke ure SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by 4� $ O, 24896 8 ,� ? l- P �y n N WOISIAI 1931 2,k 0 re q, 3nOMddV,. 1 Q 01 X10 el ,L9T9 4, CXI 1 bx TT-17 J _ F1 1.°� Ctr P O !� J � � � V 7 f iD asp- • � or/ v � zJ., 6