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Home My WebLink About4471DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -28 BOX 34 04471 ,..,...._T ,.,.._...,...m ...,T.�.:w,. F... . _... .- . .. ar"`- �, ".,.�'+ PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Haelth Servic a, Carmel, N. Y 10612 Permit r CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village _ LOeatedc Tax Map_ ` _ Block _ Tax Map Lot # r2 7 Subd. I Separate Sewerage System built by .17'" '°' — "° Mauro" — — - -- - Consisting of _ ®d Gal. Septic Tank and sr n—J C Arw Jf�/�� Other requirements Water Supply: Public Supply From 5o,,4 %2 v /r;s� V� Private Supply Drilled By Address Building Type S- - No, of Bedrooms "7 Date Permit Issued 2� Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed esser of which are attached), and in accordance with the standards, rules and regulations, i Putnam County Department Of Health. Date Certified by Addres/above D Any person occupying premises served by th systems) shall promptly take such act I conditions resulting from such usage. Approval of the separate sewerage system shall be available and the approval of the private water supply shall become null and void when a p subject to modification or change when, in the judgment of the fmironer of Health, n A I Date Rev. 9 -81 _ dlt sw o plans of the completed work ( copies '.rplan, and the permit issued by the P.E. y R.A. License No. Eurs the correction of any unsanitary as a public sanitary sewer becomes nes available. Such approvals are Itlon or Change is no ry. Title 6try Own or urc aser o Building Building Constructed by 7� ZA I�Fa, c7 Z Location - Street /�11270,1,,17 �l Municipality z�w cv � Building Type AA� Section Block 2,7 Lot Subdivision Name 2.-,7 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 regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, 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- otici� -of •-the. DIr. ed -tort' of.. the Division. 'of�- Environmental _liealtfi4 •- 5e'rvices. of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of C) cop � 19,;��r Signature Title I q � 1\Tc W1"V -5V Cor ration Name if corp. N,\ I\\ �.�. 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 �,'V _ PUTNAM COUNTY Dg [ ARTMENT OF HEALTH Division of Environmental Health Services Carmel N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or - VilFag@ TTaz Map 81ock Subdivision tom'' _ --� Lot Job Owner �/� Address Building Type ,/ f,- i t ��rf e,,"Akjot Area /� a KGs ,� f a � "? a Number of Bedrooms Design Flow° �� Total Habitable Space % Square Feet Separate Sewerage System to consist of �� Gal. Septic Tank and �� ►� •1�,iI"Y' -i)L To be constructed by/� Q W /4fZF-7J -? / Address .t j Water Supply: v Public Supply From ` 1 �( �e n,Y- �il GPAG'/° Private Supply to be drilled by Address Other Requirements 1 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 an regulations o e unarm County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwilil be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by th�P-uilder, that said builder willl place in good operating condition any part of said sewage disposal system during the period of two (2) years imme oii�QQ the date of the issw- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto, t1ot e GFWAX01 described above will be located as shown on the approved plan and that said well will be Installed in accordance w ;the st ndards, oAWIPI )o ay'! �c the Putnam X. County Department of Health. ✓> ro I pig? L� Date i e) Signed L ice$ TL R.A. Address �e �ic`etrss,rNo. _ .Y APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless c nstruction Y bu it4g 1t�aS been., updortaken and is revocable for cause or may be amended or modified when sidered necessary by the Commissioner of Health. �rit°y ch ge or alteratior '�f construction requires a nrmit. Approv or disposal of dome is it y s a private ter supply only.vyY< , °wR ^, ^ "' �` s -f Date By Gentlemen: or urm,Tlf r Ut V T` SIT) % "' r.`. . R. .:*-;,NT.M, I [FAT,T1 I qFP%k' MrS Re: Property of Located at--- _;�CU'74 Section. Block Lot This letter is to authorize Z/; i'*duly licensed professional engineer k or registered architect. (Indicate) to apply for a Construction Permit for a separate sewage system; to al serve the above noted property in accordance with'the standards, rules or regulations as pro-,ulagated 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 114,5 or. .... ... .. "147;' Edub'dfloh Law, the Public Health Law, and the Putnam County Sani- tary Code. 0, Countersi ned: P.E.1 qR- Aa&,ess Ot. /;/� 1, f 1 117 Telephone } Very truly yours, Signed Wner of Property Address Telephone K'N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY _OFFICE BUILDINCWO�'. D� -Y. 1055.2 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE 110. ) Address / / i'W er,7-�, Owner 1f;41 X., -7 Located at (Street Sec. 12a Block Lot 6dicatene&rest'-cross streeE7 Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION RET_ Eiapse Depth to Water WaE_er_7LFv_e1 No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min./in drop Inches Inches. Inches .32 Z 3 2- 2_0 13 20 2--1 2 Notes: 1) T6s kts to be repeated at same depth until approximatel� equal soil rates are obtained at each percolation test hole. All data to e submitted f or review. 2) Depth . measurements to be made from top of hole. 6 TEST PIT DATA REQUIRED.TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES t f % BOLE .�,. t . r - DEPTH -. ' —HOLE ^1�0�.� �-- N0 . j HOi,E NO. -� p G.L. 6" 12" 18" 2411 30" 36 42" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED .. , 1RDIOAT.E,LEVEL TO CH WATER' LEVEL RISES ,AFTER. BEING :ENCOUNTERED q TESTS i'�1ADE BY �.. a ^ 'Dated DESIGN Soil Rate Used 7 Mir�/1 "Drop: S.D. Usable Area Provided ® C, C, No. of Bedrooms 3 Septic Tank Capacity 06;0 Gals.:,;;:. ... .:'Type Absorption Area Prov ded By L. F. x24 " �'— W Addre s s ZQ 7 �L_ THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gala Checked by r,. • o:q.,. C. Late n, \ 0 / 2 2 7' . SJ' 90 2 3' 3 d 7' 39' 0