The URL can be used to link to this page

Home My WebLink About4473DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -31 BOX 34 IN mi is jr, , Is J IN r 04473 �,— -757,T '- T-- 'ri5,�"�,', e ,.�.,_ -i :PUTNAM COUNTY EPARTMENT, OF HEALTH: E NG I- N E E R :MUST-: `\ u Dfv�sion of Env�ronmenta/ Help /th SerwCos, Cen»% N Y 10512 PROVIDE PERMIT '1 CONS- • i.... .. .V. t' It } ••-� 9 \��„ CERTLFJCATE_'.OF ,T.RUCTION- COMP LIANCE FOR SEWAGE DISPOS�p►L'SYSTEMul�iiat!? ✓yl %,y �.. Town or. Village Located, at Ey' :� ' / - : • Tax Map ...� QJ Block . . Owner ' Tax'Mh Lot A• 2 3' Subd Lot N Z , I .1 Separate Sewerage System built by �+ ~� Address •J O/JL� -K Consistlrig of:,Gal. Sep ;Ic Tank and ,J'yy 1 ..` 7� other requirements Water SuPPIy �L PUblte' Su'D PI . Y '-Fr n P►ivate Supply. Drilled' BY Addressss� A P Building Type' , I' ��' No. of Bedrooms Date Permit Issued Has Erosion Control Beery CornplatedT r `" Has /V garbage grinder been install'ed7 6 ' I certify that the system(s),as listedserving' the above premises were construct erg Fa own on the -plans of the.completed work ( copies of which are attached), and in accordance with the standards, . rules and requlat the filed. pion, and the permit issued by the Putnam County Department - Of Health*' ealth Oatej� /f Certified by - R.A. :.4 Address . • License No. Zyg� Any person occupying premises served by t `` above - systems) shall promptly tak n a ms be rte' ry to secure the correction of any unsanitary available and the- 80proval -of the-•private water supply shalI become and�okl e a conditions resulting from,'uch usage Approval Ot'the separate sewers sts soon of a public sanitary -awsr becomes .,Wdsa�� „' , ` ly Ili emes avallatiN. Such approvals are subject to modification.” or..change.;when, in the judgment of the; om slo Of. n, in Iflcation or change s nary. IRS r'7? Oate By Tkle Rev. 6/85 - ... -... •. -. c. -e. - •. i - - +« ..•.• _. Jn � .._ •..._ .s.x ..., .. .. _., ..� ... ,., .x. _ .!' -z .+ - w5t n c. :rl .•� • .•_. >... �� - y. .- M An blaz d, I �C 11 �= i' .. rl -or I iase, di g Section -. ° i.....< r > . _. ^!; � � � _ t'. - r rr• '� %.:.`._.: Y:;. o .a-.. r� : V,'. �'... ...�� C.. .'�-v. r. crJ.. ., Building Constructed by Block Tel �- 6a a �S Location - Street Lot Municipality Subdivision Name Building Type 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 j_rec _U,0'V 0 .the -- Division o:f .Envi- rzoxim rit -a1 H.ealth.dSery ces' e : a - _Y; ..•..� . 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 19 Signature g, ,"�u�e,`� Title 2=t2 I" Corporation Name (if corp.) %; *\ �5 ✓ P 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 x PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. Date Re: Property of Located at (T) t! Section ' / Block Lot Subdivision of /i` /� %� Cl Subdv. Lot # Filed Map # Date 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 accordance 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 s. i ..1 `,...,r .... .. e•L.vv... ... �. w• r Jt ..� ..... �.. ... .. •.•✓r. �. . �r.rp i� V .. ,... .' .aV •, ... ' a•-.. J. 'l1 ... v ... .�.-. ter• - -d. .: ^•- -..�. .. ..✓ ...... ...ti .; system or systems in conformity with the yprovisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigne P . E . , -R-v-*—. , Telephone Very truly yours, Signed �mm , Owner Hof Property Address Town Telephone !) VA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY -OFFICE BUILDING; CARMEL,rjN. -Y 10512 DESIGN -DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.. Owner Add ss 106ted at (Street 6dicate 1 ,�c+Q_J Sec. )� Block v' Lot nearest cross street) Municipality � � �� ))eAj Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Ho lo ..... _ Number CLOCK TIME' PERCOLATION PERCOLATION 'Run apse Depth to Water . 'Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 23-30 0.10 30 w 9.30 IF l 3 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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.RE.QUIRED TO BE SUBMITTED WITH APPLICATION _ DESCRIPTION OF SOIL" ENCOUNTERED IN TEST HOLES DtPTH HOLE NO.— +HOLE NO .a . HOLE. -NO.J y. G.L.Q._ 6" 12" . 18" 24" . y 3011 _- .. 36�, 421 48" 5411 60" 72" MR INDICATE LEVEL AT WHICH GROUND WATER IS. ENCOUNTERED.. - ThDIC-ATE- LEVELI TO WHICH. WATER LE'V'EL RISES AFTER. BEING. EN_ COUNTERED TESTS MADE BY Date DE6IGN Soil Rate Used MirVi "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity Absorption Area P ded By L.F.x24" .. t nc . - Address THIS SPACE FOR USE BY BMLTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date S i TC A- e 4&7 P 4- A 13 32' Putnam county Department of jiealt' noted" k 2 appli le Flule Regulations of t- 04nty eal t. fora b .. J�a�a - 59-5.rA *c- n