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Home My WebLink About4499DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -33 BOX 34 A , }I r r LLI I � '. I . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environments/ HeOlth Servioss, Cannel, N. Y. 10512 Permit to CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or illage //, Block "Located at /tea TaxfMap �G�p Formerly _ Tax Map Lot # ubd. Lot N Owner Separate Sewerage System built by OJ7�-` Add► / t / aa�� I Consisting of / �fJ Gal. Septic Tank and ) % 6 Other requirements �7 Al Water Supply: Public Supply From I ZIS �f P'^ vN Private Supply Drilled By Address Building Type No, of Bedrooms Date Permit Issued Has Erosion Control Been Completed? I certify that the systems) as listed serving the above premises were constructed essential as shown h on the plans planf and completed wossuedcopies of which are attached), and in accordance with the standards, rules and regulations, i ` , by the Putnam County Department Of Health. Certified b P. E. R.A. Date r�C�' ` : License No. " Address Any, person occupying premises served by the above systems) shall promptly take s V, ion ace secure the correotlon of any unsanitary conditions resulting from "such usage. Approval of the separate sewerage system conle n snd volQ' n as avail sanitary approvals are available and the approval of the private water supply shall become null and void w Icomes tai able. Is cenary. subject to modification or change when, in the judgment of the is oner of auam� ��q a Date BY g Tit Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH Permit d Division of Environmental Health -7 Services, "Carmel;,.N :..Y.:f0512 -.ONSTRUCTIO14 PERMIT FOR SEWAGE DISPOSAL SYSTEM /F Town or illage ocated at Tax Map Block Lot - yv/" subdivision A ! _i - %Yi"t rc (" f subd Lot # -p' 'j~ Renewal Revision / j ,❑ �❑ honer /Address "C 1��! {J "f , Date Of Previous Approval !� Building Type ✓ D — Lot Area : Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D P.C. H. D. Notification Required Separate Sewerage System to consist of Gal. Septic Tank and To be constructed by Address Water Supply: i Public SuDP1Y From t %✓ `` ��s N" Private Supply to be drilled by Address iOther 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 labove described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a O the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction C tijpNObtV.- esatisfactory to the Commissioner of. Health will 1e submitted to the Department, and a written guarantee will be furnished the owner, his s�yso�9, hgiFq p`iAa ;signs by the builtler, that said builder will lceeof theca operating condition any part of said sewage disposal system during the pe d%,!'�Wok(2.1�earj-i4iTediately following thedate of the issu- pproval of the Certificate of. Construction Compliance of the original syst of a thkretC; �)" that the drilled well described above ill be located as shown on the approved plan and that said well will be Installed in accordance rhjtlie 'e rues and regulations Of the .Putnam )untY Department of Health. �T I n a its Signed 2� .,.� • K^ e A. I P.E. R n Address �G' �� i y y w %✓ n_ t' License No. 'PROVED FOR CONSTRUCTION: This pproval expires one Year from the date issue 6hi- struction of ;Hec,builtling has been undertaken and is ocable for cause or may be amended 9 modified when c ' ered necessary by the Com i ner oV: Health. 1, hjr change or e n of construction Tres new permit. Approved for disposal of dourest c sa 'tar Fewage and/ r pr We 'akv su ^ s ' y owngk or Purchaser of Building `Bui ding- - Constructed' °ti . •:`:.p Y Location - Street Municipality Building Type Section Lot / -/ t /�►/ / Subdivision Name 3� 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 are 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- -- - a_.tion..o.f..the, Director..o.f,the,Division of Environmental Health Services , Y "of'tfie Putnam'- E�ounty'_1T6parLmen't- of`healthY'a �'ar1— 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 ti� �4V'Aj - Title <a Corp raation'Name (if corp.) ` 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 A a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of �1�J Located at (T )�� 'e7aPt �` '� Section d y Block Lot tea° j Subdivision of Subdv. Lot ## -. � Filed Map #, Date Gentlemen: This letter is to authorize �j- <''��j..•' if �i' 1�/ °� a duly licensed professional engineer ,r 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 - r systeix c - systems` -ii% .cvnT6.1 iitityy" -jW " t13,e`.�o3iz,.:s.igns:.: of-.Articl'e 147 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. All T��tersigned: P.E. , , Telephone Very truly yours, F, Signed ,� •.�.��r Own r of Property Address ice., • �� c�,� Town Telephone XL 1b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COu'iVi"� OFFICE BUILDING, CARPAL; N:'�Y DESIGN DATA SHEET -` SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address "�� 74- ' / f / Located at (Street ec . Block . ,� Lot �indica e nearer -t cross s reet Municipality r,,� -9 f% Watershed SOIL PERCOLATION TEST DATA REQUIRED.•TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION— Run apse Dep o a er a er ve No. Time From Ground Surface in Inches Soil.Rate Start -Stop Min. Start Stop Drop in Min. /in drop 5 Inches. Inches Inches 31 . -. -.5 1 PUTNAIVI C OUNTY DEPT. OE HEALTH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. 4 5 1 PUTNAIVI C OUNTY DEPT. OE HEALTH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. es_ TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH AOLE ` NO' ' .. r..1._ HOLE NO" HOLE 4NO . G.L.�� 6" �( 12" 18" 2411 I� 3011 36". 42" 48" i 5411 60 66" { 72„ 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED f` " INDICATE :T,EVFJ TO. WHICH WATER,, LEVEL ,. . RISES AFTER BEING ENCOUNTERED —TESTS -MADE-BY . �. ,L, �.Fk. w - • ;�Dat8.... DESIGN ' Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided No: of Bedrooms eptic Tank Capacity Gals. Type Absorption Area Provided By L.F.x24 57 ._.,... width trench. Other A Name h k b i J ^ 7 C d Address �'- ��?�,�- �i�G'. a►�: w S o a .. THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked Date mg 3A fly OR � '- OAK pm May WOU so- OWN AM On k"wY Law lWaAn, At 41r. X. k �02'� 'f-, g - it 1W le vcmri - it -T� 7�3 ).v L -349- County Department of Rea.Lim "t. Division Of Enviro—=e-,.tpl Health Serviceff Approved es with IPPI10able --nd Fasu----tions of the C 'Ity c!r th Department, Signature DAte 141ill 49- rw / 4' 3 27 2 27 49 47 ).v L -349- County Department of Rea.Lim "t. Division Of Enviro—=e-,.tpl Health Serviceff Approved es with IPPI10able --nd Fasu----tions of the C 'Ity c!r th Department, Signature DAte 141ill 49- rw / 4'