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00037
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM �o;�
Town or Village
Located at a Te- �rlA�e Section Block %1* �o, .N
Owner T/k+p d _z:1 C Lot _ Job
Separate Sewerage System built by Address
Consisting of Gal. Septic Tank A 7g lineal Feet X �� width trench
Other requirements
Water Supply: 0100, Public Supply From
Private Supply Drilled By
Address
Building Type A �Oue No. of Bedrooms ;!%EVe Date Permit Issued
Has Erosion Control Been Completed? M aLoe &4fflV-
I certify that the system(s). as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans Wd, and the permit issue a Putnam County Department of of Health.
Date Certifi by v P,E.J!! R.A.
Address License No.�
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary.
Date / �• By Title 0�7=H t
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental . Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Town or Village
r
Located at U ift, !S LI 1�T�r- I ule - Section Block
Subdivision Lot Job
Owner ±_ �° ��=� �f►' Address
Building Type +p - Lot Area ' �
Number of Bedrooms Total Habitable Space 1Qct ^1M 0 o fi.
Square -Feet
Separate Sewerage System to consist of ��Q n Gal. Septic Tank lineal feet X 3 width trench
9;�` UP-< �0'' Sj1 o coy.- t;ro -c- -,cat— `ss 37
To be constructed by Address
a
Water Supply: Public Supply From +-
Private Supply to be drilled by
Address
Other Requirements
I 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 and regulations o e u nam
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 assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu -'
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be instal ed in accordance with the standards, rules and regulations of the Putnam
County Department off Health.
Date / 6sht Si d o P.E. R.A.
Address -e • ` e ®� k� License No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for.cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a new permit. P
pproved for disposal of dome it y segwrs�ge, a er supply only.
Date / / / BY • Title
77:777
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