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PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of .:Environmental Heaiih Services Carmel N •Y 10512
CERTIFICATE; OF CONSTRUCTION COMPLIANCE FOR SEWAGE _DISPOSAL•. SYSTEM
_. Town or Village
Located at 1' od (MQ it^r� �oci i% Section Block
Owner Lot +.2 Job
Separate Sewerage System uiit by f/ Address % / -����•
Consisting of i Iffn _Gal. Septic Tank lineal Feet X ,7`�1D width, trench
Other requirements
Water Supply: _ZPublic Supply From 06ve, ±43 n ter. rl-
Private Supply Drilled BY
r % t a, �•.
Address s`c{i ,•,tt 4a ...
t fry
Building Type No. of ee�d m
�oos Q V^
pate Permit Issued
Has Erosion Control Been Completed?
�..Piyi }1 l Ot
y�jf�tcC.,:
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on9the plans of the completed work (copies of .which are
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attached), and in accordance with the standards, rules and regulations, plans filed nd the permit', issued b e Putnam County Department of. Health.
It
Date 0 b x/ Z1 Certified f
Address License N. o.�
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 w pply becomes available. Such approvals are
subject to modification or change_ when, in the- judgment of ° e9 of Health, such r vocat o ,'modification or change is necessary.
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