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- PUTNAM C UNTY :OF HEALTH
x `:
,DEPARTMENT
.,
' Division of` Environmental_ HealtiiaSewices Came/ N.� Y 10512
CERTIFICATE, OF .CONSTRVCT•ION COMPLIANCE FOR.;SEWAGE rDISPOSAL SYSTEM
Patterson
Town or ',V Ellage
Morningsade.Dr V6 IT'
Located at Section
Alpine.Acres Inc.
Block,
S0108
Owner s. Lot
'Sewerage bwlt,by 0• :RighA. Excav Co:, Inc Address 1146 Oregon
Job
,Rd , `.Peekskill,',N Y _;
Separate S,Ystem
] 500 385 ' Feet.
3- i n0 width trench
Consisting of Gal, Septic ,Tank lineal X
other requirements
' X A1Pine Acres Water Corp
Water Supply. Public Supply From,
Private Supply Drilled - By =
Address r A 7.
F'
Frame
Building Type - No of Bedrooms Date
Permit Issued
None' * l .d
Has Erosion Control Been Completed? :.,
i certify that the system(s), as listed servinj; the above premises were constructetl 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$fEled and the peimEt issu the
` Putnam County Department of Flealth.
I
p
Date 12/28471 Certifietl
X
P, E. ^ R,A.
;._
►BSS R:D ", B,_ 35 ;Carmel -N:.Y. 10512.
29206
Atld
Lice rise 1`40..
Any :person occupying premises served by; the above systems) shal6 pro"tly: take such actEOri as maybe necessary to, secure the correction of any unsanitary
y.. •
conditiohs resulting .from such .usage Approval of the separate` sewerage system shall tiecome null' and void
soo 'as a`public sanitary.sewer becomes'
available and the approval of the private .water supply shall become null antl void when a ,publro water sup
be nes available. Such, approvals are.
subject to modificatwn or change when win the judgment of the.COm er o Health; h 'revocatEO ; ,m
_ s.
/
rfication - or- change.is necessary.
Date �- BY
f
Title
Owner or Purchaser of Building
h �
BuilAing Constructeff by
NOON 6d ea .1 i js we
Location,.,.4 Street
Building Type
4Hcolve
Lot
GUARANTY 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 guaranty to the owner, his succes-
sors,.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 :Wade 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 de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure 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� Signatures J�
�3
Title
(It corjqss)
ration, give name
and ad G
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
d4!1wWfloiIerolrow • .` - "'r' -rY .- - 4V :, �•`%. _ !F{ _
(see schedule! `a T!C
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e fended tosurJn �
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CONSTRUCTION TO CONFORM TO APPLICABLE LOCAL COUNTY f STATE RU L.E.S/ REGULATIONS/ ORDINANCES• /LAWS 1,
S C N ETJ U L E G AL.0 U L. A T I O NS' EEP 1E T P E R C LAT10
NO L E 0A.TA -N 0_L E O AIA
if the — 4TS5 SA'TJiTAR
p, ]n. DECIU G K A n Et OLE 1 al _
TANK INSIDE LENGTH ` L" NE BEfi ROCIMS Xl'i1U OAIA_`• -I '2 .�,�J N I / . _
- 'TANK INSIDE WIDTH GAL. pAY�� = I ��•'C -ai. DEPTH " •- _/�...,. ®Ep•��• Ap��y�p - fu; 7•�"� ,. �c 'mot ..
Wet to loterol LIQUIr7 LF,Y EL - ��'^...r r... / -_1Y'- N `�O � D�
}
SIZE Of SEPTIC TANK.A 2 SLOP
CAPACITY "i10€} GAL
saf.'ef to nest 3 (
f I ELQ FT. R D, C,.L.n� 'rt _ ),-OWN Oral. Bor.' --=4 PERC OLA710N RAiE A� t MIN_ .- _ _ t + x: �/t -i(Np+
14
MINUTES REeD -- k a *1 N sFOP , It
Nf LASE RAlS J _,� fllLD LENGTH WIDTH 5 I 'f t�l1t� ( -F .� + I p ENO {•.r[ �C%WN OF
vI' / i a $TA Ri � _ -fr i L/E Q. 97 %' .'_- / GTA'
Qt LEOGFNiEA. O r OR fill SECTION G'
t(et to - 101"'o/ ;, N' BO.E S�? AS PCR $CNt9lllE iI nIN ^� '' OUT"
I or It - 1" •�__�PiLOCK
r .r .. .1 S1oP iit r ',.,. P,E .dt -t gRAW N P�Yi
PLAN :..{— z STAAti —'I VI OF PPROIED
If c HEALTH
IF I LL S E C T I O N ' (iwofa'. . r - "I , -f --- -r— " 1 ISION OF • :' A $Y
PUTNAM COUNTY t DEPARTMENT. rOF HEALTH Y
lS�
Division of Environmental Hea /th Services t: rme/ N Y 10512 (g
CONSTRUCTION_ PERMIT FOR .SEWAGE: DISPOSAL SYSTEM: Patterson _'�
:Village .;
:. Town or_
Mornrn sitle. Drive.
'Located at r g r T
Al pinew'Acres 13:19
Section Block
Subdivision Lot Job
Inc
owner,: A1:pa ne AcreS , Atldress Pres r
Building Type Frame;, got A ►Ba. Oscawana� Lake Rd Putnam Valley NY 10579;
Five `.1250
Number of Bedroom Over
s Total Flabitable Space Square Feet
separate sewers a System to �os�st of 1500 385 36 4, neh
9 Gal. Septic Tank %~ lineal feet '.X width trench -
„ Owner _
Same a's above
Toi be constructed by Address C;
Water Supply. X ' public. ,'Supply' From Al ptne AcreS, Water. Corp
Private- Supply to be drilled by
Address
Other Requirements None
--� Re' l aci n Permit Issued ;11 1:8 71 P C D H.:..
I _represent that I am trorr of-the - proposed systems) `1) that 'the, separate sewage_d�sposal system
.above described will 13 constructed as shown on the - approved amendment there to and in accordance with.the standards; rules an regu atwns,o a Putnam
County Department of .Health, -and that on completion fhereof. a °':1Certificate •of. Construction Corripl!ance" satisfactory to aFie Commi ;sioner;of. Healthwill, r „'
be submitted to the Department, and a`wnttedlodaiantee will _tie furnished the owner lii ;'successors heirs or assigns by.-thebuUdek that se id, builder:will
place in ;good operating condltiori any part of 'staid sewage disposal ystem during the period of two (2j -years immediatesy;'following thedate of tlie,.issu -,.
ance of the approval of the Certificate of- Construction Compliance of ,the original syst em. or any repairs there to ;2j that:'tlie- drilled well described above
,will be located- as.shownon the a roved plan and that said well Will be installed. in accordance With. .the ndards,•. rules and r' iulaions f "the Putnam
County .Department of Health. - :- � .
Deis 1211
3/ 7r1
i9
P
..E X
Sne R A ,
.address R:;D 6 B .3;53,; .Ca el:, New:York: 051:2 License N6:29206 °N.
APPROVED FOR.CONSTRUCTION This' approval. expires one year from the date issued 'u c ±struction of the building' has been underfaken and is
►evo.cable for cause or;may_be amended or modrfied` when considered nece .y by, the Come- fission 'of,Health Any';change of alieration;of -co nstruction'
requires a new permit. Aqbr evecl for disposal of'domesti s ag pry pply only
Date By `
Title