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HomeMy WebLinkAbout2037DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.40 -1 -55 BOX 18 02037 , Is so 4 4. =' ' ' ' ' I I 41. L r r 02037 0 JUN -10 -2004 09:54 FROM MR ROOTER PLUMBING TO PMAMCO NW HFALTH DEPARTMENT DIVISION-Cip BNyIRONNMgTAL MALTH- SERVICES 2787921 P.03 Z� ISO PERSON INTERVIEWED ej= ;t J ..- HD Complaint # Aame7 Kcauensmp kw4vMucr, Numm, ew.) DATE V z z/ TY'PE' E PROPOSED ]N TALLER_A a re_ ,-L y/id /�t1. PHONE /` �D l J �l C43 Pm�l (include orating � adjacent weDa): 3 �° • `�° � � �' � � NOTE: Repair must be in same location and of same type: as o--,,aal .aew= disposal system .Different location may require submittal of proposal" from 16wped prole oral en�gineet;or registiered ac+chitect. I.-a"wner or d agent of owner to the C, Onditian*84� bli tbu form: . stONATUU , TMI SCAVieO=&4VWr DAW_ Y r o haRW ==and with the following conditions: . 1. Pt+ocur ent of aqy Town permit, if applicable. 2 Submission of as built . repair sketch in duplicate sbowiug: L Owner's lame b. Site Street Name, Town and Tax Map m wbee. C. Location of installed .componenft- tied to two fixed points (e.g.,house Comm). d. System description (e.g., 1250 gal. Concrete septic teak, three precast 6' diem. X 6 deep e. bstallers' name and` number. I System repair to be raaed.ia .accottiance with the above proposal and conditions. �1 Taspectioor's Sim dt Title DATE COPIES: White (PCHD); Yellow .(Town 01); Pink (applicant) PC-RP 99biL TOTAL P.03 o n' v JUN -10 -2004 09:54 FROM MR ' ROOTER PLUMBING TO 2787921 P.02 .Property line Capezzuto Res. <-- 241. Existing Septic Tank e� Li appr.2V Existing Pump Tank --0 0 Now "D" Box .s. New 9 each High Cap. Infiltrator ' V. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY 'R q6 -6 y SITE LOCATION R PA�1-11J14, � Ie, TM# OWNER'S NAME U ° e PHONES MAILING ADDRESS �' '1,OS PERSON INTERVIEWED QiP&e-� , e3 -2 0 t j PCHD Complaint # ame & Kelationimp ('. wner, tenant, etc. DATE e%eZ -7/6 V TYPE FACILITY 40�106;Ajt E' PROPOSED INSTALLER. 1 07 W 16ZU1701A) 6, PHONE/-o'00 7f,5-- 900 ADDRESS TION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. i� as owner; or re ed-agent -oaf own'er�agree =to the -conditions- stated -on -this =form - , - - -_. _r ...- _..._._.. - - -, _. _� - SIGNATURE l���an TITLE 5e&*V1e'E71 11%ie4 DATE W7- 7/ Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML s�"I SEPTIC TANK EXISTING DISTRIBUTION 4 HOUSE 8 PALMYRA ROAD BREWSTER NY 10509 j OPUMP PIT EXISTING 6 INFILTRATORS 6 INFILTRATORS 4 INFILTRATORS PALMYRA ROAD L; ;1- p ti • p. i 14 i f Q property line Capezzuto Res. 24' Existing Septic Tank appr.26' Existing Pump Tank —► Replaced effluent line ---0 Installed New D box - 9 each High Cap. Infiltrators Palmyra Road Angelo and Carmella Capezzuto 8 Palmyra Road Brewster, N.Y. 10509 Permit # R- 196 -04 Tax Map # 36.40 -1 -55 Approval Date 6.15.04 As Built jk $:. P11 l4 Imo : SITE LOCATION PUTNAM COUNTY HEALTH DEPARTMENT - '?2 -,4—q OF...ENVIRONMENrAL..:SIRLeTH.EER- .CAS..- :....:. - 225 -0310 PROPOSAL FOR S&iAGE DISPOSAL SYSTEM REPAIR B -T�d .K PHONE 6Y^7 / TO to lylf MAILING ADDRESS Ji" &- rPs PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTAISM ' =W i 69 SC7P7Z7-.- PHONE 1-7 f food$ Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. will Proposal 5ppr yved Proposal Disapproved 6, Ao w APA Inspector's Signature & Title i o 2. with the foll any Town ing condi t, if app Submission of as built repair sketch a. Owner's name. duplicate showing: b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two d. System description (e.g.,, 1250.gal. concrete drywells surrounded by one foot + gravel). m Dam < -� C r C , co C m z n -C fixed points (e.g.,house corneal .c/)' septic tank, three precast 6' diem. x 61 deep e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above con 'tions. SIGNATURE . TITLE 71, DATE JCPIE�: v&te (FLED); YeUc w (Tam HE); Pink (A if corm) t zzz -�'',�� I S36425 =3G� E <ry w iro n pin 009 �61111 4-41� t, Zia . , Y it - t y45 "'FL Uf�tf. I ' 1�r M1S`11 I1�.t s' 1. t .�; }. t ` r ( p \ Si0 /y fr0/!� �e r dwaY Wk>a Att ) M 1c) — H a w [•L t , 2/8 57' iror.i i+,•'n 1 ia.�... o,� 1j17 j' i�YOiv fK; t• e t N36'925 =30W - - - -- _..R SoePrAalyd� .rryt.. .. ,h C Sys y mod' � 1'�e�4f I r �� FA /5o wide) :S >' s 1 r � r 4 sw SURVEY OF PROPERTY Est PREPARED FOR r SAL V11 TORE RITACCO ©E /N6 <, ' ,1, _ors 1108 -1,112 INCL . k +`n SHOWN ON v ' `J LAKE�� ^ /✓IAF' OF PU�i��AM ti L s/ruArk IN XV i TOWN OF P ATTERSON Y t` 7 "`m, �,fi� t PUTNf M COUNT "Y, NEW YDRK, j SCALE I�=20, { CYO s Said mop filed Motrh 20, 1931 as' Map iW 149 /, James C. EdgeN, 'the surveyor who mode Certified to. FU/nalll COUnty, this map, do hereby certify that fhe Survey of Ihe, prop Vey shown heAVn was convplefed .1965. kIVIF { e „Yavt ; License Ns 2/2 ann Registration. N95 32 ,. ��WM4 of Jones a�y°rs cget! . ,:; •y.:.r:. 93`: Maid Street, Bre wslerLiNew York Jfr�iijrkfnli. ") :r�at:,;t • ` 7�iv �fi�i t r l S it K ��iVLt �x �� � t• lq i� ;a "A M2 fn i d a � k j o .aq9- �a4V qi S r j�4oNe Bed 4 u . 4. ci - & /3 o j P / ,�Z- 7- �71 5, 122. �