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HomeMy WebLinkAbout2076DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.49 -1 -8 BOX 18 02076 ,. ' ll� his � 6 r ' i L L r 02076 r ;Aui 17 -06 d 03:37pm From - CENTURY 21 845 279 5607. T -254 P.002/002 PUTNAM COUNTY HEALTH DtF'AK I MtN I DIVISION OF ENVIRONMENtAL HEALTH SERVICES A YES NC i SITE i_OCA N /,-r OWNER'S NAME MAILING ADDRESS Intemai use OnN Repair Permit Issued in last 5 years i Repair within Boyd% Comers. W. Branch or Craton. Frills Res. Repair within 200 ft, of a, watercourse or C)tG napped wetlan 41- .iei OR= zy Wes. APPLICANT . N MA 4Z J a e & Relatonship (i.e., owner, tenant, otrcor) ' I PATE j.2 g FACILITY TYPE 7 ed ors Re 1e ,,cJ0CHD COMPLAINT # PROPOSED INSTALLER dgrdiG% CyAIAad%n j _PHONE # FiV S i ADDRESS A0, do-X. 5-3a Ye,, Al tr __REGISTRATION /LICENSE # PC A2 6 Proposal (include a separate sketch locating the house,! property tines, all adjacent welts within 200 feet of repair and the location of Watinig And proposed trenches) MOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed 'Professional engineer or registered architect. F -829 ❑ Not In Watershed Q Delggated ❑ Joint Review #,'70i e YT ` d °— I, as o r reported ant of o ner agree to the conditions stated on this form t SIGNATU I _ TITLE: Pro sa roved w the follow condit g: 1. Pro ement 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; fled to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank,' etc.) e., Installers' name and phone number 3. System repair to be performed in accordance with the above proposal nd conditio s. P posal Appro Proposal Denied I spector's Si re 8 itle Datt: COPIES: White HD); Yellow v Sl); Pink (Instalier), Orange (Applicant) PC -RP 99ML Rev. 8/05: DATE M' BURDICK CONTRACTING, LTD. 1�6.< d9k 53'a BREWSTER, NEW YORK 10509 (914) 279 -4152 L /c . iqt gc - /ol6 � ow Al EA 7 �sgtfw Repair 4S/oI'L- l RBs C° ®�s�$�„��� R�►in e 6 /, j'F Rol, pc. ¢ee so y, N tl Perm,;� en. y A — C = 31 4 A _ _ ;Z3' A- a -��►' ,A 3 J -7 �s -c ° 1316'' �° 1 do' 11 1000 0.4 Conrowe� dY SURVEY OF PROPERTY PREPARED FOR ELEANOR G L A/!/GHAM BE/NG LOTS 927- 934 INCL. MAP OF SPUTNq M LAKE' si rvArE /lv TOWN OF PATTERSO/V PUTNA M COUNTY NEW YORl SCALE 1"20' . Sold mop filed Morch 2o, /93l os Moo N° /45 C. E0,9ett, the surveyor who mode do hereby certify "hot the survey rope ?rty shown hereon wos completed /96.9, LIN L /'sense Ne P12 ?91st Potion NQ5632 se of ✓omes C. Edger" L or. )d Surveyors Cry ao� Rrnwe!o� /1/aw Ynrl• nereon. orvjliv WLI// p %OB found e iron on se; —_ L i. i 1 se SZ'/ a. i.,w 16 or C C-dloA 11 %in * 44 Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH S"ION�OF'ENVIRONM T'LH SERVIGE18 - = -::__ FIELD ACTIVITY REPORT Street Town State Zip PERSON IN CHARGE OR TNTRRVTFVJF.T)-. Name and Title TYPE OF FACILITY :lJ SYs 2</-�=-c FINDINGS: 1 acknowledge receipt of this report: SIGNATURE: 02/96 Title;_ u o'17 s d I SURVEY OF PROPERTY p )E �\pi PREP.4RE0 FOR 0ELEANOR G L ANGHAM. 5 SONG J� 5� S L OTS 927 - 934 /NCL . �• O llq , \ �� SHOWN ON 40 AO ' '%LL4P OF PUTNA'N! LAKE rJ� �Z4 S/TUATE /N d° i r I� TOWN OF PATTERSO/V PUTNAM .COU/VTY, NE•W YORK ,50 Z SCALE / =20' BA% �Z °{ Said MOP filed March 20, /93/ os Mop NQ149 \-zp-' 8 �4 re ec�6 block \ (G nd f'On dirt porkln90 L/ \ y \\ I M 536 O E /60.62 /, James C. Edge /t, the surveyor who mode � � r /his mop, do hereby certify Mot the survey L the properly shown hereon wos comp /eted RHINE /FF f50'wida / `. ROAD - June 6, /969. Note: A// c6rtificohbns hefebn ore clfd for this Legend ye C' 6 ' mop ono' copies thereof only Vmid .mop New YorR License Nf 2r2 or copies boor the impressed sso/ofrhe.. poles w Conn. Registration Np5632 surveyor wGnse sionoi uie appears hereon:' stone wall Office of ✓omas C. Edgert pipe found — to nd Surveyors - iron Pin set - -o ✓09 N- °E9095 jvv"