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02547
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02547
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM R'EP'AIF
YES NO Internal Use Only
❑ ❑
Repair Permit issued in last 5 years
❑
Not in Watershed
❑ ❑
Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑
Delegated
❑ ❑
Repair within 200 ft. of a watercourse or DEC - mapped wetland
❑
Joint Review
SITE LOCATION
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f3D TM #
SYi i C� 30
OWNER'S NAME
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PHONE #
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MAILING ADDRESS
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APPLICANT ffi LV ML) C 9� H 6 C0`i
Name & Relationship (i.e., owner, tenant, contractor
DATE C% d FACILITY TYPE (Z PCHD COMPLAINT #
�APROPOSED INSTALLER I PHONE # J 6
ADDRESS -? u `T -/NfJ M V 1-t t L!4 REGISTRATION /LICENSE #
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Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 .
feet of repair and the location of existing and proposed trenches)
NOTE: 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.
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I, as owner, or rep rted agent of owner agree to the conditions stated on this for
SIGNATURE 'd—TITLE AC f -mil
Proposal .approved with the following conditions: -
1. Procurement of any Town Permit, if applicable.
ubmission of as built repair sketch in duplicate showin4� �J 0 � �2 -
. Owner's name
b. Site Street Name, Town and Tax Map number
c. Location of installed components tied 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 acc rdance with the
above: proposal and conditions. 7
DATE � �' �
Proposal Denied
re & Title
Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
H wr D GRAGERT,
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SHERLITA ALMLER, MD, MS, FAAP
Commissioner of Health
" LORETTA M " LINARI RN,- W " -
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Howard Gragert
296 Oscawana Lake Road
Putnam Valley, New York 10579
Dear Mr. Gragert:
February 14, 2006
ROBERT 1 BONDI
County Executive
V
Re: Proposed SSTS — Potts
1 Oscawana Heights Road
(T) Putnam Valley, TM# 59.19 -1 -30
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like. to offer the following comments for your review and consideration.
1. Due to the proximity of the rock, this Department requests that a deep hole be
excavated near the system to determine if any ledge is present.
.-This office will continue its review upon consideration of the above mentioned comments. Please--
J'- feel free to contact me at ext. 2157 if any questions arise.
JSP:cj
Sincerely,
Joseph S. Paravati, Jr.
Assistant Public Health Engineer
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
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