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HomeMy WebLinkAbout2661DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 53. -3 -21 BOX 23 02661 SITE LOCATION " OWNER'S NAME - MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY 6 9 -a,3 PERSON INTERVIEWED PCHD Complaint #. Name a ahons ip (i.e., owner, tenant, etc. DATE TYPE FACILITY ' S j,,,r,,,; � PROPOSED INSTALLER PrA�.; ;-,r, �Y r a�� �; •� PHONE 1 ADDRESS rT_REGISTRATION# Proposal (include sketch locating all adjacent wells): 10 D 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. C-IQ; I,_as owner, -or.xeporte gent agree to the conditions- stated on-this•form. - - - SIGNATURE TITLE 1 r � DATE Lk —1 t — d 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 AATIFle`o� COPIES: White (PCHD); Yellow (Town BI); ,P* PC-RP 99ML Epixr Tan K UjOoA Fro rv-1e— 10 Tn Q* r'aA'Crs� cfi t�Je D-06S Homeowner: Mr. and Nirs. Rudin 934 Peekskill Hollow Road Putnam Valley, NY 10579 (845) 528 -6340 Tax Map Number: 51-3-21 Description of Repair to System: Existing Block Tank Connected to 10 Infiltrators with Gravel Installer. Philip Leonforte (License #00068) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Tan K i. LA &-A Win, L-O� ri-te, Pee 1AO�10L---) q. Homeowner. Mr. and Mrs. Rudin 934 Peekskill Hollow Riiad Putnam Valley, NY 10�79 (845) 528-6340 Tax Map Number: 51-3-21 Description of Repair to System: Existing Block Tank Connected to 10 Infiltrators with Gravel Installer. Philip Leonforte (License #00068) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736-0571 y. - 9 SITE LOCATION OWNER'S NAME W MAILING ADDRESS PUTIVAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 14�-, r� : t�� , c1: ,,. , t � r . I �`I'+ ` 0 � I 1 w t 4 U- � OFFICIAL USE ONLY c� C/ ePe011slYl, e-A.? TM# 3 a� z, PHONE .7.3 PERSON INTERVIEWED DATE PROPOSED INSTALLER 1J1-i9c > `-s / �� PCHD Complaint # Relationship i.e., owner, ten , etc�- � TYPE FACILITY ADDRESS -3 46, c .1 o mb X O-/i Zr - Proposal (include sketch locating all adjacent lls)a NOTE: Repair must be in same location and of Sam tyI may require submittal of proposal from licensed profe i PHONE 5 REGISTRATION# as original sewage disposal system .Different location aal engineer or registered architect. T; as ownei; "or" "deported agent of owner agree to the conditions stated on tlN.Iform. SIGNATURE TITLE DATE JP� 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 corners). 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 DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99M L April 14, 2003 10:22 AM From: Professional Landscaping Fax #: (845) 736 -0571 Page 2 of 4 BRUCE R. FOLEY - Public Health Dlreetor LORETCA MOLWAN R.N., ms .N. Anockle Public _Health Dtredor • Director Qf Patient Services . DEPARTMENT OF 10ALTH •1 Geneva Road . Brewstq, New York 10504 Endroaoeogl Haltis (145)278.6110 Fu(a4S)278 -1421 t\ure1a8 Scrrleu (84$)278 -6558 vrtC {115)278 -6678 Fuc(845)2 1.6085 Eady Iattrrendoa (145)178.6014 PrucTtool (8SS) 228.6101 Fte(84S)27E •6648 SEPTIC SYSTEM INSTALLER REGISTRATION FORM Business Name gr + s; cx, x� ��� rri r, N-ner Name �,-- Business Addmss Business Peoria R'iS- 735 - -cS -71 c r� S cr-, r mY t t a Emergency Phone I `i —Soy$— rfi38b Fax Phone r,S '7 1 Tax I.D.# i6� ©1a�`i8 Workers' Compensation Carrier P, Policy ,�._._ .xplration Date Corporation oK Inc. (Affidavit required) President 0— V.P Treasurer Directs -- I, as owner, or agent of owner agree to follow the nguladons,pravedures and policies of the Putnam County Dept. of Health for the instaliatlon and repair of subsurface sewage tmatment systems. Signature, Tid Date 1 1,03 Approved Comments April 14, 2003 10:22 AM From: Professional Landscaping Fax 9R: (845) 738 -0579 Page 1 of 4 A-rLil:j_I_lr1rL Date: Monday, April 14, 2003 76meo 10:22 AM Too William fledges Company Fax Phone #0 273 -7921 From: April Leonforte, Precision Excavating Subject: Proposal for Septic Repair Tota9 0 of Pages (including cover): 4 o Attached find ie papeivvd�'Ir'fo�Drop- Osar[.-' rigihals- in-the- mail:" call at (845) 736 -0571 as we have some questions. K all pages were not received, p9eass call back immediately: SITE LOCATION OWNER'S NAME PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES MAILING ADDRESS $ /,� � OFFICIAL USE ONLY�f TM# s 3 2 PHONE 2 4S -'� clQ' PERSON INTERVIEWED 7 `-5�!!�r�Cav �/�i PCHD Complaint # ��i Relationship —(i.e., owner, to ,etc. DATE TYPE FACILITY ---� � PROPOSED INSTALLER ./4 re Gov PHONE__7. 3 6 --0 S-;,/ ADDRESS 3 A ��i G-d� ✓� REGISTRATION# ��y A& ��v.9,.b �cr 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 owrier, 'cr reported agent of o-wmer agree to the- conditions stated on this. form. - SIGNATURE TITLE DATE Proposal approved with the following conditions: 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 M& DATE e .. i Homeowner: Mr. and Mrs. Rudin 934 PedL* 11 Hollow Road Putnayn Malley, NY 10579 (945) 528 -6340 Tax Map Number: 51-3-21 H eeption of Repair to system:; Existing Block Tank Connected te, 10 Infiltrators with Gravel C' Installer: Philip L.eonforte (License #00060 Precision Excavating Inc. 3 Roc ambeau Road ' f Garrison, NY 10524 (945) 736 -0571 "4 3 10��s �1 t v 3 , f 7 l t f F 4 5 W 72 . s O 0 w a 0 0 N� ,I ISh Y w s 0 ; Y iww"ee. ,�G��� l,v �% Af /0'7 9 Sk nv� aj a )/ - A-5peL6Z /7'o a. P"- -,,wijvv- -, 0 ,}c -.•, j.,•..- .:E>. :;d- .s.:G ... JOHN KARELL. Jr_... P.E., M.S. Public Health Director - DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 December 3, 1992 Mr. & Mrs. Rudin 934 Peekskill Hollow Road Putnam Valley, NY 10579 Re: Proposed addition - Rudin 934 Peekskill Hollow Road (T) Putnam Valley Dear Mr. & Mrs. Rudin: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that 3 1/2 years ago, a second story addition was added consisting of an additional bedroom. One existing downstairs bedroom was converted to a dining room. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is APPROVED with the following conditions:_ . 1. The total number of bedrooms must remain at four without prior approwa °l -by= - this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. WH /jp cc: 8I (T) PV Very truly yours, William Hedges Sr. Public Health Sanitarian o & I �Dd V, y_._�..r�..:..�..:. G �a axe d PX Aul � f 2S e .000 .a �y . iaxo I t- LL W I (VP FLOb(ZAo.'— Pl,-IWU0O q 0 khvew-j- " v FIA �-z 11 &'Y- 2.0 op 4 .--- V P, , bpaolfyl .................. 78, n�. Fp aryl 7k} t S 10. it � .—,". -, , - I R '.. ....... " �,'�. . �,, , :--� �z " ,� — � - - ; . . -, . � . ';� .: ,��, — .1r." 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