HomeMy WebLinkAbout2899DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
62.15 -1 -9
BOX 24
xi.
,1 6
;.
�.
IN
L
IN
is
�.; IN
IN
''.
b
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914). 225 -0310
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Joan Omorato
PO Box '.214
Putnam Valley, New York 10579 Re: Septic Repair —As Built Sketch
21 White Birch Road, PV.
.Dear Ms:.'Omorato
"'A"ri app'lica:tion" fora sewage disposal .system was approved by the Putnam
County ' Health Department on June 15, 1990. The approval was granted
with the following condition.
Submission of As -Built repair sketch in duplicate showing:�����,f>
a) Owner's name.
b) Site Street Name, Town and Tax Map number.
c). Location of. installed components..tied to two fixed paints -
.g., house 'corn'er's)
d) System description (e.g., 1250 gal. concrete.tank, three
precast 6' diam. x 6' deep drywells surrounded by one foot
+ gravel)
e) Installer's name and number.
You'are responsible for submitting this information to the Putnam County
Health Department within 30 days. Fa.ilure to do so will make you liable
for penalties provided by law.
If you have any questions please -feel free to contact me.
For the Public Health Director
ry Puly yOU s
Johfi Karell Jr., P.E.
Public Health Director
By : 54 1!(-,4
MB:CJ:jr r Chris Jo son
Intermed to Clerk
PETER C. ALEXANDERSON
County Executive
Joan Omorato
PO Box 214
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
Putnam Valley, New York 10579
Dear MS. Omorato:
I
Re: Septic Repair -As Built Sketch
21 White Birch Road, PV
An application for a sewage disposal system was approved by the Putnam
County Health Department on June 15, 1990. The approval was granted
with the following condition.
Submission of As -Built repair sketch in duplicate showing:
a) Owner's name.
b) Site Street Name, Town and Tax Map number.
c) Locution of installed components _tied_ tef two
-d) System description (e.g., 1250 gal. concrete tank, three
precast 6' diam. x 6' deep drywells surrounded by one foot
+ gravel).
e) Installer's name and number.
You are responsible for submitting this information to the Putnam County
Health Department within 30 days. Failure to do so will make you liable
for penalties provided by law.
If you have any questions please feel free to contact me.
For the Public Health Director
ry y my yo} Is
/(
G
Johfi Karell Jr., P.E.
Public Health Director
By:
MB:CJ:jr Chris Jo son
Intermed to Clerk
IDi
SITE LOCATION 221.,
MAILING ADDRESS P 0
225 -0310
T.
-� C1 PHONE -6� 6 "q! W
TO
PERSON INTERVIEWED PM Complaint #
6/1 % Name & Relationship (-i.e, owner,tenant, etc.)
DATE TYPE FACILITY
..,. O�
Pro (include sketch locating all adjacent wells):
PHONE -5-:2-6 <--�2 5.S'
I1 A .L Liz^ y e N, Y, 14 12-5�
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.
Proposal approved Proposal Disapproved
Inspector' ig Title Date
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 camponents 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
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
w
I, as owner, o reported agent of owner agree to the above conditions.
SIGNATURE b TITLE DATE 61, 4iP6
CP1�.S: Vbibe MV; Yellow (Tam HE); Pink 0411=0
P, :
Alt
*-W tI+
` r
P-F - 13
cl) IV
-------- V4
ALI
�
-- '--------- ---- -------------' 4.�''-- ------' -----------_--____-'___-_-_-_----__--_
»� ^
-� ----~/-��- �x��-' -- -' -' - - -- -' ---' --- - — -----' ----- ' -