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NOV 01,2007 04:50A 000- 000 -00000 page 2
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSE;!_ FOR�SE�&A2E.-T.— Lr-�EK :S�i Tg:3-F:E f=� ;:. .
y - .. .a ,...
■ � � i r rrr�� arr.
Internal
k-a (0'7 - 0 -7
U
U
Repair Permit issued in last 5 years
0 Not in Watershed
0
L�
Repair within Boycre Comers, W, Branch or Croton Falls >tes,
U Delegated
U
❑
Repair within 200 ft. of a watercourse or DEC- mapped wetland
❑ Joint Review
SITE LOCATION
381 pS Ret TOWN QAA4
TM # (a,, t
OWNER'S NAME
�C�o; O �o�,c` ior, „7 PHONE #
MAILING ADDRESS
07v
APPLICANT
Name & Relatlonahip Q,e., owner, tenant, contractor)
DATE p a 01 FACILITY TYPE �;;,� >.m;1 PCHD COMPLAINT # —i2i[{
PROPOSED INSTALLER PH N
roc � °�.�,,, L;^Xc��ta }�• n� O E # $9 5- Ct�'� l
—r
ADDRESS � c ,ibazzaloc a- RA , .,,,a; risoa REGISTRATION /LICENSE #
to
eraposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 IPn A� e
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on thevpye lC ry
nature and extent of the r air. 1 e*JO
►L� f1�. f' f>,-r�an Z ][ ��a � i t� n cm+�'.�', -T-n mC L"3)
I, as owner,agrenLto the conditions stated on this form
SIGNATURE TITLE OV _ DATE
(owner)
I: the septic installer, agree t comply w K►ons of this Permit for the sertio system repair
SIGNATURE . - �� - - TITLE tp�s. �;�-4- DATE ly•-�3 -C�' �(
(installer)
Progml approved with the following conditions:
I . Procurement of any Town Permit, if applicable.
2, Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
9
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1260 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed BSTS repair will function.
5. No completed work is to W backfilled until authorization to do so has been obtained from the Department.
INTERNAL. USE ONLY
Approved / Proposal Denied 13
"' f // li 127
's Signature & Title Date Expiration Date
is in compliance with applicable codes Yes 01- No
COPIES: PCHD; Owner; Installer
PC-RP 99ML Rev. 2107
MEMORY TRANSMISSION REPORT
FILE NUMBER : 839 * ** SUCCESSFUL TX NOT ICE * **
NOV 01,2007 04:50A 000- 000 -00000 page 2
PIJTNAM COUNTY HEALTH 0EPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SEF3VICES
PF ROPOSAL- FOR 5igMMQE 7rFtF- riM1?alT sVrTF-W RF-P l age
v N internal Also 'Only p paarr to �`� 6, '' d �
Repair P.-it (awed M task B years LJ Not in Watershed
L] 1� Repair within Boyd'a Cortaro, W. erarlch or Crotnn Fans Res. (] Delegated
G1 Q Repair WhIlln 200 ll. of 0 watefQOtaree Or DEC.mapt oo wotland
_ Joint Rview
STE LOCATION Sat TOWN Q Q,! 1k _
TM 0 fra.. %!R
OWNER'S NAME
MAILIN4M ADDRESS
APPLCANT Ll - Y_•�_r- .• -5:��� r�r ems. -lko T-___
( Narnts 4 Jielarlonsntp @.e.. nfrm ar, ter—L Corttreotoh
DATE 1Q f a 3
1c, 7 FACILITY TYPE $� r1C . r PCHD OOMPL•AtNT o _A21c}
PROPOSED INSTALLER F .oc . t•,- �_,�XC�.ta k.-�c+,y� PMON__E_N 5?.- 1„6 -•7 Rt._- '7
.._ _. _. .. :._ -_ .t.+. -.• -.+ate �.i 1 _ t _ rte}. �+� - 1 eTIr1Af �r^Cr.l O .._ .. _
��..t- i� ""?.t�'EG.�TF? /t -. S__ 1!� i�_. -. , .... ...
Proposal t1neluda a separate akatcts locating th'e taoaaso, property tine. alit a4locent wells w1whin 2-00
feet of repair and ttlte location Of existing and propoised a mIsu n)
NO-CH: The Department may require submittal of proposal front licensed professional depending on the
nature and extent of the repair.
1, as owner•ogra to rho conditions stated on this form u
S1¢NA -tuna DATE lam/ 3j /0 :/
(owner)
1. the septic insta ller. agree empty w a • itions of this permit for the septic system repair
SIGNATURE •'� C. TITLE
(Anata/Aer)
P aosal aaor �v� whh. the ton rty eOndHtons•
1. Procuroment of any Town Permit. H apQnpabla.
Submission of as quilt repair sketch by the aep60 SYStarn Installer withln 30 days of the repair. in duplicate showing:
a_ Ownaes name, Site Street Name. Town and Tax Mop number
b. Location of Installed Components Ilea to two fined points
- System description (e_g.. 1290 gat concrete eaptic tank, etc.)
d. Insfallas• name and phone numl2or
3. System repair to be performed In accordance wren the abora proposal and conditions
4_ The proposed SETS repair Is considered a beet fit design and there is no guarantee to the duration at which the
completed SSTs repair WAS (unction_
s. No ootttplated work la to tae backfilled until Outhortatlon to 910 so has been obtalnad from tn0 Department-
INTERN USM OAdI -Y
Proposal Approved Proposal Denied Q =
Ins Clore Signature, & Title pats p r� anon Data
e Ir oast t9 In compliance with a Hcabla codes Y¢s No M
COPIES: PCHD: Clwnar: Installer
PC -FiP 99ML. RSV. 2/07
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER
839
DATE
NOV -02 08:29AM
TO
918457360571
DOCUMENT PAGES
001
START TIME
NOV -02 08:29AM
END TIME
NOV -02 08:30AM
SENT PAGES
001
STATUS
OK
FILE NUMBER : 839 * ** SUCCESSFUL TX NOT ICE * **
NOV 01,2007 04:50A 000- 000 -00000 page 2
PIJTNAM COUNTY HEALTH 0EPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SEF3VICES
PF ROPOSAL- FOR 5igMMQE 7rFtF- riM1?alT sVrTF-W RF-P l age
v N internal Also 'Only p paarr to �`� 6, '' d �
Repair P.-it (awed M task B years LJ Not in Watershed
L] 1� Repair within Boyd'a Cortaro, W. erarlch or Crotnn Fans Res. (] Delegated
G1 Q Repair WhIlln 200 ll. of 0 watefQOtaree Or DEC.mapt oo wotland
_ Joint Rview
STE LOCATION Sat TOWN Q Q,! 1k _
TM 0 fra.. %!R
OWNER'S NAME
MAILIN4M ADDRESS
APPLCANT Ll - Y_•�_r- .• -5:��� r�r ems. -lko T-___
( Narnts 4 Jielarlonsntp @.e.. nfrm ar, ter—L Corttreotoh
DATE 1Q f a 3
1c, 7 FACILITY TYPE $� r1C . r PCHD OOMPL•AtNT o _A21c}
PROPOSED INSTALLER F .oc . t•,- �_,�XC�.ta k.-�c+,y� PMON__E_N 5?.- 1„6 -•7 Rt._- '7
.._ _. _. .. :._ -_ .t.+. -.• -.+ate �.i 1 _ t _ rte}. �+� - 1 eTIr1Af �r^Cr.l O .._ .. _
��..t- i� ""?.t�'EG.�TF? /t -. S__ 1!� i�_. -. , .... ...
Proposal t1neluda a separate akatcts locating th'e taoaaso, property tine. alit a4locent wells w1whin 2-00
feet of repair and ttlte location Of existing and propoised a mIsu n)
NO-CH: The Department may require submittal of proposal front licensed professional depending on the
nature and extent of the repair.
1, as owner•ogra to rho conditions stated on this form u
S1¢NA -tuna DATE lam/ 3j /0 :/
(owner)
1. the septic insta ller. agree empty w a • itions of this permit for the septic system repair
SIGNATURE •'� C. TITLE
(Anata/Aer)
P aosal aaor �v� whh. the ton rty eOndHtons•
1. Procuroment of any Town Permit. H apQnpabla.
Submission of as quilt repair sketch by the aep60 SYStarn Installer withln 30 days of the repair. in duplicate showing:
a_ Ownaes name, Site Street Name. Town and Tax Mop number
b. Location of Installed Components Ilea to two fined points
- System description (e_g.. 1290 gat concrete eaptic tank, etc.)
d. Insfallas• name and phone numl2or
3. System repair to be performed In accordance wren the abora proposal and conditions
4_ The proposed SETS repair Is considered a beet fit design and there is no guarantee to the duration at which the
completed SSTs repair WAS (unction_
s. No ootttplated work la to tae backfilled until Outhortatlon to 910 so has been obtalnad from tn0 Department-
INTERN USM OAdI -Y
Proposal Approved Proposal Denied Q =
Ins Clore Signature, & Title pats p r� anon Data
e Ir oast t9 In compliance with a Hcabla codes Y¢s No M
COPIES: PCHD: Clwnar: Installer
PC -FiP 99ML. RSV. 2/07
NOV 01,2007 04:49A 000- 000 -00000 page 1
Preclsion Excavating Inc.
3 RwAawbeaa Road
Garrison. NY 10554
(846) 73"Sn
emavadejeowedmM.net
FAX TRA4\1SMI!-Fi Ai- .F-ORA1 A
To: Joe Paravati From: April Leonforte
Date Sent: November 1, 2007
Number of Pages: 2
N11-= qC.
Joe;
Here is the repair permit with the customer signature on it. Per our conversation, please fax back the permit to (845) 7W
0571, however someone needs to call first for the fax to be tumed on. You could also e-mail it to excavatinc�pn-venzon.,net,
Thank you,
April Leonfoite
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
-
YES Id Internal Use Oniv - PERMIT
❑ If Repair Permit issued in last 5 years ❑ Not in Watershed
❑ 9 Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland 1 ,(YV� ❑ Joint Review
SITE LOCATION 3$I
OWNER'S NAME
MAILING ADDRESS
TM# (,1$-I -Q
NE # g46 - 5D(:3 -Cnl$5
APPLICANTj,n.�y�
Name & Relationship (i.e., owner, tenant, contractor)
DATE 101g,3 '7 FACILITY TYPE in 11 PCHD COMPLAINT #
PROPOSED INSTALLERtr�c, i '"�; nn -Xc� ya-h' %� T_ PHONE #
ADDRESS EA. .. REGISTRATION /LICENSE #
0
RIM-
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 system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
I, as owner,agree to the conditions stated on this form
SIGNATURE TITLE DATE
(owner)
I, the septic installer, agree t comply w' e c Itions of this permit for the septic system repair
SIGNATURE TITLE CAS, r�'� DATE ►d ~D3--O —1
(installer)
Proposal approved with the following_ conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved ❑ Proposal Denied ❑
Inspector's Signature & Title Date Expiration Date
Repair proposal is in compliance with applicable codes Yes ❑ No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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oOV- 02 -200T 00:30AM
FROh9- ENVIRONMENTAL HEALTH
9451707921 T -790 P.001 /001 F -939
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�Rfl�S FOR TWIE� '8° �° 5-
- - a .n -9 _ --n
YM NO Intw" Liue Oft Pleurt s /If" V/- v r
Permit WNW In teat a yow C3 Not in Watershed
ED d Repair wYaM BeWe Carom W. Bnurch or Cromn Pane saes. 0magateo
D Q Repair whin 200 R W a Watem ume or M;Ognappad Neftw Joint Review
.SrrE LOCATION 381
OWNER'S NAME
MAILING ADDRESS
APPLICANT C?bnJ
TOWN PAraga 9,48j TM a C,;A.1$ ; a
PHONE a s45 5aC dnlQs
Name & ReiwWe" ft. &awr, tenant. conbvd*4
DATE O FACILITY TYPE i. RCMD C®MP.AtNT s
PROPOSED INSTALLER j,Lam lah. "PHONE R 2tjS - '7 &a
ADDRESS a., k-4^I't:ran FIEGMTFIATIOAI AJOENSe p
EMMM (Include a s 00110h locating the hOM. proplar@y 11nK W1 ed*9rtt weue whihin 2O
of repair and the locadon of eulsting and pooposed a~
NOTIft The Depamnent may require subnttSai of proposai frem Iioeftsad professional depending on the
1. as owner,agre to the conditions stated on this farm
SIGNATURE f TITLE ELATE
(owner'
1, the septic installer, agree t mpiy illions of this permit for the septic system repair
:�-
TITLE DATE
( instalter)
1. Prowement of any Towm flarrnk M apprmable.
Submission of an Cunt repair sketch by the septo system installer within 30 days of the repair. In duplicate showng:
a. Owmes name. Sae Sftvt Nance, Tom mW Taut Map msntm
b. LOCOM of installed WNW OM ilia to two tbmd pcirds
c. System description (e.g., 1260 get. Concrete septic tank, etc.)
d. bWAIlers' name and phone rt mum
S. System repair to be perto nWd in zc rdance with the atb" proposal amf conditions
4. The proposed SSTS repair is constdered a best fit design and there is no guarantee to the duration at which the
aornpieted SSTS repair will function.
g, No cmnVkod work is to be backMW urd aullvartmilian t0 do so has been GIB 4t m Me Department.
COPIES- PCHO; Owner: Installer
PC-RP 9SML
NOV 02,2007 03:28A
8452787921
Rev. W7
page 1