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HomeMy WebLinkAbout3092DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 62.64 -1 -18 BOX 25 03092 Z. '' mile L 06 ry 1_6 T - 1 or �. I `� III 03092 ----- - - -• -- �a ..we ^a.,acli:. b'�u r ,, w�- +s•.ww� � r.� -i,. 90. PHONE j v� lC ~ °15 ! 6 MAILING ADDRESS T'V-V 1l 1i AA Pt t-IC PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.)' DATE a-� [ 3l 7 a TYPE FACILITY t 'D P -- �- 1 PHONE (0 - c 669 5- 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 fran licensed professional engineer or registered architect. �( EpAI(QL CO Q L �E Y4 5 T I kQ b t- -t- S S'4 ry e. Proposal approved Inspector'. s Sig e & Proposal Disapproved 'gafe 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 ccmponents 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. I, as owner, or reported agent of owner agree to the above conditions. L ' SIGNATURE TITLE & J k C (t- DATE ?i CPIES: WAte QED); YeU c w (fin BU; Pink (Appliamt) :�::�•c ...;�;;�,.:., � .,�. ��..�x� .. -. ...,.:� -emu,- r..�..z.�:..�.. PETER C. ALEXANDERSON County Executive Gary Adler r:.< yue�� .,.�.a...:= +..r.,.,c.�r., —.r .. _ ., ar rvs�: v.,:, ..-vx�<a«.,...,,,.c...... -��:�. �•, o .,+... DEPARTMENT OF HEALTH. Division Of .Environmental - Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 46 Unidilla Road Putnam Valley, New York 10579 July 31, 1990 JOHN KARELL Jr., P.E, M.S. Public Health Director Re: Septic Repair -As Built Sketch Unidilla Rd., PV Dear Mr. Adler: An application for a sewage disposal system was approved by the Putnam County Health Department on February 27, 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. L;r i•u3 t —j 1.x'1 C- .r Cn`eily 8- t 1 t r (e.g., house corners). 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 ery my rs -'°�ohn -Car e11� Jr., P.E. Public Health Director By: ol'i'", MB:CJ:jr Chris Johnson Intermediate Clerk vA(tq DI i f - Er 1 s T //v G Sin ST%'P� ��Trj V 9,6'7,.,9 ,5 Y,FL G'� %� � �ot� w rT y 7'v WA/ Tllc R M/ T ell F -- Tat PLj c F-0 441 -r 4 -f 7- �; �� y �tLL , �t }�nRovlyE�S-D Kri a> `'� 2.140 //V ST/1 L L E P : /3 eNL rc oT 66 YE L H .0p�� E r 37 �1C7 C �� [C- -1 /A14;IV/ RV TN1911v 1/9 t.� t l Al S" TIq L L c'?.. ://�� //�� f, /� r ��•Z6 -- Zs �J� t �•i r rg 3 CQ�N, G 3,!C- 119 c 3J 6--C. 2116 W OW Tviyj!/ ,�'cRM rT c Gv 6i,�6r J yWE-LL,�'v�R10vvi)S 2/90 ' 2- S' L -F 33` Cam- � �c �L,���i v� lT ►� YR�c'�s