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HomeMy WebLinkAbout3672DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.15 -2 -15 BOX 29 03672 I .. .. r. y J - 03672 PUTNAM COUNTY HEALTH DEPARTMENT L DIVISION ©F ENViR�NMENTAL HEALTH SERVICES....: .... .. . OFFICIAL USE ONLY �r / yzo - V SITE LOCATION 16 Cewten Dive, Catmet, NY 10512 TM# 74.15-2-15 OWNER'S NAME Petex DiRezta PHONE 845- 526 -9155 MAILING ADDRESS same PERSON INTERVIEWED P. DiResta (Owners) PCHD Complaint # erne & Relationship i.e., owner, tenant, etc. DATE May 18, 2004 TYPE FACILITY - Private OwetUnq PROPOSED INSTALLER J MantovilMahopac Sep4c PHONE ADDRESS 485 Kennicu t HiU Road, Mahopac, NY REGISTRATION# 845 - 628 -4526 28 -01 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. Rep.ea.ce exizting do yweU with a new p4ecazt do ywe t . 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_.2t— Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NIL DATE I, as o SIGNA er, r reported agent o X er agree to the con ' ' ns stated on this form. TITLE 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_.2t— Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NIL DATE Cam. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES MRAo .9L SITE LOCATION 16 CenteA VAive fausa, NY 105W TM# 74015 -2 -15 OWNER'S NAME PeteK DiRea#a PHONE &45- 526 -4155 MAILING ADDRESS aaa�e PERSON INTERVIEWED P. U.iReeta f0twneA) PCHD Complaint #. y r� tai a ,t14 P: i e , o. er, tepAnat ,etc. DATE L . f �L� L% 7'' 1 .: T3S�PI � A ILTPY 1? cya +�F' PROPOSED INSTALLER ..1 Mantovilhiahopac Septic PHONE 845- 628 -4526 ADDRESS 485 Keruucta t t1iti Road, Mahopac, NY REGISTRATION# 28 -01 Pro (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. Pepeaciz exrat:ng -dAUww with a new. paecaa.t dayJW! I, as owner, or.reported agent of Wner agree to the conditions stated on this form.M SIGNATURE{ p'k ,l �3� r�1 ! C(_t• { -�� ., TITLE y �� DATE Proposal ap..proved with the following conditions: ~ e I . Procurement of any Town permit, if applicable. Submission of as'built repair $ketch: in duplicate shovking - 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 rte^= 1 Inspector's Signature Title. DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) F^ PC -RP 99ML f , e E e MAHOPAC SANITATION SEPTIC INC. _ 217 Kennicut Hill Road MAHOPAC, NEW YORK 10541 628.4526 Joseph A. Mantovi 1 E O I� t i a4o c�wt> a6 � �7F� �?, IQesTA A0 VRIle /#440144S *V j /o5 o/