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HomeMy WebLinkAbout4060DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -69 BOX 31 1�1./ !7 ., r , , f ,T S k4J6 1�1./ SITE MATT.] PERS( C 1 i,�-7.7 Name & Relationship (i.e, owner tenant, etc.) DATE A0 —132 � • TYPE FACILITY .-b w, QA PROPOSED INSTALLER O PHONE 9YYl 15 a . a Pr " sal (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 regi tered architect. 9Q oSo i-I \Je_ dy �1'�s �-- c� F 11 -18 -8 "1 1 S'O &C*1, �n per . rhnnenci�.�►'��s � C�,iQ�In►.n�E �ros..1 e�ldsoc; V%'-Ws, o n'0 1`5 i n r NY, rim' �G- h.ifes Proposal Inspector's Proposal Disapproved �.S & Ti i Date vim/ Cb P. r . �I Proposal approved with the following condition�- �� 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 canponents tied to two fixed points (e.g.,house corners). I 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 namme and number. 3. System repair to be performed in accordance with the above proposal and conditions. I. as owner, r reporter of owner agree to the above conditions. a A...J•+- y'.:�e: u • u�.y•.ane•„..a...:�il' ^.._- .'� .e'..w•.•..''':'::..•�..u,.,. . 4..s.P+...',. _S2d14&UAE - - - TITLE O W if1Q,r DATE JYM :. Vbite (PQD); YeUcw (Tam ED; Pink (Aaliamt) 1 n SITE 11A PERSON INTERVIEWMD `--/ PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE . $- I - $ TYPE FACILITY D w e- RJ 6 - PROPOSED INSTALLER Igo //a tv 6Aa () K eo `v S �k 14 C 4 r v A.) PHONE 9 / y- .zb - as a ;R Proposal (include sketch locating all adjacent wells): \ NM: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fret► licensed professional engineer or register architect. V .n ) n _ r e- e)C S - i PJ G- Se aJ +1 C, 40. k i. K /,z t f'� JU Proposal. approved Inspector 4 S A"4 '7 C/ 4 // r J f%/ 'N �'4 Proposal Disapproved Date Pro sal 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 natrle o b. Site Street. Name, Town and Tax Map.number. co Location of installed cmiponents tied to two fixed points ('e.g.,house corners). d. System description.(e.g., 1250 gal. concrete septic tank, three precast 61 diam. x 61 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. IMPH& VMte MED)i YeUcw (Tam HO; Pink Vgaiawt) L�.... n_I V, �� PUTNAM COUNTY DEPARTMENT OF HEALTH NO-- 322- 7 r. .CQ MPLAINT.. OR SERVIQE RE EST RECORD . . TOWN PHILIPSTOWN DATE 6/4/87 REFERRED TO TAKEN BY C.G. TELEPHONE CALL XX IN PERSON LETTER CONFIDENTIAL REQUEST FROM HARBLIN TELEPHONE 528 -8961 ADDRESS ARGULA STREET, LK PEEKSKILL ENVIRONMENTAL HEALTH: Home Sewage Rodents' Refuse Public Water Food Service Migrant Camp other 38 COMPLAINT OR REQUEST NEIGHBOR, ROUNDS ON LAKE DRIVE, 528-7022, TN,qTAT,T,PD qFPTTC SYSTEM TOO CLOSE TO HER WELL AND PROPERTY LINE. ACTION TAKEN BY C­(a DATE :Z FINDINGS_ Ul-e� 1.()VN ale- AD CAA�_ M— TUM, & *1 WAr 0 5% F cl��� MIff- 04A:75tlo,_�� As. FOLWW UP :(NSPECTIOIA (s) DATE '- / FINDINGS e -7 zo- rl DATE FINDINGS­­- ,-, ---I P7 _17 PROBLEM ABATED DATE PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT. 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