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PUTNAM COUNTY HEALTH DEPARTMENT
�} DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�][]/�(]� 225 -0310
_......_. _ .. _- .,,0R 5��_ GE.DZSPI,
OWNER °S NAME i PHONE
SITE LOCATION
MAILING ADDRESS I— of VP I I . .J •-1 ,
PERSON INTERVIEWED n cue- R_ PCHD Complaint 6
Nwe & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER C 1��Cpltel
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.
osal approved..
Inspector's Si nature & Title
Proposal Disapproved
c �}� 17`x, O„✓uvy2 f._.:.
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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 canponents 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 a t er agree to the above conditions.
SIGNATURE r TITLE
CPt IS: Wiibe (EM); YeUcw (fin HO; Pink (A#jcent)
DATE
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PETER C ACEXANCERSaN
Caunty Eucudwe
E'110 L CARRUTH_
Pumie Hes�ttt�irae:ar
JCHN X,..aEt� rr� P c
DEFIgR i NEEVT OF HEALTH cirac=r
Division Of Environmencal Health Services
110 Old Route Six Cencer, Carmel. New York 105t2
(914) 2Z5 -03 -10
September 20, 1989
Bologaja Bolic
Hewitt Street
Lake Peekskill, NY 10537.
Re: Proposed Addition - Bolic
Hewit Street
(T) PV - TM #109 -3 -7
Dear Sir
RevieW OT- my files indicates no activity on the above captioned prcject fcr score
time.
Please advise the writer as to the status of this pi-njert without delay.
Failure to receive a response by October 16,1989 Will result in the file being
returned to you, DISAPPROVED.
Very truly yours.
Lawrence C. Werper
:jr .,Assistant Public Health Engineer
CC:JK _
CC:File
PETER C. ALEXANDERSON
County Executive
Bologaja Bolic
Hewitt Street
Lake Peekskill,
Dear Mr. Bolic:
... C�'+i•'�: -e _ ... ; ..t JS,;. =.:__; y. :.>b.; rs'.i�NL7 l.Yi%CaRt?'J•F4:���:P.tl: •=vF: 'o'-
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, ,New York 10512
(914) 225 -0310
NY 10537
July 1, 1988
RE: Proposed Addition - Bolic
Hewitt Street
(T) Putnam Valley
Town No. 109 -3 -7
Review of plans and other supporting documents submitted at this
time relative to the above - captioned project has been completed.
Any addition which is considered a bedroom requires a formal
approval of plans, (Construction Permit) by the Department which
p -1 a n. s a r. e - --t o -, -b e r'e a r'e d- b.w , a P r'o, f:e Iss i o--n a l... E n g i n 2 P,x :.. ti a_,c,c o_r.d a n
_ _ _ _P.....P__._ .
with applicable sections of our submission guidelines. Plans will
provide for the installation of additional SDS area meeting present
code requirements.
It appears that the above addition of an accessory apartment
falls into this category and a repair permit for your septic system
will not meet this Department's requirements.
Very truly yours,
Lawrence C. Werper
Assistant Public Health Engineer
LCW:jb
• Proposal
FROM
R. Becc8reU Contracting _
Proposal No.
Sheet No.
Proposal Submitted To
Work To Be Performed At
Name
Street
City /i; /ter- jOkK-4 - -' State f
Date of Plans
Architect
_
Street
City
State_
Telephone Number
We hereby propose to furnish all the materials and perform all the labor necessary for the completion of
t
P C11 e_(:�11in(J cUi�4� YTNCV)N r-p 10
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings
and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars ($ ZJ(%�t
with payments to be made as follows: f
Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will '
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance u on above work. Workmen's Compensation and. Public
Liability Insurance on above work to be taken out by
1 Respectfully submitted \ fiC
Per
Note — This proposal may be withdrawn by us if not accepted within days
ACCEPTANCE OF PROPOSAL
e above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do, the work as
;ified. Payment will be made as outlined above.
Signature
Signature
i
t
OWNER'S NAME
SITE LOCATION
PUTNW COUN'T'Y HEALTH DEPARTMENT
1� 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES
225 -0310 - - -
�i PFcvJlr13T :°`•"i7ji�C76'E1L SYSi'r'IPAiFI
PHONE
MATLIM ADDRESS L a V
DATE
TO
PCHD Complaint #
Name & Relationship (i.e,- owner,tenant, etc.)
TYPE FACILITY
�n SPC(LLt�e- \ °,?. F���:r�r� PHONE'
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.
(-k .- .c"Q-�-L
Prdposal approved ;;Z-_ Proposal Disapproved
Inspector's'Sirjnature & 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 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.
I, as owner or reported a nt er agree to the above conditions.
SIGNATURE \ r k{q,( TITLE DATE
PUS: White (SID): YeU w (Tan EL); Pink (Agl.iamt)
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