Loading...
HomeMy WebLinkAbout4240DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.81 -2 -36 BOX 32 04240 .. , `� . 1 9 ' . ,. 1 �. IL , 04240 PUTNAM COUNTY HEALTH DEPARTMERr DIVISION_ OF ENVIROi1JPAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME V i �o cfw PHCNE SITE IACATION BfGI;EP� TO MAILING ADDRESS OWT 6,A1l4f- AFANZS1-�4- ,z lU -N• /©S73 7 PERSON INTERVIEWED /)? . 11'd60" fib' �w1 PCHD Canplaint # Name & Relationship U.e, owner tenant, etc.) DATE 9 % TYPE FACILITYES��,EaC/.� PROPOSED P STALLIIt 94c -Peo go op z iti x . PHONE ao?5- A ?y.S proposal (include sketch locating all adjacent wells): Nam: 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. tZaAV14V 40 IQJSi.24LC ?) -'>O° ko _ 60, Si��C SFPi i`C }SIC , 1.Jr"L. i,?A roas w1s7-o i4 , Qo Criss z ro .ivy w,E649 Proposal approved —" Inspector's Proposal Disapproved Proposal aunroved 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' diem. 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, o po agent of owner agree to the above conditions. SIGNATURE TITLE DATE Q>p1E5: V&be (MD); Yellow (in ED; Pink (Afpli®nt) AL L -PRO ��ROOTERinc. a_ - >.Sewer. &_Prain_-$e_n!*Q- _ . - • - :_: n -�. �.��'. >.�,:: �-..::.: ed�i��; ri- i-'..' a'.: o�, r' s '��::�:ss[C:•�$.i= r�-�.= v:.. >. :�sq., =ro -• e._.�.: �',>= .T:.M�- ..»':.:+�i:e.ur:'o•:��im �= a:�- n'a:,�, .��+s Elmer Galloway Rd. Katonah, NY 10536 914- 232 -8888 IC f i>ri Li RA102S G� /SiDDr; \ -5- C9�C. SEPr i 4A;_: LL FL O � _ m......� -...._ ._. .-�. s.... - -. ".� ... _.,. �-. _......._...o -ai r a ��:'- :+mo.a.•�•.. ...... __ -.� ..._.q- . -_.. _. —. - ..ee.... .� "- �-._.. a-�. _._ .......- �.:�,: �m.•�.®4,�..,.... .....� _k Oao sys i&' 'TCLL&O