HomeMy WebLinkAbout4764DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
91.26 -1 -64
BOX 36
,.
him,
1 o L .1
I t, 61 11
,
f �lu �.
,
04764
t
OWNER' S NAME
SITE LOCATION
PUINQAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR-SE DISPOSAL SYSTEM RE1*Ik r
PHONE
NAILING ADDRESS
PERSON INTERVIEWED PCHD Complaint #
���f
Name & Relationship (i.e, owner,ter►ant, etc.)
DATE (/�'
TYPE FACILITY
PROPOSED INSTALIM c° -" PHONE
REGISTRATIOi1 # � �G— -�
Prose (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 -W - �5 X L-<, ` -,p /-mss
Proposal approved - -�\ Proposal Disapproved
Inspector's Signature & Title Da
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. ration 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
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,
SIGNATURE
O"Mix: V&te 0D);
PC -RP 97
ad ag agree to the above conditions.
TITLE h'e DATE
ftm Hl); Pink (Applicant)
10/25/1997 03:01 914769252211
BETTER HOME SEWERAGE
s MM MARMW
Y T
PAGE 01
F'. L
�✓ �'a�', _ �ti` ffig .
Data
- 114 :L.:.... $ : - t .t- r,.�yQ Y' : ds _ .: to °.,:.� : _v't �.. 4i 0.�: ,Y :�i.c .•1 c •Y .3 .
�"�y"'i5rv. �f °.-:1 �1`f�:.�►' :�w �!o :ra':. �.i+'. .,"_K ,k,: .:iL',....
\3'
_7 N
6
A_-
> < > <
x� -.4
> < <
> <
Certificate No. 0361
Registration No.
377
f-7:
A A
'tj
-, �jh
COUNTY OF PUTNAM
Y
i Aj
REGISTRATION
a
V:
BETTER HOW SEWERAGE SERVICE INC.
_X7dS
X` r2_
maintaining a place of business at 144 Ed&evo-Qd Avenue Thoravood, NY 10544
is hereby duly registered according to the provisions of. Local Law 5-1991, effective T.
7,
be
Septem r 3, 1991, • engage as a Home Improvement Contra'ictor in the County • Putnam,
State of New York.
This Registration is not transferable and must be renewed ann'�ally.
i I hereby certify that the foregoing is a true copy.
A
NONE IMPROVEMENT BOARD OF PUTNA08jCO
mhpr R 1, y -N
A Xk t Q 1992 Attest
Date: y
A
Expiration: I.
77
A
A..
<
> <,J6 > <.'4:. .5,> < r. (4.; > > > > < <
J
j�
m
LIJ
(D
<1
LLJ
LLI
L41 Ile.
F-
F-
LAI
toeli
0
CN
LO -
C4
cn
r-
CY)
cr
cr,
LI) . .. . ..
CN
W O�d
UJ
!s p
zr
NIO
,-4
CA
IN
CP
LO
ti
cn
LU
m
F-
OD
ti
:7_ .7
pr
....... .. ......
ru I
Va��� -'
7D
4�!
oil
ji-4
Ips
$WAV'424 Olt
10594 is
-7&4q