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HomeMy WebLinkAbout4848PUTNAM COUNTY HEALTH DEPARTMENT pIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYST YES Internal Use Only ❑ Repair Permit issued in last 5.years [ NO J Repair within Boyd's Corners, W. Branch or Croton Falls Res. E V Repair within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION 37 Se i CAN TOWN OWA VR ii OWNER'S NAME MAILING ADDRESS 3-7 _S2r —e. PufNAW IIA, APPLICANT �EF-2�i Name & el DATE /0/11111 PROPOSED INSTALLER J. ADDRESS (i.e., owner, tenant, contractor) FACILITY TYPE C PERMIT El TM # PHONE # ED Lr--� - Not in Watershed Delegated Joint Review A _, 3 0 PCHD COMPLAINT # PHONE # TION /LICENSE # 1 O 3 Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair, , i — , I, as owner,agree to the conditions stated on this form SIGNATURE a ITLE DATE (owner) I, the septic installer, agree to comply with the conditions of this.permit for the septic system repair SIGNATU TITLE` DATE / 04� (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable, 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tar, Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS. repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilleduntil authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved nspector's Signature & T Repair proposal is in Proposal Denied ance with applicable codes /,9ZZ Dat Yes ration 'Date L7' N o ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 / (Vl� % � -1, ' r. y .. ��� �:y .v . f ��� -ri-operty vemiis - image mate unilne Page I of 2 Putnam County G Image Mate Online Navigation GIS Map Tax Maps I ORPS Links Assessment Info Help Log In I , Residential I PIroperty . info.] Owner /Sales . Inventory Improvements I . Tax Info; - I Report comparable; Municipality of Putnam Valley, Town of 864 sq. ft. First Story Area: SWIS:1 372800 ITax ID: 1 52.-3-60 0 sq. ft. Additional Story Area: 0 sq. ft. Three-Quarter Story Area: 0 sq. ft. Finished Basement: 0 sq. ft. Structure Building Style: Ranch Number of Baths: I (Full) - 1(Half) Number of Bedrooms: 2 Number of Kitchens: 2 Number of Fireplaces: I Overall Condition: Normal Overall Grade: Average Porch Type: Porch Area: Year Built: 1963 Basement Type: Full Basement Garage Cap.: 2 ,Attached Garage Cap.: 0 sq. ft. Area Living Area: 864 sq. ft. First Story Area: 864 sq. ft. Second Story Area: 0 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. Three-Quarter Story Area: 0 sq. ft. Finished Basement: 0 sq. ft. Number of Stories: No Photo Available Ma View Tax Map. Pin Property on GIS Map View in Google Maps lew in Yahoo! Maps View in Bing Maps Map Disclaimer http://Putnam.sdgnys.comlpropdetail.aspx?swis--372800&printkey=052000000306000OO... 10/17/2011