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00165
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PUTNAM QOUNTY HEALTH DEPARTMEMr
DIVISION OF ENVIRONMENrAL HEALTH SERVICES
225 -031.0
PROPOSAL FOR SEDGE DISPOSAL SYSTEM REPAIR
OWNER'S NAME PHONE JV & - W,03
SITE LOCATION
MAILING ADDRESS..C�xl
DATE
Pam Complaint #
Name & Relationship (i.e, owner tenant, etc.)
TYPE FACILITY -
)' PHONE 271-- 7615
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..
a ! � I .rte. aC _ �L...- w nil.- �►
Proposal approved Proposal Disapproved
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 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, or reported a ent of owner agree to the above conditions.
SIGNATURE A TITLE DATE •Z0 6
CPPI6: 9hite (P HD); YeUjcw (Tarn HE); Pink (Anlicent)
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PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Richard Murphy
Danby Lane
Patterson, New York 12563
Dear 'Mr. Murphy:
October 24, 1990
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Re: Septic Repair -As Built Sketch
An application for a sewage disposal system was approved by the Putnam
County Health Department on April 24, 1990 The approval was granted
with the following condition.
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 tank, three
precast 6' diam. x 6' deep drywells surrounded by one foot
+ gravel).
e) Installer's name and number.
You are responsible for submitting this information to the Putnam County
Health Department within 30 days. Failure to do so will make you liable
for penalties provided by law.
If you have any questions please feel free to contact me.
For the Public Health Director
V r y t LLII�.L._s
John Karell Jr., P.E.
Public Hea-lth Director
By:
MB:CJ:jr Chris Jo nso
Intermediat Clerk