Loading...
HomeMy WebLinkAbout0302DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -1 -48 BOX 4 00111 „ .� IN ON IN NN IN 00111 =VC PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ro Internal Use PERMIT #. ❑ ©/ Repair Permit issued in last 5 years U JN6t in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. a Delegated ❑ VRepair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 3+79 M.DoIjU )(tu t4. TOWN PAz -791LS'oAJ TM # i3. -) - 48 OWNER'S NAME /Lt I C_PfE4 € i UJN cow7 GAthNYre_ PHONE # 64 "*s7f MAILING ADDRESS 3-71 mopa U Mta 0-ti. APPLICANT (C,Igf4 j p - UN J7cb S 7� �t fiat ✓la`t +o nj Co /tom Name & Relationship (i.e., owner, tenant, contractor) DATE FACILITY TYPE 51N&j�r_ ,,,� PCHD COMPLAINT # PROPOSED-INSTALLER UNIlelbSE»'f�c c*VA -iiod PHONE # 1/4 -760 -4t0 ADDRESS '311 A,+- REGISTRATION /LICENSE # 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, as owner,agree to the conditions stated on this form SIGNATURE V % !- L�( TITLE +.— DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATUR�G�` TITLE V /GO— DATE (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 Tax 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 backfilledyntil authorization to do so has been obtained from the Department. Proposal Approved Inspector's Signature & Title is in INTERNAL USE ONLY Proposal Denied with applicable codes n 3 ZZ -3 Da / irati n Date Yes Q' No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 r 7 7Woo al/ 1- V Mi 0NEc kflc7 /20kr� ,s• S�-rIL ��1n�IL wl-yh r �i V ITED SEPTIC & �� EXCAVATION CORP. Septic Systems • Drainage 'York • Sites Developed Foundations • Grading • Utilities • Trucking .S'rn'ing ull nj Ili•sn lirru•r, hunam (- Fairfield Counties 311 Railroad Avenue Tel: (914) 242 -1999 Bedford Hills, New York 10507 Fax: (914) 242 -1909 www.unitedsepticsystenu.com 1A <,`° t >tJiL. 7—.� r— ,-">E . P—rlc. T�NI� �� F'L,4CJ-1: ME. ri j M I Hr L-E V INr-E WT t_PrNTE- 3 % M DvNE KILL l2vAt. TM #k 1 3 . — 1 — 4 $ 5F--P7— .5;,, Z- o r 3 /�- F, I fE p-riL'7r}NIL IN1-iFT 23 1 4- SEt'T (L. t An�K- OvT-,F -'j- t . 60 �i. . >3 o X. *t-. 2-7 . 3 8 3 �,N F. �. #3 Z/ 3 D 1A <,`° t >tJiL. 7—.� r— ,-">E . P—rlc. T�NI� �� F'L,4CJ-1: ME. ri j M I Hr L-E V INr-E WT t_PrNTE- 3 % M DvNE KILL l2vAt. TM #k 1 3 . — 1 — 4 $ 5F--P7— .5;,, Z- o r 3 /�- F, I fE p-riL'7r}NIL IN1-iFT 23 1 4- SEt'T (L. t An�K- OvT-,F -'j- Zia . 60 . >3 o X. *t-. 2-7 . 3 8 3 �,N F. �. #3 Z/ 3 D 1A <,`° t >tJiL. 7—.� r— ,-">E . P—rlc. T�NI� �� F'L,4CJ-1: ME. ri j M I Hr L-E V INr-E WT t_PrNTE- 3 % M DvNE KILL l2vAt. TM #k 1 3 . — 1 — 4 $ 5F--P7— .5;,, Z- o r 3 0 Print Page 1 of 1 Subject: Mooney hill 2 From: Rick Ribeiro (rjribeiro68 @gmail.com) To: Unitedsecorp @yahoo.com; Date: Friday, September 6, 2013 2:36 PM 0 Sent from my iPhone P http: / /us- mg6.mail.yahoo.com/neo /launch ?.rand= 4215 8813 8 &action= showLetter &box= Inb... .9/6/2013 Print Subject: Mooney hill 1 From: Rick Ribeiro (rjribeiro68 @gmail.com) To: Unitedsecorp @yahoo.com; Date: Friday, September 6, 2013 2:35 PM Sent from my Whone e 9 http: / /us- mg6.mail.yahoo.com/neo /launch ?.rand =4215 8813 8 &action= showLetter &box= Inb... 9/6/2013 PUTNAM COUNTY HEALTH DEPARTMENT D DIVISION OF ENVIRONMENTAL HEALTH SERVICES - PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES NO Internal Use Only ❑ d Repair Permit issued in last 5 years El N-t in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated Repair ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetlan ❑ Joint Review SITE LOCATION TM # OWNER'S NAME � L G^J it ®f 1 PHONE # MAILING ADDRESS /q t% A/ e- j Cvf 2/5 o!II A APPLICANT Name & Relationship (i.e., owner, tenant, a ntrac or % DATE FACILITY TYPE D i PCHD COMPLAINT # v PROPOSED INSTALLER �l�'"`' PHONE # ADDRESS �10 REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent welis.within 200 feet of repair and the location of existing and proposed trenches NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engi er or registered architect. , I, as owner, or 7reppoed agent of owner agree to the conditions stated on this form SIGNATURE �� / TITLE C 1,-)tV '- 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved _� Proposal Denied Inspector's Signature & Title Date COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE TTTT-r SCALE IN 1/10 OF AN INCH 1 -800 345 -7334 ' s s �6.06 I \ HOUSE Claudia Montuori 379 Mooney hill rd Patterson N.Y. PERMIT 9 R -311 -06 A B 1OOOG TANK 0 (Z) (I i i i I i �i t 1 I Al =23' B1 =12' 2=27' 2 =18'