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00602
OWNER'S NAME
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
SITE LOCATION 2 Co c, r-c- 9
MAILING ADDRESS U -i rm,
C.
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PHONE
PERSON INTERVIEWED (ct �t /('� . /�� r . G 'nil- o r PCHD Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE /0 / Q 13 TYPE FACILITY
PROPOSED INSTALLER )-f( /a %; Ifor PHONE 911 S2 foot.)
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.
5
a
Proposal
Inspector's
Proposal Disapproved
with the following conditions:
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I
natA
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 canponents 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
drywalls 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 "epo ent of owner agree to the above conditions.
SIGNATURE , TITLE
r
PIES: Mite MD); YeUcw (Ttkn E00; Pink (Appli®nt)
DATE
PHONE g'7f ZOd ?
SITE I=TION -4r 2 a.�. Xpr I Q �I#
MAILING ADDRESS 1P av , AJ Y1
PERSON INTERVIEWED PCHD Camplaint #
Name & Relationship U.e, owner,tenant, etc.)
DATE TYPE FACILITY
��
PHONE S2 !� 42- L3�
Pro (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
regi,/s�tered architect. .�n�
0✓.,e, d,n.Eea, P � L.[ad t�JCK. -72 f (� 5r4 3'0 X 4
& _D 3
Proposal Disapproved
Inspe is Sigma ure
'tle
�roposal approved wi 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 canponents tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
Date
(e.g., house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported ag t o agree to the above conditions.
SIGNATURE TITLE —
UPUS: bite MED) S Yedlsw (ten ED; Pink 01:p it)
DATE /011X0 3
�= Putnam County Health Department
Division of Environmental Health
Carmel NY 10512
RE: Septic repair permit R- 306 -93 dated 10 19 93. (Tm# 23 -2 -2)
2 Commerce Dr
own ot PaFterson, NY
Dear Mr. Hodges,
This is to inform you that I am no longer responsible for the
conclusion of the above septic repair permit. I only did the
initial exploratory work.
However, the septic installation has been completed by an
unknown contractor.
I urge you to get in touch with the owner at the following
mailing address:
Dave & Gus Realty Co.
268 Truman Drive
Cresskill NJ 07626
Sin*cereIy "I
r
ic
Taus Mueller
108 Traverse Rd
Lake Peekskill NY 10537
OWNER'S NAME ` -Uotve
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
.-
SITE LOCATION .Z C o A ►.. ,Q r c Q ,7 r, TM#
MAILING ADDRESS /0:112
PFRSCN INTERVIMED klQk,s Acwt //e r _ - oa � rgr— r' PM caVlaint #
Name & Relationship (i.e, owner tenant, etc.)
DATE /(i - 9 - 9 - - ' TYPE FACILITY
Pr (include sketch locating all adjacent wells):
N=: 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.
Proposal appraved,�_ Proposal Disapproved
Proposal approved with the follow• conditions:
1. Procurement of any Town permit, if applicable.
2. Submis$ ion of as built repair sketch in duplicate showing:
a.. owner Is name.
b. Site Street Name, Town and Tax Map number.
Da—
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' dso.;
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.
It as owner, o epo ant of owner agree to the above conditions.
SIGI�ITURE Tint DATE
.. & White (EM); Yel]cw Cliun BI); Pink LIQ1 aunt)
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