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Home My WebLink About1639DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -50 BOX 15 I I INS 10 v r IN �A% IN F � .� .. }`,�, `'j 6 '■i .6 r . T� 1.6 r. 01639 OWM' S NAME At. John Knanz % PHONE 228 -2812 SITE VOCATION 32 AgyLew D&Lve, Canme. NY 710 34./7-/-50 MAILM ADDS 32 AOvLew DaLve, Canmel NY 10512 PERSON INTERVIEWED At. Kaanz (ownertl PaD Canplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE 715100 TYPE FACILITY % a Lyat a dwe U Lag, PROPOSED n6TALLER &hopac SanLiatLon SeptLc, Inc. PHONE 628 -4526 REGISTRATION # 4/ 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 fran licensed professional engineer or registered architect. ?enlace AfeeL fank wLfh l; 000 9,g�lon gloAtLc tank. _S+,_4 e- Proposal approved i%` Proposal Disapproved #DateInspector's Signature & Title Proposal approved with the following conditions: 1. Procureperit 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 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 own , reported a ent of owner agree to the conditions. SIGNAZURE TITLE IMS: V&te (PQM YeUcw (fin HE); Pink Lkl2la nt) PC -RP 97 GATE vwJ 0 2001 I Inspector °s Si lature & Tit1e — Date . Proposal approved with the following conditions: 1. Procurement of.: any :Yawn pent, if:. applicable. ! 2. Sul$aission of.:as' built repair: sketch :in duplicate showing: i i a. ' Owner as name b. Sit6 Street Name,.Towri and Tax Map number. co Location of:,_installed 1caq nents.tied to two fixed points (e.go,house corners). i d.: System description. (e, !g. , : 1250 gal`: .concrete septic tank: ..three precast :6' diem. X. 6e, ; deep 1 is surrounded by one.. foot:. +;:gravel) , . � e m Installer ° s :: name and number. r 3. System repair >to be perforn�d in accordance with the above proposal and conditions. ,.. I, as owner's r �eprorrted agent of owner, agree ree to g g the ;conditions. SIGNATURE.- TITLE VXA-tA�2, DUE � ��. (� Zoe) . , r.h4pj. TK" PIE: ftte (S\d1SJ)/ %U67 (Tzm ED Plx-k ( [fit) PCa -RP 97 {: v. b MAHOPAC SANITATION SEPTIC, INC. ...,,Septic;Tank;SPc ices... 217 Kennicut Hill Road MAHOPAC, NEW YORK 10541 628.4526 Joseph A. Mantovi l �121Ur_W�� - I" - - - ' ' " - "", :' ' - - ` "" - ' I PKV-7 *0 �► bF =J6 l000eq� ~ Pc..Asr�r�r� �gic.TuP qr� �' � Aep r 7��k ►o' �6 ¢, o?O ©o ,3>2 YA_4V 44116 0AOr'e- aa8- -C P0?