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BOX 25
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03024
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OWNED
SITE
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Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type a original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
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Proposal approved --
Inspector's Signa
Proposal Disapproved
Dath
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 canponents 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' 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 7j: a orted agent o v agreeato the above conditions
SIGNAT TITLE DATE /
'PISS: White (PAD); YeUc w (fin ffi); Pink Lk#j®nt)
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PR£M /SES SHOWN HEREON BFIN6
Of tv: w r OF i- O r 6 SHOWN, G.V A CERTAIN
4AUREL, W000 MANOR, AROPE'Rr
W /7W ME NINIaLlAW ,SrdNDARDS OF THE• `' �N� BljR,p fi HADD£N" F!LCO /H rHr PUYMA
' A330C/Ar/O.v Os Fs�G' irsiolo#A L L AND � y SEP r£/}l2E" R 23, 1917 AS MAP A-
?UrLlBE'D /l,/ 7'NE /R '•COD, OF MACr /CE' a`� 9 � o POGFrHfR WI M OTHER LANDS
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SURVEY OF PR0A
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PREMISES SHOWN HERFON BE'INC'
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LAURS.L. WOOD MANOR, PROP£Rr
HADC'.W FLED IN rHE PUrN f
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rOGETHER WITH OTHER LANDS
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SURVEY OF PROP,
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6
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-2 U7 #E'D /Al rHV4 'CODE OF PRAMC£ a'� 1 o
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210. 00 — f
PREMISES SHOWN HERFON BE'INC'
OF t O r 6 SHO WN CN A CERTA IN
LAURS.L. WOOD MANOR, PROP£Rr
HADC'.W FLED IN rHE PUrN f
SE-P rFMt FR 25" 1-017 AS d/A,0 6
rOGETHER WITH OTHER LANDS
t -5 2• -
Z. - ?.`,
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JL EE
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SURVEY OF PROP,
S/ T U A T E IN
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TOWN
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ANO, L. S.
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PREM /SES SHOWN HEREON BEINC1,
Of NEW y p or L O T G smo wN ON A CERm IN
�p ,p lAvREL. WOOD Am NOR, PROPaRi
wI ?d rw aINImum sr.4AIDARDS Of rME `' N,t BUR � MADDEN " F1 L ED IN rmLr Purr
r ASSOC/Ar /ON OF PROFESSIONAL LAND ��` RG SEPiERlt'R 25. /9/7° AS YA"L-
,2 0rLINE�D IN YNE' /R "CODE OF PRAMCE ��� 90 YOGE W-ft W17H OTHER. LANDS
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SURVEY OF PROPi
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1
S /%UA TE IN
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AM S/IO16t OfJERJON. rOWN
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01ANE
SITE
MAIL
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PERSON INTERVIEWED PaD Complaint #
Name & Relationshio (i.e, own&'l-bihant, etc
DATE TYPE iZiLITY A
PROPOSED MMLER PHONE
Proposal (include sketch locating all adjacent wells):
Nam: 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.
'PPII-Cable and cc
`
Proposa�lapproved 4tnam County Je-alti, A
Inspector's Signature & Tit16t-"-;,
til
wigmed
DatA
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 I 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.811250 gal. concrete septic tank,, three precast 61 diam..x.61 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-agent of owner agree-to the above conditions..
SIGNATURE TITLE
DATE % �, /`� /
FRS: Vbite MUD); YeUcw (fi41 BI); Pink (Appliamt)
74
S1,
'PPII-Cable and cc
`
Proposa�lapproved 4tnam County Je-alti, A
Inspector's Signature & Tit16t-"-;,
til
wigmed
DatA
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 I 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.811250 gal. concrete septic tank,, three precast 61 diam..x.61 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-agent of owner agree-to the above conditions..
SIGNATURE TITLE
DATE % �, /`� /
FRS: Vbite MUD); YeUcw (fi41 BI); Pink (Appliamt)
7
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1 4
M
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ruznam UDUnW Department or Ae8,tn
JIVIs .on of En l�onraental Y51tk Bervices �` _.._....._ .
"s noted for conformance with U-13 4 1
ypplicable Rules and Regulations of the
: , 6
'utnam CountX_Health Department.• „ �
-4°
wl r,v rmE Q9 /N /mv& .SrAmPAROS OF THE
E AS SOC/AE/OM Of PROFESSIONAL LAND
06/ ME'D /N TNEIR ' °CODE'' OF RRAMCE
q VEYS2 "
Y�Y1 Sa •-�, - a o
1��� OF NEW j'0
S G�'N� 8 URRG fi
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y
LA90 Sua/
'S MLOV ®R4AE, /F .4NY, wT Show& MEMO#.
4 NO, L. S.
RA, MoNTRosf, N. Y•
A n
PREMISES .SHOWN HEREOF OE/N6
or .,L O P 6 SHO W N ON A C E•RTA /N
LAUREL. WOOD MANOR, PROPERT
WADDEN f /LED IN rmE' Purr
SE•PiEMtER 23. 1917 AS mAP 34
MgErHCR E9I M OMER LANDS
SURVEY OF PRPPi
S/ iU A iE /N
TOWN OF P
PUTMA M CODA/