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BOX 28
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03570
PUTNAM COUNTY HEALTH DEPARTMW
DIVISION OF HEALTH `1 i \. rJ C O U d Y `�
5::r3; i f VC:�
PROPOSAL Fit SEWAGE DISPOSAL SYSTEM I
OWNER'S NAME 4417 ,pbb AS10 PHONE 2 a Z q
SITE LOCATION C O 0 I T I;rr— R w c? 0,0 3- '/.3
PERSON IffrWIEWM PCHD Complaint /�-
Nam & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTAUM %J=A jW A c 0,1j ,3 k.; ' PHONE $ yr- G 2 8
REGISTRATION #
Pr (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.
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Proposal approved Proposal Disapproved
Inspector's Signature & Title Date
with the
t. Procurement or any lrm permit, it appLicaole.
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' 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 owner, or reported agent agree to the above conditions.
`SIGNAZTJRE r. TITLE
W. : White (MV; Yellow (Mm HI); Pink Ugliroant)
'C -RP 97
A 16
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,J h ILL. r HrIN"A I P.I.N. 8126.28, MAP NO. 1015
PUTNAM COUNTY LINE - PUTNAM COUNTY PARCELS NO. 1026 &
DUTCHESS COUNTY LINE SHEET I OF 2 SHEET!
S.H. 9481
SURVEY NOTES ON FILE AT NEN YORK STATE DEPARTMENT OF TRANSPORTATION REGIONAL OFFICE NO. 8 LOCATED AT POUMKEEPSIF. M
CCN L714 P..422 JOSEPH ENGONGOR(
POINT OF BEGINNING AND
PARCEL 1026 FRANCES ENGONGOF
(reputed owners
t
PI -23
STA. 820 +74.50
0
T
o
55't PI -22
BI9 ±94t STA. 817 +81.52
26'+- a�
CENTERLINE OF POINT OF BEGINNING
PROPOSED IMPROVEMENT
Y gpSEf PARCEL 1030
6I9 +34t
A 98t
B19 +27+
° V+ � 818 +88+
161'± B18 +80+
14'+ 172'+-
S49 8260 +25'Ea S36�S O B18 +41+-
k� ' 229'+
/ 1 30 / /z/
Q 1321 +29.23 N
80•,.5 0' N 's �
N .D TO B
REMOV
ca
54 °59'µ0E
10 >-
,
-
JOSEPH ENCONGORO
AND '
FEE FRANCES ENGONG0Z0 ,
(REPUTED OWNERS) + + „-
TOWN OF PUTNAM VALLEY 244'±
PI -z4 +3 t TAX MAP DATA• '
/ STA.823 +44,14�i SECT. 62
DEBRIS BLOCK 3 -- D
LOT 4.3 -�1
DEBRIS,
L ND --
MANUFACTURING CORP.
(REPUTED OWNER)
1026 FEE
AREA= 5,909 SQ. FT.
= 0.135 ± ACRE
1030 FE::
AREA= 1,276 t SO. FT..
= 0.029 ± ACRE
+•C
PI-221 STA 817-1-81.52
0 ISTORY
G HOUSE
CC
W
Z C.,�- 18'MInPILE
a �}i PI -22
SPIKE SET
N'.�,•,
IN-DIRT
a SHODLDER-
' C NAIL 8
U) DISK IN PP
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o
I'd oN J.
SECOR ,S >,•
LAKE
ROAD
.f
hgam,
PAUL ENGONGORO &
PATRICIA ORMSBY
oi (REPUTED OWNERS)
C
L
50f t. 0 50f t. IOOft.
SCALE BAR
TRUE NORTH AT THE
I
74 °20' MERIDIAN OF WEST LONGITUDE
P1 =23 STA B20 +-4.50
0
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JRIC
�-.. G NAIL IN
K �. IU' MAP
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u +
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WOOD 'ST, NAIL IN "'t�TOr .
DISK IN EP $I 2,
SPID RTET
IN
Fy/ SHOULDER
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tlpL III all: 11alL`i.11ii m\ it] W�
PI -241 STA B23+44.14
NAIL N PP
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PILLARS
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