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HomeMy WebLinkAbout3675DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.15 -2 -19 BOX 29 t6Ir 03675 PU NAM COUN'T'Y HEALTH DEPARTMU DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225 - 3838/225- 3833/225 -3641; PROPOSAL FOR SEWAGE-DISPOSAL-SYSTEM REPAIR ,� C OWNER'S NAME Gene Tumolo PHONE, 528 -9009 SITE LOCATION Wood Street TO MAILING ADDRESS Mahopac, N.Y. 10541 PERSON INTERVIEWED Gene Tumolo PCHD Complaint # . Name & Relationship (i.e, owner, tenant, etc.). DATE June, 1988 TYPE FACILITY PROPOSED INSTALLER Ma hopac sanitation Septic, Tne . PHONE 628 -4526 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 Iran licensed professional engineer or registered architect. Add 120' of drain field and two boxes to existing system el S. S i' f °-� ?c7 r r✓ ?�® ' �o er n/yo ✓ s-�___ ,�� + Proposal approved _ Proposal Disapproved Inspector's Signature & Ti Date Proposal approved with the followincr 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., 1256 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. (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, ox reported agent of owner -agree to the above conditions. SIGNATURE „'. (41 TITTE DATE PIES: %bite (PGD); Ye11rw (Tcwn ED; Pink (Anl amt) SEPTIC"INC.-'-"-"""-,*'',-,-�- k, e4 I "R'o-a'd Ki It