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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
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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)
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