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HomeMy WebLinkAbout4599DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -9 BOX 35 04599 7 �t� - :1 `� 1,6 g1 1 0A, '. 04599 0 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY K . G -6 � SITE LOCATION Wood St 109, Mahomc NY TM# 85.7 -2 -9 OWNER'S N PHONE 528 -4150 MAILING ADDRESS 1()g WOW ci- mahmac- my i nr,a1 PERSON INTERVIEWED E. Ruiz owner PCHD Complaint # Name & Kelationship i.e., owner, tenant, etc. DATE Aug. 12th, 2002 TYPE FACILITY Private Dwelling PROPOSED INSTALLER ,L Mantovi Ex . yatingf Tnr_ �PHONE. 628 -6410 ADDRESS 485 Kennicut Hill Rd., Mahopac NY REGISTRATION# 13 -01 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 from licensed professional engineer or registered architect. Install (20) Con acttnrs with gravel under & around units. Install (5) Junction boxes with SDR pipe between boxes. No closer to well. Same location :. I, as- owner; or reported °agEnt -af owner.agree to• the,conditions stafedori tt is -form: T _ .... SIGNATURE f� TITLE QunL A, DATE -OZ -Pro on sal aRproved 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 components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DA 1Fi 33 _4t ` ;I �• C(%y1� iU(�at 1 t Ott d PUTNAM COUNTY HEALTH DEPARTMENT \,�.PIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSALS S OFFICIALUSE ONLY SITE LOCATION W St 109, tLandpac TM# 35.7--2•) OWNER'S N PHONE 528-•ei1 .50 MAILING ADDRESS L4,34q(p.• Iac JlZ 10541 PERSON INTERVIEWED E. Ruiz (owner) PCHD Complaint # Name & K%Plionslup (,Ee., owner, tpnrt, elp.) E'ACILIT'�­'PftvAt�� DATE yp i 11i 'la PROPOSED INSTALLER J. L',Iantoyi Excavatirp, Inc. PHONE 623-6410 ADDRESS 'A3.13 Kanaicut Bill Rd., Mwhopa-c LTZ REGISTRATION4 '13-01 %­ .! Proposal (include sketch all adjacent wells): NOTE:Repair must be,in same location and of same type as original sewage disposal system Diffefent location may tequire,submittal of proposal from licensed professional engineer,or registered architect. 611 ) . 0 VA ui grave 1 Lu--vler wd 2cs Llstalll (5) Juriction box0s wi61 SM pi�,-e_ b66yeiall ml�is s . I, owivri- or4eoorted ag6tdfaikn6r, agree _to,- the cQnditibn,.,; stated _ tW qq or-rLi.- SIGNATURE—,' h, t fl. TITLE DATE Proposal approved with the following conditions: 1 Procurement of any Town permit, if applicable. 2., Submission of as built. repair sketph 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 comers). d. System escription (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installs' name and number. 3.. System repair to be performed in accordance with the above proposal and conditions. -Proposal--.approved,.:-f`''" .,..- .... . ..... . 3�10 61 q q4 -,Inspector 9-Signature & Title. DATE'. COPIES: White`(EQ);Ip) Yellow (Town BI); Pink (applicant) PC-RP 99ML MAHOPAC SANITATION .SEPTIC. INC. Septic Tana Service' y 217 Kennicut Hill Road q� MAHOPAC, NEW YORK 10541 wee 628 -4526 Joseph A. Mantovi I � ®0- 6ete'' fa�c 171 l ' .b `i7%9' r34 6 804 lei j 06 � U- 96a t•' � � r Aj Q «9 Pfol e�° N]