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4A-59
BOX 2
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PERSON INTERVIEWED PCHD Camplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY �p
PROPOSED INSTALLER krrag-,V � �y > i2 C/ PHONE c-.97040G ✓'
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.
Proposal approved
Inspector's
Proposal Disapproved
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' diam. 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 of owner agree to the above conditions.
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303 Lineal Ft. Infiltrators
1300gal. Wedco Septic Tank
Timothy Grant
Birch Hill Rd.
Patterson, N.Y.
R -38 -94
4 -19 -94
Tank - #i
Tank #2
Box #1
Box #2
Box #3
Box #4
Box #5
Box #6
A B C
43' 30'
48' 33'
115' 1 136'
Bottge Septic, Inc
Sodom Rd.
Brewster, N.Y.
119'
140'
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146'
130'
151'
137'
158'
142'
163'
Bottge Septic, Inc
Sodom Rd.
Brewster, N.Y.
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Driveway
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151'
Box #5
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Box #6
31x 19'6"
163'
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33'
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3'x 1.3'
Timothy Grant
Birch Hill Rd.
Patterson, N.Y.
R -38 -94
4 -19 -94
A B C
Tank" #1 43'
30'
Tank #2 48'
33'
Box #1
115'
136'
Box #2
11,9'
140'
Box #3
1251 .
146'
Box #4
130'
151'
Box #5
137'
158'
Box #6
142'
163'
Bottge Septic, Inc
7 Sodom Rd.
303 Lineal Ft. Infiltrators (�''=-��� Brewster, N.Y.
1300gal. Wedco Septic Tank