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00535
PROPOSAL FUR SBOM DISPOSAL SYSTEM REPAIR
OWNER'S NAME Canmd Centna.L School yiAinict PHONE 455 -7282
SITE LOCATION Bua Ganage Lt- 0 / / TK#
MAILING ADDRESS %.0. Box 296 South St. %atteAion, NY 12563
PERSON INTERVIEWED An. gamma Aahone% PCHD Complaint #
Name & Relationship U.e, owner,tenant, etc.)
DATE gull 16, 1998 TYPE FACILITY BU,. Manage
PROPOSED INSTALLER Aahopac Sanitation Septic, Inc. PHONE 628 -4526
REGISTRATION # 4/
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.
Replace Ai-eel Aeptic tank with' a new /,000 gaUon pneca.at cement aepti.c tank.
Connect in. et to tank and ou-Uet to ex Lot inq t Leld .
Proposal approved Proposal Disapproved
Inspector's Signature & Title
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 components 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 own or reported agent of owner agree to the above conditions/..
SIGMA TITLE Do r e - p4 - _DATE -7 / G F
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CPIFS: Rike (FC£D): Yellow (Tan ED; Pink (Applicant)
MAH®PAC SANITATION SEPTIC, INC.
Septic Tank Service
217 Kennicut Hill Road
MAHOPAC, NEW YORK 10541
628.4526 Joseph A. Mantovi
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