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OWNER'S NAME —MIL. Ronald {ant one U L PHONE 878 -4431
SITE LOCATION 4 Lvcutit _f U, %attention NY TO
MAILING ADDMS 4 Z ocutit Way, I attention NY 12563 2 .1. A = —/ -- F
PERSON INTERVIEWED Ma. di fonellL (ownen) PaM Ganplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE 811100 TYPE FACILITY % aLvate Dwe(.(i ng_.
PROPOSED INSTALLER Mahopac SanLtatLon SeptLc, Inc. PHCM 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.
ZntitaU 200' x 2' o4 tientLc dnaLn tLe&l and (3) YunctLOn boxeti
No c.(otien to weUA
Proposal approved Proposal Disapproved
s Signature &
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 camponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. 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.
SIGNATURE`S
PISS: Mite (MV; Yellcow Cmn SI); Pink (Applicant)
PC -RP 97
TITLE G Lvi 4 ► "12 DATE �- 10 - o o
_,
MAHOPAC SANITATION SEPTIC, INC.
Septic Tank Service
217 Kennicut Hill Road
MAHOPAC, NEW YORK 10541
628 -4526 Joseph A Mantovi
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Dgl,v,�, v/..,o
-98
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' •'� i= PUI1�M HEALTH (,/
CAW
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DIVISIf�I , QF HEALTH ,4 d
E.
etc' W Y ��•�. PROPOSAL FOR SF3,MGE DISPOSAL SYSTEM 'REPAIR
opt' S NAND Rof�d Anton L;C PHCNE 878 -4431
SITE IDCAT"ON ', 4 .Locust lUc atteRaoR Ny .
:�1 .14522
K ADDRESS 4 Locccet Wad,
� Itifteaaon NY 12563
PFRSCxI .INTERVIEWED` l��• �RntonetLZ;""t Mnenl PCfID Complaint #
& Relatiopship (i.e, owner,tenant, etc.)
l 5 Ir` Y
DATE /l�DO i TYPE FACILITY. Rai.vate liweLLinq
r
A,-� --, 62� -4526. '
PROPOSED IlZSTAT t� Mahopac Sari. of .oit Se,�f i.c, Inc. PHONE
REGI N:,
tch loctin 'acent wells):
Pr al_t11;C, .t ie ' 7
NOTE-,Re "r must; be in 16cnd of same type as original sewage disposal system.
Different ecation: may, , ire sukM%10' of proposal fran licensed professional engineer or
registere�;�ardltect. '::� .� :. :. • . .: ... ••
!x 2 ot crept i.c A acn :i.eLd and X31 Yecnct Lon' boxes
Proposal approved
Proposal approved witn 'tne rollowipj-cormt1ons:
1. Procurement of . any Town pem it;:�.it applicable.
2.�Submission of as built repair sketch in duplicate showing:
a1. Owner ' 8 name • !
47.1
b. Site Street• Name,'Towr and>Tax�Map number..
c. Location of 'installed ( components tied to two fixed points ( e. '.
,house co c' '
d. ystem. description' (e q. , 1250, gal.:' concrete septic .tank, . three
precast,. 6'�diam. X .6' deep
drywells surrounded by one "foot' +„gravel).:.,'.
e:: Installer I's name. and.; numbe
3. System repair-,to be:perfinned :in accordance with the above pr oposal
and cori�kns.
C 0413
I, as owner, or reported agent of owner agree to the above conditions.
c
SIGNATURE TITLE � y
n
DATE Y
PM bite (MD);., r11.uc a3vgo, Eirk . -ank.)
PC- RP._..:9.7. .:.�:?.. • .._ >.,,.e, Wry
MAHOPAC SANITATION SEPTIC, INC.
Septic Tank Service
217 Kennicut Hill Road
MAHOPAC, NEW YORK 10541
628 -4526 Joseph A.,Mantovi
R -a93- 9e
SIPT 14,4 ks, 19q 9
10006AL PLASVc.T�k
bimru j a'l deep
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a Nn
3
so ,
Es
770 � �a�
aa0 Zom o
e— a o 6---- a-a
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a 8OX
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tfE � aX
S4' 6'
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S 40X
PROPOSAL FOR SROM DISPOSAL SYSTEM REPAIR
OWNER'S NAME Mlt. ?onaAl Anione,LLi, pHCNE 878 -4431
SITE I=TION 4 Locust Glad, latteaaon, NY 12563 ing 14 -5 -22
MAILING ADDS Same
PgGON IlNTFRVIMEW-MED ?. 4ntonal L (Owner% PC HD Ca plaint #
Name & Relationship (i.e, owner,tenant, etc.)
AATE gull 16, 1998 TYPE FACILITY % nivate liaio! Lng
PROPOSED INSTALLM Mahopac Sanitation Septic, Inc. PHOa 628 -4526
REGISTRATION # 4/
Proposal (include sketch locating all adjacent wells):
.Non: Repair must be in same location and of same type as original.sewage disposal, system.
Different location may require sutmittal of proposal fran licensed professional engineer or
'registered architect.,
Replace ex Laf ina itea tank with new /, 000 ga l on Na f is crept is tank, i� no
ledge cock.
l - Av _.
Proposal approved — Proposal Disapproved
Inspector's Signature & Title nFkkik
Proposal approved with the following conditions:,
1. Procurement of any. Town pewit, 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 own , o reported agent of owner agree to the conditions. Q /y
SIGMIM TITLE DATE 9 0-1/
9/ d
CiP16: {white MV; YeUcw CD:hn BI); Pink LkVbamt)
MAHOP•AC SANITATION SEPTIC, INC.
Septic Tank Service
217 Kennicut Hill Road
MAHOPAC, NEW YORK 10541
628.4526 Joseph A. Mantovi
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