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HomeMy WebLinkAbout3995DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.64 -1 -30 BOX 31 03995 INA I ,� T "' ■ T i� ;o ' T � ' or r No I IN 03995 i OWNER'S NAM SITE LOCATION � MAILING ADDRESS PERSON INTERVIEWED k PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMEN'T'AL HEALTH SERVICES 225- 3838/225- 3833/225 -3641 PROPOSAL FOR SEWAGE DISPOSAL - SYSTEM REPAIR � f r %l Name & Relation: PHONE - TM# PCHD.Complaint # .e, owner, tenant, etc . ) TYPE FACILITY I PHONEi�i'� Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in sa1W location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. . _ - . . � ... - -. .- - .. - . r.- .. . Proposal approved Proposal Disappeoved Puna COLMY En* Yitotxoeinte+h �iltll 86 a�4`s'� o�i-s Inspector's Signature & Title D4fe •; � =:�a�n X22 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 owner, 9x1re po of pt agree to the above conditions. �S�GNA TITLE: G/ - DATE PIES: WAte (TCHD); Yel1cw (Tcwn BI); Pink (Appl.ioant) / A V :4-j! M , vrd- �000�4 . ".-� I ZP Lake Drive LAkeland 8-6842 Lake Peekskill, N. Y. .----j�leaning Specialist of EASTERN STATES SEPTIC CO, TRENCHING. DIGESTERS. . ANY TOWN OR STATE DRAINAGE BEDS IMHOFF TANKS SEPTIC TANKS SEPTIC TANKS CATCH BASINS K. R. LIETZ & SONS CESS POOLS INSTALLED BOOSTER PITS Raymond K. Lietz & Kenneth J. Lietz CITY DIS. PLANTS OIL PITS OIL STORAGE TANKS Owner & Operator INDUSTRIAL SLUDGES ti >I C V t.:7 011 r I a ,� V t.:7 011 r I 6 Lake Drive LAkeland 8 -6842 Lake Peekskill, N. Y. : Cleaning Speyialist TRENCHING E 70C D,`•'. o DIGESTERS DRAINAGE BEDS IMHOFF TANKS ANY TOWN OR STATE SEPTIC TANKS SEPTIC TANKS CATCH BASINS K. R. LIETZ & SONS CESS POOLS INSTALLED BOOSTER PITS Raymond K. Lietz & Kenneth J. Lietz CITY DIS. PLANTS OIL PITS Owner £, Operator OIL STORAGE TANKS INDUSTRIAL SLUDGES r u 0 N 3 - �-j l%1::§ V 4z e l- tla u 0 N 3 - �-j l%1::§ V 4z e 4 " .LAkeland 8 -6842 Cleaning Specialist of DIGESTERS IMHOFF TANKS SEPTIC TANKS CATCH BASINS BOOSTER PITS OIL PITS OIL STORAGE TANKS INDUSTRIAL SLUDGES P EASTERN STATES SEPTIC CO. ANY TOWN OR STATE K. R: LIETZ & SONS Raymond K. Lietz & Kenneth J. Lietz Owner & Operator Lake Drive Lake Peekskill, N. Y. TRENCHING DRAINAGE BEDS SEPTIC TANKS CESS POOLS INSTALLED CITY DIS. PLANTS �.�- =:1 IV/ A. 11YCZCF, 17 NI& C. .zo -,E- 000 ,99 Sa: 1-7.- 1SrOe)-'-f7'4WCCO ORCH 1410 9:111S.E N 41 /-Iry 21 L!J dqll. L A IR RIM 3ZU JW40JVN HEREON. 4•6;'11Y49 L02-:f -112-113.4" 11,4, r;4lW4E 4S SIIOPVH "='OA7- -r.410 A4.4P FILED CO LINTY cz,-R&,s- . 011; cleE 2e, /929 45 MAP /Yo. IdSE. &46FNNE;W� MON OR E IWUA r/ 7-ilA 7;E A 7' eE PEE& S& 4,4.t row/V 0.,C* Pl1r,,V-4" VAZ.1. E DUTIV,4M CO(-IN7,1,' NEW KORZ A C. 7-7-3. 0