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02432
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
>POSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
Internal Use Oniv
❑ a Repair Permit issued in last 5 years ❑ Not in Watershed
❑ ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
0 rN - io s7
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT ( .
DATE
k R�ra R Y N y
a3 u- L Ur -r"e 14,5Mk r'k5 TM# )0 C)-()
6
Na l& Relationship (i.e., owner, tenant, contractor)
Cl) FACILITY TYPE prxe V PCHD COMPLAINT #
PROPOSED INSTALLER C_O i'l Ct % gL,� �i, i� PHONE # 9 b 76-ri�
ADDRESS
r a1 Y, [ Pr �%mod l REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from licensed professional
engineer or registered architect.
_ i n
r]
I, as owner, or reported agent of owner agree to the conditions stated on this form
SIGNATURE, TITLE
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
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 �D
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to be performed in accordance with the
above proposal and conditions.
P osal Approved / Proposal Denied
�� 1 A0 Wz - t /10 6 7
spector s Signature & Title Dat
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
DATE
Kl-=�,��
&4 fe, M-
Jan 12 07 10:40a Leonardi and Son 914 736 9311 p.2
Rapi( oams 1 -800- 257 -8354
PRODUCT IIS
Page- o. of Pages .
CUSTOMER IS RESPONSIBLE FOR ANY AND ALL COLLECTION FEES.
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION.
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized ^
manner according to standard practices. Any alteration or deviation from above specifications Signature _
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tomado and other necessary Insurance. Note: This proposal maY be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
Fnd The above prices, sp ecifications
ns are satisfactory and are hereby accepted. You are authorized Signature rk as specified. Payment will be made as outlined above.
tance: Signature
LEONARDI & SON CONSTRUCTOON, BNC.
OWNER: LOUIS LEONARDI
6 CAROLYN DRIVE o CORTLANDT MANOR, NY 10567
(914) 736 -9010
LIC. #WC- 3112 -H90 o WC- SEPTIC LIC. #00067 m LIC. #PC -560 (CERTIFIED)
PROPOS SUBMITTED T
PHONE DATE
STREET
z� i
JOB NAME
CU
CITY,
STATE and ZIP CODE
_
JOB LOCATION
v
U m
ARC RECT
DATE OF PLANS
JOB PHONE
CUSTOMER IS RESPONSIBLE FOR ANY AND ALL COLLECTION FEES.
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION.
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized ^
manner according to standard practices. Any alteration or deviation from above specifications Signature _
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tomado and other necessary Insurance. Note: This proposal maY be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
Fnd The above prices, sp ecifications
ns are satisfactory and are hereby accepted. You are authorized Signature rk as specified. Payment will be made as outlined above.
tance: Signature
Jan 10 07 02:35p
PRODUCT 118
.Leonardi and Son
914 73G 9311 p.2
RapidForm 1- 800 - 257 -8354
Page
No of age:
LEONARDI & SON CONSTRUCTION, INC.
OWNER: LOUIS LEONARDI
6 CAROLYN DRIVE - CORTLANDT MANOR, NY 10567
(914) 736 -9010
LIC. #WC- 3112 -1-1190 - WC- SEPTIC LIC. #00067 - LIC. #PC -560 (CERTIFIED)
PRO S�Tt. €D TO
PHONE
DATE
Y
—
_
STREET
y^
Z-5
I
b c
JOB NAME
CITY, STATE d
l�V� A,-,/) l
JOB LOCATION
F/ )
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for: /
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........ PLFJISE. NLUE .................... SYSTEMLONGEYITY.IS. NOT. GUAFANTEED ..UNLESS..DESIGNE*1nn --- GCeNSEIrP -
'TANK TO BE PUMPED BY OTHERS AND RAID SEPARATELY.'
'NO LANDSCAPING RESTORATION, OTHER THAN GRADING DISTURBED AREAS, IS INCLUDED UNLESS SPECIFICALLY STATED.'
We FropoSP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
dollars IS ).
Payment to be made as follows:
A FINANCE CHARGE OF 11/2% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES.
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION.
All material is guaranteed to be as specified. All work to be completed In a workmanlike
Authorized
AuthOriZed
manner according to standard practices. Any alteration or deviation from above specifications
involving extra costs will be executed only upon written orders, and will become an extra
_
charge over and above the estimate. All agreements contingent upon strikes, accidents
fire, insurance.
Note: This proposal may be
or delays beyond our control. Owner to carry tomado and other necessary
Our workers are fully covered by Workman's Compensation Insurance.
withdrawn by us if not accepted within days.
Arrrptanre of Proposal— The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized
Signature _
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
Jan 12 07,10:40a Leonardi and Son
FAX c
uVER SHEET
914 736 9311
DATE:
TO: Number of pages: cc 0- - va
FAX #:
FROM.-
SUBJECT: —afp-(,� 1,
p.1
To: Julie V.
Fax number:646- 304 -4832
Re: Septic Repairs
Comments:
A facsimile from
Putnam County Health
Dept.
Karen Yates
845 - 278 -6130 ext. 2154
AM C��
Sheet of
CIO
* PUTNAM COUNTY DEPARTMENT OF- HEALTH
... r d DIdISION OF ENDII ONNIENTAL.HEA'I'L l[
-SERVICES.
:.
FIELD` ACTIVITY REPORT
' P.:
ADDR Q?
Street Town State Zip
PERSON IN CHARGE �� ® � `
Name and Title
TYPE OF FACILITY: � S'S S 4ZCf Z
FINDINGS:
44 a
sir a= Q�-o S'r�A fA
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Sig re.and itle
1 acknowledge receipt of this report: SIGNATURE:
02/96 ; Title;
Rev.
Jan 10 07 02:35p
Leonardi and Son
FAX COVER SHEET
914 736 9311
DATE: "
Number of pages:
TO:
FAX #: � �? 7S 25j2—
FROM:
SUBJECT: ' �� I*"
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