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HomeMy WebLinkAbout2789DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. s ca n y o u rd o cs . co m 631- 589 -8100 62. -2 -6 BOX 24 02789 r _alt ct7 raCc „ - FRPOSAL Pmt M DAL SY8= MAM clam's to -ry. & /}•S P"M9�� SITE 1WMI0H %�frx�e'1 //06{> 'Ro n-ae da • �°� '"� MMUW MMMS Xg Ao Ile tv PERSON n47MVIMM !aA f PM cavlaint # -2,0P -7 7 MWe & ations pie, owner, ant, eta--1 PPMWW TALL t RE 8 sr Y elr ems! n. �"n /� ri �,�/ NONE 9 �/ - •a �' ~ •S' `f� Pr_,�,_o (include eke cb lomting all adjacent o-.$) a t=e Repair must be in tom, locmtion and of smne type ao Origin&l 66090 dispowl spt M. Different. Uvmtion my require SUWtW of PVOPOsal frM liCWMA PWfeasipnml engineu cx regiatltreu a.rca>titect. . ' It art /�01✓_.. P1y��� rf Xr,--O -yr, r'AwK 11 _. - Z62 3'n5pec Wr' a S gnature & T tle Deal a ro -md with thefqUowing mrditiorA i 1. . owremo of . any Tc7w n permit, i aWli e. 2. WCnia4on of as buili% repair sketch in dvP11cat0 ­ 6b wi ngr: a. Owner In nam. b. Site Moot , lbws` and Tax Map nxdmr. c. Lamtion of instAlled camponants tied to two fixM points tb.g.,howe Corners). d. Syatem description (e.g.., 12550 gal. concrete septic ranks tMw Premt 6' dram. x 6' deep dxywel_o surrounded by ona foot ♦ gravel). e. lnatallar I a nano and number. 3. 6ystan. rspair to bs perfoxmed in accordance with the above Prpposal and vanditionG 6 I., A> saner, or r Porto ag a owner agree to. the above 00ndi.tions. M, *ate 00D) E vow Ohn H1) I Ph* tAEp icoptl NOV-4 -2003 TUE 14 :00 TEL:945- 278.792. NAME:PUTNAM COUNTY DEPWTMENT OF P. 2 N.OV -04 -03 THU 14:10 FREBAR CONSTRUCTION CORP 914 248 5444 i• DmsicN OF' SFALA'E] SaV, m 225 -0310 PROPOSAL FM SF�KNZ DISPOSPd, SYSTEM REPAIR v P.02 OHM'S M '%,4+d�ri. v /I's . /-R W-' 1vC Q pxGNE 9�y 6.�7 i ds9 SITE Y.l�.+'�J 1� !�C C //{` iS • 1 t ,/Q W. _ / . d da ° --02 PER.SM IN'MViEwm CA Ro 4 .L . L R w o me-- PM carplaint # .2•.71 Name a Relationship (i.e,, saner, tenant, etc.) '� -- DATM ljjd,103' TYPE F'AICI4ITY pRorww xris rmazR _ f i4 z 8A�¢ r'I o V PfiONL y ql yy airy' - • -F-15r (include sketch locating all adjacent wells): NONE: Repair must be in same location and of same type as original sewage disposal System. Different J=tion may require submittal of proposal from licensee professional engineer or registered architect. ..30o r a mil' JQitiAi f/ 4 Ps wi iw .S° ✓uoye,1ro.v .80 yt-s �l l� Propose- approved with the following conditions. 1. Procurement of any Town permit, if appliQUe. 2. Submisgion of as built repair sketch in duplicate "showing: a. owner's name. b. Site Street Name, mown► and Tax Map number. c. Nation of installed cargonents tied to two fib points (ia.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. it as owner, or po agent o owner agree to the above conditions. SIGNKTORR Tr= . —/.? C- l ,elewp" DATE amm Wte (MD); YeUW (Torn E[); Pink VGV04t) r, 4 Ti is 4 n . rata Tri . 04Q_07Q-7QP1 NAME • PI ITNGIM rni INTV n;:PAPTMFNT np P P NOV -04 -03 THU 14:11 FREBAR CONSTRUCTION CORP 914 248 5444 P.03 Z C i `� fn ;•4 i ir151' //VG' eUA 0 Z 1A /6 5-: K,S,Ac 4 1 > i Q ro y `� t : I ti 1 O 141 T % � • -m I��pti � t° �N � � ° a � o �o 100 to Ile Tt yp � . � c� � ' :� � o�e>:� N •ate �.,.� S C � a • ail _ _ �s" �' -,► °.° : J`__ _ � maw._ .... �� � �. 3:: �r.�.� . -Y y j��•..w.L• e •�a, 1 - ..�_.. ._ •;: `.: -. NOV -4 =2003 TUE 14:00 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 NOV -04 -03 THU 14:10 FREBAR CONSTRUCTION CORP 914 248 5444 P.01 a �c� Y• FnBAR CONSTRUCTION CORP. Box C, Maple Ave. 1 Lincolndale, N.Y. 10540 FAX RANSM1 ' N HEADER SHEET Ad AM- rr,rs, � � fL�✓ry /lea /f /� .��r F,�gBs r� Cy�sr,, Co .ems �r FAX# DI -2 Message: FAX #: 9 111- 9/V— .a2 ,V)?- x917 Number of Pages to Follow: oZ Signed: FAX -Form Coovdaht 1989 Deilecto Corowation. Indiananof& Indiana wnI i- 4 -PSM7 TI IF 1 l: sq TFI : R4S- ?7R -7gPl NAMF: PI ITNAM mi 1NTY DEPARTMENT OF P. 1 _ y - r• - • i• 9 vr IY1 J (^ 6 Gfo♦ / �°� N � i/�3� y / �/j�'^ �5 rs � err � ' ors o .�i �„wdN4^S4 ,0.0 �'., `: ` N pv1awv. , -,.�'- /d�cv x "J _... 6/v I^ y -x L ``, X "li �? �'Yp� ?/ \ „G "big s •P'Q f4 016 ac — lot CAO 't U � '3v �a i ° �• �• �QJ �H 78" IWO77O// 7 -;;N /7 ObO�' JN /.�5/.4'�'• w" ) aU� a0 a x th a. N Q N o a W WW L �Z Z (J] in r•: i } 1� 1 tOff xf } 18R, tlf�t? Y\, C h' &,IV -', i y�� I kF 1 } r � e� 11©�,� �CC•��� � ~ / V � � :t: I• 1. ;4 f if'. Ali a r•: i } 1� 1 tOff .,k V PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ­ " 7 'AdP`6SAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME SITE LOCATION MAILING ADDRESS PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER %�' Ai� G P Sf. PHONE G f Proposal (include sketch locating all adjacent wells): l d S—Ye NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fran licensed professional engineer or registered architect. Proposal approved Disapproved Inspector' s, Signature & Title e 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. SIGNATURE /" N v`'' TITLE X .M: Bite (PO); YeUcw (Ttka HI); Pink ftplimnt) DATE 0 o IR �,oi�ds . off' ,PO•GL. FA.�iY1,S o, €z.ab Q LI-OW �2aQ- W E a I. Q Q LI-OW �2aQ- 0 m rot W a I. Q 0 m rot �i feU> a> .0149 °sry . a 0 (A N I Q w a (A Z Z °a Af0 70,"/ a N ►-_ a i7 /rYSa�3c� w >. Ul Y::Z Odp� w W z 0, 0 > Z 6 U Q 1 W a � Q IN ED N. ' F v I0 �i feU> a> .0149 °sry . a 0 (A N I Q w a (A Z Z °a Af0 70,"/ a N ►-_ a i7 /rYSa�3c� w >. Ul Y::Z Odp� w W z 0, 0 > Z 6 U Q 1