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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR^
OFFICIAL USE ONLY
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SITE LOCATION 141 4ARD l d A6AD TM# 93,57-1-39
OWNER'S NAME GNAaI.'roN hL t E1.14A13*3 lG. M4 fi D1A1& PHONE 1, s -6 Ir —ep!3 So
MAILING ADDRESS is+9 N4AbiU nowh 1_814r= r✓E'EKSKILI.i Ali310M37
PERSON INTERVIEWED e9 crlf f e- PCHD Complaint #.
ame & Relationship i.e., owner, tenant, etc.
DATE
TYPE FACILITY
PROPOSEIf INSTALLER LEONAiQDh SON wii- rl-per Co• PHONE 91` - 736 •`1610
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ADDRESS !o COraDLt4 4 be.. COP.-FL4 ubT�a, -Nk REGISTRATION#
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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.
1;-.as -owner or reported agent of owne agree to the conditions-. stated_ on this form:
SIGNATURE TITLE &WAW7e..
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
DATE S /�
b. Site Street Name, Town and Tax Map number.
C. Location of installed components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved_
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99NE
ATE
Page No. of Pages
LEONARDI & SON CONSTRUCTION, INC.
6 CAROLYN DRIVE - CORTLANDT MANOR, NY 10567
" 14).73&690- 10,
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3112-H1. 7C WP-560
PROPOSAL SUBMITTED TO
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STREET
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CITY, STATE and ZIP CODE
We hereby submit specifications and estimates for:
PHONE
JOB NAME
JOB LOCATION
DATE OF PLANS
Ne" 1000 6cJ!,,v,, 'T,-v,,
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DATE
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wet
JOB PHONE
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$d_ ��� - -- ___ ..- . - - - .. _....\ 10"
✓ *NO LANDSCAPING RESTORATION, PTHER THAN GRADING DISTURBED toe)
AREAS, IS INCLUDED UNLESS SECIFICALLY STATED.` OID
We prapm hereby to furnish material and labor ---m complete in accordance with above specifications, for the sum of:
dollars ($
Payment to be made as follows:
A FINANCE CHARGE OF 1',',% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES.
CUSTOMER IS RESPONSIBLE FOR ANY AND ALL COLLECTION FEES.
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDIN(33_AF381TR . ATION.
All material is guaranteed to be as specified. All work to be completed• in a workmanlike
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manner according to standard practices. Any alteration or deviation from above specifications Authorized—
involving extra costs will be executed only upon written orders, and will become an extra S-
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado 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.��
Acceptance of Prop - 003 The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
conditions
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o do the work as specified. Payment will be made as outlined above.
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Date c
Acceptance
Acceptance: Signature
Charlton M. Harding
Elizabeth 'G. Harding _
1-40 Aiardin TRoad
Lake Peekskill, NY 10537
845 -528 -6350
Tax Map # 83.57 -1 -39
Mr. William Hedges
Putnam County Department of Health
Division of Environmental Health Services
4 Geneva Road
Brewster, NY 10509
Dear Mr. Hedges,
July 10, 2001
Please find enclosed the final layout for our recently repaired septic system. The job was
completed on July 9, 2001.
Thank you for your assistance.
---�'" Page No. of Pages
F1 I
Acceptance 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
LEONARDI & SON., CONSTRUCTION, INC.
6 C AROLYN DRIVE COR T iQ.A(s$�jDgT fAIANOR, NY 10567
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Lid. # WC,- 3112 -1-190 @ LiC. PC 560
PROPOSAL SUBMITTED TO
PHONE
DATE
STREE
JOB NAME "
CITY, STATE and ZIP CODE
JOB LOCATION
II- L /Li / ®3,37
1 -roy, MA 3.67 —1 m39,
ARCHITECT `.
DATE OF PLANS
JOB.PHONE
We hereby submit specifications and estimates for: .
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i 'NO "DA'1N^ RE >TtRATICN, .TER THAN GRADING D1aTJP£ELL�
AREAS, IS INCLUDED UNLESS SECIFICALLY STATED.'
P Propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
dollars ($ ).
4` Payment to be made as follows:
A FINANCE CHARGE OF 11!2% PER MONTH WILL BE ADDED TO ALL 4. NPAID BALANCES.
ALL DISPUTES ARE TO BE SETTLED T r?c 3i1GH BINWJ ,ARWRATION.
All material.is guaranteed to be as specified. All work to be completed in. a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authori ,e -^ __ -- -• --- - _
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involving extra costs will be executed only upon written orders, and will become an extra Signature' ! -"
charge over and above the estimate. All, agreements contingent upon, strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Notei.This proposal may be
s, u„ ---A ti„ %A/ —L, withdrawn by us.if not arrenfad within
Acceptance 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