Loading...
HomeMy WebLinkAbout4065DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -77 BOX 31 1 1 rm Va. aa. A- amml r; rL-.q all ,� ; 'r or IL ,; J ♦L ' +_ , I all all ma 04065 e .:r, A PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FORS WAGE DISPOSAL SYSTEM REPAIR r SITE LOCATION 76 L OWNER'S NAME . ). c OFFICIAL USE ONLY IR I'7-o3 TM# 93 -66 _ 2 -11 MAILING ADDRESS 76, 0, T,�.I -� (gee %5L' I 0 Y PERSON INTERVIEWED ow iL& -r PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. DATE I — ll Cd TYPE FACILITY G►v K1 v cx.► PROPOSED INSTALLER L,,, PHONE 91q 736 G 10% fw �y ADDRESS 6 _Oi^ e %41a, + Akav►nr -& Y REGISTRATION# PC - � 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. �.I.r.s+n..11 4 Nro Ni_ luuux Gid­ %; /Furs w; k. $ ivi�k 0.icr .�d-y I; as�n,e., -or re p4pd agent of owner agree to_the�conditions stated on thi_ form;,,:__ SIGNATURE i fir/ TITLE /&Ie -1-70 t Proposal n®r)rovedwith 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 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. Proposalapproved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML 5zf DATE P F ropoSP hereby to furnish material and labor — 'complete in accordance with above specifications, for the sum of: dollars ($ ). Payment to be made as follows: ' A FINANCE CHARGE OF 1'F, %PER MONTH WILL BE ADDED TO ALL UNPAID.BALANCES.::; z GUST01MER IS c ANY A1111) AWL G-01 I RG-110b 4C ALL DISPUTES ARE TO BE SETTLED TIiROIlGH.BIND!tVG ARBITRATION. All material is guaranteed to be.as specified. All work to be completed in a workmanlike ragelvo. of Pages ll b �1 involving extra costs will be executed only upon written orders, and will become an extra LEONARD & SON CONSTRUCTION, INC. charge over and above the estimate. All agreements contingent upon strikes, accidents 6 CAROLYN DRIVE ® CORTLANDT MANOR, NY 10567 or delays beyond our control. Owner to carry fire, tornado and other necessary.insurance. WC-3112 -H90 A LiC. # PC -560 (CERTIFIED) d. Withdrawn by us if,not accepted within days. PRO�?OSAL SUBMITTED TO PHONE DATE 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." _ STREET JOB,NAME 76 [ 3 q- r CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS y JOB PHONE'`. We hereby submit specifications and estimat for. t fumf .wr- o(;,n --7LL `SYSTEM LONGEVITY IS NOT GUARANTEED UNLESS DESIGNED BY A LICENSED PROFESSIONAL ENGINEER. *TANK TO BE PUMPED BY OTHERS. NO. LANDSCAPING RESTORATION, OTHER THAN GRADING DISTURBED AREAS, IS INCLUDED UNLESS SPECIFICALLY STWrED.' P F ropoSP hereby to furnish material and labor — 'complete in accordance with above specifications, for the sum of: dollars ($ ). Payment to be made as follows: ' A FINANCE CHARGE OF 1'F, %PER MONTH WILL BE ADDED TO ALL UNPAID.BALANCES.::; z GUST01MER IS c ANY A1111) AWL G-01 I RG-110b 4C ALL DISPUTES ARE TO BE SETTLED TIiROIlGH.BIND!tVG ARBITRATION. 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 Authorized 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, tornado and other necessary.insurance. Note: This proposal maybe Our workers are fully covered by Workman's Compensation Insurance. Withdrawn by us if,not accepted within days. Acceptance 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 WomrM & Son Leonardi & Son Construction, Inc. eflowi6 Carolyn Drive Phone:%14)736.9010 qprqan t A Mi nt. Z i hf_� 4, rce, Rov5e" 0 no N V� i LA_ KA_ Ove 410U) -to a mo �V'rj' f►(?-u Cover Cd I C, C-P V (95-0 elan. P V Rif ailaol'4 e 0 Y' -pu r PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Sr PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAR OFFICIAL USE ONLY SITE LOCATION °—; � -� -- fO .4 fZ1'��J/. TM# OWNER' S NAME 14,& e PHONE '5--z a MAILING ADDRESS '76' d et- ffo PERSON INTERVIEWED � ��y �„�' . PCHD Complaint # Name & Kelationship (i.e., owner, tenant, etc. DATE PROPOSED INST. TYPE FACILITY Ce, y,14 Offif, PHONE 7 ,5gp' © S t ®,.V)s�'v" />' EGISTRATION# 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. -� X1.5 /0 // � /�c%G � % �lJ'�`j"ajGp,- �i1-4 rj eiy� as. ow er, or,reporte ent of wr agree to the .eondi +ioi s:stated on -this form. SIGNATURE /✓ TITLE Proposal app ved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: DATE 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 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 i^ Inspector's Signature & Title DA COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML Bu 20 ul.w Iti.N :1 A Y • -V Pt 'J •_c.. I NI IJ1.a /I I - s 124 I I 1 8 I I 123 lo•% J I I I I WILLIAM I IKI I I Itt.0 I I ----- --- F F Y I I v - - - - Y -- x v I Y 16 I ' Km A r x x um IwfO — — - - _ _ 8 n x � AN x _ _ - - - - - -•- - - - - - - 8 - - Y_ - - _ _ N _ -_ _ _ _ _ Im% I Im.l, l lut, a 13 ' s JI,I.N R JI 12 - - - - - nl.v - - - - - - - — E x 8 8 A Ai JJ Y Y a a • _ — _ _ _ _ E /ro s A 8 _ I11.% _ - _ _ _ Itaa: I I laro , 5 - y 7 71 A / /It IN,if R I.11 I Intl _ _ _ _ _ _ _ _ _ _ D A 8 7 -- - - - -- - - - - -- ---L--- - I alwl[v ,t.. •..•. . atR,Im LIIL Wt,% mtrII1101G atlaslt cextav, LOT IWG - Ite tar. � ol,wla -- Rawlr,Rltlra — sum wlesla VUI& CNNICT I.I. —f CLL 'a IISJ IM aIMICI LIR Its. mm-D flit 6ICIIfEL ILIOYY IIICa MCgp A n 4 � o n W ? p A � E C i G w c.-. 83.57 83.58 a 83.65 83.67 tNKtu n 8173 83.74 1 83.75 t- — I ° 185 39 Ft 8 40_ ~_ w e a 37 e m - -- 41- A - - - - - - ~ A AI on xn x N 6---42 A I /N — — — — — 3 - ___ -___ --- -n /// 36 s — — — — - M — _ — — — — — — a A $ ____ ,/- s- /A - -- -6 A ur — — _ on a 6 w 34 5 8 44 A It •,aN 1f.Y 6 a 9 9 -- -- - -1, 9 - -W . -- 6 46 " s sa /a 31- -- _ ICI.« 8 -- - -A lS /ll �_ _ — _ _ E _ w 9 A 30 it — 49 A 6 D V A - _ _ _ _ _ _A _ _/A IOt4 I A IN !A•\ it --- -- -------- � . 29 'v —IR1! A_ _ID _ _ _ _ _ _ y_ _ _ _ _ _ _ 0 'N 6 6 --- 51- -r/. 6 iJr -- - - - - 91pg p PRELIMINARY SCALE 1' 5�'50' TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK NR a IflllK rwTawJnR_.._ama att s'm._t•n• at RIR M1llt f0®INTO Ili LW) R itR • 13, 6G -2 "SL( -�;, . �q Ar�•9(-- SE- 76 a `t `( AAA- 01-- ( LAf3 I 83 1 39 Ft 8 40_ ~_ w e a 37 e m - -- 41- A - - - - - - ~ A AI on xn x N 6---42 A I /N — — — — — 3 - ___ -___ --- -n /// 36 s — — — — - M — _ — — — — — — a A $ ____ ,/- s- /A - -- -6 A ur — — _ on a 6 w 34 5 8 44 A It •,aN 1f.Y 6 a 9 9 -- -- - -1, 9 - -W . -- 6 46 " s sa /a 31- -- _ ICI.« 8 -- - -A lS /ll �_ _ — _ _ E _ w 9 A 30 it — 49 A 6 D V A - _ _ _ _ _ _A _ _/A IOt4 I A IN !A•\ it --- -- -------- � . 29 'v —IR1! A_ _ID _ _ _ _ _ _ y_ _ _ _ _ _ _ 0 'N 6 6 --- 51- -r/. 6 iJr -- - - - - 91pg p PRELIMINARY SCALE 1' 5�'50' TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK NR a IflllK rwTawJnR_.._ama att s'm._t•n• at RIR M1llt f0®INTO Ili LW) R itR • 13, 6G -2 "SL( -�;, . �q Ar�•9(-- SE- 76 a `t `( AAA- 01-- ( LAf3 I 83 1 PRELIMINARY SCALE 1' 5�'50' TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK NR a IflllK rwTawJnR_.._ama att s'm._t•n• at RIR M1llt f0®INTO Ili LW) R itR • 13, 6G -2 "SL( -�;, . �q Ar�•9(-- SE- 76 a `t `( AAA- 01-- ( LAf3 I 83 1