HomeMy WebLinkAbout4099DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
83.72 -1 -69
BOX 31
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
SITE LOCATION I q
OWNER'S NAME
MAILING ADDRESS
OFFICIAL USE ONLY
PERSON INTERVIEWED J i yv� L11 vltk 4� PCHD Complaint
Name i Relationship (Le. (owner tenant, etc.
DATE (5 CT TYPE FACILITY
PROPOSED INSTALLER L� ha r d'; 4 �K PHONE fILC( ?& 6 �Q ID
ADDRESS C_4c r C> (Y H P r 0 AW,R"0ErGISTRATION# 610P COL. —:5L- n
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�-G44WUn.� 1 -1 . Ilk =rrJl C.U.-TV04-d
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ov�ner. 'o rtea I;z
e a o er agree to the conditions stated on this form.
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SIGNATURE TITLE DATE
I D wj ollowing conditions:
Proposala prove -,,-,;th th fo lowin
1. Procl TJe
,%eme t of any Town permit, if applicable.
.S
2. Submis 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 6diam. X 6' deep
e. Installers' name and number.
3. System repair to Zbeormed in accordance with the above proposal and conditions.
Proposal approved
:gpector'�SSignoature & Title DATE
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC-RP 99NE
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Jun 13 05 12:58p Leonardi and Son
914 736 9311
p.1
Date: June 13, 2005
From: Loads Leonardi
Leonardi & Son Construction, Inc.
Fax 4 (9 14) 736 -9311
Tel # (914) 736 -9010
To.- Joe Paravadi
Fax # qj6 279
Pages: 3 (including this one)
Dear Joe,
I sent the well, locations for Dalessio and the As built for Lynch. I
will send. the pictures in the mail for Lynch.
Lou
Thank you;
Array Leonardi
TUN -13 -2805 MON 12:58 TEL:845- 278 -7921 NAMF: PI ITNAM 0711 INTV nPPAPTMFNT np P 1
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PRODUCT 118
Rapifforms 1- 800 - 257 -8354
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'F..i®SIaP'tll7 ®®I & SON `8, ONS tl 0 ®4Y CTMN9 �11 �7 .
OWNER: LOUIS LEONARDI
6 CAROLYN DRIVE o CORTLANDT MANOR, NY 10567
(914) 736 -9010
LIC. #WC- 3112 -H90 WC- SEPTIC LIC. #00067 o LIC. #PC -560 (CERTIFIED)
PROPOSAL SUBMITTED TO PHONE DATE
L ` G
STREET JOB NAME
1
CITY, ST TE and ZIP C0 6E n i i JOB LOCATION
DATE OF PLANS
We hereby submit specifications and estimates for:
.................
.....................
I
......................
N
JOB PHONE
4acti.
'TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY.'
'NO LANDSCAPING RESTORATION, OTHER THAN GRADING DI RBED AREAS, IS INCLUDED UNLESS SPECIFICALLY STATED. -
VOP propOr hereby to furnish material and la r — 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 RE Ar)DFD To ALL UNPAID RALANcEs.
CUSTOMER IS RESPONSIBLE FOR ANY AND ALL CTION FEES.
ALL DISPUTES ARE TO BE SETTL Z NDI ARBITRATION.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
j 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 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. Note: This proposal may be
NOur workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
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ArrephinCt Of rOP0691 —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature