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HomeMy WebLinkAbout4131DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.74 -1 -20 BOX 32 04131 , a ' ills rr . yti I ,, . ML Le T J161 J .fi ' No i ' 'r IN i .; ` e 04131 a r PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR .S9EWA�F ©I Pt�S L Y -,Trt R P�I YES NO Internal Use only ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped weband ❑ Joint Review . SITE LOCATION rj�'j f%OL/l ; --2% TM # . 1 — "0 OWNER'S NAME 1(-14-Ati% UAJ,4/L PHONE # 995- 52? W MAILING ADDRESS /g ,�D; � f (�g- j t)D 7f, , ,o [� r � �f� i�� `1 Z05:2 7 APPLICANT &) A 2 L l u Ai ,9 L Name & Relationship (i.e., owner, tenant, contractor) DATE 01�(T FACILITY TYPE S PCHD COMPLAINT # PROPOSED INSTALLER , a PHONE # i� ADDRESS ti� REGISrTRATION /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, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE )� (� Q TITLE Pr000sal 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 components tied to two fixed points 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 ove roposal and con ti s. Pro sal prove Proposal Denied 1.4,1AhtJ ///&� L&lo-q- 9 I s P ector's Signature & Title V DaaiJ COPIES: White (PCHD); Yellow (Town BI); Pink (installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE 6/22-/07 ��:i cci• cau r to : au ra.a � 001/001 R*Mo=s 14W257 -3354 H 4ODUCT ite Page ND. LE®NARDI & SON CONSTRUCTION, INC. OWNER: LOUIS LEONARD 6 CAROLYN DRIVE - CORTLANDT MANOR, NY 10567 (914) 736 -9010 LIC. #WC- 3112 -1-190 • WC- SEPTIC LIC. #00067 - LIC. #PC -560 (CERTIFIED) PROPOSAL SUBMITTED TO PHONE Uk ! Y DATE STREET JOB NAME l O a t ue /�R?V+k CITY, STATE and ZIP CODE JOB LOCATION L Y a ARCHITECT DATE OP PLANS JOB PHONE We hereby submit specifications and estimates ior: ......._ .................. . ......................... ...................... ................ ... ......,.,.....lam.._... ........ ... . ........................... .... .................. ....... ......................... ...... ......................... E.............. ........... ... ................. ..... .............. ..... _ .............................. ..................._.-.-....................................................... -- ..... --- - - - - -• I--------- - - - - -- f................... .._._ ..... ................. ...::...::::.....:....:..:......................................................... ..................._........... ....... .. _........_....... _..:._._..:..:...._............ ......... .. 'SrS'FErrt isONt3EVli' Y•• IS• Nf?xGt1ARANT•'EED•t�NL£SS•DESiG 1W TO BE PUWM BY OTHERS AND PAID SEPARATELY' -NO LANDSCAPING RESTORATION, OTHER THAN GRADING Or VrOpggr hereby to furnish material and labor — Payment to be made as follows: ......... .. * .................... .......... ................ ........... R 79k, 1) Lit 6 t,--L, ................................................ ....................:.......... Ikt LESS SPECIFICALLY STATED.' in accordance' with above specifications, for the sum of: dollars ($ tRGE OF i V^ PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES. CUSTOMER 18 RESPONSIBLE FOR ANY AND ALL COLLECTION FEES, ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION, All material is guaranteed to be as specllled. All work to be completed In a workmanlike 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, tomado and other necessary insuranca, Note: This proposal may, be Our workers are fully covered by Workman's Compensation Insurance, withdrawn by us If not accepted within days, ,n> w 11 �� as »...R..•� 1.U�G1'pV � 22 ` t WAYN S2 n Sid f� / pj f •O,Y XI -` N J^KRAMINS 7 i i •. O �y S!�•f u i ¢ p 1 't yy NOR TN &T e 'Wi1�NQfO iii���+++••• Nei" : t x.•i'-'- ,� r > E RD Z �' ��"rrrPHKk j ` r,q t t n+ i s j i OV� i FLORID aw waw 11 ,4 ad R 0 mum 37 i �• J 0 I UU60) C ental 13 ryH J, d �pFINCN r. • y ,ov, 5�y per{ i 6mm ¢ 35 i 9 .. CKER '"^' Y � .,,.�^ cr m 9 T D POE a E e W r , rill , w low 1 helm_ � 6 u� ;�• Vile` 1 STRq T �� GRID 'STREET GRIDh ,STREET GR {D J t0 Sk iew Miller ill ;, J 10 'Penelope Ct ':. Somers Hllls'Rd L ;9 Miners L . J 9 Mourn' ope Rd J 9 Perch -Dr :. ;Peterson Rd...: se M 7 ;SouthrLake Blvd J 7 MourIt�TVieW Dr. -- J to Pheasant PI ... Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV RONMENT.-ALMCATLII.SER CE- TWtD A'6ffVITY REPORT jaraLVAINEWBRAIWD - �Innmra —W re) Street PERSON IN CHARGE Town Zip OR TNTF.IRVTP.WPT)-. Mqtp- %0 Name and Title TYPE OF FACILITY: -A FINDINGS: o. 4, iv. o t4 W le, k v 1 Signature and Title REPORT R'F-rFTVFT)'RY.* acknowledge receipt of this report: SIGNATURE, )2/96 R P-17 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR 66 L,+k SITE LOCATION I q P' /NT O- / " k OWNER'S NAME M f Ch A� ti MAILING ADDRESS19 PdjAfi OFFICIAL USE ONLY 6110 -aJ -� WTM# E3 -7V- / - 6 rn/ PHONE P9 S -- S",& J- '712 X 4., &4 h, "`W Socifh PERSON INTERVIEWED PCHD Complaint # ame Relationship (i.e., owner, tenant, etc. , DATE TYPE FACILITY S /J9 1C PROPOSED INSTALLER /:.,,� �� / PHONE�/�' /'- ADDRESS S S�9 1 t/ &7n c� W 94 ZIREGISTRATION# Pc- it q,3 R Pr=o (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. / N S f A I 0 00 6A) �..prlc TANG A PJA 3 4//7 6&1 "t- 1,itt"ftJ I; as owner; or `r9&l tCd agent of owner agree to tine conditions stafed "'on Phis iofm. TITLE If -ej!�2 [)14 be-_ DATE 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 rformed in accordance with the above proposal and conditions. Proposal approved 40, p Signature & Title COPIES: White (PCID); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE 3 - '-/ 1 ,(, ("I I fiAA qq,,�v ()Of rwlvl� 00 . .... ... .. . I 71 I PUTNAM COUNTY HEALTH DEPARTNIENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PRO YA!GE DISMAL UMM OFFMa USE ONLY -7 SITE F. LOCATION , I Pji"Vl 7 7_ OWNER'S NAME M. PHONE PV f - MAILING ADDRESS / q i�,) irA PERSON ZnTRVIEWED PCHD Complaint # Name &,Kelationsbap (i.e., owner, tenant, etc.) DATE TYPE FACILITY{ 7 PROPOSED INSTALLER. A/3 L rA PHONE /P -//-01AErJISTRA`11ON# ADDRESS f -5t/,7 T "Y/ 6147C IPA 3 19 E=sal (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. 7 6.4 NO-KA4 be.47Ne -c4e7--/ be -,4--dow o,6o,—j, S, C4 Mmek; Dr rq') tedagepr of owner agree to the conditions stated SIGNATURE 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 & diam. X & deep e. Installers' name and number. 3. System repair to be ormed in accordance with the above proposal and conditions. Proposal approved 4-- � ector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town.BI); Pink (applicant) PC-RP 99U I TT7. C4 PUTNAM COUNTY HEALTH DEPARTMENT 4 DIVISION OF ENVIRONMENTAL HEALTH SERVICES f ij f PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR , 1r2 - 0 '�- YES NO Internal Use Only ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ . Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review r SITE LOCATION (Qj �o;n �,ry` /Unr- TM # j .� — —J 0 OWNER'S NAME _/Lf -'(-4AJ ciaJ,4 L- J PHONE # -5 52,-? �J.tlQ MAILING ADDRESS /g pD:nf L%� �Dd e��r ���� �L� `� /O�i��% % APPLICANT AJ A 2 L c AJ A L Name & Relationship (i.e., owner, tenant, contractor) DATE ; . FACILITY TYPE .; PCHD COMPLAINT # PROPOSED INSTALLER VIPPHONE # ADDRESS 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, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE k (,.L,_,o„ Q 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. 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 sal and con 'ti s. P Proposal Denied ; co D . I spector's Signature & Title V Did COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE 6122-101 06/22/2007 15:57 FAX Q001/001 RaOdForis i- »00.257 -8354 H PRODUCT tit). .Y= ;�y,�=° .� ,...�.��... ,tir:,_:_�...- -� _ _ ...._.. . _P._ags�lo..... � -- � _ _ �t?s ee_•�:_.... LEONARDI & SON CONSTRUCTION, INC. OWNER: LOUIS LEONARDI 6 CAROLYN DRIVE • CORTLANDT MANOR, NY 10567 ($14) 738 -9010 UC. #WC-3112 -1i90 • WC- SEPTIC LIC. #00067 a UC. #PC -560 (CERTIRED) . PROPOSAL SURM17TED TO k-,t 4��J 1 PHONE DAB 1 % �7 STREET ► + 12 F-oi&i .rob NAME CITY, STATE and ZIP CODE L J08 LOCATION ARCHITECT DAT I OF PLANS JOR PHONE We hereby Submlt apaelflcatlon& and estlmatas for: 5.�l!� ✓Jclse �. Pro ..._........_ ................ ........................•...... ........... ....._........_......................._................ ............................... ..�..,„......, ,� :i .._ .......................... ............... ..... fy�.....,.... NJ .,.. ......,, ... „ ,,. „ .., ,,, ,, ,..t„ , ,, ,, , , „ . .............. .. ....... ...... _._ .. .................... „.,, .,,..,.,..,,,, .............. ....................... ..� p ............. _ ......... ......... ..,...._....... .............. ...... ......................,........ (( ............................ ......................... iii. ................ ..... '..yr.+ ...... ..... ............... I ............ ,..,,.,,,................... y................ ....... _....._._._._._ .._._._......._._.........._... (...., ...................„ ..... . ......... .. ............... ......................... ............................... ., . .. ............................... ..... ..................... .... .................. ............. ..... - .......... ...... .............. . .�. �.... �.... .... • i•....... ... �..i .�.• �..�i ...�..�.....,.�..� .....� �.... ��... ... ........ ................................. ........ y.................... _ ..... _._ ..... _ ........... _ .......................... . .......... ................... .. ... ... .... . N,. .. ............................... Grew . ............................................................................................................................................. ............................... „ ` ....._..+ �: fAs�.........._._. ..,�Ysrr�ioNC;�++�- ...... ,......... ............................... ���N�ss•D�st � sr�cENSEt? • I�I�A��aluaNEER,� ... ................................. ............................... 'TANK TO BE PUMPED BY OTHERS AND PAID SeP'ARATELY.• 'NO &Mkm ............. ............................... LANDSCAPING RESMRATiON, OTHER THAN GRADING D RBEO AREAS, SPECIRCALLY STATED; Or propOSR hereby to furnish material and labor — co plate in accordance' with above specifications, for the sum of: Payment to be made a6 follows: dollars ($ ). A FINANCE CHARGE OF V1j% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES, CU.STWER IS RESPONSIBLE FOR ANY AND ALL C ALL DISPUTES ARE TO BE SErnM THROUGH BINDING AROrnMON. All material Is guaranteed to be as specified. All work to be completed In a workmanlike Authorized manner according to standard P=1105, Any alteration or deviation tram above specifications Signature Involving extra costs will oe executed ant, 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 may be Aur wnrkam ara h,av rnvarad by Wnrkman'a f!�anaafinn Inm,nanea withdrswn by us H not semotad within days. APf Dtirfutfro of U1'iRtrynimXfi 015/LG /GUU7 15:5U N'AX PRODUCT 116 [A 001 /001 ltapMFFb= 14KW257,8354 H - -- -- - pq _ ,Pagi_Nn, Pales w.a��` ,.:yr...•= =- �in�i�3's"`�" ... .. .?4� . .:;��'r.;i;g - +��^'`=-- p...•.�v.. .�ti� �.....s.,� ^��:�.+:v�<,9. �-.� LEONARDI & SON CONSTRUCTION, INC. 1 OWNER: LOUIS LEONARDI 6 CAROLYN DRIVE - CORTLANDT MANOR, NY 10567 (914) 738 -8010 LIC. #WC- 3112 -H90 + WC- SEPTIC LIC. #00067. LIC. #PC -560 (CERTIFIED) PROPOSAL SUBMITTED TO (f PHONE DATE % STREET t ` , —d JOB NAME O i t Vim-E Y CITY, STATE and ZIP MME f � JOB LOCATION JOB PHONE ARCHME:CT DATE Of PLANS We hereby submit specificatlons and estimates for: 4 ............. .......... . .. ............. ..................... .........................................._._.................._.................. ... ...................... _._._._...._... ... r..rrrr........rr.. r ,r..r..rr..,r.rr....n..r,..rr.r ..r ...... .......r,r..,,, /V,.......,..... ,'',', I1.... n.. r..r r.r r... r.r r.. rr..,........ ... ..r............... M ........................... ._...... _ ............... .._. °_ ................... . ............... ............................... .......... ............ ............................... ......................... ....._................ ................I............_. ........._..................... ............. 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PI: EASE•{+l OM.................. aBY-S MWi• MWV "-- IS•NWGUARANTEED•tJNL•£SS•DE BY. r r LENSED OFEESIONAL• ENGINEER:' ......... .................................................... ................................... ... .. .... ..... r............ "TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY,' yyyrr,� NLESS SPECIFICALLY NO LANDSCAPING RESTORArON, OTHER THAN GRADING DI FlB® AREAS, INbIJJC�'B• STATED•' BlE PrOP SE hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Payment to be made as follows: dollars ($ A FINANCE CHARGE OF 111 % 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 BINDING ARBITRATION. All materiel 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 Involving extra coats 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 Our workers are fully covered by workman's Compensation Insurance. withdrawn by us If not accepted within days. 1Ptl'tD17�x9iitl`lp of 0Nli11iTItUA As Built. Drawing ♦.::.�. -ten• .o .r �iv+.� :!• ���H�.'�: su c'TI"w'..{�i °•�t�•���� -a. � }.. a �.��'' �.v+ exl-�V*-b ;00 � i 6L, -TI h, L)„ 'Dr PO4,11 I F,.Cbv: co-eGt �x �M-�v V V r r Dv ► h/ �`E- �` rc--U V� JU Y- p- C, R ISZ -off lu Leonardi & Son Construction, Inc. Date: 7- 2 -fl i z � �w Aa ,c •rte ^r ,+� ' ��; ' �• i7�d';�� '� 'l�k yra yy + •sort a•. Pi ab. P.rx •� T ,.o.s�: :._ L c ..J.,..— sro.., m-n: moo-- �•.�; 1 V � r" Y i{y�yy ...�+�,� Pt •'�t ?�'r� +� aFy, r,� �/ t : is ji a A .,.sip' Ij r k ..' PP.` � i+ ?` � i '"�, •fit k.. I� v ¢P VR Y RiNi t- .w .7v 4 � ) "N r t: a� wtik:. z E 1 VVI ! mac. + j kJ