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HomeMy WebLinkAbout4139DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.74 -1 -33 BOX 32 .., L� IN LIN ! ;� : � � r ` �.,�� - lir . �� �I 04139 111-�- t;'thfe septic in9t0er;-a " to co' ' ..m` ._.. dons of arils peFiriii°'fbr trfie'sef3f c'�ysl Yn' �epair� SIGNATUR " TLE ,tvi�Cr' �. DATE (installer) Proposal approved with the following conditions: f 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY PUTNAM COUNTY HEALTH DEPARTMENT f DIVISION OF ENVIRONMENTAL HEALTH SERVICE -- rN�S .�1:�5�E1��Y •�Y �:� °�7e.��li.� _. _. �.�.y�. :�• ab:v .. .:R YES NOY / Internal Use Only PERMIT V*" LJ 19 / Repair Permit issued in last 5 years L°J /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 SITE LOCATION lZ ('ai'4 Der Sour). , t&'� PTOW N P u+yw-wL TM # OWNER'S NAME F - Pi yo yL PHONE # �Zg 66S3 MAILING ADDRESS I Z On i v A— V v- C, nu+-�x — FeiP- . I- � / 1 APPLICANT 0 1i0 , e;? v^ r i,-r -5f-- Nit o y, Name & Relationship (i.e., owner, tenant, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE# ADDRESS 6g ��>^ Ni(r �nr >� &r- REGISTRATION /LICENSE # r'�. -- Pro osal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the n�fiirn onri nvtnn# of fhn rnnnir I, as owner,agree to the conditions stated on this form / SIGNATURE -� �%/%�f L°/ DATE 711 o ll Proposal Approved [?If Proposal Denied ❑ gz, j i Signature & Title `— DaW ExpiKatioK Date iosal is in compliance with applicable codes Yes a / • No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 n w n � i "3. +, ar , -: x �•v rb e e:,, ,•Yt �;ti ,,�^ r .y�, .,.• , �%¢ � ° 4 � S' 'cE �4 ,v'mi -• i.a.��` �A ya 4a �.XS„`a. 3 Of y`'�;: s p : `�' a � }';3' fi & k'." . {�, + .�',•t hryb" "<.a"a y Y{ >d p t• � a'j f"i ° � R .`•r . "W M y.,5"6+ 5 L 1 i5 a `{M'^� Aa y S d• ': � ¢''R' ,J'm. ,� M . {:1° J° F :ffi,` -'1 W •q- .- • "dw d�� k 7 �k.. � II in 3 xd yard i }�" a � A • 2 } �TP tI ":4 � _ n r « �-•� �.- a ° r `� "�'- ia,y.�py`+Rn1M�:'? : p g •ri„',F '3 fi .y 4 ,;r ter!; a ay t g;d y4 vi .�i �i 1 M � vl'" .w { 1 e4 �a �r aL � t A L .. `""` r 3• at � y ;R.. Ya.r� 4 °a�' k I >Ryr '` ';o.; r �'��°rr'.:' ..t� �ne�•. e. � a >d�. � >; W,.o u YNa �9 ' ar _ �'. •' ' . 'w. ''_'... '.e. •.fit` y .3k..,. .�:....; Mr � ' • `. f A ���. .:k '% ,Y.' ,.a"Ya."W ',f�' k k.: ,�° : -`. .,' ^:'kSt �l °•e^ km SO q ry v f u ..° Y�' ?a..; „.F '..�•.m.'a,a,. „ h:_ :..„ n. .w^,_�a.. ..s.:•° -. Fv,. ., �;..;�rh � ".- �. t A A $ i� i. a� a� "3 s . r _ a- a' rf R d� wo V fi y�.re r g v a do °ra nKV a Zf+^'r� ..P • °�' °� vrfy"� Z �4 0 4� �t a v ey 3 1 6 i F a � K b ✓ A , +d, p d #; J' <� 4` a" r • ' _ �, o- ";i �y y` � � y. a: ` �t t'ri a ,v„ , � 3 It i:•r - '? f `Ma *e`' � „� *��w.' �r�t� t'�5 ,. �' ' „"ms } sTM, '+FUU ° 9 wy,.� .. , s!a”" �1 s. • i;�, g r '"'.,4 �3'�",�' ' ice'' . PUTTINA-M. COUINTY DEPART-1YIE'NT Of HEALTH DIVISION, OF E-11`�rIROININMENITAL HE-A-LT-H SERVICES 19 is DESIGN D�,TA SHEET -, SUBSURFACE SEWAGE TREATIVENITT S -`j/ST-E-Pvf A-ddress: ZI= B2idA Locited at (street): TM "' Section: B I o C "I Lot Kunicipa(ity: Watershed: - 4W SOIL PERCOLATION TEST DATA Date'ofFre-50a1Jf1.r,T, Witnessed bv: Date of Percolation Test:, Hole No, II Run 'N o. Time Start Stop J Elapse Time (m in.) w•ster from Depth to round surface (inches.) Start - SE op );V'a t e r level drop in inches I Percolation Rate miniinch 2 .3 :4 2 3 4 3 4 -------------------- -3 Notes: I 7-c 7--,.rn 'np ripnrh 11r, a. TEST PIT DATA HO L HOLE H. 0 L L ---------- i.01 V1t 2. 3.0' 3.5' ai 4 ' . 'C Aix ----- - --------- f eAAJ 5, -------- 7.(J' 8. 0' LridicaTe level at which Z: --,)u-LjWaj-r 'S -,-n. I- I COUr �r, Indicate level at wach -mottlinc, is obseried Indic 3it I.eve [ to which water level rises a:-Ler being encountered Deer hole observation-, made b.-N;: '.Date DeslQf--,i Protessional Address: 4/1-4 Z- e- w✓g c . 7;;"g Page No. of Pages LE®NARDI & SON CONSTRUCTIONs INC. LOU �:0l91S L�QN- !@Rpl:._ ..._ ..:._..;. _.�. _ ::; � -�:4 :`:, T.: , -:= -;; . e_.. _; �.:r� :._x.- _:s,: , �;.:.Gi:�►Ru�Lfni'i7klY r= ® CORTLAN-i)i`iViANiCrt; NY 1'S5t�7 - I� (914) 736 -9010 LIC. #WC- 3112 -H90 © WC- SEPTIC LIC. #00067 a LIC. #PC -560 (CERTIFIED) PROPOSAL SUBMITTED TO ++ IV PHONE DATE STREET JOB NAME CITY, STATE nd ZIP CODE JOB LOCATION ARCHITECT DATE 00 PLANS JOB PHONE We hereby submit specifications and estimates for: �2L fl ....( ................ ..... ...... r�............. .... ........................ ........ ............................ ...: �......... ............. 6 0.1...h'.........'t'..i:._V ............... f ... c .......... ............................... D ... ............... ................................... ---- ...................... ............... ............. ................................................. . .............. .................................... ........................ .......... ................................................... -- ............................ ................................................................ ........................... PLEASE NOTE: SYSTEM LONGEVITY IS NOT GUARANTEED UNLESS DESIGNED BY A LICENSED PROFESSIONAL ENGINEER! TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY.' . 'NO LANDSCAPING RESTORATION OTHER THAN GRADING DISTURBED AREAS IS INCLUDED UNLESS SPECIFICALLY STATED.' 10c propQSP 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%% PER MONTH WILL 8 CUSTOMER IS RESPONSIBLE F At I nl.4pt ITFS ARF TA RIP SEM I 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 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 withdrawn by us if not accepted within Our workers are fully covered by Workman's Compensation Insurance. Arr>eptttnre 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 ) TO ALL AND ALL days. Pages Page No. of LEONARDI &SON CONSTRUCTION, INC. OWNER: LOUIS LEONARPI_ bT '(924) 716-9010 L'[%-,. C-31.12-H90 e Ww.SEPTIC LIC. #0006*17 UC. #`C-k0 (CERTIFIED) PROPOSAL SUBMITTED To PHONE DATE STREET 12- JOB NAME CITY, PTATE and ZIP CODE JOB LOCATION ARCHITECT bATE:b P Ns�! JOB PHONE We Hereby submit sp6qjflcat for: qpt!.nn6!eS., .106 > Co �te N Q- Z, > -11 (7 0,0 if i PLEASE NOTE: -,9Y-kTE-A LONGRTTY 1S NOT GUARAMIEEID UNLESS DE-S!GNED BY A LICENSED PROFESSIONAL ENG NEER.' -fA*- TO BE PUMPED BY OTHERS AND PAID SEPARA1W0/-- `NO LANDSCAPING.RESTORAT ION, OTHER THAN GRADINg0l _�R86L- ji G NdIkEVQNLES�itif:IGALLY STATFDd/ ( 4, x ,aT WP Propose hereby to furnish material and labor complete in accordance with above for the sum of: dollars ($ Payment to be made as follows: 4". A ANCEiQiARGE mok , WILL BE ADoED30AILL UNPAID SALANCES. ag CUSTOMER IS RF�� F NYqAND ALL ON FEES 'PI r 10 Al I liff, MR A PF AP qFM r. W BAND El m 1�e A QN. Is ..guarantee ! 6. All material d to. be as specified. bAl 6-4etAh" 4.rnanlik man,pe'r.qcpording to:stanclar pfactic6s. 'Any alteration 6r -deviaionlf,om"above,sp6cificatio Athorized involving extra' - costs. Will be executed only upon written orders, and will become an extra Si nature charge over, and above the estimate. All agreemehts contingent upon strikes, accidents or delays beyond our control, owner to carry fire, tornado , and other necessary insurance. Note: This proposalmay be 17- � days. Our'workers are fully covered by Workman's Compensation Insurance.. withdrawn. by Us if not accepted within rreptaurr 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 ARGYLE L Ft cm \" yd ° . 10 I air IRMA Dti LUIGI RD s CAI