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BOX 5
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00191
PUTNAM COUN'T'Y HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES �5
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
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OWNER'S NAME 1 ��_ �4�cI� PHONE
.,
SITE LOCATION
MAILING ADDRESS
TO
PERSON INTERVIEWED %, `7- c� S�(P PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
..,G Dips INN V.11 M P 04• • i
REGISTRATION #
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.
e- - 7A /- / (�
Proposal approved Proposal Disapproved
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.
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,
drywalls surrounded by one foot + gravel).
e. Installer's name and number.
Date
(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or r rted agent of owner agree to the above conditions.
SIGNATURE TITLE
IPM: Hhibe (PO:D); Yellow (Tam HI); Pink (ALpliam t)
DATE
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Page No. of Pages
a 1 BR 9 -8952
Stuart We Bates Inc.
Y-= NEW SEPTIC SYSTEMS, REPAIRS, BULLDOZING
BACKHOE WORK, GRADING, TOP SOIL, SEPTIC PUMPING STARR RIDGE ROAD RD2
BREWSTER, N.Y. 10509
PROPOSAL SUBMITTED TO
PHONE
DATE
MR. KEVIN KITOWSKI
878 -6388
.JANUARY 3, 1995
STREET
JOB NAME
151 BRICK HOUSE ROAD
CITY, STATE AND ZIP CODE '
JOB .LOCATION
PATTERSON,NY 12563
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
WE WILT, PUMI OUT . THE OLD .SE:PTIC CESSPOOL AND INSTALL A NEW 1:50 G kLLON
CONCkETE SLIM(; TANK. WE WILL HOOK UP TO THE PRESFriV'T rIELJS. WE WILL
kE —GRAUL THE ALi,rA IN WHICK WE WORK.
Or f ropoor hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
TWENTY TiiREE FFUNDAED DOLLARS PLUS TAX dollars ($ 2500.00 + T,L, �
to be made as follows:
THREL OUARTEkS DO WN Tt:E JAY WE STAP.T AiFt) T :IL 3ALA'XE UI'0:
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 specif,ca
4ons 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 delrvs beyond our control. Owner to carry fire, tornado and other necessary insurance.
Our wo,kers are fully covered by Workmen's Compensation Insurance.
Authorized f '
Signature
Note: This proposal may be
withdrawn by us If not accepted within 1 days.
,Arapt a of rapoo d —The above prices. specifications `
and conditions are satisfactory and are hereby accepted. You are authorized Signature _
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