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HomeMy WebLinkAbout0797DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -19 BOX 9 IL r 1.16 1 - 16� , 00797 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1=y— EA S PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Nol Internal Use Only PERMIT # ❑ Repair Permit issued in last 5 years El Not In Watershed ❑,% Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated L�l ❑ _ Repair within 200 ft. of a watercourse or DEC - mapped wetland Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT 1�@ I A r1— 1 TM # 4 � PHONE 7ff_ cL Name & Relationshipf(I.e., owner, tenant, i aar) DATE i C> L) _ FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER �� PHONE # ADDRESS �J �7 �S r `/� /�J REGISTRATION /LICE #%n Ala �,`.� � • 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 system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and gpxt. ►e5 of the repair: / j S k f :�. i 71 , ♦ i /,&-i .0 — —,-4ro % i't w[%G A ref . A9 .S/: I ( . ILM K r cA.&� 10 � I, as owner,agree to the conditions stated on this SIGNAT 'I (owner) I, the. septic installer, agrAe to comply with tea--'-- t � �l In 540'e -tD Ca17UA� DATE 8 ns of this permit for the septic ,system repair SIGNATURE ITLE • U%t� %1VATE (Installer) Proposal aooroveA with the'following condi tons: 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 back-filled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Pr opo l Approve Proposal Denied ❑ I pector's Signature & Title Dati Ex ratio Date ,Repair proposal is in compliance with applicable codes Yes me"' No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 i ' ( — --F �---- | / ! k,A AS7— ' Fo ion Environmental Protection New York City Department of Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State Public Health Law; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems: Putnam County Septic Repair Program Plan — March 2005. DEP Project# 1131� _ _ ____. PCHD Repair #� R_" ;730 Site Location: �3 �`4*�� ��' �" t— 1 `` T.M.# Qq -Z-/9 Reason for Joint Review: Drainage Basin 200' of WC /Wetland l✓ Repeat Repair in 5 Yrs. Name of Owner: !,►'� •!q ti s l Owner's Address: Drainage Basin of Project Site: �4s� �j/4h�� Installer•�`�", / T General Description of Sewage System Repair: • -------- ........... ...... - ----_.......... ..... .......... _.. ........ _ ....... . ......... . ... ..... lei -S ki t u Dates of Site Inspections and Soils Tests: %�� /`lam „_,. �_?'1 _z', ..... ___. ....... _�_ Appruvcd____J _ `Incomplete Delegated._._ "''` Denied __.....__��__.._ ,'Required: Soils Tests___._ Repair Sketch WC /Wetlands Wells ":Reason Determinat' n made by: ......... . ........ ... _ _...._ _.... _ ._....._...__. Em ineeiin; Di��ision Date. -71t; Cl R nV17 --v- 4W3 0,7 rz v.) 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Saiilif ultf � `ialu S :attf W& 3bc F ..Salo •. _. ?'_•� 2 4 2 18 tt�. _ :alts. �; S,du vlu �al +. N _. .: y _. 3 :, 35 .523 - _.. Uu At >aLf i1 S3I� >slu >alu r I Satz, it _Saar Salts iJt 51 lalf<::. -..: r Av r J - I,r it .••_• J�4� SaU - Situ r" .Salo . SUG� Balt �� ::Salt�' °.� ::_. ,plc: Blu' Batty SaLer Salo :::: 35. ._.. - IJ I - I 5U - tL. 517 1• . ,,Ir -•. 7alcf.:.L'•:_ t ' SatG I7 B3�p! t ;''.';r_lfi..:.�,• , . 51, -:. 71 .alu "'-.`: "•. ..... Stu Salo >alu, .... aalu Salo Bala s � .. ate xU,u �� � �` Bahr =35: -5 -26 vt� >ali ....:• ':..._: -..- S • Salo �)rr _; ,ylu...,:_, >Slu ;Sate aU,:f . �(� Mix .:_ _: Baler � _• ltr .: alf ,._.'�U.tr. `' .::'.35. 35. -5 -27 `,iJt : ialu >Sltr. � � , iU,u:, B3J� �� Btlu ia� ,Saltf kV.0 >� •'�ti �. '-'t li � _ 51r -� 51 U, - • - d = ! ,!' ,_ 1'•, �alcr .: ':::= \ +Ar. .. ..._. ,aLs '.. .,�_,alt� •_ ..... stilt ..•• ._. .. December 2, 2014 0 Wetlands NYSDEC 1:4,012 0 0.0325 0.065 0.13 mi Ij0 .1- 11 1 1 Tr' —ice I 0.05 0.1 0.2 km Sources: Esri, HERE, DeLorme, USGS, Intermap, increment P Corp., NRCAN, Esri Japan, METI, Esri Chita (Hong Kong), Esri (Thailand), Tan Tom, Mapmylrtdia, ® OpenStreetMap contributors, and the GIS User Community Putnam County ITIGIS REBECCA Wn KNBERG, RN, BSN Public Health Director ROBERT MORRL% PE Director ofEmiromnentd Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Esecu&v TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: FROM: PRIORITY - SEPTIC REPAIR DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: LOCATION: 6 My TOWN: TM # 2j,-9-1q NOTICE OF COMPLETE APPLICATION: DATE: a' c�' / ❑ Within the drainage basins of West Branch, Boyds Corner, or Croton Falls Reservoirs ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992 ❑ Design flow greater than 1,000 gallons /day. ❑ Commercial SSTS. SEPTIC REPAIR JOINT REVIEW 643 East. Branch Rd, Patterson. 24. 24-2-62A 24.-2-26, A, 4.-2-62A 24.-2-62.5 24.-2-59 7", .. ...... .... -A& 2 S., N (e. 7-1, ri, �n— L Sa, �4 ie' ... .... . A \A 'wz A ........... d, j. 0, Nk "E. A?. jk. W&. k. N\ A Atv . .......... .... 7 J" A� kj December 2, 2014 Wetlands NYSDEC A111TO I. /24.-2-60 35.-5-24 -23 1:2,006 0.015 0.03 0.06 mi 0.0275 0.055 0.11 km Sources: Esri, HERE, Dekorme, USGS, Intermap, increment P Corp_ NRCAN, Esri Japan, METI, Esri China (Hong Kong), Earl (Thailand), Tan Tom, Maprnylrda, 0 OpenStreetMap contributors, and the GIS User Community Putnam Counly IT/GIS PUTNAM COUNTY DXPARTMENT OF HEALTH DIVISION OF ENVIR011fNTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSWACE SEWAGE TREATMENT SYS -MM Owner. I.00tbd at (street): 6`13 mvewp>tlity: AM TM # SOM PERCOLATION TEST DATA . weed by: s Date of Pre�oahlaE. Dab of Pereolatin Teel: Notes: 1. Tests to be repeated at.same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < 1 min for 1 -30 mWinch, < 2 min for 31-60 miNinch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Fam DD*7, pg l of 2 'FZW1' Pl'1' DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE # HOLE # HOLE # . 1 HOLE # HOLE # G.L. fl.5' 1.0' 1.5' 2.0' 2.5' VI 3.0' 3.5' Owl 4.0' 4.5' 5.0' 5:5' 6.0' TC C444 4 " f 70' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered _... __. Indicate level at which mottling is observed N� Indicate level to which water level rises aver being encountered Deep, hole observations made by: � Date i Design Professional Name: Address: Signature: Design Professional's Seal I Revised July 2013 S4. .p T�- 'A Q'0 00(- -] S I piePsa 4 vo k ' U Site Restorations Ilc 13013- 763 Millbrook, NY 12545 Customer 43 AddressA, LKI Phone 0q. 9640 Draining /Pumping Up to 1000 Gal. Uncovered. Overage Per Gal. Gallons over 1000 Hand Dig Fee Machine Fee Heavy Sludge Fee Snake /RooterNacuum Enzyme Notes /Remarks, Date 2 z a 9A1 -9771 845- 249 -6768 I /Customer Authorizes SR Ilc to enter my property and I /Customer take full responsibility for any damage SR Ilc may cause during operation on said property. SR Ilc is not responsible for any damage on property or to any Structure wile SR Ilc is on site. Customer Date AL W i. 00 Putnam County Department of Health , Division of Environmental Health Services SSTS Repair - Fin1 Si Inspection Date:. petted by: %,1< si Installer: �u S /CG y Street Loc n: a� . B eOwnen. Town: rS Repair Permit i#: I -d -7i -/4/ TM # L 1. Type of bystem: Uonventtonal NJ Alternate U Comments: 2. Sewfic Tank Yes No •N /A Cox ts SA r� s I a. Septic tmk size ,0 1,250... other.. b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. L All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & treuches e. Jymsdaift- properly set ........................... L TMRCM i. Syst= completely opened for inspection ii. Length required Length installed iii. Poe slope checked ... ............................... iv. Installed according to plan ..................... v. 10 ft. from property line - 20 ft- foundations ... vi. Size of gravel % -1 '/, " diameter clean ......... vii. Depth of gavel in trench 12" minimum ......... viii. Ends capped .................... :.............. 3. hnAm a SETS Am located as per approved plans b. Fill swdon- c. Distance from water coursetwedands 4. Over$U Workmonahi a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... c. Back511 material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse f. Footing drains discharge away from SSTS area ......... g. 'Erosion control provided ............................ Additional Comments: USI Rev - 011312 � n-A ('�> cw(o 5 RI n1-,,l 13a�.2 ( 060 t- 4-0 cleq lu f ! e<de � n-A ('�> cw(o 5 RI n1-,,l 13a�.2 ( 060 t-