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Home My WebLink About0987DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.46 -1 -55 BOX 10 i7 oil a Rol 16 r ., 11': 20 Ivy dill- Rd.- Brewster -1-050-9--(845) 2 EXCAVATING CONTRACTORS -8809- LL. 79 - T-YNR-4,T iwsjfmc. Ems SEPTIC SYST t S4ewe Wo. IPA(,- }-� -�rSo h ! N' / ' .... ....... 1p well Ju 4 MEMORY TRANSMISSION REPORT ---TIME---- - DEC=30=2011 02:09PM-' TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER 717 r--r E: R- L- i -r L- = R. HD, MS, F es.- P 717 DEC -30 02:09PM 88786343 002 DEC-30 02:09PM DEC-30 02:09PM 002 OK SUCCESSFUL TX NOT ICE 4-522-21-2- �A�W- ROBER-rJ. BC NDI P�---- 1K In the e-s-xaf n cflfric�IrEest pi Tonzrccm rkie i=l ITS) OfFxc:-� Dx,�S-4Lr; 2-8-61.=30. erilank you PUTNAM COUNTY HEALTH DEPARTMENT / DIVISION OF ENVIRONMENTAL HEALTH SERVICES, YES N Internal Use Only PERMIT # 1'f - 09 G tQ ❑ R 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 SITE LOCATION aZ % fir-! TOWN v/r"Gr�oh TM # o?,I: q(; 1-J`;S!' OWNER'S NAME GI 44 f el PHONE #NY-,27 9- 6KZS- MAILING ADDRESS Z. i 0 r/e,r A1^ ae7e,_ d Pry �I- e-11s. 1V 4 APPLICANT Name & Relationship (iyf, owner, tenant, contractor) DATE ' i FACILITY TYPE Jj PCHD COMPLAINT # PROPOSED INSTALLER � T PHONE # tEr ADDRESS REGISTRATION /LICENSE # 13 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 extent of the repair. No I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) _ -;,-the septic insialler, agree to coin piy wiih the conditions or this permit for the "septic system repair SIGNATURE TITLE DATE (installer) Pro osal approved with the follow' conditions: , 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 Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title --Date - - Expiration Date .Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT'SYSTEM REPAIR YES NO - Internal Use Only PERMIT # ❑ / Repair Permit issued in last 5 years ❑ of in Watershed ❑ LJ Repair within Boyd's Corners, W. Branch or Croton Falls Res. 1Z Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION [�VerIin Rd TOWN Pa ph TM # 1 OWNER'S NAME PHONE # 2'7�' -lti�Z MAILING ADDRESS 2 L APPLICANT Name & Kelationship (i.e ,/owner, tenant, contractor) DATE bi- hz7 (j� FACILITY TYPES S . PCHD COMPLAINT # PROPOSED INS ALLER - - . 1 PHONE # ADDRESS all ( r /1% . REGISTRATION /LICENSE # 3 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 extent of the repair. WMIMAI I, as owner,agree to t e ondition stated o this form SIGNATURE TITLE DATE .� (owner) -- - I, the septic installer, agree to comply with the coliditiolis of this permit for the septic system repair SIGNATURE TITLE DATE (installer) Proposal approved with the folio g conditions: 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 Pro sal Approve Proposal enied ❑ c 5 , d:0 — n ector's Signature & Title Dat -Expiration Date Repair proposal is in compliance with applicable codes Yes ❑ No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 TYNDALL EXCAVATING CONTRACTORS i 20-lv-y..14.i.ii.-Rd.,,Brewste.r, NY 10509.. (845) 279-8809- SEPTIC SYsrAFMSrmc.--- �t---, Shwe Wo dao ')- 1 0 u6r- I 1'rl P-10 A49( Vi,4+,xSo h, N. ivr I W, If d" dr) s- Wei fop 9 m T4- &,A'LrL--s MEMORY TRANSIAI SS ION REPORT TIME JUN -19 -2009 08:42AM _ TEL NUMBER 8452TBT921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 090 DATE JUN -19 08:42AM TO 82795989 DOCUMENT PAGES 001 START TIME JUN -19 08:42AM END TIME JUN -19 08:42AM SENT PAGES 001 STATUS OK FILE NUMBER :090 * ** SUCCESSFUL TX NOT ICE * ** %Y/VQi4 LL EXCAVATIIsZG CONTRACTORS 3E/�T /C .SygrE,IM,Si,.� 20 Tvy Mill F2d_, Brewster, NY 10509 (845 ) 279 -8509 w� l ,i ,S ��i.,00.;,• -- a- a ��• 35.y MEMORY TRANSMISSION REPORT TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 565 DATE MAY -28 04:19PM TO 92795989 DOCUMENT PAGES 001 . START TIME MAY -28 04:19PM END-TIME MAY -28 04:20PM SENT PAGES 001 STATUS OK FILE NUMBER 565 * * * SUCCESSFUL TX NOTICE aL� 1�XCAVATINCx CdNTRACi'dR.S SEPT /C StA:a WM �_ 20 Ivy Hill 12d_, Brewster; NY 10509 (845) 279 -8809 tZ— P� -sass �S .00, cis P, A ea � ate• 3s -y �1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES' DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: Address: 4 Located at (street): 011/c Y,6 (,-Lot �-)_J TM Section: Block Municipality; 4 6-k Y' P, 7- o u Watershed: SOIL PERCOLATION TEST DATA A Witnessed by: Date of Pre-soaking: 4 ; tRi Date of Percolation Test: S 41q4r3 Hole No. Run No. Time Start — stop Elapse Time (min.) Depth to water from g round surface (inches) Start - Stop Water level drop in inches Percolation Rate min/inch -3 j1_.Qj_-J 1,20 4 5 2 3 4 5 1. 2 3 4 5 2 3 5 Notes; I Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < I min for 1,130 'i /inch, <2 min for 31 -60 mint'inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole., Form DD-97, ps I of -2 r TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE #_I HOLE # HOLE # HOLE # HOLE # G. L. 0.5' �/ I 1.0' 1.5' 2.0' 2.5' of AL Ic 3.0' _ GZp W A) 3.5' T/ T y 4.0' .D A A4 4.5' 5.0' 5.5' 6.0' 6.5' 7.0'. 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered -V Indicate level at which mottling is observed </ /4 Indicate level to which water level rises after being encountered U Deep hole observations made by: 4 w Date Design Professional Name: Address: Signature: Design Professional = Seal YNDALL G CONTRACTORS . P S 20 Ivy Hill Rd., Brewster; N, Y 10509 (845).279 -8809 L'd 6869-6LZ (968) II8PuAi dbb :£0 60 90 ABW er en c PUTN ! COU HEALTH DEPARTMENT ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES - THIS IS NOT A -R-i -A1-R- PERMIT - - - - --T- -- PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All Wormation below (must be f ,completed prior to any scheduling SITE LOCATION �1 ti j�uQ TOWN +ef -2)n TM # OWNER'S NAME SG1i ° A-a- a PHONE # �7 MAILING ADDRESS ' t PROPOSED CONTRACTORIINSTALLER t PJa S . S PHONE # cc� ADDRESS �' U /�!aREGISTRATION jUCENSE # - Reason for ex loratlon: Q failure to surface back-up in house 0 find units of system for repair 0 other (explain below) FOR COUNTY USE ONLY a Ins c6oes Signature &Tide Date App otntjneni Date: `'" J� S�- �, Tune: idy:excetseptic Z -d 6869-6LZ (gti8) IIePuAi dtt:£0 60 90 AeW 'MEMORY TRANSM.I SS I ON REPORT --- TCME- -- -`- MAY -06 -2009 04:50PM TEL NUMBER 8452787921 NAME ENVIRONMENTAL.HEALTH FILE NUMBER 940 DATE MAY -06 04:49PM TO 92795989 DOCUMENT PAGES 001 START TIME MAY -06 04:49PM END TIME MAY -06 04:50PM SENT PAGES 001 STATUS OK FILE NUMBER 940 * ** SUCCESSFUL TX NOT ICE * ** �m er er'c. G F'U-m^ GOU r )e=F -AR rmi= -w-r ' L?lVISIOI�i OF EN IRGI�liV1E[�Tt -Ai_ F-7EAL'fH SERVIC>=-S THIS IS PIQT A RE -PAIR PERMIT PROF -c a^y- FcoR_ F cen-c Ac iON OF Stg'!➢C ava-m IfI PAji -umm .Aug ➢:fri'orrsaaitos� betovir mnul3vt tbo IftAE ]G�r carnRjQmed Rrto��r //t__o any scttaduting S!'t'E IACATIQN _ %7 r.: TOvvm ��i Y�T� {�i'1 TMH owlgEFrs NAnnE .� ,�� ,, �of�d P1 -ion►s Cr _2�- s �_� MAIr_[NQ .aor�RESS PROP0.SE0 CONTRACTOR /INSTALLER C Gflta -�.-Gl J4gTlC.- .��1.�'7�ir✓ PHOiVE # 2- -%�i -" �R'CJ ADDFMOG 0 1� ti.[ I �iJ 47� / tSTRATION AL10r=At8E # 3 _ o r f CI f�c9�vra 20 surTaos la�aFo -asp In {ionaa C7 i9nd 3iss�Bls of syrsni�m for rapa7r Q oar t�xplain kas�ow) fgrratura F -r4Hs oa>� rdyseacooL-ooptio Z'd 6869 -6GZ C948) I 116PUA1 d": 00 BO 90 A- VU i