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HomeMy WebLinkAbout1029DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -2 -37 BOX 11 01029 ., ., ,� - 31 1 , 9 V6 , T 16 �' ;1 61 I 1 01029 PUTNAM COUNTY HEALTH DEPARTMENT / DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- ..._.- PROPOSAL FOR-SEWAGETREATMENT:SYSTEM REPAIR-. YES NO/ Internal Use Oniv PERMIT I ❑ � Repair Permit Issued In last 5 years U 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 ©1 TOWN & /ts'&3fi M # `I T — - 37 OWNER'S NAME PHONE # MAILING ADDRESS $ APPLICANT'' N e & Relationship p.e., owner, tenant, cordractor) DATE oZ FACILITY TYPE 1°S PCHD COMPLAINT.. # PROPOSED INSTALLER e4zgrth ePHONE # ADDRESS EGISTRATION /LICENSE # zala Proposal (Include a separate sketch locating the house, propOtty Ines,. adjacent wells, within 200 feet of repair and the location of existing and proposed,'systeiin) NOTE: The Department may require submittal of proposel.from licensed professional depending on. the nature and extent of the repair. I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) _ . -1, -the- septic installer; ag"-to comply with-the-conditions-of this permit for the-septic system -repair __._..............._..._....... _ . SIGNATURE (Installer) TITLE DATE ,« 1. Procurement of any Town befTnit, 0 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 Nance, 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 end conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duratlon at which the completed SSTS repair will function. 5. No completed work is to be badcfilled 9#1 authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ A A li 2- 4111 &D Ins o s Signature & Title D to EkoratronDate Repair proposal is in compliance with applicable codes',: Yes' ? No. O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Putnam County Department of Health Division of Environmental Health Services SSTS Repair -Fin Si Ins colon Date: Inspected by: `-: Installer. �` 1 r I Street Y:oc oi% L" c:Oei Owner:.Sv' - - n Town: °^ �Gr�d� -, Repair Permit #: - l 3 O - 12— TM # ��- 2— 1. ,Type of System: Conventional Q Alternate 0 Comments: 2. Septic Tank Yes No N/A Comments a. Septic tank s' -1,000. . 1,250... other ..... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Bog i. All outlets at same elevation (water tested) ... ii. Protected below frost ........ ................... iii. Minimum 2 ft. Original soil between box & trenches e. Junction Bog _... erl set ............................... f. Trenches i. Systenicompletely opened for inspection ft. Length required Length installed iii. Pipe sla a checked ....................... :.......... iv. Installed according to plan ..................... v. 10 ft. from property line - 20 ft - foundations ... vi. Size of gravel % -1 %2 " diameter clean ......... vii. Depth of gravel in.trench 12" minimum ......... _ _..__ �._ ....._ ...._ . :. _. .... -viii. Ends g. Pump r Dosed Systems 3. Sewage em Area a. SSTS Area located as per awroved plans b. Fill section - c. Distance from water coursetwetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... c. Backfill 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 ............................ IFT Additional Comments: RFSI Rev - 011312 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION. OF ENVIRONMENTAL HEALTH. SERVICES. FOR-SEWAGF STEM -TREATMENT-SY. -REPAIR -' -__ VIM 59 1 • . Internal, Use Only PERMIT # 0 1-] Repair Permit issued In last 5 years 11 Not In Watershed" ❑ ❑ Repair within Boyd's Comers, W. Branch or Craton Falls Res. 11 Delegated. 11 ❑ Repair within 200 it of a watemme- ouor'DEC - mapped wedand ❑ Joint Review SITE LOCATIO14 399- Drvt. TOWN P64-Ire-ri-oA TM # Stall 4,V., PHONE# V4 OWNER'S NAME - 7 9 -z8q6 MAILING ADDRESS :3:S'-L WL2&-,,,A 'd-is- AM f L 6 3 APPLICANT Name & Relationship Q.e., owner, tenant, contractor) DATE FACILITYTYPE PCHD'COMPLAJNT # PROPOSED INSTALLER a k -,,,,- PHONE # hk-L-74-88oli .ADDRESS ?-,p _Tv� kA%9k Vh. 3.raAj.%r*--s__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 system) NOTE: The Department may require submittal of proposal from licensed professional depending on the- nature and extent of the repair. 1, as owner,agree to the conditions stated on this form N 16 1 `° .. SIGNATURE TITLE DATE (owner) 1, the septic Installer, agree 6 comply with the conditions of this permit for the septic system repair (installer) Prwosal aouraved with the following conditions: I Procurement of any Town Permit, If applicable. 9. 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 fled to two faced points c: System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installets'narne 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 duiation 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 0 No 13 COPIES: PCHD; Owner; Installer PC-RP V9ML Rev. 2107 t r 6. -12 -2012 s i .1050 gal Infiltrator poly septic tank Ekisting sst i i} Sullivan 352 Haviland Dr Patterson NY Tax map # ................ w .tyndalIseptic.com (845) 279 -8809 Proposed sketch existing proposed U A s - [3v i LT-- well t Haviland Rd ' Ex. 105.0 gal m Infiltra�p'r tank i Sullivan 352 Havilarid Dr Patterson NY Tax map #.� .............. poly septic Pd ROW 9" LP Infiltrator Quick 4 NConcrete D-boxes ribers in stone __G - -- EXCAVATING CONTRACTORS Small stream —,Y.d.ft.R&— (845) 279-8809 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use PERMIT # Repair Permit issued in last 5 years U Not in Watershed ❑ Y Repair within Boyd's Comers, W. Branch or Croton Falls Res. ejolnt legated E1.3 Repair within 200 ft. of a watercourse or DEC - mapped wetland Review SITE LOCATION d OWNER'S NAME.,,' MAILING ADDRESS APPLICANT Name DATE PROPOSED INS ALLER f ADDRESS 2.41 /_ ✓i//`F 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. I, as owner,a ee to the conditions stated on this form SIGNATURE TITLE DATE (owner) _.__... .:- .I,_the.septi6iiastaller., -a 16.comply.with.-the condition af:tttis ermii.focthaseptic_s:. fBfrt_re SIGNATURE TITLE DATE 0 .3 (Installer) Proposal approved with the followi onditions: 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 Qr Proposal Denied ❑ zl�:n-�, ta5'-A-. :ZZA, Inspector's Signature & Title Dat , Eipiratiorf Date Renair DroDosal is in comDliance with applicable codes Yes C�' _ No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 i 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 ❑ Not in Watershed ❑ . ❑ Repair within Boyd% Comers, W. Branch or Croton Fails Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ' ❑ point Review SITE LOCATION TOWN TM # OWNER'S NAME T rnlo"�, �S'+� ���'ug► -t PHONE # MAILING ADDRESS 35117- I4_t" $J i i a. �� a 4 0m.: AJ y t 2-" 3 APPLICANT 1 wwlY" S, %%W C...• Name & Relationship p.e., owner, tenant, contractor). DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # 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 system) f; NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. r I, as owner,agree to the conditions stated on*this form SIGNATURE h,>� �tA-�� TITLE DATE (owner) ___ �.. _.... I, the. soptit: installer,: agree to comply with the conditions of this _ ermit for theseptic�system re air �.P p. SIGNATURE TITLE DATE (installer) Proposal aparoved with the following conditions: s I . Procurement of any Town Permit, if applicable. 2. Submission of as bulk 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 comments 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 ❑ Inspectors 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 i i i Proposed sketch well Haviland Rd �T 1 T 281F �M �'na6n �4.1•N�i1N IN �n�� � IM T 14' Sullivan 352 Haviland Dr Patterson NY Tax map # ................ Saginaw rd 6 '#-7� curtain drain k. 100 +' P Limits of existin 30' Putnam County Department of Health Division of Environmental Health Services SSTS Repair - Final Site Insp ction / Date: 2 _ Inspected•by: Installer: % is�da // Street L_o ation: 17P Owner: S✓/ A t4 Repair Permit #: R — // q- / 3' ~ _ `TM # 2S, i — a — 37 i. Systeticompletely opened for inspection ii. Length required / SD Length installedt�to iii. Pipe slope checked ... ............................... iv. Installed according to plan .... v. 10 ft. from property line — 20 ft — foundations ... A. Size of gravel % - 1 '/ " diameter clean ......... vii. Depth, of gravel in trench 12" minimum ......... _ viii. Ends ca ed ..... ............................... . Pump or Dosed Systems 3. Sewa e System Area a. SSTS Area located as per approved plans b. Fill section - c. Distance from water course /wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ....:...... b. All pipes flush with inside of box ......................... c. Backfrll material contains stones <4" diameter ......... d. Curtain drain &standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse j d ; y 7�„ r�Z WA f"" f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ 3 v 1 i Additional Comments: RFSI Rev - 011312 Environmental Protection New York. City Department of Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article l I 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# n/4 PCHD Repair# " M-8 Site Location: 3J Z �4v,' / <"�l ��. ��PvJo T.M.# as • �%7 - Z ° 3 Reason for Joint Review: / Drainage Basin 200' of WC /Wetland Repeat Repair in 5 Yrs: (/ Name of Owner: Owner's Address: a �° fie- LL _ Drainage Basin of Project Site: .. _.. v._ ..._.__._.._._.�..._........_., .............. _ __..__..�...__ - .._..... .�..._,__ _Y ......_..._..._..._ - ........_....._... _ Installer: General Description of Sewage System Repair: 1�'►f -lk �� /sD 1 e5r( LID wa' 4 Y l it F/ r4f -T /h ✓a m c� �1, qS a Xl ✓4'h. 4.1-.4 J'l/ fip&,,,. rW� /M, S_r7X (y,P&vo*iek ).r 74 4' /`Plot Dates of Site Inspections and Soils Tests: Approved (/ 'Plncomplete Delegated ''''`Denied -:`Required: Soils Tests Repair Sketch WC /Wetlands Wells Other, "Reason Dctermina ' made by: Z Z �3 - Envinee�ing Division Date il,)4 /I CLwJ1Vh b"-4 `X Gene Reed Shedlo, Daniel .[DShedlo @dep.nyc.gov]--- - - - - -- - - -- -- Sent: Tuesday, July 16, 2013 4:01 PM To: Gene Reed Cc: Pat Tyndall Subject: RE: SSTS Repair, 352 Haviland Dr., Patterson Gene, Sorry for delay some comments: 1. How many BR in the residence? 2. The sketch is a little confusing - it looks like 6 chambers are going in; not two. Please clarify 3. Locate the soils tests on the sketch 4. Will existing SSTS components be removed? 5. Show general direction and slope of area. 6. Condition of existing tank Danny - - - -- Original Message---- - From: Gene Reed [mailto:Gene.Reed @putnamcountyny.gov] Sent: Friday, July 12, 2013 3:16 PM To: Shedlo, Daniel Cc: Pat Tyndall Subject: SSTS Repair, 352 Haviland Dr., Patterson Danny, A septic tank was installed in June of 2012. Testing was witnessed in case the system needed to be replaced. This permit is for the proposed new system. Thanks! Gene D. Reed Sr. Engineering Aide Putnam County Department of Health Division of Environmental Health Services 1 Geneva Road Brewster, NY 10509 gene.reed @putnamcountyny.gov Phone (845) 808 -1390 Ext. 43261 Fax. (845) 808 -1937 - - - -- Original Message---- - From: scantomail [mailto :scantomail @putnamcounty.gov] Sent: Friday, July 12, 2013 3:06 PM To: Gene Reed Subject: Send data from MFP- 07116615 07/12/2013 15:06 Scanned from MFP- 07116615. Date: 07/12/2013 15:06 Pages:5 Resolution:200x200 DPI ---------------------------------- - - - - -- 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J.. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT-OF ENGINEERING AND DESIGN REVIEW PRIORITY-. SEPTIC REPAIR DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM PROTECT: S U JOINT REVIEW TOWN: aQ wees' SUB'D APP DATE. NOTICE OF COMPLETE APPLICATION: DATE: Z ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ . Within 500 feet of a reservoir, reservoir stem or control lake. Q/ 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 1000 gallons /day. k ❑ Commercial SSTS. jtreviewrepair n Environmental Health (845.) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 235 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Inter vention/Preschool (845) 278 -6014 Fax (845) 378 -6648 l i Proposed sketch existing proposed Ii1 T 28' a a RAY-.' well - t '.- -- Haviland Rd _ Ex. -1050 gal Infiltrator poly septi tank 36" x 9'° LP Infiltrator Quick 4 chambers in stone 'l 3 @50° } B T 14' f Sullivan 352 Havilarhd Dr Patterson NY Tax map #,, ............... 1 f ! !4 Saginaw rd 100 +' Concrete D -boxes Limits of existin system f 30' ream EXCAYAT"- CONTRACTORS (845) 279 -8809 p- PUTNAM COUNTY DEPARTMENT OE HEALTH DFVISIGN'OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET —.SUBSURFACE SEWAGE TREATMENT SYSTEM owner: !/ '` �� wvti Address': - Located at (street): i # Section: Block Lot Municipality: �014��/ Waters ed: SOIL PERCOLATION TEST DATA W itnessed .. �c %�.0 r, L Date of Pre - soaking Z Date of Percolation Test: rl ' a Hale No. Run No. Time Start - Stop Elapse Time (min,) Depth. to . water from round- g surface (inches) Start - Sto Water' level drop .. m inches Percolation Rate min/mch 3_... . ?-2c `j . 2 b 4 - �p - S 5 I 3 1 3 ,. 4 1 . Z 3 Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < l min for 1 -30 mitilinch; < 2 min for 31-60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 og I of'' PUTNAM COUNTY DEPARTIMNT OF. ]B�AL'I`H, DIVISION OF LNVIRONYMNtA:L El ALTH- WRVICLS� INITIAL INDIMUALICOMNIERCIA- SITE INSPECTION FORM. SECTION A: GENERAL INFORMATION, Name of ' Project , C,/ (1')(v) `. fi . County, Site LocationZ. v- Building constriction begun Extent. ` Is property within NYC watershed ? :...:.....:.:. :.: ~ a Yes " „ 'loo SECTION B.T.OPOGRAP (Please check all appropriate boxes) 1' 'Hilly:: Ro]ling Q Steep slope D Gentle slope 234f.t 2'. Bvidenc-e' of.wetlands 0 Low area sixb}ect to floo Y Bodes 4. water. Drainage ditches Rock Qu�gops 3. Property lines or comers evident......,.*.,,...'....-.,-.' .................................... es No 4.:. 'Do water courses exist'on or adjoin the property? ........................... Yes � No Will these affect the design of the sewage system facilities ?:........... "Yes No E],.6 r' Do watershed regulations apply in this development ? ...................... YeS rNo 7 Will extensive grading be necessary ...... ..........................:.... �---{ Yes No _8" %i11:eXtensive fill be necessary. or SS`LS ....:........... 9. Do filled areas exist within the SSTS area ?....... I ...:............." ....... Q' Yes .:�No If yes, what is.the conditiion of th° fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Q Sand: Gravel Laam. Clay HarduanMixtuie c� a _.0bser_ve' &from -:... -Barings-:._..— .B:ariir._cut. - Sa:*h. 0 exoav&offf -_..._�_:. 12. Soil borings/excavations .observed by Cr,-J, on t,/// 13. Depth to groundwat°r - on e 430 v 14. Depth tD mottling on 15. Are test holes representative of primary.& reserve areas...... .. .. ............................ ---Yes a No 1.6. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 ..• SECTION D. DRAINAGE. 18. Will proposed grading materially alter the natmral drainage in this or. aclja.ceiit areas? Yes a No 19. Will groundwater or sinface dra' ge requ ire special consideration? Q Yes F7 lo0*.:" .. 20.' Wlill, gullies, ditches, etc:, `be filled.and watercourses be relocated ? :.................t...... a Yes No • SECTION E. REN[ARKS.' ; 21. If a common water supply is proposed; liar an-'mspection been made of the existing or proposed source and facilities? .......... ....:...:....:....:.:.: .....,::........:....:..,...... CD Yes; No Inspection data J wag systems exist ?.. ..... Q des No 22. Do ad'acent wells and/or sewage ...... ........:...................... 23. Additional comments 24. Site observeeinspector and title 25. Date(s)-of pbservatioii(s)inspection(s) ..TEST PIT PRO .MES - Hole r Lot `: a 'Lot #.: Hole mole Lot n Depth to watery 6 d Depth to Water:. Depth to mottling Y Depth to mottling Depth to mottling Depth to rockf=p. - Depth to rockf=p. Depth to rock/imp. G.L. G.L;. T G.L. ; as / :0.5 os 10 u / 1.0 I or'd`"' .1 .0 2.0 2.0 i 2'.0 UY 3 :0' 3.0 J" 4.0 4.0 5.0 Af w t 6.4�'I<1 .5 6.0 GA 7.0 7.0 7.0 .8.0 8.0 8.0 9.0 9:0 9.0 10.0. 10.0 10.0