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Home My WebLink About1126DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.55 -2 -24 BOX 11 ro .T LT Is mIx ■ y 01126 A SITE LOCATION PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR OWNER'S NAME MAILING ADDRESS APPLICANT DATE PROPOSEDI ADDRESS Internal Use On ' Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC - mapped wetland Jri�G1��Qh hr `T /OWN G PERMIT #1 k::. Y17:' 1.3.. - ❑,Klot in Watershed [J Delegated ❑ Joint Review 2-2q PHONE # 7- /0y2 k,b er Name & Relationship (i.e., owner, tenant, contractor) FACILITY TYPE 12e-!Z4 , a eiPCHD COMPLAINT # PHONE ICENSE #/I r1 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,agree to the conditions stated on this form p/t S+ ear Sii e SIGNATURE TITLE DATE (owner) I, the septic installer, agree. w comply with the. conditions of this permit for the septic system repair.. SIGNATURE TITLE _e,0_ • DATE -� 3 (Installer) Proposal approved with the followi 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 E Proposal Denied ❑ In pector's SI nature & Title Dati Expiration Date ,Repair proposal is in com liance with applicable codes Yes 2X No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 T YNDALL EXCAVATING CONTRACTORS i / -�-20-1-vy Hill Rd.,- Brewster; NY-10509- (845).27M809. 'SEPTIC SYSTEMS-wo. ., 1V'l`les lea- �fersal�!1 /� y Property Details - Image Mate Online Pagel Putnam County _ __._ ._ _ _ _.... _. Image Mate Online Navigation GIS Map I Tax Maps I ORPS Links I Assessment Info Help Log Ir Residential Municipality of Patterson, Town of SWIS: 1 372400 ITax ID: 25.55 -2 -24 Structure Building Style: Old style Number of Baths: 1 (Full) Number of- Bedroo 3 ° ` `°' Number of Kitchens: 1 Number of Fireplaces: 1 Overall Condition: Normal Overall Grade: Average Porch Type: Parch,Area :... ........._ . Year Built: 195:7 Basement Type: Full Basement Garage Cap.: 0 Attached Garage Cap.: 0 sq. ft. Area Living Area: 1,068 sq. ft. First Story Area: 669 sq. ft. Second Story Area: 399 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. Three - Quarter Story Area: 0 sq. ft. Finished Basement: 0 sq. ft. Number of Stories: 2 Photographs No Photo Available i View Tax Map Pin Property on GIS Map . View in . Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer http: // Putnam. sdgnys.comlpropdetail.aspx ?swis = 372400 &printkey = 02505500020240000000 6/7/2013 OS/29/2013 12:15 FAX 8452251915 OFFICE FOR AGING May 29 13 1 1:00a Tyndall Septic Systems 8452795989 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION-OF ENVIRONMEINTAL--HEALTH SERVICES PROPWI AL FOR SEWAGE TREATMENT SYSTEM REPAIR rEs I►i0 Internal Use tkdy AepBitr Perrrri2 issued to last 5 years ❑ Repair within "d% Comers. w. Branch or Croton Falls Res. ❑ ❑ Repaiir v*hin 20D IL of a v4ftmwrse ar MOmmapped wetland SITE LOCATION OWNER'S NAME MAILING ADDRESS PERMIIT # O Not in Water. ❑ Delegated ❑ Joint Review TOWN 'OFF �rrm 1l1 f TAA # PHONE # APPLICANT Nerml 3 Relatiwistdp fLe., mm, tenant cantrattor) DATE ,7 i7ri 3 FACILITYTYPE e5r y- PCHO COMPLAINT4 PROPOSED INSTALLER PHONE# ADDRESS REGISTRATION RICENSE 4 2002 p2 Proposal (include a separates sketch IoCaitina the house. property fines, all adjacent yells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional deperi tg on the nature and extant of Me repair. I, as owner, e to the conditions slated on this torn SIGNATUR e &l Q ultivo T ITLE DATE 6 1 J i tehe septtic ir�ta>fer, ree tU comply orith the conditions of this permit for the septic system repair SIGNATURE .�� TITLE DATE Pronasar aaoroved with the fallawAng condrtfons: I- Procurement Cf any Town Permit if applicable. Z' Submission etas btWt repair sketch by the septic system Installer within 3D days of the repair, ire duplicalle showing: a. Owner's name. Site Streat Mare, Tvvvn 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 pht me nurnber 3. System repair to be performed in accordance vAth the above proposal and conditions .4. The proposed SSTS repair is considered a best fit design and there is no guarantee 10 the duration at Which the completed SSTS repair will function_ 5. No comleted work is to be badcfifted until authorization to do sa has been obUined frorn to Oepartrnent. INTERNAL USE ONLY Proposal Approved (] Proposal Denied ❑ kR;FX or'S Signature S Title Date Expiration DM Repair MpDSal is in compliance with applicable codes Yes ❑ No O COPIES: PCHD; Owner; Installer PC -R' 99[WL Rev. 2tU7 Z'd 69696LZ5b9 swelsAS oildeS IlePUAl dZZ :Z1, 96 90 unf Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Ins �ection Date: o /m 3 Inspected by: �, i?, Installer: Street Location: Owner: ' _ Town: �a► e i`Sori . _.._..... Repair Permit #: 1K-067—,13 TM # Z 7 � 6-5- — Z I® 1. Type of System: Conventional D Alternate D Comments: 2. Septic Tank Yes No N/A Comments a. Septic tank size ,000. . 1,250... other ..... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost......... I ................... d iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — 'Oro erl set .......:.................. . f. Trenches i. Systerricompletely opened for inspection ii. Length required Length installed iii. Pie slope checked ... ............................... iv. Installed according to plan ..................... V. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel % - l %: " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... g. Pum or Dosed S stems 3. Sewa e System Area a. SSTS Area located as per a roved lans 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. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse E Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 °a 'r' r i a v- r<77 y; A� r � �.A � II 4"tiiid}r?N3,' - ' whw•_:. .1 >�.am.a urwi� _ �ww.r..,a_s_. _ l_ 1 5 # a' +t v .. } ✓ 'f f' -IJ �1 • _ 34 s 3 f t .. :. •tom: �F f _ .r L Wr i x cif 4w` 1 i fix .. � �::� ,a 3 '� wa x -�� #`� <�'.�, y. 3^• ^•.- ¢Y,, .c Aa .:. �F• w^x� r � rl ;�. '. ! � 7 .ms's � i � � lA �'�p•� x �. "yam y r'�,d%�, ;. T"'ww*_ -*t � . =��r q,H€� �,:r�, .r5 .:,y .,:��,.• . {