The URL can be used to link to this page

Home My WebLink About1539DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -35 BOX 14 rW ,. , lot • : 1, 1.6 4 ;ter' 61 L1 , r 01539 PUI'NAM COUNTY HEALTH DEPARTKENP _ - DIVISION OF ENVIRONMENTAL HEALTH.. SERiiICES PROPOSAL FOR S30GE DISPOSAL SYSTEM REPAIR OWNERIS NAME Alt. Kenneth #auien PHONE 228 -4836 SITE LOCATION 262 6uUetho.Le Road, CalcmeL, NY 10512 24# 34• -4 -35 MAILING ADDRESS Same PERSON INTERVIEWED K. //auaen (Ownen PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE Novemben 2%, 1998 TYPE FACILITY l aLvate Dwe. lnu PROPOSED INSTALLER Mahopac SanUati.on 'Septi.c, Inc. pH= 628 -4526 REGISTRATION # 41 Proposal (include sketch locating all adjacent walls): 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. In, tall eLthen /NaatLc on Concrete aeptLc tank, depending upon nook Ln ane.a. Rje o f tank wa be detenmLned upon avaaab ai toy of apace. Sr If Proposal approved_ Proposal Disapproved Inspector's Signature & with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: ftte a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair.to be performed in accordance I, as own , reported agent of agree tc SIGNATURE U ✓o MES: V&te (PAD); YeUcw (Tan BI); Pink Lkl2 mnt) with the above proposal and conditions. the abvve conditions. TITLE MAHOPAC SANITATION SEPTIC, INC. Septic Tank * Service 247 Kennicut Hill Road MAHOPAC, NEW YORK 10541 'nz-6284526- -Joseph X:A4antovV.--.: - '+ -�77 -98 _. o- f� Ktto kcAus�- A pQ 6 0_3t' -7 `' �_ r ��0' A -r► =79 �+ L-- 16 '8 rL Putnam County Department of Health - Division of Environmental Health Services SSTS Repair — Final Site Inspection / Date: Inspected by: 'Q4 ,'j Installer:G�s Street Ldcation: le--/-7 Owner: four" - Town: R ep . ..,_.. ...._ ... air Permit #: ?� —v,��r -° � � TM # 1. Was System inspected? Yes (7" No ❑ If not, explain: 2. Type of System: Conventional 0 Alternate 0 Comments: 3. Septic Tank Yes No N/A Comments a. Septic tank size — 1,000 ... 1,250... other ..... b. Septic tank installed level ...................... 4. Distribution Box a. All outlets at same elevation (water tested) ... ZE 5. Junction Box — properly set ........................... 6. Trenches a. System completely opened for inspection b. Length required Length installed (>J V/' c. Pipe slope checked ... ............................... d. Installed according to plan :.................... e. Size of gravel Y4 - 1 % ". diameter clean ......... f. Depth of gravel in trench 12 "min1mum ... ......... _ g. Ends capped .... ............................... 7. Pump or Dosed Systems 8. Sewaee System Area a. SSTS Area located as per approved plans b. Fill section — 1` c. Distance from water course /wetlands 9. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. Backfill material contains stones <4" diameter ......... c. Curtain drain & standpipes installed according to plan d. Curtain drain outfall protected & dir to exist watercourse e. Erosion control provided ............................ RFSI Rev- 010515 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 'ES N i _0. Internal Use Only PERMIT # ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ I K Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION o&.2 OWNER'S NAME /Ir-� MAILING ADDRESS -2- e�l APPLICANT Name & TOWN TM # -3 Y,, w PHONE #..7V V o?,V 4 g3bl le, ar f J-6. n/S/ IoL-.F' 0'-3 -- /' e" 7 f& .G (i.e., owner, tenant, contractor) DATE ��5�� -r FACILITY TYPE fj��' ,� CHD COMPLAINT # PROPOSED INSTALLER / => r; G nq �?G PHONE # ADDRESS i! i d /0,9 o✓ /1 if REGIS RATION /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 a ent of the repair. - I /L1 f l. 19 ID •J T xA-i- i n 7 to - 13e. ' I, as owner,agree to the conditions stated on this form SIGNATURE A AAN 01 IT DATE — hi (owner) I, the septic installer, a o comply with th ions of this permit for the septic system-repair SIGNATURE _ TITLE –�� DATE (Installer) ��- Proposal approved with the following con itions: 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 Prop I Approv Proposal Denied El /V / - f— -7// 4 711411- pector's Signature & Title D to pir tion Date Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 t ol Nt -7 : �,'d �� r ri ��Q �5-bv tl rl^,�l - Sheet _of —(- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICE_ S FIELD ACTIVITY-. REPORT AnnRFC4e .(off ,J(ie,� alP 1�. 'BaActsou Street Town State Zip PERSON IN CHARGE � OR TNTFRSLTF -WFT1: —_ a��'� xL. TlatP_ Name and Title TYPE OF FACILITY : �j,` A (� FQ w�Utz FINDINGS: S, a _ �'!'ir-)7� �T7-CA �'1 rl �_0 �.✓/� �1 e.�-- �l �1 �i/2'J (/ [ �✓i.P� -Ut '✓ 1�r�1�- s�.l.- / �► �.�- �� Gads G�-- -n� �.G�i �� / .�.t�� f�u��ri��- m7�PF(�T.Q$� i- �C.�',�'1e/ s•l �� : �-- TF,j.; Signature and Title RFPnRT RF-CFTVFn RV, I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. 7 , I 7 I 7 • , , ( i l . l 1 • _ : . j I ' i i 1 � t , AL- i { ? -- - -- - t + it i I i I , " , I , i I f ....• _;_... { ._..!_ i __ 1. '_. ! _. I _ _ -'- -- - � ; " -I ; ` + � ; I{ I f PUTNAM COUNTY DEPARTMENT OF HEALTH DNiSION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner:/ Located at (street): Municipality: � ,:A(J' -\ Address: x TM # 314, _ �( Watershed: SOIL PERCOLATION TEST DATA � Witnessed by: Date of Pre- soaWngi Date of Percolation Test: ! i I I Hole depth anches) � I 1 II Stop Elapse 11 Time 11 (in.) water from 1 1 1 1 - I II Y. stop Water I I 1 in inches Percolation min/inch ■ice® �� 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 min/inch, < 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, pg 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS (ENCOUNTERED IN TEST HOLES DEPTH HOLE # HOLE # HOLE # HOLE # HOLE # G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered /U Deep hole observations made by: Date" Design Professional Name: Address.: Signature: Design Piroffessional's Seal Revised July 2013