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Home My WebLink About1833DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -11 BOX 16 I,yL �,Jij - ly Lr ` iti ■ ` T 01833 A SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANTIti . PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES RepairMeMn 8ayd"s Comers. W. Bramb or Croton Fells IWs. Ren*vf hin 2W R. of a naler con rs o ar DE Cmapped wetter PERMIT # D@tegatsd \ ❑ Joint pavieV e OWN,%Y -ersoy, J) `TM# 3S- (v —/-,7 M04 PHONE 1 1., Cwmer, tint, conhafto DATE �d x FACILITY TYPE 1Re_.s . PCHD COMPLAINT # PROPOSED INSTALLER �A _,O�l �� --its s PHONE # 5( 2'Iq -r— 9 ADDRESS D REGISTRATION AJCENSE # ?3 I/ / 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 submitiai of proposal from licensed professional depending on the nature and mom of the repair. I;�sowner, agree. tat4Q:oonditions_stste�- oa.this form ^. _ �- _ SIGNATURE TITLE DATE (per) I, the septic installer, agree to comply with the conditions of this - permit for the septic system repair SIGNATURE _ . r TITLE e s DATE Z 2—),o -7 1. Procurement of any Town Permit, It 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. Locaiim of installed components tied to two fixed points a System description (e.g., 1250 gal. Concrete septic tank, etc.) . d. lnetalWW 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 iu wftL MW `iiwi� lc is tb C>e baddi ed urttll euthortzagon to do so has been obtained from the Department. 1111 iEAb1AL t1SE CHLY �•:.H I. `:iS !:11 II : �: 1.11.11 < -:, r/ a .: ii n.! /., 1- :ir.._ �rl� - ■ . ■ COPIES: PCHD; Owner, Installer PC-RP 99ML Rev. 2107 t 1 S h ee t_[_o f�_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAMR' �lJi �l i ciw� S TPI: Street Town State Zip PERSON IN CHARGE I- le Namd and Title TYPE OF FACILITY: FINDINGS: y!- r TN4PF.(T(1R °.�y�� ilG � ��L: / L►,/�,� TFT Signature and Title RFPQRT RF(-FTVFT) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT' PROPOSAL BOR EXPLORA - 014.OF .SSPTC )tS_T M FAIL All Information below must be l completed prior to any scheduling S{TE LOCATION !� o q 1014 V. iL roWN � TM a 3 s ; � -1 -/ / OWNER'S NAME RlIaLa4d W ` t I ' � PHONE # VYS - ht-- `!S -6 - MIAIUNQ ADDRESS 4n q _ rQLd P-b- Zz PROPOSED CONTRACTORIINSTALLER � vt �d (j Stg f '? C_ & '6J PHONE #I WS' l-K- 976`i ADDRESS ' Ltd_ i Ff-r r f r�Tf- ira':S ��,ti'" REQIS7FiA710N /LICENSE k Beason for exptorstipr� 0 tdhas to surface © back -up in house © fin0 lbnits of System for repair L$ other (explain below) r kly;excel:sepfic FOR COUNTY USE ONLY S,t reA well ilS q VA kOU`Sa° 4-e V4 ire 8►'tCtle Date ` f 5 Time: /© . © GP A44 G eev d I'd 6B6S- 6L� -Sfr8 Iiepu9i fed e20 *.60 LO 11 '400 iteinbeic Corners 62 REWS R S cr .r LC OES 312 Cent MOU -Aftods Swamp Charles 6 -A 563 U� IPA C eF r st endel Pond r rs 5 R Mount Ebo Corpgrate 65 0 aines Corners 62 iteinbeic Corners 62 REWS R S cr .r LC OES 312 aviland Hollow Putnar Lake r n \um Lake Cent -Aftods Charles 6 -A U� C eF r st LA r rs 5 R Mount Ebo Corpgrate 65 0 aviland Hollow Putnar Lake r n \um Lake Charles C eF r st LA r rs Mount Ebo Corpgrate 65 nnual Corner Pond -n 0 z z > 0 0 Lj State Police > -0 Old Southeast Church z s iers OW 0. 4% '13 LL. 0 0 V ran 23 M 54 B gg r 0 0 n 0 0 ffyt gag RD > November 2007 .k 4 }1. IV' �3 infiltrators { 2 rows } @ 60' ;i F :F Permit:;# R- 258 -07 t ,w Williams 4094 Old Rt 22 Patterson NY Tax map # 35.6 -1 -10 a 4 !.J -.. •o?. � .`.tdi ,''�_.._r..:,. `jr d,.. �';, ,.., %;;' n«�a.. - ". x_:C �'..d��s r ,�-."; a,��'�f ,._ _s '��. �. A 1. 50' 2. 63' T 35'4 LJ I'm 4 1,000 gal .concrete septic tank 2 F B. 1. 148 ' 2. 57' T 43'4 2, 7O�ILL EXCAVALTIMS CONTRACTORS 845 - 279 -8805 www.ty.,d� /�sope /c oom 'M0'35-,6.Block_ Lot It Located at (Street) Tax (indicate nearest cross: street) Municipality PAT7r-K-7 S -CRA/ Watershed SOIL PERCOLATION TEST DATA Date-offreagoaEng f ` o D-ate,of-Percolation Test /,V 181477- ......... ...... .... lle t 16 2 13 r 3 XI,7. 4 3 4 5 'Z 3 4 5 2 -3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31 =60 min/inch) All data to be submitted for review. Depth measurements to be made from top.of hole. 2. Form DD-97 Indicate level at which - groundwater-is.- encountered. -A) VA) E Indicate. levelat which mottling: is observed 149 ry Indicate level >to which water level rises after being encountered Deep hole -observations 'made -by: Et . 1, F. "C', -r,>, Date Design -Probessional Name: Address: Signatiire: Design Pro"fesgionkP9 Seil TEST PIT DATA 2 DESdRiftION OF SOILS -ENCOUNTERED IN'TEST HOLES DEPTH HOLE NO -H OLE NO &L. 0.5' Lof 10 2.51 3.0 3.51 40 4.5 Ale45401 5.51: 6.0 6.5 7,0 7.5 &01 8S 9.5 10.01 Indicate level at which - groundwater-is.- encountered. -A) VA) E Indicate. levelat which mottling: is observed 149 ry Indicate level >to which water level rises after being encountered Deep hole -observations 'made -by: Et . 1, F. "C', -r,>, Date Design -Probessional Name: Address: Signatiire: Design Pro"fesgionkP9 Seil Sliect_(_of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH =- DIVISION OR ENVIRONMENTAIL HEA.TLH SERVICES- = = FIELD ACTIVITY REPORT NATyM., Tel: Street V Town State Zip PERSON IN CHARGE nR TNTFR VTFV TFD. Name and Tit`tl'e`'' TYPE OF FACILITY: Signature and Title REPORT RFC FT P.T) RV• I acknowledge receipt of this report: SIGNATURE: 02/96 Title; 4K- well no Ske- %S S i�ve64 1 y. 7-1le- ti .D_ o c oa P -r-i _ �114 11 �Vll Oct o N ,� 4 e �-� z,— ir��'s.�s'- _'�"'=a -•� „ •-�•",. _- Y�'.:tr.�• �� ,� ��P11. �- a ''4, '�.��. r'- ,F i.— "r- '•{ti..i-r,�y��•ii„_�'�' - Y 7. 52001 4 g `x`0`1 'f ©[d TLS z 19 t D T /Aa -iO f ,Zic 14 s�A('e� GJ�II o 39 LIP m m 7.01 AC. CAI. 20 -,, O pec ©wne'� s f: r,F a as o k' .fB pia k = j +� �•' /�r�.�' —�� / 8.77 AC. 1� get °W Lt LOA cp a / i' • � fxi� µ9 I ,J s v' ° AL AL 1.41 AC. __ l `I�> ('Qc,✓ /loo fit. d ,b S I e-'9 +A6 AC. I• i.