Loading...
HomeMy WebLinkAbout2048DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.41 -1 -49 BOX 18 Rv ■ 'ri LILL �' L I SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY PHONE PERSON INTERVIEWED PCHD Complaint # ame & Relationship i.e., owner, tenant, etc. DATE TYPE FACILITY P -B-o PROPOSED INSTALLER.4 , k jri AA PHONE ADDRESS � y q TION# Proposal (include sketch locating all adjacent wells): 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. I' I •;� _ 5 A i ^. -.. �+ A ri ' I Vii`' - - -4.-as owner; . r :p e D ant of owner agree o the conditions stated on this form. TITLE .� : L.,L't -, DATE d, ', Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: 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 comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved � Q Inspector's Signature & Title �/DATE/// COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML r" Putnm Courdy Depaftent of HeWO Division of Environmental Health Service Approved as' noted for conformance with ;;pplicablle Rules and ReCiukiitions of the u n m�amGo�. �a Signature & 71iFe 31 Putnm Courdy Depaftent of HeWO Division of Environmental Health Service Approved as' noted for conformance with ;;pplicablle Rules and ReCiukiitions of the u n m�amGo�. �a Signature & 71iFe 4 WOLF 845 228 0735 06/04/04 05:06pm P. 002 -P&UN-2 -2004 09:2'4 FROM:PUTNAM COMITY HEALTH B45 -279 -3578 TO:92280735 P:10110 •ri ;'. .. u• 'a :T'. :T' t,f °f: •• '. *kt. > ni rr.. ^_�. .. •• .. •.1 "t: %F n'`'T rt � to A��,A�' 6� ,,' - �°"""�'M/�"'-- ' -:• , �._. � • • • �i 5�' 6 °off tZ, '•� %' p,i - .. �� •. %• \, 7 :-. l A. it if del • o � ; '�f � '� �. �� ` \`�7 • • A� • • fir` • •� �� f rion pii� ,1 ��`.�' Y Wi .f r G }50 t50 ry'os: ^ ,.. ARC,04 RED FOR GERA'LC' 6s 65 Vf'LL SL, r:;AK-SHAIf FE LOTS S 154_3 - l54? r^I�';' . SHOWIV 0,,7 `SCCO� D l'lAF Or FIJ 5'VAICI LAKE ". S�rJ /# re !,v MMV OF P,47 7ERSO'•I PC/ rl`iA/i/ ' coUwr , NrLY YORK ' SCA� E / ,,.^ 30, Sold . map fl lea, Mo'cA POD /931 os Mop N^ 149-A I JUN -4 -2004 FRI 16:59 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P_ P a WOLF 84S 228 0785 June 4, 2004 FROM: Gregory & Teresa Wolf FAX: (845) 228 -0735 TO: Mike Luke Putnam County Health Dept FAX: 278 -7921 No. of Pages including cover sheet: 2 06/04/04 05:06pm P. 001 i VIA TELECOPIER RE: Property Address: 510 Lake Shore Dr., Brewster (Town of Patterson) Mike: The following represents a copy of the survey on the above property. If this copy is not legible, please give Ed BartDs a call as he may have a better copy. I look forward to hearing from you. Please give me a call at 225 -7007 or before 2 PM Monday through Friday at 621 -0600. 1 appreciate your time looking into the septic issue. Thanks for your help. Sincerely,; Teresa Wolf 35 China Road Carmel, NY 10512 ,THN- 4 -2G_M4 FRT i F+: SR TFI : R4S- ?7R -74 ?1 NAME: PI ITNAM rni INTV nPP0PTMPNT f1P P 1 PA "0 c 0 QL U Pit Ul 1 \41 (7 T PUT 7.1,4 30 Said map Iil5d March 20,1931 os Mop No? 149-A 1,damas C. Edgetf, Me surveyor who mo&- Certified to: Security rWe* 8 Guaranty Ca�mpclzv V ;Ictc ar Id, 4967 PRr 27 -4 -- •PUTNAM COUNTY- DEPARTMENT OF HEALTH,-• DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner I CU Address it, or Located at V61-7 (Stree sk o ,rp �d, .]L Block Lot G ' - 1l � n—dica e nearest cross s ree - (Sq - 155 3 Municipality pa4-+ Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 )41 114'5: 4 yo / 3 4 5 1 2 \ 4 Notes: 1) Tets'.to.be repeated at same depth until ay ximatelyy equal soil rates are at each percolation test hole. Al a to be submitted for review. 2) Depth measurements to be made from top of hole. FUT"AN! 0 71 Y .D I V-r S I ONT 0 L7 -I zz r�7 DrE S I G N ATA -:31HEEZET SEPA-PuATEE SEIIA,�­_E Dig_ L S Y. S T _7 FILE N 0 o,; -,or R i3,qc- A ,AA d Address- P-277 7/0 Loc a te "2 a t S t t� 2 t )._ V z v Zza& -Z14 OCR: L_"L_ 0 t #z & Sec P_ 7 (In _CZELt C�'O SS s 4-ct ic ipal it Y_ _Q�VA 2,E 7a I easay Lersh ed S 0 1 fj PE P. C' n_T_..A T 10 T*--'-qT E"", RE.911IR:- D_ pr 1C 2TT r.)V SL: 2 Hole tee_' CFC,-" -TTn\- PEIRCOUA ._.'-'i1 E I In 05c Leo 0 NO. T i r, Fr o Sroun� S:_. a c e _: -I C'. s Soil 'Da-te S t a S t Oo %14L-1 st;m �7 S t In C,-.. s In Ir.c..es 4 5 2 3 s 3 4 s No -es : 1) -Tests to he repeat-e' sa d_8D-t-'h -nS+ '�10 a'- e=c, I Lain2"' L L 0 -2 00 0-;l Ail d-:, t a t0 :D e s i b m a. t 't e '21 -or :'e`. e TEST _?EJ -0 K ;K,TTTEJ .._ _ = ,PPLICATION DESC.P T ?T T 0'.; 0� ,n - 3T , -10LE3 DEPT[ HOLE \O. .HOL s No . HOLE N 0. G.L. 121- r '18 TT _�y- .�o��,__._.__ 2 4'. 30" 3 0' _ 42'. 4-3 6 0" 6 6'f r2" /� 1 84. I \DICATE L= �'c.L aT ,:HIC r G?� \D r,, , T �� TS E \C _ l r OL N- Tom.. _ I* D1C��TE L rL�� TC� .��I (�;i (���'^J- L�.`� j'L SZiS AF!_.IR. .TJ'L,`Nh EEN T7 'TL's! -i. TESTS "'LADE 3 Date IJ Soil. kate '_'�_ ._ =7 - - -- "i7 /1 DNo,. S.D. L :s_�1e�__ ri No. 0-f, Ee •_'OC7 -.a _ Sep tic Tc _ti Cad ___L Gals. T�, l'_ 9oc� v Absorption- cirec P1'0v1Qd By L.F.x2': 37�t/ i'.'1r.Tt h trench. Other_ Sj..—.=-ture — Address � L ,;,�,g ��E. _ SEAL PUT`a' -I COi \iY DL?`._ °.i" .:'T OF r•T l. "�` t L �� Soil I,aTe �ppYove!' Sc- Ft -Aal. Checkedr h_, Date - TEST PIT DATA.REQUIRED.,TO BE SUBMITTED WITH APPLICATION _._... _ .,.r.:...Nr DE CRIPTTON'OF 'SOILS' NCOUN`T'ERED IN TE5T'_VtiTt'�': ... DEPTH HOLE NO. HOLE NO. G.L. 6" •� 12" 18" 24" 30" 361 42" 48'► 54" 60" 66" 7211 7811 84" INDICATE LEVEL TO ::`TESTS MADE BY ry- TND--WATER IS- ENCOUNTERED �H W I G UTERED O t F/a•�. ep to DESIGN Soil Rate Used -MM Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Two Septic Tank Capacity. 00 Gals. Type Absorption Area P ov ed By. )_L.F.x24" _width trench. � ,' . _ e _ _ Other DIML — wnn n. rrenzi ss , r.t oigna7mre a Address R. D. 6 Box 353 Camel, New York 0� � � r THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Chec Date �OP rn, S, so "I