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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES cD
OPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR ?� J�j
Internal Use Only PERMIT# 6?' /o Q - f t
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Repair Permit issued in last 5 years
LJ Not in Watershed
❑ .
❑
Repair within Boyd's Corners, W. Branch or Croton Falls Res.
❑ Delegated
❑
❑
Repair within 200 ft. of a watercourse or DEC - mapped wetland
❑ Joint Review
9,
SITE LOCATION
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tA c. thA NtJS TOWN &,+.+t 9-SOA
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TM # % � �� am-46-
OWNER'S NAME -37EA N y�;�5 ��6Lot+ PHONE # ('7/$) 78 z- P6 yy
MAILING ADDRESS M4 M A r4 US ROAD S900+H
APPLICANT r,bi,-J+RAC R-- C± P /,.C—
Name & Relationship (i.e., owner, tenant, contractor)
DATE 6 FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER ��- ¢�tJ f{ } ( ^PHONE # &Y5-,72 V!5-2
th
ADDRESS 163 f,91,A -VAy &L C4�Lr &1 NY REGISTRATION /LICENSE # 117-1- j ��
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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.
iAfq!tALL, 20a L /n1 a oAty qtr <iSAjO
/ rJ GJ) d: j - ie►._ 4-+ sf-P4 i L f. WLg= / F jV t " ,9A-' -J .ie F f'LALe
I, as owner,agree to the conditions stated on this form
SIGNATURE TITLE DATE
(owner)
I, the septic installer, agree co with the conditions of this permit for the septic system repair
SIGNATURE TITLE PKI S' DATE
(installer)
Proposal approved with the following 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 ❑ Proposal Denied ❑
Inspector's 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
Sherlita Amler, MD, MS, FAAP
Commissioner of Health
Robert Morris, PE
Director of Environmental Health
July 8, 2011
Departme t of health
1 Geneva Road, Brewster, NY 10509
Office (845) 808 -1390
Fax (845) 278 -7921 or (845) 808 -1937
Jean Yves Noblet
90 -94 McManus Rd. South
Patterson, NY 12563
Re: Septic Repair #R -109 -11
Dear Mr. Noblet:
This Department has received and reviewed the submitted repair permit for site 2 (octagon
building) at 90 -94 McManus Rd. South (T)Patterson, TM #23. -2 -29.2 and the following
comments are offered.
Paul Eldridge
County Executive
1. A survey of the existing site showing the property lines, wells, as -built of the existing
structures and classification on them is to be provided.
2. A floor plan of each building with bedroom count from the Town of Patterson Building
Department is to be provided.
3. A drawing for the proposed septic system is to be provided. In addition, the existing
septic tank location does not conform to current regulations, therefore the existing tank
must be abandoned and a new tank proposed.
Once we receive this information, we can proceed further with this application.
Sincerely,
Cris Dellaripa, CCM, PMP
Projects Coordinator PCHD
CD:lm
cc: Patterson Bldg. Dept.
Cheryl Smith
Septic Contractor
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGNT DATA SHEET - SUBSURFACE SEWAGE TREATLMENT SYSTEM
Owner:
Located at (street):
Municipality:
Date of Pre - soaking:
Address:
TMT 4 Section: Block Lot
Watershed:
SOIL PERCOLATION TEST DATA
Witnessed by: _
Date of Percolation Test:
Hole No.
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - Stop
eater
level drop
in inches
Percolation
Rate
min /inch
.2
DD
��;�
3
-3•!6
E
4
t
s
I
2
3
4
5
2
3. 6 6
3
/o 1/ 2-
3
1/ —3• ��
4
I
2
_
3 �
4
5 I
I
I
f
Notes:
1. Tests to be repeared at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., _< 1 mitt for 1 -30 min/inch. < 2 min for 31-60 miniinch)
AR data to be submitted for review.
2. Depth measurements to be made from top ofltole.
Form DD -97, pLy 1 of'-
TEST PIT PROFILES
Hole .# Lot #
Hole # Lot #
Hole # Lot #
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp. '
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.
1.0
1.0
avit-
2.0�
2.0
2.0
3 {
3.0
3.0
4.0
4.0
4.0
5.0 ' f'ei, C a &I-e f
5.0
5,0
6.0
7.0
7.0
7.0 ,
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
Hole # Lot #
Hole # Lot #
Hole # Lot #
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
a�
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0 G Yy,�-
4.0
4.0
5.0
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
TEST PIT PROFILES
Hole # Lot #
Hole # Lot #
Hole # Lot`'#
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0
4.0
4.0
5.0
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
Hole # . Lot
Depth to water
Depth to mottling
Depth to rock/imp.
G.L.
0.5
1.0
2.0
3.0
4.0
5.0
6.0
x 7.0
8.0
9.0
10.0
Hole # Lot #
Depth to water
Depth to mottling
Depth to rock/imp.
G.L.
0.5
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Hole # Lot #
Depth to water
Depth to mottling
Depth to rock/imp.
G.L.
0.5
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
TEST PIT PROFILES C-6 b -d- i�'y
Hole # Lot #
Hole # Lot #
Hole # Lot #
Depth to water �%�,
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L. %
G.L.
G.L.
0.5 7077
0.5
0.5
1.0 0'
1.0
1.0
2.0
2.0
2.0
n
3.0
3.0
4.0 S cn,l . �., �� jy, ��
4.0
4.0
cc,
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
7 6 o
ci r
Hole # Lot #
Hole # Lot #
Hole ,# Lot #
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
. Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0
4.0
4.0
5.0
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
'10.0
TEST PIT PROFILES
Hole .# Lot #
Hole # Lot #
Hole # Lot #
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp. '
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0
4.0
4.0
5.0
5.0
5.0
6.0.
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
Hole # Lot #
Hole # Lot #
Hole # Lot #
Depth to water
Depth to water
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0
4.0
4.0
5.0
5.0
5.0
6.0'
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
'b
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NOTES:
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LOCATION Street:_l -
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