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HomeMy WebLinkAbout4844PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Only PERMIT # A -0 k, a - 1'2- ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ elegated x' Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑' Joint Review SITE LOCATION �J- AA&-r 1 ,I %r TOWN f�q rsu.� ,�l ' TM # 'j i � 01, - 3 3 3 OWNER'S NAME /Yep 4gvra % MAILING ADDRESS 97,7 APPLICANT �'J-ymGs " i6a4 4-11� Name & RelA*6nship (i.e., owner, tenant, contractor) DATE 7-.�V/y FACILITY TYPE hte ne— PCHD COMPLAINT # PROPOSED INSTALLER .� yr1t� `,y/ � PHONE # 'Iaf / ADDRESS 3 �7 6*11c r(�r6 0- REGISTRATION /LICENSE # A� ew- % /R/ 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 conOtions�stated on this form SIGNATURE , -' �� - -°"�-� TITLE taw DATE (owner) ! I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE - � TITLE DATE ®, - L7 (installer) Proposal agor ed 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. -� iN 1 ERNAL U,t ONLY Proposal Approved Proposal Denied ❑ lnspe et' Signature Title / / [date Expifation Date Repair proposal is in compliance with applicable codes Yes COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Environmental Protection New York City Department of Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State Public Health Law; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems; Putnam County Septic Repair Program Plate — March 2005. DEP Project# • r '34 PCHD Repair# /�° 0� 2— —11— Site Location.: a3 d 1&_1W �d• U', �,e T.M.# a1• � 1— — 3 3 3 X3,1"- z Reason for Joint Review: Drainage Basin 200' of WC/Wetland Repeat Repair in 5 Yrs. Name of Owner: L`cr�u Owner's Address: 4J 4,�oke Drainage Basin of Project Site: CcuJ �hch Installer: General Description of Sewage System Repair: �PkAuue. IZX-�A6, Jee GblAt*a edit �yl .fyww—, /vce% k",r4 2KfSk.4 J STS Dates of Site Inspections and Soils Tests: Approved 1/ *Incomplete Delegated * *Denied "Required: Soils Tests Repair Sketch WC /Wetlands Wells Other "Reason Determination made by: Engineering Division Date i . ..", f d t , ..!!�' L�,� -pF � �u.•'�! '`'': i : '�`•' •x'1•"1 fA� ki �nan.1` *°. r�d,r:G n'• v�:J : '"'E?. , .. :.: 'R �V T Y� �:��� + .'' ?�;' • �`i rr•,'.•... :fir; �a':: <,7H� -. � '•till#. ..,,�� : ���; ;{�� ���� �'��.:: �• � A •:185 4. F,� • .Fip 186. r 1, • 1 ::" ���;� ;, � � . � � ITS• �a • yv 111Q$�`j' irk ,� •? ,r� +rt a �'.. .�j�.. Ji':.�` J4fY.J�4;lkk r ,f`. 1 _W JJ�� A -- 188 8 t;.: - � 7. � -Y '�'ss a:.- � •.. , ry•. tit ,• �•�� �•�:•s,/,. ' •`,::..• °.ti'• ?J •r. * `fir'" �,:7:: :..� .:J. � � tS Jty;';KEd'y@'c•�y''."r� "t • � z.. '� h•� a-r;, ;� ..��,:,,, •e:�.,'Ah - %�.. � ;4:" '�y%: .� ..1:'r. ,Yti;;,; �:.." _ . *:aCY .:.f _ •,Y. :' ,!C�'i op "•.Jaw: r.:.:, f 'L "W 'i► 4 yv %.1 5 t It r : -t h• ''. : tit • - v�,yia, �' J"!'�,,',,�{h4 *^�.y.'.��;, �5Q 5..,,�1 � t�' }z- •JrJ'�'�'r' , .��PT r9Y'ti' wl.: _ Y•L.- 'i�:tl,'.R: L'•••i vie,¢•'t:Yw •1;. ,•::{,t" aC.� ..........>:. wa j : n • ..fir,; , y " 1100 .t GYJ:. i• .,�••� -� // 1, � lI`I r' - � _ �/r /yT� )•. kk t`;'�, a ,aY`{'�i•t,: a Y t r �.: i r! v tl -;'! t 1 1" . ! . ,1:y, � . 1�. • .J.� �� �a.Y rRl.• • 1 �' }' � � r t k C ,'. f ..1 1 ar.Y'�'t('.�: r. ' t •�i.i f''" 'u;T~hi} : ":.£:,, s. ' %`fir :. '�; t r 1;t C:! J i1 r.:� v _ . " 1. .v,1�N;��r6�e�?)i?F a %licl ?; :': ��;'w sJ•. ,:� ;r.. �':�.:: � ' F,wF • ..l1 ';"4 '! "3 ".: .Irt.d...• 'fir .S' rte. >'�s 4:�:,1', .+ ::.r;.:. _ � ^� r��';.;�;•�j: -=•••. ' 1• : tAt..>^,S'C "r,:' : <irQ ;:p•., •;i•. ':t;::: `' ,�(�y�"1.�.3"ij � ,yt�� ": t',. •;M.-:.: .•1•�. :•'.:. P , : l ,,y .. y •. s:,.,l:•. ... ., . .. :..,mac, >o- .. rr x Putnam County Department of Health . Division of Environmental Health Services SSTS Repair - Final Site Inspection Date: fZ /6 /! Z ,i Inspected by: D .\&c - Installer: ira' Q j Street Location: 2 3 3 - -A 3-r f 7c v,' D, Owner: / e•, 1,,,, c,c-a Town: i9&4 -t.-s c+ Repair Permit #: K 661- 12 TM # oZ r r)1-2 -3 2 Additional Comments: RFSg Rev- 011312 I. ljrpe of system: Conventional U Alternate Comments: a 2. Se tic Tank Yes No N/A Comments a. Septic tank size -1,000 ... 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 ............................. iii. Minimum 2 ft. Original soil between box & trenches C/ e. Junetiou Box - properly set ............................. f. Trenches i. System: �ompletely opened for inspection ii. Length required ength installed iii. Pie slope checked ....................... :.......... iv. Installed according to plan ..................... v. 10 ft. from property line - 20 ft - foundations ... vi. Size of gravel % -1 '/: " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... g. Pump r Dosed Systems 3. Sewa e S stem Area a. SSTS Area located as per approved plans b. Fill section - c. Distance from water course/wedands 44. 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 f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSg Rev- 011312 ray" •.,.1. .St ;nt,..q.,..t �'y'; ,4.y^�2� d..; Gf N 8.2 - OV Ii . y Srlsa "o 'M 'b� • �' .go �i • 'ty.�'i���t,, °` .,, �. !'�, �' .a►� � � 0�,�/ a'` �G� "i Y' �X,1" r. ��' �!'''C��C y °t'iypc �� � - {r5.��,�1�4^ .t � � (tr i . 1.y . :7 �•w 1�u'1� 5^ 4L ��' �15�' 1j` Yi `ln�.,.y� Cris Dellaripa From: Shedlo, Daniel <DShedlo @dep.nyc.gov> Sent: Tuesday, April 03, 2012 3:22 PM To: Cris Dellaripa Subject: RE: 233 -235 Haviland dr. Cris, Note the following comments: 1. Put BR count on sketch 2. This is in a new treatment area and a relatively complicated design (high flows, lakes, wells, fill); a P.E. design is required. 3. Show location of soil testing (deep and.perc) on sketch 4. Show exactly how much fill will be removed and what kind of material will be brought in. Show full depth and extent of fill section. 5. Show topo on sketch 6. These flow diffusors (at 4 sf /If) are not giving enough leaching area for 5 BR flow (appox 700 gpd). Look into using infiltrators? There are other products out there with much more leaching area. 7. Show location of 1 -box on sketch 8. What kind of pipe under the driveway? Protected? 9. How far is the lake "down the hill'? 10. What will happen to the existing drywells? 11. What is condition of existing tank? 12. Tank must be pumped out until a repair is made. Thanks Danny From: Cris Dellaripa [mailto: Cris. Dellaripa@putnamcountyhy.gov] Sent: Tuesday, April 03, 2012 9:08 AM To: Shedlo, Daniel . Subject: 233 -235 Haviland dr. Hi Danny, I have attached the. following for your review: 1. There is two houses on this property 2. 5 bedrooms together 3. 1 -1000 H2O septic tank in gravel drive way with 3 pits that are failing 4. Tests are down next to the driveway 5. He wants to remove bad fill and replace with bank -run 6. He will put a junction box off of driveway and pipe new to repair and to existing pits with a speed leveler. Trying to let old rejuvenate. Thanks Cris Dellaripa, CCM,PMP 1 . r=%j 1�0(21111vymu u%j (Low Rrofde -Heavy Service) Length 1NNpyd��gh Hei h4 Invert Weight o 611 1Y z0" !6491 2570# 3" :l } 1 I ConGMIS 4= PSI 28 days SWW Rdrtf u� AS TP&f�d 615-&8 I TOP VIEW 3 fe 4" PERFORATED PIPE CAST IN PLACE 4" SIDE VIEW INVERT END MEW 39 PADANARAM ROAD PHONE: 203 - 743 -5559 DANBURY, CT 05811 1- 300 -247 -5559 FAX: 203- 790 -7011 20" Gooey-HS Page No. of Pages " James Gagiiardo Excavating Conte LTD. 37 Game Farm Road Pawling New York 12564 Photon /fax 845 -855 -3573 C) /y- 40 3 --gon PROPOSAL SUBMITTED TO n #elq M �ePr= . Y'v sh �,„.�r�•. PHONE �yf- �s�'3s�7j DATE C7��27_�,o /y STREET JOB NAME CITY, STATE and ZIP CODE �s r er),o1 JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ff /i an r.................................................:... �``............... ........................................................................................../ ............... ............... ..!..... ............................... spy, � r..,w.u�k� ................................................................... ............................... ................................................................................................................................... ............................... i J .......................... 3. 3........._ ....... ............................... r g�,y ,ry r e �rwNS�� 'i � �(�Y,y � }'�� `., "�^"�f�"�Yr..S.a�i J"' ...... ............................. ....... .............. ........... ....................... .................... MLt ✓ II�' b v��.LS.n. �a�1� b`�"� aW"£$ � 5}Tx. W `q��'$4i*� "`�f'.-dYyi'ce�L�7,S� Yw�`S ....... ........ ................... ......... .......... /................................ 4 a U: "`'� t �J............................... ,. "ij 1 ....._ ..... . . .. ........... y..._ ? a*�3,, a 'a°k ,�`.,r '.( ...........................d... .................... t /..................................... ............. ......... ...................:........... ..................... .........:.............:....... ........:.. .............. F ........ ...............:......... ... �..... ..:............... ............ .. ............. .. .............. .... .. ,....... ,....... ... ......... I ..... ............................... ... ..... ........................ ............ ................ j ............... ....... .............. ............ . ..... .................... .......................... ............................... ..................................... ......................... ........................... . ........... .............................. ............................... ............ ........... .................. ............... ............ ....................... ....................................... ......................... ......... .................. ..................................................... ........... ... ................................................. ........................... .................. .................. . ................ ............._...... .......... ............................... L........:............................................................. ...............:............... ............ ..................................... ..kG...._w.....��1 _ V ....................................................................................................................................................................... ............................... . ,,,,ccam� 1 � �% )............/..'. P� .3 FIF P 11r apairr hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: s d' L/ X',? �✓!'%7 l� Grq�� y� /�d ✓� dollars ($ ) Payment to be made a follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Authorized involving extra costs will be executed, only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us,if not,aceepted within Arreptunre of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature days. PUTNANI COUNTY DEPARTMENT OF HEALTH DM- SIGN OF EINMONI�IENTAL HEAL-TH. SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATivIENT SYSTEM 233 Owner: Ur© Address 4(x1/1�aA Located at (street): 3 ' �� �i�Y. "/ , �� TMI .4 Section25Block 2'. Lot 33 iVI traicipality: �c -�7�s 4'� Watershed: e A .! 9 6fer—a:-f^ _ SOIL PERCOLATION TEST DATA 11 LD� Witnessed by: _OL Date of Pre - soaking: 3 ill �o '"'� Date of Percolation Test: 3130 l2. Hole i<io. Rua No. Time Start — Stop Elapse Time (mina Depth to water r from m fro ground surface (inches) Start - Stop Water level drop in inches Percolation Rate thin /inch I i l'- !' -7 k1 -Z1 wl .311 Z l,l" 4.11 3 v L4 "— 11 3 %1 �o 3 A y1 - L °i I 30 t 11, 2 311 j 4 I s I Z 3 4 I 2 � 3 f 4 s. 3 j 4 I 5 Notes: t. Tests to be repeared at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < l min for 1 -3Q miniinch, < 2 min for 31 -60 miniinch). ,ill data to be submitted for review. 3. Depth measurements to be made from top of hole. Form DD -97, pe i of'_ TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE # HOLE # HOLE # HOLE # HOLE P G. L. 0.5' 2.0' M' 3.0' 3.5' 4.0' �w�ber 4,5' 5.0' l.rxn 5.5' c.►�c1� 6.0' 6.5' ... 7.0' 7.5' 8.0' 10.0' Indicate level at which groundwater is encountered ore Indicate level at which mottling. is observed NLJ y6rv&r Indicate level to which water level rises after being encountered AAA Deep hole observations made by: KAD L Date Design Professional Name: Address: Sipature: Design Professional = Seal TEST PIT DATA DESCRIPTION OF SOI "'S ENCOIINTERED IN TEST HOLES DEPTH HOLE # HOLE # HOLE #. HOLE # HOLE # — G.L. 0.5' 1.0' (�`S 2.0' 2.5' 3.0' 3.5' �-afgc 5�5 4.0' 4.5' 5.0' �- 5.5' �7anc� 6.0' 6.5' ' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered fVore Indicate level at which mottling is observed ,Lsp-rV " Indicate level to which water level rises after being encountered n11h Deep hole observations made by: SID L Date �t3� �Z Design Professional Name: Address: Sigaature: Design Professional = Seal PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION 'a3� �� ,r /%r TOWN F,17.6 7 TM # OWNER'S NAME 4 712�1 PHONE # MAILING ADDRESS sQ�c PROPOSED CONTRACTOR /INSTALLER PHONE # ADDRESS 77 9�. /c,", x� REGISTRATION /LICENSE # Re son for exploration: failure to surface 0 back -up in house find limits of system for repair 0 other (explain below) / Inspector's Signature & Title Date Appointment Date: Time: kly:excel:septic