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HomeMy WebLinkAbout2227DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -22 BOX 19 1 rrum I No &oil �Vft ,. 'r Llr � T J r- IL L a I 02227 i I PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 10 / Internal Use Only PERMIT # ❑ E Repair Permit issued in last 5 years ❑of in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Lid Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 48 Oak Ridge DrivTOWN Putnam Valley TM #41.5 -1 -22 OWNER'S NAME Dennis Ast ro 1 o PHONE # 914 522 -59A7 MAILING ADDRESS 4EFOak Ridge Drive, Putnam Valley, NY 10579 APPLICANT nenn i n Act -n l nnn 'Name & Relationship (i.e., owner, tenant, contractor) DATE 419M4 FACILITY TYPE Priv Dwell in9PCHD COMPLAINT # PROPOSED INSTALLER J Mantovi Excavating, Inc PHONE# 628 -4526 ADDRESS 485 Kennicut Hill Rd REGISTRATION /LICENSE # 126 Mahopac, NY 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. Keprace 5veei tank with 1000 gal. Plastic or cement tank same location (it ledge rock sma ler.tank will be used') I, as owner,agree to the conditions st ted on this form SIGNATURE TITLE, DATE / (owner) I,_the septic in a agree o c mply with the conditions. o this permit for the septic system repair SIGNATURE TITL DATE (installer) Pronosal approved with the followi g 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 ❑ -el /� to I &Title D e Ex ration ate Repair proposal is in compliance with applicable codes Yes 9 No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Putnam County (Department of Health BDivision of Environmental Health Services s, f SSTS Repair — Final Site Inspection '--- Date: Inspected by: 'D,',s Installer: J�4�Q� ✓�' Street Locatio © Owner: As,kz)6 V Town: (/u l r.a Repair Permit #: 2L— Uelc1— / TM # 41 , , —��— 92 1. lype or aysrem: Lonvennonai u anernate u Comments: 2. Se tic Tank Yes No N/A Continents a. Septic tank size —1,000 ... 1,250 ... other.. . . Gsl � G� �1� !✓► b. Septic tank installed level ...................... c. 10' minimum from foundation .............. T- ins�� " TUZ CG. d. (Distribution Box i. All outlets at same elevation (water tested) ... 4v^ iL ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f. Tenches i. System completely . opened for inspection ii. Length required Length installed iii. Pie slope checked ... ............................... iv. Installed according to plan .................. V. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel % -1 '/7 " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... Ends capped Pumg or Dosed Systems 3. Sewa e System Area a. SSTS Area located as per approved plans b.. Fill section — c. Distance from water course /wetlands 4. Overall Workmanship a. 'Boxes properly grouted and installed correctly ........... b.. All pipes flush with inside of box ......................... C. BackfUl 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: RFSI Rev - 011312 1 1' t 3 , a . t s A h ' j- i S ;I !Z D _ 00 NO 3�C$fi['�S�S1eBp . •�- _ __ _ -- — - - -- ,l C f I� is •I.�'�r .. y � e_ fll �•.[ it j:' €I F .. `�-� -cam, . .rte. �.. _ i '' •r..r a{ f it t i� v I �y w+ IFI . . • l 6 I3•`��tlttf�.�ctllt'ic itf i a, a J. MANTOVI EXCAVATING, INC. DBA MAHOPAC SEPTIC 485 KENNICUT HILL ROAD MAHOPPC, NEW YORK 10543 = _ 0 4's -3oJt (845) 628.4526 JOSEPH A. MANTOVO 19 B ,9e/ (845) 628.4526 JOSEPH A. MANTOVO ,mw A wr oQ 2d .,9e,� . Ail Al 1�