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HomeMy WebLinkAbout2229DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -27 BOX 19 02229 � }Ll .` KL '1 02229 � }Ll PUTNAM COUNTY HEALTH DEPARTMENT `� w � v Q� DIVI ION OF ENVIRONMENTAL HEALTH SERVICES k W ��•1� PRO OSAL FOR SEWAGE TREATMENT SYSTEM REPAIR :... YES Internal Use Only PERMIT- ,O ❑ M Repair Permit Issued in last 5 years LJ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION . . OWNER'S NAME MAILING ADDRESS APPLICANT 0 ASS Z ©g /� •- II Name & Relationship CLe., owner, tenant, contractor) DATE p c_: 7 . ZO 5 7 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER Q ' l ^ti IG ^ E C- a I ga f_C - - PHONE # &e-1 2- •-S5< ADDRESS 1-kW /Gk'r E: I3IWicr REGISTRATION /LICENSE # f,?eTOW N tom. 46 Not in Watershed El Delegated ;`� ❑ Joint Review ' r M # PHONE #.�` Pro osal (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. ti ' h%U%,.,a .r /off /�-Zu .:_�.�4l�ukr� Coy/t:'e'P //wr!i�/ 3/y �i 0 _iO 'i / A i i?t� .e f %1• - u n d �� �� , y Q� ask &J0.L GrA / /�i� �'r I, as ovmer,agree to the conditions stated on this form SIGNATUR / / / TITLE OW�er DATE / C7 (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair TITLE DATE­',/6-/T/C-) `� t�. pnstalar) Proloosd approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Suirnission 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.lnstallers' name and phone number 3. Stem repair to be performed in accordance with the above proposal' and conditions 4. Th proposed SSTS repair is considered a best fit design and there is' no guarantee to the duration at which the cmpleted SSTS repair will function. 5. N completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Signature & Title is in compliance with CCaPS: PCHD; Owner; Installer PC —IP 99ML Proposal Denied codes Date Yes 0 Expiration Date ❑ No ❑ Rev. 2/07 Gt /J /n7 A s �eJtL� r �iV lz A\/ c) t-AT PLAN �l S I o 4� -.333, 21. 4� -.333, a it . N I Igo", k ` i t !1700 f � L. ��-' ;r:;C• �,� �;<_ � r icco 601L r o <rz ► nc, ---: vim. LY P Fl L1 ❑ ❑ PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Intarrial Use Repair Permit issued in last 5 years Repair within Boyd's Corners, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC - mapped wetland nconfil 7 l X-131* \.. . Not in Watershed ❑ Delegated ❑ Joint Review SITE LOCATION / G ��t <I��V le OWN �yl %�� lKa //G TM # �� OWNER'S NAME ASS ,-6/ PHONE # -061S- ?-14/ S:�Z MAILING ADDRESS ©U , ri vC, APPLICANT D o w X CG ��- -o t - Name & Relationship (i.e., owner, tenant, contractor) DATE 7, Z 6 7 FACILITY TYPE 11-161;71k, PCHD COMPLAINT # PROPOSED INSTALLER; (j'Pam. IG Vt r,,e6 Va-4 Cry- PHONE # 2-Y ' -f 76 d ADDRESS Aj, kR ! -Ore� .L 4 t3 /- icr REGISTRATION /LICENSE # 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. .:�rn5fc:c(i A ,UUykgr.r O-r H -Zt7 4_&A�u,f�i�'S �Clo�yt �.' u. �. 3yi�s<f,�i e.Xa ,J. i i4.J Jr a ? i" i � ZC e a4G' . ms, 9t *y /'nc vt Gwen lcAZ1l a''i n I, as owner,agree to the conditions stated on this form . SIGNATUR TITLE Drier DATE �C7 (owner) 1, the septic installer, agree to comply with.the conditions of this permit for the septic system repair SIGNATURE--- TITLEr�QS (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 Insbector's Signature & Title r oroposal is in compliance with COPIES: PCHD; Owner; Installer PC -RP 99ML Proposal Denied ❑ A-00 /0 O -7 Date codes Yes `qo Expiration Date ❑ No ❑ Rev. 2/07 M ct ........... 0 PC) s .6'', Aug 16 07 07:14a BUILDINGG DEPT 9145268806 p.l PET # TOWN OF PUTNAM VALLEY COMMENCE WORK PERMIT APPLICATION OWNER >'� OCi� S� /� �� ✓c:. T.M[.#�� MAILING ADDRESS , Z (b A e -/L C tic . PHONE 9 9 = Z Zy— %j � LOCATION OF )_ PROPERTY J?_ [�� IC �'� !� F_, vti NEAREST INTERSECTION �T �� �NO✓G %2D SUBDA(ISION ZONING DESCRIPTIOI�OF CONSTRUCTION N EST. COST ��- 00 0 I,� �G , do hereby agree that the Building Code will be complied with whether thi e same is specified or not; as well as the Sanitary Code, Plumbing Code and any other Law, rule or regulation affecting said structure of building. The Inspector shall have the right to enter any premises during the daytime, at reasonable hours, in the course of his duty. Alfl work shall bg'acrformned in accordance with the construction documents submitted and accented .as part of this agalication, unless changes to those documents have been aparoved by the bode Enforcement Oiiicer responsible for enforcement of the coded 1, the owner, will be responsible for any and all outstanding Town charges including town consultant fee, o fated with this permit and payable to the Town of Putnam Valley. i(EM7AL) Temipoi'ary.'san tart' ffficil ties must be supplied uatiD permanent sanitary Tacilities are operational per Section 311 of the N.Y.S. Plumbing Code. A copy of the receipt for the portable sanitary facilities or a written acknowledgement from owner that the sanitM facilities are availab c in the existing structure during construction is being done under this permit. QIIV1'1'lIA►I�) DATE: yc- 7 �C.b caner or Agent) I find plot plan to conform to the Zoning Ordin es of the Town of Putnam Valley and hereby approve same; subject to further approval and compliance with the requirements of the State Building Code and the Sanitary Code of this Town, Plumbing Code, as well as any other law, rule or regulations of the State, County, Town or Bureau or Department hereof. DATE: BUILDING AND ZONING INSPECTOR Chapter 155 - Section 155-6 — ResidentiaR $50 Commercial 5100 Rev. 1/29/07 i I JAN -8 -2000 16:09 FROM:GABRIELLI TRUCK SALE 718 994 1567 TO:919142778278 P:1/3 AUO -31 -2007 11:25AM FR0M- ENVIRONMENTAL HEALTH 946278T921 T -208 P, 001 /001 F -178 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT PR0P0SAL F3_ XPL0RATI0N OF SEPTIC SYSTEM FAI,�UR� All Information below must be ijy completed prior to any scheduling SITE LOCATION OWNER'S NAME MAILING ADDRESE eia sJ.?. Tnw►v h! �a,.,n ►i TM # gWo .5— 1—n t I I PROPOSED C ONTRACTOR/INSTAL LEFT C« l!✓ ,� X -C PHONE # AODf�E,S$ //� dli�►^iD.SC/%/ �lE" G%� Fi 'RGI6iRAT10N NCENSE # �3 d �,DU for exq oration; iurn to sunset; 0 back -up in house 13 find Iimits0 of ". am for repair A other (expJain below) kly:excel'septic I JAN -8 -2000 16:09 FROM:GABRIELLI TRUCK SALE 718 994.1567 TO:919142778276 P:2/3 Aug 16 07 07014a BUILDING DEPT 9145268808 F.1 MMY OF MUM YA 3- MAR,WG ADDRESS � Z, Cb 4' D- /J ✓I tip p'HONE # 9 —5�~ LOCATION OF PROPERTY NEAREST INTERSECTION. /P SUBDTWSION XONI Q DESCRIPTION OF CONSTRUCTION EST, COST I, _ , do hereby agrco that the Building Code will be complied with whether the same is specified or not as well as the Sanitary Code„ gWMft Code anal any other Law, rule or regulation affecting said structure of building. The Inspector shall have the right to enter ano proaaises wring the daytime, at reasonable hours, in tho course of his duty. All.-Worg Aball be Wir9 Med in _accord2R,&,e with the_mm—c on doeurarerx s mitted and gggggigd-as ggri gf,thr,�a a=opliU n galm cir Qer to those documMM hat been aonroved v the Code arcemgg4, Q k9g reApg able ft W&MMent _uf &eon& L the owner, will be responsible for any and jaiu outstanding Town charges including town consultant fees iwtki with this permit and payable to the Town of Putnam Vaft. ....1.eneprary Wi tsry WHAW most- be supplied until peamanot operational- . per Section 311 of the N.Y.S. Plumbing Code. A copy of the receipt For the portable sanitary Paciiitaes or a written acknowledgement from owner that the sanitary facilities are availab e im the eiisti0g structure during construction is being done under this permit. ( TI DATE' (Owner or }.gent) I find plot plan to corYorrn to the Zoning Ordinances of the Town of Putnam Malley and hereby approve same; subject to further approval and compliance with the requirements of the State Building Code and the Sanitary Code of this Town, Plumbing Codo, as well as any other law, rule or regulations of the State, County, Town or Bureau or Department hereof, DATE: BUILDING AND ZONING INSPECTOR Chapter 155 - section 155-6 — Residential $50 f ommerCIAD $100 Rev. 1129/07 i JAN -8 -2000 16:10 FROM:GABRIELLI TRUCK SALE 718 994 1567 T0:919142778278 P:3/3 PUTNAM COUNTY HEAL I ht utrr'+n I iviL-ie DIVISION OF ENVIRONMENTAL HEALTH SERVICES I PROPOSAL-FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Oply Li l._) Repeir Permit Issued In last 5 years ❑ Not in Watershed U L Repair within Boyd's Comers, W. Branch or Croton Fall$ Ras, C7 Delegated ❑ ❑ ReOelr within 200 R. of a watarecurse or DEC - mapped wetla'nnd ❑ Joint/ Review A4 SITE LOCATION TOWN rr, G TM # OWNER'S NAME PHONE #V /,S- MAILING ADDRESS 061 &2, c, -i -e- APPLICANT Name Relationship (i.o., owner, tenant, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS AEGISTRATION /LICENSE # ra osal (include a separate sketch locating the house, property lines, all 0djacent wells within 200 feet of repair and the location of existing and proposed System) NOTE: The Department may require submittail of proposal from licensed professional depending on the nature and extont of the repair. I, as owner,agree to the conditions stated on this form r i. r' SIGNATU1115; •( ,� •��� �,,,w � TITLE OWAW DATE L/6 (owner) I, the septic installer, agree, to comply with the conditions of this permit for the septic system repair —SIGNATURE TITLE _ DATE (Installer) - RWMLE p _Md tC%b e f41 °wl o 1. Procurement of any Town Permit, if applicable. 2. Subml.5slon of as buiR 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 t bmponerits tied to two fixed points c. System description (e;g., 12.50 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 a. The proposed SSTS ropair 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 authorizatlon to do so has been obtained from tho Department. INTERNAL USE ONLY Proposal Apprmd I EJ Proposal Denied ; 0 Signature is in COPIES: PCHD: Owner: installer PC -RP 99ML Date Yes El Rev. 2J07 TRANSMISSION VERIFICATION REPORT TIME 09/06/2007 08 :50 NAME CLEARWATEREX FAX 9142778278 TEL SER.# 000L6J193517 DATE DIME 09106 08:50 FAX NO. /NAME 18452787921 DURATION 00:00:37 PAGE {S} 02 RESULT OK MODE STANDARD ECM 110 HARDSCRABBLE ROAD NORTH SALEM, NEW YORK 10560 91.4 -277- 3703* 1 -800- 535 -6976 *F, 0911.4 -277. 8270.. _..._...... .. :. :_:..:.:_� FAX: 914- 277 -8279 [m- 0 �Y o COMPANY c l DAT E o `F /o/'0 NO OF PAGES: -- =,? — 9 CLEARWATER EXCAVATING CORPORATION 110 HARDSCRABBLE ROAD NORTH SALEM, NEW YORK 10560 914 - 277 -3703* 1- 800 -535- 6976 *FA.X :914- 277 -8278 FAX: 914277 -8278 TO: COMPANY: FROM: gee �1.�ii�o• DATE: NO OF PAGES: COMMENTS: 111 00 r.s;lzw Please call 914 -277 -3703 if you do not receive all the pages indicated above. lz �,G �C�c— �2 `o7 I _Alr _ PVM.. e. ? 44,1 4m. I s ri, % Fl gl-,P + &)( p pjA p Q o::F �SP�,it 0 r� P DtZs7o 7 Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES / FIELD ACTIVITY. REPORT yf ! - 2.7 POrV441 Street Town State Zip PERSON IN CHARGE QR TNTF-RVTFWF. old 2 Name and Title TYPE OF FACILITY :$'�S y CT kin TAV_`C• J2 V re 2,� •(J . �� L i4 2 ld.Zli'l 2 �llC'+ . Gv) L L rj GE PUS A AP,4 LIZ- I acknowledge receipt of this report: SIGNATURE; 02/96 Title: Rev. 11/ PITI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner gg Address A�- &WX14i9' Lr Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality PerAl, Al k�2Z� Y Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 1 6i 1 2 3 4 I 1 5 1 1 1 i NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 09/06/2007 08:50 9142778278 CLEARWATEREX PAGE 01/02 CLEAR WA TER EXCAVATING CO "O."TION 110 HARDSCRABBLE ROAD NORTH SALEM, NEW YORK 10560 91.4 -277- 3703* 1 - 800 - 535 - 6976 *FAX:914 - 277,8278 IFAX: 914..277 -8278 TO: COMPANY a- C FROM: 90e I 1 DATE: ' 9 /,O"!© NO OF PAGES:, COMMENT'S: please call 914 -277 -3703 if you do not receive all the pages indicated above. 09/06/2007 08:50 9142778278 CLEARWATEREX PAGE 02/02 OKI -8-dO 0 16:619 FR0M!rASIa.1RLLI TRUCK SnLE 710 994 1561 IU:919142778278 P:1/3 AUM102007 11:25AM FR0MMVIR0NMENTAL HEALTH 6�tG276T981 T -806 P.D01lAQ1 1�F79 PU'TNAM COUNTY HFALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HFALTH SSMVICES THIS IS NOT A REPAR PERMIT PROPQ QIMIN M. V�iE ®IrCa Ma A6@ Informs0on below must �* ft & campleftcl prior to any sch daslIng SITE LOCATION el-� OWNER'$ NAME MAILINO A®DASSS 10I.M. TOWN A TM ,r 1 �� Y /6? tn I P'ROPOSIED CONTRACTOR/IPISTA1 -ER C'ZlWeganC FK ['PHONE # g� -.°, .� , - I ",UkM12t10-6=xUrMcMft hgdt-Up in hOUSO 0 Ind 11MRS IN q*@M ft� FePalf 0 0th3F ("PJAIn below) kiy:e=1,sepflc i I I