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Home My WebLink About2391DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42. -3 -10 BOX 21 i T Al, 02391 b ® J. MANMVI EXCAVATING, INC. DBA MAHOPAC SEPTIC 485 KENNICUT HILL ROAD MAHOPAC, NEW YORK 10541 ®4 cl� (845) 628.4 '526 JOSEPH A. MANYM yam, - r� t _ ;" -- 7 6 At 4 (845) 628.4 '526 JOSEPH A. MANYM yam, - r� t _ ;" -- i Putnam County Department of Health Division of Environmental Health Services SSTS Repair - Final Si a Inspection A� �� 1 Date: 11I1� Inspected by N1�1. Installer: T /" ^� v' ILnc W i• Street Lo W h4n: ¢ r oe Owner: e Town: �[ harp a Repair Permit #: T -1'I 8 -13 TM # �' • -3-(0 1. Type of System: Conventional 0 Alternate 0 Comments: IC t 2. Septic Tank Yes No -N /A Comments a. Septic tank size - 1,000 ... 1,250 ... o e 500 V plaAc pN.(b b4le .(q b. Septic tank installed level ...................... c. 10' minimum from foundation .................. _ V d. Distribution Box V i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. V iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set ........................... f. Trenches i. System. pompletely completely opened for inspection ii. Length'required Length installed iii. Pipe 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 or Dosed S stems 3. Sewa e System Area a. SSTS Area located as per a roved 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. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & d r to exist watercourse f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 oSEP -12 -x013 FROM - ENVIRONMENTAL HEALTH 9452767921 T -294 P.002/002 F -124 PUTNAM COLIN] Y HIMAL I ri Wcrr%r I I m&-I'm . DIVISION OF ENVIRONMENTAL HEALTH SERVICE ROPOSAL FOR SEWAGE TREATMENT SYSTEM RE g Internal Use Onlv PERMIT # R —1—I g, — i _->s, ❑ e Repair Permit issued in last 5 year's a Not in Watershed Cl Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair withln 200 ft of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION 1 Snifsa:t TOWN Uallav TM # -42, —3 -10 OWNER'S NAME Dai �+ 9 n— a,pxE'$2 13ytnne PHONE # 923_224 . MAILINGADDRESS 14 Seifert Lane, Putnam Valley, NY 10579 APPLICANT Name & Relationship (i.e.. owner, tenant, contractor) DATE X13 FACILITY TYPE pr; v flue 1 1 i n PCHD COMPLAINT # e. (S�Sf6ta f PROPOSED INSTALLER J Mantovi Excavating, Inc PHONE# 628 -4526 8,457 d a a opac Septic ADDRESS A5_Xenn intt. Will erf REGISTRATION /LICENSE # 26 Mahoppac NY Proposal (include a separate Sketc -N 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. Steel Tank eattaywed, Replace Stuel tank wtth plastic tatilk, from same location3if room, HLL LIEWL KULK. 1, as owner,agree to the conditions stated on this form SIGNATURE laoi,�I TITLE DATE a (owner) 'Cr 1, the septic ith the conditions of this permit for the septic system repair SIGNATUR TITLE T , , , DATE (Installer) Pr osa conditions: 1. Procurement of any Town P rmit, 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 bacOil� until authorization to do so has been obtained from the Department. C INTERNAL USE ONLY Pro os I Appro ed LJ Proposal Denied Inspector's Signature & Title Repair prOpoSal 19 In complixnch applicable nodes COPIES: PCHD; Owner: Installer PC -RP 99ML Date NO Rev. 2/07 Date V V : . J PUTNAM COUNTY HEALTH DEPARTMENT ✓ 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICE PROPOSAL FOR SEWAGE TREATMENT SYSTEM RE "449 'ES O- Internal Use Only PERNOT 01"R —1-1 f 3 ❑ Repair Permit issued in last 5 years a Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 14S ® i f e rt L,a M3 TOW N dam t, " °-`i TM # 420 —2— b 0 OWNER'S NAME D Exatriei _ PHONE # � ��$_ MAILING ADDRESS 14 Seifert Lane, Putnam Valley, NY 10579 APPLICANT 13 P. a e b� l�a►t r—i c-ia BrTn e Name & Relationship (i.e., owner, tenant, contractor) DATE MIA FACILITY TYPE pri y pw,,1 1 ing PCHD COMPLAINT # PROPOSED INSTALLER J Mantovi Excavating, Inc PHONE# 628 -4526 057 dba a opac Septic ADDRESS 48S Kenn i.c"t Will > Rd REGISTRATION /LICENSE # q ra�� / g rn2c 4426 Maho ac NY Proposal (include a separate t ketth 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. Steet Tank 0 9 TPrOW same location)IT room, I, as owner,agree to the conditions stated on this form SIGNATURE Araeh.41 TITLE e74;e621----0" DATE (owner) 1, the septic ' stalle , agree to coggtply with the conditions of this permit for the septic system repair 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 backfill until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Pro os I Appro ed Proposal Den' ❑ ncGfa(� I'2 ( V( dt Inspector's SignatureA Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes C No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 A I Geneva Rd. Brewster, NY 10509 Phone 845 -808 -1390 Fax - 845- 278 -7921 Web address - putnamcountyny.gov 4o: W6 P) I VA /(^ fFPomro: fFa=s: ?' S 6 2 g— Pages: 2 ,' ^mil w �� .� Phone: Bate: l l f -LA l Re: I `F Sec L&A,41 cc: 0 Uugeng 0 For Reviews 0 Please Comment 0 Please Reply 0 Please Recycle (D Comments: I'-) DEPARTMENT OF HEALTH <C Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y;. 10512 (914) 225 -3641 r V. APPLICATION TO CONSTRUCT A WATER WELL tl�V i PCHD PERMIT # /j ",93 WELL LOCATION re t Address � Town Village City Tax Grid Number P�+ A - - 1 WELL OWNER Name Mai i g Address. Private dli . rrl INV Public USE OF WELL 1.- primary 2 - secondary RESIDENT AL BUSINESS 13 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEA UMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specif Y O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED S /EST. OF DAILY USAGE gal REASON FOR DRILLING 0 0W, SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION PLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING I (ti WELL TYPE DRILLED ❑DRIVEN j ®DUG []GRAVEL ® OTHER IS WELL SITE SUBJECT T0'.FLOODING? YES NO IF WELL IS LOCATED IN;A.REALTY SUBDIVISION, NAME OF;SUBDIVISION: Lot No. n WATER WELL CONTRACTOR: 'Name :{CrScrl Address: e(� IS PUBLIC WATER SUPPLY j AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: I LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED' — O ON REAR -OF THIS APPLICATION S�T S ET r (date) , (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: j 1. Pump the1well until the water'is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County ,Health Department attached to;this permit. 3. Submit a Well Completion Report on a,form provided by the Putnam County Health Department. Date of Issue: ,3 Date of Expiration .'.- /' 19 ' ? Wbite Permit Issuing cia Permit is Non - Transferrable copy: H.D. File Yellow copy: Building Inspector 2/87 Pink COPY: Owner Orange copy: Well Driller VARVIN OVELL •.� Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT : September 12,. 1988 Mr. Robert Morris Department oB- Health 110 Old Route 6 Carmel, N.Y. 10512 Re: Byrne - Seifert Lane TM #18 -2 -13 Dear Mr. Morris: The proposed well shown on submitted drawings does not conform to the necessary separation requirements. TOWN HALL PUTNAM VALLEY, N.Y. (914) 526 2377 It should be considered, however, that a Variance under Local Law #1, 1978 had been granted with conditions by the Zoning Board of Appeals. Very truly yours, MARVIN O'DELL' Building Inspector MO'D:es ' CV rc4v - I k-lu-- fe _lam:" -e-, 5-e c Y-q