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51.14 -1 -15
BOX 22
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICE
S
PROPOSAL FOR SEWAGE TREATMENT SYSTEM R
�73'7�y -. lac'
YES NO Internal Use Only PERMIT Z
❑ Repair Permit issued in last 5 years R'elegated Ot in Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION j Na! 17J Vlkw IN TOWN V,71iey TM # 51-
OWNER'S NAME "n m 5; � N A.-1 PHONE # 5"26—C447
MAILING ADDRESS 3 nfv Ark yid f,N . PK hv," ylctg:7 AI y ro y
APPLICANT _ it o% S Iry gnl
Name & Relationship (i.e., owner, tenant, contractor)
IS-6oe-
DATE FACILITY TYPE ASI OLI 7�t. PCHD COMPLAINT #
PROPOSED INSTALLER ReSJA Mra��g !t C'i� S. LCt %BONE # '-� % S- (o'll� X 1 I�
ADDRESS L RC� Cd REGISTRATION /LICENSE # -22 A-J - 67f6,;P,
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.
Jr
I, as owner,agree to th conditio stated on this form
SIGNATURE TITLE 62 W I? Fk"" DATE L
(owner)
1, the.septic installery.agree.to comply with tl-� ; onditions of this Permit for the septic system repair.
SIGNATU LE DATE ((�
(installer) ^�
Proposal approved with the following conditions:
'11. 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.
INTFRNAL USE ONLY
Proposal Approved Proposal Denied ❑
6Z t'1 3
In pector's Signature & Title YaW Ex ration bate
,Repair proposal is in compliance with applicable codes' Yes l� No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
Putnam County Department of Health
Division of Environmental Health Services
SSTS Repair — Final Site Inspection (� � 1 I 1 p � R i ,
Date S Inspected by: MIL Installer:
. .. Crvc_� *_ ^.G(,�rl, c.�.'i<_.�J= :er.�__� rte¢ ..fJxmer: -, r... +an• _._•;.• i; -: ii •,r ..... ,....�. , ..._
' y
Repair Permit#. TM Town: #
1. . Type of System: Conventional ❑ Alternate ❑ Comments:
2. Septic Tank eN,
Yes
No
N/A
Comment
a. Septic tank size — 00 .. 1,250... other .....
lock
of ins ��
AML
ion.
b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
/
V
L�c0.
Con
d. Distribution Box
i. All outlets at same elevation (water tested) ...
ii. Protected below frost .............................
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box — properly set ...........................
f. Trenches
i. System 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 1/4 - 1 '/z " diameter clean :........
_ . vii., Depth of gravel in trench 12" minimum .........
viii. Ends capped .... ...............................
g. Pump 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
pfe. eX, Tk ot-I%-
0. o e-
4. Overall Workmanship
a. Boxes properly grouted and installed correctly ...........
V
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: 6 n S h o,.i-' � not
I jj /1 y n
Q. l
RFSI Rev - 011312
Ct' 2 b2t� S item Co��t� 1,0T �� �/1S�r2c�2� e to o c� D(V �,�bfts 0.S pt r (�
' 1 l j 0 l 7�
N\ -L _i or�trLS o(�L�S. i�� c,`o� d12c�. °2c,� �,� �c.��'C�i�� SystQrr� Mc�Q 2ltUt p,"0 r
_........._'_.-_..._._......._......_..... .._._..--- ....._._.__._..._.._.
10 e-
44.72, S W5070"W
1pr
ti
n
17 1 SCpliC Approx. location
of' existing septic
tank
0
Approx. location
FA of exi.-Stin:� house
Ct
t
Approx. location
of existing well
Al
r�,w
4107, d ,
1 013 1 W N15*501201111
..........
.331 51.88'
................
Z,
OWNM-
Timothy Synan
3 Northview Jane•"k
Putnam Valley,
N.Y. 10579
Tax map # 51.14 -1 -15
It is a violation orinw for any pam.n, unless he or
PROSIX31 F"If
she is acting under the direction Qra licensed
Prollossional engineer, to after any item in any way or
7NAN
(his plan. If any item bearinthe snioraiiengineer
is altered, the altering engineer shall affix to the item
Information on this plan his or her seat and the nowion."Altucd By"
Tour -j up Pq-rKA.*.s Vm-rry
provided by Owner
lbilowed by his or her signature and the date orsucl,
M,M M�X
alteration, and a specific description oflhe afteriviion.
'(4/ =:.M�L
. I 11-3& 1 " FA� .4 1 =1
S EP -1 9-200T 10:18AM FROM- ENVIRONMENTAL HEALTH 8452787921 T-365 P-001/002 F-840
SHERLITA AMLER, MD, MS, FAAP ROBERT J. BONDI
Commissioner of Health County Executive
LOIiETTA MOLIN'ARI, RN, MSN ROBERT MORRIS, PE
Associate Commissioner of Health Director of Environmental Health
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 16509
REOTMST FOR FIELD TESTING
All information below must be fiffly completed prior to any scheduling. DATE
]ENGINEER OR FIRM: PHONE #;
PERSON TO CONTACT:
❑ NEW CONSTRUCTION J REPAIR PROGRAM ❑ ADDITION PROGRAM'
RE ASON: DEEPS:4P' PERCS; PUMP TEST-. ❑
ROAD/STREET;
TOWN: TAX MAP #;
SUBDMSIO.N: LOT
OWNER:
NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING
YES NO
(3 Proposed. SSTS within the drainage basin of West Branch or Boyds Corner &
Croton Falls Reservoirs.
❑ Proposed SSTS within 50:0 'feet of a reservoir, reservoir stem or control like.
❑ a Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
* n*-,- ]Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required,
❑ Proposed SSTS for a Commercial Project.
It is the responsibility of the design prefessionail to provide the above information prior to soil testing. The
Department will determine the NYCD]EIP project status (Joint or Delegated) based on the response. If you
answered yes to any of the questions, NYCDEP must witness the soil tests. This Department will Coordinate a
mutually suitable time for field testing with the Design Professional and NYCDEP.
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil tests, it Will be the sole responsibility -of the
design professional to schedule re-witnessing of the soil testing with NYCDEP.
C LINTY USE. ONLY
DATE. ?2 TIME: ZZ111 0
COMMENTS:
En-ireumant2ilRoulth (845)27"130 Fox(945)278-792i
Water Supply Stwfinu (845) 225-5196 Fax (945) 225-5419
Nursing Services (945) 278-6558 Fax (845) 278-6026 WIC (845) 278-6678
Nursing (come Care 'Fax (945) 278-6095
Early (riterygation/Preschool (945) 278-6014 Fax (945) 278-6648
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PUTNAM COUNTY DEPARTMENT OF HEALTH
1VISI(EIN--OF ENV.1R.ONME_NTA-,TALL- :H.EAR TH, - RY WEE S:_�a..r..._.
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner 7-1 01 S tf /1.t) Address .3 Nv? r'7t V,'L -v L14-le
Located at (Street) 3 NaP r`71 Drew c.4wC Tax Map S /.1Y Block 1 Lot / S
(indicate nearest cross street)
Municipality Wit t t7 Watershed N %r
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Date of Percolation Test 312 z %/ Z
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation
rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30
min/inch, <_ 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
Pg. 1 of 2
Depth:to Water
Water `
From Ground;
Level
Perco A.jon
ole
Run l�io
Time
Elapse Time
(Min)
Su .". rface Qnches:
Start Stop
Drop In
Inches;` `
Rate
Mn/Inch
Na
Start -Stop
1
/ /s/sf
y,,
,Z �S
�;.
2
1. SS /Z -2S
3J
/2 13
/ a
�G
4
5
2
l:O'L{ 3
lz !s
3
3
3
3 / /2Z
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation
rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30
min/inch, <_ 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
Pg. 1 of 2
:::.- �.'.:...: v.. w. 4•__ �. �vw .n.w.i4.....e.✓:hl:r4•.u4dal. Nib.' iii. b] ivw• 4, v: blAaJl i. LruJli4bR4tlY4rfJV• I:+ LL: llw'. 1LW1 KJIe »:iYlGhrru...r.aUJ.i�.ttWTi[ fires' r: itia{. v.. v�..• Yiw... uMU.. lruw• wst_ u..l Ja ]4w:r.'N4W�a.nJ_a•v...n..�...nw � .vu.�.r: ,.LL.n J.- w�V.r. •. .•.�.u..x.. N.+usWL.Jrouw.
�,.�:._ ,.- ..,,a:...J:. »-,..v,::y',_ � .... ., -' ,. .�. .. .. ..•, ia� '3�c�i�! ° °- c•�= T».D ^I':T�i.�. .. ....,.,. :...._..�.., _. � ... "._ - .:]. ..,... -..... .w:- .. _.
" D DS CRIPTI FASOILS-1-I'VC 6L� "= ti—TE ST- fCS —_ ..... _ ... _ . _ _ ...... _.......
TTE-REITI;
D ? i- CLE % HOL= = _ HOLE N H0L 4 HOL
G.L.
1 w
2.G' >✓�� Sa d�
2. w % c
3.S
V,. #AOL
7.01
Q_ -
1G.G'
Lndicate !evel at which ff-oundwater is encountered A/r7�c,1f-
Indicate level at wbicn -mottling is observed
Indica-te Level to which water level rises a:-,--r being --a-countered '
Dee- bole obse_ Yatiors bade b 6. 1 -P L H Zi .Date
DesiJ_: Professional Na ml--.
Ad', d re ss:
c ,
� i gn atz,e:
- p ENGINEEMING
w ...r._, ._.. µ...n..
.. . QirOjp
`�
1222 F1.&TBUsH 1$OA1D
KINGSTON, NEW FORK 12401
(S45) 331 -5290, E -HAM 1RG1EFPE ®A0L.00M
December 21, 2012
..Mr.Gene Reed .
Putnam County Health Department
1 Genevia Road
Brewester, New York 10509
Re: Septic system repair/ replacement at 3 North View`Lane. applicant Synan
i� Town of Putnam Valley
Dear Gene:
I conducted a construction inspections for the above referenced
replacement sewage disposal system on July 7th 2012 and an 'inspection of
the water meter on November 30, 2012. The inspections revealed the
following:
The septic tanks :connection is slightly different than shown on the
plans. Please note that.the distribution box was installed on. the opposite side
of the system. The attached as -built drawing shows the orientation.
;.:..:..The _.planted grass was not established to the- construction. area and:
grass must be established and toutinely cut. The seeded area must be
inspected after each rain event until the grass is fully established and does
not washout. If the. grass. does not .establish a proper cover then the area must
be stabilized -in a different way..
n ..z 'o +ter o
i ha Yv ata. lalV vVl .%ilV Nld V V •a V VLl dlY da� 1 '.l 1a r YK14� L V 7�M{.�•a
usage and water should, be conserved to not exceed the septic system design
capacity of 130 gpd.
Based on my inspection, and the above items completed, it is my
opinion that the construction of the absorption system appeared to be
otherwise in general conformance with plans approved by the Putnam.
County Department of Health of the repaired/ replacement system. As
always it is understood that repaired/. replacement systems that ¬ meet
the county standards such as: this repaired/ replacement system cannot be
,..
guaranteed or expected to;function as4new`system that meets the standards.
- `Sincerely,
d y Robert G. agopian, P. E.
1/04;
0
0 2
5
2
5 V4
3
R.0.
-13 a i z- 1-
A
B
1 (septic tank inlet)
i
i
0
0 2
5
2
5 V4
3
R.0.
-13 a i z- 1-
OWNER. 6 (end of lateral) 11.5 9
Timothy Synan
3 Northview Lane 17 (end of lateral) 1 8,12.5
Putnam Valley, N.Y. 10579
Tax map # 51.14-1-15 REPLACEMENT SYSTEM DESIGN
It Is a violation of law for any person, unless he or THIS PLAN DOES NOT MEET CURRENT STANDARDS.
she Is acting under the direction of a licensed
professional engineer, to alter any Item In any way
of this plan. If any item hearing the seal ofan HA.Gopi&N ENGINEERING
engineer is Altered, the altering engineer shall affix' 1222FIATBUSH RD. KEqGST,014 NY, 12401 (845) 331-5270
to the Item his or her seal and the notation,
---PRCRIIOSED-PROJ-ECT-IFOR.....
_9rAer signature said the d&'of,
such allbkn on, apg a specific description o tK4.
TOWN OF PUTNAM `ALLEY
Tbpogrophy and locations on this plan were not
taken from a survey but was created by field
rntmsurcrpent. Contour datum was assumed. SHEET No.
DATE
AS BUILT
Property lines are estimations from deed plot 1 of IL
A
B
1 (septic tank inlet)
19
' 6
2 (septic tank outlet)
. 22
12
2 (distribution box)
26.5
19.
4 (end of lateral)
21
19.5
5 (end of lateral)
19.5
21
OWNER. 6 (end of lateral) 11.5 9
Timothy Synan
3 Northview Lane 17 (end of lateral) 1 8,12.5
Putnam Valley, N.Y. 10579
Tax map # 51.14-1-15 REPLACEMENT SYSTEM DESIGN
It Is a violation of law for any person, unless he or THIS PLAN DOES NOT MEET CURRENT STANDARDS.
she Is acting under the direction of a licensed
professional engineer, to alter any Item In any way
of this plan. If any item hearing the seal ofan HA.Gopi&N ENGINEERING
engineer is Altered, the altering engineer shall affix' 1222FIATBUSH RD. KEqGST,014 NY, 12401 (845) 331-5270
to the Item his or her seal and the notation,
---PRCRIIOSED-PROJ-ECT-IFOR.....
_9rAer signature said the d&'of,
such allbkn on, apg a specific description o tK4.
TOWN OF PUTNAM `ALLEY
Tbpogrophy and locations on this plan were not
taken from a survey but was created by field
rntmsurcrpent. Contour datum was assumed. SHEET No.
DATE
AS BUILT
Property lines are estimations from deed plot 1 of IL
6
H &G®PIAN ENGINEERING
.. r .....:.. -,.
lit6iiiaif G. AtaOP�ANf P.�i• -.. ..... , .
GS2 FAST CHESTER ST.
KINGSTON, NEW YORK 12401
(S45) 331- 5i17.9, E -MAM RGHPE ®AOLCOM
Mr. Gene Reed
Putnam County Health Department
1 Genevia Road
Brewester, New York 10509
Re: Septic system replacement for Timothy Synan
3 Northview Lane, Town of Putnam Valley
Dear Gene:
Please find attached the following:
1. An application fee of $ 165.00
2. Application for approval of plans
3. A Soil Percolation Test Data form
_.4. Three copies of the proposed design
If you have any questions, please contact me.
April 16, 2012
Sincerely,
10/Z
Robert G. Hagopian, P.E.
. PUTNAIVI COUNTY DEPARTIAENT OF HEALTH
DIVISION OF ENIVIRONNIMENT-Al HE-A-LTH SERVICES
DESIGN DATA SHE' ET -'SUBSLqUACE SEW. GE TREATtiIFNT, S ST I -EN f
Owner: Address:
-3
f
Located at (street), TM M" Section:
— Block Lot
iy[Unicipality: -PV4-%4-W%' \1aHe4 Watershed:
SOIL PERCOLATION TEST DATA
Date 'of Pre-soakin;
Witnessed by!
Date of Percolation Test:,
Hole `+o,
Rua Rio.
Time
Start—
.Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
hes-)
Start - Sto'p
Water
level drop
in inches
Percolation
Rate
min/inch
2-
.3.
4
2
4
—2
4
2
4
Notes:
I T-q7c fn ie-
Indicate level at which groundwater is encountered
Indicate 1eve1 at which mottling is observed A/ Z�,V C .
Indicate level to which water level rises after being encountered
Nlq
Deep hole observations made by: 6"J f X CT� o Date 3 /2., //1-
Design Professional Name: Xo/ -?tnr- /dln-6 -,.!✓
Address: .12 Z 2- F�A-rXg4 ski 2,
Signature:
Design Professional's Seal
TEST PIT DATA 2
"
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
G.L.
0.5'
1.0
- �i
1.5'
M E'fl l 4 .N %3 �� ti✓
2.0
& S A v0
2.5''
'fnA 67 rn�s1cr Cc
3.0'
3.5'
4.0'
4.5'
/Zo C-K
5.0'
5.5'
6.0'
6.5'.
7.0'
7.5'
8.0'
8.5'
. 9.0'
.............
'10.01
Indicate level at which groundwater is encountered
Indicate 1eve1 at which mottling is observed A/ Z�,V C .
Indicate level to which water level rises after being encountered
Nlq
Deep hole observations made by: 6"J f X CT� o Date 3 /2., //1-
Design Professional Name: Xo/ -?tnr- /dln-6 -,.!✓
Address: .12 Z 2- F�A-rXg4 ski 2,
Signature:
Design Professional's Seal