The URL can be used to link to this page

Home My WebLink About2847DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -1 -43 BOX 24 I,yL No in ... ti j ., j, �, �� „ .r . �- , or 1.6 irr 02847 7 1rh6Y IA- 02847 M 0 SITE LOCATION PUTNAM COUNTY HEALTH DEPARTMENT 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES ® (' Internal Use LJ / Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland OWNER'S NAME MAILING ADDRESS APPLICANT i.1x4Mdam.- TOWN W i" T EM .REPAIR PERMIT 74-.3 Not in Watershed ❑ Delegated ❑ Joint Review TM # 6 �0- f0-1 PHONE # J:7 X0.7 Name & Relationship (i.e., owner, tenant, ontracto DATE 00 FACILITY TYPE t PCHD COMPLAINT # L PROPOSED INSTALLER pp OC-4 a PHONE # Yi��CIO �s ADDRESS (4V D REGISTRATION /LICENSE # 1 C 30-3-74+1^1-3 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 tjle repair. % ,!J'S %A-W 144V I-OS -0 C'�+L _ ��`tiG T,+* J+uvoll A% I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) °•I; then - ,- a* orn p'Yriththe conditions =of this ermitfor!hes tip s meau_: SIGNATURE TITLE DATE l (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 backfi ed until authorization to do so has been obtained from the Department. Z INTERNAL USE ONLY Pro os A r � Ilposal Den ❑ ttt t f C�a n I O I� b �� Inspector's SiMiature & Title Date / Expiration Date Reoair DroDosal is in compliance with apDlicable codes Yes No D COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Mspection Date: i Inspected by: 0 L _ Installer: L a Ca tip n a f oCa Owner n Street Loca own: P _ t.- Repair Permit #. 1. Type of System: Conventional Alternate 0 Comments: r I_ W ( ra-4v l rc 2 tf- J 1. S . 2. Se tic Tank Yes No N/A Comments a. Septic tank size —1,000 ... 1,250... other ..... (D$o ��Yd@ aS� iC K b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. 1 iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... L Trenches i. Systemcompletely opened for inspection ii. Length required Length installed ! 15' ✓ 1 ^ y 5 '� -7$' iii. Pie slope checked ... ............................... iv. Installed according to plan .......:............. v. 10 ft. fr om property line — 20 ft — foundations ... Pol-Si,n1 / vi. Size of gravel 3/< - 1 %s " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... g. Pump or Dosed Systems 3. Sewage System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance from water course /wetlands fe - c 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 ......... Some- :1��e S4w es 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 .,W. t r prc a -o- c I Guy Plumbing l Drain Services Inc. 3 Finch Lane -ake Peekskill, N.Y. 10537 Tel: (845 526-2471 37,7 1( q ilft 0 64! cl//o V 17G -13 w I k o LC -7(t i7o' of 6& ( PUTNAM COUNTY SEP 16 2013 DEPAf3TIWEN7'0 F HEALTH e PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR " Use Only PERMIT # U U Repair Permit issued In Iasi 5 years ❑ Not in Watershed Repair.within Boyd's Corners, W.. Branch. or. Croton Falls Res. t�l•,- �7eleg tsd;_...M. - . �. Repair"within 200 ft. of a watercourse or DEC- mapped-wetland ❑ Joint Review SITE LOCATION W WQ47-9hbe.,,- ra-c j TOW N'P�3i X^--, -Q4 b TM # ( D • f0 ^l Y3 OWNER'S NAME PHONE # 4/7 0'0766, MAILING ADDRESS `t .5-9 UJ,4 - S I• o�-e dc-� �.: nc Ps,,, V 4�{li.� APPLICANT A I>' O ✓ '-• Name & Relationship (i.e., owner, tenan contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER 1 Ec/ ' 1J&"4$/kK PHONE # � .ice( �,! o s.. ADDRESS REGISTRATION /LICENSE # PC 3o5 7A- OJ-3 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. NST�t/ rJ4,<j /boo 9-oC p6tfi -Tic— -0F7—/c �c tj t- k,. V I, as owner,agree to the conditions stated on this form SIGNATURE /I�! TITLE DATE l� (owner) I, th tic installer to comply w'th the conditions of this permit for the septic system repair SIGNATU TITLE cw`� DATE (installer) _ P, roD,osal ap rovedd_wi with the follow] -na 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 ❑ Inspector's Signature & Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes 0 No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 0 is .l� f , .4 ,co �o � r ,--r -A(lis j /fv (�� re-vl roo, -- ?M1 AM COUNTY.DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATTVMN7 SYSTF-M Owner:. Address: lt%2S`,. s�'pre Located at (street): TIM Section: _ Block Lot [Municipality: ." IlG-lh XMI IV Watershed: -7 SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Date of Percolation Test: Hole No. Run No. Time Start — Stop Elapse Time (min_) Depth to round water from surface (inches) Start - Stop Rater level drop in inches Percolation Rate rain /inch 1 2 3 I 2.; 3 4 1 2 3 4 2 2 3 4 . 5 t Votes: 1. Tests co be repeated at same depth utttil approximately equal percolation races are obtained at each percolation rest. hole. (i.e., < t min for 1 =3Q min/inch, < 2 thin for 31 -60 min inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -9 i. p° : ,) '_ TEST PIT DATA , .. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE # HOLE # _ HOLE # HOLE # HO L_E # G.L. 0.5' 1.0' L146 Q loan z.5' k 3.0' t (OWN 3.5, �► Y a 4.0' to-kclea oe�e .(able 4.5' &cpl ad 5.0' nln 5.5' �OG I�lx 6.5' 7.0' 7.5' 8.0' 9.0' 10.0' Indicate level at which groundwater is encountered � Some St✓p A cve Indicate level at which mottlins is observed DC,55t 6 MO+ 16,q 4L, S Indicate level to which water level rises after being encountered 4 Deep hole observations made by: M n L Date q _ Design Professional Name: Address: Signature: Design Professional = Seal