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62.13 -2 -7
BOX 24
I�yL X-
116 �. �.
T T 1 1 r.
16 m
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES* 'AP
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
MIN
YES NO Internal Use Only. PERMIT #-._
■
7
SITE LOCATION
Repair Permit issued in last 5 years of in Watershed r J.v Cy
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
OWNER'S NAME
MAILING ADDRESS
TOWN 'Jbv7rY#" C�,�Lt f TM # ': _a._ 1, .
I hi old y ��"% n t -' :) i,, �„ �P1 PHONE # ¢Y:!r s LY -Z,,L4
lG tu.4 c r TdeAr 1) lit. y.c '-r
APPLICANT
Name & Relationship (i.e., owner, tenant, contractor
DATE FACILITY TYPE PCHD COMPLAINT #
�%
PROPOSED INSTALLER WV J4V PHONE # 7 z e 9Z, 3f2:
ADDRESS 4p REGISTRATION /LICENSE # ME3
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 depe ding on the
nature and extent of the repair.
I, as owner,agree to�the conditio s state on this form
SIGNATURE `°-'' LE L%WU�— DATE
(owner)
i,. the sep ins tai ;er,,agree to comply with the conditions ul this perinit for the septic system repair.
SIGNATURE (,` -° TITLE /j4( ,f,4 T DATE I /Y
(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 bac ld until authorization to do so has been obtained from the Department.
/ INTERNAL USE ONLY
Pro osal ve Proposal Denied ❑
Inirkst6es Sidnaturt & Title Date / Expiration D to
Repair proposal is in compliance with applicable codes Yes CY No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
PVTXI; 04 VA 1, LJ5V/
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CvL--tEct lZtcAaR(&F-g, 6ALLr Er
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Putnam County Department of Health
Division of Environmental Health Services
1� SSTS Repair - Final Site Inspection
Date: 1� j Inspected by: Installer:
Street Loca 'on xm QS Sate �s• Owner::. G t d j:.A Ir
Town: Repair Permit #: -006 j TM_# 2
� _
1. Type of System: Conventional O Alternate omments: . -:
- -_. O e� der S CIA. e c
2. Septic Tank - --
Yes
No
N/A
Comments
a. Septic tank size'° 1,000... 1;250 ... other .....
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 .................. I ..........
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box -properly set ...........................
.f Trenches
i. System. completel4 epened for inspection
ii. Length required Length installed 16
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 .........
i vicr. _.:Er.:is canned :.:..:........ ..............:..:.: -
� _ . .
g. Pump or Dosed Systems
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 & dir to exist watercourse
f Footing drains discharge away from SSTS area .........
g. Erosion control provided ............................
Additional Comments:
e C.6► j j� �
�C( �.2 I1 . R", Rev- 1
1 U 0113 2
PUTINANI COUNTY DEPARTMENT OF HEALTH
DrYISION OF ENVIRONMENTAL A LT H SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREAT`vIENT SYSTEM
()cvner:.�rC'�� address: �6� �'Norft N)i
L,aeated at (street): TM 4 Section: _ Block Z Lot
tViunicipality: "t &4 ° Watershed:
SOIL iERCOLATION TEST DATA
Witnessed by:
Date of Pre - soaking: Date of Percolation Test:
Hole No.
Run Na.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
thin /inch
1
{
5
{
I
.
{
2
3
f
4.
I
{ �
2
{
{ 3
{
{
4
I
�
2
4
5
[Notes:
1. Tests to be repeauzd at same depth until approximately equal percolation rags are
obtained at each percolation test, hole. (i.e., < l min for l -30 min/inch, < ? min for 31 -50 min inch).
All data to be submitted for review.
3. Depth measurements to be made front top of hole.
Form.DD -9 i, Pe I of
TEST PIT DATA
DESCRIPTION OF SOILS ENCO$JNTERED IN TEST HOLES
DEPTH HOLE #_L___ HOLE # HOLE # HOLE # HOLE #
G. L.
0.5'
2.0'
wf�
2.5' w
Q 1 �bcr 3.0' a�.M
L) 4.0'
4.5,
-
.
6.0'
6.5'
7.0'
7.5'
8.0'
9.0'
10.0'
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
AAA f-
Indicate level to which water level rises after being encountered
Deep hole observations trade by: �Ah L, Date 4 LA�
Design Professional Name:
Address:
S ipature:
Design Professional = Seal
JOHN KARELL Jr., P.E., M.S.
,•.. ._. nuhiir .l? °filth ...DilEClnr. .... .. ._ •_
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
October 16, 1992
Mr. & Mrs. Anfitreato
westshore Drive
Putnam Valley, MY 10579
Re: Proposed addition - Anfitreato
Westshore Drive - (T) Putnam Valley
Dear Mr. Anfitreato:
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The first floor plans have been approved as per plans bearing this Departments
stamp and dated October 16, 1992.
One of the two existing bedrooms eliminated on the first floor will be relocated
to the second floor. The dimension of the bedroom is 17 x 8'.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditions:
1. The total number of bedrooms must remain at three without prior approval by
t:', M D6partment, _.. �_.:. �..�.
2. The area of the existing sewage disposal system, and its expansion area, must
be maintained.
3. All plumbing fixtures must be replaced or updated with water saving devices,
i.e., low flush toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. Any other permits or variances
required are the responsibility of the applicant and the jurisdiction of the Town
of Putnam Valley.
If you have any questions, please contact me at your convenience.
Very truly yours,
(�-6 11 a,
Robert Morris
Assistant Public Health Engineer
RM /jp
cc: BI (T) Putnam Valley
.vMARVIN O'DELL...- _. .._A�, . v ...� ,........� ... `r�� �f
Bldg. inspector
03
JOHN MAHONEY TOWN OF PUTNAM VALLEY
Deputy Zoning Inspector
BUILDING, ZONING, AND SANITARY DEPARTMENT
October 1, 1992
Putnam County Dept. of Env. Health
Geneva Road
Brewster, N.Y. 10509
Att: Robert Morris
Re: Anfiteatro
Occupancy Status
116 W. Shore Dr.
TM #62.13 -2 -7
Dear Mr. Morris:
PUTNAM VALLEY, N.Y.
(914) 526 2377
BETTE STOCKINGER
Bldg. Dept. Clerk
Please be advised that an inspection of the above
noted premises on.September 28, 1992 confirms that
artzs -
.. ariMtheref ore legal .
This information is in response to your request of
September 15, 1992, item #2,(copy attached).
Very truly yours,
I �;; //a,
MARVIN 0 DEL
Building & oning Inspector
MO'D:es
enc.
DEPARTMENT. OF HEALTH
Division Of Environmental Health . Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130
Mr.. & Mrs. - Anfiteatro
West Shore Drive ` .
Putnam Valley, MY 10579
September 15, 1992
Re: Proposed Addition
(T) Putnam Valley
JOHN KARELL Jr., P.E., . M.S.
Public Health Director
Dear Mr. & Mrs. Anfiteatro:-.
Review of plans and other supporting documents submitted at this time relative to
the above-captioned project has been completed. Consents are offered as follows:
1. The site plan has been enclosed. Please show the location of the existing
well'end septic system.
2. A letter from the Torn of Putnam Valley Building Department is required .
stating.that the two bedrooms on the second floor have legal status.
3. Proposed second floor plan is to be submitted. This plan is to be
dimensioned and labeled. A sketch by the owner is sufficient.
Upon Receipt of a submission, .revised to reflect ±: sbo- r cOa;;,tr; "this
- -- - application will be considered further.
Very truly yours,
r't.1
obert Morris
Assistant Public Health Engineer
RM/jp
cc: BI (T) Putnam Valley
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