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Home My WebLink About2913DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.15 -1 -37 BOX 24 ji '■ ��I . 1 02913 AUG -31 -2007 01:36PM FROM-ENVIRONMENTAL HEALTH 8452787921 T -214 4021002 F -486 DIVISION OF ENVIRONMENTAL HEALTH SEHVILtS PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 7 � YES . . _. �.. _ .. _ - 'interr,ai i_E�E C..I '` 2N!!•T ❑ Repair Permit Issued in. last 5 years ❑ Not in Watershed CI Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Re air wit i 200 ft, o a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION O TOWN G TM OWNER'S NAME Qtcq �c-o d"[,1F�j�I f&llr,IceZ PHONE # 411x%'V1 103 1:�11 MAILING ADDRESS _FrA fti Vea e ✓) { U, O 7 9 APPLICANT Name & Relationship (i.e., owner, tenant, contraaoQ DATE —7 FACILITY TYPE �eS tT` PCHD COMPLAINT # PROPOSED INSTALLER //� G(if-Acz) C1 . �Cd' �oP ADDRESS. etdle REGISTRATioN /LICENSE n V e rv�a ^� a 0i7 `7 Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of exlsting:and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature.and extent of the repair. w.._. ice ex 5 ct k T cY t +rte -� cot, I, as owner,agree to the conditions stateq on this form SIGNATURE TITLE DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair Slu4A TUP�.�=- i�- -�4�j- TIYL�r�.- ��! DATE. (installer) _T Pr000sal 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 Mae number b. Location of installed components tied to two fixed points c. System description (e.o., 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 bpen obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ nspector's Signature & Title Date Expi atlo Date Repair prODosal is in compliance with applicable codes Yes C' No O COPIES: PCHD; Owner: Installer PC -RP 99ML Rev. 2/07 15 ly' 1Vt A z G A x'71 ` sr� A--TT,' TOSEt A pAplt9v,3, t rz t+/4 it/) SC i; -r j H F. ,zN,4r4Df Z. top ®& D P-rl H A At -T4a tip=' Ve L) _ PUTNAM COUNTY HEALTH DEPARTMENTS F DIVISION OF ENVIRONMENTAL HEALTH SERVICE: PROPOSAL FOR SEWAGE TRCATMENT SYSTEM REPAIR ❑ ❑ ❑ ❑ ❑ ❑ SITE LOCATION OWNER'S NAME 91 MAILING ADDRESS APPLICANT DATE Ic Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Fails Res. Repair within 200 R of a watercourse or DEC - mapped wetland FO i 44 fizaW-T TOWN Q--1Y, i Relationship (i.e., owner, tenant, ❑ Not in Watershed ❑ Delegated ❑ Joint Review TM #"3 P,j —1 37* .,o PHONE # 2/Y k7% ,Zo 33 %4C ) PCHD PROPOSED INSTALLER W/4" (9 ( (�'�£It� PHONE # JIY5 ,5o16 �a ADDRESS ' REGISTRATION /LICENSE # PC f 3 9 f 0 S"rIs Proposal (Include a separate sketch looting 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. Ar,, -)Lid CE I, as owner,a_gree o the conditi s stated on this form SIGNATURE. TITLE c�,Cu VitI DATE (owner) I, the septic installer, agree to comply with the nditions of this permit for the septic system repair A SIGNATURE 'i_ TITLE ( DATE 2 �a (installer) Proposal avoroved with the followina 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. 4. The proposed SSTS repair, is considered a -test fit design and there is no .guarantee to the, duration at which the completed SSTS repairwiil'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 ❑ No ❑ r COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 W i�lb Lo PC ,--'CejY It 97� -3f K7 obo p'4p'p'v6-r( to VL co 0)15 P-'�d-T-foly YO 0 c4z fo,r4pls o& A 6o a c I App -4, 5APTc li E, We C VSD9 )c. � + LI gf4 � t ev-1-1m6 -Tr)L1v(e— i4 !s;- 1 p .3 c- 41juz k /'-4' w fq, Yo L) vt-,, 14 t4 u 3' 7- ILk PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DAT SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner f(f � }-1ewAlv,o,�z- Address Located at (Street) Tax Map 6 Block 15 Lot / (indicate nearest cross street) Municipality 9'VT1,)4 ✓A1 &45 Watershed r � ' � SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 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 Sheet of PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIELD ACTIVITY REPORT NA / �JAf0)1 2, Tel: ADDRESS', 20 [Z-b I Ji j-1 vkA V A L L Is � /V 7 . Street Town State Zip PERSON IN CHARGE �� J J� �� R f1R MTTFR'VTFUURTI Name and Title TYPE OF FACILITY : ZWD, SS T S Ar A J e FINDINGS: /-// -Z S - - -/ 0 1 EPA . Signature aLfVitle REPORT RE ETVFn RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. C SS�iS' �S t p. r1-7 I G - -- 1 EPA . Signature aLfVitle REPORT RE ETVFn RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. C DEC -12 -2007 08:41 PM QEC -11 -2007 Oi;4lALI FROOM IRONI2NTAL HEALTH 8412TV111 T -080 P.001 /001 F -100 &` . 0& i PUTNAM COUNTY HEALTH DEPARTMENT 17 DIVISION OF ENVIRONMENTAL HEALTH SERVIC 'tS THIS IS NOT A REPAIR PERMIT All Informatlon below r ust be W ly completed prior to any scheduling SITE LOCATION q'OZAAe fKT ! 4 TOWN�tiy TM OWNER'S NAME PHONE �! I MAILING ADDRESS 0 PFIOPOSED CONTRACTOWNSTALL.EFi k�/f►�,d� =L�i{ ,�� PHONE N q �' 4 -d f- 6 a 5 c./fw✓r9r- ADDRESS T -G _ REGiSTF1AT10N /LICI =N$E # _,f'C O3t81 wsi for ssuurtc back-up In house tine limits of system for repair G other (explain bole" .F-QR �OUN7'� ME 6NLY `v7 n pgcv r 4-1 Sri nature —&%,a Dais Appointment Date: Time: Idly- 'ammizaptic SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Robert Hagopian, P.E. 682 East Chester Street Kingston, NY 12401 Dear Mr. Hagopian: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 24, 2007 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Repair Hernandez 80 Lake Front Rd. (T)Putnam Valley, TM #62.45 -1 -37 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Please specify what type of septic system exists and show the extent of it. 2. All existing wells and SSTS within 200 feet of the property are to be shown. This includes across the street (Lake Front Road). 3. It appears the proposed trenches are in close proximity to ground water (2.5 ft:). It is advisable to raise uie Lvliches so the bortow of the trench is no greater than 2' below the surface. 4. All wells and septics are shown as approximate location. Please specify the method of location. 5. Please add the following pump station notes as required by the Putnam County Department of Health. • Note stating "All electrical work and material for pump installation shall comply with the National Electrical Code." • Note stating, "An electrical Underwriter's Certificate for the pump chamber must be provided to the Department prior to the Department conducting a final inspection on the pump chamber." • Note stating, "The pump control panel and alarms shall be located inside the house." 6. It appears the proposed SSTS is in close proximity to the house foundation and could infiltrate into the basement or footing drains. If such exist the proposed SSTS can't be closer to the house foundation than the existing one. 7. Please show topography for the lot. Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 p .S: _ 'Rid zriaice, model; and purtip u� 9. The septic tank needs to be a minimum of 50 feet from the proposed well. 10. The Town of Putnam Valley should be notified of the proposed repair to the proximity of the stream and possible wetlands associated with the streams. 11. Please be advised that this design is not for current code. A note stating such . should be added to the plans. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Sincerely, G JSP:lM seph S. Paravati, Jr. Assistant Public Health Engineer J SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Robert Hagopian, P.E. 682 East Chester Street Kingston, NY 12401 Dear Mr. Hagopian: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 24, 2007 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Repair Hernandez 80 Lake Front Rd. (T)Putnam Valley, TM #62.45 -1 -37 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Please specify what type of septic system exists and show the extent of it. 2. All existing wells and SSTS within 200 feet of the property are to be shown. This includes across the street (Lake Front Road). 3.. It appears the proposed trenches are in close proximity .to. round water (2.5 is advisable to raise the trenches so the bottom of the trench is no greater than 2' below the surface. 4. All wells and septics are shown as approximate location. Please specify the method of location. 5. Please add the following pump station notes as required by the Putnam County Department of Health. 9 Note stating "All electrical work and material for pump installation shall comply with the National Electrical Code." • Note stating, "An electrical Underwriter's Certificate for the pump chamber must be provided to the Department prior to the Department conducting a final inspection on the pump chamber." • Note stating, "The pump control panel and alarms shall be located inside the house." 6. It appears the proposed SSTS is in close proximity to the house foundation and could infiltrate into the basement or footing drains. If such exist the proposed SSTS can't be closer to the house foundation than the existing one. 7. Please show topography for the lot. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 I W 8. The make, mo&f"and pump size snoiiiii "ue r ueCi : 9. The septic tank needs to be a minimum of 50 feet from the proposed well. 10. The Town of Putnam Valley should be notified of the proposed repair to the proximity of the stream and possible wetlands associated with the streams. 11. Please be advised that this design is not for current code. A note stating such should be added to the plans. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Sincerely, JSP:lm (Iseph S. Paravati, Jr. Assistant Public Health Engineer -� Jol y -4, — Am IQtC Q Sco TT 4- `.( 5 #4 F, R t%i6t4 Vf- it fro L 6-k rz V* ft! Lit /00,0 6A- Z- G k CQ)e,'rE 7-4 K!G OVV1eX 64vf, c. Alcla -d AD _616« ,0 vj [� tAs �- "I f n li 6 C A '4,;O�N+� ,0 vj [� tAs �- "I f n li 6 C A '4,;O�N+� j SM iron %a :x� c y4 � zR�LiSV`4, 6' 333 y fR$ 1 } r {q z x4 a i iron %a :x� c y4 � zR�LiSV`4, 6' o,7 R(C,44p- 8 .5 -r-r 6. I-t 5 .4 s R x61, IVF- Z to L6-k r ;7-g, aei P.-I pv—, 4 h4n VO, I-L-cy / NJ, t03-?�P T q3 S)x'2.6 PSPS'' l000 Z CO k cQ.£7E -M It a- (s C� • �og�y9C cs't� :-1YGILrX-7L'Rr G A 1A Pfl (Lµ% 1. /a it _ C- G� A 4 A- a ` ' S 1. /a it _ C- G� A