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HomeMy WebLinkAbout2965DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.17 -2 -8 BOX 25 'L .. .. ,. . 02965 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .PnVI-VSAL. FOR..SEMI.�AUMA. E4Tl4 Eta oSY. TE!! Mr.KA R _ . -0 - Internal Use Oniv PERMIT U F epair Permit issued In last 5 years L-1 blot in Watershed ❑ . epair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ epair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION - AV t? TOWN J� l TM # d2__ i 1 -,L 8 OWNER'S NAME /1�,Q�..,Q�� -o p r PHONE # MAILING ADDRESS �5 aVe ���1i4us Vi4 /leci APPLICANT y - Z�-Oc Name & Relationship (i.e., owner, teng<contracto DATE � ks -Zpi t FACILITY TYPE -5D S PCHD COMPLAINT # 0 PROPOSED INSTALLER Apmpl.3 E rm,r �}l , a X j,, C PHONE # -42 -60- ADDRESS �1 e1A i�ncnrti�.1 Qp I1,40ewall. -C REGISTRATION /LICENSE # `77- 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. 4 I, as owner,agree to the conditions stated thin- orm SIGNATURE AtatkSS TITLE ©o4i,-r DATE I j5 -2,o I (owner) +; •the- septie-installer, *ee46 comply - with -tiie'cond tions- of, this- permit for the septic system repair SIGNATURE--- DATE (installer) Proposal approved with the fol 4ina conditions: J 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. 1141 Ct114AL V.�C V14LT Proposal Approved Proposal Denied ❑ Inspector's Signature & Title NiV 1 Ex ratio Date ,Repair proposal is in compliance with applicable codes Yes C' No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 F JOB Z�ee z`_ . ARROW EXCAVATING, INC. SHEET NO. 15 AVALON COURT HOPEWELL JCT., NY 12533 CALCULATED - -(845) 227.4505 .(914) 528.4395 _ CHECKED BY. It SCALE OF DATE �� L n= DATE _ 1- --.. I-',...--..-...-, -.-l- clix,pamrzor, 15 AVE A VA 4.4e) rep ®F P 0 T—AMA VAt L r,,..Y -r,/Vk, 0 2, 17 - a - a Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF .ENVIRONMENTAL HEALTH SERVICES . REQUEST FOR FIELD TESTHNG All information mast bed completed prior to any scheduling. Date: 2- - !l -Z0 Y J Engineer or Firm: �6�— X(� _ Phone #: 61 Person to Contact: G ;•�� ❑ New Construction Xpepair Program El Addition Program ' Reason: -5a:�beeps ❑ Peres ❑ Pump Test Road /Street: Town: R�iqffiv' 1A \� _ Tax Map #: ( 2 Subdivision: Lot #: Owner: %y%� as ❑ Project not within NYC Watershed, . NYCDEP CRITERIkEOR JOINT REVIEW ND WITNESSING OF SOIL TESTII�IC I YES NO ❑ Proposed SSTS within the drainage basin of West Branch, Croton Falls, or Boyds Corner reservoirs. ❑ 0 Proposed SSTS within 500 feet of a reservoir, reservoir stems or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ 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 professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Les 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 Professions 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. FOR COUNTY U.SE ONLY DATE: I 'S Q � 400 TIME: ' COMMENT ! r Req.for field test -Aly 4/16/2009 an .MR c lk qrn e , Ts I I C ,Fe-dv-r1.6 R J5- .. a VJ--r A Q vat 1-,4e) ®F P107WAAVAILSy %1� eo a.,17- 2,-8, ARROW EXCAVATING, INC. 15 AVALON COURT HOPEWELL JCT., NY 12533 51914528-4395 ........ .. . . ....... . . JOB zEze _e SHEET NO. DO !A-" OFJR-068-11 CALCULATED BY f DATE SCALE .. . ...... ... . . .... ......... . .... . ....... .. . ........ ........ ... ..... //._... . . . . . . . . .... . .. . ............. ............. . ... ....... I .. ....... .. .. .......... ....... . . ..... . ...... ..... ........ ... ....... . .... . ...... ...... . .... .... ... .. . .. ..... ............ .... . ... ............. .......... ... .. ... ............. . . ... .. . . .. .... . ... . . ........ ............ ..... . .. . . .. . %.._. ............ ............. .......... . .......... ............ ............ . .......... ............. ... ............. ............ . . ...... _.... _. ._._.....__...._.........__..«_ ......... . . . . ............ . . . . . . ....... ------ - ......... ... . . .......... . ..... . ........... f-7 ........ IF- .......... . .. -A . ........ ..... ......... .. . . . . . .. . ...... ............ ........ .. ............ -... ........... ........... . . ....... . «... .......... f ........ .. . ........ ............. ... ..... .... ....... . .......... .. . ........ . ...... ... . ...... .. . .... . ........ . . ......... . .... ....... . . .......... . . ...... — ........... ............ ... . ..... ol . .......... .. ------- .......... ._.......... .. .................-... .... : »........-- 1 _ . ... . ....... .... . ...... ..... . . ........... . ......... . . _«..........._..._.... ............ .. «...._......._........_.... . ... .. ........ 2 4 -- 391 .7 log� -36 r .... . . . ...... . .. . ............ . .. ..... . ..... . . . ....... ....... . .... . ...... .... ..... .......... . . ........... .......... ...... ...... ... .. . .... .......... ......... - w. ... ........ . . . . . . . . . . . . . . . . . .... .......... ....... . ........ . . ....... ... ............ . . ...... ........... . ............. ........ ......... ...... .... .... ...... ............. ... ....... .... ............. ........... .. .. ......... . . ... ... ........ ............. .. . . ...... ........... . .............. . . .. ... ... ........ .... . .... ......... .......... .... ......... .............. ......... . ...... . . . ............ ............. ............ ............ ............. ......... ... . .. .... . .... . ..... .... . ....... ..... . ........... -,�s,i 1 ....... . .. �. . . .... . ........ -T 7 . . ....... . .......... . . ......... . ........ ....... goeZip Weir-- . . ..... c ... . . ... KL -F-e .............. 64119 ...... . ...... ............ . _.......... »_ .. . . .... ........... .......... ... ..... .. ........... .. ... ... . ..... . ..... 6%11 ..... . .. .............. .............. ............. .......... . ........... . ... . ... . . ...... ... ..... ............ ..... .... .... ........ .... ............. . .......... ....... . . . ............ . . .. ............. . .......... st, --- .... ---- ------- I .... ....... . . .. . ..... ............. ............. ............. ...... ............. ............. ......... . .. .......... . .... ... .. . ........ . .. .. ..... .... . ........ ....... ... ............. ... ......... .... . ........ ........... .. . r -�-�- C ---------- . ...... . . .... ...... . ... .. ....... . .......... .. . ........ ............ ... ... ........ .. ............ ..... ..... .. . .... 1� P UTN A_M- C O UIN TY DEPARTHE IN T O.F HEAL'TH Dn-ISION OF VIN-VIROIy�IENT -Al HEALTH SERVICES DESIGN DATA SHEET= SUBSURFACE SEWAGE TREATyfENT SYSTEM Owner: 64KEg-/V7iax Address: 167- AU4, Located at (street): TtiI "' Section: —Block _.Lot Municipality: l�untl,QM �.�L,L -6 Watershed:. A,9 :6 Date of Pre - soaking: SOIL PERCOLATION" TEST DATA Witnessed by: Date of Percolation Test: Hole No.. Run No. Time Start— Stop IDepth Elapse Time (min.) to roster from ground surface (inches) Start.. -Stogy 7 Water level drop in inches Percolation Rate min/inch _ . I 1 I I I I I .2 I I { 3 1 I' 3 4 I 1 i I I I 2 I I 3 4 i s I I I I 1 1 i I I I I f 3 s I L tYo[es: I T- IZ7; m h,- rpnp• ^rp!! ar :amp ripnrh imri( ­ ! r� �! .: , r « xa:+:.. �ln. w....,.. i. wl. V..-, �: wr�u...:.. ier' w.uatwn��t:s:+:��•tivrU.Wl';w:G. you' wstai�iWiwN 'a'r+t�dd::F�.�y.•s•.�'� •,•i- rweM1bv .:ivf+l»a/iWY:tcaiaYsti'C; t• �•. .. .' w. LLw,+ w._ 4w.... uu. u...,. v. v,......+.... r1 � .....r....tw.....+u...wAra�w.Yr ....uUn..r . , u•• .avcrn __. - .ern r.,..rv„- .... 6. .... r- ..na.. am ,.rr .i . .?�`•_. TEST PIT L DATA DESCRIPTION OF SOILS ENCOUNI FTERED IN TEST BOLES 'EP-H HGL E �_� HOLE HOLE- HOLE *. HOL= G.L. 2.0' 2, 3.S'; 4.0' 4.: 5.� 7.0' / 5, ._7_ 8.� r Lndicate level at whi.chygro=dwaier is encountered :s" C, Indicate level at which mottlinz is observer! Indicate Level to which water level rises after beinz encountered 5'1 t% � Deer hole obsenations made by: ( A? Date Desizari Professional Narme: address: S i ciarure: