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HomeMy WebLinkAbout3119DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 63. -4 -7.1 BOX 25 ON owl �Lr� - j r - 1. Oki l; 4 L. 1--m I r , '� .r r �� 1119, f PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SITE LOCATION J of W O OO (jam TM # OWNER'S NAME 0.i j (CA 100 J' V) S PHONE # MAILING ADDRESS APPLICANT DATE ' L FACILITY TYPE lld WW, PCHD COMPLAINT # I PROPOSED INSTALLER ���$� 7Z-o%6, h►S ( PHONE # ADDRESS S�ECOC C,.. REGISTRATION /LICENSE # 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 trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. I, as owne , . eported agent of owner agree to the conditions stated on this form SIGNATU TITLE Ll.,k Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the ab ve proposal and con 'on . Pro polal Approved Proposal Denied Inspector's Signature Title Date COPIES: White PCH ellow (Ton I) Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE Q 327 (,joc)tj 5T A/ o Rr � x J( J.S.. l � � � '" � c� � ( -{�—)� .77 e4l 60 /13 dP H to F S.., ...... C Flo .. rte~ _ Pat ' '3 O i-A her Tk 9,4 a vJ. (o.,e ara r+ Poo Cow �,a m _ ...... _ ........ ...... _._� . �.._... - �i j 40f j �o J �d 6c s el N � toe"i oq avw o r -411 4" 1 e-f- S Oro--, CA TEST DATA DESCRIPTION OF ` SOEL S ENCOUNTERED IN TEST HOLES G.L. 0.5` _ 1.0' -ro p 2.0` 3.0' 3.5' we 4.0' 4.5' 5.0` 5.5` 6.0' 6.5° 7.0' 7.5' 8s 9.0 9.5' 10.0' A Indicate level at which groundwater is encountered 6 . Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 2 G2(, (� Date - c Design Professional Name: - Signature: _ kqfA Design Professionzb=s Seal g� �P.L..SE �' LAND u ..... M115 r' - _ 20.0' _ � o _ • . _- °►. - ��•.?'S4s � �.a �c; r .:�:�':- :,....�: °.aV =.sa c°c�T' �'6'sc'.' -��iZ O' tY Y d a, �' �`'`� d N a p u- ,� ` ' c,� 12 M z ® �$ M to �1 V Q N fall J da . c e "KOli 4 gR@SOFt �Y cY �d U f _.K.._ w6.A —•-- t�- n 1 t ! G A qty t ,1 _j l �1 OFi {.1 NQ t (� Z �tl A -3 r 0ii f -A pT $� -,ktjo, L)oJi r� I.00 ij'c Y, f- 016, Sef . G04 , sc e .� V: -. vjm -Chad-%aa-*a. _..-, �?'••� _ °"C$.. �/ `�.� delL 4 1 PO s° Y1Tra�r'�Va e-`"' ^vra: 89 cot, Aj i S Q�� 0 PUTNAM COUNTY DEPARTAMI(T OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM R. iL Located at (Street) Municipality SUW) Address 3 2 9 WOO I 5� .TaxMap Block Lot Watm*ed . SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test 07 He No. ol Run No. Time Start -stop � Elapse Time Depth gtoWater From Ground Surface (inches) Start Stop . Watir Level Drop In Inches Percolation Rate brmlinch 30 .12. 1 130 2 3 7 4 1. 3 4- 5 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. (Le. < 1 min for 1-30 minfinch,:5 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 OD-97 Pg. I oft SHIERLITA AMLER, MD, MS, EAA1P Commissioner of Health itlH;'H"IWM'(9 :Ifs Wft -Ytiv, Associate Commissioner of Health Bruce Foley 131 Bowen Road Carmel, NY 10512 Dear Mr. Foley: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT I B ®N ®I County Executive Director of Environmental Health July 12, 2007 Re:. Proposed SSTS Repair for Higgins at 329 Wood St. (T) Putnam Valley, TM# 63- 4 -7.1. This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. 1. The PCHD Repair Permit application fee of $150.00 is to be submitted. �/2. A plan is to be submitted which shows the existing house, well, SSTS, septic tank, pool, etc. along with the proposed SSTS. f 3. The. locations of the soil tests are to be shown on the plan. /4. The submitted soil data sheet should also include the results of the deep test holes. "-"Upcin completion of the above; -this De- 05rt:ment will`coritinue ifs review. Kindly advise us if��' there are any questions. MJB:kly Respectfully, Michael J. Director of 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 InterventioniPreschool(845)278 -6014 Fax(845)278 -6648 .o YES El SITE LOCATION OWNER'S NAME PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES NO ^ - ... . - '- a Internal Use Only V . epair Permit issued in last 5 years El epair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland Q%y J MAILING ADDRESS APPLICANT ed in Watershed Review 3) Uv St?PQ TM # G3,...1�,7, �+'ryt�ND �- I�- tGG�i✓C PHONE # IC 621? ;l q wao Sq- , ftwmc my 1 06111 Name & Relationship (i.e., owner, tdnant, contractor) DATE FACILITY TYPE PCHD COMPLAINT # ` PROPOSED INSTALLER n GIC_ ycayQ PHONE# ADDRESS tb&j2( 395 MW(w ar "CIS 1 IS REGISTRATION /LICENSE # - 0 NY (aS4Z Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposedtrenches) NOTE: Repair must be in same location and of same type as R&r iginal sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. �►rY► �vP .ex i 5 �%-'t n G �O �,�tl � orb S��l� �e�t1.G�Y,�n � r(-,t� S�i.� � I t�eVJ �wraa+ I, as owner, or reported jagent of downer agree to t e conditions stated on this form SIGNATURE ✓ TITLE O'Fn'`?'!L: Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved Proposal Denied _ P-P&_ is P ector e & Title Da— to COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 �� rz,•, - 0 .2 DATE G' a vo P\ t—. 8 E-- ca-7 t_ :� o I dN 1 tai 8 5°331bo "C k�� 6 "�0 1 BO.O `0 GFSIaTCSR�LtNt_ TG tn; . ' .. _ �-3o.a _• •� .. . -000000�,; NA CA a � �t ' 3 �o Z i Jb 4 4 If rm , 6` Ctl 3;w u oI v3 ¢;0 r . Id { o c 1 , � Ei�a ©cam 2 � 2,7 0 06 �.N. • St'cowr: WALL. �y�hTe RAt..LY OPa Ll N � A tp tA IL N gm.z" Mu 2 j a. W F� LAM d !SSv rw P- A%- '—s'e 0 b 0 ED K CK EXC.C- VATI V G y INC.. P.O. BOX 395 9 Mahopac Falls, New York 10542 Wood $ ® ��`#° ) ® � 91 4248 61 48 o / /® /A 00 JQ 2 L11 '3` M