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HomeMy WebLinkAbout3574DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.06 -1 -13 BOX 28 03574 lit oil 1. T Ell 03574 I -n�I I! Vl-1 r9� 111VI l...IV 1 DIVISION Or ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPi YES NO✓✓ _ Internal Use Only PERMIT # SITE LOCATION epair ermit issued In last 5 years Repair within Boyd's Corners, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC - mapped wetland TOWN ,411-7 OWNER'S NAME MAILING AIDE APPLICANT �V LT Delegated ❑ Joint Review TM # ~I a'r% Name &Relationship (i.e., owner, tenant, contractor) DATE �'� FACILITY TYPE PCHD COMPLAI T # PROPOSED INSTALLER '`���r 4 &9,44,P G* PHONE # a/f ADDRESS /141<c'j ail' : REGISTRATION /LICENSE # --la 7 Proposal (include a separate sketch locating We 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. I. as owner,agree to the conditions stated on this form SIGNATURE S TITLE 6U0Ne.0 DATE_ a�f (owner) I, the septic installer to ply c ions of this permit for the septic system repair / TITLE -V5 (installer) - s_ Proposal approved with the foll wing 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. Z' INTERNAL USE ONLY Proposal Approved s Signature & Title I is in compliance with Proposal Denied ❑ O Dat codes Yes CY No EJ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 MAY -18 -2608 01:47P FROM: ABC PAVEMENT .- -��91„ 485506 TO: 18452787921 WC- 11596 -H01 6 t i ated & PAVEMENT MAINTENANCE, INC. I LOCUST ®RIVE. - MAHOPAC, NY 105441 © (914) 248 -8093 �����To- /o.,,, r "ram Paul V1 Phone. 19W` a 711-1a Ilb 0A. L7 For RQvlow n Piiauao 0 plerssB Replb C1 P {std st�y�la 4ammo1l'cx, Zile �p 1 � P. 1/4 PC -2072 MAY -18 -2008 01:47P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.4/4 Proposed repair to be done as follows; 1) 6 -inch gravel for bedding and drainage. 2) Installation of 2 rows of 8 infiltrators surrounded with gravel over 50 feet. 3) Installation of filter fabric. 4) 6- inches of topsoil cover. 5) Finish rake, seed and hay. MAY -18 -2008 01:47P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.2/4 viNZ �WQ 0 } 0 A� 4, '1,1 MAY -18 -2008 01 i 1 :47P FROM:ABC PAVEMENT 19142485506 k14 � 0 ZI R � o �Ob� >z� q , 3 a;14'o TO:18452787921 P.3/4 �1 Q Ak �x w VI 14 wy p�h 4 QN �a Q � ow h i N w No oZ Af QN h� w4. x O ZWX m m .i Y l Y MAY -12 -2008 09:18P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.3/6 i V, PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All Information below must be fully completed prior to any scheduling SITE LOCATION �pf ��10 � % 40e TOWN A4dw .f'i't TM # 741,06 -/-13 OWNERS NAME PHONE # (fiVS MAILING ADDRESS /IA -0,, e/ �we- PROPOSED CONTRACTOR /INSTALLER �� ��� ✓c PHONE # Z f AV 07" eD13 C o iI 7S 6 76,$ 'L -� J/ . ADDRESS ,��✓��SS� /� ®�/`�C REGISTRATION /LICENSE # A21 7 Reaggn for ex loration: to surface ❑ back -app In house ❑ find limits of system for repair ❑ other (exPiain below) eol- inspector's FOR COUNTY USE ONLY re & Title nt Date: Time: Date A Torn kin Cnrnaro 1. J a Houseman IB I I� i f — jeezi Long p, ii 1 30 <UNI g y `Ce xo ut —LA�e o- A-r P.O. A '7- Lek M am ac Pm AHOPA HS ".q V R 24 71 loo ef. T 0grger, 6 Pond,.. .::—d� �FAYK —7 b t it G An ) 'All Sf we e W L3 r Tea e Lake 37 PL �\CIencoma tz Lake o j /—,j 4 Yahpipa Far k utn4m a Lk, e4 Square Nidwin i tj S.C.. M DR Cam ao EAST &01 ,T 00" 6 14 rub ._..r �C A it o W N 4 �ff Drson' I VE Hey I 6N I BIRDSALL INDEX MUNICIPALITIES IN P ME EXT MUNICIPALITY Brewster (Village) ........ Carmel (Town) .............. 118 \1 Cold Spring (Village) ... Kent (Town) .................. Nelsonville (Village) .... . Patterson (Town) .......... Philipstown(Town) Putnam Valley (Town) .. Southeast (Town) ......... PUTNAM COUNT' Copyright 2004 Hagstrom map Company, Inc. All rights reserved. No part of Brewster ........................ this work may be reproduced or transmitted in any form or by any means, Carmel .......................... electronic or mechanical, including ohotoconvinn rnnnrninn - by nnv p Wixon , Pond, 32 U Te 33 f 49 'J —J %P tr is e? land Lake of p ,.,Canopus /is 33 ii 1 30 <UNI g y `Ce xo ut —LA�e o- A-r P.O. A '7- Lek M am ac Pm AHOPA HS ".q V R 24 71 loo ef. T 0grger, 6 Pond,.. .::—d� �FAYK —7 b t it G An ) 'All Sf we e W L3 r Tea e Lake 37 PL �\CIencoma tz Lake o j /—,j 4 Yahpipa Far k utn4m a Lk, e4 Square Nidwin i tj S.C.. M DR Cam ao EAST &01 ,T 00" 6 14 rub ._..r �C A it o W N 4 �ff Drson' I VE Hey I 6N I BIRDSALL INDEX MUNICIPALITIES IN P ME EXT MUNICIPALITY Brewster (Village) ........ Carmel (Town) .............. 118 \1 Cold Spring (Village) ... Kent (Town) .................. Nelsonville (Village) .... . Patterson (Town) .......... Philipstown(Town) Putnam Valley (Town) .. Southeast (Town) ......... PUTNAM COUNT' Copyright 2004 Hagstrom map Company, Inc. All rights reserved. No part of Brewster ........................ this work may be reproduced or transmitted in any form or by any means, Carmel .......................... electronic or mechanical, including ohotoconvinn rnnnrninn - by nnv '1 POND -- • w io / �' 6 \ SF- 4 N 3 ROAD m I 160 3751 POND a 257.30 949 9 k / IV ...17 � -4�j w 29194 1.15 AC. 8 455.68 18 A£. 1.04 AC. ° i� I ,6 4 1.38 AC. 455.68 � ISO 211.96 �L AL ie 15 12 1 0 1.66 AC. .l z19.ee z � i m N rn I F o iv 14 a 13 11.66 AC. m 284.29 410.13 � I g — P/0 74.10 -1_15 — — _ — — _ _ _ I P/0 74.10 -1 -4 ."s LINE no Brax —, PRELIMINARY :l0PFA5 LOT Was J CIAOl WGI ON ' ° °` °' LED TOWN OF PUTNAM VALLEY DIMENS Ioocsl CULAho AMA 2.34 AC. CAL i PUTNAM COUNTY, NEW YORK UAL L4NIABIO :. 74.09 74.10 74. I I ` V 0 �Q 3Q c� Z 74 9.1 gl§ N 282245tMI —IW N 926000 MAP 74.06 SCALE 1" : 100' ILO 0 100 DATE OF AERIAL %WyoMA%ff......4-I0•B7 oA7E OF MAP..... 2-It•B9 N7 STATE RAW CODAMNATES ARE NAO83 IN FEET enmr,R last wrra i i SUBJECT RESIDENTIAL SITE INQUIRY DATE : 05/13/2008 372800 PUTNAM VALLEY 74.6-1 -13 ROLL SEC TAXABLE PARCEL PRCLS 210 1 FAMILY RES FENSTER DANIEL S TOTAL RES SITES 1 LAND $135,000 12 BUTTERFLY LN TOTAL COM SITES 0 TOTAL $502,000 SALES = _________= RES SITE R01 = ______= RESIDENCE ....:. �- •= .•-- .= :.:.:..:�.:..::.,_ .._._:;:.:, :__....:::...._:. � �. _..:;; .... :..�,T . .. _. .Y.FF�Z. B.LTII,T _ YI,E::C.OI,O�IIAL_.:� 1:964 EXTWALL MAT COMPOSITION STORIES 2.0 GRADE AVERAGE - -AREAS - - PROPERTY CLASS 1 FAMILY RES I HEAT TYPE ELECTRIC 1ST STORY: 1016 ZONING R3 I NO. OF FIREPLACES •1 2ND STOR" 936 SEWER PRIVATE I NO. OF BATHROOMS 2. 1/2 ;STORY: WATER PRIVATE I NO. OF BEDROOMS 3/4 STORY: UTILITIES ELECTRIC I ATT. GAR. CAPACITY FINAASMT: NEIGHBORHOOD 28140 1 BAS. GAR. CAPACITY TOTAL SFLA: 1952 == =TOTAL IMPROVEMENT ITEMS 8 TOTAL LAND ITEMS 1 TYPE SIZE1 SIZE2 QUANI TYPE FRNT DPTH ACRES SQR FT 1 GAR,1.'O 'ATT 1 1 PRIME SITE 1.66 2 GAR,1.0 ATT 3 PORCH,SCREE 4 PORCH,SCREE F1 =MORE ITEMS F6 =ASMNT INQUIRY F10 =G0 TO MENU 75.20 03 -050 F4 =NEXT RES SITE ON FILE F9 =G0 TO XREF F11 =PREV ITEMS MAY -12 -2008 09:17P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.2/6 I VJ I I Wni Y1 VVVIV 1, I Is —nL- I 1 1 6d 6-1 r%I 1 I IVI1 -141 DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAOR YES NO Internal Use Only PERMIT #^ O SITE LOCATION I Repair Permit issued in fast 5 years ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Repair wlthln 200 ft. of a watercourse or DEC - map /ped wetland /6 &Ar i�X' 4/1 TOWN t, OWNER'S NAME MAILING ADC APPLICANT LJ Not in Watershed ❑ Delegated D Joint Review 79 Nam & Relationship (i.e., owner, tenant, contractor} DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER A "11 IW A&Vyk PHONE # If /V Yj_ -Ae"I �4)v�Yf -P�� ADDRESS IA415 1 REGISTRATION /LICENSE # Proposal ude a separate s ketch locating We house, property tines, 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. I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) I;.the,septic installer, o p.. c- this permit.for the septic system repair -. SIGNATUR TITLE (installer) 1. Procurement of any Town Permit, if applicable. 2. Submission df 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 aescription (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. !MTPAMAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ Inspector's Signature & Title Date Expiration Date .Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 MAY -12 -2008 b9:17P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.1/6 WC- 11596 —HOl i I i ated & PAVEMENT MAINTENANCE? INC. 1 LOCUST DRIVE o MAHOPAC, NY 10541 0 (914) 248 -8093 To: �'.= ►rig -1oa- froesz: Paul Fax: Phone: OK .,%7e?` 6p1,v4!XAf61 ";des: .4 Q Uigam . ❑ For R6wiew 0 Plaaao Coy woorit Q Please Reply Q Plaoso Ro*yal0 PC -2072 .47i X.N V� -j .2 4 Nl <'r}. r v At N ix -1� P-el; W 4-1 - 4,1 A ..S7 ��,itifarri . el so p. UN .47i X.N V� -j .2 4 Nl <'r}. r v At N ix MAY -12 -2008 09:20P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.6/6 Proposed repair to be done as follows; 1) 1 -foot gravel for bedding and drainage. 2) Installation of 8 infiltrators surrounded with gravel over 59 feet. 3) Installation of filter fabric. 4) 6- inches of topsoil cover. 5) Finish rake, seed and hay. WC -1 1596 =H01 PC -2072 f i I i ated v lacktop ompany ......... ............. . :w+..:._.�- ...jo..rer... .w. �.: x�+- .- .._��.v .r. ,�....�.r vi�.• + ..�..,,.., ...a:. ,�, —: .r _ti_ .. ..� ..wra...- •�.w..:.w►rw.w•.:....; .r ^:..:.. .r, ...��...�.r v:•. ,.- ..e,...0 .+.ra... ei. �.� :.'.r ;. •r _. i & PAVEMENT MAINTENANCE, INC. 1 LOCUST DRIVE • MAHOPAC, NY 10541 • (914) 248 -8093 Gee ev� /a 7f� r -�� �, �� ism -- A -�- --I*t- _ � �sA�� W(,--1 1596—H01 PC-2072 I aced Olackt'op 6,ompany & PAVEMENT MAINTENANCE, INC. 1 LOCUST DRIVE o MAHOPAC, NY 10541 o (914) 248-8093 bj Z N 1W 06 'q F. bj Z N 1W 06 'q ♦ 73 6-3 --e i /D I Sheet of PUT NAM COUNTY DEPARTMENT OF HEALTH .-.�.--..]PjLV SIGN PF.ENVIRO,NM.ENTAL,J-jEA.Tl,ll.S.ERVJCE.$ FIELD ACTIVITY REPORT iil,iri,qkvjlgwjgng. '6-0 - M--- ---- AM-RESS: 12— 1 LIZ ZA, - P Street Town State Zip PERSON, IN CHARGE OR INTF.RVTP. T) A P'.y.."e- drAlAlk Name and Title TYPE OF FACILITY: FINDINGS: All-eJ- 7�—klw 0005 94 i1Ar=d&j4kS e-ae-IA 14- 151n e-)e<+'1j4gj Signature and Title RFPn'RT RFC F.TVRT)'BV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: MAY -12 -2008 09:18P FROM:ABC PAVEMENT WC- 11596= -H01 19142485506 TO:18452787921 //Jfiliated P.4/6 PC -2072 _,.... .. .._. .�.. •"C': - , . w +.. ,..•• ^: y as:. ✓ .sw a r.-s • ^ .w+..w •was.... u. s... _ mar G v : q 1.'. Lu & PAVEMENT MAINTENANCE, INC. 1 LOCUST DRIVE o MAHOPAC, NV 10541 o (914) 248.8093 �� � LIB'' � 1143 _ 7 WO,- X/ le, �i 't t s ( ++ 1 C MAY -29 -2008 i1:14P FROM:ABC PAVEMENT 19142485506 TO:18452787921 WC- 11596 -HO1 aced aC*tC�... vor . & PAVEMENT MAINTENANCE, INC. 1 LOCUST DRIVE • MAHOPAC, NY 10541 • (914) 248 -8093 FaX rrar,ti. Paul ❑ tjr�cnr ❑ For R3viow n P1eaam coriu'ik -3r►L G Plenum Reply ❑ Pla"o R.acyale P. 1/2 PC -2072 Please find following the request for final inspection at 12 Butterfly Lane in Putnam Valley. The infiltrators used were 7 feet in length each so I put 2 rows of 7 in. I am therefore a foot short of our original 50 feet proposed. I am not pushing the issue but I will be available tomorrow (Friday 5/30/08) for inspection or not until after Monday of next week. Will be away out of state until then. Please call me on my cell phone (914) 755 -7615 or the office (914) 248 -8093 to keep me apprised of your scheduling so I can make my own. Thanks, Paul R. Funk MAY-29 -2008 111:14P FROM:ABC PAVEMENT 19142485506 TO:18452787921 P.2/2 f F .•.- s.. .,y:,. ..-. .. w.t.-e: ... .. .-. ., ca.: :. , .. . __. .. .. ... _.;�.+s... - - .e..Jn'ro ., .. .« .r .�+rr .e> ,,er. � , PUTNAM COUNTY DEPARTMENT OF HEALTH I DMSION OF E NgyO ML1 yQgTg SERVICES A it lL EI' li O `Y REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches p2 Inspections being made. PCHD Construction or Repair Permit # Located:: (T) (V) K(A Owner /Applicant Name: V4/ yt- Tm 706 Block Lot Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? Date: Is system complete? Date: Is system constructed as per plans? ,�® �/��� 04 Is well drilled? Date: isVeli`iocated -as per plans! Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved. plans and the Standards, Rules and Regulations of the .Putnam County Department of Health. Date: Certified by: PE RA Design Professional Address: Comments: � tl Form FIR -99 Lic. # Putnam County Department of Health ( Division of Environmental Health Services. I SSTS Repair - Final Site Inspection Date: ` _ Inspected b 1- Installer: �rf^ w Street Locat•�n:-j . A Owner: ��f(-1 S�- - Town: n a . Repair Permit k - - _ TM 1. Type of System: Conventional ❑ Alternate. ommentsc 2. Se tic Tank Yes No -N /A Comments a. Septic tank size -1,000 ... 1,250.:. other ..... b. Septic tank installed level ...................... d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set ........................... f. Trekhes i. Stem completely opened for inspection ii. Length required Length installed 4 iii. _Pipe slope checked ..................................... iv. Installed according to plan ..................... / V v. 10 ft. from property line - 20 ft- foundations ... vi. Size of gravel % - 1 '/2 " diameter clean ......... vii. Depth of gravel in trench 12" minimum :........ viii;- Ends capped.. ..; Pump or Dosed Systems 3. Sewaie System Area a. SSTS Area located as per a ved 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: RFSI Rev - 011312 44 HOUR SERVICE . . . . . . . . . ..... El NTL Y. y Ati'i;' Off pr iC-A 4 t. r. 5 77- "s o 4, cb, -F - u be-