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HomeMy WebLinkAbout3609DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -29 BOX 28 03609 lk—I � . r , 03609 9 PUTNAM COUNTY HEALTH DEPARTMENT -.7"' FT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'µ', ... �...: 'PROPOSAL FOWSEdlllAGE•TREATMENT SYSTEM REPAIR NO// Internal Use Only PERMIT it / 1Z' J- -3 V ❑ (✓� Repair Permit issued in last 5 years Id' Ot in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ' 0 Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 43 Perk Drive TOWN Putnam Valley TM#74. 10-1- -29 OWNER'S NAME Matt /Jennifer Cichon PHONE#a2-8-8108 MAILING ADDRESS 43 Park Drive, Putnam Valley, .NY APPLICANT Matt /Jennifer Cichon Name & Relationship (i.e., owner, tenant, contractor) DATE 11/3!11 FACILITY TYPE Pr i v Dwe 11 i n g PCHD COMPLAINT # J Mantovi Excavating, Inc 628 -4528 PROPOSED INSTALLER d PHONE # ADDRESS 485 K en n i c ut H i.l l Rd REGISTRATION /LICENSE # 1035/1036/1126 Mahopac, NY 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. 3g i y f i. y W 3 Replace old drywell with precast cement drywell.. Connect' to... _Y D6vigCt existihn -pipe & disconnect existing drywell. I, as owner,agree to the�conditions stated on this form SIGNATURE (owner) . . 1, the sedtieel TITLE /> (,j �✓ P %' DATE l �/ .. - ...... - .. .. _ agree to comply with the conditions of this permit for fie septic system repair TITLE Installer DATE 11/2/01.1 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. INTFRNAI IISF eml v Proposal Approved .Proposal Denied ❑ nspectoes Signature & Title Dat / Ex irati n Date ,Repair proposal is in compliance with applicable codes Yes Cd No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Y ;; :; ,, � . i f. �r �, i'[ %i i . � -�. 4 r :1 P�-� K i ��2�v� �, Shect of PUTNAM COUNTY DEPARTMENT OF HEALTH ..-,-.......-..,,DIVISION, O!.ENVIRONMEN-TALHEATIL,HSERVICiE.,$,.,,.. FIELD ACTIVITY REPORT Tel: Street Town State Zip PERSON IN CHARGE Name and Title TYPE OF FACILITY : 9 a s ( -§:: 0 6--- FINDINGS: TPT Signature and Title RFPQRT'R'P.C-FTVF-r) BY., I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. Title: PUT.,N.A-'vf COLNITY DEPARTAENT OF HEALTH DIti-ISIO,NOFEiN�rIRO-,N-.,'Y[EiNT-kL HEALTH SERVICES DESIGN DATA SHEET —* SUBSURFACE SEWAGE TREAT�MENIT S YSTEN-f Owner: zr.--?VO-A/ Address: FAIZR 2gjVr-- 7#,/0 2-47 Located at (street: TM Section: Bloc" Lot Municipality: 71 r ZAM L VAAL-E-x Watershed:.— SOIL PERCOLATION TEST -DATA Date orPre-soaking, Witnessed by: Date of Percolation Test:- Hole No, Rua No. Time Start— Stop Elapse Time (min'.) .) Depth to water from ground surface Start - ,S top Water level drop in n inches Percolation Rate miniinch. 2 -.3 .4 2 4 2 r I 4 - I s l I I I I I I l I I i I 2 4 Notes: I T-IZ77 rn ip -,ir -jPnrh 1tnr:1.1A— ,,;—,-;w --! --, — I t: gEscluPTIOIN W SUIL6 LINCO !N-I LF-U) TN (D E 5 — _--------- - - - - -- F, 0 L E HOLE HOLZ HOLE HC I.V I 2.0' 2. 5, bow d- 4. 4. 5. -7 G.5 Lridicate!evel at wiich gound-waieri is encountered Indicate levet at w1uch mottling is observed A/,ed Ir Indi- C e I.ev�t to ;VhIch water level, uses e,.-r beingg encountered Deer hole observations r-,,adp- by: Dace /,I/;- Design Professiorial vane: Address: C, , � i c n, at-u re: Oct 26 2011 2:47PM HP LASERJET FRX _- P. 1 PVTNAM COUNTY DEPARTMENT OF HEALTH DCV'XSION OF ENVIRONMENTAL HEALTH SERVICES "QY. UT,FQR. FIELD TESTING 'Gene Reed ATTENTION: Q Michael J. Dudzinski, PE G Joseph S. Pararvati, Jr. All trformatton muss bed coinpiazed pHor to any scheduling. Date: October 26, 2011 Engineer or Firth: I Mantovi Excavating, Inc. DBAIMehopao Septicphone It: 645- 628 -4526 Reason: Deeps D Item F0P- p�Ry l4 Road/Street: 43 Park Drive Town: Putnam Valley Tux Map t: 74.10 -1 -29 Subdivision; IAt* 10 Owner: Matt Cichon 0 Prgiect not within NYC Watershed t1YJ;2! CR3 R'El[tIA FAR J(EZN� Q%F F $014 TESTI' f, VES /Psairosed Ssi'5 within tfie t}rattmge basin of West Broach. Crotch Falls, or Royds Corner ' / 'reservoir•A. [[[[}} Proposed SSTS within 500 tleet of a reservoir, reservoir .tee► or control lake. 0 _• �'tvposad_Sgrg within 200 fact of a watercourse orn DEC wetland. _ .... _ .. �[ _ , ma W SETS- deSftn.liar:. grrtttge! on 1l±I1�0.�eFl4iie /d�Y ar Dcsl er p Proposed SM for a Commercial Project. it is tite're%porsibility of the design proressk►nal to provide ttffi above intermatioa prior to soil testing. This Departum t will determine the NYCDEP pcolect statue (Joint or Relegated) bawd an. the response. IY you answered YdA to any of the questions, MYCOEP enudt witneo the sell tests. This M- purlment will coordinate ar mutually suitable time for field tasting with the Desigw Profoulons and NYCDEP. Ir a project has bee* dotormined to be Delegated based on tba, above reitt non ood then subtt"uent lntortuation tndtcates NYCOEP is required to witness the soil test,, It wm tip the sole resoonsibillty of tim deslgo protessionol- to schedate re- wttnesieng of the soil testing with NY- CDU''. FOR COUNTY US12 ONLY f.�.l�1jd J rricLoTp,"ti 32 IDES tnam Golf and Tennis Clu ma oWN II % '77 0 Lie I V S Bryant 'i Lake -P Ce 30 P.O. 30 Aft GRID STREET GRID STREET GRID . t#13 STREET GRID STREET GRID Barger Pond 15 8A 60A P. .33 Golf club %IsGrrut Lake Mahopac ,'Canopus Island 1 AE 33 O.P G, .9 A S co loo ei� cw All, U Teak e Lake mahopa6 PEEN 5 B�`t, Bdddwin a S. C.. I E ;0 6N BIRDSALL A INDEX TO 0 MUNICIPALITIES IN PUTNAM COUNTY ER St EXT MUNICIPALITY GRID EAST OSCQO Brewster (Village) .. ............................... N7 Carmel (Town)........... .............................J7 Cold Spring (Village) ............................ B7 ............. Kent(Town) ............................................ J4 Nelsonville (Village) ............................. B6 Patterson (Town) ................................... N4 ...... . ..... Philipstown(Town) ................................ C9 Putnam Valley (Town) .............. ...... E8 tTown .................................. PUTNAM COUNTY ZIP CODES Copyright 2004 Hagstrorn Map Company, Inc. All rights reserved. No part of Brewster ........... ............................... 10509 cr this work may be reproduced or transmitted in any form or by any means, Carmel ............................................ 10512 electronic or mechanical, including photocopying, recording, or by any Coldspring ...................................... 10516 information storage and retrieval system, without permission in writing from Garrison ........... ............................... 10524 the publisher. Lake Peekskill ................................ 10537 The information shown on this map has been obtained from various Mahopac ......................................... 10541 authoritative sources. Nevertheless, a work of this scope may contain some Mahopac Falls (PO Boxes Only) .. 10542 inaccuracies. Any errors and omissions called to our attention will be greatly Patterson .......... ............................... 12563 appreciated. Putnam Valley .. .... -- ...................... 10579 REA SEE HAGSTROM'S UPPER WESTCHESTER COUNTY POCKET MAP STREET GRID STREET GRID STREET GRID . STREET GRID STREET GRID STREET GRID I STREET GRID STREET GRID STI Butternut La N 4 Fulton Of ................. R 4 Marshall Rd R 4 Somerset N 4 Arden Or 0 10 Foreman Rd Old Albany Post Alta Ad ........... D 10 1 Cour 'C ............ Caldwell Rd ............ C 0 4 Gardiner ................. R 5 McManus Rd N N 4 Sonnet La ............... N 3 Atonement C 9 451 n 7 1 A-- Forest La Rd Ca verton Rd A 14 Garfield Or 0 4 McManus Rd S N 4 South Birch Hill Rd. 0 2 Avery Rd.. ............... C 8 Fnrc—,Ale 0• Camden Rd ............ R 4 Garfunkel Way N 5 Meadow Ridge Or P 5 South Ouaknr will ^' ...... Jk MANTOVl.l . AVATING; 41NC vD ,M OP, C PT BA M' A SE IC .'• r da f 485 KENIVICUT Hi l ,ROAD „w M WAHI OP,ACzi E, b \ IV� ij, s t ► , � '� /� { i it �f try �d , 1 I. ltu D a 4- s i7. ,Se t ,j i S �,�,�` M of A � 11- A t y 9d'u �+� } AM y t u ft,a usY' \ J S \ ' ;(845j 68 =452'6 T }fa�yw �•`�S`,a�,�i"R' I ����"'�l.� X�r �:nY' I( y✓ KF+ { rC M V� c?Y y� lr�T � rY K � •�'EL i>' .� w11M' .i?-• dy' 1.. �iir�,� � � l% `kr' -�+' ..� � %.i .\ ✓ ...� } �'.�3 $l jr#�.. 1 ". d.^YY. }SIQI. 7tl' Illy ,t �- t''„f. 1 III:. ) i �m�.'�§;,.�•`t %:} .�' II V.7�r IV4; ^° Al .17 ,�' 1 z Y I � a. r F / / �, 1 '�Y 'p��# / � /i,l y.'�,, (u1 � \SS++���s n gT✓yf. ,a' I A. (�, `�. •'� raj` i; I}'� �� � N a - Lim I } • SIroc...." ..:.+.. .�.-a . ep. <. ew,.� -- :•...e.., �P e. yµ9 R �.I .) ^� t. h -: pi. '° i ill W i� r 7T �♦ I iz a %. .,a ' s5r1. 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