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HomeMy WebLinkAbout3673DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.15 -2 -16 BOX 29 03673 Ill NMI 11 ri IN me 6 �. IN 61.r .INN IN . t, , -,' IN IN _ ;� P Nlamll . , A 03673 ..A11 41 -2013 08:57AM FROM- ENVIRONMENTAL HEALTH 8452787921 T -006 P.001 /001 F -456 Q 7 PUTNAM COUNTY HEALTH DEPARTMENT -' UOk!�_ &Jv*u� DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR, a� YES NO internal Use Only PERmrr # I �' 14 y ❑ / Repair Permit Issued in last 5 yews ❑ of in Watershed ❑ ,[_�,'/ Repair within Boyd s Comers, W. Brandt or Croton Falls Res Delegated Wir ❑ ld Repair within 200 A. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 14 Center Drive TOWNS TM # 74. 15 -2 -16 OWNER'S NAME Laura Irw. n PHONE # Ag =a1g6 MAIUNG ADDRESS 14 Center Drives Mahopac, NY 10541 APPLICANT Laura Irwin Name & Relationship (i.e., owner, tenant, contractor) DATE 7MM13 FACILITYTYPEPriv Dwelling PCHDCOMPLAINT# PROPOSED INSTALLER JdMantovi Excavating, Inc_ PHONE# 626 -4526 ltop ADDRESS 4a5 Kenn icut Will Rd REGISTRATION /LICENSE # i@=Z 1e36/ 1 126 Mahopac, NY Pro; osal (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) J NOTE: The Department may require submittal of proposal from licensed professional depending on the, nature and extent of the repair. . 1, as owner,agree to the conditi s stated on this form} �/�� SIGNATUR TITLE &Z&0 / DATE (owner I, the septi st r, Agreq. t® comply with the conditions of this permit for the septic system: repair. . SIGNATU (Installer) TITLE Installer DATE 7/26/2013 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 ft 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. INTERNAL USE ONLY Proposal Approved Proposal Denied / ❑I /':. i' d/ h //jai i Signature & Title / ,� ,Dal Expi atio Date ir or000sal is in comalianee with applicable codes Yes No d COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 J. MANTOVI EXCAVATING, INC. DBA MAHOPAC SEPTIC 485 KENNICUT HILL ROAD 0€'A&.; ,N Y0f'K '1054.1 - � 1 o c 4 ' I ( t 1 (845) 528.4526 JOSEPH A. MANTOVI AN& a Putnam County Department of Health Division of Environmental Health Services ` SSTS Repair — Final Site Inspection , n eA 1 b Date: D I L Inspected by: M D Installer: S ti"► vi ' Street Locatio f 4- C N e! � 1`, Owner: ` Iv Town: ? na ti. 1/ _ Repair Permit #: l TM.# 1. Type of System: Conventional U Alternate U Comments: 2. Septic Tank Yes No -N /A Comments a. Septic tank size —1,000 . S50 .. other ..... V b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution 11ox i. All outlets at same elevation (water tested) ... ✓ ii. Protected below frost ............................. l/ iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f. Trenches i. Systemcompletely opened for inspection ✓ ii. Length required Length installed iii. Pie slope checked iv.. Installed according to plan ..................... 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.. -_ g. Z"V or Dosed Systems 3. Sewage System Area a. SSTS Area located as per a roved plus 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. Backflll 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 PUTNAM COUNTY HEALTH DEPARTMENT [. Aiww DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR( .. .. .. e...... YES _ .. N ®. _.....- -.- ... - Internal Use Only .... PERAAIT # ❑ ff/ Repair Permit issued in last 5 years �t in Watershed 1:1 ©�// Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated /T1 W' ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 14 Center Drive TOWN . t TM # 74.15 -2 -16 OWNER'S NAME Laura Irravin PHONE # ,4q4 -2186 MAILING ADDRESS 14 Center Drive, Mahopac, NY 10541 APPLICANT Laura Irwin Name & Relationship (i.e., owner, tenant, contractor) DATE FACILITY TYPEPriv Dwelling PCHDCOMPLAINT# PROPOSED INSTALLER 3 Mantovi Excavating, Inc PHONE# 628 -4526 ADDRESS 485 Kennicut Hill Rd REGISTRATION /LICENSE # 1035/1036/1126 Mah o pac, NY Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 i 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. Replaee steel tanit with 1900 @a! (eip L258 gal) . I, as owner,agree to the conditi s stated on this form SIGNATUR la TITLE DATE (owner) .I, the septic *§t7r, gre e t comply with the conditions.of this permit for the septic.system repair SIGNATU (installer) TITLE Installer DATE 7/26/2013 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. INTERNAL USE ONLY Proposal Approved car Proposal Denied ❑ Ins ector's Signature & Title / Dat _ffxphtioA Date Repair proposal is in compliance with applicable codes Yes 0 No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 YI a�„,1 �� oo %