HomeMy WebLinkAbout3941DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
83.56 -1 -17
BOX 30
��r% 1 ' ,
; F I
03941
Yu b
ID
PUTNAM CO�JNTY L
H T DEPARTMENT
DIVISION OF ENVIRONMENT" EALTH SERVICES
. �:....:.�;_�,-
1OPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
Internal Use Only PERMIT# - '0.1,3:. :::� .<
❑ VRepair air Permit issued in last 5 years C�Not in Watershed
❑ air within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ within 200 ft. of a watercourse or DEC - mapped wetland ❑ ,Joint Review
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
cell
262- 3H 3 9
APPLICANT ,) fiz -
Name & Relationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE I' PCHD COMPLAINT # .
PROPOSED l STALLER !/ r_- L U+��vt,.J ►� f� PHONE # 9/4-11f
-�
ADDRESS 0� Ihba REGISTRATION /LICENSE #
i
Proposal (include a separate s etch 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
I, as owner,agree to the conditions stated on this form
SIGNATURE'"L-J TITLE DATE �&Oi5_
(owner)
I, the septic installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE n VV
TITLE DATE
(installer)
Proposal approved with the following 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.
INTERNAL USE ONLY
Propos proved Proposal Denied ❑
G
Ins or's ' ature & Title Dat4 E ira on ate
Repair proposal is in compliance with applicable codes Yes ❑ No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
Putnam County Department of Health
Division of Environmental Health Services
1— SSTS Repair.- F anal Si Inspection
Date: Inspecteir•!1 Installer:
Owner..'
wner:.
Town: ,Repair Permit #: Q-d 74-t- TM #
---rte.
1. Type of System: Conventional 17 Alternate 0 Comments:
2. Se tic snk
Y
No
N/A
Comments
a. Septic tank size -1,000 ... 1,250 ... other ..... ,
b. Septic tank installed level ......................
I V
A
c. 10' minimum from foundation ..................
d. Distrih 'on Boa
L All outlets at same elevation (water tested) ...
Vz
I
I
L
11 P7
b,
ii. Protected below frost..............................
iii. Minimum 2 & Original soil between box &
trenches
e. Junction Bog -'- roperly set ........ ............. :...:.
f. Trench
L System: �ompletely opened for insWction
ii. Length required Length installed
33 V �,rS
iii. P° slope checked ... ...............................
iv. Installed according to plan .....................
v. 10 ft. from property line - 20 ft - foundations ...
vi. Size of gravel % -1 h " diameter clean .........
i
vii. -Depth of gravel in-trench 12" minimum .......
viii. Ends d
g. ftp or Dosed SysteMs
3. §MM System Arm
a. SSTS Area located as per approved 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 .........................
V/
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 ............................
5, JL
/7 1 �
Additional Comments:
RFSI Rev - 011312
Indicate level at which groundwater is encountered
Indicate level. at which mottling is observed
Indicate level to which water level rises after being encountered
r
Deep hole observations made by: _( ar;` Date /l 1
Design Professional Name:
Address:
Signature:
Design Professional's Seal
Revised July 2013
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: Address:
Located at (street): TM # ,!F
Municipality: � Watershed:
SOIL: PERCOLATION TEST DATA
Witnessed by:
Date of Pre- soaking: Date of Percolation Test:
Hole
H
No.
Hole
... depth
(Inches)
Run
No.
Time
Start — Stop
Elapse
Time
(min.)
Depth "to
water from
ground
surface
(ink)
Start -.Stop
Water
level drop
in inches
Percolation
Rate
min/inch
5
1
2.
3
4
5, .
2
3
4
5
1.
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. (i.e., :5 1 min for 1 -30 min/inch, < 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 DD-97, pg I oft
}
• � tt,, fit'. k� , A F , y •� * �� i .
s
•!� • it .pr: Y-� ,L� }��., '� r uik � ,,t d r�i.� f �ra....a '� @� �,FTF <i'.t }�arr �,..i�4 � :.
- t. rRtf C 1. •'��� 41-C. i41 a- .ry�� {3. 5.: p i _ f_ t'7
t
t. d
AA
<, P
Foundatmn'
z >' z Size &'lysPEach
Wts
`• � *' s �, � �.7 � ,, Room,
pith' �1(V�n o A'S, @a
fi i �
- ( 5 i i, •i _.1?_ E- R+7 r t� 'pi Es � -Cull SI � Y,_ .t, J.+ .r
"erage Sirype s
Seae�Qf Septid Tank r
Amin i _� iainaggf
� �} ����, .�• �: rn :. Cam` _r t 4 Sps �s . J �
t of :Dry. WeC�
?.r r r r r
yjtiU:(ft}+�'it''1N�9 .4
• f r ��li6�+ ` .. c .. , i 4 SCi`I!!i��'Wn 1 _�1r
Y 3
Descyp;jd j
Ia tilns,eif rtshncl��yh��r�fi3nmat►n ragw�red
t � � -r 1u EVAN-
.. �` � > . X�.. r ,� � ` y ` •�J fy Wil @n :. �eq�.E @St�
t 6 J^ Y F" C }' 9 trw t@d,
y 1 I .Y. S' •YR'
PO .f.� 'i'�
Y�)4
y �•
r ", r..;��J rF,SSi _ � *,. - �•� s��� �y� y� A,?t� _.�y k
�l \ \
ot
YAM /►
y ft
e ;..... ..,.;..: ., i. -ff:. s r... .ir, �::.: .. •.: i1► r,: %: r e v, a�ak'.it'� r.:��.� . f� . � l � � �. \- ` 1 � ` 5Y
f ..
A
jot
era
o
Foy
r Ml
TA�gDbox
W,
D�nb bn boX
now
/3'I -fo
&L
JosY�l �e'17)&ate Rrb22)
os
10 / J
sl3/aoI5
Kp-
li
OAl
At,
gry
Aoliff
F(
Afp
OIL.
Y, 1
lo
CM
dON
�15 C-f
C9A
Lorr
PCCKIK'!L L, kl.
N PROFRESSSIONAL LAND SURVEYORS -PI f NAERS nnE -P -o t6a o
TAX dfAf' DES +G7! �.ON
SECTION 83.46, BLOCK 1, LOT 17
DEED REFERENCE
Q UBER 703 PAGE 926
oe ` 2e lC� \ �• TOTAL AREA
20,683.22 Total Sq.Ft.
0.4748± Total Acres
AS PER MAP 980 S' '\._
\, 53 �N�
/ \ \
MONUMENT NOW OR FORMERLY
FOUND 1T N S 0 N
1� D,O \•. SECTION 83.56, B`Lk:'.4,_ LOT 23 52 ory,<O
" O ^ •\ S6 j, B. 1491 P. 25E� ro'
[► 7<0 cV� . f \ 28 \ O
Y F
W 5,
SS
4Z- CA1tj
o
STONE Wq��
/\ 0
\�\ LANDS NOW OR FORMERLY
/ryo
G 0 N A o °o
/ SECTION 83:56, BLK. 1, LOT 26
\s17, B. 672 P. 177 = \
46
/N
/o
N sr
ory CONCRETE
ry PATIO
Q'
SECTI(
7p9.
N
O � <
.S6j• 74 Ry 4i
77e , \•;3 F 5Ecnm a 5e. em 1. LOT 19 O v W
FENCE \.
0 Az8
n2 1 I
\�\ 75 w� '\ 9• ��""oW'I�o M i l 1
ENCE N N
BE
BELOW
4s•
'
UBER 1219 PAGE 0156 USER 0786 PAGE 297 AS MAP III 185 -E BEING LOTS 49, 50, 75, 76, 77, 7$, 79, 80 81, AND 82
'GARAGE
SCALE 1 30'
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE
OVE D
�0 Z
-J
w w
WIRE oNW I
o1+W N' U/P'
Oi3
7► �jTjn 1< C
Y O
�} fl)
W m
IV Y iiL�l.�
10
SHALL RUN ONLY TO THE PERSON AND.OR THE ORCANtZAT10N FOR
ORGANIZATION R
iN Of
� �
Oe \-\7 1 So° I
79 `�o `�` 6' • � N /
80 3
ru
47.0 g'
1O
COMPANY, GOVERNMENT AGENCY AND LENDING INSTITUTION LISTED
\-j y
BLK. 1, LOT 17
SE
ET10
N tJ
8 3 S �,P/�d
a
REFERENCES. elk. 7
1. TOWN OD PUTNAM VALLEY, LAKE PEEKSKILL TAX MAP SECTION 83.56 <OT 7S
2. DEEDS FILED IN THE PUTNAM COUNTY ,CLERK'S OFFICE /
USER 1306 PAGE 0262 LIBER 1228 PAGE 038 /
USER 1024 PAGE 0196 USER 0928 PAGE 092 /
USER, 0720 PAGE 0118 UBER 0672 PAGE 177
UBER 0429 PAGE 0400 UBER 0665 PAGE 124
UBER 0703 PAGE 0926 UBER 0697 PAGE 827
UBER 0744 PAGE 0856 USER 0747 PAGE 281
v I
I
WJ/
i
/
UBER 1587 PAGE 0383 UBER 1114 PAGE 177
UBER 0872 PAGE 0268 UBER 1219 PAGE 156 3. MAP FILED IN THE COUNTY CLERK OF PUTNAM COUNTY:CARMEL, NEW YORK,
UBER 1219 PAGE 0156 USER 0786 PAGE 297 AS MAP III 185 -E BEING LOTS 49, 50, 75, 76, 77, 7$, 79, 80 81, AND 82
UBER 1491 PAGE 0256 AS CHOWN IN BLOCK 63 OF MAP ENTTTLED"LAKE PEEKSKILL- SECTION F'
SCALE 1 30'
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE
OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE
7► �jTjn 1< C
ASSOCIATION OF PROFESSIONAL LAND SUVEYOHE SAID CATI
IV Y iiL�l.�
SHALL RUN ONLY TO THE PERSON AND.OR THE ORCANtZAT10N FOR
ORGANIZATION R
PROFESSIONAL LAND SURVEYORS- PLANNERS
WHOM THIS SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE
COMPANY, GOVERNMENT AGENCY AND LENDING INSTITUTION LISTED
3024 RADCLIFF AVENUE
HEREON AND TO THE SUCCESSORS AND OR ASSIGNEES OF THE
�•.
QQCwr�4cA^�1 N BRONX, NEW YORK 10469
LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
PH. # 718 601 9753
�n
UNAUTHORIZED ALTERATION OR ADDITION SURVEY MAP SEARING A
FAX :. 718 796 9203
A
LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION LATION OF SECTION 7209.
��F1L7Ayd MOBILE' # 917 544 8174
SUBSECTION 2, OF THE NEW YORK STATE EDUCATION LAW.
q3_3 4 OFFICE 718 884 2763
ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY STAMPED WITH
THIS IS TO CERTIFY THAT THERE ARE NO VISIBLE STREAMS OR NATURAL WATER COURSES
AN ORIGINAL OF THE LAND SURVEYOR'S EMBOSSED OR INKED SEAL
SHALL BE CONSIDERED TO BE VAUD TRUE COPIES.
ACROSS THE PROPERTY AS SHOWN ON THIS SURVEY.
CERTIFICATIONS: TIME SURVEY
1. JOSEPH FORBES•AND DEBRA FORBES OF
COUNTRYWIDE HOME LOANS
3. OLD REPUBLIC 871HLL41RROAD
4. RECORD & RETURN TITLE AGENCY, INC. 2STORYDWELLING
SrXATEDINTHE,
TOWN OFPUTN" VALLEY
DATE OF SURVEY JUNE 05, 2006
DATE DRAFTED JUNE 05, 2006
STATE OF NEW YORK
LE V. RAMSAY. PROFESSIONAL LAND.SURb
NEW YORK STATE LICENSE No. 050294 -1
I
1
t