Loading...
HomeMy WebLinkAbout3983DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.58 -1 -66 BOX 31 M: �; i % 4 j t I - Ne 16 �' r :, Ne M: V PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE_TREATMENT SYSTEM REPAIR Internal Use Only PERMIT #'' MILIBMINFUN U Y Repair Permit issued in last 5 years IV' Not in Watershed ❑ ^�/ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Ird' Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 'S'%`7 LAk-e ID Q. TOWN w . V'ci,I TM'#�Y OWNER'S NAME PHONE # t / MAILING ADDRESS APPLICANT Name & Relationship (i.e., owner, DATE /p - ?,Z -Zp I FACILITY TYPE SUS PCHD COMPLAINT # 110 PROPOSED INSTALLER Aj/l, wal C pC. ,. e PHONE # lL iSc Z5 4o Z / ADDRESS /y��p,7 14.,1-1212 /,r&jj¢IG REGISTRATION /LICENSE # ,00 l 7 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. ZLe s I, as owner,agree to the conditions stated on this form SIGNATURE TITLE p ,r. r DATE (owner) ., ;..I; the ^septic.installer; a .,e +0-comply with the conditions-of this errnit-for the septic_.sy_ste;rt SIGNATURE ,�j _ TITLE rat / alt 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 D osal A rov p p � r`t Propo; al�Denied ❑ r pw,� Ivt�� lid 0 2Z I ID 122 I Ins cto s Signature & Title Date Expiration bat ,Repair proposal is in compliance with applicable codes Yes MZ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 ,i 17 We — -------- .----------- - -- -- ijold.)X5 W5 JOB 1-40�/3 ARROW EXCAVATING, INC. SHEET NO.377 Lk, IDEZAVX OF P y HQ,g 3 CALCULATED BY ,/f4% W 6W ri.0 DATE 4A I.AJ 1 LKEU'BY DATE :& 0 Putnam County Department of Health Division of Environmental health Services SSTS Repair - Final Site Inspection Date: VS Inspected by: L Installer: ( 016 a jet . Street Locate n: -71 La Owner: Iske (ter air Permit #: K - 4 0.7, 1. Type of System: Conventional O Alternate omments: ` ` R3 3 2. Se tic Tanlr Yes No -N /A Comments a. Septic tank size -1,000 ... 1,250 ... other ..... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. 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. .Iuncti n Boa - properly set ..................:........ f. Trenches i. System romplete!y, opened for inspection ii. Length required Length installed -9 / C� (ter- 3 3 O iii. Pie slope checked ... ............................... iv. Installed according to plan ....... :............. v. 10 ft. from property line - 20 ft - foundations ... vi. Size of gravel' /. - 1 '/Z " diameter clean ......... vii. Depth of gravel.in trench 12" minimum ......... g. Pume or ased S stems 3. SewB e System ea 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 ............................ dditional Comments: blty 0( ueb. FF!! RFS1 Rev - 011312 ;U ERS ATE ROP (.include sketch locating all adjacent wells) s YM: Repair must be in same lomtiion and of same typA as original, sewage dzsposal syistan. afferent location mly regQire suhnittal of pzoposal from licsnsed professiomi engi4eer or ,jistared architects j ,-I CSC � "s� i�' /�•¢ rcr 0 � j4N Yowl approved Proposal DisapprMed �_ Inspector's Signature *,Title a cored with the following conditions: Procurement of any Town permit.. if applicaEre. suhrission of as built repair sketch in duplicate showing: a. Me r I s name. b. Site Street Rams, TQwn and Tax Map number. c. 14cation of installed components tied to two fixed points (e.g.,hause Corners), d. S3sten description (e.g., 1250 gal. conerate septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel),_.. e, sistaller's name and number. systen repair to be performed in accordance with the above proposal and con&tions. is ewnar, or reported agent -of owner agree to the above conditions. / ` 1ATURE TITLE © DATE S` Rhine (MD); yakw a= ffi) = pink 3 A- r r � _'t' , .... ... A ... �f•� - ... .. '.�C "= PVV a �'�' � � :��w :,R'�S O 3,.. .Mir .... •'- 0.+ �P` at.1 . �7 -. ....- :`IYrf -YY'I f.o..TAi CY.I. .�•�r PUTNAIM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTF-M Owner:. SVGA Address: 3 77 S 8 Located at (street] TIV� M Section: _ Block � Lot vl unicipality: e. Watershed: SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre- soakimg: Date of Percolation Test: Hole No. Run No. Time Start — Stop Elapse Time (min.) Depth to water from ground surface (inches) Start -.Stop Water Percolation level drop Rate in inches min /inch 1 2 3 I 2 3 4 1 - 2 3 4 2 3 4 � I Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation rest. hole. (i.e., < I min for 1 =30 min/inch, < i min for 31-60 miniin6). All data to be submitted for review, 2. Depth measurements to be made from top of hole. Fonn DO -9 pg ; of TEST PIT .DATA DESCRIPTION OF SOULS ENCOtNTERED IN TEST HOLES ..;<rr_ �..- ...... _ .r ...., .�.,. , .w:. .,: ,...., o x• .a.... a ..3 .: -.. � :•'+`ee`�'�:i�w- ..::.:vi c . e. ,:.7sr +;t::�;_ e... .. '•s -..ea : <<�5....' ,. a ::'7 :: � v......:- ... , DEPTH HOLE ` HOLE 0 _ HOLE 0� HOLE 0 H® L_.E 0 G.L. 0.5' 1 1.0' 1.5' Loa r^ 2.0' o 2.5' av 3.0' ` 3.5' 4.0' 4.5' G� o�S 6.0' o� 6.5' 7.0' 7.5' 9.0' • 1 / 10.0' Indicate level at which groundwater is encountered ®�_c Indicate level at which mottling is observed. Indicate level to which water level rises after being encountered 04 Deep hole observations made by: N1 Date ®2 g Design Professional Name: Address: Signature: l2� . Desigsa Professional = Seni 1�—