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HomeMy WebLinkAbout4166DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com . 631 - 589 -81'00 83.74 -2 -62 BOX 32 ., 04166 • RU ► NAM COUNTY HEALTH DEPARTMEN "i- [)IVISION OF ENVIRONMENTAL HEALTH SERVICES C� PROPOSAL PpR Si =WACzE TREATMENT SYSTcM REPAI YES NO: " Internal Use Only PERMIT # ^tea ::u pair Frermii hKbido iti tasi's pdars•' Ci epair within Boyd's Corners. w. Brant» or Croton Fans Res. Delegated C3 pair witnin 200 d.. of a watercourse or DGC- mapped wetland ❑ Joint Review F �Q SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT IA ke 10CC.kS k16 OWNeu +W1� V41 tefM 4 G., h lta k a PHONE 41 DATE ?j _ y FACILITY TYPE PCHD COMPLAINT PROPOSED INSTALLER CAP, f---v e IV1 Q f MS �� i Cru PHONE # f �/ — (oy'(� -`j 7d,Gl/ ADDRESS a� UC,n) 0 i4 �L S " AFL° REGISTRATION /LICENSE # T r000sa{ (include a eparate sketch lac n the house, pro erty lines, all adjacent welts 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 ..union nnrl nv*nnt ni tha ronair I, as owner,agree�to f-VA, P - V PA-0 P " SIGNATURE TITLE �� t�>> `� t'; C DATE ?: "r n (owner) I, the septic installer, agree to comply 'th the conditions of this.petpmit for the septic system repair SIGNAT -15RE TITLE 45" TR-010e4 -- DATF- (installer) .P- ro_7os+iatfir;,ved with he following coo Lions: 1. Procurement of any Town Penult, 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 a. System repair to be performed in accordance with the above proposal and conditions A" 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 oackfilt until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal /approved Proposal Denied ❑ �> c� � S o Inspector's Signature & Title'-Z-,7. // ¢ �5>/z -3/z 6� Repair Proposal proposal is in compliance with apolicabls codes YES COPIES: PCHD; Owner; Installer PC -RP 99ML on Date e No C3 Fiev. 2107 Vopv aPw, r-oQ, comvo/- tTll- $rAPfC - =2MEEZ -74 14 Z7— 31 rs At 7, IRF Box le 4 r-7 /41 7W A14 a u '/N 7r44/4 1„ ;y�JLQ R � ; I ! t�. U IJ A .47ZO O.A.J Id 61 -1 47 7'lrL C Vt.*A,9A"7?- CO. V. 0. F A7- JrIVAA gT!-?W14 4 P4/r/W.IAf COU�l NEW Y'OPK LANG -3l,.TrTV" t _ ... ..� .. AY) A" ! OR FC+%?A11 ;F' ?d. Y' NOW � OR' F- /Jl.�•> rr•RLY S% °'r= ti :��i / °04=30•lr /20.G��r !• st�{nF �:��� = -s` �- -r...r mom..- ,- .Ti- r�.'"T�•.:1T'r 7.�a:�Cl.'tu2�•'. ^. v..L4 'aT•FS' �' ') - /� -� � �� �:' ; ': i ir.: �'ri. ; _��'�"''t_ art�a B •e:�rur„•rvQ j yy -rrC ' . �'IrL • �. ^ =s f'a''w ` •i ; - D f/ ' `t' �� r�.i- oa ..F- +,4Lrt 44 is �; � • •:� : ^• r t � � �' O •l' � iUT.3ee fir ; ! /•� .1+5 t;j �a.? i 10-3 y jlL� r I I t;. !r, al asp .• � � . ` � G•j? r � i � 9 . v st Arss x: N� •5 ,. �V n.S.t� i�1�•~S- i�'eC�.!�ral1 ;� �i •• i OWN OF As-W rIVAA 4L' .:.irLiER 'SUN- LIVID 54.4• Lvov P G. .. 4CDiZ h "ar. q::{C• RN=JCS t:7 ; ,!�'!.'_• .:.iG \.i'•R .:'tt y�!'tw 1079:1{ "y'�1.•.e6ym•rSa • • •! � io• 4aa S•s w., a! //• -srvrs -rn e.0 :N P(�55CSS1(ti?i I,.•+v:{3+• of Troy t t Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DiviSiON 0F.ENVIROMMENTAL HEATLIUSERVICES FIELD ACTIVITY REPORT ADDRESS: Street Town State F Zip 45" PERSON IN CZAIRG—E Nam and Title TYPE CELITY rFF A, WINGS-. Hr. -------------- %-I et, 4, 3.O 1 -4— 3, o' 1 47"d, * f'. /"e. 4f Z411 7 7-le vwj-, W q., �5 ( W0,PECTOR, TF.T Signature and Title R'F.PQRT IRF.C.F.TVP-T) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: YES ❑ a SITE LOCATION OWNERS NF MAILING ADC APPLICANT PU i NAM COON i`Y HEALTH DEPARTMENT PIViSION OF ENVIRONMENTAL HEALTH SERVICES ROPOSAL FOR SEWAGE TREATMENT_SYSTEM REP) Internal PERMIT # Q s N _ p i:.�t'�yEl3r�- =��- - T: -•.. - �t_:1�7-Vi�c:ti?rs�lE'fi -•- Repair within Boyd's Corners, W. Branch or Croton Fails Res. WDelegated Repair within 200 P. of a watercourse or OG-C- mapped weu C1 g and Joint. Review b LA kG 'Pe r- ks ki /hOW N PEA i WA-4 V-4 ix DATE 3 I _ 1 O FACILITY TYPE PCHO COMPLAINT # PROPOSED INSTALLER `/ Q t4 f M r S H004- =- -�.ItT c ONES PH ADDRESS a(P tea. D� r'�- 1. &, )C REGISTRATION /LICENSE # __ Proposal (include a eparate sketch loc tin) the 11/66se,7porlperty litres, 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 ago extens of the repair. . _tp i, as awn ,agree to the cond'�ions stated on m form is *-�A C, 1, c J- PR rl-I� P• SIGNATURE li:� -4A ( t'�..� iC�:r� TITLE DATE (owner) I, the septic installer, agree to comply it the conditions of this.periWK for the septic systern repair SIGNAT -JRE TITLE 4J jJ ` p 4PeeR— DATE—?-;: 7'/() (installer) �. ProLasyl MP need Witte trig fi,llowina• conditions : , I . Procurement of any Town Permit, it 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. Syst.cm 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 a. 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 oacicfili until authorization to do so has been obtained from the Department 1NTERiVAi_ USE ONLY Proposal Approved Proposal Denied ❑ 3 S d inspector's Signature & Tide DEO I Expiration Date Reoair or000sal is in compliance with apot.icable codes YES El _ No 0 COPIES: PCHD; Owner; installer PC -RP 99ML Rev. 2/07 jr Q q. : • a' O� i • c*J.• �.. eS till 4 Aww r �I s.r .o e Ira It lot 0 0 e ��. � i awl i + i° a � New e` ee e ID ` Bs►x o e a r • Mrero 4 ami� e i � 0 • sd w� � .. ea a ®. s � em:oaee�e p + �. !� e .� 4 o s D D e S .r 6m . aee i 41 Ile ene• ww�eeerniwemr er - �i1- -e j M54'a ll 11, 00 9 e e ,e•n■!e �Y�� eme�a �... s 4 tic -a vLk m .. ' a IN W,V4 6 0 r• e + 4 .... • 0141 ,. Fl� Ids '(7 � a 4 r _ 7 .Y + OIL ` � +r :p I �4 f I • l I moo 0 .i • ti m •NY'�rrrr,r � �ii�..r. � _ IAA! . � l ip r , Itly NiA w 004'1 s10 /d f ■ • C.%pr i •� t l �fl I, IM 'I . t ► �. 1 cd •.- op v t •� s � I i�M� !if fYd �+. �Lr.'+il.►�id► t 4 oj ■ t '; SUPERIOR. PRODUCTS. ENVIRONMENTALLY-FRIENDLY PROS E" DI It E C , ' 'M'ATBRIALIS, AND J".' GVATJO 'N -9 y 01JR EN VIR ONMENT IS 0 (R. B-USINESS., MODEL MODEL' DESIGN CA TOTAL C"ACrr Y H LENG TH WEIGHT (MMIfiUnk) (P YUS CAPACITY n) -Poi6ds Gallons ! � 40 7 4" U 2 Wid 1.wie Rfvff-300 ST-300 300 (1136) 325 (1230) 273 (1033)1294 (1075) 54 (1372) 45 (1143) 50 (1270) 120(54.43) (single lay-) WW466 ST7500 50'0 o893 535:(2025) 452 (1710 )/474(1794) 51(1295 62 (1575). 601 (1524),- 225 (102.06), RMT-750 ST-750 750 (2840) 1000 (3785) 853 (3229)/898 (3399) 51 (1295) 62 (1575) 103 (2616) 360 (163.29) RMT-900-.T ST 9Q0 90 Q107 -7- 1161 (4394) 990.67471!1028-(4891) 51.(1295)- - 62 1j8(2997). 0 (29.4.) 2) �(3785) 14610 394), ., 374.7y 1028f(3891 5 k I (204,•2)&'- RKr-1060, ST -1060, 1060 (40 lij. 1337 �5061) 117.7 4455 1227 (4645) 51,(1295) 133(3378), 520,(235.97) RAT -1250 ST-1250 1250 (4730) 1469(5560) 1259 (4766)/1319 (4992) 51(1295) 62 (1575) 148(3759) 560 (254.01) ST -1. 1. 1500 (50 1771 (67R3) J— :1540 (5830)(1601(6060) Distributed by: &Ras Roth MultiTankS Fnflo Septic Tank Roth GlObal Plastics, Inc. P.O. BOX 245 Syracuse, NY 13211 P: 866-94377256 F: 315-475-0200 A - I7:? The Quick4 Equalizer 36 Chamber fits into a 24 inch wide trench. Its MultiPort end cap with six molded-in inlets/outlets allows multiple piping options and eliminates pipe fittings. Download product specs here. (PDF) Size (WxLxH) ....................:...22" x 53" x 12" (56 cm x 135 cm x 31 cm) , Storage Capacity ...................... 32 gal (121 L) Louvered Sidewall Height ......... 10" (25 cm)