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HomeMy WebLinkAbout4258DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -1 -20 BOX 32 �y� . �. , I , ; J .ML �- 04258 Y PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES -PROPOSAL -FOR SEWAGE- 1REATMENT.SYSTEM R&AIR YES NO/ Internal Use Only PERMIT #'"�� ❑ Repair Permit issued in last 5 years Not in Watershed ❑ Repair witF iri Boyd's Comers, W. Branch or Croton Falls Res. li� Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 119)_ 1A K- D2 TOWN Z/i9, PZ k&W TM # F3. V 20 OWNER'S NAME X- hd e AAJ,1fJ, PHONE # SClfs)-6 0 16 MAILING ADDRESS g' e APPLICANT dig J e6 N, Loy 4_41 X0 U 991d ^A Name & Relationship (i.e., owner, tencfnt contractor) DATE. 3 Zt- (J /FACILITY TYPE l�A'� PCHD COMPLAINT # G PROPOSED INSTALLER QGp / G.� �Lt ✓sN(� PHONE # P ' S�)( V7/ ADDRESS �j,,,�, eAf GA 1,& P-e& $ REGISTRATION /LICENSE # 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 I, as owner,agree to the conditions stated on this form SIGNATURE (owner) Tom' _ ._ i, the -sepk4r taller, agree DATE ply with the conditions of this permit for the septic system repair w A "V, SIGNATURA_ '�J -� TITLE DATE 3 Z Z O (installer) Proposal approved with the following conditions: s 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. X INTERNAL USE ONLY Proposal Approved Inspector's Signatu "re & is in COPIES: PCHD; Owner; Installer PC -RP 99ML Proposal Denied codes El .3 23 i® We Yes Ekpiratiob Date O No 21 Rev. 2/07 APPLICANT !W! J ,f) x 4,464 PUTNAM COUNTY HEALTH . DEPARTMENT. 7.1 DDA ION-P '-R0NMENTAL-'WEAt-`TK9E'R'V S"! ICE — PROPOSAL FOR SYSTEM .SEWAiG8*TREATMEN*T: ..'REPAIR YES- irte r ifUse:0ni PERMIT # ❑ Repair Permit issued In last 5 years, Not in Watershed ❑ Repair within 136ya's Cdffiersj W. Branch or Croton FAlls-Res. ❑ Repair within 200* ft: o:f a watercourse or, DEC-mapped wetland Joint : Review : SITE LOCATION jll/ Kc OR TOWN ai TM # ...... .. ...... . WNER'S: NAM PHONE # MAILING ADDRESS APPLICANT !W! J ,f) x 4,464 ae Lill "l� �, 52- rV7 XOD -154 -(I/ 14 01 m N Cluj .q i 1 11 m OF SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 16, 2010 Anthony & Lynn Capanini 182 Lake Drive Lake Peekskill, NY 10537 Dear Mr. & Mrs. Capanini: DEPARTMENT'OF HEALTH 1 Geneva Road. Brewster, New York 10509 T $2 Lake %)rive ..._ _ Lake Peekskill, NY 10537 ROBERT J. BONDI County Executive ROBERT MORRIS, PE_ Director of Environmental Health The Putman County Health Department has reason to believe that a septic_ failure may exist at your residence, TM #83.82 -1 -20. To determine if there is a septic /sewage problem at your residence, this Department requires access to your house to perform a dye test. This simply requires a tracer dye to be flushed into the septic system to check for a failure. You are hereby requested- to contact this Department to set up a date for entry to the premises to perform such test. ` Ignoring this request can result in a violation on' the property. If you already know of an existing sewage problem on your property you should contact a septic services company to investigate and offer repair services. A permit from this Department is required before such repairs begin. If you have any questions, feel free to contact the writer at ext. 43149. Thank you for your anticipated cooperation in this matter. Sincerely, Brian Stevens Public Health Sanitarian BS/lm Environmental Health (845) 278 =6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186. Fax (845) 225 -5418 PCsTN �1�1 COUNTY DEPARTiVIENT OF HEALTH DIVISION OF ENVIRONTMENTAL HEALTH SERVICES DESIGN DATA SHEET —'SUBSURFACE SEWAGE TREATINJENT SYSTEM Owner: - (�:/��� (F., / Address: 18 2.. lejgg�& Located at (street): Tit 4' Section: __ Black Lot Municipality: ?417-A,44Y ! 11 LL1v `l ' Watershed: A0!6eno �! Date of Pre-soaking- SOIL PERCOLATION TEST DATA Witnessed by: _ Date of Percolation Test: Hole No. Run No. Time Start - Stop Elapse Time (min.) Depth to water from s dace surface Start -Sto Water level drop in inches Percolation Rate min /inch '2 3 { { 4 5 { ( { 2 { { { 3 { { { { { 4 { 5 f { { { 2 3 1 I I 4. ! I s .2 1 I I N 3 4 { J I { { Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each nercolation test hole. (i.e._ < 1 min fnr t -:n min +inch TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES CEP "H' HOLE # I HOLE # 2 HOLE # HOLE # HOLE # G. L. i 1.0' L 1� oc✓✓Ja O 2.0' 2. 3.0' 3. 4:0' B �fexlrl 4.5' S 4- 5.0' 5.5' .mac 6.0' 6.5' 7.0' 7. 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Darr Desiazi Professional Name: Address: S ianatare: . �++ k m o �, �' 4 � ' ±a.s..'i8.,� ss- Y•�..e���ert.;-�se:: +�M �..a�:3 mi .t�.�5_:r{e:ieio;a�'R: TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES CEP "H' HOLE # I HOLE # 2 HOLE # HOLE # HOLE # G. L. i 1.0' L 1� oc✓✓Ja O 2.0' 2. 3.0' 3. 4:0' B �fexlrl 4.5' S 4- 5.0' 5.5' .mac 6.0' 6.5' 7.0' 7. 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Darr Desiazi Professional Name: Address: S ianatare: . �++ k m LAKE ,� 1 wa � L. - PEEKW /LL ! / NI rot � I 1 1 1 ul I ua /Jr Iar1 Yr1 126 I ra an °1 1 //! 1 '• xx'u xfl° xa I O � I I 1 1 1 1 e 29 I 1 I ! �II1 136 1 1 rr�p I 15,0 1 I 1 I 1 � I 1 I 1' 1 1) 1 1 j•.1 1� I I /. 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