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 /.
I
1228 1211
1 i I � I I l 1 1 1 •aa n 1 T
I •aa fa DRIVE
` $
1 / - 1 1 20 1 1 I r1 1 1 1 1 1 E _
rol NI Ar I I I 119 Ifi 1 / 1 I o xnul all c 4c
r D a' I I x 17 1 I I �l /rr nu i
l /b l 1 `f — 1 1 ,r Ar f 1 1 1 •8 1 15 1 I 1 I I 1 1. 1 8 -- fix
1 1 /u1 /NI t• L _ 1 rr1 b Ark I I 1 . 1 = 1 119 1 1 131 _R 1.12 1 8 /i - -II •, _ ¢
lA� /ro � � � � Il 8 � • � _ � ' 11 /// - � ' _ _ tl
/4•I I I
�11 1 1 1 1 1 x 11_ /ol ,D1Y
I 1 1 1 1 1 8 1 I 1 6 1 /DI /x l"' 1 1 1 is rolpn x / '0a t
•___I_ 1fae.l I 1 I •1 � � 8R/b1 �1 /DI /D ul/YI /r,l ylf/ril xa�i nLK ,y- ,_
BECKER 1 1 1 1 1 1 I I 1 1 I I I s /Pr - 10 /
,xet@ I fa,x I I I 1 1 I 1 I I 1 8 1 9 1 9 • `
4W-
_j _L -1, _`
�NVEYANCE - REVI; IONS SPECIAL DISTRICT INFORMATION
NVEYANCES Wea. -Sa -. MMW YI1lET R1(Ifxx ISIli !IAN UK
/v /r � GISMO tlGS
"K ./. YWLt 11 f1101xp p an @�t1 tf1111f 1IK ��
f wII11 WAp AM
OM PANY •'•fir• p—
�WN'MAINE . YIUA¢iIlx •. ____ !I@lwfa@w@
a+••.,o fer w .0 NwriN. ....
iiwn flaarC
I w I
IS . -a- - - - - R ' 8 - - .2- -1-2
-- s - - - -- - - -- - a
-
qp
r
•awl /.fw x
S -
I
xin If
CHESTER
p
mw
q4 / I 1 I ; 1 1 laws ixLf
I I 1 I 1 1 I
• oQ / s �T - rl I I � 1 / •I ' / /
/
i/
44 '
AC.
__ W 40
97
1 �
•V_ 41 s g __- _p _a 196 \ \♦ r` 45`
_ 1 1
/ _ 42`_
j� IIa!'s ..�• a
and
.
1 1 I 1
1 r
r l •�r'\ �
I 1
�.
1231 1_ 1 241 8 1
I r
rol
1 / I •
1 1 7 1
126 �
� I
I I 1 I 1
1 1
1 1 127 1
I I
1 1 1
1 1 1 1
LANE
I 1
1 1 1
•x+! fam ,
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 /.
I
1228 1211
1 i I � I I l 1 1 1 •aa n 1 T
I •aa fa DRIVE
` $
1 / - 1 1 20 1 1 I r1 1 1 1 1 1 E _
rol NI Ar I I I 119 Ifi 1 / 1 I o xnul all c 4c
r D a' I I x 17 1 I I �l /rr nu i
l /b l 1 `f — 1 1 ,r Ar f 1 1 1 •8 1 15 1 I 1 I I 1 1. 1 8 -- fix
1 1 /u1 /NI t• L _ 1 rr1 b Ark I I 1 . 1 = 1 119 1 1 131 _R 1.12 1 8 /i - -II •, _ ¢
lA� /ro � � � � Il 8 � • � _ � ' 11 /// - � ' _ _ tl
/4•I I I
�11 1 1 1 1 1 x 11_ /ol ,D1Y
I 1 1 1 1 1 8 1 I 1 6 1 /DI /x l"' 1 1 1 is rolpn x / '0a t
•___I_ 1fae.l I 1 I •1 � � 8R/b1 �1 /DI /D ul/YI /r,l ylf/ril xa�i nLK ,y- ,_
BECKER 1 1 1 1 1 1 I I 1 1 I I I s /Pr - 10 /
,xet@ I fa,x I I I 1 1 I 1 I I 1 8 1 9 1 9 • `
4W-
_j _L -1, _`
�NVEYANCE - REVI; IONS SPECIAL DISTRICT INFORMATION
NVEYANCES Wea. -Sa -. MMW YI1lET R1(Ifxx ISIli !IAN UK
/v /r � GISMO tlGS
"K ./. YWLt 11 f1101xp p an @�t1 tf1111f 1IK ��
f wII11 WAp AM
OM PANY •'•fir• p—
�WN'MAINE . YIUA¢iIlx •. ____ !I@lwfa@w@
a+••.,o fer w .0 NwriN. ....
iiwn flaarC
I w I
IS . -a- - - - - R ' 8 - - .2- -1-2
-- s - - - -- - - -- - a
-
qp
r
•awl /.fw x
S -
I
xin If
CHESTER
p
mw
q4 / I 1 I ; 1 1 laws ixLf
I I 1 I 1 1 I
• oQ / s �T - rl I I � 1 / •I ' / /
/
i/
44 '
AC.
__ W 40
97
1 �
•V_ 41 s g __- _p _a 196 \ \♦ r` 45`
_ 1 1
/ _ 42`_
I w I
IS . -a- - - - - R ' 8 - - .2- -1-2
-- s - - - -- - - -- - a
-
qp
r
•awl /.fw x
S -
I
xin If
CHESTER
p
mw
q4 / I 1 I ; 1 1 laws ixLf
I I 1 I 1 1 I
• oQ / s �T - rl I I � 1 / •I ' / /
/
i/
44 '
AC.
__ W 40
97
1 �
•V_ 41 s g __- _p _a 196 \ \♦ r` 45`
_ 1 1
/ _ 42`_