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HomeMy WebLinkAbout4262DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -2 -12 BOX 32 04262 ,. 04262 YES Ng SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT \_r DATE PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use O Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Fails Res. PROPOSED INSTALLER ADDRESS within 200 ft. of a watercourse or PERMIT # wetland ❑ 0 ok Wr*x7`a Not in Watershed Delegated Joint Review TM #ai.�S' ­Q— t Q NE # GM-S%-4—C1411 PCHD COMPLAINT # _ PHONE /LICENSE # k C):) 2L 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 t e conditions stated on this form SIGNATURE TITLE !'� ti DATE -..... - ..... -1� -s� ioinstaller -a ree_to. I virii corr�i QM$ - _4f'th rittltf r `- ,the pi g_ _ . p y.. _ ipe o .fhi3 setb system repair SIGNATURE` =' , TITLE DATE (Instiller) ' 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. IVTCnuAI I IQC f%U1 V Proposal Approved Proposal Denied ❑ Wnspiaor's Signature & Title Datd Expirdtion Dfate Repair proposal is in compliance with applicable codes Yes Q No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 V Q, BRUCE R FOLEY .. u .. -. . CO1ZE'7`cA MoLiNAi l R.N.. M.S.N. Associate Public Health Director Director of Patient Services DEPARTMEW OF HEALTH 1 Geneva Road - - •Brewster, New York 10509 REQUEST FOIE + + I.D TES G . ATTENTION: ❑ JOSEPH PARAVATI GENE RKED All information below must be IWII completed prior to any scheduling. DATE: 11::�]—tQ ENGINEER OR FIRM: N{`en : g� nn �a.tz�i a PHONE #: iLaKIKI NF, DEEPS: PERCS: ❑ PUMP TEST: ❑ READ /STREET: ` � �-a CE: , . `TOWN: c fir` C� TAX MAP#:�,�' - a SUBDIVISION: LOT!#: YES NO ❑ ❑ Proposed SSTS within the drainage basin of WestBranch orBoyds Comer Reservoirs. o ❑ froposed SS'I'S wi iaa.5Q, -Aet of it reservoir, reservoir stem or control lake. -- —13 "` ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ a Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commercial Project. It is the responsibility ofthe design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answeredyg to any of the questions, NYCDEP must witness the soli tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP Is required to witness the soil tests, it will be. the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE- Z;g- 6/, Zze COIVAVi$I�1'TS: (FIELDTEST) TM: �� .1 � C� R ZiRo QDynB O CL �.. 4 3 LAN cc _► lkl N. :R c co O QP Tunpb f r�. o►m'. o- - Q 'd FE F PUTAgKI , 4' o� ` 4 Cm O R ZiRo QDynB O CL �.. 4 3 LAN cc _► lkl N. co Tunpb f r�. 1 W® d� I f ® 4 3 cc _► W FE F ` Cm •; Yom. Y r. j 3 i end Id NO ^ obi NlSld �.�,ow f 2010 -11 -18 11.02 PRECISION EXCAVATING 18457360571>> 8452787921 P 111 Precision, Excavating Inc. 3 ems.« era Gardson, NY 10524 (845) 736 -osil VedagoerisanAet FAX TRANSMITTAL FORM To: From: Date Sent: Regarding: No. of Pages: Gene Reed April Leonforte Nov. 1 8, 2010 Test Holes Gene, 41 anted.to9lnfArm.y.� . ftt we_have-mailed. Ina permit%r 1 2 Larke_Drive, Lake Peekskill which_yau LL should receive tomorrow or Monday at the latest. I wanted f6_W if ypu _could WhtgliVey put-us on-your calendar for the deeps (pending receipt of permit) for Monday, Nov. 2M. Please call me at your earliest convenience at (845) 736 -0571. Sincerely, April Leonforte SEPTIC REPAIR "AS-BUILT" PLAN Ft S. NEW 100 GAL Si 8,-10" 6- INVERT 1/8- DROP PER FOOT 19 C 'ADDRESS: 59 NELSON BLVD BREWSTER, NY 10509 -MAP #67-.9-i-1 60 U?T LEACHING TRENCH E A C D I E F G I H I T I Y}►► j A 46!-0' 52--0- 58--2- 69' -0- 77'-4" 47-0 B 50!-G' 56'-6" 62--V 89'-6"_ �72-V 9 _j 3 0_ 97--0- 22'-6- 419-4� _ W 44'-6" 1.1 S. NEW 100 GAL Si 8,-10" 6- INVERT 1/8- DROP PER FOOT 19 C 'ADDRESS: 59 NELSON BLVD BREWSTER, NY 10509 -MAP #67-.9-i-1 60 U?T LEACHING TRENCH E A 0 �A C-) N 1 I I3onieowoer: F I Loftus Enterprises, Ltd. Jt . u 132 Lake Drive �= t -�� rope, Lake Peekskill, NY 10579 6.bove. (914) 882 -9411 Town of Putnam Valley °. Po s� f3c�, In L Tax Map: 83.82 -2 =12 Installer: C C. Philip Leonforte (License #1022) s f Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 0 ; `? (845) 736 -0571 Y' ' Description of Repair to Syste� : 1 Installation of 1,250 GallonCo4�rete k Y Tank And Two Rows of 35' [nfl, trators With 1 V2" Washed Stone:: '' for Fields r. 1 ' 1 4� .c7 n_ 7 a ctc s� #YY�r Elf ��'.� -.cam- ry.� r�rrr• �;• � : - '`'�� �'•�,k� � �.s•�` � I�*ti< � \ , � ,1, r. t fig, t dg y vl "'''jsF ° •rte- -"z f '2 a ,�. y ty �v - \ll� n �. �,�i ` cif •i% i ,p i rrr C ,t 7 iJ.s — "`n'"'.dr �•• � fr� f!` .J dfrf P �✓ 3.�� t•e`? f� � p,,. ��r� y, � ' *'I) f� r ` -�. 1_. l`�t dr,:r✓ Ott l� Sfi �cr. wrs( J.i~ ��. �t�% kZ,r, + ^vsx ��� [ — TS hRT ��+ ry � .,frd.t yhc •� � t - r R r 4: OL ty Nr 3 r h �1xl y mo� 1Q p W-M mo� t R.$xs 7is S { �, _ q. x S 1. a`i�1y 4j. �� 1��} CIA A✓,rr,5 ¢ ,�t1n�. r�2 �' t s �rirR.v i irk, 3yt, :�F 3 13� �1-.� ����� 1-� �'e �e� ks �c.` 1 I .. +.:. , .,y..:. � ..e .... .......v 1�ke Pe��s�l� 0 PAS r A % a SR G W'� 11 i ;- !. +.i a 1•• y 1'. t i; LA f: 1 � ails f' f par- At Fa b �t 4 Jqt M Ott : 4, +8 u�1 Homeowner: Loftus Enterprises, Ltd. 1,32 Lake Drive Lake Peekskill, NY 10579 (914) 882 -9411 Town of Putnam Valley Tax Map: 83.82 -2 -12 Installer: Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Description of Repair to System: Installation of 1,250 Gallon Concrete Tank And Two Rows of 35' Infil- trators With 1 '/2" Washed Stone for Fields r J � v � M par- At Fa b �t 4 Jqt M Ott : 4, +8 u�1 Homeowner: Loftus Enterprises, Ltd. 1,32 Lake Drive Lake Peekskill, NY 10579 (914) 882 -9411 Town of Putnam Valley Tax Map: 83.82 -2 -12 Installer: Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Description of Repair to System: Installation of 1,250 Gallon Concrete Tank And Two Rows of 35' Infil- trators With 1 '/2" Washed Stone for Fields PGTNANI COU -N-TY DEPARTIVIEN-T OF HEALTH DDISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET = SUBSURFACE SEWAGE TREATMENT SYSTE.NI Owner: L ©FTC S giVr;Cx I i =1 S 5 Address: /3a 13,!9X- �t-- _ /Z Located at (street): TM &" Section: _ Block _ Lot Municipality: f L17—A1,4A WLLF —�/ ' Watershed:. SOIL PERCOLATION TEST DATA Witnessed by: _ Date of Pre - soaking: Date of Percolation Test: Hole `+o. Run No. Time Start — Stop m Elapse Time (min.) Depth to water from Found surface (inches) , lard; 'ta Water level drop in inches Percolation Rate min /inch _ 2 I I I I E 3 - -I - I -- I ► -- L i I I { { I s l l i 2 ). 3 I i { 4 2 I { I 3 I I I I 4 I l I I I I } 2 { I 4 I I I I Notes: t. Tests robe repeated at same depth until approximately equal percolation ales are -- -...,L •.,,.- L,.t- /: - i t __.._ _- r -.. , _ - - "tlr7ili:s�xrprd3mtr•� ^r-a _ -- �.'— ;�-- •�;:s= s- ���ar =.- - titi1.iriB:t=- y�'::v.�ditu TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES CcP 'r, HOLE # J_ HOLE HOLc # HOLE R HOLE T G.L. Z. ,0' Z. ca_ Vlk 3.0' 4.0" 4." .� e- 5.� "a,1 - - -. ------- __...__. 7.0' 7.5' rd _ 9.5' 10 -0' Lndicate !et/el at which .aroundwaier is encountered L/_� j �' Lndicate level at which mottlinc, is observed Indicate level to which water level rises afer bein` encountered �'- Deep hole obse;tiations made by: °.eA� Date --- -IT2t1 Design Professional Name: ddress: S! ag1at?.Lre: