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HomeMy WebLinkAbout4368DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -22 BOX 33 I ON No 1 I No No IN vj 3-66 Ln NIN 6 In No ,�, ,, me N ,- � r �F No , -' F No f , No I No r� - -� , % 6 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES- PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR L3 YEi� NO Internal Use Only - `PERMIT U, Repair Permit issued in last 5 years LIB' Not in Watershed L� V Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION P'ek-S%, "� %� I JgVVN 194, 114 TM # OWNER'S NAME PHONE # MAILING ADDRESS /9-0 /n1te, , Kc-( V,41166,y /1 -- /Os,- APPLICANT Co Jf,2 C J ©r Name & Relationship (i.e., owner, tenant, contractor) DATE f4 _41 —13 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER Jo`,JJ_,41,orV0 :✓C, PHONE # q/y -�103 -6.?& ADDRESS C ©nl dQcl C ,r(ct a✓ 4 f1 REGISTRATION /LICENSE # Nv ('DS- ?s 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. RPv /re long g.¢ /. ��� �-ti ��.�. f'�.JC =�eri2 lG��� %,�%;C I, as owner,agree to the conditions Zstat s form SIGNATURE TITLE DATE --r- (owner) - I; the septic installer, agr to comply with the- conditions of this permit for the septic system repair .. . SIGNATURE TITLE ®�c,� MDATE /4 (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 Pro , Proposal penigI ❑ 2 t I oes Signature & Title Date Expiration Date Re air proposal is in compliance with applicable codes Yes IY / No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 nil I i e4_ _____9_ ----- ----- Ex-JIL-T, Frov4et 0 - A! F;11— Prov;-de S' rows o; Ot,;ck-,q — i4t'hLrafors, 33 anti-s -hct4j., 1,7:54,11 W;I-h 3 rAve-1) Cover -PWAer labric.. P'P-Op.V5e4' box II C,S- .-roe 7a 79 2.W �e V) Y' 35' S. b'd p;p-, p e Pr Sad 6'dae-p 11 Ve v I s e de cvw-�i' "I efrc-,,ti 4-c, Is-ipcci ¢'rom 77orik o,,v-.cI'rcenr- �e5 + V,. V% or O_G(j NIM z App,rc-y, g-o 5r-a1e- PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES �: _: -.: OPOSAL --fOR SEWAGE -TR T- MENT- SYST- EP&- REPAJR Internal Use Only PER004 0, ❑ Repair Permit issued in last 5 years YXot in Watershed ❑ / Repair within Boyd's Comers, W. Branch or Croton Falls Res. 0 Delegated ®' ❑ Repair within 200 ft. of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS PST 11.4IIey PHONE # APPLICANT S %%,,& 62a Name & Relationship (i.e., owner, tenant, contractor) DATE , w,' FACILITY TYPE PCHD COMPLAINT # 06 j %1411 � l � PROPOSED INSTALLER n p�r,� J �ai�o , , c PHONE # 2/y --W _a 9d e ADDRESS ��6 Cdrfy%ii4fl,►�ol ���i��3" REGISTRATION /LICENSE # Proposal (Include a separate sketch locating) the house, property lines, all adjacent wells within 2co 4w4 o4 mpair 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._ A _ I, as owmer,agree to SIGNATURE TITLE % ell' DATE J I•;-the4eptic- installe r, "ree to comply With the c6ndltlars'of this permit for the septic sytte;h repair SIGNATURE �� TITLE ecru t,- DATE S- PrORQW laroved with the followdng 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 Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Da a I Expiration Dat6 ,Repair proposal is in compliance With applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Shect of PUTNAM COUNTY DEPARTMENT OF HEALTH O"IF - D -ISION, i-.-ENVI.RONMENiT-AL-;�IIE---A�T-,L--11.;S-FR;-V-.ICES--� z IV FIELD ACTIVITY REPORT NAMF, Cot-0010 TP.1: AT)T')RF.,q,q: 110 rae-je-SWI( H0 w ISAI '-vW44W Street Town 'State Zip PERSON IN CHARGE r)T? TXTTPP'%1TPXX7Pn-- Name and Title TYPE OF FACILITY: 4it e, Fe—, S- , 7,4 ee 0 C- e- FINDINGS: —IS U 4-r, Ile-a a-ee M*L al/ 0074-/ 7o4 w, /4 Signature and Title RFP0'RT'RFCF.TV'ED BY: I acknowledge receipt of this report: SIGNATURE; 02/96 Title: T) _-;. I Arovici'e D — a-� o R.O.B. F ;!/ Provide, 5 rows o; Quick -,q 1q�t /t►°a¢or�, 33 unt♦'s Ihsfal! w ;fh 3mvel,cover - w %fg fi /fer ��brtc. • hroposcd , junco %on ' >- boX 7 . I d a 1� 1 C,B. Toe o•� F ;// # _ y 7 ;LS a' I V3 o _ :_,_ Fill $acK -Fo graci� C 35 Sol;c/ptPe -j r Pe�ora +ed o' Pt'op vend (o'deap a 0 a L Fevdscct CvV'-�iv% �rc�:R -�•o thctiink0.�Yi l5Pee•7z ¢ro•n Tc,nk O.v.ed rcenche5 ftr..ak- or 0a0(4 YFre ,k a4- �° °sue, E%x�awc�jncp 'C! T AFPTOK, 9-0 Scctle ,t 4-1 r,:.,.rnrs, ..... ..... 76 box \19i 7 0, 4-;T gralj�j ..... ..... 76 \19i 7 0, 4-;T gralj�j N-j i SHERLITA AMLER, MD, MS, FAAP Commissioner of Health EORETTWIMib RARI; IrN, MSN Associate Commissioner of Health Date: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 FAX COVER SHEET To: /� 1� l�- - �2 r;—!-F - r �'% / `gd �l'trrLKStGILL /�oGLakJ 2�i From: Gene' D. Reed Putnam County Department of Health For your information /For your review As.discussed Notes /Messages K ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Fax #: ,Z -- 19,946 No. Pages: 3 (including cover sheet) Please respond Attached as requested . ` Please: ca i r r-4 de In the event of transmission /reception difficulties please contact this office at (845) 278 -6130, ext. 2261 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 u MEMORY TRANSMISSION REPORT FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER 938 938 MAY -05 02:OOPM 85268806 003 MAY -05 02:OOPM MAY -05 02:01PM 003 OK SIIii lEi➢Z0.. ➢-Q"JL AND Q...T Ili. t►9DDs MS. 1F'AA� Con+mfssfo�er oyHgvlth DAD7RET=Al NII�D.➢IYAIIiD. ➢i<N. NDSN Associate Commissioner of Health ;TI.MEd ; MAY -05 -20:11 02.01P11 .. TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH * ** SUCCESSFUL TX NOTICE * ** W o pE=-P^F;VrMaM-r OF F-IEALTH i Giancva 12oad. Brt;wstar. New York 10:509 1z ®[aolz-r J- 1300NUR county Ezs 111 tR 41-01MIEnc tf MC�WC ZQS. D'IFL t)frector f6rry /ror�menta! Health Rim the cve�t off trvmsnnHsslon /seceptlorn cRUncolties p9case coantact dais office m4 (845) 278-6Il30> ext- 2267E Envirnamcntal ➢deatth (845) 278 -6130 Fax (845) 278 -7921 Wnter Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Scr lca (845) 278 -6558 Fax (845) 278 -6026 WnC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 r.—ty I..carvrne:ontPreaehool (845) 278 -6014 Fax (845) 278 -6648 T2 TM >�-` $ y, � 2_ — 2 �_ . ClncQar�llrag covet- slncct) ]Fa -otm1: �enae IIA_�3ee� 3L"antnnaara �oaatnty fiDelnar- tmine�t off H3[ealttla yo1aD- Hanfoa- rra�¢@o�m �� II"Qrasc scs][soaacIl /]Cos ✓ Foe- sevlew Alttaclnecl yoaar as seclnaestecl cliscaassecl II'lease call i✓'— Zz7 a-L 5 yt-o n c , i A.t cs rp a p --s G. t> 4'- f"Gt.i ✓J dY`Q i ,r�1 _ Rim the cve�t off trvmsnnHsslon /seceptlorn cRUncolties p9case coantact dais office m4 (845) 278-6Il30> ext- 2267E Envirnamcntal ➢deatth (845) 278 -6130 Fax (845) 278 -7921 Wnter Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Scr lca (845) 278 -6558 Fax (845) 278 -6026 WnC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 r.—ty I..carvrne:ontPreaehool (845) 278 -6014 Fax (845) 278 -6648 22 INFILTRATOR* systems .imc... Quick4 Equalizer0 36 and Quick4 Plus Equalizer 36 LP Chambers' in New York The Quick4 Equalizer 36 and Quick4 Plus Equalizer 36 Low Profile (LP) chambers can be installed as a drainfield media under Appendix 75-A of Title 10 NYCRR. Both chambers are 22 inches wide, .and can be installed in a 24- inch -wide trench. Both chamber models offer advanced con- touring capability with Infi.h0toes Contour Swivel Connection""", as well as end cap systems that provide a variety of insetting options. Illustrations of each chamber rnodel are provided below. Both chambers can be installed with a minimum 6 inches of soil cover over the chamber dome in non -traf- fic applications. The required trench length for the 12- inch -high Quick4 Equalizer 36 can be reduced by 25 %.compared to the length of a 2- foot -wide gravel trench. The 8- inch -high Quick4 Plus. Equalizer 36 LP chamber can be installed at a 1:1 ratio with the length of a 2- foot -wide gravel trench. Tables 1 and 2 below provide chamber system sizing guidance based on the February 3, 2010 amendments to Appendix 75-A of Title 10 NYCRR. QUICK4 EQUALIZER® 36 CHAMBER The 2010 Appendix 75 -A amendments recognize that certain gravelless absorption system products provide increased infiltration surface area for wastewater treatment in soil absorption areas. The 12- inch -high Quick4 Equalizer 36 chamber qualifies for the 250% absorption trench length reduction allowed in the amended Appendix 75 -A, as shown in Table 1. .. Nominal Specifications Size (W x'L x H) 22' x 53' x 12' Effective Length 48' Invert Height 6" QUICK4 EQUALIZER 36 MULTIPORT END CAP CHAMBER QUICK4 EQUALIZER 36 SIDE AND END VIEWS (Not to scale) 48' (EFFECTIVE LENGTH) 12' MULTIPORT END CAP 18' (Not to scale) .. , • ..... 12• 1 22• QUICK4 EQUALIZER® 36 SIZING IN NEW YORK TABLE 1:12- INCH -HIGH QUICK4 EQUALIZER 36 CHAMBER SIZING CHART FOR A 25 0/.TRENCH LENGTH REDUCTION Percolation Rate (min/in) Application Rate (gpd /sf) Numbdi of Bedrooms 2 3 4 5 Each Additional 220 GPD 330 GPD 440 GPD 550 GPD 110 GPD Min. Trench Length (it) Min. # of I Chambers Min. Trench Length (ft) Min. # of Chambers Min. Trench Length (ft) Min. # of Chambers Min. Trench Length (ft) Min. # of Chambers Min. Trench Length (ft) Min, # of Chambers 1 -5 1.2 69 18 104 26 1.3.8 35 172 43 35 9 6 -7 1.0 83 21 124 31 165 42 207 52 42 11 8 -10 0.9 92 23 138 35 184 46 230 58 46 12 11 -15 0.8 104 26 155 39 207 52 258 65 52 13 16 -20 0.7 118 30 177 45 236 59 295 74 59 15 21 -30 0.6 138 35 207 52 275 69 344 86 69 18 31 -45 0.5 1 165 42 248 62 330 83 413 104 83 21 46 -60 0.45 1 184 1 46 1 275 69 367 1 92 459 115 1 92 23 See notes on reverse side. March 2010 www.inflitratorsystems.com For more technical and product information, call 1- 800 - 221 -4436. 10 KRAAOIERS rid AX a ID c 0 LL D 2 RD ri 'a7 QVPI NO V 1 � qR` 7.6 Y HILL CT VALLEY g ms E fY L4 s ? ose Hill Park z 00 0 STFIOGE 10 fY s ? ose Hill Park z Cem Cem IV FM RD 23 1p, MILL POND 00 WOO D -RME J, A o P 0 Co, 03 PERDU liF F LARK k K o -Z - : .,. - * " :_ .4 o. PUTNANI COUNNTYDEPARTMENT OF HEALTH DDISION OF E-IN-VIROINVIVIE-INTAL HEALTH SERVICES DESIGN DATA ShTET - SUBKWACE SEWAGE TREATIVfEI►'T SYSTEM Owner: IZT—IA-114 Address: 140 1�56Ar< Located at (street): TM M"' Section%q, Block Z cot Municipality: ?V77A_/,VLq J1444,6—E—V Watershed:. SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre-soaking: Date of Percolation Test*, Rio. o. Run No. Time Start— Stop Elapse Time (min.) Depth to Water from round surface ( inches) V-S tart - S to p Water level drop in inches Percolation Rate mia/inch .2 4 5 2 4 3 4 2 4 Noces: 7-c—,, rn hr- mn,-^rpri it ric-nrh irnril 0 �•..:. nuvM�.. n'. w. waLwnwwiJ ..',aro.uiM:l.w.YiaV.a.:, • —.: ��•+ M1iufl`iai1:4:6u'WSLYbr[Ld b`Ma'd1CNAES1.iM� YpGy��y�i(aliYin�.a' . a. iv". ufw... ux. Wwit' isi:.✓,. NLJ. �J. nLp4uiW�4wi.. uYSi. 1. i.. v�. 1n.. iwa:+. vYUU .I:u.l.:v�.s.lWa:w:.i1w.WA�.'.- __ '' \G = ✓M`^ rh. -!_... .. Cz. �1� -G.�. ..� - �. .. 'r" -C ra a. �Ii. , n i ..." _.. r^ _�.: �r G 0.5' 2.0' 2.51' TEST PIT DATA ` DESCRIPTION OF SOILS ENCOLWtTERED IN, TEST HOLES l HCLE �_ HOLE= -HCLE , HOLE 4 --f— H0-L= � `i r 3.0'( 3.5 • e 4.: 5.0' fie s 5.� a 41 7.0' 7.5' g.� Lndicate level at wbi.ch �oundwai:er is is 5 V,", 51A.. ® &S57- Lndicate level at which mottlinz is observed f � Lidic3te level to wEch water level rises a;:-uer bein5 countered ,6 � Deer hole observations made bv: 04 �a l� Date 3Z.3_ Z44 . Design Professional N&-me: Address: S i anature : M �1 .I