Loading...
HomeMy WebLinkAbout4409DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -11 BOX 33 90 0-6 'r I o I' vi.9 d PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES �--� PROPOSAL' FOR° SEWAGE -TREATMENT (:-REPAIR'-",:; YES my Internal Use Only PERMIT # fA ' G ' - ❑ E9 Repair Permit issued in last 5 years ❑ Not in Watershed ❑ ❑ 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 �r) TOWN a TM # `iJj - 1 i OWNER'S NAME — PHONE # 14y(,, _QJSI MAILING ADDRESS APPLICANT Or.P 1 a )AA- nc, . 0r)C'- , "C-`-oC- Name & Relationship p.e., owner, ten t, contractor) DATE -1q— it FACILITY TYPE. PCHD COMPLAINT # PROPOSED INSTALLER ��� ,; Si�s� �jc('�;��; ,-�o, PHONE # ADDRESS Gt✓Y?t•>MNi Nr�+� � �, r, REGISTRATION /LICENSE # Pro sal (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. / 1 r ` „_. J -% l 61L AC I, as owner,agree to the gWd,itions stated on this form , SIGNATURE TITLE DATE (owner) .. I, the septic installer, agre compl with he nditions of this permit for the septic system repair SIGNATURE TITLE S, FY1� DATE-L1- o1D I 1 pnstaller) Pro appr 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 bac until authorization to do so has been obtained from the Department. INTERNAL USE ONLY P o sal proved Proposal Denied Ins or's Signature & Title -\Dat Expiration Date Repair proposal is in compliance with applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 I I -t Sheet l of rUTNAM-.CQVN-T.Y. DEPA -RT MENT Off' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIELD ACTIVITY REPORT Tel; AT)T) Street Town State Zip PERSON IN CHARGE OR TNTF.RV1FWRT)-. D a t t-.. Name a I Title TYPE OF FACILITY : r% 2,, FINDINGS: W ---s W, s,li tt� CoLVd 6,c-A-4-,1141, C F�f MC,14 TFT WSP CTnR, Signature and Title RFPORT RFCF.TVF.T) RYI I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. 201706]U4 1331 PRECISION EXCAVATING 18457360571>> 8452787921 P 112 Precision Excavating Inc. 3 Rochambeau Shmd Garrison. NV 10524 (845) 736-0571 ewavad"Overiza"et ,r:7AX JRAW'-)!V11*1-TAL FORIM To: From: Date Sent: Regarding: No. of Pages' Mitchell, Mitchell Lee April Leonforte June 6, 2011 Test Holes 2 e-a a e We-Would -likeb ne -Akh dfia-lestiing- 1606li-test-holes-for Wy-: kf4ebl�-(Ilthfl*h� � o per th Request. The original permit paperwork was filed the end of April and it has taken until now to get squared away with the town. Please call me at your earliest convenience at (845) 736-0571. Sincerely, April Leonforte 011-06 -06 13:31 PRECISION EXCAVATING 18457360571>> 8452787921 BRUCE L FO PaNk Ifealtk D&od*r DAM P 212 I.OIfEP'[i°A MOLIMAM RN., MAN, Agjadaaa PWO Hse tb D6wlgr All inTormd eft below cast be I& compkid prior to sm>y Medems. IDATE,: — REASON. - DE Se { PERCSs D PUMP 1 9ST: 20AMSTRIKE'r- � s NO _ ® a rrapdW 5STSwittimi the dridnage buia 89wastartanchorBoyd $ Comer F%sorvroin. © 0 Piroposed SM within S00 feet of a roor, voira Mervalr etem, or control lxkc a ® Proposed fisTB within 200 lest of a watmoune or m DEC wetland. 13 ® Proposed SM dew low grater that 1000 pRoW&y or MRS Permit require& a a Ioroposed &STS for a ceafterew FMject. if o project Iu been determined to be Delegated bued om &0 Mbove m8ponse and then subsequent information lndle$ tea NYCDE P is required to witness the coil *zby It Mll be the sole responsibility of 4tn design proft iolmnl to schedule re- witnessing of the oon and" rdih 1YCDEP. (RELDT'EST) KNCUUMUIZONLY, n . � . _' | ' ~� ' . . { ! . ` �� ' } / . | � --_---- �__---_ �— — :- ...�.v � t �M�Li'v ®'"�u'µYVSiS/LY b� dP•�'G47'�'�`'.s�.-`_b tv -�+' , � tf�r " . Publk Health Directar IDEPART 'T OF BEALTH 1 Geneva Road - Brewster, New York 10509 Asiodate PWic Health Dreetor Director of Patient Services ATTEPPt ON: ❑ JOSEPH PARAVATII X GENE REED All information below must be fft completed prior to any scheduling. ]DATE: — ENGMER OR :.� ►rnn 6tr.A,)�� n!2_ _ PHONE 3.kDS REASON: DEEPS: PERCS: o ' PU50 TEST: a ROAD/STREET: \0 W kAe- �- - -- TOWN: u�'n�rn �� �� TAX MAM. IN -1 I - I - I I SUBDIMION: ILOT#: OVER: NycDEP cR OoR i-ow RE—vim A'ND WrMSSIRG OF SOIL TESTING YES NO ❑ ❑ Proposed SSTS within the drainage basic of Nest Branch or Boyde Cqm eir Reservoirs.. _. k°rap6 �d SETS within 5019 feet of a reservoir,�eeaervo.r•stem or control lake. ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the 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. U you answered yq to any of the questions, NYCDEP most witness the soli tests. This Department will coordinate a mutually suitable time for meld testing with the Design Professional and M Y'CDEP. If m 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 MYCDEP. (PMLD'ESi PUTNAM COUNTY HEALTHYDEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION �(7 vJl,,�� Ra TOWN kjf%aM 11c, llt TM # OWNER'S NAME rota 1 11 PHONE # 6(�6 15 �- 65F2 MAILING ADDRESS mt^ Ult,11ti OS i PROPOSED CONTRACTOR /INSTALLER , t� �a� Cav PHONE # 5% -736-057( ADDRESS &(0SM REGISTRATION /LICENSE # (O 2 t Reason-for exploration: ❑ failurq to surface O back -up in ho u e ❑ find Ii its of system for repair Ei other (explain below) FOR COUNTY USE ONLY p I(L� Inspector's Signature & Title Appointment Date: TB 0 kly: excel: septic Time: 6 t� Date 11. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES `1- 46 06 SAfL FOR SEWAd9:`T'RE��T Internal Use PERNIT d U LJ Repair Permit issued in last 5 years U Not in Watershed ❑ ❑ 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 OWNER'S NAME MAILING ADDRESS APPLICANT TOWN TM# 24JI -1--1i PHONE # Name & Relationship (i.e., owner, ten t, contractor) DATE —�q— FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE ADDRESS REGISTRATION /L /LICENSE # 1110 Pro sal (Include a separate sketch locating the house, property lines, all adjacent tells 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. kC:nI n.Q- /01 Iris t:<<J �l V, I, as owner,agree to the SIGNATURE I, the septic installer, SIGNATURE onaftller) stated on this form 14'1-1Z-1J TITLE Vlc2,0,,C DATE compl�wit� od- Vti-o.. n.. s -...- ...� rpm.. _... Y ..... w -. .� .- .+�.w -�� �...... r �0 . w_ -•-� w w.-- of this permit for the septic system repair TITLE DATE 4�- DO •- t I 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 Date Expiration Date Repair eroposal is in com liance with applicable codes Yes O No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 �� � �� . �S 3�,� i�- .._ 7k - Homeowner: Elez Brucaj 10 White Road Putnam Valley, NY 10579 (845) 284-2982 Town of Putnam Valley Tax Map: 84.11-1-11 Installer: Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736-0571 Description of Repair to System: Installation of 150' Septic Fields With 1 1/7" Washed Stone Scale (Not to Scale) Installation Complete: 6-17-11 Legend: A -2 =20' B - 2 = 24.5' A -3 =25.5' B - 3 = 30' A -4 =32.5' B - 4 = 36.5' PUTNA M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES, DESIGN DATA SHEET - SUBSURFACE SEWAGE TREAT.NIENT SYSTEM Owner: Ca Address: Located at (street): Tim 9 Section.St"fitock Lot �I l li .. tVluaicipality: VLA nA � � t Watershed: Lk SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Date of Percolation Test: I Hole No. .Run No. Time Start — Stop Elapse Time (mina Depth to water from Found surface (inches) Start - Stop Water' ;' . ` level drop in' inch es Percolation Rate ' min /inch 2 ' 3 - 1 J 2 3 4 z 1 2 3 4 i 1 2 3 4 3 Notes: 1. Tests to be repeared at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., _< 1 min for 1 -30 min/inch, < 2 min for 3 1-60 miniinch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, po I of 2 TEST PIT DATA , DESCRIPTION OF SOUS ENCOUNTERED Ilea TEST HOLES DEPTH HOLE # HOLE # HOLE # HOLE # HOLE #� I G.L. 2.0'- .' o 2.5' 3.0' e 3.5' 4.01 4.5' 5.0' C 6.0' 6.5' oQ 7.0' 7.5' 8.5' 10.0' 1 p Indicate level at which groundwater is encountered t1 aft(l�nnV 0+ w4u Indicate level at which4 ttling is observed 4\Q Indicate level to which water level rise r being ieoun tered Deep hole observations made by: Date 6 i l l Design Professional Name: Address: Sipature: Design Professional = Seal