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HomeMy WebLinkAbout4508DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.19 -1 -42 BOX 34 ' � -r r} I,y'L L � � . 6L 0. kQT .` �. 96 f ti i ;�,� ,. b _- YES N El SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT DATE CQ PROPOSED INSTAL ADDRESS �O - (1 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC - mapped wetland - kMMR -44i 6 I TOWN 0,4'10 (r & Relationship (.e., owner, E d low b ►'�1` (- 13 Not in Watershed Delegated Joint Review Pro sal (include a separate sketch locatind the jho(j*d,`plr6p*ty 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,agreefto the conditions stated on this form- SIGNATURE / Cs� j�,��a� =f,.� TITLE DATE Qom' (owner) .'I•;_ft- _se "tip-±nstaller. agree o. ompl�rwith =the conditions-of perr� h7ffor tie peptic systems repair SIGNATURE TITLE DATE pnstaller) Proposal gRpMmd with th 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 ed until authorization to do so has been obtained from the Department. 4 INTERNAL USE ONLY pxi ?p°�a r -f . AAA.'rtoA is in compliance with applicable codes COPIES: PCHD; Owner; Installer PC -RP 99ML Cv Z'7 i � 2 1 Date Expiration [ Yes IV No O Rev. 2/07 7 . PUTS NI COUNTY DEPART-MENT Of HEALTH: DMSIO-N OF E'NVIRONNIE. INITAL HEALTH SERVICES DESIGN DATA SKEET —'SUBSURFACE SEWAGE TREAD/fENITT S —y-STE-M L Owner: Address: Located at (street): TNI Section: P.1cl 4-2- l0c" •o-C jVfunicipality: Wa t er S. h ed: - SOIL PERCOLATION TEST DATA Witnessed by,. Date 'o[Pre-soakinlgl Date of Percolation Tes-t I T-c 7--, rr,, np rn—,p nr:•! -,ir :ienrL) itnril Putnam County Department of Health Division of Environmental Health Services SSTS Repair 7 Final Site Inspection Date: r, 3 Inspected by: M h L Installer: Street Location: i a Owner: I'Alf-roll Town• ur Repair PermitA. 1. Type of System Conventional nAlternate 13 Comments: 2. Septic Tank Yes No -N/A Comments a. - Septic tank size —1,000 ... 1,250 ... other ..... V/ b. Septic tank installed level ...................... .c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ......... ? ................... iii.. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f. Trenches i. Sy stem completely opened for inspection ii. Length required _ Length installed iii. Pipe slope checked .................................. iv. Installed according to plan ..................... v. 10 ft. from property Line — 20 ft — foundations ... vi. Size of gravel % - 1 V2 " diameter clean .......... vii. Depth of gravel in trench 12" nimbinum .......... viii Ends•mped Pump or Dosed Systems .3. Sewage System Area a. SSTS Area located as pera roved pTans b. Fill section — VA c. Distance from water course /wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... c. Backfill material contains stones <4" diameter ......... . d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse f Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Ad-ditional Comments I "vjD e-N rhf\c� P - N4 r-C. vf-' CX m L/L A c, boy C_GD I'f\ S-100- RFSIRev-011312 LCLIWO 7 711. HAS I------------- ---- - - - --- �f . I - - APHRODITE CONSTRUCTION CO., INC. (T) Putnam Valley owner or Furc7&ser of Rujiding Wu i i 1-c-1-5 —a r I t —y owner as General Contractor and Building onstructcd by sec on 1)h,,-6u72:'!db -.qg� Q Knob 1A 11 5 tocation - Street Block 1 family residential - designed for bedrooms 17 guilding Type Lot GUARANTY OF S,?ARATE 31:*"141E iYSTEM I represent that I ---un wtiolly and completely responsible for the location, workmanship, construction and drainage of the sewage disposal system serving ths a"ov-e describe-d property, and that it has been constructed as shown on the anr)rovad plan, or appro--,,ed ' amendment thereto, and in accordance with ai-,.i rfx,.;lations of the Putnam County Department olf Hc',al,,h, an :i&rt;bj to t.hH owner, his succe sors, heirs or assigns, to place in . good operating condition any part of said *system constructed t.y r7io -,-ihich fails to op:-.rate for a period of two years immediately the date of initial use of the sewage disposal system, or any repai.-.4; by me to Such sysz;an, axcept where a the failure to operate properly is. us,-:id h., t1 he willful or nogligent act of the occu- pant of the building t.i z i ri ti. systam. The unders;gl.ud 1"urt.111-11 d9Z1et3.S to as conclusive the de- termination of 'L--,he F)"irector of tLn-'. Divisio.-. of 1: iv.. Health Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system ti;c oporate was caused by the w i I iful or negligent act of the occupant of C -Ie- building utilizing 111,.tj s.v3tem. t '-:, �qri _x for Aphrddit Construction Co., Inc. Signed as both Sanitary System Installer Titlegjll Street - RIOD � 3 I n, give nam® and General Contractor: Tfl�,or poraLio and address) Putnam Valley, 14ew York 10579 THREE (3) COAPii,:-S A:Z'E WiTh THHtE (3) Cu"'FIE'S 'OF' FINAL PLANS BEFORE CERTIFICATE OF COMF- ETION- WTLL BE ISSUED. GUARANTOR 7-S REqUIRLD TO FILL NQTIC� Of' DATE OF FIRST. USE OF' SYSTEM. Division of EhvironrianLal Health Servioes, Country Department of Health to NOTE: The Mill Ponds Subdivision is s erveaci by community water, from a 2 end sections t--; 4 2 mid sections C 49 "This- is to certif -,T tha t the sewage dis;oSILI` s ystem was co, tbucted as indicated 'on this plan and that. the system was inspected be"bre At was. coversd•.Over. The system was construate Tin accordan Ile e with all the rules and regula- ` �ttons; o f f. i (: =' d 01910 a at !SEAL': . 7, D(ViSION OF „r I NYS License 0439: L SAF R 1'FTRACE 250 M TOLERANCES (EXCEPT AS NOTED) a: REVISION RECORD_;;i V� 11 7777777 bra) I tp b co"CRETE PR Z�WTS ' BY . EA9T'�m3�S PRECAST 5. g 41• Z' ( '., 06 rT 3 J PLAN ©F . COMPLi TED WORK ( "As- Built")t,�'for LCYD 17 - DILL FONDS SUBDIVISION, sec , I DECIMAL service line on Enob nil to SCALE DRAWN B GENERAL CGENERAL CONTRACT M, , OWNER , & SANITARY I SYSTEM \ \\ lP' 20 INSTALLER are s same o APPROVED BV, Tnt 17 Ap.ro ite Construction Coo, Inc, FRACTIONAL P41111 Street, �FD # 3 for Aphrodite Construction Company Now,,; Putnam Valle New York 10579 field change fro ANGULAR DATE Locations per taped information vrith subsaquent Him, theodolite loca lion for dwelling, etc by GR AVE i. ALL AROUND uiider`sif; ;reed, and scaled pulls tkierefor, v�irith ToV of f A 1. F = interx)olations 9;s necessary, y, TABLE Or OFFS ETZ FF0114 HOUSE COPHERS 8 V Y hey I, :.. TEfi, DEC? ?IPTIC __ I Septic Tank T,PQnbole 15;5 33 14 s£'ri' u ti On :mot : 2 30 Center sallerq;' I 32 22 22 a :: Center - Gallery II 1 Note 4x4x4 Galleries used for I & II& Each consisted ,of 16 1 of , made of 2 end sections t--; 4 2 mid sections C 49 "This- is to certif -,T tha t the sewage dis;oSILI` s ystem was co, tbucted as indicated 'on this plan and that. the system was inspected be"bre At was. coversd•.Over. The system was construate Tin accordan Ile e with all the rules and regula- ` �ttons; o f f. i (: =' d 01910 a at !SEAL': . 7, D(ViSION OF „r I NYS License 0439: L SAF R 1'FTRACE 250 M TOLERANCES (EXCEPT AS NOTED) a: REVISION RECORD_;;i V� 11 7777777 bra) I tp b co"CRETE PR Z�WTS ' BY . EA9T'�m3�S PRECAST 5. g 41• Z' ( '., 06 rT 3 J PLAN ©F . COMPLi TED WORK ( "As- Built")t,�'for LCYD 17 - DILL FONDS SUBDIVISION, sec , I DECIMAL VY 120, P1 , IT SCALE DRAWN B Block Oa lP' 20 APPROVED BV, Tnt 17 FRACTIONAL TITLE - Prepared for Aphrodite Construction Company Now,,; Reflects a field change fro ANGULAR DATE V -4, Him, GR AVE i. ALL AROUND 1�+ F"AC4 i�4Ll:%� .o. ToV of f A 1. F = S Ir 1E,Uo SL Y V Y hey I, :.. 0