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Home My WebLink About4523DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85. -1 -27 BOX 34 04523 1 y , 44 *r 4 - 02 1 -. . �;- }, � - 6 ' �'� ` 04523 MAY -13 -2015 11:51AM FROM - ENVIRONMENTAL HEALTH 8452787921 T -024 P.001 /001 F -746 PUTNAM COUNTY t• IMAI -1 n ucr r., ., DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR _ _ - I htemal w"n, l ` - `PgAtAr Q F1%KW Perk Mued In tact 5 years NOt in Watershed ❑ Q Rep* vAMtn Boyd's Comers, W. Branch or Croton Falls Re& ❑ Delegated Q ❑ Repair within tor) ft of a watercourse or DEC - mapped wetland 17 Joint Review Re No SITE LOCATION 75 Wood Street TOWN Putnam Valley TM p 85--l-27 OWNER'S NAME MarLElUe M- PHONE # 914 980 -2578 MAILINGADDRESS 75 Wood Street, Mahopac, NY 10541- APPLICANT Mary E11 i s Name & Relalionship.(i.e., owner, tenant. contractor) DATE &7115 FACILITY TYPE Pr i v Dwe l l i nc,QCHO COMPLAINT # PROPOSED INSTALLER dba ov i ' Excavat ing, Inc pHONE 628 -4526 ADDRESS 485 Kennicut t4i l l Rd REGISTRATION [LICENSE # 1835/1 ja?6/ 1126 Mahopac, NY Propoosal (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, as owner,agres to the conditions stated on this form DATE .5 O TITLE B ga SIGNATURE" `� � �1uC� (owner) I, the septiC in lie , ree to i:!Mjy withitions s permit for the septic system re r ... .. ..., TIT ®AT1^ ft2ml anizvoik/with the j9jW-a&WMME 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system inftuar 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 o. 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. S. No completed work is to be backfiited until authorization to do so has been obtained from the Department, 1N'T MAL USE ONLY Proposal Approved 1900' Proposal Denied ❑ 100, 45 `1- sLi� it r r3 l6 r n,' _ innaturP & TMP Date E41r0ob Dan with COPIES: PCHO; Owner, installer PC-RP 99ML Rev. M7 x_ JOSEPH A. MANTOVI r w+�aeiow�►c- aewTDC TEL (845)628 -4526 S SEFMCIN07Na COMMUNRY SNCa,1Ws JOSEPH A. MANTOVI JR. FAX (845)628 -8457 ✓ .r'ww — : a,. t,i , . _ ti -w. -'•* -s u .:v - y- ...,s. x• y....±0a�•triuK- . n.: _,.�„ q•r . :.s+ a•`t'` � _ ti. may.,.' _H0111J4 P°TI .�p 485 KENNICUT HILL ROAD MAHOPAC, NEW YORK 10541 71 A p 0 1 Re,lO a ^' Y Q r�tl 0 f 7 fnt 7o z . . . . . . . . . . . . . ........ OTER inc. Sewer & Drain Service Elmer, Gal'loway Rd. Katonah, NY 10536 914-232-8888 Aol �7 7' Putnam County Department of Health - Division of Environmental Health Services SSTS Repair — Final Site Inspection Date: 6" ^_ Inspected by. Installer: . deli j Street Locati n: '� a,� 4. Owner: 174.1' _ Town: Repair Permit #: TM # �_- --�— 1. ss System"inspected? YesV No ❑ If not, explain: 2. Type of System: Conventional ❑ Alternate ❑ Comments: 3. Septic Tank Yes No N/A Comments a. Septic tank size —*w . . 1 ... other .... . b. Septic tank installed level ...................... 4. Distribution Box a. All outlets at same elevation (water tested) ... 5. Junction Box — properly set ........................... 6. Trenches a. System completely opened for inspection b. Length required Length installed ' c. Pipe slope checked ... ............................... d. Installed according to plan ..................... e. Size of gravel N - 1 %z " diameter clean ......... E Depth of gravel in trench 12" minimum ...... - Fg. Ends capped .... ............................... 7. Puma or Dosed Systems S. Sewage System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance from water c6urse/wetlands 9. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. Backfill material contains stones <4" diameter ......... c. Curtain drain & standpipes installed according to plan d. Curtain drain outfall protected & dir to exist watercourse e. Erosion control provided ............................ RFSI Rev- 010515 Re No 2—' PUTNAM COUNTY HE� TH D PAR TM E�Nc T C �/ v DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' D PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 0+ IritemaI Use. Onl PERMIT ❑ Repair Permit issued In last 5 years J9 Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 2oo ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 75 Wood Street TOWN Putnam Valley TM# 85.-1-27 OWNER'S NAME Mary Ellis PHONE # 914 980 -2578 MAILING ADDRESS 75 Wood Street, Mahopac, NY 10541 APPLICANT Mary Ellis Name & Relationship (.e., owner, tenant, contractor) DATE 5#7/t 5 FACILITY TYPE Pr i v Dwe l l i n4YCHD COMPLAINT # PROPOSED INSTALLER JdMantovi Excavating, Inc PHONE# 628 -4526 Selaiiii- ADDRESS 485 Kenn icut Hill Rd REGISTRATION /LICENSE # 1035/10-1155/1126 Mahopac, NY 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. ✓` I, as owner,agree to the conditions stated on this form SIGNATURE `� TITLE &Ua& DATE She (owner) I, the septic in le, ree to com y with the conditions permit for the septic system re 'r 4th SIGNATURE _ TiT -= DATE. (Installer) -� I wi "a 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 !UTCOUA1 Isea AfJI v Proposal Approved Proposal Denied ❑ It 3/�6 looWcuoWSignature & Title Date Ex irati Date ,Repair proposal is in compliance with applicable codes Yes © No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 .. _. ...:.:.......... . OTERInc. -sewer &.Prain Service -225-27746, 914 Elmer Galloway Rd. Katonah, NY 10536 914-232-8888 501tc -COWAO bass I �7 SZO _31 f r i i V f! 1 a r r• ; { LC C..