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HomeMy WebLinkAbout4588DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.06 -1 -26 BOX 34 r 1 '.r T �. ■ ' '' IN 96 'f NIV I 1 ■ ■� � . 1 T PUTNAM COUNTY HEALTH EYEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES`- PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO / Internal Use Only PERMIT U L-1" Repair Permit issued in last 5 years WNot in Watershed O , Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated V Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review �- TOWN t!'T/V,9^- Wwcv. TM # SITE LOCATION � ry OS T � _ OWNER'S NAME e/ Z- I-e PHONE 9� V7/ MAILING ADDRESS r ^ouey r LO G' , v� /y/wr « Ile - APPLICANT APPLICANT Vhf ep Se_,p TZc Name & Relationship (i.e., owner, tenant, contractor) DATE 9 "'� ''/ FACILITY TYPE 5f-'f It %. PCHD COMPLAINT # � PROPOSED INSTALLER Qr✓ v PHONE #— 70 -7 60 ADDRESS 311 IL ra'/M Q��r,, 06REGISTRATION /LICENSE# ¢ =V�I"`7!iI nJ 11 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. 1 Diu 'D u s IN % J_d A 6^ rA O o ore. e x t S T p 4' S S C P '� l e I--( e tk5 4 y •-� S � �e e-. 0- I, as owner,agree tot conditi7ated on this form SIGNATURE TITLE DATE (owner) I,-.the septic installer, a e.to, compl ith the conditions of this permit for the septic,system repair SIGNATURE TITLE ,�CS De•J� DATE 1 -3 (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 Proposal Approv Proposal Denied C�A //X 01,111- ra, 6 In ctor's Si nature &Title D ek o Expiration Date Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 7 160, J H IN I CE) ZF I e-1, IV P- CA vo, r4 5.17-rk L ;-J :S t-, G 1-41Y Trf i,.f�vrj ift UNITED SEPTIC & EXCAVATION CORP. Septic Systems • 6iainage Work • Sites Developed Foundations • Grading • Utilities - T rue i ki ng Palna"'& Fai> field C ti's 311 Railroad Avenue Teft. (914) 242-1999 Bedford Hills, New York t0507 Fax: (914) 242-1909 115- siferCA/ ONn-13MCI 13A3-1-ie zf- 0 co 4'0 z rL N 5.4 19 < E 5 Z 4/00 7— 60 te ^/I 'Cr) A]�] rleW 5,0 7 . 4- -j t. Day 87.1 o "4q a� , 53,5. 5 6-7 734.- 0- 0 7' 1.71 Gq C) �A 'r C ow N UNITED SEPTIC & EXCAVATION CORP. Septic Systems • Drainage Work • Sites Developed Foundations • Grading • Utilities • Trucking Sm mg 111 pul'I'lln't Faididd C 111fie, 311 Railroad Avenue Tel: (914) 242-1999 Bedford Hills. New York 10507 Fax: (914) 242-19119 www.unitedsepticsysterns.com r ' j ( r ) , s i1 1 - { , , I I , jw ! ! it Iz r, { ! IN f I f r i ' � I _ - -- p i R �. F1NNEgry 7 `:'� ONE. .... , e ,: s ,. :� r . i.:':::.:.:a• .. ' � = ? . f N- B6- 03 -25 -W W4Z1_, 145.00 r: ate. •:•�`•' i • 2 ` i �t 64.63 - a 3 W/ n-' r ,- • - 25053 PR VOST PLACE .. RCE4 SHOWN HEREON KNOWN AS 14. ON MAP OF "LANDS .OF • i " SURVEY OF PROPERTY FOR --1EV ro, AN TTO L 11V .I Vc RA i:JNAL mw or wrsTqmv TER.: R /CAN T/TLf /NSGW. CO ` . 3ITUA.TE IN 'Et AY C ;ARPENTER & CO: j'O,�/N :F PUTNAM' VALLEY ENGI"W!I . R LAND' SUjtVEYORS .1RKT0WN.'HEIGHTS, N. Y. PUTNAM COUNTY, N. Y. t:. F R =7WH OWLL�27 P . at L.lS. 12400 ! SCALD[: / " r S0 DATE: AW.20AW .6 L'Lgi to 9 3AA of Ld sr 96 io 00 00 z Go xal j ,6 L T9 L 5c,/.K IL 3,,OO,L L. LOS 13A3 i - -18 6 C 6 -�f 4 }sly 'H 0 x 60 -tR= A3-12 30 v �f 96 t\; 9Z--L" -90'58 Fgur—d IT47 cr) Cn co N 54 E 52 W P( puv� r s C c'r 9Od-L=V3dV UNITED SEPTIC & 0 ON18 0 EXCAVATION CORP. "v 9 L 7 L "' 00 Septic Systems • Drainage Work . Sit" Developed Utilities -Trucking Foundations • Grading ('11 r ,f W-14'ev'• han P 311 Railroad Avenue TO: (914) 242-1999 lledfoi A Hills, New York 10507 Fax: (914) 242-1909 AA nn i a _ r I UNITED SEPTIC EXC NATION COR -1—ie Septic Sti"c Di a Wage Work -Sites Developed ''� ..',.�.�"'e,. - -�t.. - '.v' .••. x:..:_:.'. K.. :_�?'::.3•f= .'.: �:,:: ,, �DUnttatian L cacti rtgr lre£f:il�' », .Se'l-Ml all nJ Nc uhe. rcr. Pum ? & Fairfield Cmmtrs 311 Railroad Avenue Tel: (914) 242 -1999 Redford Hills, New York 10507 Fax: (914) 242 -1909 www.un itedseptiesystems.coni 0 CO r OIL, fir, • . ,.. rJ�i� rti . 6017p= a . 01 1 ,w l �� boo � • ,, C� r4(� .� r�cA- U rJO�_ s • J AY i, tie . . 11 The AW&C`High Ca0acity - .. Chamber The Quick4 High Capacity Chamber Idluttor$ rff 48" EFFECTIVE LENGTH INFILTRATOR SYSTEMS I_NC. STANDARD LIMITED WARRANTY -(a) Thu auuctural integrity of each Oiamber, end plale,wodgc and clher aeooszory mw.faclwod by Jrfiluntor.ralnitc'1, when installed -and . operated in a leachfield of an onsile septic system in accordance with Infiltrator's instructions, is warranted to [lie original purchaser ('Holder') against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units: provided, however, that it a septic permit is not required by applicable law, the waranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder roust notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply raplamrnent Units for Units determined by Infiltrator to be covered by this 1 imiled Warranty. Infiltrator's liability specifically excludes the cost of removal and /or installation of the Units. (b)THF. I IMITCD WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. 1 HERE ARE NO OTIiER WARRANT IES WI I H RFSPFCT TO rHE UNI1 S. INCLUDING NO IMPLIFD WARRANTIFS OF MCRCI IANTABII ITY OR FITNESS rOR A PARTICULAR PURPOSE (c) This t imited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages; including loss of production and profits. labor and materials, overhead costs, or other losses or expenses incurred by the Holder or arty third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear. alteration, accident, mis use, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which arc not permitted by the installation instructions; failure to maintain the rnininlurn ground covers set lorlh in the installation instructions: the placement of improper materials into the system containing the Units: failure of the Units or the septic system due to improper siting or improper sizing, excessive waver usage, improper grease disposal. or improper operation: or any other event not mused by Infiltrator. 'I his I imited Warranty shall be void it the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage, to the Holder, the Units, or any third party resulting from installation or shipment, or from any Product liability claims of I Ioldor or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all 011ie, applicable laws: and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty No warranty applies to any party other than the original Holder. fine above represents the Standard Limited Warranty offered by Infiltrator. A limited nwnbet of stales arid counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook. Connecticut, prior to such purchase, to obtain a ropy of the applicable warranty. and should carefully read that warranty prior to the purchase of Units. SYSTEMS INC Environmental Onsite Wastewater Solutions 6 Business Park Road - P.O. Box 768 Old Saybrook, CT 06475 860 - 577 -7000 • FAX 860 - 577 -7001 1- 800 -221 -4436 www.infiltratorsystems.com For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1- 800 - 221 -4436. U.S. Patents: 4,759,661; 5.017,041: 5.156,488; 5,336,017; 5,401,116; 5,401,459: 5.511,903; 5.716.163; 5.588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4 and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registereO trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. ChamberSpacer, Contour, Contour Swivel Connection, MicroLeaching. MultiPort. PolyTi fl. Posilock. QuickCut. QuickPlay, Snapl-ock and StraightLock are trademarks of Infiltrator Systems Inc. © 2005 Infiltrator SysteMS Inc. Printed in U.S.A. 0131205WA -2 Putnam County Department of Health Division of Environmental Health Services ��FP SSTS Repair — Final S' a Inspection Date: Inspected by: % Installer: Street L ''cation: abVS,d Owner: Town: '�J� 6� y Repair Permit #: Y-17S--f&f TM # C 1. Type of System: Conventional O Alternate 0 Comments: 2. Septic Tank Yes No -N /A Comments a. Septic tank size —1,000 ... 1,250... other... , . b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box L 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. System completely opened for inspection ii. Length required ? ength installed iii. Pipe slope checked ... ............................... iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft— foundations ... vi. Size of gravel' /. -1 '/z " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped ... • ............................... g. Pump or Dosed Systems 3. Se_wafte System Area a. SSTS Area located as per a roved plans b. Fill section— V c. Distance from water course/wetlands ✓ r c 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... V/ 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 ............................ s,,...:Additional Comments ogC "�� � RFSI Rev - 011312 ` 7 rt x: Y i , • R9E4# E t /y 66.-03 -25 -ty W441. i 5 00 r W y 1 ` F FR Od0'G. t jr d � ti i s` "o os y .. ' � ... � � -.. ....�'. •.. 1 tilt' .' ' RCE4 ,SMWN HEREON KNOWN AS 14 QN,A4P 0F"LANDS OF. ` i ;FARO PAST; 411RVF.V ClF PRCIPFRTd F(lL?- f is -BRUCE ~ -R. 'I+OLEI' f-r _ • ..g. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 20, 2003 James J. Hegarty 14 Country Club Rd. Hopewell Jct., NY 12533 Re: Addition - Hegarty, 25 Provost Pl. No Increases in Number of Bedrooms (T)Putnam Valley, TM #85.6 -1 -26 Dear Mr. Hagarty: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated February 19, 2003 The addition is approved with the following conditions. 1T The total 'number of bedrooms must remain at ee without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower'heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. ,fiery truly ours, Michael Luke ML:Im Public Health Technician BRUCE FOLEY. DEPARTNMNT- I Geneva Brewste*r, New OF HEALTH Road York 10509 ltORETT& W,. A41, R Associate Public Health Director Director of Patient Services . Environinent2l Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 608 1 5 Early Intervention (845) 278 - 6014 Preschool (845) 278-6082 Fax (845) 278 - 6648. ADDITION APPLICATION (RESIDENTIAL QMM STREET #go PIW-6- TOWN&YMO TX MAP9 NAIL --IOhA-' PHONE !?V,'T—_S;ZF—)6Wr,,PCHD MAILING ADDRESS �9 Ve:�7_ Al.,9140 AV— DESCRIPTION OF ADDITION DD 33,YW ._4 464V NUMBER OF EXISTING BEDROOMS_ PROPOSED 9 OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition -which is considered a bedroom requires formal approval 'of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance With applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putna rn County Health Dept:, 4 Geneva Road, Brewster, NY' 10509, Phone 278-6130. 1. Certified check or money order for $100.00. 2.,V Sketches of existing floor plan (drawn to scale, all living area including basement) C-3 r71 *Non-professional sketches are acceptable. (0 3. V" Two sets of proposed floor plan (drawn to -scale, with name, street, and tax map *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of Installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom c.,) count of dwelling. OFFICE USE I rcoyo BFhouseguidelines ►RUCE R FOLEY iblic Health Director b LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF -HEALTH 1 Geneva Road Brewster, New York 10509 Environmental health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (84S) 278 - 6558. WIC (845) 278 - 6678 Fax (845) 278 - 6.085 Early Intervention (845) 278.6014 Preschool .(845) 278 -6082 • Fax (845) 278 - 6648 f� 2003 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re. Residence ' Tax Map Town According to records maintained by the Town, the above noted dwelling is IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD:, uilding Inspector BFhouseguidelines PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: _&Jlzrr Address: Located at (street): Dr- fawd TM# Municipality: q1 Watershed: SOIL PERCOLATION TEST DATA I? Witnessed by: D, Y/ Date of Pre-soaking: Date of Percolation Test- C//5r//"/ Hole Noi Hole depth (Inches) Run No. Time Start- Stop Elapse Time (min.) Depth to water from ground surface Que I hes) Start- stop Water level drop m Inches Percolation Rate vain/inch in _.1"r 5b g A 2 a- 3 j():V Ito-Y v - ----------- 2 3 4 F 2 3 4 5 2 3 4 5 Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (Le., :5 I min for 1-30 min/inch, < 2 min for 31-60 mill/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97. pg 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS (ENCOUNTERED IN TEST HOLES : =HOLE #., - G. L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 66 V 4.5' 5.0' 5:5' 7:0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed 1 -le,14 Indicate level to which water level rises after being encountered • x/� 4 ( Deep hole observations made by: ��a Date r - � k� A, Design Professional Name: Address: Signature: Desip Piofessionai's Seal Revised July 2013