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HomeMy WebLinkAbout4603DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -14 BOX 35 "s ' '' 0 ' i, ;. '1 ■ I "l ' T All me 9L WA h jLL' 04603 --------��-------^-----+----�----�-'-- -�-- -- . | So Aws at | '---- -- --','--'-r-�''� �----'-- ----~- � ---�-'�--�-'--�--'--''--�-----~--�-�-----r----�--- � . LO 'D-b _-'__�_+_--~-_--� --- -_-'+. ! | --r---�--+ ----�-��-���-' - | ' | --^-', �------�- ^- -'� ---- ---- ' | . � �--)J PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES YES NQ/. Internal Use Only PERMIT - I L ❑ iRepair Permit issued in last 5 years 0/-Not 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 ho Woob S 7 TOWN J�au � TM # gs, 7 OWNER'S NAME �,C,/ /%� PHONE # MAILING ADDRESS '%% /? APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE j 2.o CL FACILITY TYPE Sd 5 PCHD COMPLAINT # PROPOSED INSTALLER i ,G- PHONE #,f-�� Z�f� ADDRESS i�Qn, )n S la) tbuer 1JI Kee, 5 i L LZ REGISTRATION /LICENSE # 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 oiv yer DATE -20 / -L, (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURr- TITLE .CS s, DATE (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 backfillgd until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Or Proposal Denied ❑ I P ector's Signature & Title Daat6 -f on Date Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 -�_.._ I I � Gv ✓;'�'�� �... � ►�L 191 w }-- - - - - -- -t - -•r- -- 1 , • , I , - - , • i , I r- 1 4 I � ' i , , T I, _ _ • ,1 r_ �d V r PUTNAM COUNTY HEALTH DEPARTMENT . DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR net 10/ Internal Use Only PERMIT #/ lC — Off-' /.2 ❑ Repair Permit issued in last 5 years L-T tot in Watershed 11 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 DATE TOWN ;Pay4 �J,a rm j%��ey TM # PHONE # (i.e., owner, tenant, contractor) FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS REGISTRATION /LICENSE # 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. SIGNATURE TITLE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair DATE % SIGNATURE TITLE DATE (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 Approved Proposal Denied ❑ 2 Inspector's Signature &Title Dat6 Ex atio ate Re pair proposal is in compliance with applicable codes Yes 9 No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLII SERVIC TS- - FIELD ACTIVITY REP —0 NAME -7-,>o6A ` Oily Ann,gFss: ljo Wcop Street { ,q a , Y n 1~ } � �t„ k r � 1 z PERSON IN CHARGE OR TNTF.R VTFVVTn. A TYPE OF FACIL FINDI Name and Title 4-& 0" roe ir'.F4e- I Signature and Title RFPO'RT RFC RTVF-T) BY., .1 acknowledge receipt of this report: SIGNATURE:' 02/96 Title: if 1 .� � � II /� � '.?' �� l Q r J I. ONMIS MM FZ�1B Jra� r 3��` PB+1 7! MIEMW PC® CMVUint Name- & Relationship U.e, cwner,tenant, etc.) MM TYPE FACILITY Lamy I q 11 Il6"TALLER Q On 3m &Q8--§0(0(0 REGISTRATION # Ptasal_(include sketch locating all adjacent mlls): %1015: Repair must be in same'location and of setae type as original sewage disposal system. Different locution may require submittal of proposal from licensed profess icaal engineer or registered architect. s VLn ture & Sisbmissian of as built repair A a. Owner's name. Disapproved duplicate showing- r ..i i'I71. b. Site Street Namme, Town and Tax Map number. c. Location of installed oamponents tied to two fixed points (e.g. home corners). d. System deecript3on (e.g., 1250 gal. concrete sepltic'tank, three precast 6' dime. x 6' deed drywalls sued by one foot'+ gravel). e. Installer's name and minber. 3. System repair to be performed in accordance with the above proposal and Conditions. I,, as owner, agent of canner agree to the above conditions. TTME DATE 11/9/0?OM 0PM- WAte MW); Yhl]aw Clean BW Pk k (W ioem:t) PC -RP 97 fit:;= •�;� >� County eParcel v2.2: Powered By Freeance 5.4.0.3670 - TDC Group inc. rago I UI free.66W �R# Map Tool Options Active Tool The current cursor mode is set to'Pan / Recenter'. Clicking on the map directly will adjust tl map to the point clicked. Dragging on the map will shift the extent of the entire map. http: / /putnamcountyny. com: 8081IFreeancelClientIPublicAcce ss 1. /index. html ?appeonfig —e... 1/26/2012 Property Details - Image Mate Online DG Image .Mate Online Page Navigation A \sz?C ORPS Links Assessment Info Lf,,)g n Residential Property Info Owner /Sales inventory I Improvements Report Comparables j Municipality of Putnam Valley,'Town of 2,576 sq. ft. First Story Area: SWIS: 372800 1 Tax ID: 1 85.7-2 -14 0 sq. ft. Additional Story Area: 0 sq. ft. Three-Quarter Story Area: 0 sq. ft. Finished Basement: 1,288 sq. ft. Structure Building Style: Raised ranch Number of Baths: 2 (Full) - 1(Half) Number of Bedrooms: 4 Number of Kitchens: 1 Number of Fireplaces: 1 Overall Condition: Normal Overall Grade: Average Porch Type: Porch Area: Year Built: 1970 Basement Type: Full Basement Garage Cap.: 0 Attached Garage Cap.: 0 sq. ft. Area Living Area: 2,576 sq. ft. First Story Area: 1,288 sq. ft. Second Story Area: 0 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. Three-Quarter Story Area: 0 sq. ft. Finished Basement: 1,288 sq. ft. Number of Stories: t 'Pin Pope ,y Photographs No Photo Available http:// putnam .sdgnys.com/propdetail.aspx ?swiss 372800 &.printkey = 08500700020140000000 2 /10/2012 Maps Q ie w, tax r i r t 'Pin Pope ,y 7 VieVd i I I P y p e tt t•la ps V if >:,;r •• i http:// putnam .sdgnys.com/propdetail.aspx ?swiss 372800 &.printkey = 08500700020140000000 2 /10/2012 c: � C, EP T i-. HO! E 4 _L_ r. L 0.5 1.01 2.0' 2. -,-' 3. 0' 3.5, 7.0' 8. 5, 9. 5 TEST, PIT DATA UE SuiL�) ENC 0 C1j\-TET=;q-TEST-R-9C E S HOLE HOLE H2OL"= 4 H. 0 L - _= g Ln6cau!evel at wliich z7ou­d%vaier is encountered 3 1-d*ca'p lev,! at w"ch mottlinc is obser,­' &4A1 do 10' a., ses azfter beinq encountered ct J.evet to which water level, n Nj Dee* hole obs'eniations made b-,;: C, .Date Z 2- Desi.a-n " ss ro Pional Nam, .. le Address: PUTN k I COUNTY DEPARTMENT OF .HEALTH DIti-ISIOti OF ENI VIRONNIENTAL HEALTH SERVICES DF.SIGNi DATA SHE'--ET -'SUBSURFACE SEWAGE TREATtiEtNT S YST-DM Owner: � ©C� Address: 110 C!,OOD Si', Located at (street): TM T" Section: _ Block Lot Municipality: —PU /AlAtA VALL,F- `r watershed: V'. SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre-soaking'. Date of Percolation Tes.t:- I I Depth to I I I Time I Elapse water from I y�ater Percolation Hole Nt o. I Run o: Star Time I sFound I level drop Rate ! ' Stop I P in. ( � surface in inches min/inch (inches.) Start - Sto 11 I I I I I. 3 I I I I 1 ? 3 4 i i 4 1 i l i ? I I I I I L i .� ► i I I 1 I 4 I I I I 1 T -c-: rn :'np r °-p rp :ir :a>-;. rip•vh nnril OWNER'S NAME SITE IDCATI PU NAM COUNTY HEALTH DEPARTMENT DIVISION OF HEALTH SERVICES r,. ..ra, --i .: �L _ "...iJ . ,.g:M1q>.y: ��.,F• a- Gl qi. ". :S.ui PROPOSAL FOR SEYOM DISPOSAL SYSTEM AIR �pH� oN V I 10 f Q TO tot MAILING ADDS pffa 1 IIQ'1mRVIEm PCHD Complaint # Nam & Relationship (i.e, owner,tenant, etc') DATE K -Pie � TYPE FACT PRoposED IrsTAI� c on PHCNE REGISTRATION # Pr (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. I,U'1 �i'r1 Oli s & 2. 3. Disapproved rmll---- Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g. ;house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. drywells surrounded- by,one foot +- gravel). e. Installer's name and number. System repair to be performed in accordance with the above proposal and conditions. x 6' deep I, as owner, r e agent of owner agree to the above conditions. SI TITLE d. .5: White (POD); YeUcw (fin ED; Pink LWio3nt) I nn