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Home My WebLink About4650DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.13 -1 -40 BOX 35 04650 ` I 04650 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES' PROPOSAL, FOR SEWAGE TREATMENT SYSTEM REPAID IL YES p NO/ Internal Use Only PERMIT # SID U Imo-T Repair Permit issued in last 5 years W-"Not in Watershed ❑ L�' Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ �. Repair within 200 ft. off a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �,6 ��qp,r T TOWN a TM # 85-13- f — 46 OWNER'S NAME `lwl� All' el, a trC j (� PHONE #ff45-, -% MAILING ADDRESS APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE ACILITY TYPE PCHD COMPLAINT # PROPOSED. INSTALLER 6/k 5 LG PHONE # JW- A6 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 na re nd ext nt of the re air. l 1 I j o�riL .k Sri 1000 rJON Dft. Las• LONG 9-- �n.✓ - 1Mt(., W +1� _ Vovt 1. 6 -a) i� I`ec(ewy ' (Zj %Ak"C K � a I, as owner,agree to the conditions stated o this form r SIGNATURE ✓1 _��O�B'/ TITLE 4 IV61Z . DATE (owner) I,'the $epilc in�t l r, agreE to comply �vith the conditions of this permit for the septic system repair SIGNATURE TITLE 4., �N�'� DATE / C)- 0 (- A) pnstaller) Proposal aQproved 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 backfill until authorization to do so has been obtained from the Department. INTERNAL USE ONLY re & Title I is in compliance with COPIES: PCHD; Owner; Installer PC -RP 99ML Prop Denied codes 101 2 Date Yes 11)14113 Expi ation Date No ❑ Rev. 2/07 r. ck I NN �:� �I� . o � ��' ire � IS OOU vi e i1 U'C( .... • -.v . .i .• � � ` �' .gyp. , _ _ �.N ^��.•.<+.� -r�4 ..� T s0... �. .�. �..�t n `P �. _. l� !� ..'I. I♦ r. . -c!..-e .�Rc2.:�i.:S: �. .��1f ia_ -. .:.•ls .•. ... .. .y...t� .�• w .. iY •'ir�� •.Y. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FIELD TESTING All information must bed completed prior to any scheduling. Date: /G �51 /� Engineer or Firm: Phone #: / Person to Contact: f ❑ New Construction ❑ Repair Program ❑ Addition Program ' Reason: Deeps 6Peres Road /Street: 1 z Town: Subdivision: Owner: ❑ Pump Test ❑ Project not within NYC Watershed. Tax Map M � L,)3 Lot #: NYCDEP CRITERIA FOR .IOINT REVIEW AND NVITNESSING OF-SOIL TESUN6 ❑ ❑ Proposed SSTS within the drainage basin of West Branch, Croton Falls, or Boyds Corner reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir 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. if you answered Les to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for Held testing with the Design Professions and NYCDEP. If a 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 NYCDEP. FOR COUNT] ONLY DATE: t 0 'l TIME: D M COMMENTS: Req.for field test:kly 4/16/2009 Putnam County Department of Health Division of Environmental Health Services I SSTS Repair — Final Site Inspection Date: I o i Inspected by: I AD L Installer: ✓CAS Street Locati G `C, Owner: C own:!f'+�! r�3 e�_j :: , P �r 1! i �' ^x 1�1 1. Type of System: Conventional Alternate [ Comments: .1 I_ �n A 2. Septic Tank Yes No N/A C ents a. Septic tank size -1,000 ... 1,250 ... other ..... °7$0 760 its rae 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 ........... . ................. .l iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box -properly set ........................... f. Trenches i. . System com letel y opened for inspection ii. Length required Length installed iii. Pie sloe 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 ......... vi... -E-,ids-ca p ed .:.:............. - g. Pump or Dosed Systems 3. Sewage System Area a. SSTS Area located as per a roved plans b. Fill section - 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 ............................ Additional Comments: J+�,-L 1\Omt Ot if"e-w 1 od`^ CICCT a �aMe pwAer C,^k fQrz,t UaSQ�' Ili �"l' k iAcr2c`SQ� r ` �k UJLAI Lot�TaMt" (Icnk�o(1, .-�ADL d k RIFS1 Rev- 011312 P040 -M I I T-14 010 �- ocl -�3 .5-00 71 74q /I k C)qk 7(-4v- �oe I - PUTNAM COUNTY HEALTH DEPAR4MENr DIVISION OF ENVIRONMENTAL. HEALTH SERVICES OWNER'S NAME J b se A Cclua l ct PHONE s a F -) 13 SITE LOCATION (5 T MAILING ADDRESS /��. 1/a� Ile v A AUJ % r k l0 ,579 PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER S7 , ®�. c- P.,_ , &,A -)'I PHONE ol g- / '� / 7 Proposal (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. Ty M 0 %'J' ' 6�rti. & �_- S S n _eX i W6// . _r a l 1/ C, 7'c r 0--aw -c L S Proposal approved Proposal Disapproved Inspector's Signature & Titl Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. 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' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE 2 =~v TITLE 7' DATE M. : White MV; Yellow (Tam HI); Pink (AgLi a YQ - 71 PW F SA�,M DISPOSAL_ SYST1 1 REPAIR OWNER'S NAME J b se A Cclua l ct PHONE s a F -) 13 SITE LOCATION (5 T MAILING ADDRESS /��. 1/a� Ile v A AUJ % r k l0 ,579 PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER S7 , ®�. c- P.,_ , &,A -)'I PHONE ol g- / '� / 7 Proposal (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. Ty M 0 %'J' ' 6�rti. & �_- S S n _eX i W6// . _r a l 1/ C, 7'c r 0--aw -c L S Proposal approved Proposal Disapproved Inspector's Signature & Titl Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. 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' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE 2 =~v TITLE 7' DATE M. : White MV; Yellow (Tam HI); Pink (AgLi a YQ o PUTNAM (COUNTY DEPARTMENT OIF HEALTH a WRMON ®IF IEN VIRONM ENTAIL HEALTH SIERVRCIES APPLI<C�')I'� ®�1'® �QD�14�'1E811I�:�' e41.?Y�l�'1� W please print or type PCHD Permit # t L 30 — OS WeH Location: Street Address: Town/Village Tax Grid # 22 Barger Street, Putnam Valley, NY Map85.13 Block -1 Lot(s) -40 WeRR OwIme>re Name: Address: Thomas Cuccia 144 Ninham Road, Carmel, NY 10512 Use of WeRk X Residential Public Supply Air /Cond/Heat Pump Irrigation I- prima">ry Business Faun Test/Monitoring Other (specify) 2-second miry Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage __gal. Reason for Replace Existing Supply Test/Observation Additional Supply dD>rIl9lDnng New Supply (new dwelling) X Deepen Existing Well IlDetafled Reason On 5/4/05 we tested well to be delivering 1 gpm. for IlDriR ling WeH Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: P. F. Beal & Sons, Inc., Address: 4 Putnam Ave_ RraVdStPr NY 30 0 Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separates et/plan. Date.-- - 5/16/05• .- Applicant SignatL::e: Adam L. Beal PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. AIEPROV EllD_]FOR. CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocab for cause or may be amended or modified when considered necessary by the Public Health Director. An re 'sion or alteration of the approved plan requires a new permit. Well to be constructed by a water el er c ` ' ed by Putnam County. Date of Issue j Permit Issui Date of Expiration J Title: Permit is Nonn- Tira®sffer hR White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAIM 00"UNTY DEPARTMENT OF HEALTH DMSION OF ENIVIRONMENTAL. HEALTH SERVICES ]DESIGN EXATA-S-F-T-ET SUBSLRFACE SEWAGE TREATIv[ENT SYSTF_M 0w.ner:. CLAC C t A Address: r r-acated at (street): TM, Section !��7' Block 1 Lot 40 j%4 Unicipality: Watershed: SOIL PERCOLATION TEST DATA. Witnessed by: Date of Pre-soaking: Date of Percolation Test: Hole INO. Run Na. Time Start — Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop Water- Percolation level drop , Rate in inches min/inch 2 3 4 2 3 4 '2 .3 4 I i I 3 4 Notes: 1. Tests to be repeated at same depth until approximately eqlail percolation rates are obtained at each percolation test. hole. < 1 min for 1=30 rnin/inch, < 2 min for 31-60 min; inch). Alt data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-9 i. t)t- TEST PI'S' DATA , DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate'level at which mottling is observed 4� Indicate level to which water level rises after being encountered Deep hole observations made by: jg Design Professional Name: Address: Sipature: Desi;n Professional = Seal Date 10M t2 p .HOLE DEPTH HOLE # l HOLE # HOLE # HOLE # # G. L.ac _ �t 1.5' cv► 2.0' 2.5' 3.0' 3.5' lawn 5.0' w 5.5 S� 6.0' S kone5 6.5' 7.0' 7.5' 8.0' 8.5' 10.0' - - - - -- -- - - -- Indicate level at which groundwater is encountered Indicate'level at which mottling is observed 4� Indicate level to which water level rises after being encountered Deep hole observations made by: jg Design Professional Name: Address: Sipature: Desi;n Professional = Seal Date 10M t2