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PUTNAM COUNTY HEALTH DEPARTMENT t
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
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YES .- NO Internal'Use Only PERMIT #�
Li ,L-�,% Repair Permit issued in last 5 years LtYNot in Watershed
❑ L��!/ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ Repair within 200 ft. of a watercourse or DEC- maaDed wetland ❑ Joint Review
SITE LOCATION LtT V\o�. v- ,t TOWN VuJ
OWNER'S NAME Fp-c D V IZ t`!) v
MAILING ADDRESS _
APPLICANT 11�t
L, r.,,
ti TM# 91,16 -I -6 -7
Pi4ONE # 94-f ,�Zg — 3 /,2- /
-(r-(, nay ( o 17
N e & Relationship (i.e., owner, tenant, contractor),� "
DATE _ 1O FACILITY TYPE R ,�aql��' PCHD COMPLAINT #
PROPOSED INSTALLER ii Q C�S►�n Gti;woll- ' PHONE # B $S 1,36-05'-7/
ADDRESS 3 �� c �M br2�LN lir,.�r�5on F EGIS f RATION /LICENSE # 1 y� Z
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. k , I i t ,, ,
I, as owner,agree to the cond' 'ons stated on this form
SIGNATURE TITLE 0 DATE /�Z � ►/ � � �3
(owner)
•I, !he septic installer, agree .Comply ith the conditions gf,thikpermit for the septic system rep ir, .
SIGNATURE TITLE DATE
(Installer)
Proposal app: ved 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 bac until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
opos pr ved P posal Denied ❑
22 13ZZ 14
Inspector's Signa ure & Title Date Expiration Date
is in compliance with
codes Yes [D--,� No 0
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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Date. 6�lk
Street Location:
Putnam County Department of Health
Division of Environmental Health Services
SSTS Repair - Final Site Inspection
Inspected by: M� L
Owner: f roes clAe-1
I I
Installer:precolo!\
1. Type of System: Conventional [!(Alternate 0 Comments: -k Lej
C-4 I
Se tic Tank
Yes
No
•/A
Comments
—2.
a. Septic tank size - 1,000 ... 1,250 ... other .....
b. Septic tank installed level ......................
c'. 101 minimum from foundation ...................
d. Distribution Box
i. All outlets at same elevation (water tested)
H. Protected below frost ......... ! ...................
V/
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box - properly set ..... 00*.**& ..............
V/
f. Trenches
i. Sy stem ompletely 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 1/2 diameter clean .........
vii. Depth of gravel in trench 12" minimum .........
viii: Ei6ia-ijid ........................
g. Pump or Dosed SysteM
3. Sewaae System Area
a. SSTS Area located as per approved plans
b. Fill section -
c. Distance from Water course/wetlands
4. Overall Workmanship
a. Boxes properly grouted andinstalled 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:
&tM-0,j^RT W, ,
RIFS1 Rev - 011312
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From:
April Leonforte
Date Sent:
Precisi ®n Excavating Inc.
Regarding:
Septic Permit
3 Roebmabean Road
Garrison, NY 10524
(845) 736 -0571
excavating @verizon.net
To:
Mitchell Lee
From:
April Leonforte
Date Sent:
April 8, 2013
Regarding:
Septic Permit
Mitchell,
Attached is the permit for 44 Mathes Street in Lake Peekskill — the same property which I spoke to you about last week. We
are requesting that you waive the testing requirements since the property is limited in space and we don't want to disturb the
existing septic, as well as the fact that the footprint and mechanics of the septic system will not change. Phil would be
happy to meet with you on the property for a site review.
...,Thank . you and please fe e free to. ca( wit any comments iQ n
.s o� gaes onsz.
y
Sincerely,
April Leonforte
p�SNA� �o�NN
_ ; ApR 0.91p13
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PUTNAM COUNTY HEALTH DEPARTMENT:,'
DIVISION OF ENVIRONMENTAL HEALTH, SERVICES. .
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
F... �,. ;..,= '�:oF.�%.- -:.. �::.:�°K'e.pw' e.:�'.��:... :'w!`r� nom-. -._;'P �.:tSo 7� B :'.'.mi��..+ :. . »K �.e. - ...::..... �e,"C.e�.�. ► .�•4 w q.+':.a�- �.._"1 �.: �i 7.'.: �. -.�
R. Y NO Intemal Use 0nI ' 9 PERMIT #
❑ ® Repair P- ermit issued in last 5 years ED,-Not in Watershed
Cl 111 Repair within.Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
Name & Relationship (i.e., owner, tenant, contractor) `
DATE 4 1': FACILITYTYPE t 9;; s �,'` PCHD COMPLAINT #
PROPOSED INSTALLER PHONE #
ADDRESS?.+:, €,.z��te.,i�t ;,,, REGISTRATION /LICENSE # 1011
"
Proposal ( include, a separate sketch' locating the house, property lines, afll.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
,"� p l
'* id ti l.: 5 f- r P. S: : c_y urrl } Ei '�' •'e. sa �, d: `� k - .. _ :." n b C .�. 3'.. aY.F_i ...'CV. a rJ' r i/h. P •..t.t ..
I, as owner,agree to the conditions stated on this form
SIGNATURE `` f, ,.
'% TITLE �:' ;�' li_• DATE s
(owner) ;
the-; a�}ree.t(J:comply -with.-the-conditions Di this oermitfos -the sepiicsysteni_ repair:
.. ,
TITLE
SIGNATURE 1Ft. ` :n . f DATE ` 7 '
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., 1.250 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 ❑ ,
112 i 14.
Inspector's Signature & Title Date Expiration Date
,Repair proposal is in compliance with a.pp livable codes Yes. No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML
Rev. 2/07
❑ ❑
Repair within 200:
ft, of a wa4ercourse or DEC - mapped wetland ❑ Joint,Review ,
SITE LOCATION
t ? TOWN ; �a. °: A,, A,
TM #
OWNER'S NAME
a
' �" :
;
r >f �p �.
PHONE # �z
MAII:INf ADDRESS
i
` ` G.- - !
T ^� `'-- y
{r V
APPLICANT
Name & Relationship (i.e., owner, tenant, contractor) `
DATE 4 1': FACILITYTYPE t 9;; s �,'` PCHD COMPLAINT #
PROPOSED INSTALLER PHONE #
ADDRESS?.+:, €,.z��te.,i�t ;,,, REGISTRATION /LICENSE # 1011
"
Proposal ( include, a separate sketch' locating the house, property lines, afll.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
,"� p l
'* id ti l.: 5 f- r P. S: : c_y urrl } Ei '�' •'e. sa �, d: `� k - .. _ :." n b C .�. 3'.. aY.F_i ...'CV. a rJ' r i/h. P •..t.t ..
I, as owner,agree to the conditions stated on this form
SIGNATURE `` f, ,.
'% TITLE �:' ;�' li_• DATE s
(owner) ;
the-; a�}ree.t(J:comply -with.-the-conditions Di this oermitfos -the sepiicsysteni_ repair:
.. ,
TITLE
SIGNATURE 1Ft. ` :n . f DATE ` 7 '
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., 1.250 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 ❑ ,
112 i 14.
Inspector's Signature & Title Date Expiration Date
,Repair proposal is in compliance with a.pp livable codes Yes. No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML
Rev. 2/07
PUT AM COUNTY DEPARTHENT Of HEALTH
DID -ISIOv OF ENNVIROTN'114EINTAL HE-A-LTH SERVICF-S
DESIGN DATA SFIEET -SUBSURFACE Sir-WAGE TREAT�MENIT S 'I/STEM*
Owner: Address: +4
Locited at (stree't]r TiV1 "' Section:
— Bloc" Lot
Municipality: WACk'm' V^Lku Watershed:-
I
SOIL PERCOLATION TEST DATA
Date'o[Pre-soakin-
:1
Witnessed by: /AD L
Date of Percotation Tes.t:-
Hole No,
Run No.
Time
Start—
Stop
Elapse
Time
(m in.)
Depth to
water from
ground
surface
Start - Stop
Water
level drop
in inches
Percolation
Rite
min/inch
.2
.4.
5
4
2
-3
{ I .3 I !
I
I !
4
No (,-S:
I -c7r rn it r:-n -.1-i :a -,, -j,-nrj I In r:
711E�S FJT D -
'DESCPIPTIOIN
HOLE HOLE R HC;
L
C. L.
0.5
2.0'
2.
3.0'
15'
7.0'
1.52
8.
10.01
Lridlicate level at which V7`0im-dwaier is encountered
c,
Indicate level at which mottlin, is observed
1-,,d,*----3 ,2 Level to which water level uses azfter bein2 I-acountered
Detn hole observations made bv: MtL -Date I
Design Professional Nwn�-:
A,-'-dress:
(z :
S i on atzi e: