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HomeMy WebLinkAbout4858PUTNAM COUNTY HEALTH DEPARTMENT Q AAA DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR�o. YES Internal Use Only PERMIT # ► `�,;, ❑ Repair Permit issued in last 5 years a Not in Watershed ❑ 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 / W - z., TOWN TM # '7 S/- j Q- ?— OWNER'S NAME �,;�J �- , „1 PHONE # MAILING ADDRESS / V,4 ng -0/ „1/ 6�G,% APPLICANT 'C. -� lLi�C 7�! /�i••� J !�Gfo.�<✓ty `(�.�� yL° /S��C'cwJ':%rr��n� Name & Relationship V.e., owner, tenant, contrador) DATE J �/,✓e oZ ! rT oZo /(� FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER T ��� �, PHONE # 91$;”- 50-?'0,?19 ADDRESS / y� �� 1g/ %� Cjdr�c ✓ f��� /� REGISTRATION /LICENSE # pC /a Pro sal (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. , - ._ ineAtvis p Gl/ct / ell ��rit�jc7T,ta�vt I, as owner,agree to the conditions stated on this form SIGNATURE TITLE D L AA, ,,. DATE y (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE „� TITLE ('l(.41 DATE �T'u,✓e ��•r/ �Ol� (Installer) Pr000saliaggamd 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 ti✓ `7 I3 v Pa- / Inspector's Signature & Tftlkr Date Expiration Date Repair proposal is in compliance with applicable codes Yes ❑ No COPIES: . PCHD; Owner; Installer PC -RP 99ML Rev. 2107 V-L 6, f . vv f, L A '�Iv, �Iyv-j-ri i o lVlv\ oj <100/,A 051 a -; re 77-'M 77-'M -" �o 0 . m STANDARD MODEL 11' 3TND 14" HICAP 16" HICAP BIO 2 BIO 3 LENGT}i (A) 78" 76' 76" 87' 87' EFFECTIVE LENGTH (D 75" 76" 75" w 68' - SIDE WALL HEIGHT (C) 6.4" 9.7' 11.7' 9.0" 9.0•' OVERALL HEIGHT (D) 11" 14" 16' 12" 12" OVERALL WIDTH (E) M. 34" 34" if 15" 22' CAPACITY 9.2CF (613.6GAL) T1,91CF (89.0GAL) 13.6CF (101.7GAL) 5.00F (37AGAL) 8.5CF (63.6GAL) i lk NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT TO CHANOE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 07=A l.c{ +OEV. 1 DLeCRlFgKW ADAANCW VFV^WE SYSTEMS. INC. (MS') HAS PREPARED 11115 DEVIL SWO ON INFOMIATEN;PROMEO TO ADS. 1HS ?i % /-•;hT7Ye'�'' �Y b:d`'' : A ` DF"NG IS IHTEMXD TO DEPICT TH[ CONPOFEHIS A6.REOUM0. ADS HAS NOT PORFGRMW ANW USMM03MM OR D[SIU+ SERVICES FOR:TMS PROJWr, NOR HAS ADS DLDfl►INODMY VERFLED THE INFORMATION SUPPUED. THE..INSTALLATION_ DETAA.5 MOM0 7URM PRODUCT MMUT PROY00 ILERAN AM GCKXRAL, RDWWWNDJUIDN5 AND ARE NOT SPECNIC FOR THLS PROAM THE OIMGN.ENUWIXR 944 LL A"EW, THEM OrTAILS PRWR -TO OONSTRLL M0N. R IS THE DRSIDN VJMNEERS RE$PON9BIlf11r TO E?ISURE THE DETAL6 PROVM HUNIN:NEM OR EXCEEDS THE. APPLN'ABLE.NAWHOL STATE, OR LOCAL REQWREIAENTS AND TO WSUR[ TNaT THE DEUNS PRO"D' HEWN ARE ACCEMAW_MR M13_P93J[YT. ORAwWDNUM6ER - STD—BD9 KAO FRIRVWN BLVD _ 14ILLIARD.OH*430zs AVA"m ="-a mmm W MODEL 17° STND 14° HICAP 16^ HICAP BIO 2 BIO 3 LEIJG711 (A) 78" 76° T6" , 87° ST' EFFECTIVE LENGTH (t3 75" 75 75" 88' 88° SIDE WALL HEIGHT (C) CAI" 9.7' 11.2" 9.D 9.0" OVERALL HEIGHT (D) 11" 14" 16° ? 12" 12° OVERALL WIDTH (E) 34° 34" 34" 15" 22° CAPACITY 92CF (65.6GAL) ti.9iCF (89 -0GAL) 13.8CF (101 -7GAL) 5.013F (37AGAL) 8.5CF (63.60AL) NOTE: UNIT C014FIGURATION AND AVAILABILITY SUBJECT TO CANOE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. NCEO D7p V"E SYSTEMS. INC. (*ADS') oiA51 PREPARED THIS MIAIL 0=0 DR WORkRIM PRVVIDED TO ADS. 'THIS )Of t'>;..:y.•x�: -,,,,; Q ; "�? ! ^. MING 13 INTEWD TA DEPICT ME COMPONENTS AS REOUMI). ADS KM MDT PEMORMED ANY EWDICEICM OR DLSRPI ��'•• -(••_•t._ _�:•Y''s % %•._' rXIMCM FOR TEAS PRDJDCr. NDR HA9 ADS INDWINDMIRY VFAIF tD THE INFORNAXIM SUMED. THE INNALLATTDN DENU MOMPUMER PMDUCE DErlrAUB 'ROWIOED KUWN ARE GENERA{. REMMMENDA110NS AND AW NDT SPEINFIC FM THIS PROJECT. TYRE DEMGN ENSINEXR AIAIJ_ iw9w THESE OETALS Pmm 1D ODJISTRUC'TICN. IT Is THE D3910R 0,10"WS RSPOMSIMLITI/ TO ENSiuRE TINE DETAILS TW= HIMIN MMS OR MAIMS THE APPLICABLE NA11OWL. STAIE, OR LOCAL REQU1RDW1WS AND TO F)ud= THAT THE ORAVYINRNUMBER STD -9D9 )EEANLS 1000"O NERnm ARE ACCEPTAW FCR EMS rMcCt, NWOOOfvr elate 4040 IRUeevur 6¢.W tu2S77 -' I -;�iL' NIILURD, ONK16]026 avaa. -� �ssr® iamiaa ca ° N r s N r� �J 0_: 150 WOOD 1-0 v IN off" -P A JA V144L. Y v� I� Fx.iS:TIA4 76'0 GAt, c �� N►.atN 1y * - - -EX t6� rl * - _PROtPOSIE�75 I-wo tZdc"�S or- rlVim. U/41.7 -5 r,--146-9 tZO60. BRUCE R. FOLEY 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 - TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: PE-0 k/©o r-) 's f , TOWN: C SE P K PV DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: -7Z131 . . ...... , .„F- . J A �r PUTN AM COLFINTY DEPARTIVIENT OF HEALTH DDZSION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET = SUBSURFACE SEWAGE TREATIVIFNT SYSTEM Owner: / f g Address. A6-0 CVooD 'ST, Located at (street): TAI M Section: — Block _ Lot Municipality: ?yT�i4M VALL4 y Watershed: %%mAyj,41 -& SOIL PERCOLATION TEST DATA Witnessed bv: Date of Pre - soaking: Date of Percolation Test: V Z ' Hole, o. Run No. Time Start— Stop l I Elapse Time (min.) . Depth to .water from ground surface (inches) f Start - Stop Water level drop in inches Percolation Rate min/inch I16; -1 — I f o I 2 I ' I o I' f- Am 2- 1 / 3 3 IA 'i 1 3 Al - e� I 4 I I { { 5 I 1 I 1 I I i 2 I In 1 i 4 5 I I I I I I I 1 { 2 3 I { I 4 1 i 1 1 I I I 2 I I I I I i Notes: t . Teszs to be repeated at same depth until approximately equal percolation rates are nhT�irie�i at 8A('.Fl riP.rcnlarnn r2ST �1n�� ii a < 1 min fnr l_:!1 min::nr� ! 7 m:n n,• : t �.l .- ..+..nr! -.'. : da�l8: afrnnwur ..uuo:dt�w;sJ,i4:.m.+�.'l+L '�!'s'�,ti.;� w—m-�' `�,: igS.....ti; n.,. � uas'a�uu rl '��w1.:.•�+:��sm.otiil�i:ri.�M "' — - 4i�wi::�uAi.nWaip.�iY+v�a I TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES CE= 77r HOLE #1 _J_ HOLE HOLE # HOLE T HOLE G. L. 1 J 2.J 3.0' 3.5' 4.0' 4.. .0' 5.5 6.� 7.0' Te.o' Lndicate level at wtuch �_-oundwater is encountered Lzdicate level at which mottling is observeu 3 Indicate level to which water level rises eLe. being encountered �---�- Deer hole obsen. -atior*.s made bv: 6� Da: l � 2 � Desie-n Professional Namne: Address: 'Si: oz, lat, 'e : _L231 -Route 9W,.'N** U w y6rk 12550 qwb., rgh, Ne Ph ne(845)56 5-2270 /0 X 845' "For All Your Steel Needs" m ri 60 o U-% c5vj .4" A 60 6v A (A z4 5r 0 t �`. y yo. r 83,55; BEAMS • ANGLES • FLATS • SOME & RECTANGULAR TUBING • PIPE StCBI BARS • SHEETS • STRIP • PLATES • CHANNEL EXPANDED METAL • WIRE MESH • REBAR • Is DIAMOND PLATE • ALUMINUM • STAINLESS STEEL