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Home My WebLink About0343DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -45 BOX 4 i r 2 ; a jr ,� I loll N I; 1. I f jr r. 00152 N PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use fIx a 7 �7 � PERMIT # AC — O LIZ Repair Permit issued in last 5 years LI Olot 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 4163- OWNER'S NAME MAILING ADDRESS APPLICANT TOWN P,41%e✓ TM # 13...02 PHONE # Name & Relationship (i.e., owner, tenant, contractor) DATE / FACILITY TYPE �et�c��i��, PCHD COMPLAINT # PROPOSED INS ALLER reb-Q4 Z4 PHONE # ADDRESS REGISTRATION /LICENSE #�� . RR_eW1 r410 -, IVY 10, 10. 9' 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 I, as owner,agree t"he conditions stateA on this form SIGNATURE TITLE DATE 3 , 01 (owner) I, the septic installer, a e to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE DATE (installer) 0K PIX Proposal a roved with the f lc4lino 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. im i CMIVAL U= V17LT Proposal Approved Proposal Denied ❑ e y �, X47 h( %%%f ecto s Signature & Title Dat6 E4iralion Date ,Repair proposal is in compliance with applicable codes Yes tS No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 As Built 2014 I_1 1. 42' 2. 75' 3. 1791 4. 84' 1. 29' 2. 56' 3. 58' 4. L 60' O. Heller 465 Mooney Hill Rd Patterson 1050 gal poly septic tank "sdr 35 pipe 2 3 4 Existing `_ v�'" boxes EXCAVATING CONTRACTORS www.tyndallzepticcom (845) 279 -8809 As Built 2014 Ii! 1. 1 42' 2. 75' 3. 79' 4. 1845 1. 29' 2. 56' 3. 58' 14. 160) Heller 465 Mooney Hill Rd Patterson al 1050 O, = 9 poly 1 septic tank "sdr 35 pipe 2 3 4 Existing boxes ; — _ ,. EXCAVATING CONTRACTORS w Ayndallseptic om (845) 279 -8809 Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final S!k Inspection Date: /� �� Inspecte Cie Installer: a Street Location: Wa Owner: Town:aP,,��ol1 Repair Permit #: — 1 t) — I TM # q47 1. Type of System: Conventional O Alternate 11 Comments: 2. Septic Tank Yes No N/A Comments a. Septic tank size — 0 1,250 ... other ..... 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 ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set ........................... f. Trenches i. System completely opened for inspection U. Length required Length installed iii. Pie slope checked ... ............................... iv. Installed according to plan ....... :............. v. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel % -1 '/s " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... Pump or Dosed Systems 3. Sewa e System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance from water coursetwetlands 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: 'FU 4 y) I ()j a RFSI Rev - 011312 MEMORY TRANSMISSION REPORT TIME JUL -07 -2014 10:37AM TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 893 DATE JUL -07 10:35AM TO 82795989 DOCUMENT PAGES 001 START TIME JUL -O7 10:36AM END TIME JUL -07 10:37AM SENT PAGES 001 STATUS OK FILE NUMBER 893 ** SUCCESSFUL TX NOT ICE ** PUTNAM COUNTY HEALTH 0EPARTMENT 6 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FOR SWAGE TREATMENT SYSTEM REPAIR yyrr�� 4��iNFInQPQS^11- NO Internal use Onl PERMIT M C) - / Repdr Pcnnh Issued In [pmt 6 years �Iat in Wa[BrSn @d L-] CK/ Repair within e3 y0's comers. W. Branch or Groton Fans Ras_ ('I,d'/Celegated Q Rcoair within 2011 TL of a watercourse or ME=c-maooed wetland M Joint RAVIew SITE LOCATION OWNER'S NAME MAILING AnDFRa APPLICANT _ __ TOW N TM # / 3 15w, PHONE # Nerve 8. gelBtiOnahlp (I.e., owner, [enan[l7oontrac[or) .� GATE '7/3 �QG� /"S� FACILITY TYPE PCHi? COMPL -4INT II PROPOSED INS ALLER vrsis' PHONE If $�/� �7c'i •��'"!� AaDRESS ��i✓7�e3�dN aitl %GrJ,y�� REGISTRATION /LICENSE # ,f-fog Proposal (Include a sapara[a sicatch Locating the house, property Tines, all adjacent wells within 200 fast of repair and the location of existing and proposed systann) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature nd extant oft a repair. 1, as owner.agra0 he co�rf�dltlons stet On this form SfCiNATURE =iJFc�� - TITLE BATE Z/3 eGICb /5/ (ownar) t. the septic installer, a5lveje to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE /ilrl/ >7ATE -� �LQ/ (Installer) i P resrirs ° ° ^`•[sued with thB T ino onditions• 11- Procurement of any Town Permit, If applioabla_ 2. _ Submission of a bulK repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a_ Owner's n e, Slte Street Name, Town and Tax Map number b. Location of installed components tied to two axed points c. System description (e_g_, 1260 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 a_ The proposed SSTS repair is considered a bast fit design and there is no guarantee to the duration at which the completed SSTS repair will function. S. No completed work is to be backniled until authorlyation to do so has been obtained from the Mepartment INTERNAL tJSIM ONLY Proposal Approved Proposal Denied 0 ect s Signature e. Title i?at� E it ion Onto a air r c in c licence with 1 la Codes lees N COPIES: FPCHD; Owner, Installer PC -RP 99ML Ray. 2/07 PLTn M COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225- 3838/225- 3833/225 -3641 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR Vold j r � OWNER'S NAME 4-2 PHONE. T SITE LOCATION Tm# = MAILING ADDRESS PERSON INTERVIEWED Name & DATE dfe c 1,7 PCHD Complaint # .e, owner,tenant, etc.) TYPE FACILITY PROPOSED INSTALLER � � 1-5 PHONE Pro (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. P L 7'o Proposal approved Y Proposal Disapproved Inspector's Signature & Title Date 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' diam. 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 re rted gen of er agree to the above conditions. C SIGNATURE TITLE DATE Wnfbe ( ); YeUcw (Tam ED; Pink (Appliamt)