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HomeMy WebLinkAbout1170DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 25.62 -1 -6 BOX 12 .,1 ,t, 6 �..:. %a 01170 V PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SAL FOR GE DISPOSAL SYSTEM REEMB OFFICIAL USE ONLY / -3 &/ 0-K SITE LOCATION rtJ %� t N TM# OWNER'S NAME A1111i,41n PHONE"— MAILING ADDRESS PERSON INTERVIEWED � PCHD Complaint # X ame & Relationsfilp I.e weer nant, etc. DATE TYPE FACILITY S D S PROPOSED INSTALLER ; ,,f��2 �hJ Ar_xC ., _..-T C •I PHONE 2, 7 ADDRESS /5"',pV ove/l_z_i k� iLS33 REGISTRATION# / Z 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 enginee or registered architect. �N ��%n Il IOLC4 �sillG� `G1LC /'C �•C /�(il�� I ,I � I �^1'..�ll 1 n V/ /ore ; Kam! 5 o .110 -I,-as-owner; or reported'agent of owner agree-to the conditions stated on-this orm.-.. S I G N A .v TITLE A :C J".,_ 2- DATE �-h Q Y Proposal =roved 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 comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved 0-�� Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML .e' DA 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 (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278.6678 Fax (845) 278.6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 12, 2002 Carrie & Rick Effinger 95 Main St. Brewster, NY 10509 Re:Addition - Effinger, 34 Barnard Rd. No Increases in Number of Bedrooms (T)Patterson, TM #25.62 -1 -6 Dear Mr. & Mrs. Effinger: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated November 12,M-02—The addition is approved with the following conditions. 1. The total number of bedrooms must remain at two without prior approval by this ..department._......_ 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke Public Health Technician ML:Im cc:BI I. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY SITE LOCATION OWNER'S N ` , MAILING ADDRESS TM# PHONE ' PERSON INTERVIEWED PCHD Complaint # wne & Relationship i.e., owner, tenant, etc. DATE I// %/ 1) TYPE FACILITY PROPOSED INSTALLERS 6lali�i —?� PHONE ADDRESS REGISTRATION# 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. J -I; as owner; or repor-ted agent•o owner agrce•to -the- conditions statedo 's form. — - - - -- — SIGNATURE TTTL DATE Proposal approved with the following conditions: Z I . 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 comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6 diam. X G deep e. Installers' name and number. 3. System repair to be p erformed in accordance with the above proposal and conditions. Proposal approved L / il lb Z/0 -2-- Inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NE i O Pay 4= EDGE$ •G :. (7 oc ,� LAKE PORT MACATAM a . VAvFMG.w+r 3 i _ y a; N E4,t O4' -so Et 100.00 -` ' A - IPSL A -1ZSI f A - Is SG 5 A -1255 I A= 1254 A-IZ3 ' I q' I F'RO POSE 1 / P ( Ij - Yr. Vy Ilyn 1 ( w i t�dN.7(?I0 10.1)• d a nvL��pdsS EXISTING 0 w .NOiFy�-J n+aN I 1 1 sTOP1k PRANE �.� r p 60' L DRIVE *. i L.Lims 4 PA t// DAB `D"� Oren' in I AREA ` O, it So ACRES AAWA o4'- 5o w -+- A_,2Gi SURVEY OF PROPERTY' PREPARED FOR w JOSEPH i r J. & CAROLINE- A. 'GRAZ I OLI i PUTNAM COUNTY, HEAL , . TH. DEPT 1 Geneva Road :. (845) 278-6130 O O Brewster NY 10509 Date d Received :of The Sum :Of Dollars $ i0 00 For L jT o G 7r i yes THANK YOU! ❑Cash ❑ Check CglGO. , D Credit Card, :By G NOV -5 -2002 15:12 FROM:PUTNAM COUNTY DEPART 845 - 278 -7921 . r DRUCE X FOLEY Public Naaltb 9lractor 1 Geneva Road Bmwst4e, New York 10509 TO:918603640237 LOXETTeAe MOUNAM XLX., Ks.W. Attoclala Public Had th Dfteter Dftctor of Papom Samgaa ZnAeoniNUDI MOM (04S)270-6130 FM(943)274-7921 �loesing sarriaes (a4� X78 a 6ss8 w1C (845) 275 > 6678 V=(245)278-60G$ Eorty 1aeemn0m (04S)278 4M M PPesc9ao) (84S)278-6082 gsu (845) 278 - 6045 . cam° =Aff. UUMM MB&MED= QMM s`TREE t V l/%TOWN ! �- NAME a - 140M P1 2 &Q PCM - o TWO ADDUSS J,57 Mail) JIr f DESCRIPTION OF ADDIT .�e6On/6 662 ekd �dr NUMBER OF WaSTINCr BEDROOMS PROPOSED # OF,EEDROOMS (FROM CERT, OF OCCUPANCY OR CER T1FlCA7f ON FROM)B=I1VO'INSl %Ci0P� + r "Any addition which is considered a bedro= requires forirA approval of plus (Construction Permit) prepared by a Ptofessioaal P.ngineer or Iite�ste�d Archi4ect in acco�c� wvith applickble aections o�the Cq%Pt . S*tMy C.ode,. Please submit is Ibm and the following to Putuarn County Yee & D*:4 Geneva Road, Brewster, NY, 10509, Phote $78-6130, _ I. Ceded check or Money order for $100.00. . 2. Sketches of exisftn$ floor plan (drawn 4o scale, all Hying ana includiag baseinent) "Non-professional sketches m acceptable. 3. Two set of psoposed floor plan (dm%vn to scale, %vi& name met and tax snap 4) ONonprofessional. skades are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. include date of kmtallation if laaown. Label A hells and septic systems within 200 fed of the property UN. Contact this office with any questions. 5. Copy of Cent. Of Occupancy from Town or Cirtifccation from Building Dept, with legal bedroom count of dweliing, WM ME Comments ieb9S AFhauseguWelifles , P:2/3 i NOV -5 -2002 15:12 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 TO:918603640237 aRUCE R FOGY irblle Health Dhrato� � LORP'Li'A MOL$�TARI RN., M.S �', �+ ,IpaOdle Publb Xealth Dtmtar Dk tctar of Patlaet Se WOW DEPAR'TIvM4NI OF i EAI,TH • 1 Oeneva Road P:3/3 Brewster, New York 10509 ft"NUMaal. Beath (845) 378 - 6130 Fix (845) 278.7821 Nunlaa 8wlop ("S) 278.6558, WIC (543) 278 - 6678 Fr K (64 278.608! Isrly ]ateneoltoe (84S)279-4014 F"Rhool (845)M 082. F* (845)1'18.6648 Putnam County Dept, of Health' 4 Geneva Road Brewster, NY 10509 1 Re: eo ' ' Residenc TaxM Z5,��-�_� Gentlemen: According to reeord.5 maintained by'the town, the'above, noted dwelling ' iS,?� _.�__............._.. _ .. - a._...............__. _ IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CPRTIKCATE OF OCCUPANCY: _ ASSESSORS REEORM OTHER 411 LIZ wilding Inspect Whouseguidelines i NOU -5 -2002 `5:12 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 TO:918603640237 P:1/3 PUINAM COUNTY liNVIRONMENTAL HFALT'H 1 GENEVA ROAD BRgWSnR, NEWYORK 10509 - phone: 1�80.�78.6130 Fox, 1-045-270-7921 FAX NUIVMER.TRMSNffTTED TO: Of Date: n-- Number of Pages: CONMWTS: 0 o �o IF YOU DO NOT RECEIVE A" PACES, PLEASE TELEPHONE US D^MDIATELY AT :945-278-6130 SITE LOCATION OWNER'S NAMO 'MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAI -0 OFFICIAL USE ONLY A 0 TM# PHONE PERSON INTERVIEWED, PCHD Complaint # Name & Relationship i.e., owner, tenant, .etc. DATE f/ /0 TYPE FACILITY PROPOSED INSTALLER %�P e/�yJfr PHONE ADDRESS REGISTRATION# 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. /✓tea' A&�P , , A c -/,, , Z r _ ...._ ., as_ owner, or reported agent owner agree to the conditions stated o is fo 0 SIGNATURE T17—L- DATE Proposal jWproved with the following conditions: i 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 comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X G deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved V inspector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML C) DR i VE- P vvillILLIMS .. LAKE PORT MACAMAOA LWOOD. PRAM9, 1,49io.; ji` 1489, . W1 DASIMEW -rEP, W fl+t 0+'- 5o' E Ift.00 AREA G. F + A, tzs 0. 130 AcFtEs 411 all. 0+ 5o.'• w .rmv A -1261 I 00 " S'VRVEN. OF PROPERTY PREPARED FOR its*(. A- IZS5 1154 A IZ T3 PROPOSE !e *IDDI EXISTING rP i sTOlkli DR i VE- P vvillILLIMS .. LWOOD. PRAM9, 1,49io.; ji` 1489, . W1 DASIMEW -rEP, "OIL AREA G. F + : 0. 130 AcFtEs 411 all. 0+ 5o.'• w .rmv A -1261 I 00 " S'VRVEN. OF PROPERTY PREPARED FOR JOSEPH J CA ROLINE A 'GRAZIOLI PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR �v D ,/ � A/ BEDROOM COUNT ONLY; o ;s.-ed BEDROOMS Vionature & Tide Date J d as jft r t PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR �� p 0 BEDROOM COUNT ONLY EDROOMS ' it �a. Signature: Date 7 rvVas 0,� � ��S�do.►d Szodoja e ,16 w 1s ^ t 1 t 1647 f; i ILI i i 01 - e .,a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Locatfon Street Address: to , S ho re TownNillage: t,trN LA ,� Tax Grid # ' p., ._ , at r,. ; kA .. Map Block Lot(s) Well Owner: 'Na 'e: Address: Use of Well: 1- rima 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ! Open hole in bedrock Other Casing Details Total length -4 Z--ft. Length below gradeO ft. Diameter FO in. Weight per foot / i lb/ft. Materials: __X Steel Plastic Other Joints: _Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner _Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _Pumped Compressed Air Hours Yield -LO— gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve anal se . _ y__...s ....,.._ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface �', / ' Ar a j 4- J . l Z A. A Irt � �' �.Co f`a'd.. _Ant_ITi. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 6(&b Capacity Depth -90 Model7 Voltage a30 HP Tank Type QbMKVolume LLO Date Well Completed 10 Putnam County Certification No. Date of Report Well ri er (signature) NOTE: Exact location of well with' distances to at least two.peimanent landmarks to be provided on a separate sheevplan. Well Driller's N e/ OXLWj w cma Address: �Xlvoiyk_ Signature: Date: 6110/10 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 n YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 - Albert H. Padovani, Director LAB #: 3.000256 CLIENT #: 114 NON STAT PROC PAGE: 1 of 2 TORLISH & SONS DATE /TIME TAKEN: 05/14/10 10:30 BOX 271, 45 MAPLE AVE. DATE /TIME RECD: 05/14/10 11:10 ATTENTION: DUANE TORLISH REPORT DATE: 05/21/10 ARMONK, NY 10504 PHONE: (914)- 273 -3448 SAMPLING SITE: 288 LAKESHORE DRIVE, PUTNAM LAKE SAMPLE TYPE..: POTABLE _ TANK PRESERVATIVES: NONE COL• .'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 05/14/10 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 05/19/10 LEAD (IMS) 2.2 ppb 0 -15 ppb SM 18 -19 3113B 05/20/10 NITRATE NITROG 3.54 MG /L 0 - 10 SM18- 20450ONO3 05/14/10 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 05/18/10 IRON (Fe) 0.290 MG /L 0 -0.3 mg /l SM 18 -20 3111B 05./20/10 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 05/2y0/10 SODIUM (Na) 113 MG /L N/A SM 18 -20 3111B 05/14/10 pH 6.4 UNITS 6.5 -8.5 SM18 -20 4500HB 05'/21/10 HARDNESS,TOTAL 140 MG /L N/A SM 18 -20 2340C 05/21/10 ALKALINITY (AS 98.0 MG /L N/A SM 18 -20 2320B 05/14/10 TURBIDITY (TUR 11.9 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC a Coliform = This result indicates that the water (was) (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter.. This comment applies'-to the Total Coliform test only. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. a YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914.) 245 -2800 Albert H. Padovani, Director LAB #: 3.000256 CLIENT #: 114 1 NON STAT PROC PAGE: 2 of 2 TORLISH & SONS DATE /TIME TAKEN: 05/14/10 10:30 BOX 271; 45 MAPLE AVE. DATE /TIME RECD: 05/14/10 11:10 ATTENTION: DUANE TORLISH REPORT DATE: 05/21/10 ARMONK, NY 10504 PHONE: (914). - 273 =3448 SAMPLING SITE: 228 LAKESHORE DRIVE, PUTNAM LAKE SAMPLE TYPE..: POTABLE : TANK PRESERVATIVES: NONE COLD BY: D. TORLISH TEMPERATURE..:. < 4C NOTES — .- COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD i Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM.& MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER:,.0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L i MG /L = MILLIGRAM PER LITER HARD WATER:ti40 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE -ONLY TO THESE SAMPLES,RECEIVED BY THE LAB SUBMITTED BY: � Albert,H. Pa ovani, M.T.(ASCP) Director ELAP# 10323 U PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES e_ APPLICATION TO CONSTRUCT A WATER WELL please print or type 09815 T�OWaif, 0, Well Location Street Address: Town/Village: Tax Map # �� �� 30 - 31-- 3 z ICU bk ©t' f Map Block Lot(s) Well Owner: Name: Address: Phone #: 7{11 m pk-S jvs�t � ? ; �,AA �, � - 17 9 Use of Well: _Residential _Public Supply Air /cond /heat pump _Irrigation I - Primary Business Farm Test/monitoring Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gavel Other Is well site subject to flooding? ....................................................... ............................... Yes — No Is well located in a realty subdivision? ........................................... ............................... Yes Nom Name of subdivision b Lot No. Water Well Contractor: / fq-"I1 4- sc lys Address: '1I� Is Public Water Supply available on 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 r vided on separat eet/plan. 2 V "� Date: � Applicant Signature: X412 - 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 Departmel 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. APPROVED 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 revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alt ration of the app d plan requires a new permit. Well to be constructed by a water well driller certified by Putnam ugty. Date of Issue Permit Iss I g Offici I: Date of Expiration Title: Permit is Non- Transf rab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owl r; Orange copy - Well driller Form WP -97 Rev. 3106 a �� t�t �� :�� r�