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HomeMy WebLinkAbout2345DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.11 -1 -10 BOX 20 02345 rnA INN. NJ .1 16 A�. r ir NN L4 8 r r� . 1 : R , _ 02345 '= . . � :66 private Supply DOW -&,tMjjjAtL6t Si me 16dader Been- 1.9teEW? that the '8j, M(s), as. listed Y. as a iplwted,work copies Putnam couhty ;Of Health. ortified by f S Is Pr system conditions resulting from 'Such UMVL Approval a t Me i tc "If, boWfM n I void as i6on es - putir: asnury sewer becomes nor t thwe -1 Date By T YML ENVIRONMENTAL SERVICES 321 Kear Street _ Yorktown Heishts, N.Y. 10598 Albert H. Padovani, Director LAB #: 32"4000I3 CLIENT #: 3779 NON STAT PRQC PAGE 1 CH[NTOW, PETER DATE/TIME TAKEN: 07/11/94 10:30 435 E; 57TH ST DATE/TIME REVD: 07/11/94 11:35 NEW YORK, NY 10022 REPORT DATE: 07/15/94 . PHONE: (212)-223-2590 SAMPLING'SITE: 119 PUDDING ST KITCHEN TAP SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: PETER CHONTOW _ _ TEMPERATURE,.: <4C NOTES...: COLIFURH METH: MF —1 ---- —���� DATE FLAG PROCEDURE RESULT NORMAL — RANGE 07/15/94 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINY����THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANI]ARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ^ SUBMITTED 8Y:__ _______________ Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH -- •DIVISIO'V_ OF ENVIRONMEN'1 �lI ". O'L Onc.,j Owner or Purchaser of Building C'j Building Constructed by Location - Street Municipality 1 Building Type Section Block Lot Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, -and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs. or assigns, to place in good operating condition any part of .said system constructed by me which fails to operate for a period_of two years immediately following the date of approval of the - ItCert- i- Eicate --of-- - Gonstr-uction Compliance" f-or- th ea sewage-- disposal--systert, • or any - repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of th building utilizing the system. Dated this day of 19 Signature -- ; Title l \'A Genes 1 Contractor (Owner) - Signature &)z Corporation Corporation Name (if Corp.) q-;� e 45:4 o-� �U Address rev. 9/85 mk Corporation Name (if Corp.) Address CMG I WELL COMPLETION DVUf%Dlr .4 DEPARTMENT OF HEALTH :7- - I— -.:. ­ . - r ei -j PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET A0®RESS: lUW;;VlLLAP.L1CIIY TAx GRio mumw: R 00kv r)i '&k 4,4k, AJP�,cift,. V.1le WELL OWNER NAME: I ADDRESS: a 11 o w AL-fiha 1,4ke 0 A A 9, # /41,f WBIVATE I 0 PUBLIC USE OF WELL 1 - primary 2 - secondary - G4ESIDENTIAL 0 PUBLIC SUPPL C1 AIR/COND_1HFTT PUMP 0 ABAND04ED 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm.1N0. PEOPLE SERVED EST. OF DAILY USAGE — gal. REASON FOR DRILLING ❑RF;PLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY [YEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH —ft. I STATIC WATER LEVEL _21 ft. FOATE MEASURED DRILLING EQUIPMENT PWARY 0 COMPRESSED AIR PERCUSSION 0 DUG tf WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED 9-6PEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 10 tL MATERIALS: 01-STEAL 0 PLASTIC 0 OTHER LENGTHS BELOW GRADE _L-Ki ft. JOINTS:. -0 WELDED, . THREADED ❑ OTHER DIAMETER-,',, _16— in. SEAL: dl- alt GROUT 0 BENTONITE 0 OTHER WEIGHT PER FOOT lb./ft. , DRIVE SHOE. 0 YES LINERtO YES DAD SCREEN DETAILS ,DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST OTES-ONO SECOND* GRAVEL PACK 1 0 YES, ", 0 NO DIAMETER OF PACK In. in] TOP DEPTH IL BOTTOM DEPTH — ft. WELL YIELD TEST "J.1,4"kailed pumping MEII�00: 0 PUMPED ,k�were done is in- IMMPRESSED AIR d'imat .9 f ion attached? 0 BAILED 0 OTHER YES 0 NO WELL LOG e detailed formation descriptions or sieve analyses 'a'remov'ailable, please attach. DEPTH FROM SURFACIF 'Water Bear- Well mete In FORMATION DESCRIPTION COCE WELL DEPTH It. DURATION hr. min. 011440WN !i� - IV` YIELD m. Land Surtace Ou*, 6u- A WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS O.COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? OYES 0 NO STORAGE TANK: TYPE ky �( -q-N-z CAPACITY GAL. WELL DRILLER NAME ji DATE A ADDRESS UA,% V. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE 2a Io n PUTNAM COUNTY ''DEPARTMENT-OF E HE'ALTH`; Division - of Fovironmental Health Services, Camel N, "•. Y " 10512 x CONSTRUCTION PERMIT FOR :SEWAGE Dt�P.OSA� SY$TENh Town or 915agiii r1 oCateo':at Subdivisiono hP_� J G'� oF��< 6eE' �L �� Job Owner" �= Address Building Type �{7 176 r�\_ 1.� �n Lot ArreeaL, ' Number of Bedrooms '. Deslgn :Flow w� Total'Ha4�table Spacer r��(z l`� Square Feet . r 1 Separate Sewerage System to consist of ` , Oc7 C`� Gal. Septic Tank and, �.C7: i� .`rt " A+ K-4 To be constructed by Address =x Water Supply. Public Supply. From �+ vate $uPPIY . to be 'drilled .by Address Other Requirements 1. represent that I am wholly and completely responsible for the design and location of , the proposed system(s); 1) that. the separate sewage disposal. system above described will be, constructed as shown on the approved amendment thereao and' fn accordance with the standards rules and .regu a !ons oil, e u nam County..gepartment. of. Health; entl that oncompleUOn thereof a - 'Gertificate•- of Coristruction.Coinpliance' satisfactory. d the.'Commisilorie of, Heatth.will be'submitted to the 'Department,'and a' 'written : guarantee willcbe'furnished the owner, 'his successors, heirs, or, assigns by, the builder.1hat said builder will period of two (2) years immediately following'ttiedate , of the issu- ancee of .the. approval' of the' Ceitif cat of , construct on sewage Complpanice of�the, or g nal systm or any, repairs tl , et"; 2) t tie drilled well described ;above t will be located as shown on the approved ' plan and that said well will'be � n.:acco;►dance with'.th` stand ds,'rul an r la i� o�i ns of thee. Putnam County Depart enit of Health Data 1 l Gl (. %C� Signeq - vC` P.E. Address a G.� �in. nse No. ' APPROVED FOR" CONSTRUCTION• This - approval expires one year•from the date_. issued .unless, construction `of the bu�I has been undertaken and is , I. revocable foricause or may 6e amended or`•modified wtien` considered necessary by 'the Commission of Health. Any change or ;alteration of construction requires a new. permit. Approved for disposal. of domestic sa se ge, an. ate'w supply' only. vets By Title „ PUTNAM COUNTY DEPARTNIN T OF HEALTH DIIr ,STON_ OF,:�- MI- VI.RONt ENTAL -HiEEA Tri` SER ICES _._.. <....... _. _ . i Date ; ]w e 7 Re Property of Located at Section Block Lot Gentlemen This -letter is to authorize T. = Michael Daly, P.E- a duly licensed professional engineer for registered architect (Indicate) to apply for a Construction Permit for.a separate sewerage system; to serve the above noted property.in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in. connection with this matter and to supervise _the .construets_o,n.-::of:_sa3d - - - system or systems in conformity with the provisions of Article 1L.5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Owner of Property Countersign P.E., R.A.., # 48468 BQ,x 243, :312enorock ( Seal ) Adore s s N.Y., 10587 248 -7022 Telephone %33 Ale - Address 4'-12 - Y93- "®% Telephone r a D E G 11981 PUTNAM COUNTY DEPT. OF WEAL. T F . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF f'mRUNMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEh,IN. Y. , 10512�___� <_ -_- _ ... _ - -. _ •., - -_- -_.. _._.. DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM- FILE NO. Owner Address 9 60 Tu my A..I r� tai •`�. G . 7,0,,E t►�,�� � Located at (Street v���� - 5'r. Sec. oc Lot ca `e rfearest cross s ree Municipality. PQ"rfo Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number • CLOCK TIME PERCOLATION 1 PERCOLATION NEE Elapse ]Depth o a e� r Water bevel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 20 - 3 3 7- 3 D .-- 3,.. - 2 n r-r�i 3 COUN OFAUCH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 7-/ 1 4v 5 y 3 7- 3 D .-- 3,.. - z7 / ..z. 5.0'- 3 �� z� - z/ 3 - 2 n r-r�i 3 COUN OFAUCH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED. WITH APPLICATION DESCRIPTION OF SOILS..LTJC,OUN�r RED- IN -TEST HOLES', DEPTH HOLE -. N0. / HOLE. NO.;_.' . G.L. 6" 12" 72.. 7 84" ' INDICATE.,- NDICATE LEVEL. AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL, RISES AFTER BEING ENCOUNTERED -5- TESTS MADE BY, �% _ .:. __.Z2 s_e ..•. -.. .n.. .4. .. _ -- e.. .... . -. r -. t .w .0 .o <r. n._�. ..-ir- ..s+... . r.T....n a�... —. u.. _: Soil Rate Used D -S MirVI "Drop: S.D. No. of Bedrooms Septic Tank Capacity Absorption Area Prded.By L.F.x24." Name a . Z_Md.M-9- ;!).� &0 • cs inn Usable Area,. Provided /®® U Gals.. Type o 3b" width ' trenc . Other 44e> ure Address SEAL m . THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Boil Rate Approved Sq. Ft /Cal. Checked by Date 01- 0 SHERLITA AMLER,'1VIll;*§, - Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Eng/Ioukhnovets c/o Kevin Molnar 34 Hiawatha Road Putnam Valley, NY 10579 Dear Mr. Molnar: _._ ROBERT J. BONDI t _ County Executive DEPARTMENT OF HEALTH 1 Geneva Road,. Brewster, New York 10509 October 27, 2005 Re: Addition — Eng/Ioukhnovets 119 Pudding Street No Increases in Number of Bedroom (T) Putnam Valley, TM # 41.11 -1 -10 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 10/26/05. The addition is approved with the following ..conditions:_. 1. The total number of bedrooms must remain at 2 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, restrictor 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 Putnam Valley. If you have any questions, please contact me at your convenience. Sincerely, Michael Luke Public. Health Sanitarian ML:kly cc: (T) Putnam Valley, B.I. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 /QAC\ 170 LA1 A L`.... /OA C\ nt O —AO SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 0 ° �r= ` - I Geneva Road, Brewster, New York 10509 � �IoJ� ADDITION APPLICATION RESIDENTIAL ONLY ADDRESS M1W lt�-j YqP,, IrT�Q .. 1o5�orjq DESCRIPTION OF ADDITION 9!-:PI 9&lie 1 'V1Ot-1 eL_� �o NUMBER OF EXISTING BEDROOMS 2, PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. ::...... _ _.. P ease. su mit this form an the following -to Putnam County Health -Dept., 1 Geneva R , _ _ Brewster, N _ 10509, Phone: (845) 278 -6130. - 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845)3'18 -6130 Fax(845)278-7921 Nursing Services (845) 278 -6558 WIC(845)279-6678 Fax(845)278-6085 WV' y wit SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PU_ TNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 To Whom It May. Concern: ROBERT J. BONDI County Executive Re: 119 Pudding Street Residence TAX MAP# 41.11 -1 -10 TOWN of Putnam Valley According.to records maintained by the Town, the above noted dwelling, xx IN COMPLIANCE WITH TOWN CODE. IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS 2 This information has been obtained from: CERTIFICATE OF OCCUPANCY: xx OTHER: Septic compliance Assist. Building Inspector JOHN W. ALLEN 9/2/05 Date CERTIFICATE OF OCCUPANCY im Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -600 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 V-1- T-#- o .H /Procrhnnl (Rd51 *77R_AOIA Pnv (RdSI'7R_FAdA � r� r � t r \ J GL ! 4 y ,,..,,,,.. ss++ 2 11 - 1 .. .. ' . of 1 -" ' _ t ca s °z . t ', -? y -u �' -a —.V. ... _ �.= .•.;�.sri;:- .o`u--a —_. - -. _ .. -_. L f Y - w tJ ,+ i rt. �" it _ r k . s Q � •4 r t t 1.. :aY $ ..+ .. l 'S V. " ..' b t Yid', r J ' �';" .. L �s� m. J ." ^n a� 9 0 ' - < ?: .. . .. .. r ' f r z it . .. t ?� A . ' 1. r �� a ff R -..-v r a Y. `Y - „,a o5.''ti _. —. .— .. .6 .. - .-- ..— ._...— . .. —. ,., .rah Ygr , rr . 1. s s.1 . K. .. ` .�. .:. t� 1✓: . . .1 -. K T +- t 1 * -_3 r, E.3t i .. c t d v ,y, •; } © + .. F tt ,. Q [ v „k . r x 11 qO�; j 1 S O r �� 1-1 i ;i:, f h sta '' 'Yr 1 . \. } 1...' ig 2 j 1 ' , � . 'ter �N i. 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