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PUTNAM COUNTY HEALTH DEPARTMENT 1 � rQ , -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES t� i
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SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT
DATE / 2
ADDRESS
Internal Use Only PERMIT #
Repair Permit issued in last 5 years
Repair within Boyd's Comers, W. Branch or Croton Falls Res.
r�Repair within 200 ft. of a watercourse or DEC - mapped wetland
G A"4LFc. T-4f,0 TOWN JT14tMV q &
Name & Relationship (i.e., owner, tenant,
INSTALLER
1`7v OSCA
T.D
L-W Not in Watershed
U Delegated
❑ Joint Review
TM # S/a i V"1 f' -17
NE # Vj�� .5 -* "k KZ- --
PCHD COMPLAINT
$If'S
PHONE #cr,u F7�
REGISTRATION /LICENSE # 10 16
V-1 VXProposal (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.
/000 CA, L- %'VL 17t E S" < <. AR 1 n.e '1AA AAA v _A..
33® `7 cv r.
I, as owner,agree 10 the conditions stated on this form
SIGNATURI
(owner)
1-the S?ptic-
�ei'•`L
TITLE owN Fe-
DATE
agree t0 GOillply vyith the conditions-of permit fei the septic system - repay-
_
SIGNATU �n -.._. / TITLE A6 DATE 1-1(30 1 3
(Installer)
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., 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 backfill�d until authorization to do so has been obtained from the Department.
C INTERNAL USE ONLY
Prop sal A pro ed [if Pw6 P, roposal Denied ❑
11 Al ul
1r A�Uey\� 4, 6 l 6 t •5
Inspecto s Signahre & W le Dale / Expiration Date
Repair Droposal is in compliance with applicable codes Yes Cd' No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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Kevin Shiels
7 Oakridge Road
Putnam Valley, NY .10579.
Dear Mr. Shiels:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
BRUCE A. FOLEY,_ R.S._ _....
Aciirig Public Health Director
December 15, 1994
Re: Addition
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans have been approved as per plans bearing this Departments stamp and
dated December 16, 1994.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditions:
1. The total number of bedrooms must remain at two without prior approval by
this Department.
,..The,-area,of e sewQ-ji;sal.xstem and_i.ts expasion..rea-mush
. ag
be maintained.
3. All plumbing fixtures must be replaced or updated with water saving devices,
i.e., low flush toilets, restrictors for shower heads and.faucets, etc.
Approval is granted for sewage disposal only. 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.
Very,t,ruly yours,
Robert Morris, P. E.
Public Health Engineer
RM /jp
cc: BI (T) Putnam Valley
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ArFLICATICJ - ACDITICN - (FESIDENT'IAL CNLY) ,
"`N2rr�e: " ✓ /i"J J���LS Fhcne -Z z�'. oiS Year of Original
Street/ 041124 te 04b TM:._ S/ i _ / -Z.~f Construction i
Mai 1 ing Address ,&7W, 657-9 Tcwn &ir (rte FCi:D Perm. t
Description of Addition q6 <A/ac, /Ct'At1z01A1Q wmwycSrU/ry
Number of existing bedrooms 2 Proposed number of bedrooms Z-•
A) Square Footage of existing hcuse 700
6] Square Footage of Proposed Addition 1 -7,iv
% increase in floor area ( A divided by B) X 1CO = 6
Please submit this form and the following to FUT�W4 COUNTY HEALTH DEPARTMENT, 4
GENEVA FORD, eFEWSTER, NY 10509, Frcne 278 -6130 with the following information.
IF THE FFGPQSEJ ADDITION IS C-FEATErR TPAN 15%
CERTIFIED CHECK C_R 1,10NCY CFOER
1. CHECK for $1C0.00
2. Sketch of existing floor plans (all living area including basement, if e_ny)
Non- professional drawing
3. Sketch of proposed floor plan.
Ncn professional drawing
4. Copy of survey showing well and septic location, to the best el your
knowledge. Include date of installation if known. Any questions please
contact William Hedges or F.cbert Morris.
IF THE A.DDITICN WILL RESULT IN AN ADDITIGNAL eEDRX11 THAN
CERTIFIED CHECK Cfi MONEY CFDER
i, CHECK for $100.00
••2: -- Sketch bf .existing. flaor plans. (all living area including basement, if any
Non- professional drawing
3. Sketch of proposed floor plan.
ron professional drawing
4. Plans for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
OFFICE USE
Comments and /or conditions
Approve by: TITLE
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
November 21, 1994
Kevin Shiels
7 Oakdale Road
Putnam Valley, NY 10579
Re: Proposed Addition - Shiels
7 Oakdale Road
(T) Putnam Valley
Dear Mr. Shiels:
JOHN KARELL Jr', P.E. M.S.
Pubiiu Ti6aftri'Diretlor `
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project has peen completed. Comments are offered as follows:
1. Separation distance between well and septic is approximately 55 feet, 100
feet is required by today's standards.
2. Expansion area for the existing septic system, 100 feet frcl the existing
well, is not available.
In light of the foregoing, you application is hereby denied.
.. J t .. i s advised. that_ the prdacsed 3ddi t i orgy . i s revi se...d. tp =meet: c ,rren standards.
You may also choose to appeal this decision to the Putnam County Board of Health.
I may be reached at ext. 166 if you have any questions.
RM/J P
Ver truly yours,
i:90?"
Robert Morris
Public Health Engineer
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner. Address:
Located at (street): TM .# Section: _ Bloch Lot
kunicipality: Wate.n ed:
SOIL. PERCOLATION TEST DATA
witnessed by:,
Date of Pro-on a-3 / Date of Percolation Tor.. _V / � 3 /l'/
.,,
Hole No.
Rua No.
Time
Start —
Stop
`
Elapse
Time
(min.)
Depth to .
water from
ground
surface
(inches)
Start - Sto
Water PeccoLatfon
Level drop Rote
in inches miAftc6
2
°; 23
B %a.— 2'
3
3
- 3
- -24
3
4
I
2
3
4
1
2
3
4
3
I
2.
3
4
S
'
Notes:
I. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < I min for 1 -30 min/mch, < 1 min for 31-60 min/inch).
All daze to be submitted for review.
1. Depth measurements to be made from top of hole.
Form DD-97, PtioP'?
TEST' PIT DATA
DESCRIPTION OF SOILS ENC(3.0 1!ITEItED IN TEST HOLES
Indicate level at which groundwater is encountered Ajt7 A19
Indicate level at which mottling is observed A, IQ tJ!
Indicate level to which water level rises after being encountered
Deep hole observations made by: 1Z.. ? G U,, Date 3
Design Professional Name:
Address:
Signature:
Design Professional = Seal
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Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
-
FIELD ACTIVITY REPORT Y.
AnDI2FCQ:
Street Town State Zip
PERSON IN CHARGE
nR TNTFRVTFWFT); T)stP_
Name and Title
TYPE OF FACILITY:
FINDINGS:
P
TNCnFCTpR-, TFT
Signature and Title
REPORT RFrF.TVFT) BY
I acknowledge receipt. of this report: SIGNATURE:
02/96 Title:
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is cerhfied only to:
V SH /EL S
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Area = 9,080 Sq. Ff
SURVEY OF PROPERTY
S PliDWir: f' l'OR
KEVIN SH /EL S
sntralf by rHc
TOWN OF PUTNAM VAL L EY
g ' PUTNAM COUNTY
NEW YORK
SCALE / /A = 20 t/. MAY'—*:" 1989
a
We hereby cerlily that the s✓rvey ahown hereon
No/cs was complc9rd by us on May 3, 1989 , 7hol
this mup wos cot weleri on Moy 5 , 1989,
J. Altelalion of Iles document, eAcept by o - lrcenseJ Lar ?d' •'- and that Ihrs survey has baen prrpored in accordance.., -
surv(.vor , is rllegol. `. with the e,isling Cepde of Pioctrce for Lond Sure <:ps
P. A" CerlIficuhons ore valid to, lhrs maP and cnpq >s os adapted Gy ihtr New )'rrf Slate Acs.ly -bon of
/hereof only rl surd mup or copies bear'llte embosrr'd: Professional Land Surver,, >, hn
seal of the sur veyor whose srgnotare opp'cors heieo,r ` r O
3. Underground improvements, cosements or encrnochrire�tfs, ``O�� pAl tq,�, 0 fi /4
If Onv ore oat chn wn h— -� /1
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