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HomeMy WebLinkAbout2536DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -17 BOX 22 17-2,P i■ � M. 1. mot or 02536 PUTNAM COUNTY DEPARTMENT OF HEALTH Permit e Division of Environmental Health services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEMS T own or age x -Mop; c `� .. Qlo kr.1 Subdivision <�� /f f�' S rc? s2� s� ev Alejr�Subd. rot # / J� Renewal Revision __[3 Owner /Address_ � Date Of Previous Approval Building Type - Lot 1 Fill Section Only ❑ Number of Bedrooms Design Flow G /P /D P.C. H. D. Notification Required Separate Sewerage System to consist of �%49 G' Gal. Septic Tank and 3 2eg .e�'% y'jfq/J CIC° ^GPiCr/� a To be constructed by Water Supply: P blic Supply From Prfvate Supply to be drilled by Address Other Requirements Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis oral system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a cons o the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactor y? to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his we ssigns by the builder, that mid builder will place in good operating condition any part of said sewage disposal system during the peri 'ttv� (� r� ediately following thedate of the isw- once of the approval of the Certificate of. Construction Compliance of the original systen7j0 `� %.e tAi�er ' that the drilled well described above will be located as shown On the approved plan and that said well will be installed in accordanc2 lb, ul and regu a onf Of the Putnam County Department of Health, m , ` o� Date / , Signed �'�C ° � o cr P.E. R.A. Address - ✓ ate- z c License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued. st uctio of Qh f ilding has been undertaken and is revocable for cause or may be amended or modified when co ed necessary by the Co ` loner✓ a R�l. oAFt1ychange or alteration of construction requires a new permit. Approved for disposal of domest a san ry se e, a or p I�pp I v ell By Date V r) N 3quQ. - Title _ Rev. 9 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH �. Division of Environmental Health.. Services, Carmel, N. Y. 10512 arms` _ - _ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or Village Tax Map 3� / .4 Block Located at -� Tax Map Lott / Subd. Lot 9 Owner ' r>��g : /Formerly J L Separate Sewerage System built by prz Address Consisting of ! 1OIr G Gal. Septic Tank and Other requirements Water Supply: Public Supply From Private Supply Drilled BY 7- Address No. of Bedrooms Date Permit Issued Building Type _ Has Erosion Cointrol Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies with the standards, rules and regulations, 'in accord% Q €ingfffiled plan, and the Permit issued by the of which are attached), and in accordance Putnam County Department Of Health. ,o eoeeo oe P.E. R.A. / -i� Certified by , Date d J ,� h i7 `• e� fi License No. %dam �s Address g � , to dJr 'the correction of any unsanitary Any person occupying premises served by th above. systems) shall promptly take such set ►� ul s sa conditions resulting from such usage. Approval of the separate sewerage system (hall be ull id asbfooA`i!s i visitable. saniSuchsa approvals becomes rvailable and the approval of the private water supply shall become II and void whop a t pdifkaf on or change if necessary. :bjeet to modification or change when, in the judgment of the o issionet of Health, �,.. e v v Title' — 7. - - 0 ENVIRONMENTAL ERU.ICES . INC. � moo, s NIT Y,51 BEETT °fOt1�;3s1ai� 4 " r HOPEWELL,JUNCTION NEW YORK° $533 (914)2242485 ME. ESS _ Rom 82'�"" �TN ENT:. CHLORINATED` 4( 4 PPM) SOFTENER O;,OTHtR Ct' RCE:' DRINKING WATER` WASTEWATER EFFLOONT © OTHER ECTED. BY: - . F TIM M E P Nt. D'ATE RTtafEk6 COMPLEX ti= #nISTITUTION O PRi &E RESFDENCE ❑ SSW_IM POOL CH [7 MUNICIPAL [] RES7AlJRANT g ❑ *. MPORARY RESIDENCE - P AP 1t NUMING HOME C7 SCHOOL = ❑ TRAILER PARK.,, M 4ABOR CAMP n, PRIVATE COMPANY .- __ , a. SEWAGE TREATMENT PLANT , ` - O OTHER ,. . ,., K 'ACCOLIFORM C011AiT M.F.T: < � - PER 100 M.L.. 616TAL COLIIFORM C011N P.M;P N. _ PEA t40 M L AL COLtFORM COUNT M.F.T: _ - PER 100 M.L. ❑, FECAL COLIFORM COUNT M:P:N. - = I ?ER 100 M L ; IZEN i3ESSERT PLATE, ❑ AGAR PLATE:COUNT _PER 1 M.L - - LABORATORY TECH . GIAN' OA REPO TED LABORATORY DI TOR i -n tyv u E A O ,qs-v /0,/) � Jack 91.0 ?I; A d7 :Vllek P" V- 11eX / / 1 0() 37, , / �, ,, zed OoAq tl 6 �e c Xuo � C1,54 5-+2r"-,5 �'—P-G-MAM COUNly DEPARIMENT BF irEA6W HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS To, 02 Cc r m, /IArL t Cb�frc a7 :Vll ek Bli ! 16, o A [6 C) It �6 0 r J 3 0,:Pl /71 Ilan /a nR 0 k 00 7, x -5 lO/ C 7. 49 Putnam County Department of Heal' Division Of Env'-,rO"m.2rtal Health Serviose as nOt8d for 00-formance with applic ..le FVj. nd F., , ',Jations Of the Put C OuntY h D;part.e W signature itle Date J,4 .2 U -QF HEAL F Ile c A, a /7-1 V,2 NO 2 2 T, 3 5f d _7' 2 kep 44, GALLON SEPTIC TANK ?20 LF X 74A13S. TRENCH I - -- ---------- rn 5 vision t L, L aal 0Y HBaiLL Health Service, lith =ions the Of --. the 419natur at,p R E C E I V E D JUL 2 61983 PUTNAM,COUNTY DEPT QF MALTH 21 7" 1,9 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM TOWN OF r. COUNTY.NEW.YORK DATE SCALEope NO. � ? -,/Zx SULLIVAN - =ZME-*lW CONSULTING ENGINEERS I I 23 -3 GALLON SEPTIC TANK ?20 LF X 74A13S. TRENCH I - -- ---------- rn 5 vision t L, L aal 0Y HBaiLL Health Service, lith =ions the Of --. the 419natur at,p R E C E I V E D JUL 2 61983 PUTNAM,COUNTY DEPT QF MALTH 21 7" 1,9 AS CONSTRUCTED SEPARATE SEWAGE DISPOSAL SYSTEM TOWN OF r. COUNTY.NEW.YORK DATE SCALEope NO. � ? -,/Zx SULLIVAN - =ZME-*lW CONSULTING ENGINEERS I I Date Re: Property of Located at �1r 4/1 Section Block Lot Gentlemen.: This letter is to authorize r a duly licensed professional engineer or .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 construction ,of. said system or systems in conformity with the provisions of Article 145 or 147, Educa•tion•Law, tha•Publie Health Law, and the Putnam County Sani- tary Code. 3 a L�I A4 eo8�88 Countersigned. P.E., R.�A- # Aaaress ✓,jp�f 04.8 &W &C 0 � 0t.• -� yam, • _ ObO� •:J1 � f^a To phone �o T :Naa� m Very truly yours, Signed x `D er of NTroperty Address Telephone a / <,,Ile caner or Purchaser o'er BVilding Municipality - Building Construct6-a by Section 5; A/ el- CAj L'�?a ¢ 2 oca oii - Stree—F B16c u nE, YPe GUARANTY OF SEPARATE SEWAGE 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 stsndards,.rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, hears 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 initial use of the sewage disposal system, 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 occu- pant of the.building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the division of Environmental Health Ser- vices 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 odcupant of the building utilizing the system:--. Dated this---- da. of a- Si nature y Y � .; 19 g jo, ) Title corporation, g v harm and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FIL9 OTTC9 OF _ATE OF FIRST USE OF SYSTEM. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of Health a FN 10 T 8r Y 1 s9'Z amt crb�i 717'1 -1 1 S Ld • o2all,1 I l ` 1 \ I I X0.1 1 I �No .7941!1 cool" 1 t ��oo -,QJZ oL S a. .CQ�nv�7 1n7 11 `-.W 41v r t Gf� i . � 1! . o/ n, \ o 0e/11/2004 11:43 CASH MGMT STAMFORD 4 91845278—f321 1p Ul NO.495 002 � w • Q LA • Ail BRUCE R. FOLEY Public Health Director LORETTA MOLINAR.I R_-N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT. OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Iiealth (845)278 -6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 -6648 P Putnam County Dept. of Health 4 Geneva Road Brewster,'NY 10509 Re: t5 C Residence vl, Tax Map J�i, Town /10 • V) Gentlemen: According to records maintained by the Town, the above noted dwelling IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER LA BFhouseguidelines IWO16, A HIM V W4 IR"310%, 0 LORETTA MOLINARI Public health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 Scheurich 27 Silleck Blvd. Putnam Valley, NY 10579 Deer Mr. & Mrs. Scheurich: ROBERT J. BONDI County Executive August 11, 2004 Re: Addition — Scheurich, Silleck Blvd. No Increase in Number of Bedrooms (T) Putnam Valley, TM #51.19 -1 -7 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 August 11, 2004. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at three 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 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. ML:lm cc: BI (T) Putnam Valley Sincerely, Michael Luke Public Health Sanitarian ,. , BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLMARI R.N., M.S.N. ,Issociate Public Health Director Director of Patient Services **&DO Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET ;7 5;'I%Cr 81 t'J TOWN TX MAPS S /,,l`� — %� % NNA-NM Crd -elge're sCkA/,' --h PHONE fiY JW -9f2 PCHD9 A o? MAILING ADDRESS o�1_ y,,11ece F /bl/ ®,<hG/+ JA& NL/ 15-79 DESCRIPTION OF ADDITION .S Se,Savl SG') 1' &0A1 avr ' 1Jea'lecfG KORYMER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIF- ICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Coamction Permit). ... prepared by a Professior>al - grocer or .Registered - Architect in acscrda-ice :vith applicable sectioru ai tie Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. ."I. Certified check or money &d6r fof $100.00. �,2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 0) *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, 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 Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhoaseguidelines n PUTNAM.COUNTY DEPARTMENT. OF HEALTH ...DIVISION OF_ENVIRONMENTAL HEALTH SERVICES_ _ COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL - SYSTEM FILE NO. Owner �"/G.x c2 /�G�'" �'.� Q Address % f (✓r-cC h_ Q /d A27.0 .Aneo gG N Y v Located. at ( Street ,j > V � c- is see. 2 .y Block Lot Indicate nearest cross s ree Municipality , Watershed °- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole .... Number CLOCK TIME PERCOLATION PERCOLATION Elapse p .. o Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 22 L4 7 3 2:�� 4 217 Notes: 1) Te'pts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 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 .ENCOUTeCERED : IN -TEST ' HOLES DEPTH:: .._. HQLE Y.. G.L.. 6" 12�r . 18" 30 3611 �2rr 72" 78n... - 84" INDICATE LEVEL AT WHICH- GROUND WATER IS ENC-OUNTERED_ INDICATE LEVEL TO WHICH WATER LEVEL RJSES AFTER BEING ENCOUNTERED TESTS -MADE BY - - - s. De;te _ DESIGN,- ..: Soil Rate Used..... "Drop: S.D. Usable Area Provided G No. of Bedrooms Septic Tank Capacity p649 Gals . Typea ©ra r Absor tion Area...Prov ded- width Trench. P.. By.� t'..lL.F. x24. ll —guam oub– (It-har t` QF NEW y >o Name , �i..� Signature o ° ate. Address 2%72. THIS ACE FOR USE BY HEALTH DEPART I2 T ONLY: °�.��F� ��• 2 0000 ��O` ° • . o °� 4.01 Soil Rate Approved Sq. Ft /Gal. Checked by ° ° °° :EyS:�aa''` Date