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HomeMy WebLinkAbout2686DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61. -1 -43 BOX 23 .. NIL yr I, I IN 1 oil ■ IN ■ MIN Fy'.r . Name & Relationship (i.e, owner,tenant, etc.) TYPE FACILITY PHONE REGISTRATION # Primal (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-.-,---.,, '% _ I . _ ( .. . f_ n Proposal appr Proposal Disapproved (41�v IYo, C, .124 h Y Inspectors 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 own rr- report gent of owner agree to the above cpnditi S. SIGNATURE TITLE DATE 2P�& Wiitie (PCED); Yellow (Tapin ffi); Pink Ukpliaant) 'L- 'ocated' at -,= � ' _.Separate` Sewei m TO I ALLEY TOW OF PUTNAh .1T WLLL DRILLrtS LOG AI�?D .i'ORT - .v• �-n -.� - n ;-rz, -gin: �s�:: -: a. .a..o..F,_. ..._ ,...m. -w..w -�.- .._... .n : .a -.:, �.. .. :.- _...<..:m.•,... -.- 5�., `-.:�. :� n .-s. n. ao.. . -_.. ,�: a, .,,.., _... .r ':.,r �,•_ ... . ... WELT., DOCATION a�C.d 6'l se.`i� �l � t� Il u, WELL OWNER WELL DRILL: name name street •o e section block lot . address city or town 6. ��� S� 'Lill 117 Cam% address city or town CASING DETAILS YIELD TEST WATER T,EVEh SCREEN DETAILS Bailed Measure from land surface i Ler�gh: feet or Pumped S.tati(36 ft Make.o Inch es, l GM .. Cin d lei en Bailed r 6ft lot Len th -. Ft. size Diameter_ . '_ In. "AL DEPTH OF WELL ��,� Feet - 3epth From - 'Give description of formation penetrated, such as: peat, 'round Surface .e silt, sand,. gravel* -clay9 hardpan., shale, sandstone,. ranite, etc. Include size of gravel(diameter and sand fine,:• medium, course), color of material,- structure Loose`., packede .. cemented, : ..soft,-- hard): (Exo Oft. to 27 ft. o fine, acked 'yellow. ba .d., 27_ ft to 134- ftgrM - ranite) yet toze_et.AFomatieQn Des_ cri Lion Sketch; exact -location • of­ ? jell to at least two permenant Landmarks i 1105- 5 1� ate Well Completed Date ' of Report--,2 7� Well Driller. si ture C PEEKSKILL NEDICAL LABORATORY 1879 C.rorhpond - -Bd Barclay:Plazii: l A Apt ;1 Peekskill :New :York 105.66_ = PE,�.87,7,7 M.t !. - . : .n,b r rv. r .� ,. ..1 ....- s3Wx h ^ ^. •.q' t. . , .. r .. �y r t :ei'. ..cca v'• 7 DATE COLLECTED RESULTS OF EXAMINATION, OF WATER 'OWNER 1 tt ATE RECEIVED CITY, VILLAGE; TOWN & /OR NAME OF SUPPLY... DATE REPORTED um SAMPLING POINT; '. BACTERI A PER ML. (Agar plate; count at 35 . C). COLIFORM GROUP (Most probable No. ;100.1. ). AIJL '. ES , TOTAL - ppm DETERGENTS-ppm NITRATES (os N) ' "ppm. IRON; TOTAL - ppm. c� -''�` Owner or Purc aser of Building Municipality Building by Sunset Hill Read Location - Street 57 Section Block mised Ranch 302 Building Type Lot GUARANTY OF SEPARATE SE14AGE- 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 guaranty to the.owner, his succes- sors, 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 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- :. t_e.rmina.tion of the. Director of .,the .Divis.ion..-of, Env-�ronmenral .Health " "'vicas "df "'the"'Piztnain' Coun'ty'Departiner�t�og' KeaT'tri "aS tb 'whetrier -or 'ifff 'th: i failure of.the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the sys em. Dated this 2 day of ftbruwY 19 76 Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP,ETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health Owner or Purchaser of Building Municipality Rnbxrt t 57 Building Constructed by ;Section sutse mil load 3 Location - Street Block Based Mom 5.' Building Type Lot 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 standards, rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, 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 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- -.. - - -oaf - th:e -Putnam .,County, Department _ of :;Heal -th- a s,_to °_whe the . jor, failure of the system to operate was caused by the willful or egligent act of the occupant of the building utilizing the sys Dated this 2 day of Fobru 19 76 Signature d Title If corporation, give name 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 FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health Owner or Purchaser oT Building Municipality Robert Antoinette Building Constructed by Sunset Hill Road Location - Street. Raised Ranch Building Type 57 Section 3. Block 3.2 Lot 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 standards, rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, 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 initial use of the sewage disposal system, or any repairs :Wade 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- f., ces_of..the; p _t�iam.Cour_ty 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 the.b.uilding utilizing the syskvm. Dated this 2 day of February 19 76 Signature Title If corporation, give name 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 FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division 'of Environmental Health Services, Putnam County Department of Health Fli DivW6 &06fikh," L - zCONSTRUCTION.PERMIT1POR : SEWAGE I $R9 16MIS46. 7 Subdivision Robert & kn'n_ A 'too ette e . split cLOt Are; Number of Bedrooms ,Water Supply-� �_',_-,Public ,,Supply. � From ,. 140"te SUOOIY ;fo be drilled by 'Adprest, wliaI l;t & �T -Addressi—, V.ED FOF; CONSTRUCTION T,hi -App lures &,:�,n- e- w fc ApW'ro_v'e' d—I 'iiiioUi, 66f, U M Lei /V. 77 777 4,054:2- 9. Town- or-' Village ob, F3 tb V, MOM 7­ ace -Square. Feet meal feet X .30" ,width french eii:IX r4:_ wage �'cli ,disposal ,systern ita r ons of the -putnarh Belli i9sloner of Health,will 0 b id (builder "will V N hme'date o.f.the,iSsu- a qp2 p2 rIIII described above s a I of the . -Putnam X P. 27846. 0 ion J oietjie, u cl Seen un,dertb . ken 'cif alts ruction only -7. le q F'l1T 'AM C(TNTY nf;i'IRT`T \T OT IfF.Arjlt HF.1T,jejf'SF`Rkl[CPS ,a,,:....:. Date May 109 1975 Re: Property of Rlabert & Ann Antoinette Located at Sunset Hill fied9 Piatuam Valley Section. 57 Block . 3 Lot 3.2 Gentlemen: This letter is to. authorize John S° Rome a ''duly licensed professional' engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards., rules or "regulations as..promulagated 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 1�F7i Eelucat %on Law; the Public Health Law, and the Putnam County Sani- tary Code... Very trul ours ° t ,o Signed _ Owner o Property Countersigned • 3 v nue9 Pella Napo 10803 c7846 Address �.E 738 o 01M I Nortbridgo Road Telephone ,. 00000. Om Add e ®e3ki119 N.Y. 10566 Ep@1aL ENG /HfF9 a • ° 737 = 1056 e q o a• Telephone @ sf 27846 ° e °qfF� NEW � o PUTNAM •COUN'a DEPART i,U_NT OF J-1:2ALTH DIVISION OF EPMRONMENTAL HMALTH SERVICES COUNTY OFFICE I:UIT -DING, CAR1`EL,r-1T. _Y. DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL. SYSTEM FILE NO..... _ R©bert & Ana Antoinette N.Y. 1080 OFmei _ . _ Address ,� �� 3/x.2 Fifth Avenue, Pelham, Located at (Street Sunset Hill Road Sec. 57 Block 3 Lot 3.2• �Ind.- -at-e-nearest; cross aree•L )- Muriici.jmli_ty Patnam galley Watershed Peekskill SOIL PERCOLAMON TEST DATA REQUIRED TO BE SUTBMI'1TTED WITH APPLICATIONS -T o.l e Number CLOCK 'TINE PERCOLATION PERCOLATION Run lapse Depth to 'Water Water LeveI No. Time F,om Ground Surface in Inches Soil Rate Start -Stop . Min. Start Stop • Drop in ftin. /in drop Inches Inches Inches 1 2 No teats made as ground water height was within 14" of surface. 3 Curtain drain to be installed between house,and -septic tank to 4 dry area behind house and verify assumed rate of 11-15 minutes / inch - 5 `'i Vii• w ' l.. `C:. 2 ... �_ •. 2 3 S Note")': 1) Tests to be repeated at same depth unt ,il a . proximately equal so:i..1 rates are obtained at. each percolation test hole. A��. data to be subrrii.tted for review. k 2) Tr:pth mebasurements to be made from top of.hole. 1 2 3 S Note")': 1) Tests to be repeated at same depth unt ,il a . proximately equal so:i..1 rates are obtained at. each percolation test hole. A��. data to be subrrii.tted for review. k 2) Tr:pth mebasurements to be made from top of.hole. TEST PIT DATA REQUIRED TO 13E SUI)1­;1 T`.I'ED WITH APPL:I- CATION DESCR:IP`I'J:ON OF SOIL�l 11,1 ` JlE,2T H01. �3 DEPTH HOLE~ -'N0. 1 HOLE NO. 2. BOLE PLO..., 3 oitl _ _.:Toil TPnil 611 a^. ;S 12.11 Topsoil Topsoil Topsoil 1.811 sandy gravelly loam sandy gravelly loam sandy gravelly ° loam 211 11 7 11 3611 4211 4811 5411 6011 6611 7211 i 7011 INDICATE =VEL AT W ICH GROUND (WATER IS ENCOUNTERED 34 a same INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY John Se Romeo Date �hy 10,9. 1975 I ..__ .�._. , ._........,_ _.te..... _._.._ ... DES LGN .. _ -- - - Soil Ra. Used 'll °�5 M i l "Drop : S . D: ' Use U1e'- Ar�a� °Pr ov -LdEd Oar 5 =0 SA6 No. of Bedrooms 4 Septic Tank Capacity 1200 Gals. Type o!Fy Absorption Area Provided. By_ 320 L.F.x2411 y 3b"'- M width trench. A o4..04%her Name. John S, Romeo Signature Address 1 Northridge Road A SE y � O ° . o Peekskill, NJ, 10566 _ O � THIS SPACE FOR USE BY HEALTH DEPART Elff ONLY: ° ® ®�� 278a6 a ao Soil: Rate Approved Sq. FL /Gal. Checkocl by o,e ° ® ® ©,a0© Date, i • i { } t Public Health Director - �- .:.-„,., ..-...>.. L- ORETTA =:MOLINARI•�R.I�I:= M,�::PF::., •� =•... Associate Public Health Director Director of Patient Services 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 (845)278-6014 Fax(845)278-6648. Preschool (845)228-5912 Fax(845)228-6113 June 27, 2002 Robert Antonette 158 Sunset Hill Rd. Putnam Valley, NY 10579 Re: Addition- Antonette, 158 Sunset Hill Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #61 -1 -43 Dear Mr. Attonette: 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 form this Department dated June 27, 2002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain ate„ without prior approval by this department. _ 2.. The area of the existing sewage disposal system, and its expansion area, must be 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 Putnam Valley.. If you have any questions, please contact me at your convenience. Very truly yours, -- --"�� -� William Hedges WH:lm Senior Public Health Sanitarian cc: BI 6 BRUCE R. FOLEY - Public -- Health: Director LORETTA MOLINARI RN. .M.S.N ..._..._.... __....__. Associate - Pu6lie Health Director Director of Patient Services 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONL)o STREET .5UA-150-7- WILL )eo TOWN lurAAW U4147 T: X MAP# 6/. — V3 NAME 6Co 6 WrZ. f-b.?%t Pjtr,rC PHONE OV r 4-1(.. ?.7-7.(. P CHD# MAILING ADDRESS /5-$ SvArSr &T x44_( Ab /carr-i !l #U4cf AJY 16S,79 DESCRIPTION OF ADDITION 3 w A LL ADD 1-11 6A) FAQ_ C- d j-rtCCE NUMBER OF EXISTING BEDROOMS i PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUMDING 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. - - Please submit this-form and-the following to Putnam County Health-Dept:; 47 Geneva Road; Brewster, NY' 107, Phone 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) *Non- professional sketches are acceptable. 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 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.V Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines k .. s. 1 I BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Z d� DALAIc- Z-- �/ Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Residence Tax Map �/ K3 Townr�c Gentlemen: According to records maintained by the Town, the above noted dwelling IS 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 Building Inspec or BFhouseguidelines r3 ,F :w i 16 2 S Ip {v, !� 20 �c r t« t� tv ,t i - ;i :r �r /Z o U 44"4- M; A, l,�I�peP f - --.V - / CS . - _ e SECTION j p ya♦ry .I.,,ne♦ 1� tl �z Zn 33- Pie �I 1(u tk u Ge 7i tpa77, r—. � G.4• 7:: 41.0 - � :� is Sx ..7:p. .� �a. (iL '• ' _9