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02691
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES i (]
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 4
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YES Nv� - Internal Use Only PERMR #i,�_
❑ '❑ Repair Permit issued in last 5 years Ltr Not in Watershed
❑ /Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑
Joint Review
SITE LOCATION 1 Zb C.¢o TOWN cL TM # 6 1, —1 - ) �
OWNER'S NAME O, � - PHONE # '`%
g 5 V6 U
MAILING ADDRESS Gia ru.P
APPLICANT j. L. wce c vu �n�� . �L C
Name & Relationship (i.e., owner, tenan con actor)
DATE % 1 '16 " I Z FACILITY TYPE Z.Qot, Rc-> PCHD COMPLAINT #
PROPOSED INSTALLER b eP cl.- �w x PHONE # c//�f -736 /`611
ADDRESS ( K, ,, /,. V r A#K REGISTRATION /LICENSE # fG 5SGD
Proposal (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. /�
. i -,_,11 �., �.(� �� . ! ° : n �. _I � �i 7
I, as owner,agree to the conditions st on this form
SIGNATURE TITLE ayt.Lr� DATE % %/, 'f2_
(owner)
;..----- .......... I,..the.septic installer, agree to comply with the - conditions: of this perm it.for.the septic system repair
SIGNATURE TITLE DATE /I - 1 G -0
pnstaller)
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 backfillod until authorization to do so has been obtained from the Department.
Proposal roved lad
w
Insp ctor's Si nature & Title
Repair Droposal is in compliance with al
COPIES: PCHD; Owner; Installer
PC -RP 99ML
INTERNAL USE ONLY
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2 �� 1 lq I2
Date
codes Yes
No ❑
Rev. 2/07
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LEONARDI AND SON CONSTRUCION INC-,:
6 CAROLYN DR.
CORTLANDT MANOR, NY 10967
(914) 980-3594
Putnam lic.# PC-560 West. LIc.# 067
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HEVISION OE' ENVIRONMENTAL YENTA HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEiM
Owner: � � r �� lr Address: D. C.n O Vt.-S o l( �W
r
Located at (street): Z �%M1n U5 ®. + f14 Section: Block Lot 53
Municipality: VAL&AA* a- Watershed: �-
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre- soaking: Date of Percolatian Test:
Ho[e lNo.
Run Na.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - Stop
eater Percolation
level drop Rate
is inches rnin /inch
1
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3
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1
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3
4
2
3
f
4
2
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4
7±
I
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Notes:
1. Tests co be repeated at same depth until approximately equal percolation rates are
obtained at each percolation rest, hole. (i.: -, _< l min for 1 -30 inin/inch, < ? min for 31 -54 min inch).
All data to be submitted for reviev.
3. Depth measurements to be made from top of (tole.
Fonn D0-9 i, p„ : z)t
TEST PIT DATA
DESCRIPTI ®N OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE #—L HOLE # _ HOLE # HOLE # HO LE #
G. L.
0.5'
1.0' . t,
2.0'
2.5' T �`
3.0'
3.5'
4.0'
4.5' .
5.0' GA n
5.5' n�
6.0'
6.5'
7.0'
i
7.5'
8.0'
8.5
i
9.0'
10.0'
Indicate level at which groundwater is encountered do -a
Indicate level at which mottling. is observed ot12
Indicate level to which water level rises after being encountered
Deep hole observations made by: IV\ Date =�C�,
Design Professional Name:
Address:
Signature:
Design Professional -- Seal
Putnam County Department of Health
Division of Environmental Health Services
SSTS Repair - Final Site Inspection
Date: Inspected b L Installer: Leoec.rk
Street Locatio ZD C c n K> w Owner: � we.. Ae f
u . .;Tb�gii:: _ :< . :Repair Permit # ' - , 2'5�: ► ; ' . ''j%NI # 6 .L-4
1. Type of System: Conventional ❑ Alternate ❑ Comments:
2. Se tic Tan9t
Yes
No
N/A
Comments
a. Septic tank size -1,000 ... 1,250.. -: -other .:...
b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
d. Distribution Box
i. All outlets at same elevation (water tested) ...
ii. Protected below frost .............................
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box - properly set ...........................
0� 6o i
q M6
f. Trenches
✓
S Q,y�,
i. System wrnpletely opened for inspection
'
ii. Length required a Length installed Cko'
Cower. -�o .liu�•AI�
res� j f"z
iii. Pie slope checked ... ...............................
iv. Installed according to plan ...............:.....
v. 10 ft. from property line - 20 ft - foundations ...
vi. Size of gravel '/4 - 1 '/z " diameter clean ........ .
vii. Depth of gravel in trench 12" minimum .........
viii. Ends capped .... ...............................
oKrc S. _ Q
g. Pump or Dosed S stems
3. Sewa e System Area
a. SSTS Area located as per a roved plans
b. Fill section -
c. Distance from water course /wetlands
4. Overall Workmanship
a. ' Boxes properly grouted and installed correctly ...........
b. All pipes flush with inside of box ..........................
c. Backfill material contains stones <4" diameter ..:......
d. Curtain drain & standpipes installed according to plan
e. 'Curtain drain outfall protected & dir to exist watercourse
f. Footing drains discharge away from SSTS area .........
g. Erosion control provided ............................
Additional Comments: ( r C l O �ee � t �r`t�' 6,�& r5 i6s v 04 open
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Sl Rev - 011312
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"..:" 'S'HLIZLIT� A'ML�'R;1VIlD,`lVi5; FRAY" •.•" -... "'.. .
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
October 25, 2005
Robert Fairweather
120 Canopus Hollow Road
Putnam Valley, NY 10579
Dear Mr. Fairweather:
. ,.......'- ROBER'1:J: -BOND .. ...
County Executive
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
Re: Addition — Fairweather
120 Canopus Hollow Road
(T) Putnam Valley, T.M. 61 -1 -53
I have received and reviewed the plans for the proposed addition to the above - mentioned residence.
Based on the information submitted, the above mentioned addition cannot be approved for the
following reasons:
1. --The second --kitchen is considered an additional potential bedroom.
2. The legal bedroom count for the dwelling is five. The potential bedroom count of your
proposed addition is six.
3. The addition of a potential bedroom(s) requires this Department's approval of a revised
septic system plan from a professional engineer.
Please revise the proposed floor plan to reflect no more than five potential bedrooms or have a
professional engineer or registered architect design a sub - surface sewage treatment system meeting
present code requirements.
If you have any questions, please contact me at your convenience.
JP:cw
Sincerely,
-,jP
ose h S. Paravati Jr.
Assistant Public Health Engineer
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
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
September 16, 2005
Robert Fairweather.
120 Canopus Hollow Road
Putnam Valley NY 10579
Dear Mr. Fairweather:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re: Proposed Addition - Fairweather
120 Canopus Hollow Road
(T) Putnam Valley, T.M. 61 -1 -53
ROBERT J. BONDI -
County Executive
Review of plans and other supporting document submitted at this time relative to the above
mentioned project has been completed. The following comment is offered:
o Documentations must be submitted to this Department that the accessory apartment is
legal.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:cw
Sin ly,
Robert Morris P.E.
Senior Public Health Engineer
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
Early Intrrvent*n /PiPsAool 9451 279 -6014 Far (845) 77R -664R
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
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DEPARTMENT OF HEALTH G
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET /aO aa04&S A1j110�WtTOWNAj4jLft-4 TAX MAP# & / 43
NAME � ��� l� ` �v/ o'PHONEP & ,.2 8"F6 10 PCHD#
MAILING
ADDRESS
DESCRIPTION OF
ADDITION r iCf k/J11 6 V Q kX5 5S� /�c/�
NUMBER OF EXISTING BEDROOMS 5 PROPOSED # OF BEDROOMS O
(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.
Please submit this form and the following to Putnam County Health Dept:, 1 Geneva Rd,
Brewster,.NY' 10509, Phone: (845.) 278= G1`30:.
.. .. .._ .. .. .. .. t •. y -. .. ..
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) 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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
°" VORE`Y`TA. MOLIN aiRI, R1V ;'1VISN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT. OF HEALTH
1 GENEVA ROAD
BREWSTER, NY 10509
To Whom It May Concern:
ROBERT 1 BOND]
County Executive
2 ��,
�
Re:_/���/Gu> 7ff n
Residence
TAX MAP#
TOWN
According to records maintained by the Town, the above noted dwelling,
is : -: IN COMPLIANCE WITH 'TOWN COME.
I5 NOT IN COMPLIANCE WITH TOWN CODE
C3��
LEGAL ]BEDROOM COUNT IS � � 4cc esse✓''y 1179r.
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
OTHER:
�v
uilding Inspector
Date
CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Im
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
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.DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
June 24, 1993
Robert Fairweather
PO Box 708
Putnam Valley, NY 10579
Re: Proposed Addition:
Fairweather
Canopus Hollow Road
(T) Putnam Valley
Dear Mr. Fairweather:
JOHN KARELL Jr., P.E., M.S.
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project is in progress.
1. Formal approval of plans, prepared by a professional engineer in accordance
with applicable sections of our submission guidelines, is required. Plans
will provide for the installation of additional subsurface sewage disposal
system meeting present code requirements for a 5 bedroom house.
Upon receipt of a submission, revised to reflect.the above comments, this
application will be considered further. I may be reached at ext. 166 to discuss
any questions concerning the above comments.
Very truly yours,
RM/jp
Robert Morris
Assistant Public Health Engineer
ell-
_. r.�..,... ..f .•,...... .....� �•7�'.,.., �.,- :�J�HN'KAHELL•�Jr., P.E..��M.S. -....� ,.I
Public Health Director
DEPARTMENT OF HEALTH
Division. Of' Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
June `4, 1993
Robert Fairweather
PO Box 708
Putnam Valley, NY 10579
Re: Proposed Addition:
Fairweather
Canopus Hollow Road
(T) Putnam Valley
Dear Mr. Fairweather:
Review of plans and other supporting documents submitted at this time relative to
the above- captioned project is in progress.
1. Formal approval of plans, prepared by a profes:,ional engineer in accordance
with applicable sections of our submission guidelines, is required. Plans
will provide for the installation of additional subsurface sewage disposal
system meeting present code requirements for a 5 bedroom house.
-- •• - .._:.,. Upon receipt_of:.:a. submission, revised .- to - refIec.t_.the above - :comments,; thi•s_..
application vii ,1.1 be' 6&6 s--f dared , further. rilay be raached at` &C -166 16 'di -scuss
any questions concerning the above comments.
RM /jp
Very truly yours.
/"-� , t, NI UP7
Robert Morris
Assistant Public, Health Engineer
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AREA = 3.050 ACRES SURVEY OF PROPERTY
51TUA7E IN THE
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TOWN OF PUTRIANI VALI.
mifco+iom h— or wqd' fw ,h. map and wpi•s
if wid maP w rppi., b.w �. impr.u.d PUTNAM COUNTY
of of +h. +vrv.TOr «vho+. +ignatrr. gpp.ar+ her.pn. • : �� 1 -.
Unauthorized alf.rctcn;or cedilicn to c surrey }_ NEW YORK,.
SURVEYED & PREPARED BY mop b9ar1n9 a lice ... d: land surveyor% seal ss
BLINNEY ASSOCIATES u :riolatIon-of S9tWw—..7209; sub - derision 2, of SCALE 1' =s0' DATE:OGT Z4,- 1989
the= Nw.York Stan Educotlon Law.
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