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HomeMy WebLinkAbout2851DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -2 -2 BOX 24 I.tiL , ■ I I 0119 T� ' V f- :l Ij '? 02851 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES, PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR �f 'ES NO Internal Use Only PERMIT ❑ Repair Permit issued in last 5 years Not i , Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within Zoo ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS TM # 62, � 7- .1- V NE # g%% 5Y256dI APPLICANT OA) 06.E f r Name & Relationship (i.e., owner, tenant, contractor) DATE 1 j Q FACILITY TYPE 2 PCHD COMPLAINT # PROPOSED INSTALLER R,261,L 11 r.4 0 y PHONE # 6a5- ADDRESS 59 Wji2A &I+U AVAJh REGISTRATION /LICENSE #_ I t) % Pr000sal (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. i5i - X - I, as owner,agree TP tio ns st on this form SIGNATURE TITLE [;W t '�' DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE ] ,Ei �� TITLE (� W 45;/Z, DATE % (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 backfil until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Tnsp6does SignaKire & Title Date Expirati n Date Repair proposal is in compliance with applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Flu al�Site Inspection Date: ! �` !1�^ Inspecteil.by: F�TZ installeP: v Street L an: r. � Town: VU-7 7*h-7 Repair Permit RFSI Rev - 011312 \L �L� fGN�Y Q` r J � e Call t° �4 a� 11 qoo 1 yi I ?v �i ,v r i i P j pi-:: f-901-A r14 H)l i i LAKE- . v�••- �uc..0 P—w -j ®- lie v15 S. 5 vnt+s per row. �� A4cl v n c m," o� i�� 7^5,4, . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT,SYSTEM Owner: &j� OSk- Address: 1,4A+ F7'zonlr Located at (street): TM # Section: Block Lot Municipality: LgY Watershed: SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Date of Percolation Test: Hole No. Run No. Time Start — Stop Elapse Time (min.) Depth to Water. from ground surface (inches) Start - Stop Water level dro p in inches. Perco.lation Rate min /inch 1 2 3 4: 5 1 2 3 4 5 1 2 3 4 1 2 3 4. 5 Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < 1 min f6r.1-30 min/inch,- <2 min. for 31 -60 min /inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97. oe I oft 1 � Vim-- -- :, J ? d.�f � . ,. � a`b , a it tF" --,' i =i T a r Yt � s � „�. _. �' „nv �px � i �. �...�,�.,,.e.,,,� .. -.' �-,. 3 i a �. 1 "`• ' -1 `s, r .,.�'�.. _,� * *�� PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION 1 `a -2j 1� Y co,4&TOWN Q \.N N A OWNER'S NAME ri 1:+ `'I b t­, PHONE # -11 i MAILING ADDRESS P , — Vv'tcv6rV'\ \,j!\\ @ PROPOSED CONTRACTOR /INSTALLER �, o c� �` �`�`� PHONE # -6 l5 ADDRESS n 1R D REGISTRATION /LICENSE # Reason for exploration: ❑ failure to surface ❑ back -up in house ❑ find limits of system for repair. other ("Plain below) e i Inspector's Sig Title Date pointment Date: Time: kly:excel:septic L RA e R 4 °' eeves r � .�Cgnseryu Pond tsx nor <y o Nelson Corner ok g° rk Pond 1¢ fu son¢ at Park !✓ S1 t k Eq HILL t ig 9° Po } �„�� Garnson��k �• 11 Travis Corners unity c ►' ` ". South Highland aO1 � k 9 \ ®ice i I i Act PUTNAM GOER 'ty HEALTH DEPAR MERr d DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL MR SEWAGE DISPO6AL SYSTEM REPAIR._ PROPOSAL C� OWNER'S NAME , VOkivr 7- A. v (yt" PHONE S b --.3 ( S SITE LOCATION / 'a Ly4- / -.rvratzco P' Rd TO /',,Pw , /-0 Z - (j z 4 j MAILING PERSON INTERVIEWED PCHD Camplairit # Name &Relationship (i.e, owner, tenant, etc.) DATE kA TYPE FACILM Y 96s-, PROPOSED IAISTALLM PHONE -r� Z (o -- d-5-F ir REGISTRATION # 1 Y Proposal (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 fran licensed professional engineer or registered architect. 6 r4- u5 v tt4 1tr r,j !bbo 6Ae- VG at., PA- fi,41PL lac c; 7' /DyL_ Proposal Disapproved to 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 caTponents 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 owner, reported agent of owner agree to the above conditions. SIGNATURE !L -kA;- enl I Mn Whine MV • Yellow (un ffi); Pink (glioant) PC -RP 97 TITLE A& ear SATE WC -, -e SHERLITAAMLER, MD, MS, FAAP Commissioner of Health LORETTA-MOLINARI, RN, MSN Associate Commissioner of Health Craig Piotrowski 123 Lakefront Road. Putnam Valley, NY 10579 Dear Mr. Piotrowski: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 June 17, 2009 Re: Addition- A- 081 -09 . No Increase in Number of Bedrooms 123 Lakefront Road (T) Putnam Valley, T.M. # 62.10 -2 -2 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 June 16, 2009. The addition is approved with the following conditions: 1. The old metal septic tank must be replaced with a up to date septic tank. A certificate of occupancy may not be issued without prior approval of said repair. 2. The total number of bedrooms must remain at two without prior approval by this Department. _- 3:.: The area of the existing sewage, disposal system and its expansion area rnnst be maippined.. 4: '.tiii`piumding fixtures riiusf be updaf&d with water saving devaces, i.e:; new'tow flush toilets, restrictors for shower heads and faucets etc. 5. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not. obtained proper approvals 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 (845) 278 -6130, ext. 2261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly . cc: BI, (T) Putnam Valley . Environmental Health (845)278-6130. Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax. (845) 225 -1580 3 �j CIO N5'/9 vY !V /60 92 � � � i , ( NAB•''. (�7• 1 .. 26,78 N Gom SL_ /..STpRY °. . � ?.p FRA /'.. ' .c • /2, p0 • � � / , -HOUSE ', .. ' � ass ' ' P � (�� -•' ° s .�- -; � .!L (off � ' � - Sj - � .F �/ � I w� � � � / � � �+• -® © ® cn � �j..fi � ' � e f7 �• P v .�i .. ExIST. roN f l .0 EXIST r 1 6EVLRA44r. . ON Lir/ GALE: J' c.30:� , i rh/ 1�. I rvESr Fn ce 'o' -A -golf' ' ' _L �- CERT F =E•O T °: /� �y /ate(' ® d O ' r'� /-1 �� • ®► lT r+ ®/� ® �I N �T /TL�AN -° RGP 506.957, .. '�" � � °1I plop• I •S'NO' CN•4SE /Y!/�7NHyTT•9N - -- -- - SHERLITA AMLER,,MD,�MQ ,:EAAD - _ mm'is°si'oner —.7r a I LORETTA.MOLINARI, RN, MSN Associate Commissioner of Health Michael Beyer, P.E. Beyer & Associates 273 Starr Ridge Road Brewster, NY 10509 Dear Mr. Piotrowski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 R_OBERT_.J. BONDI September 23, 2005 Re: Proposed Addition — Piotrowski 123 Lake Front Road, (T) Putnam Valley TM# 62.10 -2 -2 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Iri order to increase bedroom count, either an existing system t11at meets current code .. needs to be added onto to meet the new bedroom count, or if the existing system does not meet current code, a brand new system that meets current code must be provided. 2. If the house is demolished and rebuilt at 2 bedrooms, this Department requests that a new SSTS for 2 bedrooms be constructed to meet current code. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, Joseph 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 273 Starr Ridge Road Tel. (845) 278 -6212 Brewster, NY 10509 Fax. (845) 278 -0403 Joseph S. Paravati Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: PCDOH SSTS Upgrade Plans, TM 62.10 -2 -2 Dear Mr. Paravati, August 8, 2005 Our client would like to upgrade there existing septic system(2 bedroom house on file) to an aerobic treatment system and locate the leaching fields within a fill pad at the center of the property. Although we will not be able to. provide enough fields to meet current PCDOH regulations for a 3 bedroom system we are requesting that the PCDOH consider granting a waiver to allow constructions of an additional bedroom due to the proposed treatment system. Enclosed please find a copy of the following plans for your review. o Preliminary SSTS Plans dated 616105 by Beyer & Associates. o Copy of Town of Putnam Valley Wetland Permit. o Request for field testing ( if required) I trust the above materials are adequate for your review of the above project, However if you have. any questions concerning this project, please do not hesitate to call me. � ✓1� (.� SSl� Very truly yours, Michael Beyer, P.E. Project Manager BRUCE _ R. _ _F.CLEY_ _ ' � °- %uniio � Neal'tli Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 1 1' 1. pill 1 All ATTENTION: Y10E PARAVATI ❑ GENE REED Associate Public Health Director Director of Patient Services All information below must be fid-11 completed prior to any scheduling. DATE: 3 C1 1 0 5 ENGINEER OR FIRM: LEN Q'I j f 2 c, PHONE #: 23 9 "'� Z REASON: 12f?#t►0-'l�t� DEEPS: ❑ PERCS: ❑ PUMP TEST: ❑ ROAD /STREET: 12- 5 LAM CtZury . i J20N-�--> TOWN: P,tr %ice .i MAI TAX MAP #• _6 2-. t b - 2- - Z SUBDIVISION: LOT #: OWNER: Vt2a�af,tci sa�4.1'.��� -w NYCDEP CRITERIA FOR JOINT RMEW AND WITNESSING OF SOIL TESTIN[* YES NO ❑ IX- Proposed SSTS within the drainage basin cf Vest Ereanch or Dt - -& Corner Reservoir=. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ tW Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ i?'- Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COU\'TY USE ONLY DATE: T IE: COMMENTS: (FMDTEST) A: OD if tmulAb I CIIAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York The Town Wetlands In4pNtor, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PE1t1VdI.T EXPIRES: APPLICANT/SPONSOR: Craig & Mary Piotrowski 123 Lake Front Road Putnam Valley, NY 10579 PROPERTY LOCATION: May 22, 2005 May 22, 2006 123 Lake Front Road TAX MAP #: 62.10 -2 -1,2,3 SIZE OF PARCEL: .772 acres. ZONING: R -3 PROPOSED ACTION.: Repairs to _existing stone retaining wall within Lake. rem^vp distaged vrees; repaiirs to septic system, repair split rail fence along driveway 1. Application Materials, file # WT- 2005 -22. 2. Application Materials, WT -32, AND WT -53. CONDITIONS OF PERMIT: 1. Repairs to the existing stone retaining wall within the Lake to be repaired only by the use of hand equipment. A solid wall of sandbags to be placed around the entire perimeter of the stone retaining wall to create a construction barrier and minimize disturbance and leaching of sediment or concrete slurry into the lake. All work to be performed from the dge. of the lake; not directly . 2. Sandbag filter to be inspected by Wetlands Inspector prior to the start of construction activities. Other erosion controls to be installed around the perimeter of the septic system. Page i of t d ~" 3. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 4. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 5. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the projecf from time to time. 6. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 7. The Wetlands Inspector to be contacted when work completed to perform a final inspection of work. 8. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. (this requirement waived, if additional deposit done at time of application) Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 494 -5544, or the office of the Building . Irsp =.ctn�.ini4l:52G- 237i�:. -• - -�_._: -__ ..__. _ ..___._ ..., Date of Site Inspection: May 14, 2005 k) - ap'�� Stephen W. 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SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINAR'l' R1V;`MSIV Associate Commissioner. of Health ROBERT I BONDI County Executive Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET,V-Q-11" TOWN Ax MaP# (VectKZ "Z NAME( VcOTY5,�c\ PHONES&tS Ay9�Z8 PCxD# i9'O�1 MAILING ADDRESS �ZZ✓ �K�►U'� DESCRIPTION OF ADDITION Cl Q, NUMBER OF EXISTING BEDROOMS 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. _. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brew&ter,.NY 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 . �. 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 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventiontPreschool (845.) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH I Geneva Road,- Brewster, New York 16500 ROBERT J' BONDI Town Legal Bedroom Count Re: (YrRc) W/S k I (Owner's Name) Tax Map #: Address: 123 LAK.L".TROITr 1?V-1 Town: Pa TNJAk VAucj- Year Built: According to records maintained by the Town, the above noted dwelling, is in compliance with Town 'Code. is not in compliance with Town Code.. The Legal Bedroom Count is: 21 This information has been obtained from: Certificate of Occupancy: Other: '1-s LA i rq Wk1,z-rAAr--v-T I LLs S5 IE SS- �DRIJ Building Inspector Dad 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 Interveotion/Preschool (845) 278-6014 Fax (845) 278-6648