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Home My WebLink About3271DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -85 BOX 26 03271 ji , it T r '6. ' I lr-:j T I I' L T2 03271 PUTNAM COUNTY DEPARTMENT OF HEALTH . .... ... - VW wA YT �1�'T��r.T _ W ':. /' �T�r .1 T' i hi � #\ �, ,r '�` Tea T � Y �f r •,:::.::_ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # -CS�- Located at 7 P-ee"i �It Id 110 L, U, Town or Village 0`� Owner /Applicant Name \ e h h e- S . PGi 1"�e d`Tax Map - Block 1 Lot Formerly d, i'L°.Gk-.) Ce le ..,� e,!y Subdivision Name Mailing Address % q ? -P� f Z� 11 Subd. Lot # l Zip 1 � q Date Construction Permit Issued by PCHD /1 1 �' o 2 Separate Sewerage System built by (gJ/ ?)*i MAT&ess C/5/7 Fee—, &, Consisting of / C1 Gallon Septic Tank and 5o o t,✓ r A 5 D- 6nxes y � becl r -coYy7 S Other Requirements: Water Sun olt' j: J Public Supply From —Address- or: �'�r Private Supply Drilled by P F e act Address Building Type c7 i le loii�i / Has erosion control been completed? 11 Number of Bedrooms 5 Has garbage grinder been installed? dv _i1.:.._:.� -- - I certify that the system(s), as listed, serving the built plans. (copies of which are attached), in ac plans and the standards, rules and regulation Date: r ZO- 05-Certified by Address premises were constructed essentially as shown on the as- with the i slued PCHD Construction Permit and approved itnam C ty Departrrme: of alth. V P. E. R.A. License # q 00 % / t Any person occupying premises served by the above. system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By- ��C- Title: 410#r White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Date: 346 Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM CJh V - C�1 4e_rS0y_\ 73 Owner or Purchaser of Building Tax Map Block Lot i^r to % (_C-qd16r1 Building Coh4tructed by 41 `f 7 t � /--le, X40 4_0 ��-�- Location - Street �l� / r4g1 �� Ale 1,;,-7 Building pe TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 guarantee to the owner, his successors, 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 approval of the "Certificate of Construction Compliance" for the sewage treatment 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 occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director 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 occupant of the building utilizing the system. Dated: ntf..Xl Day 66) Year z�� Signature: Title: eSjT . General on ctor (Owner) - Signature Corporati Name (if corporation�) / Address: qq 7 �� , �C K b //C(,%/ S tate /ja a Zip `Q Corporati ` Name (if corporation) Address: s®t ,-gt e- State \� Zip 0 � 7 Form GS -97 OWNEE SITE MAIL? Et.® PERSON INTERVIEWED « U ,� ' PCHID Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE // I ,A 7 TYPE FACILITY PROPOSED INSTALLER - _ b N a5 a 3'° 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 from licensed professional engineer or registered architect. Al N F -e— h /% -- Proposal approved Proposal Disapproved Inspector's Signature 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 camponents 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, or reported agent of ZTZOTITLE CLZ� above conditions. SIGNATURE DATE OPHS: WAte MD); Yellc w (Tam ED; Pink (Appl.iamt) �M BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 18, 2002 Kenneth Patterson 447 Peekskill Hollow Rd.��' Q Putnam Valley, NY Re: Addition- Patterson- 447 Peekskill Hollow Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 73 -1 -85 Dear Mr. Patterson: 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 November 18, 2002 . The addition is approved with the following conditions: 1. The total number of bedrooms must remain at •Five without prior approval by this department. Tile' sewage uispos&1 'system) and its expansion area, mu "st be constursted as shown on plan proposed by A. Paese P.E. dated 11/18/02 R331 -02 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 s; William Hedges WH:kg Senior Public Health Sanitarian cc: BI ----------- ---------------- ------------------------ ---------------------- -------------- - ----------------- - ---------- --- ------------------------- -- ---------- - -------------- ---- - --------- - --------- --------------- ------------ IL -------------- 04UX VATUD F------------------- 'F ------ --- -- -- -- --------------- ii ii STOOP FOOTING DETAIL NY5 =nerqy Code Compliance Statement EA5EMENT FLOOR PLAN .. ........ O Rl Mal M R I Ili I Buy W6 auto I FT.= 1-4 ------------- L-J rlo- .. ........ O Rl Mal M R I Ili I Buy W6 auto I FT.= PWK AND STAIR GONSTWKTION I'61 INf��.a,,�.. SPt= t;IFIGATTONS SEGOND AREI u FLOOR PLAN. vlNS wT Ww 1` 1 wnmow�� w�Or6 WYi. Q lewe«w �' Inrw axaarm wam .+o sc«mas. @(alan Wtee a. o�iwBE 9P�I eD w PL/x!. ML M &G MMP5 a.wl tuYm e. roserKR wr, na caws wuu wr • oom amp v r�e�x m reraas •ve wr °i«e°ra uror.x�roawm .gl5T XANXft NOIE V L B° M rll v TIONS racTAµr� • mream arcmn ua>a 1 V L BEAM DETAIL LOT 3 SLAT REVISION ter, — Ag warm Iv�a�orn 5 - r•* ja e a1 �1 �l 3� r; i.' a� 1.. A 1. �1 1 u, o¢ ;1 3! TUT UN '- WA ^ ucted. y-1111. uop and -a. writter pace An..,good opera ing'. condition �,any_ part ~ said Wely*ill DEPART I 6q- F`W4MALTH TE rillage Pol Lo Total Habitable Space. iq�are'F'eet ter V. Gentlemen: PUTNAM COUNTY-DEPARTNIN T OF HEALTH .FW V' Rl1 TT nl!zm7m T 1 .ITT Tt�ITTT� : v.. A T T7 T n . . Date Re: Property of Mr. Ignac Biro .Located at /ILK /44 llo4LoW Mo.4k 7,4XAA p - Z Block I Lot Aff This letter is to authorize George A. Haughney a duly licensed professional engineer. X 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 ayctem cr sysV,wlTi�/ ill "VVlilVl111111iy inr 1 Li }l %I�eiT'owison's of Article 145 or 14 7, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. •. -� Very truly Signed . . t;�,��iYYY.If #yid` 'ON �F NF � Owne of Property Countersigned: ° '�¢ Address P.E., R.A., 04 0 :a m ,e. /�BRG��rK• 1%OIrJY. 1 �f(-;� %• Route -52 �PC0400' �T �.,'p elephone Address suu��t`` Car -mel , N. Y. 10512 (914) 225 -9353 Telephone PUTNAM COUNTY DEPARTMENT OF BEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'OP ch , 8VIL ING; laAR i -L, . Iv° 'Y-... iu51 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 0� Address //�EEii'.S'1�6 I�OGLUvc/ �y.4 /� Located at ( Street GC) Block / Lot 6dicate nearest cross street) Municipality, l r,l-w Adaez Watershed l SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 2 & i0 3 fir% - A'45- V's r' 3 1 2 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All 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 ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. / ,HOLE NO. HOLE NO. .,tea- - - - • - •, n � _ . � . v = a r..:.. - :d•: _ ��.�.;::� �- ..c .vvi: •`u e'1Ja ':: ;a. - s�.e ci -.�F._ .'srw•- .:.�4'c..� .::a;... -. w;` yw s r;. vim-: 4:= r-: c' r.° a. c:. wW .'�- +�.R- r.'wr-- �.:.w�y.- .;;i: 611 12" 2411 . 3011 3611 42" 481 54 60" 66" 72 781 a 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY l J'_Date Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided .5000#t No. of Bedrooms • Septic Tank Capacity gap Gals. Type�,4d` Absorption Area Prov ed By 2E,70 L.F.x241' b`` width trench. Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by • Oifi `J a> ,,PAte PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. PROPOSAL FOR WAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY O SITE LOCATION yY >�E��'S,� /�. }-/ �✓ ,� TM# SCC..�Z72 � X00 3 �� ` OWNER' 5 NAME n an PHONE `y lei 7 S" -- O Fits MAILING ADDRESS 4 47 ME S/; /G(, a-1 6L L0L✓ fa PQTA)VfM (&&C- y MY I CIT;y PERSON INTERVIEWED Q,2 PCHD Complaint # D>7y —dame z e ations p (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSESD INST PHONE C I 7�9' 0% ADDIE<,S `7 �dt� � REGISTRATION# AA AJ Y t DS'6Z ro osa (include sket locating all adjacent wells): NOTE: repair must be in same location and of same type as original sewage disposal system .Different location may regVre submittal of proposal from licensed professional engineer or registered architect. Q [' Qo1 r 4-,z> 4a—,t 's S Lv7vr, ,.. or ✓t� C 1 r0c ,- le, .a - �`,,�_;��.� �.� 1 �" /� �o -� x. Joy si °� . -5►�y� tz�- -- OV1i I; "Ur T� "-G 0: Of ,....Iyl arc.°.:: tC Lie CC_ ^•`i2 }iC ^.° .�.te rJt! - !Lc for in. SIGNA•ME TITLE �-� �E OF NF Z, rzoQZ, \ENO G- .o PE o gved with the followin .conditions: g � I • tocurement of any Town permit, if applicable. « >� , 2. ubmission of as built repair sketch in duplicate showing: Owner's name = =' Site Street Name, Town and Tax Map number. Location of installed components tied to two fixed alts a S). System description (e.g., 1250 gal. Concrete septic tank, three� ' diam. X 6' deep Installers' name and number. 3. ;ystem repair to be performed in accordance with the above proposal and conditions. Pr®p6 approved LISPK&'s Signature & Title COPXI White (PCHD); Yellow (Town BI); Pink (applicant) PC -1:;t-1qML DA PITTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _AP_PLICATION TO CONSTRUCT A WATER WELL. -:.�. .. .. a. ,Y. .. please print or type...<., PC H permit ' g. .�` I _w . Well Location: Street Address: Town/Village Tax Grid # 73. -1 -85 447 Peekskill Hollow Rd, Putnam Valley Map Block Lot(s) Well Owner: Name: Harrington Address: Custom Homes, Inc. 46 Gordon Avenue, Briarcliff, NY 10510 Use of Well: _X Residential Public. Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 -7 gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existi2g Well Detailed Reason P.w x,10)► -ti �t/CvY for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Putman Ave. Brewster NY'10509 Is Public Water Supply available to site? .........:........................ ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location &sources of contamination to be provid d on separate s eet/ an. __8/14/ 02- _ - Apt)'*-ai�t Signature:_ Adam L. Beal PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a w ter well driller certified by Putnam County. Date of Issue Permit Date of Expiration O --v? Title: _ Permit is lion- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Ownei" Orange copy - Well driller Form WP -97 Harrington Custom Homes PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Ivu rr:: rxact location or well wttn aistances to at Least two permanent lanamarxs to oe provtoea on a separate snccuptai,. Well Driller's Name r F. .Deal &Sons, Inc.. Signature: Adadi' L. Heal Address: `I Putnam Ave., Sit-water, N1 1.0509 Date: l l/ 14/0%2 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 447 Peekskill Hollow Road :�1ax,rt'#':NI3''`' Putnam Valley =tS� Map Block Lot(s) Well Owner: Name: Address: Harrington Custom .Homes, 447 Peekskill Hollow Rd, Putaatu Valley, NY Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing . X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 19lb /ft. Materials: X Steel —Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No _ Liner Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6T—Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 3' During yield test(ft) 440' Depth of completed well in feet 3305' Well Log If more detailed information descriptions or sieve analyses are available,..... — please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 25 Drilling in over den ealay and boulders Hit rock at 25' ... .. 42 .. Dr111in . in- r-ocic f— czet czam ing -roeeA jrawil to - 42 505 Drilling in rock If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Sub Capacity ' �A Depth 4601 Model 5ii:.lv-412 Voltage 230 HP i Tank Type WX302 Volume 86 gal Date Well Completed 11 /i1 /C2 Putnam County Certification No. 002 Date of Report 11/14/02 Well D ' ler (signature) r ' ��''''" A':�ak� 'L:. f dal'' Ivu rr:: rxact location or well wttn aistances to at Least two permanent lanamarxs to oe provtoea on a separate snccuptai,. Well Driller's Name r F. .Deal &Sons, Inc.. Signature: Adadi' L. Heal Address: `I Putnam Ave., Sit-water, N1 1.0509 Date: l l/ 14/0%2 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 Ct- Sheet of� PUTNAM COUNTY DEPARTMENT OF HEALTH T T 7 TY - - _ �,�k — :.- )�r_a.S Epi��E S —`,.r _ . , :, ti ............:w_:.�.�.. ,...;. FIELD ACTIVITY REPORT Street Town State Zip PERSON IN CHARGE nD TATTI;DXfM VXrCTl• Tlo4n• I V "1 Name and WROX., 1 � WSPF('Tl1R Signature and Title RFPnRT RFCFTVR.T) RY1 I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rcv_ Iy -4, -A 250 1wsPe6rED AND A"AR fmamrsR 010 71 IV w Al RR IM IED M,I: 9". � GW 0 NS t', t', AM