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HomeMy WebLinkAbout3410DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.17 -1 -9 BOX 27 03410 IN , ,6 I IN T ■ IN r 1 - , , � IN . IN 03410 •�,,. ,-:BWCE_ .R..TOLIY:.�:. Public Health Director LORETTA MOLINARI R.N., . M.S.N. , _" 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) 228 - 6108 Fax (845) 278 - 6648 June 19, 2001 Mr. & Mrs: John Franciosa PO Box 151 Shrub Oaks, NY Re: Addition- Franciosa - 16 Dogwood Lane No Increases in Number of Bedrooms (T) Putnam Valley. Tax # 73.17 -1 -9 . Dear Mr. & Mrs. Franciosa: 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 19, 2001 The addition is approved with the following conditions: 1 2. 3 The total number of bedrooms must remain at Four without prior approval by this department. The area of the existing sewage disposal system,'and its expansion area, must be maintained: 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 William Hedges WH:kg ,: Senior Public Health Sanitarian cc: BT BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. F 04 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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 46'° /g- 0/ ADDITION APPLICATION (RESIDENTIAL ONLY STREET 00 6& Mod //f - TOWN all- w 014MAP# 73,17-1- i 'l%oj#A/ItA E AIUNIG ADDRESS ®`:19 Ar g �.; - 1-151e �d,44- /AA % ®�s " M DESCRIPTION OF ADDITION / °© q to S NUTIMBER OF EXISTING BEDROOMS__6/ 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., 4 Geneva Road, Brewster, NY i0; 9,Phone278 -6130. `— Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to.the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert.. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments a { Feb98 BFhouseguidelines PSo �<JL. 5 EPi /G yiO.v�Y ate• - - -_ -- - - --'� v � � a 2QB. P 71 ' 1�.e012N /oVV / A? or Ex/S7: Qw.R.9/D4E A 4" C.OeT AeOA/ �ei/s� �f.NQ r/O/V , m# i d i S�wtN sFW lw ` ONE` M Z 00/'g5 1 1 /-•�L sfJN t APPROVED A l! G ` 21972 PNAy COUNTY DfVISI(IN ENVIRONMENTA[ NFAITN SF0Y— ;Aarr ^0.0,0- No. TyKJ AL 9P- r-X Al- 3 , G nT a$ -IV AS CONSTRUCTED �•• SEPARATE SEWAGE DISPOSAL SYSTE'.44 So A-T. A:i�MY of wpb' �B/awiti3�. Ro.�7l o��- o� a.�rsvAs�Ae 6 no.v� /R orJ� $.00as ociec's Ova 3.row.N ow I°A?0p 'G.e9Y o!r ovwov.p sxaJA3$6R ': es A1` q•'ri6ar P..ma ✓ ✓AOCrioa goyf all /-•�L sfJN t APPROVED A l! G ` 21972 PNAy COUNTY DfVISI(IN ENVIRONMENTA[ NFAITN SF0Y— ;Aarr ^0.0,0- No. TyKJ AL 9P- r-X Al- 3 , G nT a$ -IV AS CONSTRUCTED �•• SEPARATE SEWAGE DISPOSAL SYSTE'.44 So A-T. A:i�MY of wpb' �B/awiti3�. Ro.�7l o��- o� a.�rsvAs�Ae 6 no.v� /R orJ� $.00as ociec's Ova 3.row.N ow I°A?0p 'G.e9Y o!r ovwov.p sxaJA3$6R ': es WELL COMPLETION REPORT PUTNAM., COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY FF OICE BUILDING - CARMEL, NEW.YORK This report is to be completed by well driller and submitted,to County Health Department together with laboratory report of.::,. f , analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. . REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER 1 NAME,,, A ADDRESS LOCATION r r n (No. & Street) r� t ( �i (Town) 1 (Lot Number) PROPOSED D BUSINESS DRILLING r rn COMPRESSED CABLE CASING L LENGTH (feet) D DIAMETER(Inc - W WEIGHT PER FOOT O O C CASING NO YIELD H HOURS G.P.M. Y YIELD (G.P.M.) WATER f MEASURE FROM LAND SURFACE— STATIC (Specify feet) D DURING YIELD TEST feet) of Completed Well SCREEN MAKE L LENGTH OPEN TO AQUIFER (feet) DETAILS S SLOT SIZE D DIAMETER (Inches) I IF GRAVEL D Diameter of well including G GRAVEL SIZE (Inches) F FROM (feet) T TO (feet) DEPTH FROM LAND SURFACE S FORMATION DESCRIPTION t Sketch exact location of well with distances, to at least FEET to FEET F 1 AMC L; , E5-- ., .1, . N11tUEj2y&1 T 14 yield was tested at different depths during drilling, list below FEET G GALLONS PER MINUTE DAJ�E WELL COMPLETED D DATE OF REPORT W WELL DRILLER (Signature) --mss, �I 71 -IZZ a �,I4 � ••f Sal'.'••.hT'i.}.r�,< }On l.G.i ,RI's- �.: ri... ti K. '. .7 . .w ��:.i is �� -- .._ [ \� - .; -.v � p. 'w it �....�:iw" "A a � -�� . Owner or Purchaser of Building Municipality St, A ti rA N F Q_- Acs c% :n i, A, -74- Building Constructed by Vie:=' -raw a. Ap Location - Street Block 4. 6eDe00s-\ OLS �.AQ,���y ���� �c� `r'A)< kg. Building Type Lot 9.0013's -kc6--e 'FAV-PC -SL �li_Z� C1 IA.' to o .i kA6 C> A� N to c� A R C�� 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- - te;rmi,nation of the Director of the Division__.o.f Env' ronmental Health Ser To vices- of -the- 'LIIZL'ti dm°Uounty" Di� partmerlt' -of, Houlth"a's ' DoT whether° -ter �zrt- the= failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the syste, Dated this day of 19J 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 Deprartmett of Health 0 PUTNAII COU- !'�" DE:P .bF D T DI IIS.IO I Or _ L - - = -- - „E_. T CLS . Date P T 2 19 -11 Re': Property of <D"o AQQ, k Located at pot, D e0ND • .. T A ►r as A P 'rA�c `7 9- ` Block Lot EJ C) VC A, 2;'0O66_ A; G.zE P ©p_-T\®tv ov PF2OPE Gentlemen: Wt4h KP`tz�EP� This letter is, to author_ze ►,�c s ua• 'rN�E�c. -P.E;_ a .duly licensed professional e'_' _ ^�e� or ^eCg st - — architect (Indic -:e) t0 apply' for .a Construction_ �v„�_t _,D .. so: w ^'��a s�:;era7 s; step:• to �. serve the atiJOVe ;!Gte3 Drop�r� a.- CJro_nce _th the standa�^ds, .rul s o'r regulations as rro 7atea b.- Co, o" try Putnam Coimtr y 2�'t; ant of '-ie.al.th,•�.an :.t.o si. -n i n °.�S.S�� -_ o oars e^ my behalf in f. - - •- --- -.• -- - -- - .. r, . -.. -< ._...... -... � ...........,. _, It , ..;.• .'.` _.,:..;,:�_.:,__.." -. _�.:: CO?llleCtiOn �•iitil tiai S. *-:after and t0 Su ^ °:":'_se the construction of said Sys' or systems in conform-1t. *_- : the pro- =ons of Article 1�5 or 147, Education Law, the Public Health La::, and. the Put County Sari- tart' .Cods . Very t o.zrs,. Si� _rgperty .•�/ ►0537 Counters_tined.: A�.r ss ��`i� < �% F' -� ,� t� �. � ::� w -1'x•1.1 E ®�, X114 -�2 T 23'02 ( ) -1 g SUIIIVAi�. THIEDE P 1 W. T p Address FA. BOX .308 M I Tel p a g . ; 9QFE8810WP� PUTNAM COUN! Y DE =A ?^:• T OF LTH - :. DIVISION OF EN`rpG. \ -`r.— A t rALi =?V1, CES .y �. .. ".''!'•' �`IViI. K e} •.J:. t � h C .,, 4 M1 .. _ .. .. ._. y. ? L .. h _ r41 . . DESIGN DATA S iLET SEPM -RA E ,SE.' a E. DIS : AL SYSIE': FILE N0. amer Jog► -hmo AwN:A -Address i.A.ec6 : Pf--E.a«xec:L, �:y... (g p w t� �:o AAD rA4>e KA AF' T'ptr Loc ated at (S Free t)'o� r- ��A �w��3 E ®wo 2t� . ._ •74 . Block 3 LOt I+ (Indicate n e a _ es t c_ oss s. reet) 1\ Pa,Cz:T� ot� OAF _ Municipality `T'o wN ®v=-, v= �,O-rwAM \N "Uj. atershed O � c. a \.A4 A, ,z.k SOIL . PERCOL: TIO�: TEST DATA REOUIP�D TO. BE SUS:: ED .-;I , 1 »pLICaTION' �F A� N3 . •KA2 GE R Hole NLC�er CLCC� TI'fE PERCOLATION PEr''.COLATIC`�:. Ain Elaose Deg t'. �o..F;aze_ :•iGter Level No.. Time. From Ground Su_ _ace i:� Inc=es Soil Rate ' St a„ Stog `l r.. Star= top D - op i- `iin /in ~d, oo Inc' Inc =.eS Irc -es 1 10: 2p t0:3Z la 6'q Z 2 �B. . i 2 -•10:44- 1Z Aq 4 3 lo: 44 to: GG i� 19 4 Z 1 IO:2Z 10:34- 1.z z 2'3 3 2 i;o . 34 I D= �: 6 1 Z 20 5 . - - - -- = SIRIHtED.E -- -. M -Ax) s X11: CLARK PLACE . _ 9 ��npac� SEW OR�I K 10541 Notes. .. 1) Tests to -be-'- reoeated'at s-z-:e depth until agpro:ci- =Le1i• eTsa1 so -1 rates are ob- tained at'. e�,� percolation t e s t hole. all d to he sub -pitted far re ie:':.. 2) DeptIh measL:1emi,en:s to..3e ade from » t o of hole "ESA -•PZ•T DATA. :-PIC)[:.T _3, .�..:.:fl -:T T�EO A.P.PLICA.T.I.O`;;... - r DESCRIPTIO�i 0 SOILS - -^ TER�D I',- =�T HOLES 24f: 30` 78' - -- -- 84' r LFVEL AT ;;,-{IC r GROUKD .:,'_3T? IS = �;COUYTE,R_ 1� o LE c-, -e . I`DIC Tc, �_, •� INDICATE L=t %rl H E:D TO �Cr ,ATE L=�: L RIS =S FT�R P= ^ TESTS �_ DL-- 8 .' u �>,� V NQ _ Tt� %E oE CO.0`3V1..T.I I•�Cs- Date 9- Z o - -1 i 1"�tJG�NEER� - Soil RE M;i /l" Dro? S.D. ,` I` .��`a moo• e, SL000 i- A Sor;p �� on A ea 'Provided L }r Z•Od. I. F.x2 �: 30' � G: �y r�,;�4 l � C�Y`1 °l• " . �. �.i.y.s: "L�c: No: X3802 - � (. ✓ Na- e .1� R �� c. �S w . "C'ti 1 EE Si= ��re OF SULLIVAN • TNIEDE : �0% . Tti� o� i iii Yy Address M co, CUM PLACE F HEALTH MA06PAC NEW YORK 1054 PU NA'M COUNTY E Pa3i�E,\ --OF ci ALT Soil Date Ao;�ro� e` Sq. Ft. /GaI . Check. _ p9OFE881O�1a� Date PE�C. -re �T PE�G.."'EST DEPTH HOSE N0: 1 ,HOL e '0. z HOLE NO. A6M SAWp�I 12r: �,.E> A t-k .DERS � taovL -r,es S t..p d,M . wjaOuLxlEe _181T / _ _ .I.• 24f: 30` 78' - -- -- 84' r LFVEL AT ;;,-{IC r GROUKD .:,'_3T? IS = �;COUYTE,R_ 1� o LE c-, -e . I`DIC Tc, �_, •� INDICATE L=t %rl H E:D TO �Cr ,ATE L=�: L RIS =S FT�R P= ^ TESTS �_ DL-- 8 .' u �>,� V NQ _ Tt� %E oE CO.0`3V1..T.I I•�Cs- Date 9- Z o - -1 i 1"�tJG�NEER� - Soil RE M;i /l" Dro? S.D. ,` I` .��`a moo• e, SL000 i- A Sor;p �� on A ea 'Provided L }r Z•Od. I. F.x2 �: 30' � G: �y r�,;�4 l � C�Y`1 °l• " . �. �.i.y.s: "L�c: No: X3802 - � (. ✓ Na- e .1� R �� c. �S w . "C'ti 1 EE Si= ��re OF SULLIVAN • TNIEDE : �0% . Tti� o� i iii Yy Address M co, CUM PLACE F HEALTH MA06PAC NEW YORK 1054 PU NA'M COUNTY E Pa3i�E,\ --OF ci ALT Soil Date Ao;�ro� e` Sq. Ft. /GaI . Check. _ p9OFE881O�1a� Date PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y., 10512 4 I ' CONSTRUCTION :PERMIT FOR SEWAGE DISPOSAL SYSTEM ' i C)uUM OF 4JA VA LLEy 50`R4GNY al= WAy pRP dVL TAX MAP Town ,or Village Located at Ki'AMEQom" abNT> QGP'% seobieyo �� Block '?C:.} , -- : Reg��2�ry' .:o6 =r A ►.� IJA R. K��lQC�AE r� Yo �A:. a;P_T._taN_�Job 14-` Subdivision vi ot� Owner Je7itm Awy Qiyt.)A RpefJCfjGt��.y Address hQc"'1L -S 4F::,TF'EE-T Building Type O"%lE� EHA M (t-lf KESO Lot Area. 2, COS 9 AeRCM L-/Q �14-E T-E E l-SKt. LI.- Number of Bedrooms, A. 13 FED eine >%AM Total Habitable Space 11.5on= '}' Square Feet Separate Sewerage System to consist of 20G Gal. Septic Tank pd lineal feet X it width trench To be constructed by 10 KM 0 W Address Water Supply: Public Supply From VPrivate Supply to be drilled by (y m KN Q W I,3 Address Other Requirements C, ta I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnishe a ssors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal syst i I wo (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction' Compliance of Wst epairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be in ' ISO ac y® t standards, rules and regulations the Putnam County Department of Health. �Q' F N _ ;r 1 Er ID � Date � � P- + Z,3 X. I Q i l Signed I ' P,E. �L R.A. Address ©x S0 Q, License No. Z3 SQZ APPROVED FOR CONSTRUCTION: This approval expires one year fr n s @ uc�i©- of t e building has been undertaken and is revocable for ,cause or may be amended or modified when considered nec the Com f Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary w ,ldn Op upply only. Date" By Title i ,n 3 i I -? - I - I? '... , .-.- - - PUTNAM COUNTY. DEPARTMENT OF HEALTH DNision- of Environniantal Health °S it ices, . Carmen," -N:" Y- 1(35-12' - - - CERTIFICATE-OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM (T) Putnam, Valley Town or Village 50.1. Right of Wa ( Eppwin Rtod) i off of M=ers- ..Pond Road T*K* Located at Section Block 4• Jo$n & Anna. FTraneiolral� Th Owner Lot Job Separate Sewerage System built b Finggrr Address Putnam �1`alleg � NAY• X00; n Consisting of I25'0 Gal, Septic Tank lineal Feet X = � width trench Other requirements Water Supply: Public Supply From Private Supply Drilled By Ptl�kC We �? Address �P W Building Type Reasidenc® �Pe�� i Date Permit )hssued i'f •5: Has Erosion Control Been Completed ?`I I certify that the system(s), as listed serving the above premises were constr tai sse plans of a ompleted work (copies of which are attached), and in accordance with the standards, rules and regulations, pl f� , permit i by a nam County Department of Health. Date Address Box No. Certified by Nlye License No. 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 sewerage 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 Commissioner of Health, such revocation, modification or change is necessary. Dater— 2 ��� B���: