HomeMy WebLinkAbout3430DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
73.17 -1-42
BOX 27
-ly
� J
f � jr r
� -' , � F , ,fir* 3, �, • �
03430
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
RTIFICATE "0F`C0N& UCTrON' COMPLIANCE FOR SEWAGE DISPOSAL* SYSTEM le-
CE j►
Town or Village
Located at Section� Block `
Owner 9 Lot I7• .3 Jgbb
d / ddress
Separate Sewerage System built by
Consisting of 12-Gal. Septic Tank" 2 yV lineal Feet X width trench
Other requirements
Water Supply: Public Supply From
Private Supply Drilled By _
Building Type 3 L M
Has Erosion Control Been Completed?
No. of Bedrooms Date Permit Issued
�aS laaa 0C 9'S�APD
S
I certify that the system(s), as listed serving the above premises were constructed essentially as shown o the plans of the
attached), and in a orda C with the standards, rules and regulations, plans filed, and the permit sued th °
o
Date /" Certified by
/a +— o
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary t4iaurbi
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soo"41,,,�
available and the approval of the private water supply shall become null and void when a public water s ecoml3tal
subject to modification or change when, ' in' the judgment of the Commissioney%-k�Ith, such revo on, r�dification
1
Date /V �'. By
OWNER
Fppieg.of which are
N%tmegt of Health.
'' o VL 4
o -
o�ec,�i6n�C�+ilny unsanitary
111 itjGj� sewer becomes
`a,k%liuch approvals are
ge is necessary.
Title
PEEKSKILL MEDICAL LABORATORY
1879 Crompond Rd. Maple Terrace Bldg. A
PE 7 -8777
RESULTS OF EXAMINATION OF WATER
A*\
CITY,' VILLAGE, TOW & /OR NAME OF SUPPLS
SAMPLING POINT
BACTERIA PER ML. (Agai plate count at 35 0C.)
CHLORIDES (CI) mg. /1.
FLOURIDE (F) - mg. /I.
1
DATE COLLECTED
DATE'RECEIVED
/0 - as -
DATE REPORTED
l0 -a�
GROUP (Most probable No. /100ml.)
TES (as N) - mg. /l:
RESIDUAL CHLORINE AS RECORDED AT
SAMPLING POINT I POINT OF TREATMENT
These results indicate that the water was of a satisfactory sanitary quality when the sample was collected.
A. H. PADOVANI, M. T. (ASCP)
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
"LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Ben D'Addona
49 Lincoln Road
Putnam Valley, NY 10579
Dear Mr. D'Addonu:
DEPARTMENT OF HEALTH
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE ✓
Director of Environmental Health
1 Geneva Road, Brewster, New York 10509 April 26, 2007
Re: Addition — Approval — D'Addona, A- 078 -07
No Increases in Number of Bedrooms
49 Lincoln Road
(T) Putnam Valley, TM '# 73.17 -1 -42
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 the Department dated April 26, 2007. The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at three without prior approval by this
department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
°viees- t—, -n �v s}T
_.
toilets, restrictors for shower heads and faucets, etc.
4. 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 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.
Sincerely,
Lawrence C. Werper
Public Health Engineer
LCW: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 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 218 -6014 Fax (845) 278 -6648
SHER1LOTA AM LER, MD, ISIS, )FAAP
11-4-,.!:_: . , .',_CoMMissiQ! Cr'g(4,egkh.,
LORE'I I'A It✓ OLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
,,., ..: .. _County,Executive _
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT MORRIS, PE
Director of Environmental Health
AIDIDITION APPLICATION RESIDENTIAL ONLY
y
STREET U N W t_j j R-u V$� TOWN ; _I- TAX .MAP# =1 T `"1.¢ I
NAME PHONE (P n- � M 9 PCHD#
MAILING
ADDRESS 14 � U t-1 Cot- 6-3 A-- , Py-C�VtAk
DESCRIPTIQN OF
ADDITION ac-po5-
t0S-;tq
NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS -3
(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 1.0509, 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
-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
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 Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS; FAAP .
�>� � • - , •_ Commissione'r of I�e�ilthi� ='*�" �A:�� -• - •
LORETTA MOLINARI, RN, MSN
Associate Commissioner. of Health
DEPARTMENT 'OF HEALTH.
1 Geneva Road, Brewster, New York :10509
ROBERT I BONDI .
�C'Who�i x`iscu`tive -
Town.Lef!al Bedroom- Count
Re: W ADDONA. (Owner's Name)
Tax Map # 73-17-1--'-4'2-----
Address: 49 Lincoln Road
Town: Putnam Valle'
Year Built: 19 7 2
According to records maintained by the Town, the above noted dwelling,
is XX in compliance with Town. Code.
is not in compliance with Town Code.
r =���,• «u:..+ -.; ...e.. wa+•.:e....... r. :....y ....�s... .s.� -• .. v- cs�. �•..«..++- wm. w�... ..+.= rw- •w+— .r►.co... «.+.... -.. ._•� �:^' - ..
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy: GO #71 -404 Uatt�rbed)
Other:
> s i s t . Building Inspector Da e.
i
Environmental Health. (845) 278 -6130 Faz'(845) 278 -7921
Nursing Services (845) 278 -6558 Fax (845)--27&666. .wIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (84 5) 278 -6014 Fax (845) 278 -6648
-
�i r a
r i,,��,t c • y �" ��y�,�pr.y� ,�i�- ,}{ r,.. r �(y�,.�r ��t ji '.- .�!y! �" '8A�i1 A6.04
fd,,rye-/
. �..:[s„1,:�4U�.._I'�.'J 1....i'%�lliw. �e:°' �t` dMevl�d; o•` �li��i 'k�.Ok1�7'rAi"rm'i.°,iie':5 ": 1V:G�S�i:`t: ,9 o1i•[is -' ?.r ..,-c..:. :,- ,.s. w.
c s y E 5�y,,;.,t1 �.-� C0.; �GGei t�!7^t'' �3���A�• ! Lr�K�t� -�A�oD,�'�o�o4(,�e�uCBSal�'o„ '�o�'SiI g�QI <)�C �.a�: ti �s,�� .
A(oA )sZy 5a , 60� fe:ofee A y; _yo�� r$5 0� ld' 'i,1 e 1�yBi y,�( ��`{ y;-• ;y�y �`.�.��i �..�.y -� � L � s � F .$.�Ate6o.X � i�i<��
,+ Ail-
4 y q
"(.I .. (O A d A 0 I r°•.� 1 ry 1 �11
(AC h l v Y` `A rr ti if
� ?�. li`i el t14�Ce�a .�!'�. C��a 1���• I�A� �C'� °�eQA. �c {� 1.gr�ce�:�`ic �9'�P3?+ ' � �.
'", . .. .. - t,� Ui LvuLJ1 i.,1Un
TO SEPTIC TANK AND FIELDS ...... AREA RESERVED FOR SEWAGE DISPOSAL
;i SYSTEM TO REMAIN UNDISTURBED. ALL CONSTRUCTION TO CONFORM, TO STATE
AND LOCAL STANDARDS AND REGULATIONS ..... , .. .
%a.✓T /° /I°4r �IYO�LTE SelI✓Q�iL+,. ,. ,
�C1�I/ d�yl• SOX � •'
- - -- - -- sa.ver
,vw „ T/ ANT
�.
' � ,..,;.' 'moo r�.0 /.� .�:,� rie•�"� 3. s. v. sv�
T /�'•1� BoX
v t.v.'.r t
i�
er-
�J
50 •'�ANCt�•' -•'f A
J'p .
s
L
._/ U
/'r °.20/
J•UN
PUT COUNTY NT. OF HEALTIJ
BY..... ................_ .....
......
P,
DIRECTOR, DIVISION OF
ENVIRONMENTAL HEALTH. $ERVICFj
7%�.Ir i•!�'s� /✓o, /T ,�LOG',C'�0. /, Y�X .COT /1/O, /7.
,e?�- ✓is�G PROPOSED
SEPARATE SEWAGE DISPOSAL SYSTEM
/4 'vr/✓�i+9 r.•9.C,C EY c'o/��'r,�vc rio.�'
Vol, IdlcZp"9x;p
c o/e'oo.�.Q rio�l/
Sca'C E COU/Irr.E°Y G°'- STiD;P -wv'S
TOWN OF
COUNTY, NEW YORK
DATE 6 - 2- >/ SCALE,ps �os� J08 NO 7a - /.27
SULLIVAN - THIEDE
CONSULTING ENGINEERS
_CLARK PLACE MAW)PAC,NEW YORK
OOn3.17-1-51
G.
ti
Ott
00/ 17-1-44
00/73.17-1-43
00/73.17-12'2
-42
0073.1 7 -1 -41
00/73'. 7 -1-9
00173.17-1-40
�11VCdPA., Rp 40`PK�.
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
. Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
Tbis;apci rip:- tabeacamplated -.b�4vur-A.dizillea -and submitted= to.County.�• Health :.Departmrit•togethervith labor -story report of --<- ......., '.
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
NAME ( i �r
U fi vw 1 lei
SS
ADDR`E,�
LOCATION
(No. B Stre t) (Town) VLot Number)
OF WELL
11 BUSINESS F]
❑
PROPOSED
DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL
11 El INDUSTRIAL ❑ CONDITIONING ❑ (SPeif ER
I
SUPPLY )
DRILLING
COMPRESSED CABLE OTHER
® ROTARY ❑ AIR ❑
EQUIP MENT
PERCUSSION PERCUSSION (Specify)
CASING
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
j �j
❑
DRIVE SHOE
❑
CASING
9AQUTED?
DETAILS
3,J
Jr !�
Jdl THREADED WELDED
YES NO
YES
LJ NO
YIELD
HOURS G.P.M.
❑ El
YIELD (G.P.M.)
TEST
BAILED PUMPED ,�) COMPRESSED AIR
WATER
MEASURE FROM LAND SURFACE —STATIC (Specifyfeet)
DURING YIELD TEST [feet)
Depth of Completed Well
LEVEL
in feet below Land surface: 5
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
EIFGRAVEL
Diameter of well including
GRAVEL SIZE (inches) FROM (feet) TO (feet)
:
gravol pack (Inches):
DEPTH "FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
t
%C
35
k>tRa A/ C- Bo VJ_ DG R-s
or y ul✓T/4 C cTl-g.D
3 r /SS f—le-ET
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
FYI
J i5 %
DATE WELL COMPLETED
[?,ATE OF REPORT
WELL DRILLER. (Signature)
7
� 72
T,
1b
Owner or Purchaser of Building Municipality
Building Constructed by
Location - Street
�cs�i,r�csvn •�
Building Type
n
i
Block
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=
vice- s.Y -o_f thy.. Putnam .-Coun-ty; ..Departmentt :of ..Health a.s_ t:,on wh.et-her,-,or:. not, the
- faure oz' the •_system- to` operate " +;gas caused bye .willful or negligent' ����
act of the occupant of the building utilizing the system.
Dated this % day of /i%U 197e, SignatureL -n
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
P.UTNAM COUNTY DEPARTMRI T OF HEALTH
r`?'Al.:.F�r��:
a
PU.T�A�I CQU�;TY DC ?�?T_�T OF : =.LTH
DIVISIO OT E`V l?C`:` `:?1L HALT =?t CES .
H
•.a•:T: `. — ;rnli s�-...s f•. -4�' �J'� "a1 W�.'F..FIM v+� ;.y;'cW.r;a— •i:r�i .•L3YY':+Wi4.Yw C ;w�..v.'Fr?'v W'r••+1.- ,e4wNY -'r N"' ¢:..AV .sGaii,: va•MS�..'w.G�W VMrit'y Yi.'M.+l R.. .rC• {
DESIGN DATA SHEET ' -: SEPARATE SD.TAGE DIS?;S.aL SYSTE_: FILE ,o
70 -127
_ PUTNAM VALLEY C ONST, . ' C'ORP ..:
CtMer' C BERNARD R. ROLL 4- Address OX 6 mOHFGAN LAkP
nRK
TA ;P
Located- at (Street). LINCOLN ROAD �G 57 Block -__ L_
_ -= -
Lot 17
.
a .rte ,,. �-
(Indicat �_ �sL 'e:0S3 s-ree�) .
PEEKSKILL HOLLOW ::BROOK
.Municipality' TOIN PW-VALLEY -a�ershed OSCAWANA :BROOK
SOIL PERCQL TIQ�: 'TEST DATA .REQUIP ,D' T O BE SUS:•:I�=! ED ;;IT1 2' :P_pL'ICaTIO�'
SECTION B COUNTRY .ESTATES LOT 23
Hole ,
Num5c CLCC < TI:IIE PE RCOI -A TICS
PEt,CO.L AT10
Flu Elaose De: - --o -o lv-azer er Level
No'.' Tirre Fro.:- Grour:", S:Irf = .= in Inc es
Soil Rat
Start Stop _`lip. Start StLo-:) Prop in
Inches I-, c -es
I: T ••,12::30 12:x}2 12- 20 23 3
" 1 2 12:42 12'54`. 12 20 2.3 3
4''
1 3 12:-54 I : 06 12 20 23 3.
4 - - ---
2' 1 12:31'_ I2.s43 .12 20 23 3
4, .
2 .12-43 J2:55_ 12 . 20 '23. 3 .
2 .: - ' T2:55. 1, 07 12 20 23 3
5
Notes:.
-i
1) Tests to be repeated et sa --6 depth u:- 11. aoorc:;i -_teI v eZua1, so`_1 rites . are ob-
tained a.t e::ch oer cola _ �o test hols . all d =ta =� be subi =tea for
2)! Depth ��.eas:Ye .e is to 3e in_3e from �c�2 ,of hole
Soil 6 Mli /1` D.^c? . - S D Us.H i e .Are- pro-.•_`e. 5000 SF_�
te t G is : lYp MASONRY
NO
. of u?4 oC -.� Q pp ►pp Ce2 i� TG..: C_� _ _� j,
Abs orp c.io t Ar p �6`a %b °�p °OO� 200 L .Y2� 306" �ti7 r1 ail trench.. Othe.'
N. Y °S° Pm F
000
.aTF C°ortd
Nate JOSEP $ A Sim atare
Address C' n SEAL
g0 I654.
�Offff 111(11 /�, ..
PUTti'A`I COUNNTY DE?ART'LE N-T OF HL.`%LT i
Soil Rate A ?pYoved Sq. .F- . /Gal. Checkled L
Date
EF
•
I
.4 PUTNA H
PC w v Y`O'
HOUSE PLANS
Ll
COUNT ONLY.
FOORPtL
APPROVED
BWROOMS
ALL'SUBSEQUEW RtVj§jdpgAj.-
TERATIONS TO THESE HOUSE
MU
im-To THE PCDOq FdqpjpP-
i4v p NS USTBES�IJIBM
ROVAL
Sj(;NT�
: �, TT.
IrmaTilar I? —
f
)(K
•
p
----------
F-
lo,
+
c:
a f sk y d��i 2a1� sf"
6P Ail
' ' t ;*tq. d'k�! M1�`3, �` , FfT•:
jl
n
N " i
S
7 b
— _ a
a
PI ( ;� M i R,
�' • L,ouNATrY QOM ; � � `'
do `
LLJ
I cK
'• a
� I � - -- - �• � _ _ .._�_�� _. �.. -•_ - - _ _�_ -- —. -._ - 3 ,[ a 6 A? � fix 6D ' 3 — — _ - - - -°
I'•
i
4 ,a.
i
lit
i