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HomeMy WebLinkAbout3517DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -5657 BOX 28 03517 koif` 1.6 1 'jL r . , 03517 PUTNAM COUNTY HEALTH DEPARTMENT D DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - - QROPOSAL.-FOR SEWAGE TREAT:M ENT. ..SYST M.REPAIR. YES N0_ Internal Use Only PERMIT -* _h 0 ❑ / Repair Permit issued in last 5 years 16 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 ll q & � It- & TOWN ,i% j,/ TM # 7 7 OWNER'S NAME DQV.,O fZ/F;75 PHONE #,d Z7 :ZZ2.6 MAILING ADDRESS APPLICANT Name & Relationship o.e., owner, ten contractor DATE �i�� �� FACILITY TYPE ,s,Q S PCHD COMPLAINT #.X-1 0 PROPOSED INSTALLER AWbZ- )Z1oC, � i PHONE # I�XLZYS'iYOY ADDRESS REGISTRATION /LICENSE # , /D/ % 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, as owner,agree to the conditions stated on this form SIGNATURE J'.- TITLE ®-rd DATE (owner) –'- .= l,.th"apti0!-4stallerragr,9e -•.o comply -with the•conditions rat` -this permit -for: the septic system. repair..:....._ ' r SIGNATURE TITLE DATE le -Z0 /,, (Installer) Proposal approved wit th 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 backfilled until authorization to do so has been obtained from the Department. t \ITGn\IA1 11C0 A \II V m I cn11§i+L. V.7L I Proposal Approved Proposal Denied ❑ k I pector's Signature & Title Date pira ion Date Re air ro osal is in compliance with applicable codes Yes No 0 COPIES: P.CHD; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY HEALTH DEPARTMENT t1125U--- DIVISION OF ENVIRONMENTAL HEALTH SERVICES i'I ' (his! AI :�,I v A)G, ,,F `,' r "' f MA !�T ;YCTf —f, 47 •'iy�l't Internal Use Only PERM a ®/ Repair Permit issued in last 5 years e6 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 /f q &t. /1� TOWN fl TAO #2%.-1-513 1> 7 OWNER'S NAME 71qVio 12,FP5 PHONE #,�Y,� MAILING ADDRESS APPLICANT Name & Relationship (i.e., owner, ten contractor DATE 0 FACILITY TYPE 1125 PCHD COMPLAINT # � d' PROPOSED INSTALLER �s�QG�./�1oc. �� PHONE # gyf ZJ5 ADDRESS REGISTRATION /LICENSE # /QZ % Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the locatlon 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, as owner,agree to the conditions stated on this form SIGNATURE — ^� ch, /G TITLE �dvr� -rr DATE (owner) ,:.....: �_... _ itli.the-conditions of this . � ermit for the -se tic -s tem-r'e air. - I;�the septictrtstalter; e�gree to comply p p ys p SIGNATURE TITLE DATE le ~ (installer) Proposal approved wit th 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 backfilled until authorization to do so has been obtained from the Department. IAITCptf1A1 I ICC AAAI N uv Proposal Approved Proposal Denied ❑ k S7, 11 4A c r pector's Signature & Title Date Eipiralion Date Re air eroposal is in com liance with applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 I -�. or7V_ i u t/ • 111` 1 ��y ....,.,::� �.i} ��":�. ,- <-= '�•�`�• -'�:, ...; -.2 �.1'.. _- .. -•i - .s�:a..... ;t ,.: �_ ,r,,,d .�•�+��- -,•si4R �,:-.. ry...:=-• �•• C•• �--! �'= ��T�- ��•Ct�.:.r:':;(�T::?�+:.s • -r-- j . j I i t 1 o if of µI ec i I Y�' UN i ) ' t t , — I Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Inspection ])ate: Inspected Inspected by rd ,L, Oj, Owner: Street-Loc 'on:.. - /,00 -s- 011 V -. J&WT:W- Installer:A # i. 'type of aystem: u—onvennonai m Anernate u Lomments: 2. Yes No -N/A ------------ C Gnunents a. Septic tank size t,011 ... 1,250 ... other..... L/ b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box - is All outlets at same elevation (water tested) ... ------------- ii. Protected below frost ............................... iii. Minimum 2 ft. Original soil between box & trenches e. haWgLln — properly set ............. V. f �Trenches i. System completely opened for inspection V ii. Length required Length installed 177 , iii. Pipe slope checked ............................ iv. Installed according to plan ....... 4 ............. v. 10 ft. from property line — 20 ft— foundations... vi. Size of gravel % -1 1/2 " diameter clean ......... vii. Depth of gravel in trench 12" minimum ..... viii. Ends capped ................................... t7 ............... g. Pulig or 22W 51steMs 3. Sg]LaLe ft_stem &M a. SSTS Area located as per approved plans LZ 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: RIFS1 Rev - 011312 I�. i I I• i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM a Address Owner: °�7 /'�'l j t' Located at (street): TM # . ! " I Q -- / — l3 S—% Municipality: lwwo vd��e Watershed: SOIL PERCOLATION TEST DATA 0 t Mussed by: Bate of lra- isal�`• JaM �of Paswl w. Ted: .16 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 for 1 -30 min/inch, < 2 min for 31-60 Inwinch). All data to be submitted for review: 2. Depth measurements to be made from top of hole. Form DDA7, PB 1 of 2 �. O�0 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 for 1 -30 min/inch, < 2 min for 31-60 Inwinch). All data to be submitted for review: 2. Depth measurements to be made from top of hole. Form DDA7, PB 1 of 2 PEST PIT DATA ]DESCRIPTION OF SOELS ENCOUNTERED HM TEST HOLES DEPTH HOLE o_L— HOLES H ®LE # HOLE 0 H ®(L •:, x - -i r: --sl- *= .:�'F: x- £;...+:.� -d = ;,,_�. ,r+e.;e r!�'..:.i; ..e'iam,.,�crs'.x-k :== ~.�, = -r 's'. :tii .a,r ._,sT�.x'.'.. g.��...�•r�:�,tia...�- 'fir -�:s a G.L. 0.5' VIA 2.0' 3.0' r. n.4101 3:5' 5.0' 5:�' 0.0' 7.5' 0.0' 90.0' •. -�.: v -'. -�.. - - -• - - -- 1.. .,� .. -a., .s- w': '_ •r:.- r .:ay....� • .. s. two- •-. �. met- .Y vr'a<:- .�pc_- v: r ._. C. rcnV..-+ naa..+r eeat r.. ..A �>wa`D ea Indicate level at which groundw►atmis encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observation's by: i DU Design Professional Name: Address: Signature: � Ii'lrofessaola�ll's Beall � I Revised July 2013 r MTV Y LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 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 August 5, 2004 Ripps 114 Rochdale Rd. Putnam Valley, NY 10579 Re: Addition — Ripps, Rochdale Rd. No Increase in Number of Bedrooms (T) Putnam Valley, TM #74 -1 -5.59, Dear Mr. Ripps: 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 August 5, 2004. 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. _.• _ .M::Y �_ -_._.: _..:::. 1lpL nktingflXtures biw9t. e� p�dkte4 ;with.Water.saving..devicea; i:e:; new low flush_ .:'."-_ _� ., F • . 9 '^ice. toilets, restrictors for shower heads and faucets, etc. 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. ML:lm cc: BI (T) Putnam Valley Sincerely, Michael Luke Public Health Sanitarian BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. ,I.csociate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 :C3 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 �` 1- 0 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET .'R O & A a TOWN '� V Tx MAPS NAME 1 PHONE a - X02 $'- S�f2iPCHD9�� -d MAILr\'G ADDRESS / /14 T\© DESCRIPTION OF ADDITION &L Sf 7 ar-, k--C� rcokn -S. (Z-` O' r-d- -fi r e-1C s4in,9 4C'( +c (C_kj -4 6q�_Ctrbo NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BE OOMS 3 5farq.� aak4 (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. accprdA .=4)ith:applicable_sectioas.o� the. Putnam County-Sii i Code. - - - Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money &der f6t $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. OFF7CE USE Comments /I N Feb98 BFhouseguidelines BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLWARI R.N., M.S.N. Associate Public Health 'Director Director of Poliehl Services I Environmental Health (845)278-6130 Fax (845)278-7921 Nursiag Services (845)278-6558 WIC (845) 278 - 6678 fix (845) 278 - 6085 Early Intervention (845) 278 -6014 Preschool (845) 278-6082 Fax (845) 278 -6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: --42- (t b� Re: — I ; Residence Tax M a D To %vn VA I According to records maintained by the Town, the above noted dwelling IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from- CERTIFICATE OF OCCUPANCY: ' ASSESSORS RECORD: OTHER </ B'uildin Inspector BFhouseguidelines ;�4,- 5 11'8 5'3 9'2 IT BATH BEDROOM 11 T�7 �88 x BEDROOM ATH 4-11 x 77 8'8 x 11'10 MASTER BDRM 11'2 x 11'9 BATH 5'3 x 5'6 Current House (Sept 02) LIVING AREA 1034 sq ft 1, `7 'E"OEDROOM 13'6 x 8'3 -151 PORCH 13'5 x 13'6 Fixed Rock 61 12' KITCHEN ',N T6 x 13'4 LIVING 11'8 x 25'2 DINING T6 x 11'6 I —13'11 12' 1 8.. IVA 01 IYI, C( ::5- 7 ,--lax M Ck Community Water Supply Enters Here 5'3 92 BATH BEDROOM A 8'8 x 11'10 49'11 17�7 Fixed Rock MASTER BATH jl� 19 11'2 x 1 V9 3'1 12' H= 5'3 x 5'6 BEDROOM 13'5 x 8'3 Current House (Sept 02) LIVING AREA I PORCH 13'5 x: 13'6 1038 sq ft 1 1311 LIVING Septic Tank Septic Field KITCHEN "T ' 7 �Cx 13 '6 x 13'4 DINING 7'6 x 11'6 1 1