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Home My WebLink About3519DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.- 1 -5C01 BOX 28 03519 JIM '.• is T 1. 'T. ' 16 ■ 4V mj r I rm. MM .�' 03519 Sheet _of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV.IRONMENTAL,HEATLH SERVICES - T`IELD'ACTIVITY- REPORT" AnnRFsq: 3 v:H P,'N.os pvi- � %/aq,ev nl y, Street Town State Zip PERSON IN CHARGE ss// nR TNTF.RVT VIF.Tl; ffOGJA � - a1e-c+ - 5-14 1O!r Name and Title TYPE OF FACILITY: FINDINGS: Ak4 P10AL Se :ire 61, J TNCPR(' .�� _ �- J � � TFT Signature and Title I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Pc Pu u4cc.s /Y �J W."ll S-S,q s- 5- DIVISION OF ENVIRONMENTAL HEALTH SERVICES: PgZnPn-qAU FnR APWAGIF TFIFATUIRMT SYSTEM REPA 10-W 4� 1Y 17 jr6- 3 5; 64UC 'I SO T- X ❑ ❑ /Repair lit issued ln Iasi 5y=m a Not InWatershed ❑. Repair v4Wn*BuVft Comers, W. Branch or Croton Fags Res. ❑ . Delegated ❑ Repair within 200 fL of a wMromm or D .wetland ❑ Joint Review . IN SITE LOCATION NWE, P_� TOWN _%-1-f4&0, OWNER'S NAME JR09R I C, PHONE #6//76% n MAILING ADDRESS T -A 0,L - V L4c— 4 4A -Y (A C16- &0 Co- S -c- Ae-xv 0 Wq —,qg r I - 71) APPLICANT ILS, ffA W-J_ Name & DATE 0/2,0 A 9, 4F CILITY TYPE S PCHD COMPLAINT# PROPOSED INST'. j L!�� PHONE# c e. 6 Lk. REGISTRATION /LICENSE # ADDRESS AL A I/,Q i�LA_7v'j N - r-, __ 11 5-717 ftg=l (Include a sepmft sketch locating thelh'bakm, property tines, all adjacent wells within 200 fed of repair and the location of 9**" and proposed sygem) NOM The Department may require submkW of proposal from, licensed professional depending on the nature and extent of the repair.- a, 41 , W - 14e.4-uv dar-j._ loox- cAl 1. as owner,amtDthe conditions shod on this form SIGNATURE TITLE 0 DATE �IV le-C .(owneo' 7 1 1, the septic install r, agree to comply with the conditions of this permit for the septic system 'repair IGNATUR -TiTLE (Installey) EM12211119MMved WM the Mod ma 1. Procurement of any Town Permit. If 2. Submission of as built repair Afth by the septic system installer wkft 30 dap of the repair,, in duplicaig showing. a. Owner's name, Me Street Name, Tom WW Tax Map number b. Uxation of Installed components tied to two fixed points r. System desor"on (e.g., 1250. gal. Cowaft septic tank oft.) d. Installers' name and Phone. number 3. System repair to be performed In accordance Wilh the above proposal and C&MIUM 4. 7hevroposed SSTS repair, IP considered a- Wed fit design and them Is no Quarantee to the,dum&m at which the COM~ SETS repair will%imcdon. S. No completed work to to be bsckl l Pd urdh aulhorbstion to do so has been obtained from the Depaftent Proposal Approved. Ll Proposal Denied Skjnawre in compliance with COPIES: PCHD,' Owner, installer PC-RP 99ML UM Rev. 2107 '\ I � °7cA;� -09 PA u L- �Q�L W R� 10 t C- Pv mp La A fxT ter,V-T ' 6 pv wt o 7.4/ C �7,i). 09 I...... . VAtLv-,Y/ t-C4-, C- gy 4JO.-WA4-4 R� �� l Pock Uc C- PV MP W\.p ti a--t V-tv, V-T C, <I J ✓ �� oc PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ® n , PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAJR ®, Internal Use Oniv PE DOrr O CY Repair Permit issued in last 5 years M 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 01 Twi 14 K rs. VTOWN Py r ti ,VA L i_CFM # 7 V - -! - OWNER'S NAME L., t, mo P, I-I I I PHONE # J%/ % 6% qVd ,S' BAILING ADDRESS CIAK,,g •iK?,y-rL 4 (2s-cw COAPP M, 651316 :R.5 r, FV, IV Y rcg79 ,APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE f' FACILITY TYPE 29—J. PCHD COMPLAINT # . 5r e PROPOSED INSTALLER iL,l/ 0 C7 (14 i✓q ii PHONE # 9i(/ ;!75' 39Y7 ADDRESS %? 'U S CA .w A M& I'_ Ii ke" CZ. REGISTRATION /LICENSE # 104,43- C� Pr000sal (IZaN1+WUVALLE1 0 a separate ske locating the house, property lines, all adjacent wells within 200 Brat 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. �( �10U)5 i8 ��N� C( ��ct•�y vcck �/ .�rmFlgzfj'tv�LS r. ¢= J C t h o'l 2F A ! 00 0 CoA L i)itc -t14 F--Lt nd6 1:- tzo WL ..ZDo.k 02 `7El - °CS-1 . -) r. ny, �-t- V< FT«1 ►4, -rr/+ck rZ � I, as owner,agree to the conditions stated on this form SIGNATURE TITLE (3(,(J1419Z- DATE (owner) ' [,.the septic installer agree to.comply with -th . onditions of this permit for the septic system repair . SIGNATURE TITLE 6 'T— DATE '°► q /IL{ _ QDrus�llc�r) Proposal aooroved 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..:: - -- -- - - - •- --•, -- - -- - e; 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 backfill ntil authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Ins or's SigrFature & Title Date T. E pira on Date Repair propo sal is in com liance with applicable codes Yes No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Date: gpfl n e Street Location: _ Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Fina ite spection Inspected by: Installer: �'rYtti crZ` Owner: 44y; it Repair Permit #: w / 14� - // . ; TM.# i. Type of system: l;onvennonal u Alternate u comments: 2. Septic Tank Yes No N/A Comments a. Septic tank size —1,000 ... 1,250... other .... . b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f. Trenches i. System rompletely completely opened for inspection ii. Length required Length installed �,rl _ _ qf4 A l iii. Pie slope checked ... ............................... iv. Installed according to plan .......:............. v. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel 3/. -1 '/s " diameter clean ......... vii. Depth of gravel in trench 12" minimum*... 'viii. Ends ca ed _ .... _, g. Pump or Dosed Systems 3. Sews e System Area a. SSTS Area located as per approved plans 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: RFSI Rev - 011312 4 P 1 dM COUNTY DEPARTMENT 01F«tw0E .•- I - - M BMSIO N OF ENVIRONMENTAL HEAL u H SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE uREATNENT SYSTEM ®aaaDer: Address:'�� Located at (street): TW# 7 M01Mlxlpafl .ty: �(J r1Gt�'1 g Ae �rate��ed: SOIL PERCOLATION TIEST IIDAIrA Witeeasdd by: Date of Pre-soak hg: J note of Percokdom Vest: 4,— /::ii/`/' Iffole Noi Bob depth (bclaes) ROM No. Time Start — Stop Elapse Time (MiEL) iDeptb to cater f1rom EM6 surbee (Inehu) Stet Sto waltem level dmp in JRehS P ercolatlomm Rate vafi/iarh fl 4 fl' fl 3 4 Dotes: 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 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. FOM DD-97, pg t of 2 �J T- PV LC. C 1 r yl ) rT :I �s ,: f L 7' '7 S7 .4 p- Plo ws (lot " � � e - k. Pi, 14o r, 4 c, . e,�L 0 �® 00 .......... .... _ ( /jam .. . ter/ _,� i -T M rZ Y - I "? eerz I4 lz Rows � l! l WL R Q 1 i -;' 7tv r c cE s D_ �'�rrn U A oc:E X J` Ins2cy rl Pi. 14o wR-M Co &AG et-:t- . C.r c P�• EoY'3 o �f It S S :2b IL _ ...._ .......... ,4 flR. Ry ..................... AVP P SHERLITA AMLER, MD, MS, FAAP Commissioner of Health 1LORE'T'TA MOLINARI, RN, MSN Associate Commissioner. of Health ROBERT J. BONDS County Executive ]n .. - .J-i. ..r^r .iYr. `��..:- .r :�'Pw„ 4!'.- rtar•.. yg,.` r .T. -_ ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH Oo t Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 2., . T V" I P"i SHERLITA AMLER, MD, MS, FAAP :Commissioner of Health . . .: . <..., LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 1609 Town Legal Bedroom Count ROBERT L BONDI . County Execudve Re: I L L (Owner's Name) Tax Map #: 1 4. p Address: 2 I W f `►� I (N� �� Town: fQTNAtV\ Year Built: I �1 According to records maintained by the Town, the above noted dwelling, is V in compliance with Town Code. is not in compliance with Town Code. .......: ,� The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Other: _ _ Lk Building Inspector Date 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 Interveution /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AM LER, MD, MS, >FAAP Commissioner of Health �_...._^ .. fir' : =;�""= •- $.ORETTA M06NAR1, RN, I i1 Associate Commissioner of Health Joel Greenberg, R.A. 2' Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT 3. BOND1 County Executive `' •- �.2:• - - -� �,... ., �a.- �"'.�. ....tea? .- ,- ,-. ,... ROBERT MORRIS, PE V Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 15, 2008 Re: Addition- A- 179 -08 No Increase in Number of Bedrooms 2 Twin Pines Road (T) Putnam Valley, T.M. # 74. -1 -5 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 September 15, 2008. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at one without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush .toilets, restrictors for shower. heads and fa etc..: =_ ._ r_': _.::� :::: ''::� ''.' -_ -_ - -' _.:._ . • -' ��-' ' �_ 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 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. GDR:kly cc: BI, (T) PV Sincerely, �?- Gene D. Ree Senior Engineering Aide 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 DIVISION OF ENVIRONMENTAL HEALTH SERVICES- 00monAA1 Fnp -Qr-WAn.F T=ATUF:NT -QV-QWafi RI;P'd IntdinalUsib Onli---, tpce 4- t C) Vc? �5- 3F 7o e4uc,L" 'I so , 0 0 / Repair permit dt In tat 5 Yom Ld' Not in Watershed ❑. [-�'/"'Repek within Boyft Comers, W. Branch or Craton Fab Res. ❑ Delegated ❑ Q Repair within 2aoiLofawamoumarDEGoapped—mmw 0 Joint Review SITE LOCATION T wt A 0-S P4 TOWN-Rfrw&'o, �r TM # OWNER'S NAME PHONE #'1176% MAILING ADDRESS APPLICANT IV: Nerve & RetWorift (m, owner, MWIL CMVBCW) DATE 0/2, Az— F CiLrryTYPE (9-jFS- PCHD COMPLAINT # PROPOSED INST PHONE # ':Z46 <55c, 4-;� ADDRESS REGISTRATION/UCENSE# hZ3 Prop-m (Include a separate 9WAch locating ft house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE. The Department may require submkW of proposal from, licensed professional depending on the nature and extent of the repair.- � r. . -r F- e- (- 7,9-H 4,- to 11y'a- 'U ? 1, as,owner"aamatothe conditions stated on this form r%v j DATE Zj (owner) 1, the septic install r, agree to comply with the conditions of this permit for the septic system repair 7 . comply �0 Aj /,tTq '.SIGNATUR TITLE eitic F, Proanal avar-mied with the folLoWma condillo 1. Procurement Of any Town Permit if applicable_ 2. Submission of as built repair Afth by the septic system Installer within 30 days of the repair, ht duplicate showing: a. Owner's name. Site Street Name. Town and Tax Map number b. Location of installed componerristl6d to two lbod points a. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair lobe performed In accordance with the ati6ve proposal and 6bnditions 4. 7he'pmposed SSTS repair: is considered a-bbd 2 design and there is no,quararfte to the,duration at which the . completed SSTS repair will mcdon. 5. No completed work is to be until authorization to do so has ' been obtained from the Department NVIMNAL USE ONLY Approved Lff Proposal Dented ❑ atom & Tide Expf ration rDal Is In compliance with applicable codes Yes 13 No 0 COPIES: PCHD, Owner, Installer PC-RP 99ML t Rev. 2/07 1*1 Sr 1) c e- C c- 4� v t (.,-F 0 '7-� -08 ... _ . _ „ cnrin�.�1(� -'-� ..�_�� £�;- '..- `� -.`R. ...4•a; _, .t.'. -...- _ <:ri7�i- �soa.r ., . .> - �.t- ...::t' •£yam J� Y 4WA4- 4 G 7 -*� 10 ce 3 8 Ce S.- 5�1(o -,;L S.?7,f �R l 4 C-- /0 � C- - /a ' PI IIJ2 ID — a . 0. . . -Tlv� --7Y. L-- :«.:w W- s�•.•.ai- • .m._ .: ,m «�«.: -•a' .c+..:"�,•+ti:y..- �•`*n -ro: q�-;._ x -st%: r . w �'iF:%t,';. r. - „y�ii'- 'F:.:,•a:r, w.:.....:rc .: .. �_ "a:.. a� ��y� � -� � Y • - 3 Pc Nib Fa Q,,Crz- -r /j-Iq 4-- ssys �j �L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: ft-, Address: 401141.w Located at (street): TM # 7 °" 1 -- Municipality: �'ngm Ilel Watershed: SOIL PERCOLATION TEST DATA Witnessed by: Date of Presoaking: " i� Date of Percolation Test: Hole No: de th depth (Inches) Ran No. Start Elapse �1e (ndn') Depth to war firm sSi'o� (inches) Start - stop Water level drop p in inches Percolation Rate njjn&ch 3 4 -- 5 _ - - 2 3 4 5 1" 2. 3 4 5 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., :5 1 min for 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, pg l of 2 TEST PIT DATA DESCRIF' ON OF SOELS ENCOUNTERED IN TEST HOLES DEPTH HOLE, HOLE # .HOLE S. HOLE.# Ham — G. L. 1.0' 2.0' 0 0 2.5' J 3.0' 3:5' 4.0' 4.5' 5.0' TO' 7. 5.0' 9.5' 9.0' 9.5' 10.0' _ _ .� Indicate level at which groundwater is encountered Indicate level at which mottling is observed lt4 /VV Indicate level to which water level rises after being encountered 4,1A h Deep hole observations made by: �, ; -41s Date !/4-P f� Design Professional Name: Address: Signature: Design Proffessionsfl9s SeRR � I Revised July 2013 A 1r i r Q d- a i^ - �B �e -�!. 1� f� 1= 1p � C s 770 11' e+ XI5 >j X\ / X 751.6 ulvlsion e:f Environmental Health Services W510 i AnUroved as rotwd £nr 7 +ti - -- 720---� tl;;-_-, 751.• 1 a p e Rules and Repulations of the nam aunty Real th 'Department. JOHN FELL:,-X P.E. 121 CUSHMAN FrOAD ens ne. es. PATTERSON, NEW YORK 12563 MORRILL 5c u-n- nT�sT 2 TWIN PINES ROAD PUTNAM VALLEY (T) SHO�N D iTED: 517EeT HO- WELL INSTALLATION 6I5/D7 Cl7�GKED: 1 OF 1