HomeMy WebLinkAbout3519DOCUMENT 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