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HomeMy WebLinkAbout3640DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.13 -1 -17 BOX 29 03640 ..; ' ,` M. %r , ' 11 .- . a , 03640 / k a t PUTNAM COUNTY DEPARTMENTF ;OF HEALTH j{ _ Drarrsron of Environmental_ Health Services Carmel N Y 10512 ,_, _ `� . AF:CONST.RUCTION COIUIPLIANCE „FOR_SEWAGE D15POSA_LSYSY,EM x _ D�c�IV /w`!� ,- 'f►�LC CERTIFICATE. _. _ n �; ✓% Town or Village ;Located at /Q- %ky 1 it by Address c { � Separate Sewerage System: bui �- �' s r j Consisting of..FZ� Gal` Septic'3Tanli € / lineal -Feet X: width trench k y � Other regwrements _ Water SuPPIY Public SupPlY From r V ) _`private Supply Dulled By L 1 �, Sv .0 `S w% ..'f/' � J �.! � • l { �R�� � / �� 3 .M S 4 �. 'a �i .c S N i Builtling r � � m F are is * `Date Permit lssuedr z T,ype' r No ofNBedrooms , .• 2.. y� iii fi� .: _ t ? t ✓ Z i 1r,. �'.h e. ° xc SS _ 1 Nk.xR. s-1 P Has Erosion Control Been Completed PP. r + 4yE[.,k r �9I ®�IiB. t` Y t �t �i I ; certify hat,the system(s):,as listed serving the above pram c r�tf ) hown on the plans of the - completed work:f copies of which are attached); and in accordance with the staritlard rules a, emit Issued y_ the nam County Department of Health i n pERA .: Date /r. 7 s Za� l �cense No: f Ai - L5 T a f a r 'Any--: person ;occupying premises _served by the above syst (s) at Pro fly. uch tIgnA may,;be necessary to sec_ ure the'corredion of any i conditions cesultirig from` such usage Approvaltiof the.: SB agi•� become, null. and void' as soon: as a public sanitary :•, available and the `approval of the private water supply `sFiall „, -•� en a_ public, water supply becomes available _Suc sub�ectito _modification,or change whem"in the judgment o m Tss ealth such revocation drfication orr: change .is nek w- a.✓,..r• BARGER ST. PUTNAM VALLEY. N.Y.; I 6/4/75 ,S,AMPLING'POINT VTme!uF!RT m A'w_- T.run - -4, OQ- rT-.nO(.' AMG')RR MIP R. RTTAMROF K PRTVF: BACTERIA PER ML. (Agar plate count at 35_ C).'COLIFORM.GROUP (Most, probable. No. /100m1.) LESS THAN - 2. RARDNESS, TOTAL -'ppm DETERGENTS - ppm NITRATES (asN) -. PPm IRON; TOTAL - ppm' FLOURIWE it-') - mg./i. These results "indicate't.hat the water was YESof a satisfactory sanitary quality when thus � as A. H. P.ADOVAN,- M. T. (ASC OWNM SITE MAIL: I fL PERSON INTERVIEWED `r PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER . A SUPINO SON! s ; SEPTIC EXCAVATION PHONE 528 5518 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. ... /`- 's Signature & Proposal Disapproved fJ Datte proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of. as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywalls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, r reported agent of owner agree to the above conditions. I SIGNATURE TITLE DATE PUSS: WAte (PAD); YeUc w Mun ED; Pink Lki lia mt) - r Owner or Purchaser of Building Building Constructed by Locatio - Street Building Type Municipality F =7272 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.guarar_ty 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 theDi.rector- of the Division of Environmen�al._He.alth._.Ser vice- s- of-_- thy°--Putnam'Coun-ty �ff'earthr' as° to w1 e-t'her o.r-•not—the• _.__.._ . failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of 19 Signatu Title 90ZJA/&4. 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. ° PUTNAM COUNTY DEPARTMENT OF HEALTH :d. ;-.;�-..� -� -: ��_-:; ��: c,:.-.: �: �a.-- 4;:-... :::.:- :.:..- ._..=- III�IS�fSN =;OF - ENVIRON1�r�TA%r,.. HEAD- �I1.:: SER�iI= GHS•:.:...- ..:_�..__r._._�__,�: _ ;,..,- ;..�.., -: Datel�et� Re: Property of- 11'jo • Located at Ayci< Pl< /vim �.�w� a� ���. -✓�`9 y�`�L��c/ TAB N%P, / Seen Block Lot Gentlemen: This letter is to authorize STANLEY- I. LANDER a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards., rules or regulations as promulagated by the Commissioner of the.PUtnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to. supervise the construction of said system or systems in conformity with the provisions of Article 14S or 147,' _Education Laws the .Public Health..Law,: and the Putnam County San .7 . ._ tary Code. 1 ountersig e Very truly yours, Signed Owner l of Property R4RG ,4 /Z cJT• /�T11111_� 14441 Address P . E . , =_� � a Telephone 4 �7. - - PUTNAM COUNTY H'A`LYMj�°t ` i�, DIVISION OF ENViRONMENrtAiL HEALTHERVlCES ' PROPOSAL FOR SEWAGE TREATMENT SYSTEIVI:REPAh� U Lam,/ Repair Permit Issued In lost 5 years lJ mot in WattirShed ❑/ L'� Repeirwithin 9oyd's Corners, W. Branch or Croton Falb Res. & Delogated I2 ❑ Ro0alr within 200 ft. of a watercourse or DSGmapped wetland 0 Joint Review SITE LOCATION 21 Shamrock Drive TOWN Pu #Warn V;311ey TM ;7,4 13:: -1 OWNER'S NAME Glenn &Nancy Sapir _ PHONE # 845 528 Q96 - y6q- MAILING ADDRESS Same APPLICANT Glenn & Nancy Sapir (owner) Name & Relatiomhip (i.e., owner, tenant, contractor) DATE April 30, 2009 FACILITY TYPE Private Dwelling PCHO COMPLAINT # PROPOSED INSTALLER J M.antovi Excavating, Inc D$A/Ma.hopac,Septic PHONE # 628 -4526 ADDRESS 485 Kennicut Hill Road, Mahopac, NY REGISTRATION /LICENSE fiI 1035/1036/1126 Proposal (include a.separate sketch locating the house, property lines, all adjacent welts 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. Junction Box filled with tree roots into the 1st field approximately 20 to 25ft. Replace pipe and gravel. Will 1, as own®r,agree to the conditions stated on this form SIGNATURE _ TITLE Owner DATE 30 O (owner) 1, the septic ins ler agree to Imply with the conditions of this permit for the septic system repair ,� �:. A nl 30 2009 _ SIGN:'1r'tJRE._. - __,:�.. DATE.._ f?_..... ,._._,�,- n . (installer) Proposal approv d with the following ions: 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. i INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ /3 2 Inspector's Signature & Title D afe Expiration Date Ro air proposal Is In com liancc with applicable codes Yes No 0 COPIES: PCHD; Owner; Installer, PC -RP 99ML Rev. 2/07 MEMORY TRANSMISSION REPORT - - 00,9, 10:15A n . TEL NUMBER 8452787921 NAME : ENVIRONMENTAL HEALTH. FILE NUMBER 133 DATE MAY -1.3 10:14AM TO 96288457 DOCUMENT PAGES 001 START TIME' MAY -13 10:14AM END TIME MAY -13 10:15AM SENT PAGES 001 STATUS OK FILE NUMBER 133 * ** SUCCESSFUL TX NOTICE * ** PU7 NAM GcDurq'T'Y HEALTH DEPARTMENT D1\/ISICa4 OF EIV\/IIRC)NM1 =1�tTA - HEALTH SEFt\/ICES ■i'A V 11 LAY/ Rep Wr 1--I 1-cd in last s yoar'B �-J vi to vv ai6 r6naa Repair wtthin Boyd•a Corners. W.: eranch or Croton Falle Res_ I?01e518ted I� Repair within 200 ft. of a watercourse or PEG- mapped wade -d O Joint RBviaw SITE LOCATION 21 Shamrock Drives TOWN Putnam Valley .TM # 74.13 -1 -17 OWNER'S NAME .. GI ®nn 8. Nancy Sapir PHONE a 845 -528 -0968 yo`��g64- MAII-INt3 ADDRESS Same ' APPLICANT Olen- & Nancy Sapir (owner) - Name 6 f3elmtie -ship (i.e_, owner, 2ar,ant, consracce� DATE April 30, 2009 FACILITY TYPE Privates Dwelling PCHO COMPLAINT a PROPOSED INSTALLER J Mantovl a oavatinn. Inc 0BA1Mmhopac Septic PHONE 0. 628 -4526 -_ AflORESS" -485 Kerinic0t Hill 1°ZG5ad, Ntahc pm6, We RHGISTRATION /LICENSE it 1035/1036/1 126 Proposal (Include a separate sketch locating the house, property Tines, . all adjacent -wells withln 200 feet of repair and the location or existing and proposed system) NOTE: The [department may require submittal of proposal from licensed prolosalonal depending on the nature and extent of the repair. Junction Box Hiked with tr ee roots into the. 1st field approxtmetaly 20 to 26ft. Replace pipe• and gravel. Will check 2nd and 3rd Function boxers and field for roots. t, as owner,agree to the conditions stated on this form SIGNATURE / //Lsc� .�lJl TITLE OwnOr 0A.-re 41 9 (owner) t• the saptio in er agree t110 c mply with the conditions of this permit for the septic system repair SIGNATURE ot- TITLE . President OATS April 30, 2009 (Installer) .. F-rom.aal 1 . Procurement of any Town Permit, lf,applics-ble. 2. Submission of as buttt repair sketch by the septic system installer within 30 days of the repair, in duplimto showing: s. O r wnes name, Etta Street Nmmm, Town and Tax Map number b- Location of installed components t/¢d to two fixed points a. System dasariptlon (e.g., 12so gal. Conarata septic task, etc.) d. Installers, -ame and phone --mbar 3_ System repair to be performed in accordancs with the above proposat and condittons ' 4_ The proposed aSTS "repair to considered a bast fit design and there is no guarantee to tho duration at which the completed SETS repeTr will function. s_ No completed work is to be bacKlllled until authortzatlon to do so has been obtained from the Oepartmont / [NTSriNAL Uism ONLY - roposal Approved� --� /i��� Proposal Denied 'i'%� �Cl C•�cysE C� Vii/ �r� �L ins actor's Signature Sc Title' � D�a a �r - EScpiratlon Oate . R pair proposal IO in compl -anoe wlth mppl'c ble No O COPIES_ PCHO; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES EW EM REPAI YES NO 1 Internal Use Only PERMIT # ❑ Repair Permit Issued in last 5 years ❑ �Wot in Watershed ❑ / Repair within Boyd's Corners, W. Branch or Croton Falls Res. L6 Delegated ❑ Repair within 200 ft. of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION 21 Shamrock Drive TOWN Putnam Valley TM # 74.13 -1 -17 OWNER'S NAME Glenn & Nancy Sapir PHONE # 845- 528 -0968 g ®�� y�q, MAILING ADDRESS Same APPLICANT Glenn & Nancy Sapir (owner) Name & Relationship (i.e., owner, tenant, contractor) DATE April 30, 2009 FACILITY TYPE Private Dwelling PCHD COMPLAINT # PROPOSED INSTALLER J Mantovi Excavating, Inc DBA/Mahopac Septic PHONE # 628 -4526 ADDRESS 485 Kennicut Hill Road, Mahopac, NY REGISTRATION /LICENSE #. 1035/1036/1126 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. Junction Box filled with tree roots into the 1 st field approximately 20 to 25ft. Replace pipe and gravel. Will check 2nd and 3rd junction boxes and field for roots. I, as owner,agree to the conditions stated on this form — i n k SIGNATURE (owner) SIGNATURE (installer) TITLE Owner DATE :agree tjais-pefm +t: #or-the- septic- �SYOF* m r-ep ,2-ff-.:__ TITLE President DATE April 30, 2009 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 backfllled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature &Title Dafe Expiration Date Repair proposal is in compliance with applicable codes Yes sL No ❑ COPIES: , PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 MAR t2 0 9 08052 IIi► its k 'ifl �. PM SAPIR _ 8455286939 P.02 t . ! �! F� A. SUPINO & SONS EXCAVATING & SEPf lC 4 Y t 3320 HOLLYWOOD STREET GAN LAKE NY 10547 yl� I (914)52n 55..18(FAX) "2]b a a w,, 7L •td! l °v�r ►;1 VS, I I goO-�' t J S}6 ti (D 4 3.01 AC. 2 1.14. AC. CAL.* 3 1.2C 1.00 AC. 10 1.00 AC. CAL 1.00 AC. CA 1.00 AC. 00 /S 1.04 AC. CAL. I.00 AC. 13 1.00 AC. 1. 00 AC. ISO 0 19 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address ,C.a,eGc�� azy,1 TA* 14-14-0 Located at (Street � l�/�i',2cx,� Q,�y'_ B1ock Lot linclica e nearest cross street) Municipality, / zl-w �'F A74i -Iel .Q ,6� , Watershed , 5 �iLG . ILAI-4ari,W oa,� -T SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 34;z� 4�'z 24 5 2 �4&lel 3 4 Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop le, I apse Time Min. Deptft to Water From Ground Surface Start Stop Inches Inches water ve .in Inches Drop in Inches. Soil Rate Min. /in drop 4 5 34;z� 4�'z 24 5 2 �4&lel 3 4 5 Notes: 1) Te§ts to be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. A11 pp data to be submitted for review. 2) Depth measurements to be made from top of hole.. DEPTH G.L. 6" 12" 18" 2`h" 30" 361 4211 48" 5411 60" 66" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES f` HOLE NO. /�% HOLE NO. /`�L HOLE N0. Z, /r✓/�S/ -�iG cap��iL �o�S<J�L /,r '7/�c� ENO G t�i�� �✓O L ! � �2� h 72" .78" .. __..._ 8411 9 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 2` ,INDICATE LEVEL TO WHICH E1� LEVEL RISES AFTER BEING ENCOUNTERED Z' TESTS MADE BY � Date 4 - /J'-- .71 DESIGN Soil Rate Used 15 Min/1 "Drop: S.D. Usable Area Provided J-D a p No. of Bedrooms Septic Tank Capacity ©D l Type Absorption Area Prdd e L.F.x24" �b� width trench. Other Address a THIS SPACE FOR USE BY HEALTH DE Soil Rate Approved Sq.. by Date PUTNAM COUNT'f DEPARTMENT OF HEALTH J DIVISION OF ANVIRONME TAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 . DESIGN DATA-SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner �5 / "IIG l Address 44,e6 ve— LLJTTE fa�•/t y � /J, Located` at (Street, Block Q- Lot ndica e nearest cross street) Municipality 6L ,O.J Watershed �I/c /4, G G G4-6) SOIL PERCOLATION'T:EST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS hole Number CLOCK TIPS PERCOLATION PERCOLATION Run Elapse No. Time Start -Stop Min. Depth to Water From Ground Start * Inche Surface Inches Water Levei in Inches Drop in Inches Soil Rate Min. /in drop n 2 J112- 4'/ � 4 {_ 5 lei J9, 3 4. Z Notes: 1) Tests to be repeated at-`same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements­to be made from top of hole. TEST PIT DATA REWIRED TO BE SU13MITTIM WITH APPLICATION DESCRIPTIM OF SOILS E ICGUJ� ?`iERED III' TEST HULLS DEPTH HOLE NO._ HOLE NO. i�� HOLE N0. G . L.. �/bf�5.0 iG 12" l/ n 24-11 4 C4 36" .4211 A 48" 4 5T" A a 60" __._.....6611 Ay . 72„ 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE IZIEL TO WHICH ER, LEVEL RISES AFTER BEING ENCOUNTERED TESTS MDE BY Date_ J1. 7j� DESIGN Soil Rate Used 0 ,0. Min/l "Drop: S. D. Usable Area Provided "- No. of Bedrooms �' e ,- Septic Tank Capacity % - - Gals ". Type CI VA', Absorption Ares, Provided By_��L.F.x24" - - - Sb" width trench. STANLEY I LA FR T17— Othe�� . Name Any bignz THIS SPACE FOR USE BY HEALTH DEP Soil Rate Approved Sq . Ft /Cal e1 I ;1 q¢ c f- (00 A,. 117 OC4 7- F-- 14 s `} ZIP71 Ar Aloca APPROVED JUN3 -Iff twwnguA�w -EAO� i CMR#f&. 017VITION 6,F:' WOWhWqTAL HEAtlw sEwvtrt- 4P 77 �r A toom 6,117 —IMS,\\4