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03763
BRUCE R. FOLEY
DEPARTMENT OF HEALTH
. 1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
- Associate . PuSl:c =Renith .Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
March 20, 2001
Andrew Brief
19 Angela Dr.
Putnam Valley NY 10579
Re: Addition- Brief- Angela Dr.
No Increases,in Number of Bedrooms
(T) Putnam Valley Tax # 83 -1 -2
Dear Mr. Brief:
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 form this Department dated March 20, 2001 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.
All plumbing fixtures must be updated with water saving devices, i.e., new low
flush toilets, restrictors for shower heads and faucets, etc.
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 your convenience.
Very truly yours,
Michael Luke
ML:kg Public Health Technician
cc: BI(T)
d r�,
BRUCE R. FOLEY
Puklic Health Director
LORFTTA ..MOLINAR:I ..R:N,,.- 14t;S..N.; .:..a::..
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845).278 - 6558 WIC (845) 27-8 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
�Z- - q )y-szy- yS &o
R l - fayG - -f'�o
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET i9 An a OfwL TOWN ,ftAgm \(Q)1e X MAP# R 3: -1 - Z, .
NAME r&) ®r; a 95 -cSZ6- y7 0 PCHD# ak q -0
MAILING ADDRESS ve o+nam N01 � y (OS?-r-
DESCRIPTION OF ADDITION
NUMBER OF EXISTING BEDROOMS_.2_PROPOSED # OF BEDROOMS_
(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., 4 Geneva Road, Brewster, NY
10509, Phone 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)
*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.
OFFICE USE
Comments
Feb98
BFhouseguidelines
BRUCE R. FOLEY
Public Health Director.
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
4ssociate...,Pu5jic :?Zerlth - Diiectar
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
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
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
I
Re: I I 61VIV.
Residence
Tax Map
Town „tt,1,r— tL�(it
According to records maintained by the Town, the above noted dwelling
IS
IS NOT”
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
F
CERTIFICATE OCCUPANCY: J,
C
ASSESSORS RECORD:
OTHER
BFhouseguidelines
/ Building Inector
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PUTNA %'1 COUNTY DEPARTMENT OF HEALTH
HOUSE PLANTS APPROVED FOR
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HOUSE PLANS APP ROVED FOR
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MaWng Address
PUTNAM'COUNTY DEPARTMENT OF HEALTH :3
Division of Environmental Health Scivices, Carmel, N.Y. 10512 Y
Engineer Must Provide
�., P.C.H.D. Permit
'T 7. _
1F CONSTRUCTION C014PLIANCE FOR SEWAGE. DISI
Separate Sewerage System built by_
Consisting of
d r��
Ad v <7
OSAL SYSTEM /_ o
Tarup�
Subdivision Name
5-W Date Permit issued
Gallon Septic Tank and
Town'or Vlilag
_ Block Lot
Sabdv. Lot N_Jf
� FA "Z !X V
0�.fc;
Water Snpplyt Public Supply Isom
Address
ors Private Supply Drilled by Al S O.-1,
Address
Building Type , Y/� % Ig`1'/44�_fHas Erosion Control Been Completed?
Number of Bedrooms -Has Garbage der Peen
Ala
JInstalled?
y
Other Requirements /� l% f L✓ u6' ' �/
I certify that the system(s) as listed serving the above premises were construcCe ^�"
ally as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regula I
dace with the f led plan, and the permit issued by the
Putnam County rrtmyent Of He /alth.
j -
Date _ C of {ed by _A �
/ / �/�
a P.E. R.A.
'Is
99'
9' S-"
Address _
License No.��
Any person occupying premises served by the ove system(s) shall promptly ttik t c
a e necessary to secure the correction of any unsanitary
conditions resulting from such usage. 'Approval of the separate sewerage
and void as soon as a pubs'.: sanitary sewer becomes
available and the, approval of the private water supply shall become null a d vo L vv„
hid6l3
ate supply b available. Such approvals are
hit Is
subject to mode icetio or change sal n; in th(e� Judgment of the Corn Is of
revocation, m i nor meet
Date _ J By
YmL ENV IR.ONMENTAL. SF-RV ICEq.
321. Kea• Street
Yorktown Heights.,,N.Y. 101,598
(914)'245-2800
Albert H. Padovan.j', rfirectnr
I_AB #0. :32.4018.01 CLIENT #'. 823 NON STAT PROD PAGE I
-------------------------------------- --- ----------------------------------------
PADILLA, ROLAND DATE/TIME TAKEN: 09/22/94 09:50
466- OSCAWANA I-AKE RD DATE/TIME REC,-D*- 09/22/94 10:30
PUTNAM VALLEY.,. NY 1OF179 REPORT DATE: 09/26/94
PHONE: (914)-52.8-2992
SAMPI-ING SITE: SAME AS ABOVE SAMPLE TYPE.." POTABLE
PRESERVATIVES: NONE
C01.-'D BY: ROLAND .PAPILLA TEMPERATURE .." < 4C.
COL IFORM METH. MF
------------------- ------
DATE FLAG PROCEDURE RESULT NORMAL. RANGE
09/26/94 MF T. COLIFORM -ABSENT /100.ML ABSENT
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER ( WAS) , WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDINI. T- HE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, .FAIR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
SU8MTTTED BY:
Albert H. Padovani� M.T.(ASf-'P).
Director
EI-AP# 10323
PUTNAM COUNTY DEPARTMW OF HEAL-JH
DIVISION ..OF .ENVIRONMFNEAL HEALTH_ SERVICES
Owner or Purchaser of Building Section Block Lot
Building Constructed by
Locatio - Street
Municipality - --
, I �_,: � i decd
Building Type
Subdivision Name
I
Subdivision Lot #
GUARAWEE OF SUBSURFACE SEMGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
worknanship, 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 guarantee to the owner, his successors, 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 approval of the
. "Certificate -.of Construction. C( rTpliance- for _thee s wage:dispoSal ., ,ystan, or any ... -
repair`s made`by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental Health Services of the Putnam County
Department of Health as to whether or 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
Title
General Contractor (Owner) /- [/Signature
u�ij a r, • CCJo7 �f�C/� d'Z I
Corporation Name (if Corp.)
Address
rev. 9/85
mk
G1..- kt .,
Corporation Name (if Corp.)
Address
C(�IT�i
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health
- FIELD ACTIVITY REPORT -
Sheet of
2Q[U_A
INSPECTION
NAME
_ Orig. Routine
m
Wtve
'
L,✓T* i
Orig. Cmiplain
ADDRESS LA
V
orig. Request
No. Street
Town
TM No.
_—
_ Compliance
_ Complaint Comp
MAILING ADDRESS
Final
P.O. Box
Post Office
Zip Code
Group Illness
_
Construction
TELEPHONE
_
�• • N a n,I
Name and'Title
DATE TYPE FACILITY
TIME ARRIVED TIME LEFT U V
FINDINGS:
Reinspection
Field, Sampling Only
Field Conference
Other
Explain
INSPEC'T'OR:
tune and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
- FQ1mmcoumtlfDImpAlTIr�1':OFLD:.ALTH - - ^f
` M EibbblaidaidFUMMMd Beim ser4kes, Ca"04 lI.Y. I�SU �bls :b Awid� [stilt 1" T
ai CERTU ICATE OF C0
CONStlQC1i0N ! FOD'BEiYA6i ID!$lOSAL SYSl�1[ Poart ` i
w f f
Les/.i �� .ri�•�G .wi vim.. _
Ta: bbp
teoswal_0 !lo�laloi ❑
Owear /Apprialit N� e� .
C
McAiieao_ Town Dab d l'4/l" ZIP
Date Subdivision Approved ' -7 Fee Enclosed Amr;,,r,f 3vo
IM Area Fm Seed 0, : v.la>De
Nobs �[ Balsas•. 3 _ Dav Flow G "P D 6 a` PCHD Noflseat w 4 itegtitrad Wbu FM 6 ceinlided
$*Pmub SOWMV Srh.. M COMM d 1Q'G t9 Gallons Soptic Took sa cJ
Te b.ea ga.os.a bi AdWbm .
WiNr Stns Pti81e Sttp I+1rs_ Adieu
sttfPsiba 411101100, Died by
1 reprea.ot'.that 1'am whO11Y and tompkttaly nsponsi0l. for•tM ditty and kication, of the propOYd system(s); 1)" that the separate
tew di�p�Yl system
above described willb e constructed as shown on the'apprii arMndment tneii, to and in aeeordince with the standards, rules a rpu i'anf p1; ng ruinam
County L>•parM nt of "lth.. and ttut oncomplei" thereof a Certifiat. Of :Construction Complianp" Ytlsfattory to the commissioner at H"Ithwill 1 -11 be suseittteq. tO. tIN" O"Ofte Me , and i- written guarantee will Oi .furnished'the owner; his: sgcoi - " " - - assilins by the huflew tflet; Yid canoe► will
Mac0 ill flood opatating eond"n any:pwt of, said iawagp dispoW tyit ' during the periotl, oft) nt.alat.iy tolbwiilg`tMdati Of tM iseu
ante of tho,appmaf of the Certificate of Construction ComplumCe of 'the original system o►, that the diilNd wNl O fCitUaO above
WIN M located as shown On the,a0a►oved Plan and that Ykt well will- inst in acco " nee,:1A� d. rpui Iona of the, :Putnam
County 0epartmint ate
of ""Ith
Date
Address
APPROVED FOR CONSTRUCTION: Tjl approval expires two years from :the: date issued
revocable for caw" or may 60-0 4d or modifi.0 when eon ed .e ry ,py''
'"uir" a new permit. A�' owed for disposal Of domed Y it y . and
Rev. /a_ / ./�
10/88 Date ._ 9y
P.E. _ R.A. _
q.
Lic.rse No Z'yss'
4LVP-
W,uctlog uilding has been undertiken and4s-z
Change or alteration of " "cpniiructbn
Tit
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELh+ "`
PCHD PERMIT i_9/3� ®�
WELL LOCATION
Street Address Town V llage it ,. Tax Grid Number
WELL OWNER
e M iling Address �ff
i ���� df ��i �.e r- X
Private
Public
USE OF WELL
1 - primary
2 - secondary
JKRESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
® BUSINESS O FARM O TEST /OBSERVATION
® INDUSTRIAL b INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT -gpm /# PEOPLE SERVED -Of /EST. OF DAILY USAGE .-_4O® gal
❑ REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION GL ADDITIONAL SUPPLY-
NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN ®DUG ® GRAVEL
0 OTHER
IS WELL SITE SUBJECT. TO FLOODING? YES P' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name 0 ao X0.17 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES dam' NO
NAME OF PUBLIC WATER SUPPLY: — TOWN /VIL /CITY
.. ;._ .DISTAL I^.E T0. d'ROPERTv :FROM NKAREST - WATER MIA
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
Q`ON SEPARATE SHEET
(date) (signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or o r ise contamin to surface or groundwater.
Date of Issue: 19
Date of Expiration 19� Permit Issuing Off' al
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
- - -- – REVIEW__SHEET for CONSTRUCTIOT
RMIT
NAME O w ER u . 4� i I STREET - LOCATION -
B Y c v Q. DATE % 3 �'� TAX MAP # Ss 3 z--
DOCUMENTS.
Y43 -) I RM IT APPLICATION
1
LLPERMIT;lu PWS LETTER
3I14EERS AUTHORIZATION.—
SIGN DATA SHEET(DDS)__
T HOLE LOG _
VSISTENT PERC RESULTS (3)_
L"LJ PERC HOLE DEPTH _
C �PORATE RESOLUTION
LANS THREE SETS
HOUSE PLANS - TWO SETS
M ARIANCE REQUEST!
GENERAL
GAL SUBDIVISION
SUBDIVISION APPROVAL CHECKED
ERC RATE
C U�UT REQUIRED
TAIN DRAIN REQUIRED CDSTANDPIPES
PPROVAL SSDS ADJ. LOTS
.AND (TOWN/DEC PERMIT R & D)
k ON DDS PLANS & PERMIT SAME
1969 - NEIGHBOR NOTTFIFTCATION
LETTER BVZBA
100 YR--FLOOD ELEVA
SEWAGE SYSTEM PLAN - (NORTH ARROW)
SSDS HYDRAULIC PROFILE 117 GRAVITY FLOW .
b/ J BOX m TRENCH/GALLEY M P- PTT DETAILS
SEPTIC TANK - SIZE, DETAIL_
ELL DETAIL, SERVICE LINE IF OVER
CONSTRUCTION NOTES (GRINDER RATE)
DESIGN DATA: PERC AND DEEP RESULTS
iWO -FOOT CONTOURS EXISTI14G & PROPOSED
DRIVEWAY & SLOPES CUT
FOOTING /GUTTER/CURTAIN DRAINS
CHARGE (OK)
:C & DEEP HOLES LOCATED
'RESENTATTVE OF PRIMARY AND EXPANSION
'. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
UMPED PIT & D BOX SHOWN & DETAILED
JSE - NO. OF BEDROOMS
LLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
)PERTY METES & BOUNDS
JSE SETBACK NECESSARY (TIGHT LOT)
JSE SEWER - 1 /4 "/FT. 4"0; TYPE PIPE
BENDS; MAX. BENDS 45 W /CLEANOUT
i FILL SYSTEMS
YBARRIER
T HORIZONTAL: SLOPE 3:1 TO GRADE
L-SPECS
PROFILE & DIMENSIONS
TRENCH
PROVIDED
LWIPARALLEL TO CONTOURS
100% EXPANSION PROVIDED
SEPARATION DISTANCES SPECIFIED ON PLAN
FIELLDS,!
" 1 TU'P.i., DRIVEWAY; °�.ARGE TREES "SOP JF TI L-
20' TO FOUNDATION WALLS
00 WELL, 200' IN D.L.O.D., 150' PITS
TO STREAM WATERCOURSE LAKE (INC.EXPAN)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
V TO WATER LINE (PITS -20')
50' INTERMITTENT DRAINAGE COURSE
200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS
SEPTIC TANKS
10' OM FOUNDATION, 50' TO WELL
WELLS
15' WELL TO P.L.
COMMENTS:
ca s,eJ
PUIN AM COMM DEPARTMENT OF HEALTH
DIVISION OF ENVI11aVENTAL HEALTH ggMCES
DESIGN DATA SHEET- SUEISUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner �� C! L °�� /� Address /. nr�v /o0�* Ads
Located at (Street) -_,A �i �J �r�' ✓r Sec. ?J . Block Lot
(in to nearest cross street)
f
Municipality R41111274?* C9 %�� Watershed
SOIL PERCOLATION TEST DATA RBQUnM TO BE SUBNIITTED WITH APPLICATIONS
Date of Pre- Soaking _ 9 �� Date of Percolation Test WIf g d'
HOLE
NUMBER CLOCK TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Frcm
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min /In Drop
Inches Inches
Inches
4
5
4
5
1
2
3
4
5
NO'T'ES: 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 measw-ements to be made fran top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DE7.rH-'--nzH0,11 NO:
-6-
G.L.
21 IYO!21 2'e-f"
31
41
51
61
71
81
91
.10,
ill
12'
131
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED A�14pe-
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: t -on DATE:,9
DESIGN
Soil Rate Used 16' Min/1° Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity gals. Type.--*K�.
Absorption Area Provided By 3 +U x 24" width trench
Other
Name Signature of NE
Address X72, SEAL
THIS SPACE FOR
ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
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