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PUTNAM COUNTY HEALTH DEPAR'MM
DIVISION OF ENVIRONMENTAL HEALTH SEWICfS
225 -0310
-PROPOS, FORS: DISPOSAL- SYSTEIK REPAIR....,,,
OWNER'S NAME Kam Lee PHONE 528-5357
SITE NATION Park St. Lot # 93 & 94 TO
MAILING ADDRESS Park St. Putnam Valley N.Y. 10579
PERSON INTERVIEW-W PCHD CWplaint #.
3-3-92 Nam & Relationship (i.e, owner, tenant, etc.)
DATE TYPE FACILITY Res . 2 b,dr. .
PROPOSED INSTALLER Valley Excavating PHONE 245 -22761
Proposal 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.
Installation of eight contractor gallies rated at 125 gal. each.
I,s� is 1=e n e e e 3 7 ga w �ioFe 3 -�•ea� L J _
Existing fields.to be left connected & undisturbed.
New repair to be located between existing fields.,
&;piagem .42' -9t .`eE6W -8 �og e-opt !. tank
'2f -PA(J- IS TO 3r- 10 -SAKE, Lta A'70ij AS E.LLMOG S445TrIp-
A<N D C-" Ijor sf- LZ65 -M AA Ekjr,= I-00 -nAg.
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Proposal Disapproved
3 --9_ ��-
Date
proposal approved with the following conditions:
1. Procurement of any Taws 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 eanponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep
drywells 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, or reported agent of owner agree to the above conditions.
�: White (MV; Yellow (Tam ffi); Pink Qal amt)
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VALLEY EXCAVATING
BOX 141
JEFFERSON VLY., NY 10535
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D. BY_______ DATE --------- ____________________ _______________________________ JOB NO ----------------------
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PUTNAM COUNTY HEALTH DEPARTMO
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
2,25-0310
PROPOSAL FOR SEKftW DISPOSAL SYSTEM REPAIR
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Po a'.. 4'X *,)
OWNER'S NAME '.kow
PHONE
SITE LOCATION Pzi i- k
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i'llot 4 93 &
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MAILING ADDRESS i.: k
Putnzir(i
'101-09
PERSON INTERVIEWED,
PaiD Om plaint
Name
& RelaRonship (
.ep ownertEgi—wtr etc.)
DATE
TYPE FACILITY
PROPOSED INSTALLER
Vt)) ley
PHONE 2'i
EEgRMl (include sketch locating all adjacent wells):
NOTEt Repair must be in same location and of same type as original seft'ge fteposal system.
Different'location may require submittal of proposal from liceneW professicftl engineer or
registered architect.
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Proposal approved I Proposal Disapproved
Data
Lo22RI approved with the following conditions.-
1. Procurement of any Town pemit,, if applicable.
2. Submis4ion of as built repair sketch in duplicate showingt
a. Owner I a name.
b. Site Street Nampo, Town and Tax Map number.
c. Location of in4611ed ocimponents tied to two fixed point's (e.g.,house corners).
d. System description (e.g.r 1250 gal. concrete septic tank, three precast 61 diem. x 61
drywells surrounded by one foot + gravel).
e. Installer's name and nud)er+.
3. System repair to be perfonyed in accordance with the above proposal and conditions.
I, as owner, or.reported agent of owner agree to the above conditions.
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VALLEY EXCAVATING
Box 141
Jefferson Valley, N.Y. 10535
(914): 245 -2276
1 Date De. x. 14 19 1)
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i To Kam Al, 0C!
Job Description Price I
1:'xcavate and 3.nstal.I one 1000
<.; 11.c)n polyethyl one septic tank
. i r, Same ..1.0(",1t.i or a Ox i.:;t. i ng rite -- $ 1 1700. 00
i e1. tank.
Romovo .exc<::ss NI.l.,machine 9.i-ade.
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Approved
-.-- - - - - - - - - - - - - - - - - - - - - - - - ---- - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
VALLEY EXCAVATING
BOX 141
JEFFERSON VLY., NY 10535
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Dear Sir,
I am planning to convert my upstairs attic unfinished space into a den and a
bedroom: The conversion essentially consists of putting up insulation and
sheetrocks and there will be no structural change in the existing floor plan of the
attic. Since this expansion plan of living space requires your prior approval before
application of zoning variance, I am submitting to you the details of the existing
floor plans and the proposed new den and bedroom in the attic for your consid-
eration.
For your consideration, I am also submitting to you the details of the drawings
of the new septic field and septic tank which were installed for the house by
Valley Excavating at Jefferson Valley, New York in 1992. Since this work was
approved by your department, I am sure your department also has copies of these
drawings. My understanding from. Valley Excavating is that the 8 polyethylene
gallies (total capacities of 1000 gallon) for the septic field were added to the ex-
isting septic field. A new 1000 gallon tank was also installed to' replace the exist-
ing septic tank in 12/92.
I would like to draw your attention that the name of the road: where my, house is
located was renamed by the Town of Putnam. Valley as "Breezy Park. Road"
about a. year ago. Thus the residential address of my house is. 8, Breezy Park
Road, Putnam Valley. However, our mailing address is P.O. Box 627, Putnam
valley, NY 10579. Please send your, correspondence to us using the mailing ad-
dress, otherwise, we will not get your correspondence.
If you have any question relating to my application for your approval, please give
me a call at 914- 945 -1697 (work phone) or 914 -528- 5357 (Home °phone). Thank
you for your careful consideration and hope to hear favorable response from you:
Yours faithfully,
Kam Leung Lee
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
please print or type INRi Perm
Well Location
Street Address: Town/Village: Tax Map #
2 1-1-Y V a Ile Map Block Lot(s)
Well Owner:
N
Address: p
Pc� Q
Phone #:
//ame:
XC- 4n �r
/r h,
Vq e
Use of Well:
___L,,Re_sidenti I _Public Supp y Air /cond /heat pump_ Irrigation
1- Primary
Business Farm Test/monitoring —Other(specify)
2- Secondary
Industrial Institutional Standby
Amount of-Use
Yield Sought !�_gpm #People Served Est. of Daily usage gal.
Replace Existing Supply Additional Supply
Reason for Drilling
Deepen
New Supply (new dwelling) ! Deepen Existing Well
Detailed Reason
a P �, L. C�- . S k I
for Drilling
Well Type
ed Driven Gravel Other
Is well site subject to flooding? ....................................................... ............................... Yes
—No
Is well located in a realty subd' vision? ........................................... ............................... Yes _ No
Name of subdivision 16,11 f4 Lot No.
Water Well Contractor: u P�r�t Address: � �21r
Is Public Water Supply available on site? ....................................... ............................... Yes _ No y
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on s rate sheet/plan.
/ �.
Apolict..!lt Signptureg_ - -
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam
County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmel
take appropriate action to assure that any and all water and waste products from such well drilling operations be
contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater.
APPROVED FOR CONSTRUCTION: This approval expiresfiv-years from the date issued unless construction of the
well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified
when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a
new permit. Well to be constructed by a water well driller certified by Putnam Cy)unty.
Date of Issue Permit Iss ' l`
g fficial: ��
Date of Expiration Title: n
Permit is Non - Transfe
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
Rev. 3/06
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GERTIPI6D' TO: G,"A. r -slawJ
B.WC . L.4.tI1 7Xw.t4ZG tic
SURVEY OF PROPERTY
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SURVEYED: _Cxr ,
Tdlo Co. (Tarr. (.r fliu 1r.e.ction
FOR •
BROUGHT TO DATE
&*. C.,66"fiolr .r. ^ol fr.e(«.M. fo
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KAAI LC( ti L'.4/ L.G✓6
DROUGHT TO DATE
AN a.tibnfial. Mnpn .n Y.W for Ai.
LEE
'°� � `° �`� nseP or
JOHN SALVATORE ROMEO
wl wl of
cope hNr 1ho anpw.a wl of the er•
SITUATE IN THE
Cwu,dfin; Pngirra M Lnd Survcyc,
r ym whose rgn.Mo .pp..N Mason.
Tows/ 41 ~,V.4" ✓ALLOY
I NORTHRIDGE ROAD
*If is Mr.by cortifi.d A.f Ais enr.y wu
F0VTN 4M COUNTY
. PEEKSKILL. N. Y.
pnp.nd in .ccvrd.nc. with *..misting
NEW YORK
Ced. d f4.cfico for Lnd s.rwy..dopt.d
6y A. Now Yoh Sf.% Au-i.fi.n of Pro-
. H. S L 5. NYS LIC. NO. 027846
hs.iood L-A.Slmvypr.-
SCALE: Imo= /6
OACH.IENTi EELOW GRADE IF ANY NOT SHOWN
SURVEYED AS IN POSSESSION
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