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HomeMy WebLinkAbout3980DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.58 -1 -39 BOX 31 Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 0n'.rrA" IvrOY;;rNAM AN. &I-S N:' Associate Public Health 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 June 6, 2001 Nat Santos 22 Lake Dr. Putnam Valley NY Re: Addition- Santos- 22 Lake Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.58 -1 -39 Dear Mr. Santos: 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 June 6, 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. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The 10x17 office and 7x13 computer room must not be used as bedrooms withour prior approval by PCHD, and the Putnam Valley Building Dept. 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, 11""// h' William Hedges WH:kg Senior Public Health Sanitarian cc:BI JUN -06 -2001 13:27 11 P.02 MMAIW COflTM DI PARTME ' OF MAL'iM ~ _ w R 5B tea, M Y. 10512 CERTIVOWE OF ca aRUMOM COMPI6UAM FOR SEWAGE D • L SVSYW lOG8tc31 at tan nap J�e :..stock I A.R, � e/ POru2r1Y a tot amp Lot a Mug. f sh. L' t SCOM90 3onOrao lystorn Built t)y , Lza4.cas G/ 5- y 4J3r'o Addraa D $ A^ a . '7 / YP9�r y J'y� Consist np of - other i" Water Supply: Sullaing Typo Has erosion caAtre I cortity that rho 08 touch ago o%tw ftww Cou nty capew Onto --I a. O 1 Gal. Soptte. Tank and Supply Frola p(// �Jl• $u ®ply Cr111cat oy Aef Pro. of scarowns- Data I>tilrmlt Ismod aeon gomptOtedr I I /at ®1 ) an listed sewing the atravo premises wars cons""AC9o8 saes lir J- sA awordanca pith um Standards, ruloa aad rogmlation6, in want of saalth. cart if iod Ael6ro4y /F6 ��'�� � '�'C�sidilc" 9 any Dorton occupying Drolso6 wrvoa by th0 abavo systomt£ snail promptly talwo su¢q -.91 conditions rMuttlas fret" 211ch 40080. /Approval of tho 2000rate staroraso system Mall l avolloblo and 1116 approval cth0 private rioter supply snail DOCCH10 null ant void often 0 subjart to modal lon at onsa whonr in tho ludon wot of 1110 C EIf taa= m. aay. 9 -sl plan* of the Completed wort ( copies ,od plan, and tha patmit issued by the s P.E. R.A. 4tsonco o two cwroalon of any una©nitary R�3a I a pwile Y0w114ary - B-05 rZ avail *kl Sutp SO.Novola ao Codes or tt+ a la nseels". wpb TOTAL P.02 _ __.B.RUCE- K FO LEY Pubiic Heaht "'Director 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) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION PRESIDENTIAL ONLY STREET Lx-,4-XP l k TOWN M V44 TX MAP# NAME PO-T- c 44y & ";� PHONE PCHD# 1%- —0 . MAILING ADDRESS .� DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS 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 #) *Nori- 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 a6"' ...;, _ 1 --e' ^— l®_ e'y /> S' O /its - Feb98 �f2 6 f�G' /t-2 tea. °� 2 c�•� ---z - --- _ _ _ ' _ _._._.. ..............__.....__ - - -- _. _...__... - -- _ .... ....... ....._ BRUCE -R. FOLEY �4 LORETTA MOLINARI R.N., M.S.N. .. Pudic �I1h Diree�or - <..�,:..,..���. �� -.- ..��:.�0....., v._,: �:.;:.; �.'._..3. ils�uititite�• Pu1iI% �fa�ftk�l3ia `�",^i� ^= ��''- • "• ;�=- w:': «: 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) 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 Re: _. Residence c Town_ Gentlemen: According to records maintained by the Town, the above noted dwelling IS 'IS NOT .k � ..._. _ ..._ ....:., .,..... a._... - ..:. :-�.� �. _.. .' .... -. ._. ..... - _. _.... ..` ; in compliance with Town-code and the total number of bedrooms on record is &iA- This information has been obtained from: CERTIFICATE OF OCCUPANCY: = ASSESSORS RECORD: OTHER St tc _ V`"•3�� �1 S�o)oo Building Inspector BFhouseguidelines T. �1 17 ED: RE EI D,4 R -2 %U E511 FS r'2-1 A FACSIMILE F N.Y.S. SEALS NEW S RK S T E DIVIION OF 151- HOUSI", MUNITY RENEWAL STAMP 0 APPROVAL FOR A MODEL OR COMPONENT VIV131" P"M APPROVAL N DATE Of APPROVAL 001 25 BR 2 NOTICE.- This opw"ovel II not relieve the Wmfactu•er % T trorn responsM�ty for d tone from the ;•Pr- ot, --oc.- meets nor does "is appro I relieve him from fesp o,m.b;i;ty ter error: at omissions. t a t OOMMISSIONER By:......- ............ ......... NEW YORK S TE DIVISION OF HOUSING AND C MUNITY RENEWAL This plan appr is applicable only to twe commporient component f the factory manu- are assembled and in- '2; at the -91/1 tory manufacturer's 16, *.A AL I tA All— PL,& 30(, mc: Uwr V&M;3C,;3 '1.813¢ REV. UL2 L 400 9- LA.*1 ERR 'W4- SUPERIOR BUILDERS OWN. BY: OAT E SCALE: FAD ILI 10. .5 1 L-ITT- DATC_ vis.4riowi 5(-64&r7uLF- BUILDER /DEVELOPER AUTHORIZATION: L& f IS6 '4, 1 OR ALl H �--P—1 I -RIIATI— I ./41c4ived go.�h 5 �G ! - _ - -- _.- ��' �.��- 7. < ?.� -: -. ..♦ - .. ..'.':.�.:.... -: was;': - -,r- �i?�:"•:- �'r _.j. ',�*, .. ••;..:.- ,�•.,� ... • gym. .. _. • .. .. ..... _ ._.. .. cl ' . 9- - �.;�.... tip.._ ..:.......... a. L -jVl`^ r ;I 4j: _ . c. .. ... �) _ � /3� � ��d-�: .fix ... .. .. _ ... �) �•�•?�� r o �k- /;3.... tc� M 3 PUTNC(�Ul�'!'Y DAiT �— r--o /344 ��u ro 7 op" 7. I�1J Co HOUSE PLANS A*AgMfR*ep . BEDROOM .COUNT ONLY] _.. 4i Signature & Title � h ... �.... place 'on .' good operatingnconddion any.'part of said seWage disposal system = during;, the. per i0gof- tV642JAY i ua�dia ly following'thedate of the. issu -. ance .of ahe' approval of._the Certifleate; of Construction ,:Compliance original. system r arty us there f! Botha tno drilled well described above '6i_ will beaocated adahown or the approved plan and that said well will ba, nstalled �n accordance _ tt6° e t ds r ®a¢{ regu a�Tons ; ;.04 :the" Putnam County Department of Health p p . . x Date` .� Signed r G yi Address cerise No 9 APPROVED FOR: CONSTRUCTION 'I s approval expires one, year ,from e4 date issued u �Ean yOctidh QbIt Iding has been, undertaken and is w, :.. ,< _ sio i aghange or::alteration of construction be modified -con d' by the reyocable:for, cause or may amends or when ecessary C o�9 requires`'a new .pe mit - Approved for isposal of domestI ` sani r sews e, antl /o`r. � irate - .; :. ater. S�f ° - --- •, - _ - assa Date BY ... .. ..• Rev. 9 -81 :• ,. _ 0 I I., In PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located .at r. (T C-1,171 a'l-rZ Section Block Lot Zp �j Subdivision of Subdv. Lot #- Filed Map #, Gentlemen: Date C5 This letter is to authorize elf 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 . i n conf or�ifj WI "t - "il fi- e-'pr-ovisions of-'Articie 145 or 147, ' Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: or 0 WP' 4. Address Telephone • ....... Very truly yours, Signed Owner of Property 17D X. ) Z. Address Town 3.�9e Telephone h4e M6- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _• -. i �'<_ 4a^ e�e�..r .tr . � ... -. '. 1.<� .': .p � '. "... �: �. ay-•.r� i�•l. s L v � f♦ -•���` ,c s � ,._ _..• �. r� ..n ♦ u .: +0+. .. � M��.w . COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /s% G�✓a'r'�r� Address Em'�D' 12,y T Located at (Street � A 1,,f ae, Sec. f/ Block Lot- --L7`� � 'dicate neares - cross street) Municipality �' Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches a j 23 3 47" 4 5 07 20 4 5 1 4 3 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. A TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICA'T'ION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES' DEPTH HOLE NO. HOLE NO. HOLE NO. ­3 G.L. 611 12" _ 18 11 h 24" 30" 361f . 42" 48" 5411 � 60" 66" 7211 78" 84" INDICATE LEVEL AT WHICH GROUND WATER- IS ENCOUNTERED H"ICTI.__WATER LL+V L..RISE .A?± TER 1REIJ C., ENI.,�UNTER.FP - TESTS MADE BY Date DESIGN Soil Rate Used _Min/1 "Drop: S.D. Usable Area Provided v6OP C> No. of Bedrooms -3 Septic Tank Capacity /P410' Gals. Type Absorption Area Provided By- � L. F.x24" '— width trenc . Address THIS SPACE FOR USE BY HEA112H DEPARTPZFNT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by to 7 ]PST NAM COUNTY DEPARTMENT Off' HEALTH l Division of Environmental Haolih Services, Carmel, N. Y. 10392 Permit # = =g7 -'�CERTIFOCATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town a iage Located at �J�i` Tax Map Bloc Owns Owns ►�i' ^ �' / Formerly Tax Map Lot #�r I Subd. Lot # f a y / Separate Sewerage System built by rQ+ In AddressG Consisting of r�Oal. Septic Tank and �. r� /1 J��� s^P- "cr: Other requirements Water Supply: n Public Supply From _ �:" Private Supply Drilled By Address Building Type j e-!t�' -; '. No. of Bedrooms —� Date Permit Issued � Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentia of which are attached), and in accordance with the standards, rules and regulations, in Putnam County Department Of Health. ° 0o66 o Date Certified Address Any person occupying premises served by the above system(s) shall promptly take such act 9(0; 'k.m be conditions resulting from such usage. Approval of the separate sewerage system shall be e�frpn available and the approval of the private water supply shall become null and void when a p subject to modification or change when, in the judgment of the Co nor of Health, Rev. 9 -81 � go, l� a plans of the completed work ( copies S�bled plan, and the permit issued by the ��� / F.� � P. E. R.A. License No.� the corroction of any unsanitary a public sanitary sower becomes avalloblo. Such opprovals are i or change Is necoswry. Title WELL COMPLETION REPORT y P.UTNAM COUNTY DEPARTMENT OF HEALTH e 3)71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. • ,. "• , <; :: �,_ „; REP® :: b9uSZ ` :3 'SgF EDT DAS V'A N MPLETI6N_9 � _ :_ ; : ; • :-., ;; :.. ~; := � : tNAME C w ADDRESS OWNER LOCATION / . OF WELL ❑ ❑BUSINESS ESTABLISHMENT FARM ❑ INDUSTRIAL AIR ❑ CONDITIONING PROPOSED. 2 DOMESTIC USE OF PERCUSSION WELL PUBLIC ❑ PUMPED L^J SUPPLY DRILLING (� EQUIPMENT I! 7' ROTARY CASING LENGTH (feet) —DE AILS YIELD j TEST CJ BAILED WATER MEASURE FROM LEVEL MAKE SCREEN DETAILS SLOT SIZE DEPTH FROM LAND SURFACE FEET to FEET goo 7'}6 / . ❑ ❑BUSINESS ESTABLISHMENT FARM ❑ INDUSTRIAL AIR ❑ CONDITIONING CABLE ❑ ❑COMPRESSED AIR PERCUSSION PERCUSSION )IAMETER(Inches) /r WEIGHT PER FOOTS THREADED ❑ WELDED PUMPED L^J COMPRESSED AIR I °^1 L URFACE —STATIC (Specify feet)I DURING YIELD TEST [loot) ❑ TEST WELL OTHER (Specify) ❑OTHER (Specify) (AYES U NO I eSJ YES U NO i:PM'. —_. _.. _ -_ YIELD'(G.P.M.) �S Depth of Completed Well in feet below Land surface: DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (toot) TO PACKED: gravel pack (inches): FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE i DATE WELL ! MPlET40 DATE OF REPORT I jLLER (` n ure ,�_ �ORKT,OWN MEDICAL LABORATORY INC. P.G. fox 99 321 Kear Street LOCATIONS: Yorktown Heights, N.Y. 10598 ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 - - -- 9 o- nn q . _ ❑ 495 MAIN - KISCO,.N.Y. 10549 666.3335 ,Li -320.3 - . _ _ .. _ . O STONELEIGH AVE. (NEAR HOSPITAL). CARMEL; N: Y.'10512 278 1AB # 14959 r MICHAEL ROTH L TAKE PEMKILL9 NY 10536 DATE TAKEN: DATE RECEIVED: DATE REPORTED: 101119184 SAMPLE SOURCE:KM T T Po REFERRED BY: PHIMUpf J COLLECTED BY: LABORATORY REPORT mg /L ❑ ACIDITY ..............:............. ............................... ❑ ALKALINITY .................%`%• ............................... BACTERIA, TOTAL /mL .......<.... • .............................. ❑ SOD. 5 DAY ............................ ............................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, f REE ........ ............................... ❑ CHLORIDE ............................ ............................... ❑ CHLORINE ............................ ............................... ❑ COD ..................................... ........................ ........ ❑ COLOR ................................ ............................... ❑ CYANIDE ............................ ............................... ❑ .DETERGENT, ANIONIC ............ ............................... RFLUOR10F ............................ ............................... ❑ HARDNESS ............................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml . ......... ../.II................... MFT COLIFORM COUNT/ 100 ml ...... C .................. ❑.CONFIRMATORY TEST ............ ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ ODOR ................................ ............................... ❑ OIL & GREASE ... ...................... ............................... ❑ PH ............................ ..... ❑ PHENOL ................................ ............................... ❑ PHOSPHATE (ortho) ............................................... O PHOSPHATE (condensed) ............ ............................... ❑ PHOSPHATE (total) ................ ............................... O SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ SOLIDS, DISSOLVED ........................................ ❑ SOLIDS, TOTAL ..................... ............................... ❑ SOLIDS. VOLATILE ................. ............................... ❑ SPECIFIC CONDUCTANCE ......... .....................:......... OSULFATE ............................. ............................... ❑ SULFIDE ............................. ............................... OSULFITE ............................. ............................... ❑ SURFACTANTS ❑ TURBIDITY ......................... ............................... ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY .............. ............................... ❑ ARSENIC .................................... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............:.................. ❑ BISMUTH .................................... ............................... ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM (tot.) ........:................... ............................... ❑ CHROMIUM (heuavalent) .................... ............................... ❑ COBALT .................................... ............................... OCOPPER .................................... ............................... ❑ GOLD .........................:.............. ............................... ❑ IRON ........................................ ............................... ❑ LEAD ..:.............................'........ ............................... ❑ LITHIUM .................................... ............................... ...4... ❑ MANGANESE ......................" ..... ............................... i� ❑ MERCURY .................................... ............................... ❑.NICKEL ............................:........... ............................... - ❑ PALLADIUM ................................ ............................... OPOTASSIUM ................................ ............................... ❑ RHODIUM ............................... . ............................... ❑ SELENIUM ..................................... .............................. ❑ SI LICQ� .................................... ............................... ❑ SILVER ..........:............................. ............................... OSODIUM ........................................ ............................... ❑ TIN ............................................ ............................... ` ❑ ZINC ............................................ ............................... ❑ .................................................... ............................... ❑ .................................................. . ............................ .�... ❑ REMARKS: ........................................... ! .......................... ❑ .................................................... ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... O.................................................... ............................... ❑ .................................................... ............................... O.................................................... ............................... THESE RESULTS INDICATE THAT T11F WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED; �THEESEO�RRRKKESgULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEMICAL QUALITY OF RYPARAMETEADMINISTRATIVE ST RULES & REGULATIONS, DRINKING WATER RSSTAND S .(PART 72). ALBERT__RI_ PADOVANI 11 'f (ASCP1 DTRECTOR -* Owner or Purc aser of Building I/ Section i'TZtI'dtr�g' i.Ci�rls ~zYi c'�e'cl`''by "' Bloc Location - Street Municipality Building Type 'A Lot Subdivision Name i Subdv. Lot # GUARANTEE 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 guarantee to the owner,.his success- ors, 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 made 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 determin- at:i.on.. of -the Director. of .the Division. of Enviroiii rental °-Hea'lth''S ;ervkc,eg; b° t` he " °t'utiiam'Courity"Department"of Health as to� whether or not the fail- y ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. �O Dated this day of 19`P -J- Signature�� O� Title Corporation Name if corp. 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 P " 1 17 2. ell Ile 4