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HomeMy WebLinkAbout4023DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.65 -2 -7 BOX 31 04023 + ■� !!,r--! ,' how 1 . 116 IS �ti , , ■ ,. . 04023 _tk 6 J PUTNAM COUNTY HEALTH DEPARTMENT /i DIVISION OF ENVIRONMENTAL HEALTH SERVICES ® _ PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO/ . Internal Use Only PERMIT # UJ- ❑ Repair Permit issued in last 5 years ❑- ,Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. M, /' Delegated ❑ lJ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �9�' Ti3N6t.�w I,�,p¢ ��OW N �� TM '# 6 S- - Q. `l OWNER'S NAME J-r-e L.0 e- !N rA' p. ft,J; �,VW- 4J PHONE # 9'1 y -s ilo ' 1�►lo f MAILING ADDRESS 4-k C `PCKSV- tI , AI �` t 0-5-,C3 "I APPLICANT _ W#" i4•fi(ot:R,Qr Name & Relationship (i.e., owner, tenant, contractor) DATE FACILITY TYPE P-9-S' PCHD COMPLAINT # 496. &st+4WNW+ C P-0� PROPOSED INSTALLER 40-- Rig--s-5 9S ao GPAS �- �.... �` �f ter' P4 ADDRESS REGISTRATION /LICENSE Proposal (include a separa% sketch local!ing 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 I, as owner,agree to the conditions st ted on this form SIGNATURE TITLE V VJ4E rL DATE 4111VI se, (owner) CIL I; ihe:- septic-ins liar; agreeao comply with,the conditiensolof this permit-for the septic-.system repair:. SIGNATUR TITLE �(',k j' DATE (installer) Proposal approved 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 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. INTERNAL USE ONLY Proposal Approved E�K Proposal Denied ❑ 99&=m,1 Z:�Z� ----A Ins rector's Signature & Title e / Ex (ratio ' Date Re air proposal is in compliance with applicable codes Yes t►7' No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Putnam County Departmen¢ of Health Division of Environmental Health Services al ' SSTS Repair — Final Slte lira tion aee: �/7 Her: 3 ow �r • _� °.fir Town• R ®pair Permit #: ? — 0 S —/ 4� 'I'1� # Y S . S o'Z — 7 A. Type of System: Conventional ® Alternate ® Comments: 2. N&TAM I Yes No N /.4 Comments L Septic tank size — 1,000... 1,250... other..... Used c."we- -z,, k w �e �e b. Septic tank installed level ...................... c. 10° minimum from foundation .................. d. L All outlets at same elevation (grater tested) .. . I Protected below frost............................. iii. Minimum 2 ti. Original soil between box � trenches P. ft Raw — erk set . ..... f L lets o ned for ' mection ii. Length required / Leagdr installed. wl Z 33& .` yolt -4 -rocs iii. Pipe slope checked ... ............................... iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft — foundations ... VI. Size of gravel % - l diameter clean ......... :....a3epffr of gavel In Wench 12" minim= - - viii. Ends .,. a. UNILor am fibkak L SM Ater WCWd as Per 8PPr0Ved Plans b. An section — c. Distance from wafer course/wetlands 4. overall Workin L Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... c. Backfll material contains stones <4" diameter....... .. d., Curtain drain do standpipes installed according to plan a. Curtain drain outfall protected dr dir to exist watercourse f ]Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev- 011312 As 06 10.x'3`, CQO f Fvr j;1(7 -r -------------- As 06 c.T-- -------- _ aYof -- - r--.s : i:r`= _ ^r .`�.. �_ ..::u-�l �-•�! i ^IJ' -':..- .--- �-C.4.� �. s' .I�..4 ?'.:. -�`+ :... h.,... ...r ray. 330 rD p6s J j is c C s YI e X tsTl �G Pt w e QA -� - �s fL -._ ....... G OS eill p 10 rm 1C4 108 Tan glewylde Rd 25 m Tue Apr 15 2014 02:37:45 PM. tches 2 iil I = .e..4:. .�. ,s�r+•'%.i.. .'6, =�r� ,'.Yew, e�...'�Y', �. -..r '.e,: .- Snr'd�• *'lam PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: Z I GAG �d`'�✓l'y�� S Loeated at (street): - Ta n ri le W'/ � d Municipality: yTVI I✓� V � Address: V, le'4 TM# A _�g �OS =� — 7 Watershed: - SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre-soaking: Date of Percolation Test: �/ 11 1 Hole No: Hole depth (Inches) Ran No. Start— Elapse Time (min.) Depth to water from surface �o (inches) Start- Stop water level drop p in inches Percolation Rate vain/inch 2 7 3 3 1 2 r. ' 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. Forth DN97, Pg I of 2 TEST PIT DATA DESCMPTI ®N OF SOILS ENC®IlMREIlD IN TEST HOLES G.L. 0.5' 1.0' 1.5' CA 2.0' 2.5' 3.0'. 3.5' 4.0' 4.5' 5.0' 5:5' 6.0' 7:0' i 6.0' 6.5' 9.0' 9.5' Indicate level at which groundwater is encountered Indicate level at which mottling is observed A/0-- Indicate level to which water level rises after being encountered /j/ L Deep. hole observations grade by: : — Date gJ16 Design Professional Name: Address: Signature: IIDesngo ProfessionaaRls Seall Revised July 2013 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR SITE LOCATION My. OWNER'S NAME MAILING ADDRESS ,= OFFICIAL USE ONLY -DA TM# 6 Z 7 tD PHONE -2id' U,4-Q kL c2 Pr -- &/Z Zs� (Ae N• 1136 PERSON INTERVIEWED PCHD Complaint # Name & RE ations ip i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER ,�/ �4., ��% PHONE ADDRESS REGISTRATION# PL 33,0 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. Is. i�wi�err.D 4► d.a cr a ip t:t>,e.:n�iltic>ns sttcci �t�:tb�s ern. SIGNATURE TITLE[ /NC' Proposal approved with the following conditions: I . Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: DATE Za- a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved� loe Inspector's Signature & Title D COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML i� r BRUCE R. FOLEY . Public Health Director LORETTA MOLINARI R.N., M.S.N. 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 24, 2002 Mike Arnold 38 -08 212st Bayside, NY 11361 Re: Addition - Arnold, 108 Tanglewylde Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #83.65 -2 -7 Dear Mr. Arnold: 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 24, 2002. The. addition is approved with the following conditions: �1: hE- tiathmbor-0 fedxoomast- Temaaate-it;rautprioi^ 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. 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 your , ._ -.. _:._...... . William Hedges WH -lm Senior Public Health Sanitarian CC:BI Y, S . • �.,.PS..�- p•:'Y. l"l+••.asa �' ..1. �'�"r <.'�"��.'1��. r..�: t�. w. a. T/` .. a BRUCE R FOLEY Public Health Director i - c�ygd':'r! F4i r }� �. - ,n.,..�T.�•" .-.:yam a Tr •.. R` t. �1. -..v_� DEPARTMENT OF B EAI,TH 1 Geneva Road Brewster, New York 10509 LOREM MOLINARI RN., M.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)279-6014 Preschool (845) 278 -6082. Fax (845) 278 - 6648 . ADDITION APPLICATION (RESIDENTIAL ONLY), e9 f2 STREETAV 7-4-v � c� RPTO %+X MAPfO NAME N i PHONE�I,� %2 © A PCHD4 MAULING ADDRESS 2,12S;4, DESCRIPTION OF ADDITION r � ivG U Vim 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 ofplans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam ::o'z:nttj 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 51 al, DEPARTMENT, OF HEALTH I Geneva Road Brewster, New York 10509 ORPT-TA- = MOLIN '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 (84S) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278-6082 Fax (845) 278 - 6648 September 23, 2002 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 108 Tanglewylde Road Residence Tax Map 83 65-2-7 Town of Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling ls� 0 0 in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: BFhouseguidelines INSPECTOR 1 - ..- 161.84 1Ao w t� 157• ,�39 lo V 149.18 6 1 gyp' t KP- 10 � ��. `-- -• f - X33 1 co ' 128.94 • l ' X32 v .'.c Syr..: .. ....r. a Y..,•!"'���--r� � tr,,.. .is °0 �c 3 3 6� 366 361 369 3�0 3� 1 1 69 084 . t. — .. 'f. Q:� �+'. r 'Y .. .'4e. ..4r_ ia:• . ,�..' v- :�.`�'E`'�. �• 'C` �,rlt �. .I. •� �� s A e9 157.64 —�. 6c cg 31 3 CS rob CO to 36� p ® P? d 128.94 0 � 31® D