HomeMy WebLinkAbout4136DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631 -589 -8100
83.74 -1 -29
BOX 32
IN r �. �•� �+ . O r Loom
■
�
• �
No
Ids No
�
r rz
,
I UL
w IN
04136
n
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES1
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
YES NOX, Internal Use Only PERMIT # s .
—/ Z 1az
❑ Repair Permit issued in last 5 years of in Watershed
Cl Repair within Boyd's Comers, W. Branch or Croton Falls Res. 0 Delegated
I
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland I 1 ❑ Joint Review
SITE LOCATION
OWNER'S NAME CJic� c�c� k
MAILING ADDRESS /d 'Pol
TOWN
TM # 3, `14 f - --I
NE # 63 —,� 4/a
APPLICANT CD(na,2 _ Vie t
Name & Relationship p.e., owner, tenant, contractor)
DATE 8111 12-- FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER
ADDRESS
_ REGISTRATION /LICENSE # %IS
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 roposal from licensed professional depending on the
I, as owner, ree the. con =sted s form
)( SIGNATURE QATITLE DATE � vL a
(owner)
I, the septic installer, agree to comp) with the conditions of this permit for the septic system repair
SIGNATURE_ , TITLE 4�4� . DATE l
(Installer)
Proposal moved 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 ❑ Proposal Denied ❑
Inspector's Signature & Title DatlK
/ Expiratio Date
,Repair proposal is in compliance with applicable codes Yes No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2107
Sheet_ of
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEATLH SERVICES
FIELD ACTIVITY REPORT
AT)T)RFR4s C, A/i VQ/IC.s V,
Street Town State Zip
PERSON IN CHARGE
OR TNTFR VTFF ;� WD. d? /9 4 .6'aid 104a don S-1 llatP
Name and Title
TYPE OF FACILITY: S; ►� a I Fg. %� �c ��,/,e,,,�c 5 r 5 �,�..`d®
FINDINGS:
0 We
TN1,RPF,rT0R; TFT
Signature and Title
RF_P_ORT RFrRTVFT) RV:
I acknowledge receipt of this report: SIGNATURE:
02/96 Title;
Rev.
��33a izs.��arge
SAD
C6
!d
. PUT-NAN-1. COUNITY DEPARTTIVIENT OF HEALTH
DESIGN' DATA SI-IET -* SUBSURFACE Sri-WAGE TREAT,/EENTTS 7-L'STE-M
Owner; i ve—VOL Address: -�K' zz. 1P.010
Located at (street).- 13. 7#
TV1 m Sec ti o n:
— B I Q C k Luc
Municipality: 71 j �- Wzte-shed: . 2��116 �14
SOIL PERCOLATION TEST DATA
Witnessed by: —
D a te *o I Pre-5oa kin"T. Date of Percolation Test:*
Hole 'iN o.
Run Rio.
Time
Start —
Stop
I Elapse
Time
(m in.
Depth to
water from
I
1
-round
surface
(inches.)
Start - S to-P
);Pater
le-vet . drop
in inches
1 Percolation
Rate
miniinch
2
.3
I
�4
-------------------
3
4
- -----
2-
3
4
.3
I T-q7r ,n -.p ripnrh IIT,.,;l
TEST PIT DATA
CI iPTI' FS 9=
-'0L= = HOLE HOL=
T
1.01
2.:"
3.0'
3.S
4.cl,
C'em R-4,c
TO,
Indicate !ev--1 at w1uch zmundwaler is encounnl,.re, files r
Indicate [ev.-I at which motiljn-� ;,s obser-i-ld,
I Level to which water level, uses a ter bei -
; --co un e
re
Deto
hole obs'—,vailons made bv:
Design Professional Nanne-,
Address:
Q :
S, p,
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICKT'1ON rU
PCHD PERMIT #`�
WELL LOCATION
StreeVgAddre Town
J� 7aff
City Tax Grid Number
///- _Z_ -
WELL OWNER
Name Mailing Address
LL//a!22 / 2 4AWe,6VI
ZPrivate
7 O Public
OF WELL
1 - primary
- secondary
RESIDENTIAL O PUBLIC SUPPLY
O BUSINESS O FARM
0 INDUSTRIAL O INSTITUTIONAL
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
/ ,�,
YIELD SOUGHT�_gpm /# PEOPLE SERVED /EST. OF DAILY USAGEl "Jgal
PLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING 13 DEEPEN E TING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
S' G < ol
WELL TYPE
RILLED
DRIVEN
DUG
GRAVEL
OTHER
IS WELL SITE SUBJECT. TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: ,
Name. & '! ,, h-76 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: 5e45 ,(W YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY -• FROM - NEAREST - WATER - MAIN:-
LOCATION SKETCV,,& SOURCES OF CONTAMINATION PROVIDED
N 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
thirt -y (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 dr' ', operations be contained on this
property and in such a manner as not to degrade or othe a contZZ rface or groundwater.
Date of Issue: 6,1j_1 1913 tf r
Date of Expiration6 21 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
!t
..........
j, ji, j; Two
OOV &,ellvCw SURVEY
C -oe -5--- e 7101V
OF PROPERTY SITUATE AT
-,fLAKE! PEEKSKILL
TOWN OF, PUTNAM VALLEY, PUTNAM CO., N. Y.
SCALE --L=
SURVEYED BY
J. WILBUR IRISH
.---,906 SOUTH ST-PEEKSKILL, N. Y.
0
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Carl DeNisco
4 Point Drive North
Lake Peekskill, NY 10537
Dear Mr. DeNisco:
:BRUCE - R.- FOLEY, .R.S.....-
-
_Acti _
ng Public Health Director
February 21, 1996
Re: Addition -
No increase in number of
bedrooms
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 latest
revision date of February 21, 1996 and this Department's approval stamp.
Based on the information submitted, the above mentioned 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 -.e.:, new-
_ , .._.... .
lo,�:.f ?us" 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.
Sincerely,
f�
Robert Morris, P. E.
Public Health Engineer
RM/ j p
cc: BI (T) Putnam Valley
MARVIN O'DELL
TOWN HALL-,
UTNAM VALLEY, N.Y.
Bldg. Inspector ° (914) 526 2377
w.
BETTE STOCKINGER
JOHN MAHONEY Bldg. Dept. Clerk
Deputy Zoning Inspector TOWN OF P U T N A M VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
February 13, 1996
Putnam County Dept. of Health
4 Geneva Road
Brewster, N.Y. 10509
Att: Robert Morris
Re: Building Status
Carl DeNisco, III
4 Point Dr. N.
TM #83.74 -1 -27
Dear Mr. Morris:
The above noted residence proposed to be expanded,
presently consists of three bedrooms (3) with an
upper aevel loft which. i.s approximately. 20'
Very truly yours,
MARVIN 0 DELL
Building & Zoning Inspector
MO'D:es
I
07;14/95 FRI 15:55 FAX 2.1.2-695 0058 CR.IRLES RIZZO
✓ H I
W'
O�
c
1i
v �
O � �
�OOJ
9
N'
(A
ev-
..
-
Jl _
O
( IJTl VI171LV M1� �
f
_
,•. 4
_f
4.
F
o
q
Ll
1 (
Y 9
r
'
tip :
_ v
� ._. � .�
��;• � �,.
•
' �
11.1:
I 1
1 •
CD
(17/14/95 FRI 15:55 FAX 212 605 6058. CHARLES RIZZO
(n
0