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Home My WebLink About4276DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -2 -54 BOX 32 04276 NY r 0 ;' I ti I IN., L W.N. 1 1 T ■ I , �1 ' IN 1 , m IN IN IN 1 I 1 ,,, 04276 PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Internal Use Oniv PERMIT # LJ u Repair Permit issued In last 5 years LJ Not in Watershed ❑ ❑ Repair within Boyd's Comers, W. Branch or. Croton Falls Res.. ❑ D_Ble ated - -❑ - -- ❑ - - RefSalr'wlthih 160 it' of• a'vratercourse ar'DEC= mapped wettan�i _ ❑ Joint Review SITE LOCATION TOWN1C�1 •vr� -� i/, 6� TM # OWNER'S NAME (i trt_ i.(i PHONE # MAILING ADDRESS _ � C.% ' tS l&,a7 APPLICANT 06 L) L b / e e'/L Name & Relationship (i.e., owner, tenant, contractor) DATE 31, 413 FACILITY TYPE PCHD COMPLAINT # :-.PROPOSED INSTALLER 6q-( �. vy i�LJr+rr3 +^6 PHONE # f°5,66/ t9 >-j A�' z- ADDRESS ", -&C, bt) c� REGISTRATION /LICENSE # f�3 037 A- Pro o al (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 proposal from licensed professional depending on the nature and extent of the repair. fz) - .._ A S & 0WL ia." J 01 V3 I, as owner,agree p the conditions stated on this form SIGNATURE TITLE 401V, 4oir t� DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE 1/It+�.�..�i1�- DATE 7/t 9-/!i (installer) Proposal approved with the following conditions; - - - -- i : —Procurement of any T Own Permit, If app'iicable. r 2. Submission of as built repair sketch by the septic system installer within 30 days, of the repair, in duplicate show g: 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 Date Expiration Date ,Repair proposal is in compliance with applicable codes Yes G No n COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES T✓ r NO/ Internal Use Only PERMIT #e'er 01?�. –i3 Li L*J Repair Permit issued in last 5 years ffI,,Nbt in. W atershed ❑,/` Repair within Boyd's Comers, W. Branch or Croton Falls Res. W Delegated L ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review. . SITE LOCATION oy /A Sr— TOWN TM # f3 OWNER'S NAME /? lc% PHONE # ` /PW" 66.1? MAILING ADDRESS �'%� C 4.- 5 APPLICANT ✓ L n Alf Name & Relationship (i.e., ownef, tenant, c ntract9!;y / DATE 3 L10�7 FACILITY TYPE e.� PCHD COMPLAINT # PROPOSED INSTALLER °PHONE # ADDRESS i % 6 REGISTRATION /LICENSE # )1-3 30-3-7/7 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 proposal from licensed professional depending on the nature a d extent of the rem. ! ! 1141-1110 'Of 4 C-4/t I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) :.t,�tkte�epflc �g'r _coftPly with theerfdiions c�fYhis:peit#�x it�e septic srstere� air: ; : _ - -37 SIGNATU TITLE . "r:, 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. r INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Dale Ef pirati Date .Repair proposal is in compliance with applicable codes Yes E No D COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 `F PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..PROPOSAL FOR - SEWAGE. TREATMENT_SYSTEWREPAIR. YES NO Internal Use Only PERMIT # K, O 40 ❑ ❑ pair Permit issued in last 5 years ❑ t in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION a� 11.94 Zit 571-- TOWN 0;**-A VA 11UL1 TM # OWNER'S NAME 04-MAr4 lWT.>, PI ONE# 7/9.7) • 13 MAILING ADDRESS Dw JL1,46&-!k Sr -e¢, Iu1 101''7 APPLICANT A01r M414r. C4 [. ivy Pl! � Name & Relationship (i.e., owner, tenant (contractor) DATE FACILITY-TYPE / L i-,VM PCHD COMPLAINT # PROPOSED INSTALLER 4 P(Om03P -4 PHONE #FV S-d�oaY7 ADDRESS v GAJ '*FAQ- Ae� REGISTRATION . /LICENSE #P063-7/59 1013 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 proposal from licensed professional depending on the K ture nd exte of a repair i r� I, as owner,agreelfdthe conditioitts vWtedM this form SIGNATURE (owner) TITLE Du:VI `eC DATE 3 -13�- 1 u apse to rti h4hedon- troiii- -xhis psrmit'f6r,;l. i6 s6ptlG "system repar SIGNATURE v VAL TITLE Qi1AStrrDy ---'] 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. iurcQtier "CF: ~ v Proposal Approved Proposal Denied ❑ rs D to Expiration Date r & Repair proposal is in compliance with applicable codes Yes 0 No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 .0 ;�acal Guy Plumbing I brain { s Services Inc. 3 Finch, Lane i Lake Peekskill, MY. 10537 r' TAI: (845) 525.2471 r 3 A/G Ao a1 r�STI /000 i ✓C fa 4 , 1 1 :1 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH I Geneva Road, . Brewster, New York 10509 ROBERT. J. BONDI County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6559 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) �71K TOWN lou V4 STREET 1XVA14 :5 TX MAP # y �� Y NAME Aktq W1-W1,-XMS PHONE-S4g sas PCHD # d�S�- OY_ MAILING ADDRESS -?a' %u le 37 6 jjri)t)jAAP_( i� IIS NY IQSEIO DESCRIPTION OF ADDITION r-L, z NUMBER OF EXISTING BEDROOMS . 3 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 ..sections ofthe,Putnam. County -S Code-i- pli able anataty- Please submit this form and the following to Putnam County Health Dept, 4 Geneva Rd., Brewster, NY -10509, Phone 278-6130.. dd check or money order for $100.00. 2. Sketches of existing, floor plan (drawn to'scale, all Wing area including basement) Non-prof6ssional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with pame,street, and tax map Non-professional sketches are acceptable 4. Copy ofsurvey 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 Ceft., of Occupancy from Town or Certification from Building Dept with legal bedroom count of dwelling. OFF UCE- Comments Feb 98 T:'�J.:4 {' ,� tr •:.,�. wq .ii'p � P., f - ".[, = w .... 4' ...� .� C�--.. ... � . � LORETTA MOLINARI Public Health Director 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 2, 2004 First Choice 872 Route 376 Wappingers Falls, NY 12590 Re: Addition- Williams, 28 Harper St. No Increases in Number of Bedrooms (T) Putnam. Valley, TM #83. -2 -54 Dear Sirs: ROBERT J. BONDI County Executive I h ave r eceived a nd r eviewed t he p lans f or t he p roposed r eplacement t o the above - mentioned residence which was destroyed by fire. The proposal for the replacement has been approved as per plans bearing the approval stamp from this Department dated September 2, 2004. The addition is approved with the following conditions: The total number of bedrooms must remain at three without prior approval by this department. `. ..' 2. ". ;`I`lie ea if.tliE',ex sting:se ag�.zlisposa�l_j;ysteri3,� 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, William Hedges WH: lm Senior Public Health Sanitarian cc:BI (T) Putnam Valley y4v As —i3 �_0 �l 3 iY r371 wl 6 16.c Local G'I'v Phumbing Drain 'ec S ervi., - - inc. 3 Finch Lane Lake Peekskill, N.Y. 10537 Tell: (345) 526-2471 ,f' r371 wl 6 16.c Sheet I of PUTNAM COUNTY DEPARTMENT OF HEALTH SID FIELD ACTIVITY REPORT AT)DRE.'s, Street Town State Zip PERSON IN CHARGE Name and Titl/e' TYPE OF FACILITY: h 80 TWSPF,C,T()'R, TFT Signature and Title REPORT RFC-FTVF-D"BV,' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. FINDINGS 13, h 80 TWSPF,C,T()'R, TFT Signature and Title REPORT RFC-FTVF-D"BV,' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. of 19 afLq .......::� . ........,.:. ;:.i;, ,...rxl:euf Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Inspection Date: 3 A Inspected by: �, �e�Q Installer: .�c-d-� Street Loca ion: �$ a rr�t- S{ _ Owner: Repair Permit #: Z — ol 13 TM #. Q3 1. Type of System: Conventional 0 Alternate 0 Comments: 2. Se tic Tank �.- - Yes No N/A Comments .a. Septic tank size - 1,OOO,,... 1,250 ... other ..... ii. Length required Length installed b. Septic tank installed level ...................... i iii. Pie slope checked c. 10' minimum from foundation -' iv. Installed according to plan d. Distribution Bog v. 10 ft. from property line — 20 ft — foundations ... i. All outlets at same elevation (water tested) ... / 4CC.,/ k1l, Mel�! Ati��I%! vi. Size of gravel' /. - 1 %s " diameter clean ......... ii. Protected below frost......... vii. Depth of gravel in trench 12" minimum ......... G iii. Minimum 2 ft. Original soil between box & trenches i viii. Ends capped e. Junction Box —properly set ........................... .� L. i reucues i. System completely opened for inspection ii. Length required Length installed iii. Pie slope checked -' iv. Installed according to plan v. 10 ft. from property line — 20 ft — foundations ... �•' / 4CC.,/ k1l, Mel�! Ati��I%! vi. Size of gravel' /. - 1 %s " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped g. Pump or Dosed Systems 3. SewaLye System Area , e a. SSTS Area located as per a roved plans b. Fill section — c. Distance from water course /wetlands 4.- Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... �,•° c. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 xis 4 Ale -�✓. . i �- 5�' jeaetlyJc�i' w :r ....._ .. ter' . s r - _ .. ... ..•.. ;.ya'. „ �. , .. .. - ......_ - - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: 046G S / �h74Z. Address: 8�7 a 8� •— 02•- �� Located at (street): TM # Section: — Block — Lot Municipality: Watershed: SOH- PERCOLATION TEST DATA Witnessed by: Date of Pre- soaking: Date of Percolation Test: Mote No. Run No. Time Start — Stop Elapse Time (min,) Depth. to . water from ground surface (inches) . Start - Stop Water level drop in inches Percolation Rate min /inch 1 Z 3 5 1 a 3 4 1' 2 3 4 5 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., < 1 min for 1 -30 min/inch, < Z min for 31 -60 miniinch), All data to be submitted for review. ?. Depth measurements to be made from top of hole. Form DD -97, pg I of''_ TEST PIT.]DATA DESCRIPTION OF SOIL$ ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered AZ2V,6 Indicate level at which mottling is observed A119AZ6 . Indicate level to which water level rises after being countered Deep hole observations made by: ra, 2bat. , ZZO l3 Design Professional Name: Address:. Signature: Design Professional = Seal ! r .7 lo. - 4— V 4" .............. . . . . . . . . . . Zr L, r, •44 Jo I T rl IL 4AT.4 ILI 4 13 I A,r zi Pzzl OFT. 3 A-5 FUTRAM COUNTY DEpARTMW OF jMa HOUSE PLAINS APPIROM FOR ZAOdddV SOld Zsfloli 477 do