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631- 589 -8100
84. -2 -28
BOX 33
04374
?'l mev. 3186
J
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Mast Provide
P.C.H.D. Permit N - - - -- - --
CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
' Located a � �t'I�i ,
Owner /applicant Name be V f 1To Formerly
Melling Address
v-rr4AtrA Vic"-4C
�rrT� _ Town or Village .
Tax Map U" —1' a "`: - Z' '
Subdivision Name SCAWA L--ji Sabdv. Lot N�
Date Permit Issued O 1 Ado V 9 &
Separate Sewerage System built by rv`0 L— 1., 6L-r96C IAG Ad/dressp i ON 05162 -
Consisting of ��� Gallon Septic Tank and`t +► ��% T
1J0T divll�IfJ4t. P� tLkt? 5.3�ccrnEA („Sr3 k e� Tl�.G► H• I �tSE� aP w.�fo tiv�PA� �tol �I,litu t' +/Ir �°E�.tftl�
Water Supply: Public Supply From Address p p
or:n a Private Supply Drilled by g��` °e Address q f0- rMtW kg
Building Type ' B o`�` Has Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance w th jihe filed plan, the permit issued by the
Putnam County Department Of Health. _ /
Date �7 A Pi' ell �^ Certified by c .2 P.E. v �)R.A.
Address ;L �0V *C 1LJ— 5-C, IPi)T:JA$4A �/�U, /v z ��y "License No. f1wo 9(a
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a publi: sanitary Sewer becomes
available and the approval of the private water supply shall become null and void when a �lc...water -. ly becomes available. Such approvals are
subject to modification or change when, in the Judgment of the Commissioner of. (h_such r ti0 , odifiutlon or change Is necessary.
Date � � Title
PU MAII[ COUffI'Y DBPARTNM OF HEALTH �� ��!'
J LP� Dl W --jR *4@gug@W Sun Ieevloea t7usel. N.Y. 1161? CO CENTEFICATS COVELIAMC POTt SEWAGE DISPOSAL SYST®l[ Prslt I ,
1�
-Town of Putnam Valley
- owl ar -- VMS&— . . - .. a ..
2 .. n.. David M. Schwartz Solid_ lot I 1 Tax Nisp 84 Blod 2 f� 28
Reaffloid-0 0
Omm /App■ca�t Mamma
Thomas A. Piacentini
Date of Previous Approval
mwfts �,� 5 -15 Rtnn ' 1 tZi al" Aup
JpatC Subdivision Annroved 7 -6 -89 #2422
nwmbs Type Residential Let Area 1.83 Ac
Mtabt d He�aama 3 Deep Fbw. G' P D 600
SepaleaM Sauraaage Sptam to pelum d—IM—Gallm Sq* Tack -ad 00 r,F
To be oumakectrd by Tri hp dPtermi ned Addrm
zip 10512
300
Fm Section Dept Volume
PCHD NoWleallob 4>Zegalred Wben Fig Is completed
F 7A11 ...4.1.E -1•:-- - -4+i ^n f•v -onnh
Water Supply. Public Supply Ftum Addmsi' .
an X Pdwab Sup Drilled by To be mod&. determined
Odw g. Mkreme.t, 81 — 011 DAPp Curt-j icaiI}
1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(Q. 1) that thaw rate saw a di o�sal s slam
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu ns o -i�EF� RI+�
County Department of Heath, and that on completion thereof a ••Catifioate of Construction Compliance" satisfactory to the CommiuMnar of Heallhwill
a submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier. that laid builds will
Noce in good operating condition any part of laid 0, go disposal system during the period of two 12) years immediately following the "to Of the Inm-
ana of the Opp►n at of the Certificate of Construction Compliance of the original system or any repairs thereto: 2) that the drilled well desurglou above
well be WAted as prows on the approved plan and that old wall will be Installed i accopan Ith standards, rules and ragu ns of the Putnam
County aOertment of Health.
X
Date May 51 1995 Signed P.E.— R.A.
Address
BADEY & WATSON P. Roca elks No 62505
APPROVED FOR CONSTRUCTION: This aPprOVal expires two years m he date Issued unless construction of the building has been undertaken and is
revocable for caw or 7rn,4A,,ovod be amalded or modified when consider y by the Issiomr of Health. Any change or alteration of construction
squires a new mill lOr, disposal of domestic fans ,and /o. afar supply only.
VV.
8 eta By Title
JUL -23 -2004 05:22 FROM MR ROOTER PLUMBING
TO
2787921
PU NAM COUNTY HEALTH DEPARTUMT
"OM SON OF -L IROMI,— E'jNTiL"HEA ,TH SERVICES
10) 11VI VA-174THI" �1.;X'Zlfl W31-11 v "!.. !,;!1
� r
SITE LOCATION pulti4m TM# y it eq 47
OWNER'S NAME /1 /7/ A! & * 10 1 A- PHONE 5
MAILING ADDRESS 2- f1?o *kt - .sr& 6
P. 02
V
PERSON INTERVIEWED L'/#e&/AJ tr i0-0WWE &-V-46 PCHD Complaint #
/ / OE a aaonss xp U., Owner, tenu etc.
DATE Z/ TYPE FACILITY I�eS N �i►6 -i
PROPOSED INSTALLER IY4. AbonrgA T4W PHONE 63S - 2WO -L -
ADDRESS / 7 140 ALE Afj KMCm I )U < - -V, /42-'�' UGISTRA`z'ION#
Ecogal (include sketch locating all adjacent wolfs):
NOTE: Repair must be in some location and of same type as original sewage disposal system .Diti+erent location
may require submittal of proposal from licensed professional engineer or registered architect
&SAX,F see
Y, as owner, or reneoted agent of owner agree to-d .-conditions
Emosal annraved'with the fnllQA U- godfitiom
1. Procurement of any Town 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 components tied to two fixed points (e g.,house corners).
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 oonditions.
Proposal approved
Inspector's Signature & Title
COPIES: _'White'(PCHD); Wow (Town E1); Pink (applicant)
PC-" 99UL
fATE
sfl- ..nnr_070_7004 MnMC. DI ITAICIM fYll 6JTV f1C0nDTMCAIT f1C D 0
JUL-23-2004 05:22 FROM MR ROOTER PLUMBING
Cowl
itiq M
nmeet
ti PLIV�V�w CO3 Ulu
TO 1 2797921 P.01
Fax Fromn (845) 635-1173
Volev., (845) 635-2102
Number of Pages (Including CoverSheet�;
Message.
AJ
Z Sir
C AT/o Fb &46ei- 7'
SITE LOCATION
OWNER'S NAME i
MAILING ADDRESS
�f f
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM _REPAIR
OFFICIAL USE ONLY
V -0
PERSON INTERVIEWED 0e-V i y PCHD Complaint #
- Dame -i .Relationship (i.e., owner, tenant, etc.)
DATE zz /A f/ TYPE FACILITY ReS,&AJ hi s--1
PROPOSED INSTALLER 104. 1?00I e- 1ZPZtJ/y',& AJ(b �c� PHONE 636 - Z✓o 7.
ADDRESS 1714) ,�LEd4S �� YAR � <� � REGISTRATION#
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.
jC6444F see AIIAC,414
r as owner, or renerited a en't of'owner'a ee to'the wiidit ons-Stated on tlns form: - -
SIGNATURE �y � TITLE COO. Vt&l & rt DATE 2 3/0 r
Proposal approved with the following conditions:
1. Procurement of any Town 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 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.
Proposal approved
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 9%E
DATE
I " a , , 11.
e
I• �- n ..i �.�_.G ."o •... .'e�!_ � PAa cn. o.. �av .+CO:�oesFy+%os'�� .- ,-v:- e - . .r �,i.A �`. ...: ...:a..' . - -.� �Oo f`� .a.. •v .oie: a4_.a9.irC'h �. � •e've-
Carmine Devito
2 Foothills Street
Putnam Valley, N.Y.
New High Cap.
Infiltrators New "D" Box
New "D" Box `® Failed lateral
"D" Box installed
incorrectly
Rest of field not used
IE
. 4
Exisitng leech lines
.� I
i.
Existing D Boxes
Speed Levelers Installed
Existing Tank not changed
New -D- Box
Existing leech lines
Permit # R-253-04
Tax Map # 84-2-28
Approval Date 7.27.04
As Built
Carmine Devito
2 Foothills Street
ti
Putnam Valley, N.Y.
New High Cap.
Infiltrators
32 ft
--MEW-
Exisitng leech lines
.� I
i.
Existing D Boxes
Speed Levelers Installed
Existing Tank not changed
New -D- Box
Existing leech lines
Permit # R-253-04
Tax Map # 84-2-28
Approval Date 7.27.04
As Built
Wt;LL L;Ur1rLr.11U►4 AE1rUr%.1 office Use Only
Y-4
DEPARTMENT OF HEALTH
i is-1'6,n- *Of'EnfiY6iVt6WM moa
v' I
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREET ESS: TAX GRID NUMBER:
WELL LOCATION Foothill Street, Putnam Valley, NY 7 —
WELL OWNER
NAME: ADDRESS:
.Carmine DeVito, 60 Barker St.,Apt..624,.-Mt-.---Kisco, NY 105 49
❑ PRIVATE
10 PUBLIC
USE OF WELL
1 - primary
2- secondary
12 RESIDENTIAL 0 PUBLIC SUPPLY O'AIR/COND./HEAT PUMP ❑ ABANDONED
❑ BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify)
C3 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY 0
AMOUNT OF USE
YIELD SOUGHT — gpm.INO. PEOPLE SERVED _/ EST. OF DAILY USAGE — gal.
REASON FOR
DRILLING
❑REPLACE EXISTING SUPPLY []TEST /OBSERVATION []ADDITIONAL SUPPLY
E]NEW SUPPLY (NEW DWELLING) ODEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 625 _ ft. I
STATIC WATER LEVEL 30 ft.1
DATE MEASURED 3/20/97
DRILLING
EQUIPMENT
[5 ROTARY (2 COMPRESSED AIR PERCUSSION 0 DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify):
WELL TYPE
❑ SCREENED 0 OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
TOTAL LENGTH --Ia— tL
MATERIALS: [2 STEEL 0 PLASTIC 0 OTHER
LENGTH BELOW GRADE 120 ft.
JOINTS: 0 WELDED 0 THREADED 0 OTHER
DIAMETER 6 in.
SEAL: 0 CEMENT GROUT 0 BENTONITE 0 OTHER
WEIGHT PER FOOT 19 Ib.1ft.
I DRIVE SHOE F3 YES 0 NO I LINER: OYES ONO
SCREEN
DETAILS...,
DIAMETER (in)
'SLOT SIZE
LENGTH (it)
DEPTH TU SCREEN (it)
DEVELOPED?
FIRST
0 YES ONO
HOURS,
-SECOND
GRAVEL PACK
C1 YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK - in. I
TOP
DEPTH —ft.
BOTTOM
DEPTH — ft.
WELL YIELD TEST -'If detailed pumping
METHOD: 0 PUMPED tests were done is in-
0 COMPRESSED AIR lormation attached?
l? BAILED 0 OTHER ❑ YES 0 NO
WELL LOG
it more detailed formation descriptions or Sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water Well
Bear. Dia-
inq mete
In
FORMATION DESCRIPTION
Mae
it .
ft.
WELL OEM
It.
DURATION
hr. min.
ORAWOOWN
It.
YIELD
gym.
L Ce
Surface
Suria
12
D r 111
Dr ilihg
in overburden clay and boulders
12
Hi rc
Hi rc
2k at 121
6251
6 hr.
560,
5
12
121
Dr llj
lliag
in rock, set casing, grouted
121
625
llffig
Dr llj
Dt
in rock granite
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? 0 YES 0 No
STORAGE TANK: TYPE_WX ±tM2 Well Xtrol
CAPACITY GAT,. 86
- - ---
1
PUMP INFORMATION
TYPE 4 Goulds — CAPACITY 5 qpm
MAK submersible DEPTH 5801
MODEL 5GS10412 VOLTAGE 2Q HP
WELL DRILLER NAME P.F. Beal & Sons, o DATE 17/97
ADDRESS 4 Putnam Avenue stGuATu
Brewster, NY 10509
3/89 - Maldolm T. Bear, Jr.
ti
=NORTH AMERICAN
t ,.70
-0.08A 0109-INC2.
CERTIFICATE OF LABORATORY ANALYSIS
LAB ID NUMBER: 97 -2068
CLIENT: P F Beal & Sons
4 Putnam Ave
Brewster NY 10509
SAMPLING LOCATION: Hose bib: Carmine DeVito, Foothill St, Putnam Valley
COLLECTED BY: MTB
DATE COLLECTED: 04 /16/97 TIME COLLECTED: 3:30 PM
DATE RECEIVED: 04 /17/97
DATE OF REPORT: 04 /21/97
ANALYTE
RESULT* UNITS
MAX CNTMT LEVEL **
METHOD
ANALYZED
Total Coliform
E. Coli
Absent
Absent
Must be "Absent"
Must be "Absent"
SM18(9223)
SM18(9223)
04/17/97
04/17/97
ibis "sample; -8 submitted- tc r'he laboratory, and' as compared f6 fl e'1Clew'Yoik'State•limifs for'dffiikirig-
water quality for the tests performed, was:
✓ ACCEPTABLE. _ NOT ACCEPTABLE.
r
NYS ELAP #11218
Maryann Fasano, Assistant Laboratory Director CT Lab Approval #PH -0171
* Underlined results are unacceptable according to health department and /or US EPA codes. .
** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes).
618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914- 278 -7600 / Fax 914- 278.7754 / E -mail: NoAmLab ®aol.com
PUTNAM COUN'T'Y DEPART OF HEALTH
_ DIVISION OF ENVIROi1I'AL HEALTH SERVICES _
n' � _ c a: .:f ♦ me.. 1.+�f�." s "b:- �...�„ ,� ri.5 �G _-r z.4i -e _ _ _ �. . •!�.�.��. � � .... .,
t'y � .. ••4.- _. " >!f rt^" Yv 1 ♦ '�1 .�:ww• v7.. `r -sa \N •_'i[i" ,CS .CF74 •:G:.i:P �t4. _. � ♦.
C_-' i2.m ("!le Q_Z_ V ( TAO
Owner or Purchaser of Building
pmt Cam � t f � "o
Building Constructed by
..Z- A;O rWI LL
Location - Street
-7-142
Municipality
3 &L . ;�c5t —D c
Building Type
94 - 2 Zg
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARANTM OF SUBSURFACE SEWAGE DISPOSAL 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 successors, 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 approval of the
°'Certificate, of :Construction. .Compliance ". -for ._- the_,sewage disposal .system, or any,....
+ repairs made by nie to "sucfi system, `&6ee� where the '`faillir`e tw ope'rate- properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this 0 ( day of 19-22
General Contractor er) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
l
Signature
Title
Corporation Name (if Corp.)
Address
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
- APPLICAfi f3N =. ,TO -,(?O �'rSTRUCT. -'.�1WEi�- W�LI.
PCHD PERMIT #
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
Foothill Street Town of Putnam valle 84 -2 -28
WELL OWNER
Name Mailing Address ¢Private
Thomas A. Piacentini 5 -15 Stoneleigh Ave. Carmel O Public
USE OF WELL
1 - primary
2- secondary
ORESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify,
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED . 5 /EST. OF DAILY USAGE 500 gal
I] REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13 ADDITIONAL SUPPLY
CMEW SUPPLY NEW DWELLING O DEEPEN E2JISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
New supply for proposed residence
WELL TYPE
30DRILLED
DRIVEN
ODUG
GRAVEL. C]
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: David M. Schwartz
Lot No. rot 1
WATER WELL CONTRACTOR: Name To be determined Address:
_ PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO
NAME OF PUBLIC WATER SUPPLY: N_LA TOWN /VIL /CITY
:.... _,DI$T"C _Tq ,PRQPERTY FROM NEAREST WATER :MAIN» . .
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON SEPARATE SHEET
May 5, 1995
(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
thirty (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 drilling operations be contained on this
property and in su a manner as not to degrade or oth i e cont irate surface or groundwater.
Je of Issue: �� ^19 �r r
Date of Expiration �� 19 9 Permit Issuing Official
Permit is Non-Tran s ferra le White copy: HD Filet Pink copy:.Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
BAIDEY & WATSON
Surveying and Engineering, F.C.
Route_9. -
.- dd Sprigng, ICY 10516.
(914) 265 -9217 739 -3577 628 -1800
FAX (914) 265 -4428
TO:
Putnam County Department of Health
4 Geneva Road
Brewster NY 10509
We are sending you: Attached
Via: US Mail
Date: May 11, 1995
Attention: Mr. Robert Morris, P.E.
Re: Thomas A. Piacentini
SSDS Permit
Foothill Street
Town of Putnam Valley
TM# 84 -2 -28
No. Description
Construction Permit SSDS
Application PC -1
Design Data Sheet
Construction Permit Well
Letter of Authorization:_ ' :.... :.
Plan of Proposed SSDS
House Plans
These are transmitted: For approval
Remarks: Application fee has been recieved by you under a seperate cover.
Copy to: T. Piacentini Signed:. Kurt Schollmeyer, P.E.
Copies
Date
1
5/5/95
1
1
1
5/5/95
5/5195
4
5/5/95
2
2/6/95
Date: May 11, 1995
Attention: Mr. Robert Morris, P.E.
Re: Thomas A. Piacentini
SSDS Permit
Foothill Street
Town of Putnam Valley
TM# 84 -2 -28
No. Description
Construction Permit SSDS
Application PC -1
Design Data Sheet
Construction Permit Well
Letter of Authorization:_ ' :.... :.
Plan of Proposed SSDS
House Plans
These are transmitted: For approval
Remarks: Application fee has been recieved by you under a seperate cover.
Copy to: T. Piacentini Signed:. Kurt Schollmeyer, P.E.
WAY-08-1995 11:32 MCI METRO-TYSON'S CORNER 703 506 6671 P-01
t. Id2
AVIN.'"'I CULN'I'f DSPAIMMNr Or- ULA111'11
1, I)IN,
DXVISI()N OF ENYIR0N-,XNTAL HEALTH SERVICES A PPE-:14
Datc:- May _5r I
IRe: Property 9f Thous A. Piacentini
Loco t e d at Foothill street
(T) Putnam Palley SccLion 84 Blork 2 1,c) t 28
Sul division Sch'Kartly-
Subtly. Lot ff 1 riled map # 2422 Date` 7-6-89
GentlenzcAl;
This letter is t6 auMorizoJOhn P. Delw*t p.S.
a duly licensed proressional, enSintcr, X or registered architect
to apply for a Construction Permit for a Separate sewage System, to
Gcrvc tho nbovQ )Iatcd property in aQcordanccc with the staxidards, rulc;.,,
ur regulations as pi-omilla-vatcd by the Commissioner of the Putnam Cou.nLy
DcP'I'l-tilleat 0� llcalth, 11-xd to *i.gn a.11 ncCq:r,-Anry paper.q on my itl
cowi�.,ction with tlix4 wo"%.,ter and to supervisc the con:ifruction of said
system or systems in col f02-nlity With the U;V Article 14 V'r
COU.11 Y
tary Code;.
Very truly yoktrz,
Signed IL� (Px�,Ce �- - ----
'Cowitcrsi,vnvd: Ovaiar of 11roperty
f' 62545 5-15 Stoneleigh Ave
SADZY & WATSM P.C. 0512
Address
US MI� —Oldsvxiag—UL 1651-6 - 279-8385
Tolephona
(914) 265-9217
Telephone
a.
TOTAL P.02
TOTAL P• 01
°RLITA AMLER, MD, MS, FAAP
Commissioner of Health -:
A0R_ETTA MOLINAW,, RN, MSN
j` Associate Commissioner of Health
May 13, 2005
Robin & Diane Sewell
2 Foothill Street
Putnam Valley, NY 10579
Dear Mr. and Mrs. Sewell:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
County Executive
Re: Addition — 2 Foothill Street
No Increases in Number of Bedrooms
(T) Putnam Valley, T.M. # 84 -2 -28
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 May 13, 2005. The addition is approved with the following conditions.
I . The total number of.bedrooms must i-emairi at`thr without prior approval by this
Departnient....z ..._
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 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,
Joseph S. Paravati Jr.
Assistant Public Health Engineer
JP:cw
Cc: Building Inspector, Putnam Valley
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845 ) 27 8 -
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
DEPARTMENT ' OF HEALTH ® °
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET Z f^ I I TOWN P%,/4-ne� Vck N TAX MAP# S` 2— 2 is
D
NAME nu� ►�►�,�� s- ew-eA . PHONE �`f�' ^2� X34- PCHD# LSO
MAILING
ADDRESS
DESCRIPTION OF
ADDITION
NY
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 applicable sections of the
Putnam County Sanitary Code.
Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd,
-Brewster, NY. 10503 ,- Phone: -(845).2Zg.7,613.Q;
1. Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #)
*Non- professional sketches are acceptable
4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
11:35 • 91 . 45262130. TOWN OF PV PAGE 01
b X5/06/2005
SKRLITA,kMLER, MD, MS, FAAP
Commissioner of goallh
LORETTA MOLLNARJ, RN, MSN
,45SOCiOtC COMMissioner of Heoith
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT, OF HEALTH
I GENEVA: ROAD
BREWSTER, NY 10509
Re:—
Residence
TAY, MAP# "64
TOWN
To Whom It May Concern:
i-ng,'to-reems-iii��iiitaLlObd -by--jbq:-T---own;..tbe above-.nowd dwwel4ing,
A�cord*
is
IS NOT
County 4recuti-
IN O C
q --MPLIANCE WITH town code and. the total number of bedrooms on record
is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:''
ASSESSORS RECORD:
OTHER: R
hokiseguidchnc3
Building Inspector
Water Supply Section (845) 22,5.5186 Fax (845) 225-5418
Environmental Health (845) 278-6130 Fax (845) 278-7921
Nursing Services (845) 27$ -6558 WIC (845) 278-6678 Fax (845) 279-6085
Early Interventioft/Preschaul (845) 27A-6014 Fax (845) 278-6648
PUTNAN� COUNTY D7EY- 'A,.>FL'7C'L�EN�' �F HEALTH.
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSALbYTEM' '�' "`' " "y
1. Name and Address of Applicant: Thomas A. Piacentini
5 -15 Stoneleigh Ave
Carmel NY 10512
2. Name of Project: Sameas Applicant 3. Location T /XK*j x ut aam v-j 1e4
4. Project Engineer:BADEY & WATSON P.C. 5. Address: US Route 9
i
Cold Spring NY 10516
License Number: 62505 Phone:914- 265 -9217
6. Type of Project:
Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Bailding Realty Subdivision Other (specify)
7. Is this project subject to State Environmental Quality Review (SEQR)?
Tie Status (Check One) Type I.. Exempt
Type II. Unlisted X
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. NO
Has DEIS been completed and found acceptable by Lead Agency? ........... N/A
10. Name-of Lead Agency Putnam County Department Of Health
r11.�Is this project "i'n",an "ar'ea`Gnder' °thy contro'i n�-_koca -1 w*i11a'nn•i•n'g,•- z6ni�ig.4:,:
or other officials, ordinances? ......... ...........................:... YESy
12. If so, have plans been submitted to such authorities? NO
13. Has preliminary approval been granted by such authorities? NO Date Granted: N/A
14. Type of Sewage Disposal System Discharge...... Surface.Water X Ground Waters
15. If surface water discharge, what is the stream class designation ?........ N/A
16. Waters index number (surface) ................... .. N/A
17. Is project located near a public water supply system? .................. NO
18. If yes, name of water supply N/A Distance'to water supply N/A
19. Is project site near a public sewage collection'or disposal system ?..... NO
20. Name of sewage system N/A Distance to sewage system N/A
late observed: May 1987 23. Name of Health Inspector: Michael J. Budzinski, PE
24. Project design flow (gallons per day) ...... ............................... 600
.A
2.
•25:,- I�S S:tate� Ro",]ibtant. -, D s. charge - Eliminata emi� "(SPDES) Permit;: re4u�i;red?-..i�i
N /A.
26. Has SPDES Application been submitted to local DEC Office? ...............
27. Is any portion of this project located within a designated Town or State NO
wetland? .................................. ...:...........................
28. Wetland ID Number ........................ ............................... N/A
9. Is Wetland Permit required? ......... .. .. ........................... NO
2 q ...
Has application been made to Town or Local DEC Office? N/A
30. Does project require a DEC Stream Disturbance Permit? ................... NO
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? YES or NO NO
32. Is project located within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination. YES or NO NO
DESCRIBE:
33. Is there a local master plan or file with the Town or Village? ........... YES
34. Are community water, sewer facilities planned to be developed within 15 years? mn
35. Are any sewage disposa'f �areais fh excess of` 1'5 %` s`1`bOe'T .:: ".::':'::": "..:'.:::.......'"yF
36. Tax Map ID Number ......................... ............................... 84 -28
37. Approved Plans are to be returned to: ................ Applicant X Engineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this
form is .true to the best`of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Pena 1 Law.
SIGNATURES & OFFICIAL TITLES: Engineer
B EY & WATSON, Surveying & Engineering P.c.
MAILING ADDRESS: US Route 9 Cold Spring MY 10511
A
a
l
PUIN114 CaMY -.DEPAI2TMENT OF. aEATLTH...
-'F CES
nI DMIS ION OF ;HEALTH Ftft
GN az T A SHFM _'C
7-SUESYJFJD� -E. SDYP=- DISP-0SPL SYSTEM FILE.
7"
•ner Thqqs A. PiLacentini AdL,-es*s 5-15 Stoneleigh, Ave. Carmel NY 10512
-Eccated at (S L• Foothill Street Sec.:-. 84 -Block 2 Lot 28
(inclicate nearest cross street)
Municipality T/O Putnam Valley
S011, PERCO LL=C'N -rzgr DATE, REQUI-R,
Watershed Hudson River
M- TO BE SUafll VM'H:.APP1JCATIQNS
Date -of Pre - Soaking 7/9/87
Da' U-e of Percolation Test
7/10/87
BOLE
NaMBM CLOCK TIME
PER03LD=CN
PEROOLUION
Run Elapse
No, Time
Stax-L-Stop Min.
Depth to
Ground.
Start
Inches
Water Frcm
Surfac'e
Stop
Inches
Water LOi-,l
In. 1.nches
Drop-•In.
inches
Soil Rate
Min/In Drop
A. 1 1:00 1:30 30
•22
23
1
30
. ... ...
2 1:30 2:00 30
22
23
1
30
2:00 2.:30 30 _-
22
23.
1
30
- -_
- -.
B 12:05 12:22. 17 22
2 12:22 12:37 15 22
3 12:40 - 12:57 17
.5
5
r
22
26 1/2 4 1/2 4
25 3 5
26 1/2 4 1/2 4
s ts to be r .peated at sah-e - depth .until apprcx1Ma't-elv equal soil rates
are --cbtaine-i a�- each parc-ilation -L-_�t hole. . All 'data - t,6'- be sdbi�tttd- -
'*_or rev.L&14.
2- Depth rre_,,sL,_rerjznts- to he wa-cle fro-n top of 1,o1e_
PIT u. :U 'lU uL
DES [ON OF SO= EMCOUN RED IN NEST -EQL: �S
D �TE3 iiOLE NO. JA HOLE NO 1B HOLE NO
41w •.•[• . .a rt .. ..... :O+.i. ,'-t ti; v�, %P_'�'b'•.•.5c•:ei*�•o. .G,. — - - —
Topsoil 7 Topsoih
=_
8 __ ..8s
Silt Loam to"2' 61 _ Silt•Loam P
21
3'
Sandy Loam:
51
ff
6
i'
"
8'
End
9'
10'
11' •
?.3 '
14,
Sandy .,.Loam
End
G.W. encountered @ 5' -6"
}
i17D1Ci��T L;r1l i, AT •.- rri7:C�a. ut',C Jtr'7 ;,, ;.'75.. �Y�URTERr_0 ° _,T e __ 01
iNDIC11TE LE"v7, TO iqH CEx ��-%TF.R LEVEL, RISES AFTER BEING ENMUNTEPO� D 51 - 6"
DTP HOLE OBSERM'IONS MADE BY:BADEY & WATSOAT P.C. DATE: 5/15/57
i
- - - -�- DEIGN
Soil Rat Used 30 `Lin /1" .Di:op: S.D. Us-�bJ e Area I?rovided 6,000 SF
No. of Bedrecos 3 Septic Tank Capacity 1000 gals. Tjrpe Q=.
Absorption Area Provide`l By 500 L.F. „ 24" width t,.ench
0 er 817 0" Deep curtian drain
S n�1 turd r ��'v...i Lai
BA'DEY & WATSON • 9
—
Surveying & Engineering, P. C. `l���fi4i fidl� /�i,
Address Route 9. SERI, 4F NEwYp
CO Dk-
Cold Spring NY 10516
A yp
°C
'aEIxS SPACE 'QR USE BX Ai; 1 DEPARTNi- 7T ONLY:.
lb
Fp 062 1
Soil Mate Apprm -ed sq. f L- /gal. Checked by