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HomeMy WebLinkAbout4374DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 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