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HomeMy WebLinkAbout4418DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -23 BOX 33 11% oil Is r Ail. 171, 1 ,. -' 6 IN Is d hr t or .. IN .: � . ri.1 19 r so I Is lRev., 3!86 `,e Located at Ld PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. lOS12 Engineer Mast Provide P.C.H.D. Permit N e.. FOR Town or VWeg r Tax Map �/ Block Lot Owner /applicant Name / Q 1 VZ Z-1 K-1 •° -u i f Formerly Subdivision Name �' P abdv. Lot N -AP Melling Address a 3y J�e." /J/ nip. / 6 _r79 Date Permit issued `��4 Separate Sewerage System built by 0 n-XV, eel 4 Address a4 fit' i Consisting of �e© U Gallon Septic Tank and - Od Z 1Ls- tfhG�/J�.S Water Supply: Public Supply From Address C -If ors Private Supply Drilled by ✓y ^ X7 07d+� -s °� Address c' /"4 L'� d�• 1�• Bading•7ype t%j% / d19Ce' -Has Erosion Control Been Completed? Number of Bedrooms Has Garbage Grinder Been In talled Other Requirements �l/ I cattily that the system(s) as listed serving the above.premiaes were construc d i�Qially° a1)� rho on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regula on @ in I anc < th a filed plan, and the permit issued by the Putnam County Departments Of Health. a Dates( �© Cer ified by P.E. R.A. Address G� License No� 2 iC`.u9� �c Any person occupying premises served by th above system(s) shall promptly take suc �W'7.r ssry to sec ure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall id as soon as a pubtt: Unitary sewer becomes available and the approval of the private water supply shall become null and void when a ply becomes available. Such approvals are subject to modificatio���nyyy or change when, in the judgment of the COmmisslow of Health, ocatlon, mods tion r change is necessary. Date ����L y Title I, i igar Cp� -, I . . �Kl r4 /1 TT"T T ^7,A'nT rlmvnm nVn^nM DEPARTMENT OF HEALTH -Of,-­Rw r6fakental PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only ell --<6 —790, WELL LOCATION STREET RESS: L 0 U 444 NAME: TAx . GRIO Numsvt: Lei A I- A ks ki-A 14o I low -A ADDRESS. [&fBIVATE _&3a 0 PUBLIC WELL`OWNER US' OF WELL 1- primary , 2 - secondary OkESIDENTIAL 0 PUBLIC SUPPLY ' 0 AIR /COND. /HEAT PUMP 0 ABANDONED 0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE —gal. REASON FOR DRILLING PLACE EXISTING SUPPLY []TEST/OBSERVATION []ADDITIONAL SUPPLY UfNEW SUPPLY (NEW DWELLING) DDEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 00 —ft. I STATIC WATER LEVEL -2A— ft.1DATE MEASURED .7 Lh DRILLING EQUIPMENT OROTARY ❑ WELL POINT ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ CABLE PERCUSSION - . ❑ OTHER (specify): WELL TYPE ❑ SCREENED 91"OPEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH ft. MATERIALS: WfEEL 0 PLASTIC 0 OTHER CASING LENGTH BELOW GRADE - 5rft. JOINTS: 0 WELDED 93-THREADED ❑ OTHER DETAILS -DIAMETER in. SEAL: 0 . CEMENT GROUT ❑ BENTONITE OTHER WEIGHT PER FOOT lb./ft. , DRIVE SH OE_;0 YES (PoM LINER: 0 YES &NO SCREEN ­­DETAILS, — DIAMETER D (in) SIZE LENGTH (ft) _I DEPTH TO SCREEN (ft) DEVELOPED? FIRST. - S00ND-­_ GRAVEL PACK 11 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. I TOP DEPTH _tL BOTTOM DEPTH — It. WELL YIELD TEST METHOD: 0 PUMPED A](*,COMPRESSEO AIR .0 -BAILED 0 OTHER If detailed tests were formation ❑ YES pumping pumping done is in- ? attached? ❑ NO NO WELL LOG It more detailed formation descriptfbns or sieve analyses are available, please attach. DEPTH FROM SURFACE ling water Bear. Well Dia- ter I,.' FORMATION DESCRIPTION CODE I ft. WELL DEPTH It. DURATION hr., min. DRAWDOWN It. YIELD gpm- Land Surface z l�-4 21 GO to WATER 0 CLEAR QUALITY 0 CLOUDY 0 COLORED ANALYSIS ATTACHED? TEMP. HARDNESS ANALYZED? 0 0 YES YES 0 NO 0 NO STORAGE TANK: TYPE CAPACITY GAL-.-- PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE — HP WELL DRILLER NAME DATE ­A/,V tz h, a 4 4144rscllk xC ACORES �, ") Ig " x 5IGMMRE t-01 Ok 1k V4 I I e loj —7f , _Aq , J/89 LAB # _1:7• C'0416. Yorktorwn Medical •L;aboratory, Inc. Date Taken: �v -Time:, ' °o 42 321 Kear Street Date Rc'd: L4Y fv Time Yorktown Heights, N. Y. 1059 Date,.. R�po.rted 1 990 . -- • �t 5'T . .r .w 0914 )wL'-ZU�Qra ='M.q .. - •.n- �'P„f-.:o -r. _yyr• 1♦ y' "j= .:�t«� Gorlec Eed 'By . C: , Director: Albert H. Padovani M. T. (ASCP) PO /Client # Referred By:� Sampling Site: -70 1-oila-ev C,/ -„ye- ^/- L/. 10�1 " 75 q Phone REPORT ON THE gAkLITY OF WATER ~ INORGANICS m L MICROBIOLOGICAL '100mL Alkalinity Standard Plate Count Chloride _ ( CFU /1 mL) __.. Copper NA = Not Detergents, MBAS Mei4brane Filtration Method Hardness, Calcium VTotal = Too Numerous To Count Hardness, Total Coliform t _ Iron Dead Fecal Coliform. _ ..� Manganeso a Fecal Streptococcus M �_ Itrogen, Ammonia Most Probable Number Method ` Nitrogen, Nitrate �_— Nitrogen, Nitrite — Total Coliform .� y Phosphate, Total _ Fecal Coliform Silver --- Sodium Fecal Streptococcus ` _. v:."...•Siil'f Sulfite Zinc Total Coliform P A PHYSICAL /MISCELL.kNEOUS KEY FOR TERMINOLOGY PH (•S . U .) Color (Units). Conductance (uhms /c) Odor (TON) Turbidity (NTU) CFU = Colony Forming Units LT = <' = Less Than GT = >.= Greater Than NA = Not Applicable SA = See.Attached TNTC = Too Numerous To Count REMARKS COMMENTS For Lab Use (For Lab Use) SAMPLE TYPE: (Ch One) One) Potable Non- potable OUTGOING: (Check Each) HNO HC13 NaOH _ ZnOAc Na2S203 Other.: INCOMING: (Check Each) THESE RESULTS INDICATE THAT THE WATER SAMPLE WASfl (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTIONo THESE RESULTS INDICATIE.THAT THE WATER SAMPLE (DID) (DID NOT) (NA • MEET THE SATISFACTORY CHEMI L LITY STANDARDS OF THE NEW YORK STATE B C DRINK ING WATER CODES, Fn PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. 7 /87(Rvsd1 /90)RWE A bert R. Padovani, .T. A P , hector _ _17'k 4 /LE 209G GT 200C PH LE 2 pH GE '12 -- Other: THESE RESULTS INDICATE THAT THE WATER SAMPLE WASfl (WAS NOT) (NA) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE PUBLIC DRINKING WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTIONo THESE RESULTS INDICATIE.THAT THE WATER SAMPLE (DID) (DID NOT) (NA • MEET THE SATISFACTORY CHEMI L LITY STANDARDS OF THE NEW YORK STATE B C DRINK ING WATER CODES, Fn PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION. 7 /87(Rvsd1 /90)RWE A bert R. Padovani, .T. A P , hector ;Iuacatgon - Street Subdivision Dame �/ inic$pality. Subdivision Lot # �ugldbnfg x � - GUAPAN E OF SUBSURFACE SZOM 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 imnediately following the date of approval of the ... ,;_....:._°°Certificate::c�f:_. Construction_ Compliance" . for., .the ,sewage dispQsal._sxstgn, or, any.. repairs mane..- by`-me"to" such-- syttsn,° except- where-the fail&e- to'vbperate- proper- y caused by the willful or negligent act of the occupant of the building utilizing the systeno y The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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 t building uti izing ..the , systeno Dated this day of 0 X 19-Y d signature Title General Contractor (Owner) - Signature ...Corporation Name (if Corp.) x °revo 9/�5 e-�7 w17 e, Corporation Name (if Corp.) irf - PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Euvirm tal Health Services. Carmel. N.Y.10S1? Enaneec to Provide, Permit N CONSTRUCTION FOR SEWAGE-DISPOSAL SYSTEM Subdivision Name Ar✓e-Il "/ c• Sabd. Lot M`� Owner /Appikent Name_ MaWng Address I _v / d t% /7f zN on CERTIFICATE OF CO CIE Permit B 17 '9�5 190/7.7Arm W i V AW .��.�._p. -- Town:= a•.�'.!ll .'-... .. _ ., . ......•. Tax Map —ILL —Block '� Lot / Renewal_ ❑ Revision ❑ Date of Previous Approval Town yip ��iSi �it7'! C C ?d 111111,11111141 Type Lot Area '{ FIR Section Ody De fb Volume P Number of Bedrooms r Design Flow G P D PCIID Notification is Required When Fill is completed ` Separate Sewerage System to consist of le 6% GaBon Septic Tank and 3 O y W� eh t—< To be constructed by Address Water Supply: Supply From Address on / Private Supply Drilled by /ddress Ad C 6 11 -e-1 Otber Reoalremeuts ' 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s)1 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construct lo mpliance" satisfactory to the Commissioner of Healthwill :De submitted to the Department, and a written guarantee will be furnished the owner heirs or assigns by the builder, that said builder Will lace good operating condition any part of sai0 sewage disposal system during years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the origin sqs li�+JRY3 1 'thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in a r w the in rtls, r le and regulations of the Putnam County Depart ant of Health, f' Date 7 zl— Q igned ' /r = P.E. R.A. Address n a. r APPROVEO FOR CONSTRUCTION: This DOroval expires two years from the date revocable for be License No v t ,44lian of the building has been undertaken and Is cause or may amended r modified when consider necessary by th stand f�f7osilth. Any change or alteration of construction requires a w permit. Approved for disposal of domestic sanitary sewage /o >Et)p onl . 81 Date Title _� _ V. vi DSc `rc^ c- .r Cz C= =r E 10 f ^ -- =- i Cr =e" `:i 1 e- 20 =Afr, SIM BS:- ECT' -CJT Cate. E. Rcan 5055 I I 6v cwb] E R G � , 10. c avel in trEncl! 12" I!L -1-1 .-i I I I io- 1 size of C-= C=ll Fr 4k .. Ka r S1ir�^ DISPC`rr, A LE I 4. I a_ SIDE 2rea 1�-�- =1=^ as per a= DI��s 4. P=p easily �r 6..CJCl e w_- ___= by L= =1 tz De =tZE't I --'cti P' I i s `ca - Date of placs-1--nt I I 2:1 T, , `> LC-L yc.JpT-h C_ PTztur� sci_ rct s triC� 1 4-' 1 c_ 6`.r•e, bru E=C_ , Cruet =r 15' fran SLS arm_ I 14-� I E- si., arc= wa ; acc=ctal2ie_ CVO ,1'i c_ F— XF 5 =i C_CL't� 1 E_ 140 f �._ fr wad a _ cclir = °_ T:vc =� �+ c. A:1 yireE f u' ., With 7 rL -de of bCt i G. Back-H-1-1 C i to ins stcnes < d„ in II _ DIEPCS?L a. Sectic t= _ s_ z=' - '�. 1,2EO C. d_ L.0 a0,3 b=r CQ c. _ �cLt w = =rila 10 f = cf 45° bard f-csi.. Yl iL-7 2 -- cr;C' �� w11 h;: _ ee_ Ccx ar-r- T _ 1. V. vi DSc `rc^ c- .r Cz C= =r E 10 f ^ -- =- i Cr =e" `:i 1 e- 20 7. Dem `'t C- L= _ _'_" < 30 L c = -'r'' E. Rcan 5055 I Cf P- 10. c avel in trEncl! 12" I!L -1-1 .-i I I I 1 size of C-= C=ll Fr 4k 2. tank 4. P=p easily �r 6..CJCl e w_- ___= by L= =1 tz De =tZE't I --'cti I esa= ACT CrC!2 t.:=i C. R t7-= 1cc Lr acrrcvai Plans Ce C Z= 1CCL c L a7 -::r: V e, U i cn c -tarjc= Z_=. S ar== me s't:_r—al E- si., arc= wa ; acc=ctal2ie_ CVO ,1'i c_ F— XF 5 =i C_CL't� 1 b. ,1 —1, Fl"c5 Cc= ' c! ' 'T b.-_C�21 1 cr'• I 1 �+ c. A:1 yireE f u' ., With 7 rL -de of bCt G. Back-H-1-1 C i to ins stcnes < d„ in i. C —ter_ c~` c�a11 �rcte & away tiQil area- h- runt_ C=C.t =C __C:1 adecuate I _ i =CS.CA C :.. C! Cr^,V1C__ CP_ siGCcs Crater t-. "M"JaRKMI PUIMM COUNTY DEPAMII`�T OF HEALTH - IMIVIDUAL WATER SUPPLY & SUBSURFACE (Name of Owner) (Street COMMENTS YES NO DIVISION OF ENVIROMRMAL HEALTH SERVICES SEWAGE DISPOSAL SYSTEMS DATE RMEWED: BY: Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets s/S Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans - Two sets permit; P"IS letter a-r4ance Request GENERAL 'Legal Subdivision Subdivision Approval Checked Ex-approval SSDS Adj. Lots Checked et4Fd (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow ile & Dimensions - Volume J ;Trench /Gallery; Pump pit detail's rSep Mc Size, Detail Well Detail, Service Line if over ..Notes_- .(grinaer rate).,,-.­­.... D6sign' 'p-erd­�ichd _ddd§_'i6su1:i'S' Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Purped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS I s Win-200 ft. of Proposed Systems Property Metes .& Bounds House Setback Necessary (Tight lot) House Sewer - 1/4"/ft. 4"0; Type pipe No Bends; Max. Bends 450 w/cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 101 to P.L., Driveway, large Trees,Top of fill 201 to Foundation Walls 1001 to Well; 2001 in D.L.O.D, 1501 pits 1001 to Stream, Watercourse, Lake (inc. expan) 151 to Drains-Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercourse 1.41- e�o, LF trench provided required f��45: ­�&.W.- ..-ft. max. Plarellel to contours exp. ......Cqr�structj_on FILL SYSTEMS claybarrier 10 ft. fill notes A-0" news 00- depth gauges 100 yr. flood elev. 200 ft. reservoir, etc. 150 ft. trigall/gall. L 101 to Water Line (pits-20') 501 intermittent drainage course Septic Tanks 101 from Foundation; 'S0' to well 151 Well to PL 9 � •° • � . ■• •� � Iii Y' '� .� .�1• . M� - - YS R' DESIGN DAM1 ' 5WT -SUBSU FACE "SE A'E - DTS�USAL S Owner, ✓" G 60 �r/ // �� V ° P Address ��,o�/,,.5 �� °'�� 6✓/�C6 Located at (Street) ,ol d )W� Za ,�P 6, Sec. / Block_3 Lot la (indicate nearest cross street) Municipality • ■ m •$1••• r 5. �, Y• Watershed TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking ��� _ Date of Peroolation Test HOLE NUMBER CLOCK TINE PERCOLA7.ZON PERCOLATION Run Elapse Depth to Water Fran Beater Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches inches Inches S 4 6 2241 11;�3 4 5 1 2 3 4 5 NOTES: 1• Tests to be repeated are obtained.at each for review. 2• Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to' be sukmi.tted be made from top of bole. le . k1% . TEST PIT DATA MQUIRED TO BE SUBMITTED WITH APPLICATION DEPTH HOLE NO., I. G.L. 21 31 41 51 61 71 8.1 91 10, ill 12' 13' HOLE NO. HOLE NO. Too '0 v �004 loiev 141 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO -WHICH WATER IBM RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: Yore gy-vizv, DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No.- of Bedrooms Septic Tank Capacity /0"y gals. Type//4,A6,) Absorption Area Provided By L.F. x 24" width trench Other EPEA, Address 2&1?— z THIS ACE FOR USE BY Soil Rate Approved _ OF, Ng,, 0 SignatUr ?, ONLY: - sq.ft/gal. Checked by Date 9 DEPTH HOLE NO. B H01 NO. HOLE NO. .... � q y � ��}_h�} // / /pn/ unLS" � . - 'f' �~ 1. • -_ � r. � {a � • ' .^b ..�. . "C'_.F.�.'�GI" • .. •,Y•+'. C,h ul..'.. .n r�d Pt --•t- :y. � .�it��CB� �4r Y ��.. �C'. -i.0 %����j� �, w.� .r .. • �• _... 1 ° � 20. J6 IV 49 o, 30 -we �o 7° 89 °J° I 10° 110 12° 13° n• @1 W, r• ate o�. • x� J+ INDICATE LEVEL TO %MCH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: v7' �� ��i 012FTd, f' DATE; DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No o of Bedroom Septic Tank Capacity /00 0 gals. Type. � �,�, Absorption Area Provided By .� L.F. LF x 24 " width trench Other 0 dS- THIS MACE FOR USE BY Soil Rate Approved OF NEW YO •d �� SigriaturQ Z ONLY: sgoft/galo Checked by _ Date DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y., 10512 (914) 225 -0310 APPLICATION TO. CONSTRUCT A WATER WELL PCHD PERMIT #�' WELL LOCATION Street Address T wn Village ity Tax Grid Number � i� A r /,/ ,#- -3-fa WELL OWNER Name Mailing Address o ca r a yv .,A m e-f ArPrivate %/ % o r/ /`�d �%� O Public USE OF WELL 1 - primary 2- secondary UMSIDENTIAL O PUBLIC SUPPLY U BUSINESS O FARM O INDUSTRIAL O INSTITUTIONAL Q AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify, O STAND -BY O AMOUNT OF USE YIELD SOUGHT j"*'_gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 400 gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13- ADDITIONAL SUPPLY OR& SUPPLY NEW DWELLING) O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE In ILLED DRIVEN []DUG .GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES ,/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -li G�Gvr-sf Lot No. /41 WATER WELL CONTRACTOR: Name W. Address: /©w b7 0'.P7 y Ile - IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _.k..-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY -- DISTe1NCE TO PROPERTY FROM NEAREST -WATER MAIN: - ^- °.. • �` :� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ON SEPARATE SHEET ;�` 1 (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; (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 such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �v%, /� 19 Date of Expiration 19 Permit Issuing Official �- 'ermit is Non - Transferrable White copy: HD File Pink copy: Owner '89 Yellow copy: Bldg. Insp. Orange copy: Well Driller BkUCE �R��•1+OLEY:: - • ;r:.- `... .. <_, Public Health Director � _ . gym.. -x . TC+`2..''.a• <� : _.,, ' fi±- - . "n. �. ° „¢r4 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTIVEN'T 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 (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 June 26, 2002 Paul Kastuk Jr. 70 Lovers Lane Putnam Valley, NY Re: Addition - Kastuk- 70 Lovers Lane No Increases in Number of Bedrooms (T) Putnam Valley Tax # 84.11 -1 -23 Dear Mr. Kastuk: 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 form this Department dated June 26 2„ 002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at-Four 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, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The SSTS must be expanded as show on R211 -02 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:kg Senior Public Health Sanitarian cc: BI BRUCE R. FOLEY Public Health- Diieetor',i,.=.i;= - DEPARTNMNT 1 _Geneva Brewster,. New - LORETTA. MOLINAR.L -R.N.r M -S.N :. a . ""' ��ssocrote"- Pu61ic Health Director - Director of Patient Services OF HEALTH Road 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET -%O L, dvcdi,5[ TOWN 'I'X MA 1 6/i NA! PHONE 1'" g -,q % PCHD# , 5,3 -c-) a, MAILING ADDRESS us2T DESCRIPTION OF ADDITION ,sz 14-� -7.^ A ,•• -.1' _!Z ��s! NUMBER OF EXISTING BEDROOMS`_K,—PROPOSED # OF.BEDROOMS ',70, (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 subriiit thMorm and 'the f1oll'owing to Putnam County I-Tealth Depi., 4zGeneva Road,Trewster, NY 10509, Phone 278 -6130. Certified check or money order for MOM- 2. 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 9) *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 Feb98 BFhouseguidelines BRUCE R. FOLEY LORETTA MOLINARI RN., M.S.N tii ' Dir Associ318{'Pu6!!c` l eCtor . »'. Director of Patient Services DEPART TENT 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 (845)278-6014 Preschool (845) 278 -6082 Fax(845)278-6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Residence Tax Map Town Gentlemen: According to records maintained by the Town, the above noted :dwe11ing. IS 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: OTHER Building Inspector BFhouseguidelines N:t.fT Ttl or%'V:F Dooe AMp L _1-1007 7�37Z` II ° `� I I \I h 8 I 4 1< , ' I I AmP 2 -71 I I cy ss I - 2 I -- - - - - -- I J �! L - i 2 O � o i I I . I �l ELEC oaoP `'i nle,rr `. p O+'rtt � iAOO.t 55 e t I ; c I tr - -- 7. '• -- f } I I — — — _ r 53-13 -- --- w-3 7a� I I 1 I I , tl i —5 lkll A/1 Fe4r_� NOTES: 1. B' CEILINGS 3. BASEBOARD ELECTRIC HEAT= 4 2. 2X6 WALLS. MALTA WINDOWS 4. BUILD HOUSE AS RANCH BUILDER KASTUK & SONS INC.V Pno7No- CLIENT: SPEC #1 Om'FR N¢ 03! v 'PENN LYON HOMES. INC. DRAWN BY: DATE: STATE � � NY P.O. BOX 27, AIRPORT ROAD REVISED Or. DATE: SCALE: SELLNSGROVE. PA 17670 NOOEL' DISK NQ DRAWING: ROOF SY$ 1 . PO 9� L _1-1007 7�37Z` II ° `� I I \I h 8 I 4 1< , ' I I AmP 2 -71 I I cy ss I - 2 I -- - - - - -- I J �! L - i 2 O � o i I I . I �l ELEC oaoP `'i nle,rr `. p O+'rtt � iAOO.t 55 e t I ; c I tr - -- 7. '• -- f } I I — — — _ r 53-13 -- --- w-3 7a� I I 1 I I , tl i —5 lkll A/1 Fe4r_� NOTES: 1. B' CEILINGS 3. BASEBOARD ELECTRIC HEAT= 4 2. 2X6 WALLS. MALTA WINDOWS 4. BUILD HOUSE AS RANCH BUILDER KASTUK & SONS INC.V Pno7No- CLIENT: SPEC #1 Om'FR N¢ 03! v 'PENN LYON HOMES. INC. DRAWN BY: DATE: STATE � � NY P.O. BOX 27, AIRPORT ROAD REVISED Or. DATE: SCALE: SELLNSGROVE. PA 17670 NOOEL' DISK NQ DRAWING: ROOF SY$ ge-oc 'To orcter Ooot To orrm f UooR- r' xisr i g. . " 2 2X6 W I,C ALLSlL11YUJ ON.7G�V N1'IU CLCI. � nll.. nCN 1 ' � . ,MALTA WINDOWS 4. BUILD HOUSE AS RANCH c 0 BUILDER' KASTUK & SONS INC. CLIENT: SPEC #i ® ^ ^ ^^V » .HOME ^.^ DRAWN BY: DATE m PENN LYON HOMES, INC. .. REVISED 81 1 DATES DISK ROOF 9e'L I PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SITE LOCATION OWNER'S NAME `/ SYSTEM- OFFICIAL USE ONLY TM# CU MAILING ADDRESS PERSON INTERVIEWED © 41c--f '- - PCHD Complaint #. ame & Relationship i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER �%�-°� ,� /� ®S cry PHONE ADDRESS 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. I,.ac.owner,.:orre arted er,a eeditions.stated . _ age t. �f own this SIGNATURE TITLE DATE 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_ / 2C " GA Inspector's Signature & Title DA COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML t o a flf ' f It 1 y� th � qN- ..... . .... t. Ali et . Re -57 3y -tz vi tc Kiel - 40 9 md { • p�'j 7t r ""''` l f• Y s Oct. y hft I fy ` F. i3 g �w x .a`w+w' � - '�,^'i'l� R+•� -. -•. _w.a..w�.unCwNr eXd.w� ' -�9 Qfl m { —4� 1, f �. mow+• ZY � r 4