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04433
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04433
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
T , 1-1 L
OFFICIAL USE ONLY
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SITE LOCATION � � r L �. !'Y� L cow am#
OWNER'S NAME r L r.rl - PHONE S 6
MAILING ADDRESS a-c y
PERSON INTERVIEWED PCHD Complaint #
t J. Name & Relationship (i.e., owner, tenant, etc.
DATE
PROPS
INSTALLER ftvwrl
TYPE FACILITY
/`'ft S
PHONE S� 6 ", S-5�
L,k, 110
K;y , i C 5-79 REGISTRATION# PC % 9-
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.
---T— --T as,ov`rler;
agree to--the ctjnditio' ns- stated -onthis-fbrm.
4 TITLE/1`1 k F. • /tl l 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 99NIL
D E
SITE LOCATION
OWNER'S NAME_
MAILING ADDRESS
PERSON INTER
DATE
PUTNAM COUNTY HEALTH DEPARTMENT
,DIVISION OF ENVIRONMENTAL HEALTH SERVICES t _
PROPOSAL FOR SEWAGE IiDISPOSAL SYSTEM REPAIR
OFFICIAL USE ONLY�j
V
DE
PCHD Complaint #
ame & Relationship (i.e., owner, tenant, etc.
TYPE FACILITY howse-
PROPOSED INSTALLER flNMel PHONE.
ADDRESS 5M wr 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.
wo ✓l f,((c tole
I, as owner, or report ed age t o owner agree to the conditions stated on this form.
Z / 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 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 conditions.
Proposal approved
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML,
,; /9 /04(
a
OWNEF
SITE
MAIL]
PERSON INTERVIEWED
DATE
PROPOSED INSTALLER
PC HD Camplaint #
Name & Relationship (i.e, owner,tenant, etc.)
TYPE FACILITYJ
A /GP t �i f�'�c2 S f� PHONE
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of wine type as•"or ginal sews dis
. ge posal
Different location may require submittal of proposal frain licensed professional engineer or,
registered architect.. we tl
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44 EJera 69) O 46 0 ��0� �lJ�i' i � ,,i @ ! C
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twe ee S .,0 000, h n ra: a. -.J &
Proposal approved
s
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Proposal Disapproved
11-5-1-5z->711--
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 corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywerlls surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or,-,Apop& agent of owner agree to the above conditions.
SIGNUM
CIPI6: Hhite (MD); YeUcw (2kin ED; Pink (P,ppliamt)
TITLE
DATE
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
Carl Kemp
187 Old West Port Road
Garrison, MY 10524
Dear Mr. Kemp:
JOHN KARELL Jr., P.E., M.S.
Public Health Director
January 31, 1992
Re: H/F Frank Sapionz®
234 Peekskill Hollov Road
Putnam Valley
TH #
I have revieved the plans of the previously existing single family residence vith
an accessory apartment.
The plans indicate that no addition or change in use is proposed. The sevage
disposal system vas repaired in early 1991 (Repair Permit #R- 9 -91).
subuitt_d,- this' Department --has. no obJection to -th-
continued use of the accessory apartment.
The continued use may require special use permits or variances from the Tovn of
Putnam Valley. Any other permits or variances are the responsibility of the
applicant and the jurisdiction of the Tovn of Putnam Valley.
If you have any questions please contact me at 225 -0310.
Very truly yours,
William Hedges
Sr. Public Health Sanitarian
WH /jp
cc: John Mahoney (T) Putnam Valley
cc: Frank Sapionza, 602 H Bedford Street, Georgetown, DE 19947
00
0
EXISTING
WELL
Ob, ELEV 107.80'
EXISTING
4BEDROOM
DWELLING
CURT
LOCATION OF EXISTING 1000 GALLON REAR CONCRETE TANK
EXISTING SEWER PIPE FROM REAR TANK
DISTRIBUTION BOX
',4" SDR-35 SLOPED 1/4" FT
FRAME _EXPANSION
GARAGE AREA
ELEV 105.77' ELE 105.58'
CURTAIN DRAIN @ 99.00'
IINIV IN 94.1' 0
1250 GALLON CONCR.
__ L.F. TRI-GALLERY
...... ... . ........ ) ........... ......
7-N 0 - 12"1 PERVIOUS FILL - 137.08 FT
I USE 24 Y.
42.92 FT
la,
12" SDR-35 SLEEVE
C11 4" SDR-35 0 1/4" / FT/
POLE
40 L.F. TRI-GALLERY
D.. 1.
POLE
/p I.
GRATE 101.60'
18" H:D.P.E.
99. 76'
ELEV 101.19'
SKATE
H.D.P.E. IN
18" C.M.P. INV OUT 96.50'
E EV. 100.00'
put" County Department
TRI-G!L:ILEYS TO BE COVERED WITH R.O.B. SAND & GRAVEL BACKIFILLED TO GRADE EXCEPT
!
rWisibn of Environmental Hai
IN DRIVEWAY AREA TOP 6" OF BACKFILL
TO BE LIMESTONE ITEM-4
& noted for conforms;
,plicabI14.Rules and Regulation!
Ile
3ignatur
F,
7.