HomeMy WebLinkAbout4481DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
84.19 -1 -11
BOX 34
Mme*
L
; -
19
.
I
:1
I
�'r
_
I J
L
7�
,�
I' ir
1_6
.,
r
1
Mme*
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Internal Use Oniv PERMIT #
- _.1•-
❑ Repair Permit issued in last 5 years Not in Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review i
SITE LOCATION 2Z AtIll S - TOWN t9A7h,,A_ Utdlq TM #
OWNER'S NAME L PHONE # gd _736 14p/D
MAILING ADDRESS Z ' r i l nA %Iii bJ4 0 Y
APPLICANT
Narde & Relationship (i.e., owner, tenant, contractor)
DATE Jf} FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER Lego" rd- c *K C7KS -i - PHONE # 47/5t 990 ?55�
ADDRESS
� =n
REGISTRATION /LICENSE # / S�
Pro osal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nntiirc nnri nvfnnt of fhn rnnoir
I, as owner,agree to the condition stated o is form y�
SIGNATURE TITLE � ,� Usk ��' DATE 1(' ���—/v
(owner)
i; the-septic-installer, agree, to- com h•the conditions -of, this permit for the septic system repair...._..
SIGNATUR TITLE 67wA&k- DATE lo --Z`j ,/p
(installer) CP
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved Proposal Denied ❑
~ D �( l0 /Z l v
Ins ector's Signature & Title Dat6 Expiration Date
,Repair proposal is in compliance with applicable codes Yes @' No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
MEMORY TRANSMISSION REPORT
FILE NUMBER
DATE
TO
DOCUMENT PAGES
START TIME
END TIME
SENT PAGES
STATUS
FILE NUMBER 081
TIME OCT -26 -2010 09:55AM
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
081
OCT -26 09:54AM
819147369311
001
OCT -26 09:54AM
OCT -26 09:55AM
001
OK
* ** SUCCESSFUL TX NOT ICE * **
PuTNAM COUNTY HEALTH aEPARTMENT
E3IVISION OF ENVIRONMENTAL HEALTH SERVECES
a Rr -pair Perrr - Issatetl in le<..t 6 years Not in Waters _
Repair wnttin MsW's Comers, W. Ornnon or Croton Falls Ras. D ®legated
Q Ra r w[tttin 200 ft. of a watercourse or KJeC -ma wetlantl Q ,Joint Review _
SITE LOCATION " -7 a /�,C 1- �TO/OW N %a,7-hv�n = Lhz_J_W TM d - ---� �
OWNER'S NAME r'iLr% PHONE #
MAILINC3 AOOFIESS -Z-1- 42 -
APPLICANT pze--
Nnrrta 8 Relationship Q.e.. owner, tenant, cantrartor)
PATE fi7% -J1 FACT L{TY TYPE Sft. )I 7tige PCHO COMPLAINT #
PROPOSED INSTALLER ��atL� -:2f p� 4::3oK2nL PHONE #
„- Sr�.w___,�f•- ��Y. �.�Z � i4EGISTRATI(:>N /LICENSE
f- r000sel Qnrlude a separate akettch. Iocatin$ the house, properly - lines, all u6jaoartt walls wlthin 200 -
fast of repair and the (oration of exlstin® and proposed system)
NOTE: The Gapartm ant may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
1, as owner,agree to the conditlo too o Is form
SIC3NATLIRE 7 � TITLE GATE
(owner,
1, the septic instollerr. ag� omply -%v th the conditions of this permit for trio septic system repair
SIGNATURE���1 %� -1^s TITI..E i92r >iL�s� GATE �[,'> �'J /�
(Installer)
Precoemwl a orrnvad wltb the following oonriitionc,
i. Procuremont of any Town Permit, if applicable_
2_ Submtssion of as bcullt repair sketch by the septic system Installer within 30 days of the repair, in duplicate ahowing-
a. 01wnars name. Site Street Nama, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System dsscrlption (e.g_, 1260 gal. Concrete septic tank, etc_)
d. Installers' name aria phone number
3. System repair to be perfortrted in accordance with the above proposal and conditions
4_ _rho proposed SS-r8 repair Is considered a best fft design and there is no guarantee to the duratlon at whlch this
completed SSTS repair will function.
No camplUtl d work Is to be bacMillad unw authorization to do so has been obtained from the OapartrrlenL
[IfrERNAL USB OKLY
'roposal Approved Q Proposal Denied d
—7r 5,
"i �Cl��� Flo �/O / �- �. -�-•� �/ Q
n actor's Signature aL Title Dates '—` Explra ton Oeta
4epair proposal IS In compllancc with applicable co oa Yea No O
COPIES: PC1-101; C7wnor: Installer
PC -RP 99ML
i
Rev. 2/07
Qv=wm% L ltGJiLLilVlltiL J11Li tiv�/U1tCt L1�lr, U4 /VG /GVV`J
372800yPUTNAM VALLEY 84.19 -1 =11 ROLL SEC TAXABLE
PARCEL PRCLS 210 1 FAMILY RES
CROWDER WILLIAM & ELIZABE TOTAL RES SITES 1 LAND $129.;000
26 MILL ST TOTAL COM SITES, O TOTAL $298,500
SALES= _____ =___= RES SITE RO1 = ______= RESIDENCE ==== ________
-I BLDG $TT .__
,....,..... �.. -- ;__._..- ..��. - - .:. :.,L•E - OT�D :STYLE::. _ ...- YES?- ,13UIL,T 1$4�---
.T . EXTWALr, iuT' COMPd8fTf6N -' 'STORIES 2.0
__________- SITE=== ======= === = = = = =i GRADE ECONOMY - - -AREAS - - -
PROPERTY CLASS 1.FAMILY RES I HEAT TYPE HOT WTR /STM 1ST STORY: 1008
ZONING R1 I NO. OF FIREPLACES 1 2ND STORY: 462
.SEWER PRIVATE I NO. OF BATHROOMS 1.0 1/2 STORY: 546
WATER PRIVATE- I NO. OF BEDROOMS 3 3/4 STORY:
UTILITIES ELECTRIC I ATT. GAR. CAPACITY FIN BASMT:
NEIGHBORHOOD 28070 I BAS. GAR. CAPACITY TOTAL SFLA: 1743
== =TOTAL IMPROVEMENT ITEMS, 6 = = = =I= _ = = = == =TOTAL LAND ITEMS 1 =__=
TYPE SIZE1 SIZE2 QUANI TYPE FRNT DPTH ACRES SQR FT
1 SHED,MACHIN I 1 PRIME SITE 180 .79
2 SHED,MACHIN
3 SHED,MACHIN I
4 SHED,MACHIN I
F1 =MORE ITEMS I F6 =ASMNT INQUIRY F10 =G0 TO MENU
.75.20 03 -050 F4 =NEX;T RES SITE ON FILE F9 =G0 TO XREF Fll =PREV ITEMS
0
It
N 91M00
M" 9,
M"
t
P/0 84.15.1 10
wxas
. —
• o
c 9
ci
0
\ 4 8
ia
Leo -
g I81.72 AC.
2
RECREATION AREA- CAL."
2.15 AC. CAL. , ..6B �y1� 61,93
All 93.22 212
100
i •.! 192.11 10
1.16 K
zn9.e9 RECREATION
AREA
12 0 2.9
w�• . 1.04 AC. CAL.
I 1.12 AC.
CAL.' 1 ISe.xs
32 s°
�•\loo.3e
\ MIL
z 40, L `yti.
/ v
ta
.5
47 p
/ 2.21 AC. CAL. 14
'� '+RECREATION ��
AREA'
Ix
39.1�
� _ 161.09 _ 49''4 300.00 � 220191
. _ T0.22 23Le9
t 9.95 AC.
Page No. of rages
LEONARDI & SON CONSTRUCTION, INC.
OWNER: LOUIS LEONARDI
6 CAROLYN DRIVE • CORTLANDT MANOR, NY 10567
DAYTIME, CELLA914) 980 - 3554.:. • OFFICE .(914) 736.9410:
`ZIC: #WC 31IZ -H90 .1NC`SEPTIC fC: #D0067 4 LIC. #PC- 560" (CERTIFIED)'
PROPOSAL SUBMITTED TO
PHONE
—
O (rP% C. O V l� �— it ,GLGLV— �,
involving extra costs will be executed only upon written orders, and will become an extra
_
STREET
G ��fo �►�
JOB NAME
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
withdrawn I
CITY, STATE and ZIP E
JOB LOCATION
ARCHITECT
DATE OF PLANS
and conditions are satisfactory and are hereby accepted. You are authorized
JOB PHONE
to do the work as specified. Payment will be made as outlined above.
ill
�u
We hereby submit specifications and estimates fo��w L
/ .
l �
_._....... ........._
' NOLANDS CAPINGRESTDRATION ,OTHERTHANGRADINGDISTURBED AREAS, IS INCLUDED UNLESS SPEGFI=Y STATED.'
We PrOIJOSP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
dollars ($ ).
Payment to be made as follows:
A FINANCE CHARGE OF 11h% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES.
GUSTOMER IS RESPONSIBLE FOR ANY AND ALL GOLLEGTIGN
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBrfAAT10N.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
Authorized
manner according to standard practices. Any alteration or deviation from above specifications
Signature
g
involving extra costs will be executed only upon written orders, and will become an extra
_
charge over and above the estimate. All agreements contingent upon strikes, accidents
P
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
withdrawn I
Our workers are fully covered by Workman's Compensation Insurance.
Arreptatcre of Proposal— The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized
Signature _
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance:
Signature
Pis proposal "may be
if not accepted within
days.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
•.-_. AP`PLVM'V l3h' . T O', - 0 STRUCT A WATER WELL
PCHD PERMIT
FALL LOCATION
Street Address
zb �Iijlc./_ s
,
Town/Village/City Tax
PAN li41 L" ,
Grid Number
WELL OWNER
Name
,/NIt #,q s, G ffle'WPCK
Mailing
Address
RPrivate
® Public
TISE OF WELL
primary
- secondary
13 RESIDENTIAL
® BUSINESS
13 INDUSTRIAL
® PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
® ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT gpm /#
O REPLACE EXISTING SUPPLY
O NEW SUPPLY NEW DWELLING)
PEOPLE SERVED Z /EST. OF DAILY USAGE �Djffil
® TEST /OBSERVATION 13 ADDITIONAL SUPPLY
DEEPEN E ISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
C CL oo' a
Ir To A4 B y
D�yte Lo /BEM �•yT ;A1/ C �.U7'� �V blN�r G/,4T�J� Lacs
�'R� R��.,^s
WELL TYPE
DRILLED
DRIVEN
ODUG OGRAVEL
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES "---NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A p
Lot No.
WATER WELL CONTRACTOR: NameAA/y�,pSul� l✓G•'ZG 1 RI LL 97/`f ... Address : P02111 1t- i
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY .
DISTANCE T0. PROPERTY. FROM _ATEST_.
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
_ /fB OON SEPARATE SHEET ,p
ate (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 }c (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 sucl a manner as not to degrade or othe se contam' a e surface or groundwater.
Date of Issue: 19 "t
Date of Expiration 19� Pe ssuing 0 ficial y �.
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
T5 1 7 1 G
20-S
Jil
re
30
313 OLO I—SA" 9
15*5
0 0+
37-5- W41
tn-k-It. - - -
JL
1" l`c� �S { � ! O
IK 1,11 . s -t-.
JJY
r) 10961)
OL-V),- - CD
•Cec, C- ? CDC,
HO U
ZG ALi It st
Owr,e : Lou i s Lao Y\.*-val
2.&
PA-Y,A.W%-- U&—t(e--y Oy
0 ► n M477 9
7
2.7-2-
T5 1 7 1 G
20-S
Jil
re
30
313 OLO I—SA" 9
15*5
0 0+
37-5- W41
tn-k-It. - - -
JL
1" l`c� �S { � ! O
IK 1,11 . s -t-.
JJY
r) 10961)
OL-V),- - CD
•Cec, C- ? CDC,
HO U
ZG ALi It st
Owr,e : Lou i s Lao Y\.*-val
2.&
PA-Y,A.W%-- U&—t(e--y Oy
0 ► n M477 9
OCT-26-2010 89.15AM . FROM- ENVIRONMENTAL HEALTH 6452TOT921 T-44U P.UUI/UUI t-Ulli
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ROPOSAL FOR SEWAGE TREATMENT SYSTEI
VIES NO Internal Use On
❑ Repair Permit i= in least 5 years
❑ 1 Repair within BoVd's Comers, W. Branch or Craton Falls Res.
RL
❑ Repair within 200 ft, of a watercourse or DI CTsqEqed wettand
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT
NQ
Not in Wal
Delegated
AA TOWN TM #
P6*LKA e
tu- od-ly t-11
PHONE#
& Relationship (i.e., owner, tenant. contractor)
DATE FACILITY TYPE PCHD COMPLAINT#
PROPOSED INSTALLER 4,j�99—AA a4, d-5ek%' eoxS-E PHONE# Q/SA %Q ?5-!S3�
ADDRESS REGISTRATION /LICENSE #
Proposal (include a separate sketch km=ing the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
evah wo anA owtnnft of tho rmanate
1, as owneragree to the conditio tated O!Lfflis form
SIGNATURE TITLE & WA per- DATE
(owner)
1, the septic.installer, agree to com h the conditions of this permit for the septic system repair
SIGNATUR TITLE �qW DATE
onstalleo "00'�.
Proposal aporoved with the followirtg_ooeditions
1. Procurement of any Town Permit, it applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
aL owners name, Site Street Name, Town and Tax Map number
b. Location of hmll.ed components tied to two fixed points
a. System description (e.g., 1250 go]. Concrete septic tank, etc.)
d. Ingellers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department
INTERNAL USE ONLY
Proposal Approved Q Proposal Denied ❑
In ectol's Signature &Title k Dat6 Expirdtion Date
Repair eroposal Is in compliance with applicable codes Yes NO ❑
COPIES: PCHD; Owner; Installer
PC-RP 99ML Rev. 2/07
a*
jg I {1I � I rQ.
c4's
ZIN
I
+J;,,>..++, mss �..' ^G,', .w'x r, 1si+ "' ••.,�a,. — a,,,�, -:r«i
WAD, N)
R W-P.
a�y'a
�p r
f !•
s fl n - IOU
't
!�
.. .,�,�.,.�'.'.., .. �' �: _.� � v��`.diac��.,.�*%•L`- .n.'y-.id« .::JAR
t s'•4y
044
y m v
y a 7 s• tin � R'Rt� F r a
•ry b R X-'��' aK �y t i r
4 Id .N �
W,34;,
l
�
-ar
'x
N
r a
t s'•4y
044
y m v
y a 7 s• tin � R'Rt� F r a
•ry b R X-'��' aK �y t i r
4 Id .N �
W,34;,
w
. .. "Sw %. °.:n•�!ti'Ys..r,�. -ter. .•� \ .. � .. - •:r:�s�. -.� . : «-... •. ... �. "'1' ..r '+r `* .:i+•�'y.::'%��a: -•��,ro �r. ..r:. � r � .-r.• v . '..- ,.ae��. .. "..1�" ,..e
..► .- .o.T - . • .... a -.._ _ . .�.- -•• _' - � _.. '� .�-.. �- --� _ ._ .. .. .. .. �
i . �1'4i''ry'. ��» rJ C.:4Tt+." !'sF"•�L•.Tfi4" –....: N+..H � {e--- . b - r:A' C'.... r �ili�'`i�� 'Cosa Ktr�.`�.. ��. Tn��. +'—v 1`..:0! `l.... l.. i r _sa. !' �r., r -��s+e �e� v
k
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner:
Located at (street):
Address: ;.6 . /y( I L L 5+,
TM # 'Section: Block Lot
Municipality: 19I17—Al. 4,A4 UALLK Watershed: /-4 Q50AJ
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre - soaking: Date of Percolation Test:
Hole No.
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
min /inch
1
;4
5
1
2
3
4.
5
1
2
3
4
1
2
3
4
5
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min for 1 -30 min/inch, < 2 min for 31 -60 miniinch).
All data to be submitted for review.
2. Depth measurements to be made from top of hole.
�. Win:._.....:.
(� TES'g'7�PIT DrrA�T�'A�y��7 may. 4s �+ f-ri 7U �C i:a�c.
w., •w �'�7-..°".�s?2`.�'y.-� ..•wr`..:r.:.piy,.;. F`i6i �i�IlJ1 \- �� .i.I'TII'�S'' 1�F`l:�[/f4'17'5i'IJ3L�c.§l�" 1`r "lvv 9. m'v-.. _ • - .t r.r .:.�:"1.:..
DEPTH HOLE_ # -L_ HOLE # HOLE # .HOLE # HOLE #
G.L.
0.5'
1.5' h
2.0' �' S,ti�
2.5'
3:0' -
3.5'
4.0'
4.5'
T
5.5' S' 4 "d
6.0' r✓
6.5, .
7.0'
7.5' '
8.0'
9.
9..5'
10.0'
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: Date
Design Professional Name:
Address:
Signature:
Design Professional Seal
.. r
' RECREAT ION AREA t.,HL'
3
2.15 AC. CAL.
• j hi A ✓
1 c - ILLS.
6 A4
(7) P,,-,v/4,A Q,41,L, v
• , . '�9 109 a' �
Al /A.
• �`s i i S •f."
z: 16 A(
•, 89 RAPCREATI
AREA
s co
a r 9�. 02 1.04 Ac. qA, L.
.1 d.
• CAL. E 1s3s
. 64 _
Fw
S
Et,