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HomeMy WebLinkAbout4602DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -12 BOX 35 r7 r r ,. ., IL ik ' ,` 06. Big r 04602 JUL49 -2015 02:34PM FROM. - ENVIRONMENTAL HEALTH 8452787921 T -471 P.001 /001 F -699 jW We, PUTNAM COUNTY HEALTH - DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. .r &T:r�a', � a- +�:c".�c,..- .- .e. -:� .�•i �.:" ..':�: w�,; t`- Vic_ -- •. ..�. i.. ;`•. .... :,�...:.�.r %�..+ssSR'= c.� -.;v i3 .�i• 4. .. PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR V~ A SITE LOCATION OWNER'S NAME MAILING ADDRESS Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Fells Res. within 200 ft. of a watercourse or Vogt Mace TOWN # lk- tJ ti: t : weuand ❑ Joint Review ey TM rAom padowm PHONE #914- 755 -396A i R­e­g­J—Ln­a_1J_e_ni owich Name & Relationship 6.o., owner, tenant, contractor) G 7 y11�M6 Priv Dwelling DATE * . a9f9KTyF_"Wi irata 9V a— PCHD COMPL/ PROPOSED INSTALLER dba► /Mahopac Septic PHONE# 495 Kennicut Hill Rd 1 /1036 26 ADDRESS Mehe�,t�Y REGISTRATION /LICENSE # Proposal (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 nature and extent of the rep air. Replace exxsts"g tank with 1290 gallon cement tank same Sam actati;n -;-;;Id fields I, as owner,agreg.to tt}e-cgnditions stated on this form SIGNATURE TITLE DATE 7_ (owner) 1, the septic nsta r, agre comply he conditions o is permit for the septic system repair SIGNATU TIT DATE /1 (installer) 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 backfill ntiI authorization to do so has been obtained from the Department. INTERNAL. USE ONLY C�__ is in comoliance with Proposal Denied ❑ 7116 fir. D e' rati n Qate COPIES: PCHD; Owner: Installer PC -RP 99ML Rev. 2/07 a 'MA4iQ`PAC +8'�PT1C� z JOSEPH A. MANTOVI; » , _se,NO„ew..N;Nrms�cla �r TEL (845)628 -4526 - ,�OSP,H.A.MAIVTOVd,JB. " pFAX.(845)628- 8457._ _ ,:oy KC:'9' 485 KENNICUT HILL ROAD MAHOPAC, NEW YORK 10541 � tP Lu e 0 J Wks' 3. �� f o i 94, 0 ;9-0 ON c Rep p/c. o � i I I I � ell% � I 1 0 � 1-10 boo Raa Owfa IS. eko ptocr pwe 14oA #e- IK- PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL.. IFOR. SEWAGETREATMENT- SYS�TEM.REPAIR, YES NO ," Internal Use Only PERMIT # ❑ 0 Repair Permit issued in last 5 years VDele'gated of in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 15 Provost Place TOWN Putnam Valley TM #85.7-2 -12 OWNER'S NAME MAILING ADDRESS APPLICANT Room Pvdawkh PHONE #914- 755 -3969 15 Provost Place Regina Peniowich Name & Relationship (i.e., owner, tenant, contractor) Y DATE Wns TY Priv Dwelling PCHDCOMP 1 PROPOSED INSTALLER dba /Mahopac Sept is PHONE # ADDRESS 4B5 Kennicut Hill Rd Mahepae, -NY REGISTRATION /LICENSE # 1 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 natuLe and extent of Xhe repair. Replace existing tank with 1250 gallon cement tank same I, as owner, SIGNATURE (owner) ' ;-th septicX SIGNATU (installer) stated on this form TITLE ����,J,/ DATE Z/_ZZ�S­- ire' cornple conditions o is permit'for'the septic system - repair TIT DATE 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 backfill ntil authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposa pproved Proposal Denied ❑ 7116 7// 6 /K spectoe ignature & Title Date irati n Date Repair proposal is in compliance with applicable codes Yes O No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 _I I N ti (; LL Putnam County Department of Health - Division of Environmental Health Services "I.- I Date: SSTS Repair - Final Site Inspection Installer: Al 9, -0,� 17dyr / — Inspected by: 'D /Qwi Street Location: IS- ronj w,&%4,o Owner: 0 k/1 CA -7Z/ TM T-6 it.#: - - 1. Was System inspected? Yes q' NoO If not, explain: 2. Type of System: Conventional ITMternate 0 Comments: 3. Septic Tank Yes No N/A Comments a. Septic tank size - 1,000.. other ..... b. Septic tank installed level ...................... 4. Distribution Box a. All outlets at same elevation (water tested) ... 5. Junction Box - properly set ...................... 6. Trenches a. System completely opened for inspection V b. Length required_ Length installed ..c. Pipe slope checked ............................... d. Installed according to plan ..................... e. Size of gravel 3/4 - 1 1/2 " diameter clean ......... U -Deptlf of gravel .*in -trench F' IV/ g. Ends capped ................................... 7. Pump or Dosed Systems 8. Sewage System Area' a. SSTS Area located as per approved plans V b. Fill section - c. Distance from water course/wetlands 9. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. Backfill material contains stones <4" diameter ......... c. Curtain drain & standpipes installed according to plan d. Curtain drain outfall protected & dir to exist watercourse e. Erosion control provided ............................ RFSI Rev-010515 LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services G ROBERT J. BONDI County Executive DEPARTMENT 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Mr. & Mrs. Peniowich 15 Provost Place Mahopac, NY 10541 Dear Mr. & Mrs. Peniowich: July 16, 2003 Re: Addition: Peniowich, Provost Pl. No Increase in Number of Bedroom (T) Carmel TM #85.7 -2 -12 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 latest revision date of July 16, 2003 and this Department's approval stamp. - Based on the - inforination submitted, the above mentioned addition is approved. with the following conditions. 1. The total number of bedrooms must remain at Three 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. Approval is granted for sewage disposal only. Any permits or_variances required are the responsibility of the applicant and the jurisdiction of the Town of Carmel. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke Public Health Technician ML /jp cc: BI (T) Carmel BRUCE R. FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. Associate , Public, Health Director, Direcloi` °of "�zrtienC`Service3''`' DEPARTMENT 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 ADDITION APPLICATION (RESIDENTIAL ONLY STREET �.> NOV051- TOWN %V6 -C, TXMAP# NAME EIUl cvic PHONE �;`i i ?. a &955 PCHD# . ( o MAILENG ADDRESS 15 Qeoljo.s-r DESCRIPTION OF ADDITION bi Nl tu NTUMBER.OF EXISTING BEDROOMS ..1 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., 4 Geneva. Road,. Brewster, NY. ; _ - 10509 M6ne 278 =6130. _ ,.. ... _.:..... > . F _.. _._... ..... w '.k 1. Certified check or money- order for $100.00. . 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 #) *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 Comments Feb98 BFhouseguidelines /• BRUCE R. FOLEY blic Health Director .per LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Direc,{or ,qf P91 /tt.. Setvfces Brewster;. Nevi 'York 10509 Eavironmental? Health : (845) 278. =:6130 Fax (845) 278 - 7921 Nursing'- Services- (845) 278 6558 W1C•{845)> 378 =6678 •� Fax (845) 278 - 6085 Early Interveation (845)278-;6.014,. Presc6dol :(845) 278=6082 Fax(845)278-6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: pmwl Residence Tax Map, Town �% Gentlemen- According to records maintained by the Town, the above noted dwelling IS IS NOT ♦. .. a.. 4. r— ....a. r �.ae.Y '. vYt. .M y' _b -.. .. -. -. v♦� `q a. ..rw . hp.y1 v 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: ,Building Inspector </ BFhouseguidelines t PUTI IAWGOUNTY DEPARTMENT OF HEALTH 4„ HOUSE P ANS APPROVED FOR BEDROOI A COUNT ONLY; 3 -B ROOMS �417 7 Y 67tmnwG MaRoom La x! �F aw II mcgInm B%19mc HCDROO)( !.4F 'r. t , .t .i PHAPt] 9a 0"cl Rmb( pwpcmCD rAmtLy RAG1( ran , • f r� SX13PD(G 1G'1JCmw � G y 9�6• 4 ` + MCWT1NG LMNG RGG!( 444 A OKBROGK• b V a G1 FMST FLOOR PLAN K • 1'y r`Q - Sro�oS� ©� m PQni,oujt,d-,h N m CD (}1 9 V LD W w �o AT PEMMn= REM3 dCB 5 PRU#M PLALB 1 a Qr TiTlt)gy OSIar t� ie f A -3 -X=NC BLDRr:41 W334 P'7 I ' 0 c I' C- N Be ra PIWOSED FAMMY ROotf G. MCEWFMG W.440 RO(w .F!AL 111/10^1 1 MCGW,--F MACR 'I V17 FIRST YWOR MAN I'l A fir CD tQ Ul Ili W Ul M PUTNAM COUNTY :DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner:—) Located at (street): Municipality: i 1% Address: ��a/ysi I TM# .2 [ca Watershed: SOIL PERCOLATION TEST.DATA Witnessed by: j .J Date of Pre - soaking- Date of Percolation Test: 777 S` 6 1 Hole No. Hole depth (Inches) Run No. Time Start – Stop Elapse Time (min.) Depth to water from ground snrface . (inches) Start - Stop Water level drop in inches Percolation Rate min inch . I q " I 3 4 _ ��.... 1 2 3 4 5 �1 2 3 4 5 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 min/inch), All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97, pg 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED ION WEST HOLES q _ , �'?�' �. ,- � :: -. �,.`eL�a=_. -:::: : r: s. .�.. - - r... ;. e. - . :�- _ _ T� :;.r �. -: ,�'� „-� �- ...•'mss.:_.- .. '�3 ,.c. .. car.; :� , .. x . ' DEPTH HOLE V y . HOLE # HOLE # ` HOLE # HOLE # `Y G.L: 0.5' 1.0' 2.0' 2.5' J, I If 3.0' Vr 3.5' 4.0' 4.5' Q 5.0' 5.5' 6.0' . 6.5' 7.0' 7.5' 8.0' 8.5' '9.0' 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: A it ,) Date 6/P5 ` I Design Professional Name: Address: Signature: Desip ProffessionaR's SemR Revised July 2013 -- TITLE NO.^ 70 �� P This is to certify'that I have surveyed ARISTOTLE BO U R N AZOS, P.C. PROPER -N ON TWE. SOUTHERLY SIDE Or PROVOST PLACE , MID -TANT 58`5.00' FROM LAND SURVEYORS-PLANNERS THE_ WESTERLY S1DE OF WOOD ST. , LOCATE'D IM //�� ucENSeoiN THE TOWN OP PUTNAM VALLEY( PUTNAM CDUNTYr u 5:'HNONSN Y`Mo NEWJERSEY NEW YORK . ALSO 5HOWN1 ON MAP " OART OF7'LANOS "Ir"I"wNlo I� CONNECTICUI Or EMILY MARTUA L. WOOD "ro BE ACQUI1ZE17 Ps( EDW. PROVOST' Filed In the PUTNAM County Clerk's Office Division of Land Recoids. OCT. 3, 1944 as Map N° 290 I have located all existing buildings and lines of possession and have shown their positions hereon. Survey completed: AUGUST Z5, 1983 Map dralted: 6,UGu5Y 29 , 1983 on scale of one inch to 3p feet. I hereby certify this survey lo WILLIAM THI6LEMAN 11 11'"T TwiELEMAN v4I.C.4553 .� COMMON WEALTH LAND TITLE INSURANCE Co. St13LEY CoRP. i NOW OR L,( N 7:'1NNERY M 810.45'!O"k/ 72.84' N &4 W 9,1,74 Field Book No. Papa No. OMico Map No. Certificate No. Survey No, O d' do V U'\ N U V ti N U . ` J J 1 1 . z �n Q Zpc > c aU O ul o v) U d _ �"� En t7� • Cf W Uj } tul W ul CC K 56' 6 D � �1,LL ell! Q vt • t0 l0. 0. r U. C­ 1K. o 2 Z • U r4er • Z , � '. One StO y Cramp o E ,y. �' d) d,,. v 3 3 O�a`� �1 Q I f,}t 5A nl Ate i''� 9p "` 1.6 - � 3 o 3 •' in co Y. n P141 .-ALL CEItTIFI:: nFk•..;•.�. +.'�::.'•�•..,...: ..ID FOR THIS 34 to 3' N 81d`410 •ZrJ "��:`_.:_�• - 1 ^` l\ CV .• . AND CGPI�. .. ' r SAID MAP OR L� r DEAR THE SEAL OF THE SURVEYOP / O , ,nNATUKE APPEARS HEREON. (� r O� �/ ARISTOTLE BOURNAZOS. P.C. V ttt" Field Book No. Papa No. OMico Map No. Certificate No. Survey No, n u Vn �hoQ�cc PUTNAM COUNN DEPARTMENT OF HEALTH MOUSE PLANS APPROVED FOR t BEDROOM COUNT ONLY; 3 BEDROOMS / iy�.�..� -/dam• P K-7 .. �, "1 !� � � nature Two ate D �6 s4r :a 'E a+' °p r., v �x. n u Vn �hoQ�cc PUTNAM COUNN DEPARTMENT OF HEALTH MOUSE PLANS APPROVED FOR t BEDROOM COUNT ONLY; 3 BEDROOMS / iy�.�..� -/dam• P K-7 .. �, "1 !� � � nature Two ate D