HomeMy WebLinkAbout4636DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
85.13 -1 -5
BOX 35
04636
A L
'
�6
L -
Ali
-i1
�
1�
fm
J
i
J
Z
Ll
04636
PUTNAM COUNTY HEALTH DEPARTMENT®
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Internal Use Only PERMIT #
C �
s
U
LI'
Repair Permit issued in last 5 years
❑/Not in Watershed
❑
El
Repair within Boyd's Comers, W. Branch or Croton Falls Res.
L+l D @legated
❑
❑
Repair within 200 ft. of a watercourse or DEC - mapped wetland
❑ Joint Review
SITE LOCATION. d t 6i46J 6 M TOWN
OWNER'S NAME i -,v 2A LE -Z — ( <E}hkrt1
MAILING ADDRESS
APPLICANT
NAPtM66 y TM A
?'o PHONE #
Im
.� d-Z3
Name a &jRelationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE %S ET PCHD COMIr PLAPTJ _
PROPOSED INSTALLER wi4Rb �( 99;1— PHONE # q ) cl/ R Z �
ADDRESS o S ctiwA K4 L6 /z e REGISTRATION /LICENSE # y3
Proposal (Include a separate sketch locatin 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 repair. ,
1- Ui.(.F OLD S?E0C TA MV- wh1Gjg k/ / too G4_ C,
A, VK 1E L o c A -r r o N s �c�T�c# �4- r T.q - c HE rf
I, as owner,agree to the conditions stated on this form
SIGNATURE 4� TITLE 8W 7v-6A" DATE � `-2- f
(owner)
i, the septic instNler, agree tc comply%.w_i a h-e conditions.,of
SIGNATURE
IAWMIA�I_VAL TITLE 6"9fiv_r DATE
(Installer)
Pr000sal 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 ET'_ Proposal Denied ❑
h A �h
Inh-pectoes Signature & Title Date I
j ExIfiratibn Date
Repair proposal is in compliance with applicable codes Yes 1 No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
F
v iLT-
LC
USX' ``�
Oopzcck 5-r
0 iml
"o FOo.
0�
(Zo r4 AP
TL 1394
L��
pUpy����-
km
� vo
CAT:s
),Nwa
�
ow
� ^
noe,x
�
| ~� - � _ |
_
- --------- -----------------'------------ -- ----- �
ovvv
'
Putnam County Department of Health
Division of Environmental Health Services
L SSTS Repair — Final Site Inspection
Date: 5 yi Inspected by: Ii, 11-ci Installer: _ 4,
Street Location: powner: 6v-*, cs j6'N4i_
TOyyn:_ ��1�/'p:" V-'.' .. -^ 9° ` +rti`;pG1r
1. Type of System: Conventional O Alternate 0 Comments:
2. Septic Tank
Yes
No
N/A
Comments
a. Septic tank size — 1,000 ... 1,250 ... other .....
0
a
h
b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
d. Distrihution Box
i. All outlets at same elevation (water tested) .. .
ii. Protected below frost .............................
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box —properly set ...........................
f. Trenches
i. System completely opened for inspection
ii. Length required Length installed
iii. Pie slope checked ............. I ....................
iv. Installed according to plan .....................
v. 10 ft. from property line — 20 ft — foundations ...
vi. Size of gravel' /. - 1 '/2 " diameter clean .........
vii. Depth of gravel in trench 12" minimum .........
viii:- ELds a -. ;: . .
g. PumR or Dosed Systems
3. Sewage System Area
a. SSTS Area located as per approved plans
b. Fill section —
c. Distance from water course /wetlands
4. Overall Workmanship
a. ' Boxes properly grouted and installed correctly ...........
b.. All pipes flush with inside of box .........................
c. Backfill material contains stones <4" diameter .........
d. Curtain drain & standpipes installed according to plan
e.. Curtain drain outfall protected & dir to exist watercourse
f Footing drains discharge away from SSTS area .........
g. Erosion control provided ............................
Additional Comments:
RJS1 Rev - 011312
,' • ._„{: . fir :.C•..: a'i :;'. .. i. c•; ••�,r 7
l'. _ ..,. .. " "-?'i -� • � - . - 'F'. .:•{ ..� ?a :. . , . -._ :W;$ 1. . -;� a .- ,. '�ii' . ., . .. .... ..., . ,.•
v 1(�
a11/1SION OENVIRONMENTAL HEALTH SERVICES
F- ROPOSAIL FOR SEWAGE TREATMENT SYSTEM BI.FPAIFt CJ O
NO Internal Use Only PERMIT M 6
Repair p®rmlt innued in IaSI s year's Not In Waterahed
IZ-3 :D Repair wtthln Boyd'. Comans. W. Branch er Croton Fall. Rao_ ED Delegated
0 1] Repair within aoo n- of a watercourse or DEG - mapped wetland O Joint Review
SITE LOCATION TM p
OWNER'S NAME <',m GE 'Z, !� E MK�j-t — S' ltEQ PHONE b -70
•% '� Co Q J — �o YS7
-� MAILING ADDR -6
ESS �t i�f 4 ?-4 ; S .% pv T1�"+'j•�'tf f9- �(��l L�L ' .f °S
APPLICANT ( 1Ao4 P'a=/I �
Name �8 Relatlonahip (1 "a., owner• tenant, contractor)
DATE g C�? � FACtIJTY TYPE � F�-S PCHD COi�,aT��� }+-yam .�
PROPOSED INSTALLER A-f 0 ��2-�� __ _ PC
f {HI✓ A /7�•,' S�` h'� 7,• 7
-
ADDRESS ��P a S CHI.cIi4 -/�A- Lf'9 -L•t ,e �' REGISTRATION /LICENSE N
�v T r�r, r3• to
' Proposal (Irtclu a a separate sketch IOCatinigi The 1'tOUSe, property tines, all adjacent walla 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 extan of the repair.
R KO 1" 01 SS E � t Q-o ° q- c-
5' •al d tw O G /4 T r O i!
1, as owner,agr o tto/ this condit�io�ns_statod on this form
SIGNATURE
(owner) '-P
1, the septic in=1�qr, ree t o comply with the conditions of thiits permit for the septic system repair
SIGNATURE d^ i� - 'A�.oti _ _ TITLE •74 6- 'fib ?� DATE S/T L /A�'�
(Installer)
Profleactl ar,nrovad wic" the followlno c�nditior a
1 _ PlroptsrtPSrtar! of a9r Tewrrf. Ptarot� i! -
2- Submission of as built repair stretch by the septic systam installer within 30 days of the repair• In dupricstu throwing•_
a. Ownar's name. Site Street Name. Town and Tax Map number '
b- Location of Installed components tied to two Axed points -
c. System description (e -S., 1280 gal_ Concrete septic tank• ate.)
d. Installers' name and phone number ,
3" System rapair to be performed In accordance wttn the above proposal and conditions
4, -rho proposed SSTS repair is considered a bast fit design and there is no guarantee to the duration at whlch the
completed SSTS repair will function_
5. No completed work is to be beckfilled until authorization to do so has been obtalned from the Oeportmom.
INTERNAL USE ONLY
Proposal Approved Proposal Denied Q
In-Mpoctov`s Signature & Title Date 1=-x Fllratlon Data
Repair proposal is In compliance with applicable codes leas No Q
:'i�r.�RIF_Sc- -� �1pC1 ^f1T� rJ� wnesr: IiRSt0�1_ai�.- ':Y-- .._. {ri . � v... :., a.. ,.• ,. _
p ro-�'r JI
.'_ ^- --•`- Fi!`�• F39M1 ,;' Rev.
�� ••2Jt�7
* * * 301ION X1 711=iSS30011S * ** 99Z : Ham 3113
H11V3H 1V1N3AN081AN3 3WVN
IZ6192M8 Ham 131
AVVZ :80 VIOZ- 6I -AVA 3W11
NO Sf11V1S
l00 : S39Vd AM
AVVZ:80 61-AM : 3A11 ON3
AVZZ :80 6l -AVIN : MI IdV1S
l00 S39Vd 1N3Wf1000
969MG8 01
WVZZ :BO 61-AVA : 31V0
99Z : d39WI1N 3113
- LNOd321 NO I SS I WSNVN -L ANOW3W
2. •.W K.. �,�
lin
BRUCE R. FOLEY, R.S.
Acting Public Health
DEPARDA-cNT OF HEALTH
Division Of Environmental Health Services
Geneva Road, .6rev:ster, New York 10509
(914) 276 -6130
':�DITION' APPLICATION _ (RESIDENTIAL ONLY)
STRE =T: 2 I. dyaAjlA'k J T0Y,'N' 4TN�t U e TX ht4P
S A_R�74-�8'
Da,V(,&1, AI°� �� P;;O�\ =flea .�Y33 PCHD PERMIT
iKkILING ADDRESS -SA/ttL
Description of Addition
cell 4Z 1 ,vclaalc� -k
;wiber of existing bed:'or_-:. s �v ?ropos °d number of bedrooms
front Certificate of Occupancy or�
Certification from Buildln= inspector
kiy addition which is considered a beldrccm requires fornal approval of plants
(Construction Permit) prepared by a Prof essional Engineer or Registered Architect
in accordance with aoolicable sections of the Putnam County Sanitary Code.
Please submit this form an-t the following to P'UTW'N CWFY HEALTH DEPARTMENT,
.
4 GENEVA ROAD, BRE4�ISTER, N, 10509, R1.Q:�e 27E7�130 wi tip• na 7nfo m3�t i;
-. ,.r .'.. ..., -..- .T Y - ` - ...v ..- 'R:- .S........... T 's ...tea. ♦ ...��+ F..
t•n e ...f �l- l�:�i. r
`1 . - Certified -Check for $100.00.
2. Sketch of existing flo*-,r plan (all living area including basement, if any)
Non- professional drawing is acceptable.
3. Sketch of proposed f1oo- plan. s" � . ))N Non professional draNinc is acceptablee—
4. Copy of survey showing well and septic location, to the best of your
-knowledge. Include date of installation if known.
Include all wells and septic systems within 200 feet of property line. Any
questions please contact this office.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
application
August 1995
July 1996 (Revised)
r" •vr�
�R
Daniel Napoli
21 Barger Street
Putnam Valley NY
Dear Mr. Napoli:
BRUCE R. FOLEY
-: r..�- :.. � ..._ r: ' % . � f'rE;lis' I'ealt':a: = 1yz�•r�ct�:r �, -.
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
TeL (914) 278 - 6130 Fax (914) 27 - 79 1
c toger 30, 1998
12579
Re: Addition - Napoli, 21 Barger Street
No Increase in Number of Bedrooms
(T) Putnam Valley, TM# 85.13 -1 -5
, LOBO,'
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
October 28, 1998 and this Department's approval stamp.
Based on the information 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 -sysi:em; 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 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
William Hedges
Sr. Public Health Sanitarian
WH:tn
cc: BI (T)
V) m
CID
U
0
1 l t) '�1�b a �
"'o.06d
F
4,
ei
a.
AIR
I��3
13 -, id ,
L
PUTNAM COUNTY DEP.ArjTp ..
"OP fM, ALTH
HOUSE PLANTS APPROVED ror3
BEDROOM COUNT ONLY;
S,
V
ki
Jot
�'t a
J.
�7
F
4,
ei
a.
AIR
I��3
13 -, id ,
L
PUTNAM COUNTY DEP.ArjTp ..
"OP fM, ALTH
HOUSE PLANTS APPROVED ror3
BEDROOM COUNT ONLY;
S,
V
ki
Jot
�'t a
J.
a.
r-
u
0
-4
U')
th
0.
Q
fl
PUTNAM COUNTY DEPARTMENT OF.HEAIX
HOUSE PLANS-APPROVED FOR
nr, r)Dr)nM Pr)"MT ONIT V
I'77^ ROOMS
Sign--turo & Title ate
C
oc
1
I
Ci
FROM Knighted Computer Systems, Inc PHONE NO. 914 96214S1 Oct. 281998 02:50PM PS
�JA Po
5
-- cu J, t�
flad
t--j, o
O tj
. �.
/ C
O
O C= Ul
c+
F
tD K C t
" t--j t
0 '
LIAR-
/x•04
d
W.C.
sulldlnq Oh.
(Wall Under.
2 DWE� NG
Pr ose
h
n
a b n .
O
r
o
m
a O
� o
A
\
C
e IN Well Cop
\
0%
t
or to be \
Re•-Constructed A \\
.D�
Steps t
tA Gor*00
� N
wT")
4
v Rood ace Stone Wall Generally A on a ale
Deed Jd7.1►'
Macadam P moment
S TRt t r % .
t,
Drive -
"~ Ovirheod +, 'tell YCr �• -� - _
t � � •
Drive
Pole
-4tic
SURVEY OF PROPERTY
PREPARED FOR
DAN0EL
R..
In Accordance
The New
iflcations
and on His LOCATED IN
Institutlon
Certiflcatlons
nets.
s Thereof . TOWN OF' PUTNAM VALLEY
byor Whose '
SUBJECT TO ELEC1T4IC AND /OR TELEPHONE CO•
EAS01ENT5. IF ANY. FOR OVERHEAD AND /OR
UNDERGROUND SERVICE.
SURVEYED AS IN POSSESSION, (No Lines of Possession
Other Than Indicated).
030Y� t
®�41oo p0''1a `.
p,0 VA `q � a °P..
ooa �1oM
1 °`r�oa5od ®�
a °Ua
00
SUBSTRUCTURES AND /OR THEIR ENCROACHMENTS
BELOW GRADE, IF ANY, NOT SHOWN.
-.. 'AW9E`0" SE S-''T'AKe4 TOE "Svirid OR Trim.
PROPERTY CORNERS NOT STAKED.
THIS SURVEY IS HEREBY CERTIFIED, ONLY TO:
9. DANIEL R. NAPOU
2
3.
Jo CARRONT
Y _. CO.
LAND SURVEYING AND MAPPING
YORKTOWN HEIGHTSP N.Y.
Wo. J. Henry Carpenter 8t Co: `Do Her Y Certify That on SGPt. 3,. 1996
a Survey of The Premises Shown .Hereon Was Made and That This Map
Is Made In Accordance With The Mold of Sold Survey.
JAMES R SEASOLDT, P.L.S. Flo. 49286
Certifications Indicated Hereon Signify
Vfith The Existing Code of Practice For
York State Association of Professional
Shall Run Only To The Psmon For Who
Behalf To The Title Company, Governm,
Listed Hamon, and To The Assignees c
Are Not Transferable To Additional Inst
All Certifications Listed Hereon are Val
only If Sold Map or Copies Bear The It
Signature Appears Hermon.
Alteration of This Map Other Than BY I
Copyright ® 1998 J. Henry Carpenter
All RIghto Reserved. Including Rights o
NE 1w v STLE
SEPTIC SYSTEM REPORT
DATE: SEPTEMBER 24, 1997
ADDRESS: 21 BARGER STREET, PUTNAM VALLEY, NEW YORK 10579
SEPTIC TANK LOCATION: 10' SOUTH, AWAY FROM THE SIDE PORCH ENTRANCE
DOOR STEPS.
TYPE OF TANK: A.S.M.E. STEEL, 500 GALLON CAPACITY. (APPROXIMATE)
TANK LAST CLEANED: INFORMATION NOT AVAILABLE.
TEST PERFORMED: THE SEPTIC SYSTEM WAS FILLED WITH 150 GALLONS OF
WATER AT A FLOW RATE OF 4 GALLONS PER MINUTE, A
TRACER DYE WAS INJECTED AND THE LEACHING AREAS
WERE SPOT PROBED AT DEPTHS OF 12 ". .
' ^NOT)V8 WATER VAS PRESENT ON TiIE SURFAC:; � ' TI'i CRu�Nu . ".REA sN.THE'
PERCOLATION AREA.
THE INSPECTION IS BASED ON A VISUAL EXAMINATION AND SURFACE PROBE OF THE
GROUND AREA DURING A TEST FOR FUNCTIONAL DRAINAGE.
A SEPTIC TRACER DYE TEST IS AN ACCEPTED STANDARD TEST, HOWEVER IT IS A
NON- CONCLUSIVE TEST AND DOES NOT GUARANTEE THE SYSTEM.
NOTE: THE SEPTIC TANK SHOULD BE PUMPED AND CLEANED EVERY TWO YEARS,
LIQUID DETERGENT SHOULD BE USED FOR LAUNDRY, BALANCE OUT YOUR
WASHING CYCLES AND INSTALL LOW -FLOW WATER SAVING SHOWER HEADS.
PHONE (914) 941 -3331 • 94 INNINCWOOD ROAD, MILLWOOD, M' 10546 • FAX (914) 941 -3242
FROM Knighted Computer Systems, Inc PHONE NO. 914 9621451 Oct. 28 1998 02:48PM P2
el \
O ® 1 �•
�Cy .
�r
•
,
i
! 7
l
r --t 7 t' -r
OK
-
:
i
,
, 1
i
- -- - - -
,
I '
,
:
l
l
l _
ern
I ,
'.
i
I ;
I
,
,
: •
l i
, • :
I
• :
1
' I
1 i
:
t
:
t
I
I
:
,
:
:
i
I '
t
P 7.
Y, v
cr
i
DI? 1 ✓�� I I
: l ; I
l
I
� I
tI
,
:
1
-- - -4
i
i
.1
f
l
:
l ,
'
t
, I
,
t
I
i ,
I
I
, l
I
f)•
i l
- Tom. _ �S /� _�_� _
z
C) Cq
Ci
C)
�f �
ewP ou-,ts �- loe�
,/Vc) s��`
-; ; � /c, C'. , ,
I