The URL can be used to link to this page

Home My WebLink About4693DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.24 -1 -40 BOX 35 ro r V . ..:.I -of r + IL . ' Z�- 8l I ,, S, UL 04693 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225 -0310 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPArR OWNER'S NAME Lt'_ PHCW .,5-29—'07(o5 SITE IACATION 2-4 AA LL, kct TM# %& —3 ^ 2, MAILING ADDRESS LA y- PERSON INTERVIEWED PCHD Canplaint # Name.& Relationship (i.e, owner,tenant, etc.) DATE &W,71 TYPE FACILITY PHONE Pro (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. �'' ''�� l�'� � c,r4-G � �� [s �_r �lG 5'T� G L TA -1�,� t� , � •,� �cr ,�,�,.. ; Proposal approved`, ? Proposal Disapproved Inspector's Signature & Title 3. cate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed cauponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three'precast 6' diam. drywalls surrounded by one foot + gravel). e. Installer's name and number. System repair to be performed in accordance with the above proposal and conditions. Date I, as owner, r reported agent of owner agree to the above conditions. SIGNATURE TITLE, �p PIES: Mite MD); Yellow Mm ED; Pink (Apptiamt) x 6' deep CP �Oo CO ... . ...... &-A . fit J0 4k. I.ve_;Y�stle_a... 7-b- Ko-..f [e- �,A ��tr� Ucall�.1 Leonardi & Son Construction, Inc. 6 Carolyn Dr. Cortlandt Mano''r 10567 (91 4) 7.36-9010 7 Date: ii-1y -D Jf 54- -; 3L') 1ZS -i0 J0 4k. I.ve_;Y�stle_a... 7-b- Ko-..f [e- �,A ��tr� Ucall�.1 Leonardi & Son Construction, Inc. 6 Carolyn Dr. Cortlandt Mano''r 10567 (91 4) 7.36-9010 7 Date: ii-1y -D Nov 20 08 09:19a Leonardi & Son Constructi 1- 914736 -9311 p,1 MOV -20 -2008 09:05AM FROW- ENVIRONMENTAL HEALTH 8452787921 T -267 P.001/001 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPDSAL FOR SEWAGE TREATMENT SYSTEM REP_AI_ _ = a = r' : .« .:' .'.:�: c<,F�• :=s'. ^B ::ems::.. tom: a: :.tr,;¢�I;r';.:,�� :.:,�.$:. �_.:wt: ;�;, %i.i't'�Ir 'rte::: =. Intemal Use Only PERMIT PERV/Kepair Permh issued in last 5 years ❑/Noi in Watershed J Repair wllhin Boyd's Comers, W. Branch or Groton Falls Res. (�' Delegated ❑ Repair within 200 h. of a watercourse or DEC- mappeo wetland ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS TOWN TM 4V Gi PHONE # APPLICANT Q W jl AL Name 6 Reiadonshfp (.e., owner, tendnt, t:ontrssxar) DATE O L O qf FACILrTY TYPE . ' PCHD COMPLAINT # PROPOSED INSTALLER r'-220 /k l ' CIL � J'Ve, PHONE # ADDRESS REGISTRATION /LICENSE # G � Pro I (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 P. I, as owner,ag to th Ition: ted SIGNATURE_ TITLE _ A %&4 &l- DATE (owner) I, the septic instal , agree to comply with the conditions of this permit for the septic system repair Q "ATtJF1E ITI:EI! DATE.... %�-- Z(�'�J�� (installer) Proposal aaoroved with thip following conditions: t. Procurement of any Town Permit, if applicable. 2. Submission or 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 insta tea 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 perfoaned in accordance with the above proposal and conditions 4. The propmed 55TS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair viii function. 5. No completed work is to be baelclillled until authorization to do so has been obtained from the Department INTERNAL USE ONLY Proposal Approved s Signature is in Proposal Denied ❑ =�Ao COPIES: PCHD; Owner, installer PC -RP 99ML Rev. 2107 Date a AS B - UILT DRAWING -1'3 F—t I C--� sad. F-l' It er% AM 3 2,9 lK Leonardi & Son Construction, Inc. 6 Cat•Olyn Dr. Cortlandt A/ (914) 736-9010 fanor 1 0567 Date: i 01, 2- 454 3 2-- 3 2,9 lK Leonardi & Son Construction, Inc. 6 Cat•Olyn Dr. Cortlandt A/ (914) 736-9010 fanor 1 0567 Date: i 01, vc Now mV y c .t E r : ' r 3 .;�1 ! a }�• 4 gib +f 77, �'` Au ° 17,51A. 03"ll-I Iz POO PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES , r'1- Wr- % -J.7ML r-%Jn JGVV,06% AC 1 r'4CN1 INICIN 1 O T.7 t CIHI v ^ "�i'. Gi:' .r �[•::�.::..- `K.w:�K.�f. el ...��4j= �+.,C,: i�.rr�:::4a.. b.C{i .. .,.. ��M� ®�Y"^�� ✓( J \� Internal Use Only PERMIT # iJ 71% Repair Permit issued in last 5 years LJ Not in Watershed ❑ ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION TOWN 7966q�g TM # OWNER'S NAME. 80 Ns ?66 B - .PHONE # MAILING ADDRESS 7—t MMA W& �. t APPLICANT O w Na ., Name & Relationship (i.e., owner, tenant, contractor) DATE gig ® FACILITY TYPE 4tw4rA, AAJ9QqPCHD COMPLAINT # PROPOSED INSTALLER ADDRESS PHONE # REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property fines, 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. I, as owner,ag to th itions ated o SIGNATURE_ TITLE DATE Q�� (owner) I, the septic instal , agree to comply with the conditions of th is. permit for. the septic system:.'repair.F SIGNATURE TITLE DATE (installer) 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 ❑ Inspector's Signature & Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes 0 No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LO RETTA MOLINAIt�� vniv.ms - G••.v,•- <Ba0^ry.. - v.y.� -•. associate Commtssion. er of #ealtth Robert Hagopian Hagopian Engineering 682 East Chester St. Kingston, NY 12401 Dear Mr. Hagopian: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive w Director of Environmental Health October 29, 2008 Re: SSTS Repair 26 Maple Road (T) Putnam Valley, TM # 91.24 -1 -40 At this time, plans submitted to this Department for the SSTS repair are approvable. Please be advised that once the owner has hired .a.Puknam_CQunty�l= ice?xsed Contracfor,the,contr�ctcr - co"fiptet6.4 -n - sig' lhe--a11-•rndy �ulidiitted -npair pefml prior - i' constiuctio .*"8eTurther advised that the permit will not be approved until such time that said contractor signs the permit. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Very truly yours, -1� OVIN j, 17 Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 09/12/2008 12:52 FAX 8453313279 HAGOPIANENGINEERING la 002 /002 SE -19 -2007 10:18AM FROM-ENVIRONMENTAL HEALTH I.. SHERLITA AML91t, .M.D, SRS, FAA- F ` Associale ComfidMiOner Of Health 8452787921 DEPARTMENT* OF HEALTH I Geneva Road, Brewster, Now York 10509 'REQUEST QUEST FOR FIELD T ESI'I NG T -385 P 001/002 F -840 ROSERT1 BOND). ROBERT MORRIS, FE Direcror of Environmental Health All information below must be fully completed prior to any scheduling. DAT E: P ENGMER OR FIRM., fl1%Vre4(%J PH ONE #Aq-10 - 3,71 PERSON TO CONTACT: 1-44tLel.� ❑ NEW CONSTRUCTION REPAIR (PROGRAM ❑ ADDITION PROGRAM JASON: DEEPS:)S PERCS: PUMP TEST: r] ROAD/STREET: 2 6 'Arc. C 12. ,�q TOWN: gLi T/V 4fi'1 �Fb,j x MAP #: � � � � � d y4, S UBDMSION: LOT #: OV,rNER: jz)S14 NYCDEP GRIT ER1A_Em>1 JQ2 _%J&w ANU TNB5 Z19j QJ 5QJL ,TESTIpIg YES NO .._:�: wSSTS,withln_thc�_ Croton palls 'Reservoirs, ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. O Proposed SSTS design Slow greater th4a 1000 gallons/day or SMS ;permit required. ❑ Proposed SSTS for a Commercial Project. , It is the responsibility of the design professional to provide the above Ilniormatriovi prior to soil testing. The Department will determine the NYCDEP project status (.Joint or Delegated) based on the response. If you .answered y& to any of the questions, INYCDEP must witness the soil tests. ThisDepartmanywfl! coordinate a mutiny suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Dolegated based on the above response and then subsequent information indicates NYCDEP Is required to witness the soil tests, It will be the sole respo>nelblltty of the design professional to schedule re-witnessing of the soil testing with NYCDEP. )F R COUNTY USE ONLY QQ— are.,aa Envivonmental Health (845) 278-6] 30 Fux (845) 378 -7921 Water Supply section (845) 225 -5186 Fax (945) 225 -5418 Nursing Services (845) 278.6558 Fax (845) 279.6036 WIC(34j)278-6678 NurSieg Rome Care Fax (845) 273.6085 gaPly Intervension /!Preschool(845)378 -6014 Fax (845) 278.6648 Q ;;T "I r o J-y) VII, 9 rs itou 0, RI S.. ,v, ,. York State §111 Reservation 11 Fi e God. ;h ,e I cem f ;I a- Hoo 6N itou 0, RI S.. ,v, ,. York State §111 Reservation 11 �-T L 91" P n -A t des, i 10537 Fi e God. cem f 0 tine itat Village fli L �-T L 91" P n -A t des, i 10537 20 il - CT- - VA L Yq THAM C CHESTER, Moheganj Lake 10 Jj e God. cem f 20 il - CT- - VA L Yq THAM C CHESTER, Moheganj Lake s X'1 V15 0 0 W100.00 �00- u y l N N44055'00"E