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HomeMy WebLinkAbout1205DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.63 -1 -1 BOX 12 J-1 T ,` �s IT 01205 q OWNER'S NAM SITE LOCATION ±i •• :1� Lei• 1 IDo PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR oaf nJ e- PHONE 6 J M "el (Z J /.R WIeS Name & Relationship Ui e, owner, cxC—Q-11 PM Complaint # _ tenant, etc.) TYPE FACILITY S; A) je FC�r -►, '/, _ PROPOSED nWAL1M �- � (Uf�^�S PHONE REGISTRATION # Proposal (include sketch locating all adjacent wells): NOM: 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. N© 2e'r10, rJa �1,1a i lot 816- - -Z s t // nle ki l /' oe!) A,�.11ia.� %-,v �( r: ,.in%� r .� /� !'l 15�./S Al;-f4 a la ✓e-/' 6 _ m —r'7 / q�,, k. S+, �we // 's Sianature & d 9 '11e00,00,000011W roposal 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' dim. x 6' (13ep drywells 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 reported agent of owner agree to the above conditions. SIGNATURE TITLE Pr, r o ,�. DATE COPIES: Write MV; YeUcw ('fin ED; Pink (Ap lioant) PC -RP 97 T I IJ�[!fl� +lA SVr[ + +LPI "nc� +l ^n['.L t. N�+ 1�+ t" nRrt" nt/+ t" 7�R:+ t" AI" nt!.+["-+ L" r[! Tt�rt^ nLl�t�+[! �I" J�t�rl^- +t "� +L• +tr' +1� +t ", +I� +1 "_ +l,"_. �L ^L•' +I� +1� +1 -IG "L ^L ^LL'. L "_ ^I� ±I. 1.1 ^Iti +l " +L. V_ +L +lnL LI�L "+ y' f'l�l fiJr!� ".9 C OIJf lTl FiE 'LTFI ©EPT. ``•, _? 5 10 o � � c. APPLICATION - ADDITION - (RESIDENTIAL ONLY) / l rj 27 I Name: �Joh. -� a i6a r� (,�r�lnrr- Phone.,? �i - 3 �[� �" Yea of .Original f 1 ta? ST. !o f Su Ca vn rt.e /Cd TM- - ____ Construction �^ l/ Mailing Address o ( JeI[ee !M(%t0 / Town Description of Addition Re-V eA.. 10�1 Please submit this form and the following 'to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. Number of existing bedrooms Proposed number of bedrooms 3 A] Square = Dotage of existing House 4 a X B] Square Footage of Proposed Addition 1O CSC f4- -t- ' % increase in floor area ( A divided by E) X 100)= THE PROPOSED ADDITION IS GREATER THAN 15% L/ G ��CHECK for $100.00 Sketch of existing floor plans Tali living area including casement, if any) Non - professional drawing 3.. Sketch of proposed floor plan. _ Non professional drawing Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if krcwn. Any questions please contact William Hedges or Robert Morris. IF THE ADDITION WILL RESULT IN AN ADDITIONAL BEDROC,M THAN 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area irc7udinG basement, if any) Non- professional drawing 3. Sketch of proposed floor plan. Non professional drawing .4. Plans for the Sewage Disposal System prepared by a Professional Engineer meeting present code requirements, may be recuired. PUTNAM COUNTRY HEALTH DEPT. APPROVAL IS REQUIRED. OFFICE USE Comments and /or conditions _� /C G "'/" _�' % s� P d iZ c' c:51--7 < .e � 5X r- . %-s . `' -e �? U A Approved by /� ­-TITLE ---5 Date: G '� cc: BI (T) U PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 October 1, 199O John I Berbera Gardner 61 Sycasaore Hosed Patterson, P4ew York 12363 Res Addition 61 Sycamore Road (T) Patterson Dear Odra & arse Gardners JOHN KARELL Jr., P.E., M.S. Public Health Director % have received and reviewed the piano for the proposed addition to the above mentioned residence. The plans indicate that the kitchen and living room are to be enlarged by a 141 x 26° addition. The survey indicaitera that sufficient area exists to expend or repair the sewage disposal syssteo, should it becocle necessary in the future. Therefore, based on the information submitted, the above wotioned addition is approved pith the following conditionsa s le The total number of bedr000ss oust remain at three without prior approval by this Departoente ao The area of the existing sewage disposal syatea, and its expansion area, must be maintained. 3e All pluabing fixtures oust be replaced or updated with water saving devices, i.e., low flusah toilets, resstrictorss for shower heads and faucets, etc. Approval is granted for sewage disposal only. Any other percaits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. %f you have any questions, please contact oe at your convenience. Ve truly yours, Robert Norris Assistant Public Health Engineer RN/jp ccs BI (T) Patterson fared -LIO P7 C4 • C i t t t { i 01 O lD to ~ N ED 0 lD �. t0 tD co . N N to cli I r_ //.79' /story fralm I dwelling N O e , q // N. D C 4i lD % 100. 00 .:.�• �,; ; ,:(r prove /.: 'porAing.. Oleo --,. 5YdAM0RE t 5o'wide/ JOAD SURVEY OF PROPERTY • BE/NG L OTS A 617 A 621 /NCL . SHOWN ON 'MAP A OF PUTNAM LAKE" S/ rVAre /N TOWN OF PATTERSON PUTNAM COUNTY, NEW YORK SCALE / "= 20' Sold mop 6*d March 20, /93/ as Mop NP149- A Legend Iron pin set — • drill ho% set —x, , pole B wires.— _. cionc. RV// Certified on /y to: Edmund Kordovshos Putnom County Savings Bon* Reo/ty Abstrocl Inc. and rho riAt Guarantee Ca for. rifle NO hWl- /B /7. 1, ✓ones C. Edget t, the surveyor who 0 o0Q1 NoM: Ap certlAcotlon hereon ore vo //d for th /s WS mop, do hereby certify ffia Me surrey mep and copies thereof only if SO/d~ of h)e property shown hereon was comp/ehpd or copies beer lhr Impressed see/ of the Oct. 14,1969. Revised June 25, /974: ��` surveyor whose signoturs. oppeorr hereon. N Y_ License N *372 = �' �ctc� +� nn. Registration Nr5632 Jr.J Office of James C. 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