HomeMy WebLinkAbout1231DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25.63 -2 -49
BOX 12
.,
I�yti �. ; P' Jesse - 1 :: I�
' : -0
J.IN _, , �,
Is
T Z �r - ■
7b 1111ril -drimins T-
01231
F
SITE LOCATION
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION.OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR .�
Use
LJ Repair Permit issued in last 5 years
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland
TOWN 'XJ thf23jW
OWNER'S NAME OHN //1 Z};
MAILING ADDRESS ( S fee N �1�
APPLICANT
Name & Relationship (i.e., owner, tenant,
DATE -7-19-1) FACILITY TYPE
PERMIT #
U Not in Watershed
❑ Delegated
❑ Joint Review
TM # -Q�_o & 3 -.2 - `if
PHONE# Pklr,279 tocD ?7
4M e, PCHD COMPLAINT #
PROPOSED INSTALLER J3
y nms sad-, �,, PHONE #
ADDRESS /I 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 repair.
I, as owner,agree to the conditions stated on this form
SIGNATURE TITLE OW W-e (L/ DATE -7 f b
(owner)
1, the septic installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE f TITLE otegLe%L, 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 El
e
Inspe oes ignature & Title Date Expiration Date
Re air proposal is in compliance with applicable codes Yes No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
r
i
I
f
I
L�
i
i
PGT�'A_ I COUNTY DEPARTMENT OF HEALTH
DI'VZSION OF ENVIROI+�IENTAL HEALTH SERVICES
DESIGN DATA SHEET= SUBSURFACE SEWA0E TREATIVENT SYSTEM
Owner: ✓/ eGh ZGA G� J^, Address:
Loczted at (street : �� /) e� 171 E`�� TAI R' Sectio ns,-L Bloc'. Lot V y
Municipality: �CTL'Jdh Watershed:
SOIL PERCOLATION+ TEST DATA
Witnessed by: C(Li
ria to nrpro_cno I. inIA /(5) T)at. T.,..�� n r.
cr
CD
v
m
N
W
CD
ti
0
z
z
0
f
0
m
LL
0/2 J',v e, w #,y
boot r
Colic,
�r.
i
X
4
Low
O
is,
A
co
Z
y
Z
0
pgvJ4 Z, fip/D
7W0
1�
'orn STU�� TeS
r
i'
E
3 �
u1
f AT T eje v�
fi
1� To
/ 8'
To s
;0
Td
Td�,
t�
ATO 6 7
'IT a 6 = 3s-
To 7 -' / `
.6 TO T,gAll(= Iif .6j,
Sheet 1 of 1
_ Putnam County Department of Health
Division of EhVhi 6riinental- Health 'Services
Field Activity Report
Name: Panzanella Telephone:279 -6097
Address: 15 Kenton Rd Putnam Lake NY
Street Town State Zip
Person in Charge or Interviewed: Date: 11 /10 /11
Name and Title
Findings: R- 134 -11, Went to site for final. The repair was installed as per drawings.
Inspector: ��, Telephone:
Signature and Title
Report Received by:
1 ackn6wlecige ieceipt of this*report: Signature:
Title:
Field Activity Report: cw Date:
YAAIAAIAAIAAlAA1M IM IMIA AIAAIA^IAA/AAIAAiAAI."
e
(W"I"lNNl1l Wifl" NYIYNtilNIN NIN NI NNIQNINNIN NIM
IMIAA:AAIAAIMIAAIA AI AAiAAIAAli1f.
V11f 1/ MIM IAAlAA1MIAAIMIAAIAAfQAIAAIAAIA AIQnIAA1MIQA]AAIMI�A
i
• 9
1
.9
y
y
i
�
s
y
V: 11 117 �( 11i1i1i] YYIi fV1111iI1111IVVrill1111V111111V
W1iVl itHlNliIliLI1/ H11 111I111111/V11/11I�/WIV111J1Y1► INLIN- li/�1VW1J1YI11V1�
t
r
PROPOSED ADDITION APPLICATION PRESIDENTIAL ONLY0
STREET TOWN9& X MAP #.2 e5, &3 a -1-9
I
Ltil iii A ;,. .
DESCRIPTION OF ADDITION c.,
Vel
NUMBER OF EXISTING BEDROOMS -S PROPOSED # OF BEDROOMS v -
(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.
!'lease submit this form and the fbHowing to Putnam County Health Dept., 4 Geneva Road, Brewsier, NY
105Q9, Phone 278 -6130.
1. Certified check or money order for $100.00.
2.1"' Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non - professional sketches are acceptable..
3.k"" 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
I
BRUCE R. FOLEY
• - ,Public Hidlih - Dir'e'ctor
LORETTA_ . MOLINARI, -R,N., M.S.N.
Associate Public Health Director
Director of Patient Services
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
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Re:�v
Reside ce
Tax Maps S. 63
Townr�l�� /l'y
According to records maintained by the Town, the above noted dwelling
IS
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:
OTHER
vt /I-
Inspector
BFhouseguidelines
BRUCE R. FOLEY
Reaith Director
- - -- ............ .
_ LORETTA...MOL INARI.R,N.. - M.S:N, .,.. •:
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF BEALTH
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
January 12, 2001
John Panzanella
15 Kenton Rd.
Patterson NY 12563
Re: Addition- Panzanella - Kenton Rd.
No Increases in Number of Bedrooms
(T) Patterson Tax # 25.63 -2 -49
Dear Mr. Panzanella:
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 approval
stamp form this Department dated January 120 2001 The 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 exp zsmn rrea, 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 Patterson.
If you have any questions, please contact me at your convenience.
Very truly yours,
Michael Luke
NUAg Public Health Technician.
cc: BI
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PRO
Internal Use
P
M
❑ 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
SITE LOCATION TM #S
OWNER'S NAME yQ� A--) ZA1VC11A PHONE•# a 9"?
MAILING ADDRESS
APPLICANT s�Q
Name & Relationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER PHONE #
ADDRESS S; REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 260
feet of repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type'as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from licensed professional
1, as owner, or reported agent of owner agree to the conditions stated on this form 1
SIGNATURE '2a /Jo& TITLE V / DATE
Proposal aporoved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owners name
b. Site Street Name, Town and Tax Map number
c. Location of installed components tied to two fixed points
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to'be performed in accordance with the
above proposal and conditions.
Proposal Approved Proposal Denied
Inspector's Signature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
P('.-PP 00hAI i
To/ : 13 .4
CCIAOC,
I,vf"
<
've
0
I )
\
a j
i
-.
i
pi z,4 AleV19
/s� /� e�vrdiu X2,0
G'f�i7-ee.soa N �' laS63
S%o1v /,irAl-L i
�R eA T9< v !
{
s TePS �.
nn i
...... ..... .. _._....__. _ . .
r
1
j
7--
)hn & Debbie Panzanella
5 Kenton Road
itterson, N.Y. 12563
145) 279 6097
Entrance
24'-5"
PUTNAM 'COUNTY DEF XW MENT OF HEALTH
ISO' L ueA43t� 1`16ff
L BEDROOM 00
)KIP',
Date
14
Existing conditions
as of Jan. 2001
Laund
\ - - - - -- ---------
Una of now cont. beam above
Entrance
NMI
:)hn & Debbie Panzanel.la
5 Kenton Road
atterson, N.Y. 12563
345) 2.79 609.7
24-511
63 -40 PUTNIANI (.01jiffy DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
F�EGJ'1,0011,1 COUNT ONLY;
3 BEDROO.-YIS
T
MID
Proposed 1 st floor
O
-- . . - - 1
Proposed 2nd Floor �
Q
w
�
LL
O
Z
U
w
C)
LU
O
cn
Q
C J
7
w_-
J
d
:.
N
Q
z
-j �?
O
Cl.
w p
m
N C
C;--
cc
O Lu
M
_c
Proposed 2nd Floor �
W
\
'A
ci
� t ;
1� PIN � � / � I I � � • / �
KLNTON DRIVE �
u�v '
o.' •PROPERTI'
JOHN. 0591P.�A �►NZANMIJL.A
AND, OFWnC)N Or a PAM.W
f{•n.l MAP • plR • PIJTTIAM L AK6 % f� M ' MAP �
TOWN �!' PAT1'�R7N PUTNAM 'GO •� N`�
SC•IA LM . 1� 1 �EPT'�M�ele 2tl t
�prnF1E0'RJ crt'Y ,FP -P�t�. �,evllvsa''r�+� a> rrawloo r:.; ..
AmAym" T rtpft P OLJC:y 0 SA S+"'Prol sro.'
C8r>K1�{C1�T10�Jai t1.b�Cr4 � F 1 _,K.�.IILY 'iitut" ryllii U 7Mb2»E1D A1L7v-=Clow Cc aCat7,lc)a1 7D'1►p
%AW, PC4F7JCM iu Aim=cA I CA v rm Ifi ,l V IOLXnOAJ eg 6M,�77W *
^T►8 LJ k1 `,(oL'1G 7E •:4�CiGJ.�t1GF� of �,5 rd�JAl. 'rt r sTa[rrr EA 1:11 LAW.
1411& -=:a �ME!& t Ft►N "!r
-
L/!<JP a �ye�flpKi9e �fiA1D C��TA K 'SFId� =-. 9L,4J, aAY L. G<ICI[AC MLI'! ►eCp- -Osj AM %AIJb Ct]I
tilE sou .Rc �ilNgwl'f}r)c .� . AJU0 'TW 4 MA.P AWD GoPIGfi - wimE�' d.lLY IF �,6.IQ
' ►1th y�LF.'ic �IfAE. R1? c C�?My K ,M- w..uE-Lw►.1G,. Mt1P de cam; PF.AJz ('Pda mpers*'E=� 66AL
l•MrTCl1.11"tb1.� ;1- � 4.wnpr.A lCW4 Am LCR' '> �. vE�+be t6ki 6L 61&mj.A APREU
�- sr�.it.•� 1o�•W.- >t,lSmt'�T1o�..lFi c� , ' , ►F�o� -�• '.
7_EM d°_I�ILEJ�lCx *�F'GGIJ.INS
c I
f°,4lCK
•�'' t
t
NAP P
PUTNAM LAKE C
C0MMUN1fY C
COUNCIL-, INC.
i
s'
y'U
\
'A
ci
� t ;
1� PIN � � / � I I � � • / �
KLNTON DRIVE �
u�v '
o.' •PROPERTI'
JOHN. 0591P.�A �►NZANMIJL.A
AND, OFWnC)N Or a PAM.W
f{•n.l MAP • plR • PIJTTIAM L AK6 % f� M ' MAP �
TOWN �!' PAT1'�R7N PUTNAM 'GO •� N`�
SC•IA LM . 1� 1 �EPT'�M�ele 2tl t
�prnF1E0'RJ crt'Y ,FP -P�t�. �,evllvsa''r�+� a> rrawloo r:.; ..
AmAym" T rtpft P OLJC:y 0 SA S+"'Prol sro.'
C8r>K1�{C1�T10�Jai t1.b�Cr4 � F 1 _,K.�.IILY 'iitut" ryllii U 7Mb2»E1D A1L7v-=Clow Cc aCat7,lc)a1 7D'1►p
%AW, PC4F7JCM iu Aim=cA I CA v rm Ifi ,l V IOLXnOAJ eg 6M,�77W *
^T►8 LJ k1 `,(oL'1G 7E •:4�CiGJ.�t1GF� of �,5 rd�JAl. 'rt r sTa[rrr EA 1:11 LAW.
1411& -=:a �ME!& t Ft►N "!r
-
L/!<JP a �ye�flpKi9e �fiA1D C��TA K 'SFId� =-. 9L,4J, aAY L. G<ICI[AC MLI'! ►eCp- -Osj AM %AIJb Ct]I
tilE sou .Rc �ilNgwl'f}r)c .� . AJU0 'TW 4 MA.P AWD GoPIGfi - wimE�' d.lLY IF �,6.IQ
' ►1th y�LF.'ic �IfAE. R1? c C�?My K ,M- w..uE-Lw►.1G,. Mt1P de cam; PF.AJz ('Pda mpers*'E=� 66AL
l•MrTCl1.11"tb1.� ;1- � 4.wnpr.A lCW4 Am LCR' '> �. vE�+be t6ki 6L 61&mj.A APREU
�- sr�.it.•� 1o�•W.- >t,lSmt'�T1o�..lFi c� , ' , ►F�o� -�• '.
7_EM d°_I�ILEJ�lCx *�F'GGIJ.INS
c I
On & Debbie Panzanella
5 Kenton Road
itterson, N.Y. 12563
45) 279 6097
Entrance
a
Existing conditions
as of Jan. 00
r
E
•
I
ra �. "'�'
e
u�
? ��m 1 � -1 -600 - -- I _----- �-------------- - - - - %-
John & Debbie Panzanella
15 Kenton Road
Patterson, N.Y. 12563
(645) 279 ®6097
m a� I ;(-
9
Proposed 2nd Floor
N/- NAM P AKS coAgPjf' f CouNCIL- , INC.
t I.
pj
16 AC9
}t �r 41A 5
t-F
i
i
uk 0� PROPERTY
PkliP1 mrmb FC)R
OREBR ; PANZANELMLA
LOS V . GJAA -moo
�S St••apwM ON
I L-OH TH M^p AP PLMAAM LAKE 4 .FRI -tom MAP 1�9Cy FILED : -24 -31
cr. fwATTIHRUX�. . PVrNAM CAD -1 NY,
6 l
cER'nFFEQ '1U GH'Y f empAI_ . AV N&� mANI a 'srA'TCw1c Fe
A,t3.$i'p. &zr rt:)ft Poi- -1 0 3A 919`aO
GPc�SI ,Il�o NL�- .CP i Jt6°d °Y�taRb° YFii� U�� W CC A=rr;c"-J �"RA
k/b PMFAAM lu ACC=CA&r-F- Y.TN'ME Y "A \Jj0L n0AJ at= Ge.'!Y7C4.J *'T?1� =�
lg97a c =f-; cP FVA=Y-.# -.tom t �. -Wl,A�� a -ePk.r tae SfRf L °�►cc.t e- '9tct•
-r►� a. `!off tE i4Fs47=A7%:* 1 aF 44,*C LA6 LPG tt= AJJY "!r .
lrAe.Ja +Jt l�`lGL3ir'�dI�GF.C�fF�[�TIc�A. + 3NAI i- gL*i cs.JLY. Al-L CEJ=n9lC- An0&J6 NEVA -o$J AM \.tLtl ttl
'Y►i!= 1 . 1iltEgailil l ►+r 1)46 MAP AJD Cpp�ap -t}�F' al !LY tF �6ta
t� �.� °i}?�E• -r r? S 0wAPW -H , qt -gyp.. Ll OINJCA M9P C, cn5g tE eEAr-' -t9F- MttplS%ED 6EAL-•
t.J R4tJT'{e�.t d.a g ,1. t Et iGEr- •AnoW, ° ,ems L=r vg:., 7w -S � 5t&,& �
�..� -ro ,i'lca- lA,►.. t�.1314'Pt.�flaa.c�, ate, tom•
tJL� tl° a. Cn r_itJs
D
O
o�g �
o r
4 C
V`
A i41 0
rh
N
�rn
rm
u.
D�
(p <
n-
m
f
�o
.m
z C
003 0
DZ Y
0 0 to
11Dz or0
0
3
mr
-01Z��AO
o £ o t
� ° -6
N zll
��
m# -0rz
3 N �.
mDc -"- D rn -
A3� Z --
1V C1 m M
.�
r
w
1.31
. o y
w
7
I
�I
z
�I
.Z�
A�
c
13a I \
i
Z
3
� D
0 7D
3 �
zi
m/^ Z
(1
-oz20 r
b�pD
mZ