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HomeMy WebLinkAbout1332DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.78 -1 -3 BOX 13 11 INS 1,N%• 'k ' • ' 'i� I • , T 1 . ■ I .. .. iIl r I 16 � T .I . ■ 6I 01332 ti t -'Z PUTNAM COUNTY HEALTH DEPARTMENT' DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL 'FOR REPAIW- Internal Use Only PERMIT # ❑ Repair Permit issued in last 5 years LJ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Z Delegated ❑ /Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �F/ Gd TOWN TM # 7,q - OWNER'S NAME / htyM <AC4.SJJrA WV PHONE # $YS-. HQy, g:V MAILING ADDRESS APPLICANT Name & Relationship (i.e., owner, tenant, contractor) " 1t) let DATE /' 2110 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER '67n,- je, PHONE # BYE. Z7 ff - 6069 ADDRESS 41q 24, (,,, , %trim- REGISTRATION /LICENSE # 106V 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. ZW4'a-- 6 r`l5?1X.t°, Ai Wa?-7AWI- A ZA, -Sl-; A/eau �f " 949- 35 Dc , z,FT I, as owner,agree to the conditions stated on this form SIGNATURE - TITLE ©VJ "T- DATE (owner) I, the septic installer, agree to comply with'lhe conditions of this permit'foFthe septic system repair SIGNATURE TITLE DATE J/• ?-Zy/a (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 backfil!,eeuntil authorization to do so has been obtained from the Department. INTERNAL USE ONLY Pr osal Approv d Proposal Denied ❑ I pector's`3lgnature & Title -, Date Expiration Date Repair proposal is in compliance with applicable codes Yes 0 No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 ?. f r2onr Prry hNn��v�� $ 15iS -� Q •}' 6 � � is � � 2 a �+.�'°� aG "w to" �S Qsj ax,, 4io rp P r" CC,Aj oN /N bv��As+t?°�,. ".... SZ� ry-�'.N Tim Fry Sep u/�o m �' C�o2 Goo o A(a a- 2 i�tt o CgtiC Li . rrev►.rO °�� 22di<O S 0.3-1 ;S. � 1;' O� ---= •n:�b N..� O��aW. q oo „E5. Id. a00mPa m I : o i w"I !-,iA" PUT_N_-,15,_M COI. `T �T OF HEALTH DILVISION Oc-E,'N-�"IRC)-N,-A/IENT.�:,HE-A-LTH.Sr—RVICES DES! G-N DATA SKEET - SUBSTURFAC L' E -"4,-kGE TREATMENT SYSTEM Owner- Address: Located at ;street;: TM' Section: Block Lot Nfunicipaiiti Watershed: SOIL PERCOLATION TEST DAT-A Witnessed by: Date df Pre - soaking: /I/ ✓' Date oflPer6ofatioia Test Hole No. 1 Run No, 1 — 2 3 4 5 3 4 5 3 4 5 Noces .1 2 1. Tasis Ec, be -,'��psac5d aT SLTn,- de��t, un--.: avpro-dmaueiv -_Qual percoiat!07, rall.S are obtained a--. zaclh?e-coladon esr hoie., < 1,Tdh iCr 1-30 miniincil., < data za be submined for rzvievv. min/incn i. Depth mtasu. s=.iis to be made from to of !jo Depth to Time Start — ElaDse Time water from I round ey Water Stop (Min.) surface level drop Rate (inches) in inches min/inch Start - Stop J 2-1 e) D Noces .1 2 1. Tasis Ec, be -,'��psac5d aT SLTn,- de��t, un--.: avpro-dmaueiv -_Qual percoiat!07, rall.S are obtained a--. zaclh?e-coladon esr hoie., < 1,Tdh iCr 1-30 miniincil., < data za be submined for rzvievv. min/incn i. Depth mtasu. s=.iis to be made from to of !jo 4 c�! V r t 00 et mm PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR ✓���� ,w OFFICIAL USE ONLY SITE LOCATION 2 e—/ .ZA 1'0Z TM# ,r ? �- —/ o� OWNER'S N PHONE MAILING ADDRESS c 42:2=i / �.! aig - y1.P� 1�- PERSON INTERVIEWED O �'' ' PCHD Complaint #_ Name & Relationghip i.e., owner, tenant, etc. DATE PROPOSED ADDRESS TYPE FACILITY ALLER / PHONE REGISTRATION# Proposal (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. -e ,r -. .I, as owner; or reported agent of owned•. -agre/- conditions - stated on this form. UR ... SIGNATE TITLE G Proposal 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 DATE b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved . —cam Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE A .`a CK PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY �i' 7 d/ SITE LOCATION_ 2 e-1 TM# 4�' ? `a' --/ - 5- OWNER'S NAME_ v h �3 oft �, ; o •� PHONE MAILING ADDRESS PERSON INTERVIEWED ~ O �-' ' PCHD Complaint # ___Nam__e7& RelationsHip (i.e., owner, tenant, etc. DA TYPE FACILITY PROPOSED INSTALLER PHONE ADDRESS REGISTRATION# Proposal (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. sI 5 /Lo /% ! of c✓. ` • J� S .� �y 2 ' .may �� �`'� .�. --.� .. ,--as owner; or-reported -agent of owner agre conditions'stated on this form. SIGNATURE � /j e" i� • `� �' TITLE / DATE Proposal 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 comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e.. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved T Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML / DATE r -� El SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH o 1 Geneva Road..Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREE lily /% TO ` ` / Lei TAX MAP # NAME �� /'/ !,r . iris �� PHONE PCHD# NIAILING ADDRESS DESCRIPTION OF ADDITION NUMBER OF EXISTING BdDROOMS -3 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., 1 Geneva Rd, Breww ter, NY 10509, Phone: (845) 278 -6130. ✓1. Certified check or move y, order for $ 100:00. - - _ 2.,= Sketches-of—existing floor plan (drawn to scale, all. living area -including 'hasement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor.plans (drawn to scale with name, street and tax map #) *. Non - professional sketches are acceptable and preferred. (See Section 3.d'of Bulletin HA -1) 4.. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions.. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. ; OFFICE USE COMMENTS 5. 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 Nursing Home Care Fax. (845) 278 -6085 WIC (845) 278 -6678 . Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN ROBERT J. BONDI County Executive ROBERT MORRIS, PE. n.*-- E t 1H !h Associate omm�ssronyr of eat ctor of rtvtronmen a ea t DEPARTMENT OF HEALTH I Geneva Road. Brewster, New York] 0509 Town Legal Bedroom Count & Proposed Addition Status . Re: (Owner's Name) Tax Wo Z,v, � _ e —,3 Address: Town: Year Built: According to records maintained by the Town, the above noted dwelling, is in, compliance with Town. Code. Is not in compliance. with Town Code. The Legal Bedroom Count is: .This information. _has.,!Oen obtained from:. Certificate of Occupancy: Other: - � . The plans for the proposed addition are considered: . N ew Construction Addition to existing house only Teardown and /or re =build allowed under Town Regulations BuildintIn pector..... Date 6. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5 T86 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 - Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 2282847 Fax (8.45) 225. =1580 _74 v Lli I i_.____ SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 17, 2010 Marvin Sagastume 24 Inwood Place Patterson, NY 12563 Dear Mr. Sagastume: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition 7-A-020-10 24 Inwood Place (T) Patterson, TM # 25.78 -1 -3 I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. 2. Q The proposed room titled "New Office" is considered a potential bedroom. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer Please revise the proposed floor plans to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. GDR:kly Sincerely, " � , T). Gene D. Reed Sr. Environmental 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 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 =6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 28, 2009 Mr. Marvin Sagastume 24 Inwood Place Patterson, NY 12563 Dear Mr. Sagastume: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition- A- 020 -10 No Increase in Number of Bedrooms 24 Inwood Place (T) Patterson, T.M. # 25.78=1 -3 I have received and reviewed the revised 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 from this Department dated March 11, 2010. 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 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. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals 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 (845) 278 -6130, ext. 43261. Sincerely, 44 t), Ge'� Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Patterson 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 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention/ Preschool (845) 228 -2847 Fax (845) 225 -1580 QQI 1A LU i 7 F 1 cl- QQI LU i QQI 1 1 la d ttil om tog 61) s;V\) m • QUEST gENC.0 g.y - sN�aD9 pLV�cE 17 zz4zzz4-- M J' �7 o 3 O �_._- ...... h Q- _ _.. - -' - - -- x H �i d� _ i� r o moll- PLRN 0 05E-� CnASTER BEJRDDWI W9 9KRR0 0w COUPiTI CC'l:iT':9ENT 0f -ALT-It ITOUSE PLANS APPROVED FO i EEL';i00ki COUIT UHLY A - ozo -.io _3 GEDRQOf:AS 7;,.f,# ALL ,':I IBSEOUEN't TO THESE IiCUS.F PLANS MUST BF SI;6�:iiT T ED 10 T1-IE PCDOH FOR APPROVAL 4 (ENERgL NoTE,S I�1' GDX �IyWOOi% 536 rnFltcn �x�S. Shy R 14 �Asvl►r ors I3Rt H R�ow� _. 6RcEN �03n�. 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