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HomeMy WebLinkAbout1380DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.79 -1 -76 BOX 13 1. ' lQirml OU. 01 ON* No oil a NJ NO No OR ON F . .,,.,� .. , ON I ��� #�., N _ AL 4- 01380 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES. P-A0,00-S-A-L PGk_9_EWAGE_ThF_A!M E_ N-Ir S_ Y.-ST-E` M REPAIR YE k NO Internal Use Only. PERMIT 0 El ❑ Repair Permit issued in last 5 years Not in Watershed ❑ L K, Repair within Boyd's Comers, W. Branch or Croton Falls Res. TDelegated CY' ❑ Repair within 200 ft. of a watercourse or DEC-mapped wetiand Joint Review 7 " �_:' , . - TM #,A, SITE LOCATION TOWN OWNER'S NAME PHONE # zY -j, -7 MAILING,ADDRESS v,7" APPLICANT «C; Name & Relationship (i.e., owner, tenant, contractor) DATE )_ • 2 • FACILITY TYPE _� 5 PCHO COMPLAINT # _ PROPOSED INSTALLER 'PHONE # A e- ADDRESS REGISTRATION /LICENSE # _/0 0 V Pr000sal (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. 5 V. 7 I wner,a'gree to the conditi6ns stat6d'6 this lorm -aso . ..... ...... . • SIGNATURE rLE DATE- (owner) ... ... 1, the septic instiller, a gree to 1 with the conditions of this permit for the septic system, repair 'o comply TITLE DATE,-, 61 Z____ SIGNATURE (Installer) ProWol ag=ved with the following conditions: 1. Procurement of any Town , Oerm ft, if applicable: 2. Submission Was 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 bed to two fixed points c. System description (e.g., 1256 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. 6' ' ': ".No completed work is to be backfilled until authorization, to do'sb`,has been obtained from the Department. 'ftLIAI %1T- ^&IN Ai IlLrPIT I NAM Proposal ApptdVbd `Proposal -Denied ❑ 412— lrispectors-'Signatute & Title ­-11;,*­ -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 ag PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF;-ENVIRONMENTAL HEALTH SERVICES - -- - XQ :PROPOSAL-FOR SEWAGE -TREA MENT -SYSTEM *'REPA R,µ- Internal Use ❑ / Repair Permit issued in last 5 years Not in Watershed ❑ IJ z Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated G� ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME d� TM # d6'( 7ci -1 - 76 PHONE #6tK- 119 - 9(,J7 MAILING ADDRESS Jk 1-1 ulp,zacr�1 ccaj /U-`1. ►ZUS APPLICANT fibt,?Ti am - 0C.0 &t%= = r. - Name & Relationship (i.e., owner, tenant, contractor) DATE _J 20 12-= FACILITY TYPE PCHD COMPLAINT # _ PROPOSED INSTALLER —PHONE # c9g V Zx} ' 6W/ ADDRESS #. 56A&,, L& 0440t, ` �i�.- REGISTRATION /LICENSE # /00 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 systairt) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. _ n ii. /r * WA 1i . Sin / /!lam__ A I,.as. owner,agree to the conditions stated is form SIGNATURE TITLE /j Q2.t/C2 DATEp% 3•ZO %2,,- (owner) 7 _ . i, trie septic installer, agPe6 to coin ly ritti the conditions of'this pea rrtit forth® septic system repair SIGNATURE TITLE. DATEJ, 3 Z 0171 (Installer) . Proposal approved with the following conditions: 1. Procurement of any Town Permit, it 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 paints 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 0' Proposal Denied ❑ 3 / 2 �z Inspector' lgnature & Title Date iration Date Re it proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 . 'PUTNAM COUNTY DEPARTMENT OF. 1 HEALTH. DIVISION OF ENVIR.O rN'IAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM . SECTION A.. GENERAL INFORMATION Name of Project -()a r +in c - _ (�C�') P P� � ;'. County, I�� n:A.;r� ' - Site Location jl) Building construction begun .Extent Is propel-ty within NYC Watershed ? :................ � Yes � No 0 SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. ' Hilly Rolling a Steep slope �entle slope. Flat' 2. evidence 'of ,wetlands 0 Low area subject to flooding 1 Bodies .of water. a 0 Drainage ditches ©ock outcrops 3. Property lines -or comers evident ........................................................... 'des No 4... 'Do water courses exist on or adjoin - the - property? .............................. yet . No 6. Will these affect the design ofthe sewage system facilities ?......::.... Yes. 'No 6. Do watershed regulations apply in this development ? ....................... 0 Yes FZ No .7. Will extensive grading be necessary?.......,...... ... ...........,...:............:.. � Yes No _ . .. -a8': Will' exteasive ftll be necessary for SSTS?...: ..... ..:...........:................ — Yes No' 9. Do filled areas exist within the SSTS area? ........ ...:....:.:.:....:......:.:.... Q Yes . No If yes, what is. the condition of the fill? SECTION C. S01L OBSERVATIONS 1 G. Appeance of soil: Sand Gravel Loam Clay Hazdpan Mixture . . ® C� - � - D y $.�- �......._:_ . . _ 12. Soil borings /excavations observed by C- c i S r' �p,� on 13. Depth'to groundwater on .14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............................... Yes Iv o 0 . 1,6 ..Soil percolation tests made by on 17. -Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 SECTION D. DPWNAGE. 18. Will oposed pr grading mat.. ' rially alter the natural drainage in thts or, acijaceat areas. Yes No: 19. Will groundwater or surface drainage . regwre special consideration? ,. .... .... e .. 20. Will gullies, ditches, etc.-, be filled and wat.°rcourses be relocated ? :............... ..<..... a Yes No SEC'T'ION E. RED . . 21. If a common water supply is proposed; has an�inspection been made of the existing or proposed source and facilities ? ........::...:...: .......... ......................... . Yes; : • � No Inspection data 22. Do adjacent wells and/or sewage systems. exist ?.,......... , i. . ....... ........ . ............ Yes .. No 23 .. - . Additional comments 24. Site observer /inspector and title 25. Date(s)-of pbservation(s)inspection(s) TEST PIT PROMES Hole T i Lat Hole 4 `Lot # 'Hole. _ :Lot ir Depth to water 'water'. Depth to _ ... ..._ - . �. _ . _ -_ ..... Depth to mottling. Depth to mottling Depth to mottling Depth to rocklimp. _. r A Depth to rocklimp Depth to rock/imp. G.L. 0.5 Z S D 'l (' lb��, 0.5 G.L. f . . 0.5 _ 3.4' w o it� 3.0 4.0 4.0 -�- ro 5.0 c 0, 5.0 4.0 5.0 6.0 6.0 7.0 7.0 . 7.0 . 8.0 $ 0 8.0 9.0 90 9.0 10.0. 10.0 10.0 a i PUTNAu1N1 COUNTY DEPARTNIENT Of HEALTH DIVISION OF ENVIRRONINIENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMEN17 SYSTEM Owner: Ma,r f k'Il 67— Address: Located at (street): I W����, ��. TIM 9 SectionziS� Block? / Lot I Municipality: pe*��_so, — (2Ld -%< k c_ Watershed: Date of Pre - soaking: SOIL PERCOLATION TEST DATA Witnessed 6y: Date of Percolation Test: Hole No. Run No. Time Start – Stop Elapse Time (min.) Depth to water from °und surface (inches) Start - Stop dater level drop in inches Percolation Rate min /inch - as — a t 13 77 ' 2 1206-123V_ — 2./ ' 3 - - i i 4 I 2 3 4 I � 2 3 4 I ` . 2 3 4 Notes: 1. Tests to be repeated at-same depth unrl approximately equal percolation rates are obtained at each percolation test hole. (i.e., _< 1 min for I -30 min/inch, < 2 min for 31-60 miniinch). R 11 data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pe I of PUTNAM COUNTY - HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT REPAIR PERMIT PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION l 7 12r TOWN TM # " 7q OWNER'S NAME 1 PHONE # MAILING ADDRESS IVA PROPOSED CONTRACTOR/INSTALLER �j��e � / PHONE # ,qK2- t% ADDRESS 11 REGISTRATION /LICENSE # _ 1Q0V Reason for exploration: `❑ failure to surface ❑ back -up in house Er"-find limits of system for repair ❑ other (explain below) + Inspecto s Signature Appointment Date: kly: excel: septic FOR COUNTY USE ONLY Title 0)2 -11L Time: Date .5 P17 P-K Vj I L5 :lI r,,P! OIC* INI'Vir ZIN �k ALTNW� 1 E) -2241 -22.42 0-2240 -:22-48 0,,2247 p-22!46� 03'-2245� 0-2244 powa a�W Ole, M.0011C W., 10.52- .0-2220 19 -2219 Fe.U.eHt1.32'. PAW or rmr 2225� 0-222V 0-2222 0-2221 0- ii o- 7 PNCKff FtN= 16,79' VLOCK Of. W,#" t I 17 1122' FCR /§ 0-2216 O-2226 A " WA -i N26*41-0O"W 140.00, WAR N POW 5uwey OF t iC. pawy MWAMP VOR CHR15T0PI+.--R & MIN t9ETZ un W5.0-2" *IV" A-4 90WN ON MAP "ey' 0? PWUW L*=, FLW MAP NO. 149-K. FLVP 6H9-M SMAM IN TOWN M IPAMR50N PUTNAM GO., N.Y. 5CAXi I" — 20' 5WIVAMR 1-7,19W cormew @ 19" nmty Ommm7owe GA-Lm. ALL Maws O*irvw %V"'PW OWY W IM MRSON x mm" "flo %RW WAS FWFAIW AW ON dqCA%"Aw'Nor WA4%TxA" vo AM - "A -19FA ON OF %KWY W VY ROM ormw nv" " 000401� MWAM Is W* V-*V$rA COWU" AW Wf W " 0 = PUTNAM t COUNTY Ha COUNTY �LTH_D_EF_AR.TJM,ENT__.__ 6,IVIS�10N OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT VHVFUbAL FOR EXPLORATION OF SEPTfQ SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION TOWN on T M 001NER'S NAME MAILING ADDRESS -=HONE 9 _4 7 3 (P 17 7 PROPOSED CONTRACTOPONSTALLER PHONE 9 ADDRESS REGIS TRA TION # I I C Reason for exploratio Cl failure to surface back-up in house find limits Of system for repair Wither (explain belo%v) EQ-11COUNTY USE ONLY _41 In Vector's &gnature & Title Date Appointment Dare: i ime: kly:exca-1 septic 7-d POPC-P / 7 IC+,O) ller)UA I 600T)l I I ill JeW YNDALLEXCAVATING CONTRACTORS SEPTIC 5ySrEmSm,. 20 Ivy Hill Rd., Brewster, NY 10509 (845) 279-8809 (�aye -I,-, upouAi IZQn:OL LL t1L MN -Job Name`i��:c�l Address /7 wo- r'rert 2 City LA r,t'sdn State A.-W Zip Z2,5-63 00 98 Maple Grange Rd., Vernon, NJ 07462 1-8-428 -6166 $ {OCk Lot Home Phone 0951 P17'7- 74 Date S /V Job Description 6V-4— e St 17 atik /aoG 10,/ M N■ MEN INE NONE MEN M IN IN MEN IN ME ON IN ONO ■ ■ n ii ■� :.�..�::. 1111111 MEN ME .� IN ME IN 0 iiiiIN 010 NONE ONE 0 11111111 MESON NONE NINO NMI OEM ON 0 ... ....... MEMO uiiii ROME ONEEN iii IN �� iii iiii�■�M��i� i i3 -225 r3- 226t�t D�2��3 � -2242 [3'22�t1 I '0-2224- 0 -2222 0 2 21 �- 1 AMA i4.000 R -221 Mr. aXAR �.sa - Piazy m ,VLOCK W'r. WAU 1 s r 1426'4110011W 140.00' I 5 &Y p ? POPMRP -?Olt CrK _$ % A$ h`M; ON S '►t�rr. OF FBI:llt�tfVN1'{ /y; ; Sl.t�re%• Mlw No, i49-r, mwo a-19 -m /' 5! t1ykT SIN CO,, V 1 Vf I" a� R IV ' P C MY, Q 1999 7rntY MFZEWOWr C.(.at: AW, A. Ida" WSMtVt7 1 M 1li15 1 tt Ai.'T�dt' TWN OF Y MAPS W At+ FCWL WV WITH 'IYC OVER MAN'lif O haIM& C WA W.6 POR LJ3T±IC! 51�RVFYS i.11 -AMNO. C4*4nr" ASP NOr 94 :b5►1�VK /��� � y ACTON YW-1�/�M ,o*V O "W tr m '". PLMIG. . MOM O.W . , 1 L.—OL LAiSNf l . . a fir©. , /sV W*Z1M-A IN"- t:- r 1426'4110011W 140.00' I 5 &Y p ? POPMRP -?Olt CrK _$ % A$ h`M; ON S '►t�rr. OF FBI:llt�tfVN1'{ /y; ; Sl.t�re%• Mlw No, i49-r, mwo a-19 -m /' 5! t1ykT SIN CO,, V 1 Vf I" a� R IV ' P C MY, Q 1999 7rntY MFZEWOWr C.(.at: AW, A. Ida" WSMtVt7 1 M 1li15 1 tt Ai.'T�dt' TWN OF Y MAPS W At+ FCWL WV WITH 'IYC OVER MAN'lif O haIM& C WA W.6 POR LJ3T±IC! 51�RVFYS i.11 -AMNO. C4*4nr" ASP NOr 94 :b5►1�VK /��� � y ACTON YW-1�/�M ,o*V O "W tr m '". PLMIG. . MOM O.W . , 1 L.—OL LAiSNf l . . a fir©. , /sV W*Z1M-A IN"- MEMORY TRANSMISSION REPORT TIME. MAk-;l5-201I 01:23PM' TEL NUMBER 8452787921 NAVE ENVIRONMENTAL HEALTH FILE NUMBER 037 DATE MAR-15 03:22PM TO 82795989 DOCUMENT PAGES 004 START TIME MAR-15 03:22PM END TIME MAR-15 03:23PM SENT PAGES 004 STATUS OK FILE NUMBER 037 SUCCESSFUL TX NOT ICE FU-1-1,j.Arvi C--C)U"-r-eHE^L-rf-4 0EPAR-rMENT 01\/Ia!4N C>F= -rHES I;S MC:)-r iAL Rl=—P^IIR PERAfil-r Ail Fri-fiormat1corm below must be-, fLiff clornpiff3tect' prior t4:> any m=t'jacluling c52.5 -< -7 SITE LCDCATJON m 0 -caq .�p 4# -7 �avvN PQ 4" A,% C VV " E r--VS "A.M E F- 1-10, N E-- . .... . ..... ..... . ..... P!RC)F-OSE- I=CJ.14-rF-I^C-r.C:)R/tN:S-rAL-LEFi --------- - . . . . . ........ AL)OFRE-SS Z-1- "s m ow) Q raffure to sur-f--t M back -tsp In fi�oumo find lirmlim of 33yatem for rapialr So, otti-r tax emin Ax=,PcJJrwtmeml onze.. 'T" i ml 0; k lY-. i9>c(- el ZS aptt I PuTNAm co NTY 11EALTH DEPART SE cEs DrvY5 0%t of ENVTROI` gRjTAL jjFAL1'H - . '` 1.BTil'B► PRO -SY OFFICIAL USE ONLY t�„iG.rr�N TM #,__ Sl "1'E LpCATION� 7 �`� PHONE T4 49 7 OWNER'S NAME_ MAILING ADDRESS PCIiD Complaint #_ _- ---- pE;RSON INTERVIEWED_. , T YPE FAC.WTY 1�ATE `'%$ -6 /46PROPOSED IN5TALLF.R �ii REGIS . T 1tATI , pN# ADDRESS d � (include sketch locating all adjacent wells): 1 sev a s& system .Different location EL�� as on � NO"1'F: Repair must be in same location and of Same engineer or registered arabitect. may require submittal of proposal from li"'nsed Pr � d v 1 141,00 ,ao.l , , own _ .� ..__.... PO gerit 0f ow;ae. agree tot ondi _ .... DATE t, •lions stated on this orm I, as er or re� fo114�]llg.�.��; 1, Procurement of any Town permit, if applicable- 2. Submission (if as built repair sketch in duplicate showing: a. Ownor's name b• Town and Tax Map n=ber. ,ins e. out corners). Site Street Name, o rents tied to two fixed pt (9-h �� deep C. Loca-don of installed components gal. Concrete septic tank, three precast G diarn. p d. System description (e.g., e Installers' name and number. osal an 3, System repair to be pe d conditions. rformed in accordance with the above prop Proposal approved__,,, ' DATE. InsP,d")r's Signature & Title ticant) COPIES: Wbite (PCIiD); Yellow (Town Bn; Pink (app PC -RP 99M L t,I:d }10b9b9LZL6t6:01 I26L- 8L2 -S08 lddd3t7 iigno9 Wtt- 4ind*J0dd SS:01 E002-6-ddU �.�. COU c Job Name � customer r-i.0 -.. _`.�'� Address �? tvc�►-�-erl � C :IAA e. -Sor+ State !� zip city 99 Maple Grange Rd., Vernon, NJ 07462 Block Lot 1- 800 -428 -6166 Home Phone # ?`�� 7 _ Date S IN 103 Job Description t� lGce Se 4 , F4 _ - i : 7 4 1 i 11 rt 1 _... 7, - - IT _ : : — : 1 r ' _� _- .i._.... -7 «ra_. rr Lj n ' y "FY_."C _ �€ SITE LOCATION !" OWNER'S NAME-e MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY -b TM# 79---l- 76 PHONE PERSON INTERVIEWED KD 1rj&l h'n G z Q tJ» ei - PCHD Complaint # e ations p i.e., owner, tenant, etc. DATE '0 17101Lf TYPE FACILITY %" e-S/ deAc e, PROPOSED INSTALLER ADDRESS 21D " f , HONE REGISTRATION# q Proposal (include skitch 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. s as owner;-or reported agent of ri ec agree to the conditions stated* on this"forin.- SIGNATURE TITLE ,/ i' S DATE Z16 Proposal 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 b' diam. X b' deep e. Installers' name and number. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML -Z= d DATE _ _.__BRUCE _ R. _. FOLEY,- - Public Health Director_.. _ _ .. _... LOR>a lTA_-MOLINAKI. l tL, M.S.N. ,....._.... Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Hcalth (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 August 29, 2000 Erin Dietz 17 Warren Dr. Patterson NY Re: Addition- Dietz -17 Warren Dr. No Increases in Number of Bedrooms (T) Patterson Tax # 25.79 -1 -76 Dear Ms. Dietz: I have received and reviewed the plans for the proposed addition of the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated ug st 29, 2000 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Two without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must. .be _ maintaired7 _.....,._. _..._...___. __::.. _ _....... �.. �.. 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, — William Hedges WH:kg Senior Public Health Sanitarian cc: BI PUTNAM COUNTY HEALTH DEPT. 4 Geneva Road (914) 278.6130 Brewster, NY 10509 Received cif �022136 .. _ /. z 19& The Sum Of..LL!' For _ THANE YOU! [_ r _tea c�� Card By DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 BRUCE R" FOLEY = Public Health Director STREET �1, r- r-a tom, TOWN el tf r'.a,r,.TX IV7[AP # PHU ° NF _2i� -7t?7 ,PCHD # MAILING ADDRESS V��f N, nj 2, DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS � 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., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. 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 Feb 98 DEPARTMENT OF HEALTH Division , Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 BRUCE R. FOLEY, R.S. Acting Public.Health Director Re: _ Residence Tax Map Town Gentlemen: According i records maintained by the Town, the above noted dwelling IS IS NOT 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.���,'s A�:t' wilding Inspector JAMES A. BASLI General Contractors 167 Lake Dr. a MAHOPAC, NY 10541 (914) 628 -8872 (203) 410 -3719 JOB SHEET NO. CALCULATED BY CHECKED BY_ cr AI r DATE DATE JAMES A. BASLI General Contractors 167 Lake Dr. � 16 MAHOPAC, NY 10541 - ....._ .._(914) 628 -8872 (203) 410 -3719 JOB SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE crci c JUL -25 -2000 07:39 FROM:JAMES BASLI CONSTRUC 9146287225 TO:12032220021 { 4 i• j. i � r r {. ! i _ r S � r i s I 1. ' i r ' i i i ..i.� - i- ' � I t j \K . �..1 1 1 ' 1 � 1 + i 1111,••• < , s 1 t tAl �j 14M i + 1 P :2/2 14 11 III JAMES A. BASLI - M5 �!.�► General Contractors 167 Lake Dr. sme r HD• oi=� MAHOPAC, NY 10541 CAt.cu1AI DBlr DATE _ ) 1 719 . 0340.3 C.NECKED BY OAYE_ { 4 i• j. i � r r {. ! i _ r S � r i s I 1. ' i r ' i i i ..i.� - i- ' � I t j \K . �..1 1 1 ' 1 � 1 + i 1111,••• < , s 1 t tAl �j 14M i + 1 P :2/2 14 11 III JUL -25 -2060 07:35 FROM:JAMES BASLI CONSTRUC 9146237225 TO:12032220021 P:1/2 • I� JAMES A. BASLI JOB General Contractors' 167 Lake Dr. SMEETNO. OF ! a �s96. 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