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HomeMy WebLinkAbout1862DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -55 BOX 17 I INloom I ' _ � Vii r Kr � ' r;�L r COO 01862 YES El SITE LOCATION OWNER'S NAME PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR Lo `_. Internal Use Onl....�,.._ !�Repalr Repair Permit issued in last 5 years of in Watershed within Boyd's Comers, W. Branch or Croton Falls Res. DBlegated Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review MAILING ADDRESS APPLICANT 5"U, TM # s 1(1 4 -,5:5-- PHONE # Name & Relationship (i.., owne tenant, contractor) s t DATE ' ��t, FACILITY TYPE PCHD COMPLAIN��T //# PROPOSED INSTALLER All Co PHONE#q�+u- `y�S"��p ADDRESS 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 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 I, as owner, or rep ed agent of wn r agree to the conditions stated on this form SIGNATURE alY\ TITLE 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 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 7fl el�j N. O Inspector's Signa ure & itle Dityd- COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE �(l/ / O 12 2.20 AC. CAC. 1 I G In ft1 o \,, /9 o O a e 15L40 al p 155.00 �p P/ 310.26 32 41 46 ° VGA 235.'51 175.62 33 n 40 47 _ u 20'!.35 93.00 269 99 v JV P! J O 34 39 z1�r2 o _ � S /O z16.ix - 48 209,31 e 35 Pl N # e a 38 tsz» � a 2 � 49 203.65 21.56 196.52 °m 37 Iss61 •N a CF, 13sos o 50 /z 150.89 2, ti 40 ROAD !S 51 N 35 53 I�xs6 54 g 0 _ tit N 291996(N7 N 956000 73 8 IZ I ��J Tit .'0-21,9-6 R x AM c IC Sheet _ V -'0 TNA' COUNTY DEPARTMENT OF T, MENT HEALTH -- rur yo iv , M!toL-j-----&kTL--vf WaA 'N TIMM- fiv -Y FIELD AC ff REPORT WATyM—, 0 T;-h -�2- 7`1- il R S Sifeet- L PERSON IN CHARGE 2% p ORINTIRRV el, aie, " ' "Title : ame N , and. TYPE. OF FACILITY IF -FINPING87 Adt k 4, �4 j. oor AA 71 A Tit .'0-21,9-6 R . .00 MLITA AMLER, MD, MS, FAAP y Commissioner of Health �.. :. -.,.- - WRET'TAMOLINARI, RN, MSN.s.9:,_ Associate Commissioner of Health ROBERT J. BONDI. County Executive ROBERT M01iki9, Pj e Director o§knvironmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 'P/ /S0, "AL TOWN TAX MAP# .Srg;�'% ,SS NAME' ONE PCHD# MAILING ADDRESS "14 020 .DESCRIPTION ,�d ADDITION . a NUMBER OF. EXISTING BEDROOMS. PROPOSED # OF BEDROOMS D (FROM CERT. OF.000UPANCY 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, Brewster, IVY 10509,.Phone: (845),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) 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 locations 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 Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE "COMMENTS • 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 . e ' SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI Environmental Health: (845) 278 -6136 Fax (845) 278 -7921 Nursing Services (845) 278 =6558 Fax (845) 278 -6026 1 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278-6085, Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SUERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Hossein & Susan Moein 4045 Old Route 22 Patterson, NY 12563 Dear Mr .& Mrs. Moein: ROBERT J. BONDI County Executive - ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 December 31, 2008 Re: Addition- Approval — Moein No Increase in Number of Bedrooms 4045 Old Route 22 (T) Patterson, T.M. # 35.06 -1 -55 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 from the Department date December 31, 2008. 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 oriiy: This approval does n6t validate any construcfion 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 your convenience. , Respectfully, p Joseph S. Paravati, Jr. istant Public Health Engineer JSP: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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax(845) 278 -6648 SHERL[TA AMLER, MD, MS, FAAP . Commissioner of Health � ��.. LORETTA MOL1NARl, RN, MSNy' Associate Commissioner of Health Hossein & Susan Moein 4045 Old Route 22 Patterson, NY 12563 Dear Mr. & Mrs. Moein: ROBERT J. BONDI County Executive R ROBERT MORRIS, PE� Director of Environmental Health DEPARTMENT -OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 10, 2008 Re: Addition — Moein 4045 Old Route 22 (T) Patterson, TM # 35.06 -1 -55 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The living room (formally the master bedroom) is a potential bedroom. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. _.. _. _._.. .._ .:'.. '3.-.. _The.addition,of a.potential. bedroom requi.res .this_Departmw nt.'s approvaf of a:xeuised -" . - septic system plan from a professional engineer. Please revise the proposed floor plan 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. JSP:kly Respectfully, oseph S. Paravati, Jr.' Assistant Public Health Engineer 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 � Su �a� i �oenn Cut cvd� kl&f uc16 ra.&t katte, Yl . �:V-44- PUTNAM: COUNTY DEPARTMENT OF HEALTH PT A'N S AP ROVED FOR BEDPo T! Oill COUNT ONLY, T' TIC' "S TO THESE flousE JT PC D011 FOR APPROVAL T U R Er T I T t, E DATE v A- -moa r. 7;1l (T) PkMPL• 5 �4 TM 1115- 6 - I- r . i t 1'VI'NNIVI COUNTY ??EP RTNIsENT OF .HEALTH � ._.__._. _..._..._.. ...._ ..p � .• Vii_ ., . _ .. . _.:.. _... _ , III T'. S APPROVED FOR I El _ll'0, lg COUNT ONLY. 1I TO THESE HOUSE ILfiNa 1L,It t E,L �.I....T ,FED TO 1.1 MOH FOR APPROVAL Sl: T +j:.` +'U.RE_ & INTLF i D,r TE 1. - 1 r H I-Lit. 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