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HomeMy WebLinkAbout2157DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -51 BOX 19 ' Uy� ■'�� J T 1 - ` , , , .,, F��i 1' r 6 .. 02157 APPLICATICN - ADDITION - RESIDENTIAL ONLY Name: -6 Ui %¢ _Phone A -12- 9E32 Year of Original -�street'.::�o� -y Mai 1 ing Address ZZ'/ Pu D 0W4 S T 7cwn ?v%nu.•tY41(sFCHD Permit Description of Addition © n Number of existing bedrocros�^ Proposed umber of bedrooms A) Square Footage of existing house 1 l3 B) Square Footage of Proposed Addition — 5:76 % increase in floor area ( A divided by B) X 100 Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA FOND, ERBISTER, NY 10509, Phone 278 -6130 with the following information. . IF THE PROPOSED ADDITION IS GREATER THAN 15% CERTIFIED CHECK OR MGM JEY CEDER �i(. HECK for $100.00 Sketch of existing flcor plans (all living area including basement, if any) 'on- professional drawing Sketch of proposed floor plan. Nen professional drawing Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Any questions please contact William Hedges or Fobert Norris. IF THE ADDITICN WILL RESULT IN AN ADDITIQ\AL BEDRCCM THAN CERTIFIED CHECK CR MONEY ORDER 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basement, if any) . Non- professional drawing 3. Sketch -6f proposed floor- p'1an' " _- Non professional drawing 4. Plans for the Sewage Disposal System prepared by a Professional Engineer meeting present code requirements, may be required. OFFICE USE Comments and /or conditions i 7 7C G Approved by: TITLE Date: 3 �' cc: BI (T) addition gi b nl�"1 � \�•t'-'y. -l" E .�... � _ _ -- ... ,3°x-1. �E�' .0 � .- . A V 4� �oO pe N �o �T•Ks 1.L.1\ AG2ES w LL' r � w , 7aPD146et1 r\ IV I' SYr. Flt. > I • ow ,1.11 ,• i q0 fit, . I 0 P6. S.E. 0' j n • . 5 od It ti —rdy r► z ti'w �,„ t'v ra. � 3 t ^I Z4 S"i =zo "�V .,,f •' � yls-0 V PUDDING STREET � :i u Iz SURVEY OF PROPERTY PREPAREpiOR ' LESLIE • 8� FRAN SHIFRIN SIIUAtF TOWN ` OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE Iin L,D It Igo% ; L RICHAAO H. GORR the surveyor who made Ihn map• certify that NOl ES: rho survey shown hereon was completed byme on Aare. I. All certifications are valid for this map and copies ther✓lol IL le dl Mat this mop was completed by me I A 1-4 to Bt only it the said map or copies Dear Iha� impressed see/ of the tld � - Lind Thar dus survey hst beon•preoared in accordanro wdh the surveyor whose 91yn01ute appears hereon, i er,.tltn0 Code of Pracoco for Land Surveys adtlp m tod by the Now 2. Alteration of this document, except by a licensed Land Surveyor, 1.4 Stile Association at Protossronal Land Surveyors is illegal. ' GOMMOw1WEAl -':4� t.t\NO •'CI�F� � � f . ►►J gus2C.s.ictL GO, 1\ RICNAAON. OORA, P L 8 N.Y S tie. No. 40013 R.O. 00, LAKEVIEW OA AIAHO PAC, N. V 1090 _ -- REFER 10 JOB No $(-Iriq , , I� e ' N gi b nl�"1 � \�•t'-'y. -l" E .�... � _ _ -- ... ,3°x-1. �E�' .0 � .- . A V 4� �oO pe N �o �T•Ks 1.L.1\ AG2ES w LL' r � w , 7aPD146et1 r\ IV I' SYr. Flt. > I • ow ,1.11 ,• i q0 fit, . I 0 P6. S.E. 0' j n • . 5 od It ti —rdy r► z ti'w �,„ t'v ra. � 3 t ^I Z4 S"i =zo "�V .,,f •' � yls-0 V PUDDING STREET � :i u Iz SURVEY OF PROPERTY PREPAREpiOR ' LESLIE • 8� FRAN SHIFRIN SIIUAtF TOWN ` OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE Iin L,D It Igo% ; L RICHAAO H. GORR the surveyor who made Ihn map• certify that NOl ES: rho survey shown hereon was completed byme on Aare. I. All certifications are valid for this map and copies ther✓lol IL le dl Mat this mop was completed by me I A 1-4 to Bt only it the said map or copies Dear Iha� impressed see/ of the tld � - Lind Thar dus survey hst beon•preoared in accordanro wdh the surveyor whose 91yn01ute appears hereon, i er,.tltn0 Code of Pracoco for Land Surveys adtlp m tod by the Now 2. Alteration of this document, except by a licensed Land Surveyor, 1.4 Stile Association at Protossronal Land Surveyors is illegal. ' GOMMOw1WEAl -':4� t.t\NO •'CI�F� � � f . ►►J gus2C.s.ictL GO, 1\ RICNAAON. OORA, P L 8 N.Y S tie. No. 40013 R.O. 00, LAKEVIEW OA AIAHO PAC, N. V 1090 _ -- REFER 10 JOB No $(-Iriq , , I� .4 ../:: ty E- .y �'' ,.�7y ��7< "__w. -: erg.' fr^ v�.• c���. LST•'Yt:'•S`'h.''(•"Sv`t� %-/:�y •ai � i' �. � .'/'��'' - :r � - ya-. . -. _ �{ -- - .Y7. oj1� _ �. :�Cj�� ?1X���f ei� �� ,h -• d�'' !� z, �u u ✓� t.ai�'� �5 ii•.•.'1',.' s� va .[GAP. ii; �� -r y��� 5i =' Fv1 1� �'i�•.. ySy7�. J 5. -- •�4 �ti' i�.r.�.�a yJ YL -G '��t�- �,Y,t.�.'^ � ��� l'tr✓ ^� ,..,.� b.Yw..•!S.j.}•'��'F. - • -R i{ �.•t'� _v -.. �- t^. k Y- T.s. [- "'._.r ..l.ti. �Y. ,± 32M•l'C�l ^'��„�i. � T'�•,�'� . __- J��' _ - a:• .. �.. i:,�': --- •-... - ���. "_: .. � i� xo-s�-'�.' F�: �^... -r�. fit.- - i?e t t.. S..•1 - - -,ty:. • ) ;;4',y:a[ v .T::.p_ .�^ . 7i lift L -.'-�t ~C��- ��?�ucd..: - .°�e- �•.J!!;rrl��i -.�-K `ate•^,•. � '•S »i _.,,,'�L..R} �; ,t � � J��"�r rs ly��: � -. _.. b " ,ror: y _ ,�... ' .:� � :• f= .r.; � - -�, � 9• f ^ �9 + •ova .# ° -_ t - �i )' -.CA� '.► \ D�Ydl41LL^L4_. _ C�Y..J .r--. o. - y' _' {- ..:,...':l- �._ �. .Y'r -i- _ •� . �.,: r - M1•�'- �,��.�rF� -t Apps- I •�.. T <rl7tiac.1/rriti. 't vy. 1lJ+a:�i1 �`)T! i'it{._i• - -' -- -- -.ty►� 1"� .. a �_ • _.., r' 1� ,� � � i f �% .. - � � � .1 (zs , J Bp , M s5 .. P:- i . 4 { t " , ? � 4`° �_I1 -" i� ,�, .�_ }�(�t7��S���` .. .-�s•l�` �E' /.r,,,.� '1�'!�c= �i. Ir °7Z4�_ .r rt /. . /�C_ ✓p. d 'y.. :y V.Q. �.__. 6 Jaii- .� -••/V .- _1f�N. ri. Y r.' {- liTf�f}} %'� = f r• 7 _�A .;L�.k ° ? tj�= �•,7t' by e4-- - Y 4 t t i 1 g _ .tic 'at ;-'r �^ �•v fig, s4 � r 1 I 'F x ��a /Jos_G. —� 6o DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 August 25, 1993 Anthony Pedulla 224 Pudding Street Putnam Valley, NY 10579 Re: Proposed Addition: Dear Mr. Pedulla: r- JOHN KARELL Jr., P.E., M.S. Review of plans and other supporting documents submitted at this time relative to the above - captioned project is in prcgress. 1. Formal approval of plans, prepared by a professional engineer in accordance with applicable sections of our submission guidelines, is required. Plans will provide for the installation of addit;onal subsurface sewage disposal system meeting present code requirements for a three bedroom house. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. : may be reached at ext. 161 to dicuss any questions concerning the above comments. ..... c _ Very Yuly yours Robert Morris Assistant Public Health Engineer RM/jp im 0 v —9 �a z I, _e u i IL In 4 N L OL ci 4p wo� F.. TFL4, V:v, :,tv 77 A) }�vTifP 1[ A:U P4,4 - 1-1 114 IF . 4 Yj Na o .3i 77 A) }�vTifP 1[ A:U P4,4 - 1-1 114 IF TITLE No. eA - -It Le S 7-•%• P 0 IV IV k As(— cz IE t-L 0 1L = � :CD SURVEY OF PROPERTY PREPAAEOFOR U _4 LESLIE.& % • SITUATE IN THE TOWN' OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE i in 11 0 is in- 'I.PCHAR H. GORR the survey. who made this offily that NOTES: '...,shown hereon wascomplefedbymoon Aq;Jir4 . 1. All certifications are valid for Phis . map and copies therbot lL 19 61 that this map was C*Mplof#d bi, me only if the said map or copies beer the impressed seat of the 1 Xuc, -4 and that this survey his been.proosted in accordance with the OV4 exisling Code or Practice for Land Surveys adopted by The Now 2. All , oration of this document, ONCepf by 0 licensed, Land Surveyor, 0 Z4. is illegal. 0. A L j off j q PUDDING ';TRFPT SURVEY OF PROPERTY PREPAAEOFOR U _4 RICNAAD N. GORR. P L S N.Y S Lx. ft. 40613 R.O. 0 9. LAKEVIEW DR IWAHOPAC, N.Y robot REFER TO JOB No Sk-IS9 91 ft Ii It LESLIE.& FRAN SHIFRIN • SITUATE IN THE TOWN' OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE i in 11 0 is in- 'I.PCHAR H. GORR the survey. who made this offily that NOTES: '...,shown hereon wascomplefedbymoon Aq;Jir4 . 1. All certifications are valid for Phis . map and copies therbot lL 19 61 that this map was C*Mplof#d bi, me only if the said map or copies beer the impressed seat of the 1 Xuc, -4 and that this survey his been.proosted in accordance with the SMOY00' appears hereon. Who$@ 31gnStUf@ exisling Code or Practice for Land Surveys adopted by The Now 2. All , oration of this document, ONCepf by 0 licensed, Land Surveyor, York Slits Association of Professional Land Surveyors is illegal. RICNAAD N. GORR. P L S N.Y S Lx. ft. 40613 R.O. 0 9. LAKEVIEW DR IWAHOPAC, N.Y robot REFER TO JOB No Sk-IS9 91 ft Ii It T, .�qJ1 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES. P QPQSAL FOR SEWAGE TRE* ATMENT SYSTEM REPA yE .. �,.. _ ._ .. ... .... 6neernal. U96 Ontiv , U L1/ Repair Permit issued In last 5 years WDelegated Not in Watershed ❑ �� Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OlayjpO& O; p& I TOWN ,Y TM # 30,--a— OWNER'S NAME g:,O; T R i -Z, C k, RQS'a -- i LCer, PHONE # MAILING ADDRESS 'P;, - r-hoq &1 Vr+( KdE-. f g jSt,* _ iLo S:?2 ' Name & Relationship (i.e., owner, tenant, contractor) DATE dVA d 1) FACILITY TYPES PCHD COMPLAINT # PROPOSED INSTALLER PHONE # YV� -S,$o -dV_5_ ADDRESS �,� ,seat mz i./„q r` i, . ,.,c REGISTRATION /LICENSE # A �3 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 I, as owner,agree to th conditions stated on this form SIGNATURE TITLE t Gtl /V eA- DATE (owner) ) I, the septic ins ler, agree to comply with the conditions of this permit for the septic system repair - SIGNATUt' E - TITLE i:r �k: DATE Z:` - (installer) 7 1 _ 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 foxed 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 backfilied until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ nspector's Signature & Title Defte f Ex0iratiofi Date Repair proposal is in compliance with applicable codes Yes No 0 P COPIES: PCHD; Owner; installer PC -RP 99ML Rev. 2/07 Sheet —L_of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.IIEATLH SE_ RVIC_ ES r. _ FIELD ACTIVITY REPORT NAM-: -OosA - kE ,t &aIz- TPl• Anng-F-Ovs: ZZ41 /RU1J17 /AA 5% poTn�,�m r/,4LL� y .tip! Street Town State Zip PERSON IN CHARGE /� nR TNTFR VTF.WM N0U/� l� 60'ef E7Z'T TlatP Name and Title TYPE OF FACILITY : 7Z gj--z t.j T? FINDINGS: 044-2 50-1PT1c TAAJK 7zC.p4,46E1> &&;W CZ44- -A/ RV-4- TAN �. 5AN1E" LocAT /o,y Q k, Signature and Title RFPORT RFCFTVFT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. q Ob 11-7 ,, -r , F Aa6'v4(Xzd- ti Y v Go -v .-r Lk-. I Q -L rzc--Pct�cr,.�' ' fv C- L) vi V, IL-J, Luc LL) m O /000 6 r4 c- t-rz a LO PVC -'��- Mac i•.�� c. c � r�� n� �� Z, I. C * I0Y3