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HomeMy WebLinkAbout2225DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -18 BOX 19 02225 _- 1 16 �� i ■ L r lit. ., M 6 1L Pno . ll TL 02225 i; PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .::P.ROP_OSAL- F.OWSEWAGE TREATMENT SYSTEM UPAIR .. _.:. /..1..,..v�:.._.;_. Internal Use Only,:.' PERMIT LJ LJ Repair Permit issued in last 5 years L'J of in Watershed Repair within Boyd's Comers, W. Branch or Croton F* alls Res.: _ Delegated "t` ❑ Joint Review El Repair within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION C - Q "� A TOWN OWNER'S NAME to 0 MAILING ADDRESS * 1 APPLICANT Name & Relationship (I.e., owner, tenant. Affifiactdr) TM # 0-11, J 71 NE# QI- -X 5Z .0 DATE - � $'� FACILITY TYPE `iiG" /'P �,y C /PCHD COMPLAINT # PROPOSED INSTALLER rr =+n. PHONE # �j% "��I�•. �' ADDRESS 60 (• _tAa_ VU-0-5 REGISTRATION /LICENSE # Pro sal (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 naty,re and extent of tl a repair. ve-, 4 Dom &S add 1r"lb-C c r- arc: Zo 72, I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE A? -F r�I (owner) = - I, tke- septic it s ler, agree to; ,ply with the condfions of this permit. for the septic system repair. :. SIGNATURE TITLE /"�tJ''' -�� DATE (Installer) "., ProQoeal oRawW 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 dumbon 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 Q Proposal Denied ❑ ifis-octor's Signature & Title Date Expiration Date ,Repair proposal is in compliance with applicable codes Yes. ca No p COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 Sheet of r PUTNAM COUNTY DEPARTMENT OF HEALTH T DIVISION OF ENVIRONMENTAL IIEATLII SERVICES -FIELD ACTIVITY REPORT NAME' G %��l�a,rs Tel; A T)DR E.4 R: 67 ©RAK �i�4 �' T_�J 11��s 2or� ���tl�c ✓ /V �` ' Street Town State Zip PERSON IN CHARGE QR INTER:VTEWET)- Armd z",&W Name and Title TYPE OF FACILITY: FINDINGS: VA n. Signature and Title RFP0RT RFCFTVFT) BY: I acknowledge receipt of this report: SIGNATURE; 02/96 7 Title;_ Rev. N 0 fl 0 N J a 2 v I J �� L.. j ��a, AJ 10 n ti d . •X� d, rj with ura -yel 7o C�awA- 10 14ou5e 5� I� r I~ yV1^]J' V y kL 0 0 J sheet PUTNAM COUNTY DEPARTM ENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES—.,.. FIELD ACTIVITY REPORT NAMP, -Tel: A T) 1) R F-S S: (p -7 0--le- 7,,A, c- -Aj, Street Town State zip PERSON IN CHARGE Name and Title TYPE OF FACILITY: - rcL M,, k/ e FINDINGS: 7- I , ofejawlc 5,.,;/ ays--/ Avb"� sm-A IV) /21 -014, 02/96 Title: Rev. Lake Tibet 0I 67 PU J14 k6 o 'California Hill MuNple'Use Arep" 0 21 0 Lak Pkins Comers Cam it V -4p -Y t.y Y -7 32 Ot 11 �Utnam G I'le and Tennis Clu J X J R RD Hil Ce L t nl 30 91 I iI 11 , I Vr-4 ! �172 Loll J T7� /-,� ) -on ry t r BRUCE R.OLE� Public Health Director r. -LORET W MOLINARI' RA., Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New Yorks 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 Fax (845) 278 - 6648 .Preschool (845) 228 - 5912 Fax (845) 228 - 6113 August 22, 2002 John Listwan 67 Oakridge Dr. Putnam Valley, NY 10579 Re: Addition- Listwan, 67 Oakridge Dr. No Increases in Number of Bedrooms (T)Putnam Valley, TM #41.5 -1 -18 Dear Mr. Listwan: 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 this Department dated August 21, 2002 . 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;; and4s 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley . If you have any questions, please contact me at your convenience. Very truly — William Hedges 'WH:lm Senior Public Health Sanitarian cc: BI A. - V6 BRUCE R. FOLEY } Public Healih''97trector ='- LORETTA —MOL;INARI 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 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET ®study Dr TOWNP ttIcz "I TX MAP #� NAB .=�yhn Ais;MAf► PHONE ft -5„96 -:b656 PCHD-# 3 8, (M MAMENG ADDRESS t,�7 c&A(,d u a Pe- Putnam Lulls � /V/ lags? ' DESCRIPTION OF ADDITION 6a& ; dry ®i» (,�ratryy� \TUvIBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS 3 (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. M Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, 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 Feb98 BFhouseguidelines BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N.:.. . - ttssocidte 'Public °Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Rdad 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 - 664 8 i Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 16 PAA� Re: Residence s Tax Map , Town -� Gentlemen: According to records maintained by the Town, the above noted dwelling IS J ISNOT - -. -- ._... ti ... _.. �...:.... _ ..:_.. _.__.........._ ........_. .... ... in compliance with Town code and the total number of bedrooms on record is i This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER �uilding Inspector BFhouseguidelines - --� Liu 4h41 (QOM PUT1 COUN CEP o PL S AP- Aj a � � /o ,c cos ;. PROVED FOR i?t COUNT ONLY; - -,:5BEDROOMI S LOA ��tuxe & Title. E r f j 601. I u { - f ITY .. YiY ;, i z PUTNn SOUSE PANS APPROVED FOR BED OOM COUNT ONLY; EDROOMS Slz.?ature & Title 3 A01 j ft!.!gmmkv1 14 1 * VAW 14W MK. pa ere oiwj ° fl � 33 PUTNAM Comm7DEPARTHWOF SMSE PLW APPROVED FOR. BEDROOM COUNT ONLY; 3 EDROO Ms #3 Ignature &Title .40 fu rev FIN ,AID, //v ! I • i i ' ! � �- t3�'w�ni i i I I ! i i ff . �C /Gp','r' _ /;- r`A�►�S�•u=? -.. I _ } ! _._I____'___I -_ _ _ _ _ _ __! _ L. .. }. - i : k1l. Dr I I U.11, _ I I.Co DEP tF: IOU I . I � 1 QED 00 CO NT `ON .. - ' i, { orkle, Title 1 it { 2.D, i i I { 3 ! j I i I i ! ( •1764- f e/%'.e�_.1 17 ,. _..�� -_� -.;., ! } ; f it ed i �� � � C 31 ........ ........ ... . .. ..... III - -_- 'Ice v -- _i - -.- I 1. {- � __� � ��_ -- � - - - +i �it II.�: ------- F6 f I C; 0, ]ER der q 9 51 ... '� ,/ �T�+. yv..! �.. ���.• �.. r� +��'rrrrv.r�.wr.�wv.- ....�.�,. ... �- ,�• ,_- .!:m.. r..: : +„r.--- � -.:.- \... r. ._.... •r�� .. ... " flyj i.�sia� MCI I CERTIFICATE OF OCCUPANCY eillficate of Occupancy No.�..7 /.lal,�........... Applications /y......... cation"r.of..Pre lses `g•�,•• :1� [�' h.a. ' . ... of j1#i having it ere or .filed an application for a building permit pursuant to the Zoning cuna4i e, Sanitary Code and, •the Laws in effect in the Town of Putnam Valley, Putnam County, New York, having paid the inquired fee therefor and the undersigned having by personal inspection ascertained that the applicant h &s subsequently proceeded with the erection or improvement of the proposed struc- . ture in copipliance with the requirements of the laws as 'aforementioned and that the said work and materials met every requirement of the laws as aforementioned and that the premises have now'been fully 'tompleted and are ready for occupancy pursuant to the provisions of law, Now, therefore, this certificate of occu ancy .is�•he eby issued under the seal of the Town of Putnam is Vaney this ',�. .day of , .. .r:.........; 19�. ' Not valid unless signed in ink by a du. authorized agent TOW OF PUTNAM, VALL Y+ E ORK y.: of and Under the seal of the Town of Putnam Valley. D i. By N - C.... .... r. 494• N>` AITT3- Ftv mv eo 0,�M 495 A � GF P 1m jitt, ::ON0l16111 0 PROFMIONAC [31 OW LARD- - -- - -- SJR:'ry ^F. AS WINW I; IS A V10LAT!(Jk OF THEE~ THE STATE OF14MIM Area_ .= 41.176 Sq. Ft. //,,, 1,,# " 196 7 vr- s -r -rg Mot o d�Udn9 Co f ' J I 000 l' 4 fir• C#,raa / e b� r �l ^ aa• «.f Q/ ay r I, / PRINTED _ SEP 00 Y & WATSON SURWY OF PROPERTY SUBYEYI ENCNEERt Pit PREPARED FOR MARCY L KAHN & D /ANE CHURCH /LL Avis map ras Prepared for the e.�alus;W .9'7VA7f IN 7HE -`- - use of and i cerNaed o+/y to: Notes P TOWN OF PUTNAY VALLEY r=.. A/ARCY L KAHN DIANE QYUR&ALL 1. CDPYRK,7iT 1996' by BADEY & WA7SM,, Surw,fmg B Engineerwg, P.C. F/TNAM COUNTY .,CWN US7WAN A# Rights Reserwd. Unouthor;zed oWIcafron is o violation of cWfcobfe LAURA USIWAN faws. NEW YORK i�Z I MVA/aVHFAL 7N LAND n71,- tNSURANC£ CO. 2. Unouthor&ed alteration or addition to o survey mop prepared by o fvensed 1—d a ive.or is a vafofron of Secfian 7709 . Sus - Division 2 SCALE 1 in. _ ..30 ff. SEPTT•MBER 9 1996