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Home My WebLink About2335DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -2 -63 BOX 20 I non ' Ll 02335 AWO@,� 'iD PUTNAM COUNTY HEALTH DEPARTMENT 11 *7 DIVISION OF ENVIRONMENTAL HEALTH SERVICES 15lu PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES N Internal Use Only PERMIT- Nj� ❑ 191/ epair Permit issued in last 5 years Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 3l Lin& Vrus S J TOWN ?V-Xt4 ^ YPrG,Lify TM # ! A /0 OWNER'S NAME MF,07- d- MA4LI kA RfjgN 1EX- PHONE # MAILING ADDRESSyT/�/}pt APPLICANT (�t,l {� ¢i p �' (s•i9� A� r Name & Relationship (i.e., owner, tenant, contractor) DATE. q1t FACILITY TYPE S PCHD COMPLAINT # - VW,s �� 2S"z 1 PROPOSED INSTALLER AO u�o�} �/L19�(,¢:nT- PHONE# g4eo 49 ADDRESS 6SC.�w 14,- REGISTRATION /LICENSE # 10S'rlS Pro osal (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. C- I, as owner,agree to a con i n stated on this form SIGNATURO TITLE DATE. t t l (owner) I, the septic instal er, agree to comply with the conditions of this permit for the septic system repair SIGNATURE .4"4k.. 44U-1- TITLE NeYY r DATE Z? t (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, Sfte.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 backfilled until authorization to do so has been obtained from the. Department. J INTERNAL USE ONLY Pr I proved U Proposal Denied El OJLft(� t t `7 L11 1) Insp tor's Signature & Title Date / Expiration Date Repair proposal is in compliance with applicable codes Yes i� No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 IJZ X t. vaG► M �I J vaG► M �I J �T' AC. � D I LL Imo^ %;p .f 0 -L (I ql 'VV Qh Iii a0� v31t® � _ CIO— i�,ac�1 304� s 4S;' I�S� C C y� J �T' D I LL Imo^ %;p .f 0 -L (I ql 'VV Qh Iii a0� v31t® � _ CIO— i�,ac�1 304� s 4S;' I�S� C C y� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ,y.. ;-�: LORETTA- MOLINARL .RN;,,,MS!N..:- _,.._._.:;.::..- Associate Commissioner of Health November 15, 2007 Toni -Ann Deszaran 31 Arbutus Street Putnam Valley, NY 10579 Dear Ms. Deszaran: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive ;ROBERT. MORRIS, PE Director of Environmental Health Re: Addition Approval — Deszaran No Increase in Number of Bedrooms 31 Arbutus Street (T) Putnam Valley, T.M. # 41.10 -2 -63 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 November 14, 2007. 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 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 approvaf i`s 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 Putnam Valley. If you have any questions, please contact me at your convenience. Respectfully, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:ens cc: BI, (T) Putnam Valley 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 PUTNAlk COUNTY DEPARTIME-Ni'll C!N- REAl"Ill ROUSE PLANS.AHROV-JA) I-"OR f!"DR00i'd COUNT ONLY, J'aD-07 711 ALL SUBz`jEQUiS-�`N`T il,'t.Ei,*I�-41l)?,�I'l�kt,TL,']'I.ATI-t-,NS TO T-H,.lSE.1-IOUSE PLANS MUST' BE TO ThE PCDOH FOR APPROVAL ATURE & TITLE rf c PIL DA' K i SS �i +9 i .r J� 10a-a- a-4, 7?Z J � is -, .. _ f — — V� �iR/,�•l:'I tA�J �—+/ � f 1�-�z� II IL ;�-- AZJ �KS3 it h �' i f r Kz`i PUTy CX N Y AF 114- i\1EN'f op IiE k, t ` i► , HOUSE APPRO�r D FOR •:3FDROO CUUNT i LYE BEDR ALL SUBSEQUENT Cd \�ISI�I�IALTERATIrNS TO V �� P NS iVIBST BE Ui v11; iL TO THE PC.DOII FOR �LPPIi AL SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health DEPARTMENT OF HEALTH ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONL J v "pop I-,.I,�^ STREET 3I _Jr UIJb JT TOWN " C�f TAX MAP# NAME PRONE QI � -8D —n PCHD# � _ad 6 ADDRESS 31 4bLJw � Udl N7 .I v s ;�' DESCRIPTION O ADDITION (. Maize .✓1n,.' .,�..� %J 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 Pounty Health Dept., 1 Geneva Rd, _ Brewster,. NY 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. 1. 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 r •T h _ SHERLITAAMLER,_ MD, MS,.FAAP " JCorriinissioner LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New f ork 1609 Town Legal Bedroom Count ROBERT J: BONDI . 'Coun7y`- �..zecufive -" Re: DE S ZARAN (Owner's Name) Tax Map #: 41.10 -2 -63 Address: 31 Arbutus Street Town: Putnam Valley Year Built: 1961 According to records maintained by the Town, the above noted dwelling, is XX in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: 2 This information has been obtained from: Certificate of Occupancy: C0#67177 - 8/81167 Other: 9/7/07 Date Environmental Health :(845)278 -6130 Fax (845) 278 -7921 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health. LORft , MOLINARI, RN, MSN Associate Commissioner of Health October 11, 2007 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mr. Deszaran 31 Arbutus St. Putnam Valley, NY 10579 Dear Mr. Deszaran: ROBERT J. BONDI County Executive ROBERT MORRIS, PE K Director of Environmental Health Re: Addition A- 220 -07 Application Incomplete 31 Arbutus St. (T)Putnam Valley, TM # 41.10 -2 -63 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. The following was not submitted with your application. 1. Sketches of existing floor plans for all floors in the residence. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. GDR:Im Sincerely, Gene D. Reed Senior 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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 October 17, 2007 Gene D. Reed Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Re: Addition A- 220 -07 Application Incomplete 31 Arbutus St. (T) Putnam Valley, TM # 41.10 -2 -63 Dear Mr. Reed: I am in receipt of your letter dated October 11, 2007. Please find enclosed 2 copies of the existing floor plans for both the first floor and the basement. I apologize for any inconvenience this may have caused. Please feel free to contact me with any additional questions or concerns. Thank you in advance for your attention to this matter. Sincerely, Toni Ann Deszaran Brick x t r _ al INTERIOR Lake F. � � mm i hd belief Signal !cant, coo hereby rti that l as asae t Insp, 030607 Borrower Toni ann Deszran I : . Property Address 31 Arbutus Road city Putnam Valley i. County Putnam State NY zip code 10579 26' 44' Calculations 44 X 26 X I Level = 1144 J7 FI k {I Division of Sanitation mffi' Ell�i } I i of tj! 31 qv Ov • -r. ; � I i �' �` � I . , I G,:�,, .ice P�?"``� �r�r+ 2 i O.. , 1 of �u I 1 ,SP-5t�Q j , a Y '{�. i