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Home My WebLink About2505DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.14 -1 -19 BOX 22 !7- ii T. Lo ir .� 02505 - PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FO_ R SEWAGE DISPOSAL SYSTEM REPAIR / YES NO / Internal Use Only ❑ L�7 Repair 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 ' I' "`' 0, N C Ae--&4w iv RD TM # S-/, / " 19 OWNER'S NAME PHONE MAILING ADC APPLICANT Name & Relationship (Le., owner, tenant, contractor) DATE IfW41f FACILITY TYPE S PCHD COMPLAINT # PROPOSED INSTALLER O It" r./ZT" PHONE # ADDRESS P0-T-/44#J I%,+ t L P—V REGISTRATION /LICENSE # FC z 0..s ?� 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 engineer or registered architect. , , __ v. _ _ _.. _ _......._........ _............ _.... _ . . - - - -- . 6- f*k- On Q. t 1 It, I, as owner, or repdirted agent of owner agree to the �� G,►`��SIGNA �E ,...,�..�.... o -. 44"rft, .. 4._... W511 rtt' 7 W V C LZ r t.-;-h -ra Ct r -rte %�. conditions stated on this form r TITLE DATE % 1 Procurement of any Town Permit, if applicable. Submission of as built repair sketch in duplicate showing: a. Owners 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 a ,5p6rdance with the above proposal and conditions Prop al Denied oo - 0 & Title Datef COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Howard Gragert 296 Oscawana Lake Road Putnam Valley, New York 10579 Dear Mr. Gragert: January 4, 2006 ROBERT J. BONDI County Executive Re: Repair Incomplete — Pinel 21 Pine Hollow Road, (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above - regarded repair has been completed. The following was not submitted with your application: ® Please describe in the proposal section on the permit (enclosed) what is being proposed to repair the existing SSTS (trenches, galleys, etc.). = - - - - Upon -receipt- of a s-d-b.-liis-sion;- revised =to reflect the° above- wmmoiits, -this -repair application will -:- be considered further. JSP:cj lq75- Sin 'girely, 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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 L....1.. i— �..— ....�.s.... T........6....� 10AC %'1'70 LAt A C.... /OAC% "0 LCAO SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 4, 2006 Howard Gragert 296 Oscawana Lake Road Putnam Valley, New York 10579 Re: Dear Mr. Gragert: ROBERT J. BONDI County Executive Repair Incomplete — Pinel 21 Pine Hollow Road, (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above-, regarded repair has been completed. The following was not submitted with your application: • Please describe in the proposal section on the permit (enclosed) what is being proposed to repair the existing SSTS (trenches, galleys, etc.). - .......: - - -Upon .cceipt•of -a sttbmis-sl(,,rf; revised to- e f�ct*the- above -comm4iits; be considered further. JSP:cj Sinc rely, 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 t Ape . AK d- 3 0 TOZ gqb.lp Y5 W (3y On I V Cup s e--s �.e GG � r ��y ®v��lo� < 0 k /',IF, ly T tz J) 0 u IrCA. ctvt�460�lr " �47 "V38V 380c-0 .iij -13 ct Wu 11C 71, O 46 It (` I �ah 15,1,9 f=T. OV F'o po t4 cr WAY (10 Ul (eO wl?" Z z z LLJ LLJ Ez < z C-% DATA C)RA,w i N6 WA, -TH. Ag" i 24 ' 661Z-FL;�wpwT -l!A oL.vwr- (41 AL ...3 �-)Tff4ART t� IOIG Wg,LD* I,E\V .1 \iVW45 P4-t4 6-0 - %7 . .4 � plo tVo ��j N V L 'OS, QP 4, v S .� •t rrJ 5 h Y� h y1 l-. b4t F r 9'. ^�. i• �''I�"sgN. MFG r v S .� •t rrJ 5 h Y� h y1 a* - .,.;" SYtERPi..ITA`AIEYLIr3t, °t�7il�; i6�S;`I;'Ae�i':• : -�- :._: . Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health December 2, 2005 Karen Pinel c/o John Lentini, Architect 124 Allan Street Cortlandt, NY 10567 -1614 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ML County Executive Re: Addition — Approval — Pinel No Increase in Number of Bedrooms 21 Pine Hollow Road (T) Putnam Valley, T.M. 51.14 -1 -19 Dear Ms. Pinel: 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 dated December 2, 2005. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at 1 without prior approval by this Department. _....... _. __ . _ .2:° The area of tl�� e�r�stirrg sc age-disposal system and -its expwasion-Anea 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 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. Very truly. yours, 44L Michael Luke Public Health Sanitarian ML:cw cc: Building Inspector, (T) Putnam Valley 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 j b a .......: -. °..,_z_.....� �._. - - BRUCE .� .- EQ.L-I✓Y.� _ .- . -.-... Public Health Director DEPARTMENT OF HEALTHY Division of Environmental Health Services 4 Geneva Road (c L Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 " • ' • , • 1 , • • " • �D , • STREETL-1 9101-;- l TOWN TX MAP # RtJEC / NAMEV P e Q PHONE ! PCHD # MAILING ADDRESS 90 L-0"r" t 2� ALl..W S_- (=C.I, PtCN DESCRIPTION OF ADDITION N�CWF f .'Cf � L V 1 'V1 �C 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 Divisions Of = Envirb6ne —'ntal Health Services 4 Geneva Road, Brewster, New York 10509 (914) '278 =6130 Putnam County Dept. 'of Health 4 Geneva Road Brewster, NY' 10509 Gentlemen: BRUCE R., FOLEY, R.S. Acting Public .Health Director Re: Residence Tax Ma -- 'Town Accor ing to 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 Building Inspector JOHN A- L EE NT I N 19 A'�-ch i $o<c-t 124 Allan Street Cortlandt Manor, NY 10567 (914) 737 -2890 Fax -1915 DHL 4360358365 EXPRESS October 25, 2005 v s DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road Brewster, NY 10509 Attn: PROPOSED ADDITION APPLICATION Re: 21 PINE HOLLOW RD PUTNAM VALLEY, NY TM 51.14 -1 -19 Please find , enclosed, proposed addition application and the following: 1. Certified check for $100 2. 2 copies of survey (part) 3. 2 copies of plans indicating existing, proposed and plot plan info Please note the proposal is for relocating an existing bedroom to the attic. In order to perform this work the attic will be improved. All submitted for approval. Thank -you 7n A., "LENtiTINI -` CHITECT . enni, RA Cc: KAREN PINEL 21 PINE HOLLOW ROAD Putnam Valley, NY 10579 ENCL W/ COPIES