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Home My WebLink About2515DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.15 -1 -1 BOX 22 02515 k L 19 1.6; 196 9�k-. r A ♦1 02515 I? eva-4` PUTNAM COUNTY HEALTH DEPARTMENT (/ DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY J SITE LOCATION 6 SF I-L < k OWNER'S NAME_ MAILING ADDRESS [ lv- D TM# o yJ I PHONE .vim!. &�' �1, ,e PERSON INTERVIEWED PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. DATE 7L6 e 3 PROPOSED INSTALLER ADDRESS OP-0 v TYPE FACILITY_ PHONE S Rf 3 .a 6-iS TION# P C / -3 ge-5 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. CV f'f� C/ti &7 4, R4, lu I, as owner, or reported'agent'of owner agree to the conditions stated on this form. SIGNATURE "' TITLE 14 DATE 6� 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 (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be p ormed in accordance with the above proposal and conditions. ProNsal approved s Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NE BRUCE R. FOLEY Public Health Director DEPARTMENT "OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 29, 2002 Pat & Jacquie VanTassell 64 Silleck Blvd. Putnam Valley, NY 10579 Re: Addition- VanTassell, 64 Silleck Blvd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #51.15 -1 -1 Dear. Mr. & Mrs. VanTassell: 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 290 2002, The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by tks 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam VaUU If you have any questions, please contact me at your convenience. WH:lm cc:BI w unam rneages Senior Public Health Sanitarian M _" - Bttt7LE�- R " "FOI:EY:• - ....:..,G:. _� ; .. ;�. ,-� <r �,....- ..a... Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 Au ausl 2 . Acr`a -T ADDITION APPLICATION (RESIDENTIAL ONLY) STREET —L LA N V& TOWN t TX MAP# 51 tiTAME art TJacs i f. Va 10 SSc l PHONE_ t-- 5A1e if (j5 FS P CHD# 43�5-OA MAILI1tG ADDRESS (pL4 S i 1),e( C ICI VA . DESCRIPTION OF ADDITION Iii 14C- d 0-MCLQcfd 112 C,•f �)cLiCc liit t) 1 'UiNIBER 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. 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 Public Health Director DEPARTMENT. OF HEALTH 1 Geneva Road Ltj•RETI"A MOLINARI R-N., M.S.N. Associate Public Health Director Director of Patient Services Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Scrvices (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 2- If Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Residence Tax Map Town Ta�+M JqIle N?' Gentlemen: According 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 Alt" uilding Inspector BFhouseguidelines / 'T Ilt.� EX�s4, C {1060- rl/9N i�a-i� Vary ?r! 5se ay LL q Of (�v`•� S�`�' Li i i (� I 0� 1 I Oerh./ dewVS �1�0K �1�� K S1 ( I« Pu 4N., VAr��y ASse Sys- 5�6— ti�s£s d�BS� liiJ� �%7 o� ?UTNA14 COUNT4.DEPARTMT OF HOUSE PLANS APPROVED FO . BEDROOM COUNT ONLY; �. e & Tit.,® .IAN I Sill ct� fl`11V4V.. �141�ry/ Vr/al lG° b,g� . �� { \lC �Jb, f I :Ucw PUTNAM OOUNTYcDEPARTMENT OF Map HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; EOnOOMS Sunature &Title L ex • Wcw %� L -J ;� is Anti. (i9�JPI � T5�1 �• 5��- �lySC Jkl. C c I -I r 1 JIMSE PLANS APPROVED FOR BEDRG') ?' COUNT ONLY; BEDROOMS INDEX 512813 635465 .0.13. rields No"' or f armed y 2 24 x o Olt 28.67 Area = 16, _073 Sq:_Ft. t tt - ox I- ecIr .. --- --- ---------- Asp tA ts " �.A 4 c O O . 7 Motes i. copymw ww- by gAory WA 7517N silrv&Xng 11 'flg,17 —11g P.C. All Rlghts Res&-vad. Unauthorized dmpllcallpn V '* 7c Cb 40 O 00 cl Cl Paa AUG ? SURVEY OF PROPERTY PREPARED Fa? PA TRICK VA A/ TASSELL 577ZIA7F /,V 7HE j.