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HomeMy WebLinkAbout2809DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -2 -38 BOX 24 ' go I I all a I .r, J _} T ` I1 "W ' JIT��6 1 . ', '' '1 M-ri 1 t ` ir -'a FROM :DUNLAVEY & ASSOC. ARCHITECTURE FAX NO. :914 345 8637 Mar. 13 2003 11:33AM P2 DIMICN or MRONMONIAL 129M SEMM cam's lsawe- -r wall2k. sx-m LK—K-04 / ---CeEj3aW -VA&(1Wj N.Y. IUQ 1Z Pnrm naERviEm 4io cawwat 6 9/a/ FMM & AU-aUdnghip (i.d, CIAler , etc.) — arm Tel namw .041,0 M te PWP= MOV.-Um mom ME" (include skatch lomting all adjacent Wei IS).. . N=1 FgWr most be in same location and or sods type as crigiml so*" disposal. system. Different Jamtjon may require silbmiftal of proposal fray licensed qWfeaejorAj wqineex or registered architect. P-1 A Fr Z- t=18 J* JR. PcoposaS ftVrovW with the follming conditiwA.- CA 4-- rn .19 ;0 X'- 1. Procurement of aura TOwn permit, if appliMe. < 2. Submission of as built repair sketch in dt*alcate &h6wiAq: no WWI$ name b.-- Site Street Nov e, Tmm and Tw Mao number. a. - rAwation of instal2ad owpormts tied to two fixed points Ce.1, ohcm corners). d. -Syst4m -description (0-9. r-'-225w-9A-' c0nVMt8'A"*!ic tank, three Ya^eaeet 6' &M. z 6' &wP drywells surrounded by one foot * gravel). a. installer's naft and number. 3.' System repair to, ba rerf=mad 4WWWd04t*-wL-th the abCm* Ptapool AW conditimS. IF as ewrere lrbad-lacuat -of • ,-aqres tQ the above amiditions. 51WATUM .:Trw e; jo (SM); VA law MM M),. pidt UnLiazo MAR-15-2003 SAT 11:30 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 A, y 2 .7- Dw I ;L LL '1/0 6 ok -- ---- ---- G ea P-1 A Fr Z- t=18 J* JR. PcoposaS ftVrovW with the follming conditiwA.- CA 4-- rn .19 ;0 X'- 1. Procurement of aura TOwn permit, if appliMe. < 2. Submission of as built repair sketch in dt*alcate &h6wiAq: no WWI$ name b.-- Site Street Nov e, Tmm and Tw Mao number. a. - rAwation of instal2ad owpormts tied to two fixed points Ce.1, ohcm corners). d. -Syst4m -description (0-9. r-'-225w-9A-' c0nVMt8'A"*!ic tank, three Ya^eaeet 6' &M. z 6' &wP drywells surrounded by one foot * gravel). a. installer's naft and number. 3.' System repair to, ba rerf=mad 4WWWd04t*-wL-th the abCm* Ptapool AW conditimS. IF as ewrere lrbad-lacuat -of • ,-aqres tQ the above amiditions. 51WATUM .:Trw e; jo (SM); VA law MM M),. pidt UnLiazo MAR-15-2003 SAT 11:30 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 8 FROM :DUNLAUEY & ASSOC. ARCHITECTURE FAX NO. :914 345 8637 Mar. 13 2003 11:34AM P3 _ . _ . ... . _ _ ; a , ,ya -.... -., , S%1 ar iw � cgs ,"�w,M. •.. r `., , - ' .. *1 q`1 7, MOWS N sm LOW= . S. Ply INTERVIENM morlEd Pam Complaint # TYPE rAclury BM02M& (inch Sketch Iomtirq s]1 adjacent wells): INKXM: Repair must be in Sam location and of $me • type an original soap diepami 8"t4m. Different location may rewire subuttal okf-7 propami ft m licmmeed pr0%ge#C0&2 srgirsamr W registered architmt. ,d 0..., IL Inspector °s S gtsature & Title PrOM4, Amusta A2 the foluming conditions: 1. Pracurewnt Of any '1� pe=t, f applime. I. Submission of as built repair sketch in duplicate abcming: a. Owner ► s trams. b. Site Street Name, 'Town and Tax Map va*ar. c. i,o MUM Of il%BWW cwPMents tied to two fixW points (e.g. ,house corners) . d. Spstam desor'tptim (e.g., 1250 gal. Ctrctete mptie tat*r tbzm precast 6' diem. x 61 6ftP drywells sur *=dad by ane foot + gravy l) . e. lmtaller °e game and comber. 3. Systen revaix to be perfomoed in aemrdanm with the above prvpml sad awAitlem. 774 4 1,, : F-4 MAR -15 -2003 SAT 11:30 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 m ED Inspector °s S gtsature & Title PrOM4, Amusta A2 the foluming conditions: 1. Pracurewnt Of any '1� pe=t, f applime. I. Submission of as built repair sketch in duplicate abcming: a. Owner ► s trams. b. Site Street Name, 'Town and Tax Map va*ar. c. i,o MUM Of il%BWW cwPMents tied to two fixW points (e.g. ,house corners) . d. Spstam desor'tptim (e.g., 1250 gal. Ctrctete mptie tat*r tbzm precast 6' diem. x 61 6ftP drywells sur *=dad by ane foot + gravy l) . e. lmtaller °e game and comber. 3. Systen revaix to be perfomoed in aemrdanm with the above prvpml sad awAitlem. 774 4 1,, : F-4 MAR -15 -2003 SAT 11:30 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 FROM :DUNLAUEY & ASSOC. ARCHITECTURE FAX NO. :914 345 8637 Mar. 13 2003 11:33AM P1 a v i i MIT IF Rs Dunlavey & Associates Architecture Hawthorne, MY 10532 Voice: 914 345 -7153 Fax: 914 345 -8637 To: Bill Hedges Fax; 845 278 7921 Putnam County Environmental From: Jim Dunlavey Date: 03/13/03 Re: BOR Approval Pages: 3 448 Qscawana Lake Road CC: ❑ Urgent X For Revlew 0 Please Catntnent 0 Please Reply 13 Please Recycle r i0r Bill. I spoke to you a week or so ago and you advised I gather the information attached, two pages. .The tax map number is 62.2 -38 The address, the year the system was built and the gallons capacity are noted on the attachment. My Client, Mr. Ralph Smith, wants to add a bedroom and bath to his small home, Do we still need a meeting? Or do you want to walk the site? Please let me know. Jim Dunlavey ................ MAR -15 -2003 SAT 11:29 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 o' OM Sim MAI] PER! Name & Relationship (i.e,, owner,tenant, etc.) DATE 9 /aZ 14?d- -- TYPE FACILITY PROPOSED INSTALLER el "S PHA 5-22-/0,60 Pro (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. i• ... -. Proposal Disapproved iature & Title rn 1DatE; ;: f F-1t Proposal approved with the following conditions: CIO zi 1. Procurement of any Town permit, if applicable. F` ' 2. Submission of as built repair sketch in duplicate showing: W C:) (7) a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6.1 diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as 5owner, o r po ag t of er agree to the above conditions. / SIGNA TITLE ow P1 �'" DATE 9 l Ll q Z PIE;: Pa M YeUcw (� az); Pink (Applicant) l.��4 ,ls samau�.olc�C Ari �, h,►4..p.t ¢ ' / ' �,, .D w e i• ... -. Proposal Disapproved iature & Title rn 1DatE; ;: f F-1t Proposal approved with the following conditions: CIO zi 1. Procurement of any Town permit, if applicable. F` ' 2. Submission of as built repair sketch in duplicate showing: W C:) (7) a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6.1 diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as 5owner, o r po ag t of er agree to the above conditions. / SIGNA TITLE ow P1 �'" DATE 9 l Ll q Z PIE;: Pa M YeUcw (� az); Pink (Applicant) � b X01 SIT]] MAI] -- DATE 2 PROPOSED INSTALLER Name & Relationship (i.e, owner,tenant, etc.) TYPE FACILITY /7/0 P" 2 PHONE 5-20D - Pro (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. Well Proposal approved Proposal Disapproved Inspector's Signature & Title 3_: 1.36. 137 Date roposal 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 canponents 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 drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as ownerl? or Of O�pi Aiiiii �,. _.�• C SIGNATURE ��DATE E Public Health Director DEPARTMENT. OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., 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 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Residence Tax Map - Town Gentlemen: According to records maintained by the Town, the above noted dwelling IS NOT in compliance with Town code and the total number of bedrooms on record is -z_- This information has been obtained from: / CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER BFhouse n LORETTA MOLINARI Public Health Director 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 . Smith 448 0scawana Lake Rd. Putnam Valley, NY 10579 Dear Smith: June 3, 2004 ROBERT J. BONDI County Executive Re: Addition - Smith, 0scawana Lake Rd. No Increase in Number of Bedrooms (T) Putnam Valley, TM #60 -1 -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 this Department dated June 2, 2004. 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. 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. Sincerely, Michael Luke Public Health Sanitarian ML: lm cc: BI (T) Putnam Valley I PUTNAM. COUNTY DEPARTMENT OF HEAUTH. HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; a- BEDROOMS . Signature & Title Date . EXISTING MASTER BEDROOM EXISTING LIVINGROOM EXIST. STAIR ON EXISTING KITCHEN ,h� ��. DEMO. DOOR ! OFFICE A4COVE STA�R WALLS, 146 51 .� UP a x i TIT - -- - I EX15T'G. REMOVE EXISTING OKAL. PREPARE V � p /- I BATH SPACE FOR NEW SFPA+orE! ' DEMO. CEILI TO PROVIDE It O N I . FUR OUT EXISTING EXTERIOR . . WALLS TO ALIGN WITH NEW REMOVE EAST'S,. FLUE. ' 2'X5' FRAMING ABOVE. INSTALL MEN FLUE ON EXTERIOR WALL ! EMOL05E WITH FRAMING TO MATCH ` EXISTING HOUSE. FIR5T FLOOR PLAN 4 4 0 0 v I I 1 1 1 I 1 1 i 1 LINE i i i 5EGOND FLOOR PLAN ABOVE EXISTING HALL. OOVERHANS 1 I I I I i 4 � I FRAF E.°LATFORM ACROSS - ' =C-ON STAIR WELL FOR NEH -� \A.G.ttil'r'j,�(js SfdrD,G. f--- - - - - -- - LINE OF ROOF OVERNAN6 A>�PROx. Loc. ' �V 51Gn16NT ' i I I i 1 ,ATTIC SPACE 1. . LIMED ACCESS ' I I I I . I INSTALL CABINET IV I L'oe", CHUTE IN LOWER I SECTION ! STORA6E ABOVE I I _ I ----- - ----J 4 S 1 PUTNAM COUNTY DEPARTMENT OF"flEALIM HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY: BEDROOMS tic Signature &Title s' , LORETTA MOLINARI R.N., M.S.N. Acting . Public Health Director Director of Patient Services .. � _. >...- .,...._..�.... _� .. m ., -.. �.. ROBERT J. BONDI County Executive 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 /Preschool .(845) 278 - 6014 Fax (845) 278 - 6648 May 22, 2003 Mr. Smith 448 Oscawana Lake Road Putnam Valley, NY 10579 Re: Addition - Smith, Oscawana Lake Road No Increases in Number of Bedrooms Putnam Valley TM #60 -1 -63 Dear Mr. Smith: 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 May 21, 2003. Based on the information submitted, the above - mentioned addition is approved with the following conditions. 1. The total number of bedrooms must remain at two without prior approval by this department. ��f the , ?sr�stit w� eF�¢a�P rlic kcal. cycYPr�a�..3rdJtc_Fgrt�ncl��� . ar.Pa� ._ iict be .. :_. s ..... - - - -- - r 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 yours, Michael Luke ML:jp Public Health Technician cc:BI (T) Putnam Valley ■ V I V e' 5 << ©'1— L, o k 5-� t I PUTNAM COUNT`!'' DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, 'BEDROOMS Sl nature & Title Date p� Basement Level - EXIST. MICH. ------ LAM DRY TMN 60 -1 -63 o First Flr. Plan - PROP. @Lecon1,F!;1. Pln. -PROP. e. GARAGE RM. April 10, 2003 Smith Residence proposed Plan - Scheme 'A' DUNL�AVEY 448 0skawana Lake Road scale: as noted Associates Architecture Putnam Valley, NY 10579 note: all dimensions to be verified 37 SAW RIVER 914- 345 -7153 i:w1 TA ­N 6IJif4 I "R.N., M.S.N. _ Acting Public Health Director Director of Patient Services y ROBERTV J. BONDI County Executive 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 April 16, 2003 Ralph Smith 448 Oscawana Lake Rd. Putnam Valley, NY 10579 Re:Addition- Smith, Oscawana Lake Rd. (T)Putnam Valley, TM #60 -1 -63 Dear Mr. Smith: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A second floor bedroom. Based on the information submitted the above mentioned addition cannot be approved for the . _..-_ •- - -�• - •iJllvv ?lj'ig.•iG0.S��S' •.•.. .... _. _ .. r._...._ _ -__ .. _�...... _...... ... ... _..._,... .. _..._ ...... .._...� ....___.__... _. ,..._ .._......_ ..,.._...,_-•- --- �._... �.... _� 1. The office is considered a potential bedroom. 2. The legal bedroom count for the dwelling is two . The potential bedroom count of the dwelling with your proposed addition is three, 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than two potential bedrooms, or have a professional engineer or registered architect design a sub- surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML:Im Very truly yours, Michael Luke Public Health Technician APR -10 -2003 09:53 FROM: PUTNAM CMiT`•, ' DEPART E1,45 -278 -7921 f , r 8?tI;CE -„ �FOL T. Public Health Director TO:9191434586 37 P:415 ` WkE f4 ;MOLINARt ILN., 1vI.S.N. Associate public health Director Director of Patient Servtaer DEPAR` N ENT . OF BEALTH 1 Geneva Road Browster, New York 10509 Envlranineatal MOM (845) 278.6130 ,F0X (A45) 2 ?8.7921 Nuning Services (945) 271 - 6558 WIC (84S)271.6678 Fax(84S)278 -608S Early Intervention (845) 278.6914 Preschool (145) 279-6082 Fax (845) 278 -6648 ,ADDITION APPLICATION (RESIDENTIAL 0I% Lake li�oaci #, s STREET nc_akjaaa v TOWN_ TX MAP* NAr�IE S if PHONE 1 SZ C j5L_PCBID# 3 3 MAtLiNmi A17 mss 443 Os-cawaa L-ak:e atd R1 td, 'afn 1 e 1051-9 DESCRIPTION OF ADDITION rLoX. j O �� KITC+le?1 "PA051 ak and - AFrtLo.� . 3-5'0 SF' ZED rcav n scuire- Al' r--xl5-rG A -r-riC NUMBER OF MSTING BEDROOMS Z PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTMCAnON MOM BUILDING INSPECTOR) ; *Any addition which is considered a bedroom requires formal approval"o£platrs (Construction Permit) prepared by a Professional. Engineer or Registered Architect in aocdrdance vdiih applicable sections of the Putnam County Sanitary Code. Pleas submit this form and the following to Putnam County Health Dept" 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130 = - 1;... - Ceitrs cu`cncex or money order 3oi CIE.- d,, - ,- 2. Sketches r e7tsstrng floor plan =(drawn to scale, all living azca dingiy i ementj Non- prdfess�ronal�sketches ace acceptable 3, Two sets of PzoPosed r plan ](drawn to,. cale, whh�n strei and tax ii►ap *Non profession i sketches arc acceptable 'y t" , "` f 4. Copy of su vev howing well and septic-location, to the best of your knowledge, Include date of r`insiallatio if Bown. Label all wells and septic systcrns within, 200 feet of the property line. Contact this office with any questions. S. Copy of Ccrt Of Occupancy, from Town or Certification frorn Building Dept. with legal bedroom count of di:vcllii - ORFWE USE Feb98 13Fhouseguidelil,es U HPH -10 -20113 09:53 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 O ME R FOLEY to HWA arrctor. 70:9191434SeG37 P:5 ,'5 7 _— -•.� r . ... ,.- na ti r..n. . .,-. ..n• :.b- ....a.. r -. - .�p.e :. . .... .+. •- • .•ray LOIi'B't'?A MOLINARI RX. M.S.N. alctaclals Pab!!e Xsa1r$ Dlrteato, DAectar of Patient &WMVW VkWAKIM N1 UY - BhA1;f11 1 Geneva Road Brewster. Now York 10309 Rnvlronmental Ralik (845)278.6130 Fax (84S)272 -7921 Nurslej 6ervlter (ton 271 - 6552, V1ZC (24!) 271 -0091 Yax (145) 278.6025 Huty Ietarv"tI= (845) 271.6014 Resebad 0143) 27M R1 • Fan (945) 2!t -6648 . Putnam County Dept, of Health 4 Genova Road Brewster, NY 10509 Re: `F�°O OzaW2 y1 at 1.�. ad . 1?V Residence raxmap. (0 Q Town Gentlemen: According to records, maintained by the Town, the above noted dwelling ' in comphatee with Town code and the total n=ber of beftbms on xecoxd is This information has been obtained from; CERMCATi OF OCCUPANCY: ASSESSORS ORD: OTHER ' Bulldtng IuspeCtor BPhousegnidelines N First Fir. Plan - EXIST. R scale: _ - Second Fir. Pin. - EXIST. R ca e: = TT Basement Level - EXIST. R cae: _ - TMN 60 -1 -63 First Fir. Plan - PROP. R Scale : _ - Second Fir. Pin. - PROP. R CH. I GARAGE RM. April 10, 2003 Smith Residence Proposed Plan - Scheme'A"I DUNL�AVEY 448 Oskawana Lake Road scale: as noted Associates Architecture Putnam Valley, NY 10579 37 SAW MILL RIVER ROAD note: all dimensions to be verified HAWTHORNE, NY 10532 914 -345 -7153 OW MA PII - -- — - Name & Relationship (i.e, owner,tenant, etc.) / ' DATE lqd- TYPE F'I+ICILITY �0 ir e PROPOSED INSTALLER l &gU, M cA. O f L �. ; .' PHA S 2 S ~/ o d O pro (include sketch locating all adjacent wells): N=: 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. u Proposal appra /v, d Proposal Disapproved s Signature & rn .•� - - `� teats_ � m r 1000set Lk. �� , O O G ea u Proposal appra /v, d Proposal Disapproved s Signature & Progpsa.l approved with the following conditions: Z. 1. Procurement of any Town pennit, 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.,hcuse corners). d. System description (e.g: >••1250':gal. concrete' septic •tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to, be performed In.iacaordance:. ith the above proposal and conditions. I, as owner, r ag t of er agree to the above conditions. I l SIGNATURE TITLE h L-' Y' DATE 9 xPgSa (FQi�)i Yel.]raw {fin ffi); Pink GAEflpliaant) rn .•� - - `� teats_ � m Progpsa.l approved with the following conditions: Z. 1. Procurement of any Town pennit, 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.,hcuse corners). d. System description (e.g: >••1250':gal. concrete' septic •tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to, be performed In.iacaordance:. ith the above proposal and conditions. I, as owner, r ag t of er agree to the above conditions. I l SIGNATURE TITLE h L-' Y' DATE 9 xPgSa (FQi�)i Yel.]raw {fin ffi); Pink GAEflpliaant) PUTNAM CDUNW HEALTIS DEPAR'.D3ii' UMSIbN OF MMM44DUAT, HEALTH SWICES PROPOSAL FOR SD@M DISPOSAL SYST34 REPAIR OWNER'S NAME SIM LOCATION MAILING ADUUSS. Name ' : -t. ationship Me, owner, tenant, etc.) TYPE How 2 gyp_ / -6-Z ` A' /U ,AC --70- CM Canplaint # �4 vn e PHCM 5.2 pr9 oral (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 Bran licensed professional engineer or registered architect. As - 9L I� Proposal approved. _Proposal Disapproved. -. .� _. � .., _. ._....... -. � ._ __ �_ ... _.._� ..._. ?. . -.. ..__. � .. ... ..- -_ • -_.... ._.. -._ w._.. _.� .. .. .�.. �... .dam. _.. _....._ .. _.... -..... ._. f. .... _..�- . -..... �._�...r.. �_.. ... ... .. Inspector's Signature & Title Date Promo oral approvgi with the follawinct eonditior�s: 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 c5anponents tied to two fixed points (e.g.,house carriers). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. as i;(FMMD • r, f • e of agree''t-b- the above conditions. SIGMTURE h " M 3/53 r • ea M . :� .. ., Y 8RLJC'E R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. ,4ssociate 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 #q j0, ciu�cev>a Lk. -R . TOWN ta ZV1Aw.�1 . TX MAPS VaUQ NME �7'v,n c.4-\ PHONE �?4 5 - 5'Lg (S 1S PCHD9 MAILING ADDRESS ilS0ios77 DESCRIPTION OF ADDITION, \UiNIBER OF EXISTING BEDROOMS oL 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 ._. P" tram County Sanitsry Code. ... _ - _ .. y ... _ 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 &r-&� foi $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 9) *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 Khoaseguidelines AA,a. �p N3 /O 5 O E \ b3 9 •d� 2 •• V^ 0 e" Oe PQ °a N63 °19'00 " W _� c p�► /8.00' .. _ ":ilr, ; 1'• o C 1 ":! � N31 ;38'0i6.00 ? %� °38�00 "4Y ``{I /6.00," b . aX-1 nyvr i ��'e � �O�'e � •• . � / o S 72 °2 1'00 °E 0 _��oFra 22.15' F . p� Farce/ / 5 x ru, t °.na S76 °48'00 "E °I 20. /9' �. �o S63 °19'40�E /0.00' , Farce/ 141.61 ' WO SURVEY OF PROPERTY P v° PREPARED FOR 3 RA PH E. SM/ iH a L AURA A. TRIOL 14 O c,n SITUATE IN THE ' C.) ¢de�m1issyn TOWN OF PUTNAM VALLEY, Area 16,4 99 Sq. ft. e(y E HY 1459 PU MAM COUNTY It "E Fran f0fm N� NEW YORK Z o 9140 0r �• N�� SCALE / is = 20 ft. OCTOBER // /994 This map was prepared for the exclusive 5 8 4 a_� oet 0 P C • ' use of and is certified only to: ` ,row °e N 2 , RALPH E. SMITH -.vro Se pe hereby certify that tAs survey shown hereon , was comp /sled by us on October // , 1994 that LAURA A. TR/GLIA NOTES this mop was completed on October /3, 1994, . /. Alteration of this document, eerept by a licensed Lend and that this survey has been prepared in accordance ' Surveyor, is illegal. with the existing Code of Practice for Land Surveys Z. All certifications are valid for this map and copies as adopted by The New York State Association of thereof on /y if said map or copies bear the impressed Professlonol Loud Surveyors ,Inc. seal of the suivoyvr whose si7i70ture appears hereon. 3. Underornnnd ,mnrnvemente .n anm o.. r< n. °,..•.�n.•n...mm - F Off' V Jam' titi\0 0 ' � 3 �O � N37 °04 00 E 10.15' \ 9 71 a , r A N63 °19'00 "W—_ /8.00' N31°38'00 "W� Arec = 16,4 99 Sq. ft' ,U,-, A h' P 01 r\ b O I0 v- z iG' I ,Fof TITLE. N4._ - -- '--.._.. , \ �(511 <1\ Q \ r. l S /• Parcel / { Porcel l an5 n E X1;5 Y �o "E Formeforw �'jo. 1459) ,q9 or r.. 9 • 9� u 4 � S72 °2100 "E a F� 22.15' 1 yr �.X-cul found '� r h' S76 °48'00 "E ° 20.19' ; S63%940E 3 /0.00' s ! y. 141. � OA SURVEY OF PROPERTY pip, RALPH E. PREPARED FOR SMITH a LAURA A. TRIGL M, SITUATE IN THE TOWN OF PUTNAM VALLEY 5 PUTNAM COUNTY '. NEW YORK j SCALE 11n.= 20 ft. OCTOBER // ,1994 n; r �i A i ii