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07/21/2015 11:13 8455262560 TOMPKINS LANDSC CORP PAGE 02/03
APR-D -2013 11:45AM FROM-ENVIRMANTAL HEALTH 8452797821 T -2$6 P.001/001 F -812
- PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION-0MVIRONMENTAL HEALTH SERVICES -
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPr41R
[ntemal Use Onl Polmri v
❑ Repair Permit Imued in last 5 years Hot in Watershed
LI whrwt Boyd's Comers, w. Branclror Croton Pelt Res_ U Delegated L U t 4
[� Rap* within 200 fL of a woermuree or EC -mnp�0 w6t�Ane ❑ ,�41n2 iiBview
WE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT !a6 ,iW l LLXY4 ,11
NaMO B 0M8t10nship (i.e., o net,
DA'Z'E 4--'30 Q FACILITY TYPS
PROPOSED INSTALLER 1
ADDRESS
O PLAINT #/V
# '
# I
PmposW (Include a sepalrate sketch lo-04n5 t& house, lamperty ones, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
►IATC- TM.a Mandmnnt m9v rortf,tYp �1 SMh11ft'al [1A 11Mr1RCAI fTArfl tl[•P_nSf?rf [1fr9fLGSiAr1AI [tA[k4nd1n8 on thA
t, as owner,agree to the conditi f its Stated on this tom►
61GNA74,1RE �_ TITLE �!tp`,rt f +'~ DATE .�-J /J —
I, the septic installer, rig comply with the conditions of this permit for the septic system repair
SIGNATURE J - TITLE 1Z Q DATE
1. Proxxarernent of any wn Permit, It applimble-
2, Submission a4 as, built repair sketch by tho 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 lrtst AW components tied to two foxed pol is
c. syawm de4I Don (e -9-. 1250 qW. Concrete septic tank, etr-)
d, Irrstaliers' manna and phone number
3. System repar to be performed M amfdanoe with the above propotol and condidoris
4. The pmposw SSTS repair L5 considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair wilt iunction.
9. No completed work Is to be backtill until at orh alion to do sa has been obtained from the Department
/ INTERNAL USE ONLY
M - p i Denied
R
tture & Tire
is in Wnipiiance with app
COPIES: P'CHD; Owner; Installer
PC -FtP 99ML
Date
Ins
Rev. =7
07/21/2015 11:13 8455262560
LOT S3
TOMPKINS LANDSC CORP
16 1
PAGE 03/03
LOT '51
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES -
f,
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
yu KQ Internal Use Only PERMIT ll . } 5
❑ Repair Permit issued in last 5 years ff Not in Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ It Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION^ ff N TM #
OWNER'S NAME , P NE #
MAILING ADDRESS �r
APPLICANT
Name & Relationship (i.e., o er, t, co ctor)
DATE '���� 13 FACILITY TYPE PC COMPLAINT #i.1,
PROPOSED INSTALLER / % P3NE # J.:
ADDRESS ij=0Jt,W1REGISTRATIO LICENSE # G
Prog_osal (include a separate sketch locating he house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system) "" The Department may require submittal of proposal from licensed professional depending on the a
I, as owner,agree to the conditi ns stated on this form
r�
SIGNATUREf TITLE � ,� -' +� DATE. Gi,Z /J?
(owner)
I, the septic installer, agr comply with the conditions of this permit for the septic system repair
SIGNATURE L TITLE DATE h ?
(Installer)
r oposal ARRanad wfth th ilowing conditions:
1. Procurement of any 19wn 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 duration at which the
completed SSTS repair will function.
5. No completed work is to be backfill4until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Pro Prpp Hied ❑
�t M"t"
I spe or's Signature & Title Date / Expiration ate
Reoair or000sal is in compliance with applicable codes Yes No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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iIIIIE. :.:APR -23 -2013' 1.1:45AM
iEL:NUMBER 845"787921
;'LAME ENVIRONMENTAL. HEALTH
DATE
APR -23 II:45AM
F.
85262560
DOCUMENT . PAGES .
,.001
START, TIIiIE' .• ..
APR 723 11 :45AM
END TIME
APR -21 II:4EAM
SENT _PAGES
`STATUS:.
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.,FILE 812 x I' S,UCCE-SSFUL'TX. NOT I CE **
YC1ThJA.Pc'I CfJI_JNT`i HIEAL`TH CAF: PARTFd1ENT
00XISION (DF- E-N \ /I,RCI`' MENTAL I- EE:ALTH `3EF7VICES
PdP?r; =0 s.eaL :: C ►:f:�_5EOP1/e��(,�;IT'FtEATPALI P"9 SYSTEM REPAIR r�
Ir,ternat Uso.�nry _ PERMIT �u
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fact Qt' rwPUr ara'cl ttte tocnrdor. of eicit9 -IIIA0 a.-Bee pt.,::,p:osacf
NC>TC°. The- C28partmant n-rtay require subm ittat of proposal from live:. used professional depending on t11a
ristporci. an .axtgntyof 'IM49 trc:palr.
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1, as c,wne_cj:agrrae to the. co- 'tditign_- rm'r, cI n this fr 'rn r%
t31G vIN' r: i:' 1' L1fiEi /.r.l;:- : °_: {�•C�'12c��!::r.�_ TI'rLE_Ge.E s� 17AT0� `�.�..'�� -✓ /J�
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CATE`7
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�:1 ear�:i�ni 3lFlitic'+^ad `�•LSL?`j- } /�ca9owln:n cSiRQ3.tiL9SF�.. .
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,. 3. S,.tbmlelsion oT as_t,.iltt r.st�air �sicatah by the ur�atle s:r`:tem installer wltt,en 31] days oT the rapalr, In dupllcata "showing:
a t'-- tWniol�K navte. Slt. nrroet Nams. Tw €nd Ta;: -48ap numtaor
' .
b. l.:Ja Wane of irtat:xllercf •cr,mpone:rrrs tksd to two Iix. J poirKy
•y9ten'r docariFyLlon (q_, 12501 ya1_ Canorete 361wio mr0c, e1;=_)
�d_ lrrrdat)ars':nam.a and c "Ian'0 numoar
3_'� .r_'V l;am'n pdm r to ta.n p.arti :irm"cf in rs.od vc;,snea with Ilta aGov proFwoai and concImons_
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c:.�rripLSIItac. SS TS rep.eir vr(1l Tunctl0n. '
5_ is: t"? b, baciclill�) until authori:t; -Mors to do s hrss bean obt3ained from the Capartmant
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07/21/2015 11:13 8455262560 TOMPKINS LANDSC CORP
Fax Cover Sheet
Tompkins landscaping Corp
'D /B /A Tompkins Excavating
845- 528 -8513 914- 403 -6543 Cell
845 -526 -2560 Fax
Email: Stacey@TompkinsExcavating . com
Send to: From: /Wa -X14
Stacey Tompkins
,{) Date 7 cR
Office Location: Office Location:
Fax Number: gY5'-- c'� 7Y 790 Phone Number: 845- 528 -8513
❑ Urgent ❑ Reply ASAP
❑ Please comment Q Please Review ❑ For your Information
Total pages, including cover. pages
PAGE 01/03
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETrA 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
July 9, 2002
Joel Greenberg
Muscoot North
Mahopac, NY 10541
Re: Addition - Earle, 655 Sprout Brook Rd.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #72.19 -1 -7
Dear Mr. Greenberg:
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 form this Department dated July 9, 2002. 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 Vallev.
If you have any questions, please contact me at your convenience.
Very truly yours,
William Hedges
WH:lm Senior Public Health Sanitarian
cc:BI
i
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 1OS09
LORETTA MOUNARI RN., M.S.N.
.tssociate Public Health Director
!)tractor of Pattunt Services
''9fMr0nroent21 Health (845) 218.6130 Fax (84S) 278 - 7921,
Nurving Services (84S) 278.655$ WIC (84S) 218.6618 FOX (845)178.6085
Early laterventlon (845)279-014 Pruchoat (845) 278 -6082 Fax (US) 278.6648
ADDITION APPLICATInN FSMRMAL ONLY)
STREET 1�o�. gro °k TO�wN-��� /MAPA
NAME? /r�t/�D[I erye pHONF- PqS- -73q,a909 PCHD4
MAQ,ING ADDRESS -_9 S ._.. ��'Ii�;m U�ey. r �5 7 R
DESCRIPTION OF ADDITION Vey
NUMBER OF EXISTING BEDROOMS a PROPOSED 9 OF,BEDROOMS�_
(FROM CEPM OF OCCUPANCY OA
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. t
Please submit this form and the following to Putnam County Health Dept, 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified cheek or money order for $100.00..
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non- professional sketches are acceptable.
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
*Non- professional sketches are acceptable.
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known, Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling,
OFFXF VMR
Comments
F498
13Fhouseguldelints
9.,5 =d 621t792S6 :0l ti26)-- a2-soe iZlddK AINf109 WdNind :WOu SC :20 2002- 02 -6dW
t
BRUCE R. FOLEY
Public hialth Director
LORMA MOLINARI RN., M.S.N.
Aijaatate Public Realth Director
Director of Palied Servlces
DEPARTMENT OF HEALTH
l Geneva Road
Brewster, New York 10509
Envireamoatai }lcaith (545)278.6130 Fax(845)278 -7921
NuMag Setvieea (845) 776 - 6558 WIC (84S) 278 - 6678 Fax (845) 278 - 6085,
Early lnterventloo (645) 278.6014 8reaahool (&41)278-6082 Fax (843) 278.6648 '
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509,�/��
Re: f7
Residence
Tax Map
TownwTw e1
Gentlemen-
According to records maintained by the Town, the, above noted:dwi lng
iS • _. •
IS NOT
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIRCATE OF OCCUPANCY:
ASSESSOR$ RECORD:
OTFMk
i3fliouseguidelines
q, c; :A 62)_ b9 2c'6 : n 1
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