The URL can be used to link to this page

Home My WebLink About3856DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -41 BOX 30 ki I 0. I �� ■ 'r . I '. K tvY SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY yam- a=a n') --, . . PERSON INTERVIEWED Q1JA9'e*t PCHD Complaint # Name & Rehit-ionship (i.e., owner, tenant, etc. DATE 'S / Z Z f TYPE FACILITY PROPOSED INSTALLER —X,C ADDRESS REGISTRATION# 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. f owner,-- r- rtcd agent oP o_ per agree to tie condi ions stated on this foran. SIGNA Z� TITLE d w 13 DA.TE � 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 performed in accordance with the above proposal and conditions. Proposal approve' Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE --7 , - /" _ i /,,I / C / ... � .^ O• ' -C' . , e. ' .• ..y;. ..r C✓ T - K r`: —: � �.. « . r. K n �..: �ti. t.. R ' -✓.. . , e. .. . ^tC. -� .'_C� �r(y_ _ i'.� � -t �.. . ♦N� .r... v ,rte .- BPF:J�'Z-.•P.,,, _{iuBX: Public Health Director ,: -;� .:m LL? TTA..11ffl1,1R1A3tI FX, M.&N._: , Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road 'Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (9 14) 278 - 6648 October 26, 1999 Joseph & Donna Verra 57 Orchard Rd. Putnam Valley NY 10579 Re: Addition- Verra - Orchard Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.12 -3 -41 Dear Mr. & Mrs. Verra: 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 October 25. 1999 The addition is approved with the follow_ ing 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_:. .� ....�.. w . _._ :maintained:`�,....__.z ..., 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:kg Public Health Technician CC:BI addition a e. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLYI Public Health Director STREET,) C`l`C y 1 /� ,2P TOWN Z-Wkm �, MAP N IJb� ONE <" Z2K'�P HD # MAILING ADDRESS S� ��c=t �i�'1 7 PJT_&,-AA dVALS:��j DESCRIPTION OF ADDITION9S( 0.. Sc- 2��t"� �k7�c�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 *he-Putna-n Co�.Int -y Sanitary Cod..; 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 k . is DEPARTMENT 01: FILALTH Division 01. I'livir0l)MCIA,11 I-Ical.1,11 ServiCcS 11 GCIlCV1 UrCWSLCF, New York- -10509 (91-0 278-6'130 UIIUCL It. FOLLY, 11 S. AclinU Public Iloalth J.),i .,: I'Llula►ll County IDCp1. of Health 4 Gcneva Road Drmstcr, NY 10509 RcsidClIcc Tax Map r63, ell, GcnLicnicn: -Accol,c].kir, to records mainialud by IhCf'own, thc above. noted dwdling! Is IS NOT in complialicc, with Town code and the total number of bedrooms on record Is— This Information has been obtained from: CERTIFI.CATE OF OCCUPANCY: )/ ASSESSORS RECORD: L/ OTHER e�413uildim, Inspect STONE w. ' � • ..... .......... /270.30'......... •• . 11� uH.CHARD ROAD srAXE j S. 66 °.�c� "6 X0.00' sry�re o � �� I n o ttu, •p 0 0 t 26.00' vooc 25.87' L3 i 6' /q. 8 7 . \1 ti 2. o' i s roR✓ .'ppo' FRAME ABC, HovsE r 25.86 gQ 25:96' J V W N � Y � SURVEYED & PREPARED BY BUNNEY ASSOCIATES ENGINEERS &.SURVEYORS 4TONAH AVE, 929 MAIN STREET NEW YORK 10536 PEEKSKILL, NEW YORK 10566 ,iI •• .._ _..I _� � � �� -�r- -! coo -- - - — - -- - ! � -- ,- - __ owe! L-- L IL 7TI i L r)A A (Z I C5 I f All All P�oPa:D PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project 5 Or J'01J JO Year of Construction Size of Parcel SECTION B: TOPOGRAPHY (Please check all appropriate boxes) I. ❑Hilly ❑Rolling ❑Steep Slope 1 ANentle Slope (A lat 2. ❑Evidence of wetland ❑Low area subject to flooding ❑Bodies of water.; ❑Drainage ditches Mock outcrop YES NO �., Property lines evident? 4. Water courses exist on, or adjacent to parcel: ❑ Lam" S. Existing individual wells within 200ft of the existing SSTS? ❑ U� SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. ❑Level U Gentle Slope ❑ Steep slope B. ❑Well drained nM derately well drained ❑Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited ❑Somewhat limited Mdequate _ft x ft n . . b D. IMPECTION Date Inspector L4 \o exidence of failure ®Evidence of failure OENidence of seasonal failure ---=---------------------------------------------- - - - - -- ------- - - - - -- --- - - - - -- ---- - - - - -- (Indicate North) 7 c� En N HOUSE � 1 VA* ----------------------------------- - - ------------------ -- --------------------------------------- (1) Indicate location of SSTS A. Size and type of septic tank gallons - ClMeW OConcrete CIPlastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams/wetlands) SECTION,E. EXISTING WATER SUPPLY WAIS [1hared well ❑Individual well ❑ Clucy . OCasing, above ground CONi DENTS : REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: