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HomeMy WebLinkAbout3862DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -47 BOX 30 03862 i a T ,� I,y1. 7 �$ r�, , 1 , } � . r br: - � i )VO r 03862 w =;. v'P.LrTGE Public Health Director . -- ..... i.nR_E'I"I'A•::M�L..TN_QR�I -- R ?J., �t�.S.T ?..: , . _. 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 May 25, 1999 Barbara & Adam DeMey 12 Edwin Road Putnam Valley, NY 10579 Re: Addition - DeMay, Edwin Road No Increase in Number of Bedrooms (T) TM #83- 12 -3 -47 Dear Mr. & Mrs. DeMey: 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 latest revision date of May 21, 1999 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: T. e Qtay- nuritber of uedre-oms must re,!laix_ at three. wsthou! prior approval_by tliis 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. Approval is granted for sewage disposal only. 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. ML.jp cc: BI (T) Putnam Valley Very truly yours Michael Luke Public Health Technician �.�� :-vii � . ,=Ac ' o .- .. .. . -.. ••u_ _ r ... � -rc- _ sl��l 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 ONLY) ulilic Health Director' STREET 2d 1 J I n Zad TOWN P4. VO j lei TX MAP #, 093 " d�a7 ° L � ' Oq 7 -- da �{ n�ss c�vo a NAME �(&M h A&M C.,,telPl HONE �' CHD # — MAILING ADDRESS 1 9 105 1 NUMBER OF EXISTING BEDROOMS J 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., a ~ 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 Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 se, "V Re: Residence Tax Map / Town A L) BRUCE R. FOLEY, R.S. Acting Public Health Director Gentlemen: According to records maintained by the To%vn, the above noted dwelling IS IS NOT in compliance Nvith ToNNm code and the total number of bedrooms on record is 3 °1 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER��i E �:Sk'GcTi� �•�inl9 y Building Inspector f----- -- - - -- / °I l . 1 \ o s 0 T ' to o 4 ;r.. t e, 0000— _Gho..� ©4-.. �tQ -Ega a`i f�v ri Ali a� /► w�r+'f'�# �° r✓;'C' (�� Z I w (Y Mai C.Y ---------- ), 79 �s O 1. /Y,Ak 0 ............. C5 f -A -16 0 CKE'A OF H HOUSE PLANS APIPRO'VED FOR BEDR001M COUNT OND', BEDROOMS 2,14 Signature & Title POP 05/21/1999 13:11 9145281822 a 430vwo � d h CROSSROADS PHARMACY PAGE 02 rid 2�� q Qm o Ti v a Oil, wok Q F VC Ny1 6 �. 9. Tv .o �nmjv , PUTNAPA COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; 3 BEDfsJMWIS' rt aH7- s'l2 1 i% 9 Signature & Title Date � s � rn I � d h CROSSROADS PHARMACY PAGE 02 rid 2�� q Qm o Ti v a Oil, wok Q F VC Ny1 6 �. 9. Tv .o �nmjv , PUTNAPA COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; 3 BEDfsJMWIS' rt aH7- s'l2 1 i% 9 Signature & Title Date PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES, , PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR WE OFFICIAL USE ONLY SITE LOCATION /c� U W1 Al n9 TM# ear / v2 ° 3 — 6 OWNER'S NAME !:T-512,64 C., In ® L. Z-0 PHONE Sag' °-- 3 9S1 MAILING ADDRESS f v'TrNerP1 f I A CUG-1 tL .-Y • 105-7f PERSON INTERVIEWED PCHD Complaint #, ame & Relationship i.e., owner, tenant, etc. DATE .i TYPE FACILITY /�- ,oa�/.Y PROPOSED ZALLER aS C, ADDRESS P,, Inc PHONE TRATION# F (71- 13 Lf If 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. 'R Le (7- - 62 Cps rn - 'S A-r-k- E f4YL 19 L to r-A Tro iy If rr JV6 ro®0CAC- C0- /VC"7s-r 04"V Elf l X - i.✓r4- T f_2 I, as owner, reported agent of owner, agree to the conditions stated on this form. SIGNA TITLE A,4 % _ DATE ,y f 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 comers). 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 approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML ATE � aA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFOR,yMATION Name of Project i 2 ��Q �''^ r T V V TM# Year of Construction Size of Parcel SECTION .* TOPOGRAPHY (Please check all appropriate boxes) 1. ❑Hilly LJRolling ❑Steep Slope Mentle Slope OFlat 2. ❑Evidence of wetland ❑Low area subject to flooding ❑Bodies of water ❑Drainage ditches ❑Rock outcrop YES NO 3. Property lines evident? 4. Water courses exist on, or adjacent to parcel: U t 5. Existing ndividual wells within 200ft of the existing SSTS? ❑ g .. SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. []Level* (71/ Gentle SloP e ❑Stee slope e B. ❑Well drained L/derately well drained ❑Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) .( ❑Extremely limited L'�J'Somewhat limited ❑Adequate ft x ft D. INSPECTION Date Inspector o evidence of failure Evidence of failure OEvidence of seasonal failure ---------=--=-=-----=-=---=-----------==---=-==-=-=---------- - - - - -- - - - - -- -- -- - -- - a i (Indicate North) r n _ HOUSE • 3� (1) Indicate location of SSTS A. Size and type of septic tank gallons 131%letal 11 Concrete [Ilastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks,'front street, backyard, and side yard dimensions TY` (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 0Shared well MIndividual well DDrilled ®Dug ®Casing above ground CMB ENTS : REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: Zso 85 . �.. 1 9 9 r 62 1 175.0o 46 s l ?10 s 1 1 35 ' 54.JI �3 3; 1 r40 1.02 AC. 47 Js /o 42 I e 1)0 0 . 69.30 F��RADgN S 48 se 62.6 J9 52.08 ra36Zg12 00 �` 1 � 160.00 49 50 19 51 sc 160 *- � 1� 69.30 6? 6 pJ � 5 0 56. 24 97 Go 19 17 $ 16 15 69' 3o IN, ?1 g 14 13 cn os 6 2.1 J6 6B e l i ' g 22 51, 1p 69 e L ARD 160 IJ • & g Z 3 ,9 a �B �2 �� 09 6J ' _ _ _ PO e _ 2 25 4s lop so 26 5 ( 8o 60 s. -50 r .4 °. �. 60 e0 rw" _ 10o ° ' . 6L a 6 co 56 i3 ' 8,o 8p _ 8- a. ° 0 45 80 54 ~ 44 JIB 80 80 V V eo 57 1s Cl 58 �� 160 so s/ o Jz1cS1 too CO 59 100 0 IJo 10o S 74 r 0.0 160 60 - . o eo 66 0 too 130 0 64 200 0 si 65 9 67 � g l zoo 68 1 ~ -- rpo.o 69 s