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HomeMy WebLinkAbout3874DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -71 BOX 30 03874 �T All ir _. 03874 PUTNAM COUNTY HEALTH DEPARTMENT ��M U+ DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` �� �� r e 6 SV PROPOSAL FOR SE1QAGE DISPOSAL SYSTEM REP OWNER'S NAME /Y-A074-o/4 y ©t CG� l�%%IG�4/ � � < < i PHCNE r Z 6 SITE I=TION �% %%i¢ T/�4[�f I�Wf lam- To 0- 3 C (. MAILING ADDRESS Pu—r�"�hti 'l it LC, �/ r hit'y • `71t' PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE I-- iif 6 TYPE FACILITY PROPOSED INSTALLER %� 4 �✓/' -� PHONE 2G ' a Sir' T 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. Proposal Disapproved 's Sianature & Title % c h -r _t to Re A C. Date 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 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 owner, o reported agent of owner agree to the above conditions. SIGNATURE S-� TITLE A 6 W"t t- i DATE OOM: W-dbe (M); Yellow (Tai HE); Pink (Applicant) BRUCE R FOLEY Public Health Director 4i•�p 7. LORETTA MOLINARI RN., M.S.N. Associate 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) 228 - 6108 Fax (845) 278 - 6648 May 21, 2001 Mr. & Mrs. Mascarelli 37 Dartmouth Rd. Putnam Valley NY Re: Addition - Mascarelli- Dartmouth Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.12-3 -71 Dear Mr. & Mrs. Mascarelli: - -- - -. - - -- -. _... -- ._..__..__. -- - -_... _ ----- 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 May 21, 2001 The addition is approved with the following conditions: 1, The total ,number of bedrooms must remain. at- Three without prior approval by_ this department. ........ - _....... 2 . "Tn°e-aiea oftheexiscing sewage -disposai-sy stein, aiid s-e�rrans o yea; -dust -tae: __o Y -_. _ maintained. _._-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 iequired 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: WH:kg cc: BI 4 Very truly youp,-� William Hedges Senior Public Health Sanitarian .. s a 'a LRI CE ;.R' Fo? F1' ...... -• :.,.v fyµa... ..ter.. -,♦ u f♦ .. i - Public Health Director .: �-:,,;.; ,:,�;.;}p�;'I'TA;• *vfO,T'.%'A.� R?'�c; F�I.S:ld•.. ..... Associate 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 �J� DP�r''. CMOC�-�� R�. TOWN Pte, 'MmV(,16 -y TX MAP# -) NAME "R'GC-A1PJ--- LL.i PHONE PCHD# U DESCRIPTION OF ADDITION V�.o F. L O O R Ab b`iZ' 101 NUMBER OF EXISTING BEDROOMS_ Z_­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. <.. �.......... ter.: ... .. .,. _.> .. -.. ..... : -o - ,.. -. �.. ..- _-.. ... - -. .. ... �"_.� -.- ..,.- ..,.___ .,. .,._.... -... ... .- .e . ♦... .. _.� . .. t_-�.. .e, ...., - .. 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 $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Khouseguidelines e � i Actinfl Public, l.lualth:Uur•r:t�r DEPARTMENT Of 1-ICALTI-1 Division Of Environmental I-Icalth Services 4 Geneva Road, Brewster, New. York 10509 (TIII) .2713 -6130 Putnam County Dcht. of Health 4 Gencva Road Brewster, NY 10509 32 1g1p 0lA7,Y Residence Tax Map Gentlemen: According to records ma,inliained. by the Town, the above noted dwelling IS NOT in comhlialice with Town code and thc.tolal number of bedrooms on record is This information has been obtained from: - CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER -5 f re ��'� t° c,�/ d .� aa�; 71 �L BUildintg Inspector ?TIFfED TO: AHII ony d Ab.-helle A42,5corelli sfom 7ille 5erv',^� C , Inc. �_s t . -urily Title A &,kironty Co. ­47s ­1� THE :IA1$*1-C, CODE 00 PRAC!10 Now 0 r t-ot-me S. - ;R.f,S ADOPIF:��I% THE "!*� 100E STAIF a110, �,F PROFESS16NA1l LANC -jUR%FVOPC LOnds oy tnG 7o-- of Volley ..Noc k•A.t Pu. ONLY TO lHO'; ­L­W-)AlC 5HO-1. —Cl.— ABOVt %4.,j CFP11FK.A11O"! ARE N(-T 0 Ivo • N.E. Corner A,,, =01, 17 d Florodon E.Sjoiej. Inc. Pa/c -A Z>AR7 -IOUTH ROAD Grave 's 66'3e ff, ioo. o6 Gravel b Parking I I I Q L " _j I 4Z) t Xj ii a LJ ,a c Z L. S:`Ory Poch House t,W FV AREA = 0.230AC. a% N C4 qu C. t zo nj P ti CD CJ C-3 C� CD C SURVEY OF PPOPER7 IV 6 w 100 S17UAT4F IN THE Now or Formerly TOWN OF PUTAIAM jj Florocon Estoies. %V r Formerly i-c a- .0, SCA L �6' SURVEYED b ;.FMPARED By UnOU1110MILd alteration at addition to a surwev BUNMEY A70SOCIATES map bearing 0 licensed land surveyory o' -S a vool0flon of Section 7202, sub-osvisiasn"i2 of LAND 5 OhVEYORS tne he- York Slats Education Lo- * MAL RcKrrE 82 FIELDS LANE The 10C4119011, Of UndgrgroUnd Improvements or k NORiK'SALEM NEW YORK 10560 entroach—nis, it any guisi.ors not corl.fied `Pr-oPvsa L 9 1 Z 164" •%i 16-4. PAK,AL o T deck • 3 -6 q b v 2 =4" 6 -0" x 6-8- co N Cu living room WA -6" -- '- 5 "� -2 =7" m T great room N O j i� _...... — - - drREng ro _ . om 0 T T 2- 6 "x6 -g" 29, 2" — FUTNAK COUNTY D ®F LowE-R LEVEL. HOUSE PLO$ APPROVED FOR BEDROOM COUNT ONLY; EDROOMs st Ouze & Tit16 Y 7z o� CO 4 ;closet closet x master bedroom N ' bedroom suite bathroom N _ 2 -6 "x6_8" _ _ -- 2'-6" x 6 =8" - - --- Ahallway 2'-6'x 6' -8" 2nd floor 1053 sq. ft. YU'PNAM COUNTY DEPARTMENT OF WIIR HOUSE PLANS A P ONLY; FOR BEDROOM COUNT EDROOMS ignature &T M4 .. .. . .S TJm /o, ric ocr- VICC4, -1L•• :ilriiy rifle d Gaoronty Co. •'.1pA ».. rn» 1.4 U671 »c coot O, ...cuo S'JY.t.< .00111? 11 1.1 »t. .0•. SI.lt At•Jw 01 t101f SS10M.1 L. »0 SUI. /YO.a 41A.1 .U» 0»I. 10 1M04i l'•I;vlAl• •• ^'Ir•• »S 3 »O.. r. »!I(ON 11.t1f1 1.11 '1111 1'••11N. 11 +. A10vf 4.{t c1•u1..A1.DW Att »t-1 Now or Forme_ y r- Londs or 11he Town or .°!.•rrnom Vo / /ey 1 } •' w /689.96• _ _ �> _ � ' ' • O ' ' S •s - _ _ 1 690• LO'OQ OCI. • •� - N•E. Comei o (Died) Hot -o nd F/OrOdort ESto>es. I!7c. od Pone 'k. ROAD 100.00 Grove /0 Po(•.'crrr9j >t O C . a Q 0 1 .l v rpC 10 V . 'O V t t �, ::r �a•aenm E � a ". `v aj =io�se %. Fv AREA = O.23OAG O'6 N b 3. o (r C j l h W �� 7-00 1 i 4 p COIYImun'1 �+�- .+....� u O L In 6 In W SURVEY OF RR OPERT y N ec'9B'fY 100 C1. S/TvArE /N TH5 Now or Former ly TOWN OF PUTAIAM VA f /Croaon CStoteS; _• ^C. Formerly .. ........ > .. .. 1 - . — Done/ Roder . • •• ..w .v. vq +....•.1.... .•.. SCALE • /' SURVEYED 6 PREPARED B• ' vlovtl.o•oed atLrtlhtll. a /Wa.non to 0 1vr.et .laa O.w-9 o I.o.n..d land .W...1w'. 1.0, BUNNEY ASSOCIATES o .'0101lm of Salon 7209, wb- 0,.1uon 2. of LAND SURVEYORS .n. ►w. Twl Stet. Ea.calm. L.. IRAL ROUTE i2 FIELDS LANE . 1n. loccom of 11na .rgloun0 lmwew.•..nt. d ' NORTH SALEM NEW YORK 1055�60 .neaoachmonts. ,1 any 6.111, we not Or/.l,.d l � � l ii 7PP A, L BS MTV DEC K t-A ITQ C-1 INitJCC L Rooms ENT 93 3 r. (o 5 3 s F+, Ia/ 06 >( I C) 0' f, LOT is - 'F- LOOPI PLAW