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HomeMy WebLinkAbout4029DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.65-2-33 BOX 31 Mow'] MAX Ii I +. ;, J:, ' jr..} - r Mow'] PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES g3,��-'p? -.�� PROPOSAL FOR SEWAGE TREATMENT SYSTEM, REPAIR YES Internal Use Only PER I'T -1i 77 " t-) ❑ Repair Permit issued in' last 5 years . VDOOI��ted Watershed Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �9 (�. �P.iS ► I TOWN '' Tv K"'' �% TM a OWNER'S NAME l ✓l C5,1 cAA19-e --',P PHONE MAILING ADDRESS 3cas- Lvr lg�t r+ (� -ce. 1 G•, APPLICANT Name & Relationship p.e., owner, tenant, nhractor) DATE S D1 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER `o Gp! �✓ Y I��cJ�1 Q /n/G PHONE # e yS 6G1 0-)-Z1'" ADDRESS 3 t���. Lnl Lam/ { f . REGISTRATION /LICENSE # Pe, .7037- /f,& 0.3 Proposal (Include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed profession depending on the nature and eidt t of th repair. /,V� Fl /1%C k) 'rep T C O `i• iN t' %/7 rctl� r s • C�G�z y 5/ I, as owner,agre7the d' " stet n thi , fomcY SIGNATURE TITLE �%� f� DATE I; the se' trinstaller, agree -t com ly'with a conditions of this permit fo( the septic system repair. SIGNATURE TITLE DATE (Installer) Proposal approved with the following conditions: 1. Procurement of any Town 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 feed 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 ft design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be ba77until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Q Proposal Denied ❑ In pector's Signature & Title ¢ r ratio Date Repair oroaosal is in comaliance with applicable odes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07;; t 6 l:` .. .•' ?�.-.. _ - � r�' - -- 'e ._ v' -. �:va°�:.,� -'�: d.'... .. . _ . �..:<+«+..— .d. ... ..`�i�:: s+ ....C.7:�`,- 'e:r�:.n., ..a` +"�'_, =.'i -a -�. ; . w+.r:.,: - =;: �%f::�: ` _,:�,.C.. w... "•0 "4� at-'- ,,-5 3�D P I -� At LmaL b-i ("ll I C-I PUTNAM"UOUNTY HEALTH'bLPARTM'ENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All information below must be fully completed prior to any scheduling SITE LOCATION 0- TOWN UA- P4TM # OWNER'S'NAME 6,9 PHONE # MAILING ADDRESS Q0 !9'- 1, A- PROPOSED CONTRACTOR /INSTALLER PHONE # ,-3 ADDRESS % -REGISTRATION /LICENSE# f0ff7f9 1//Q-L3 Reason for exploration: failure to surface 0 back-up in house K—find limits of system for repair 0 other (explain below) FOR COUNTY USE ONLY A41e?e j-c o4 iP r 3 -3&A-,o w5 /,ev o&, a:,,L 7,-w -Ir 40 1�4 '5411i-Oeev Sig Appointment Date: kly: excel: septic X41 Time.: Dfate P MEMORY TRANSMISSION REPORT Tii+' �t =ilo' °20=ri G927;tni - - ; TEL NUMBER 8452787921 NAK ENVIRONMENTAL HEALTH FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER 125 125 SEP -06 09:25AM 85280781 001 SEP -06 09:26AM SEP -06 09:26AM 001 OK * ** SUCCESSFUL TX NOT ICE * ** PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 3.l05" a -.33 L^7 / LuI Ropalr Parrnlc /sates M last S ya9rs U In waiaranao Repair —IMIn anyd's Carww". W. t9rar�eh rF C/Otnn Fails Ras - ®Ie9ataC1 O Fl. air within 200 TL ar a wataroo .tss w OECr...aooaa wauarw O ,Joint Review SITE LOCATION OWNER'S NAME MAILING AOORESS APPLICANT 409 a..-, . 6'> A" / PHONE a JP g' /03- f � / Y Y • ��^ FACILrTY TYPE �'i� ��°"` PCHC COMPLAINT J! GATE �_ • -- - - r+�r,�r�rns�c> cw_s•s.aLL�iz- .. �'mG� / 6 ✓� � /�.••.,�.•..•,�� .��PHan+�eai s°Y.�66/ O� -�t-- • ADDRE88 '�- �'�+.0 � L.✓�Co9'>�_:'� -ict L' -!%9s° FtEGi'.3':i-wTivN:Li: iERS`.'t�di p�3�:,.r'-- � J's�:� - _ Proposal (Inaluda a separate altetclt locating ttte itousa. property iinao. all ad)aaenit wells wMilrt 200 iqe oT repair and One lacagorr of eziating and proper SYStam) NOTE: The r3apertment may require submittal of proposal from licensed professional depending on the nature and extent of tno repair. 1. as owner.agre , to the sta this form �e SIGNATURE �� TITL.E (f)WR eJ'�. DATE (owner 1. the sepV Iler. ag ccrll ly with /Aha - conditions of this permit for the septic system repair SIGNATURE �i� %� TITLE,�6 ��a ✓-� __ QATE �`�� / 9 pnamw""ll �•.+ mil a��..sd witlh y.a follow = conditions: 1 . Pro�anarrlarrt of an, Town Pe.rh. H .,-Cmbia. 2. Submission W as built repair aketoh by the septic system installer within 00 Clays of the repair, in dupftoata shotMr a: a. Owner's narta. She Street Name. Town end Tax Map Harbor b. LoCatlon W Installed components fled to two 11bead point= c. Systar description (e_g.. 1260 gal. Concrete eeptio tank. atc-) d. InatallsmW name and phone number 3. System repair to be performed in accordance vAM the above proposal and coroOMons 4. Tha proposal SST8 repair IS consldared a bast fit design and meta Is no gunruntae W the tlurntion at which the aorX90tad SS-1`3 rapair will function - 6. "a, comploted work Is to be b kctcHltqj*-onttl authorlration to d0 so has bean obtained from the Otepartrnart. Approved Proposal Denied a • � COPIES: PCHO:Owner. Installer PG-RP 99ML Rev. 2/07 -S.7� �- ul UF LfN qq 30 Ot coo C:--j C-4 �wl Pt ir Aw lot jo �•.o i£aa.�c'��. r°"�a „�'. t �,t'- .arm;"'• c4i'i- a.:-= +.:irvsr�ao�^err°• bn =,..,: am.• stv ICA j TS � ... �' �, r i � A' Y" • �' w t .�t ,� � P' ��, l�. , 'fin 4'y � � �'�r ��. S i% VF r � w 4 49/08/2 9/08/2011 L�9•m91 ^' 4�ro- ..•ACS• —.P •�•.m .c•G --c '. - vin ^? _ y�,F,�, - ti V77. L. Q ki 2 d -AO IN3Wl8bWGa AiNrM WUNIFid: 3WbN q,1 /l,':' ftos..LAI , 7 aaS:,- 9002-9-13S,3-dM i. E: 'd ---0 IN34161jid30 AjNrM Wb"jrjd:3&q• T26L7EV-2-GbQ:131 St, . :0 9002-9-135 5 o T. Bar ppr p %. 4 sfcv -7 1. 61 PuTNAm COUNTY DEPARTMENT OF HEA13H HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY. BEDROOMS I-HS 71710C. (below AlIllovi) Signature & Me Dam II 1p ilk 0:. y K % 2. IL S. C. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health , d LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 7, 2006 Paul Goldenberg Jan Calman 305 Lake Drive Lake Peekskill, New York 10537 Re: Dear Mr. Goldenberg & Ms. Calman: ROBERT J. BONDIt.. County Executive ROBERT MORRIS, PE Director of Environmental Health Addition Approval — Goldenberg & Calman No Increase in Number of Bedrooms 305 Lake Drive, (T)PV, TM# 83.65 -2 -33 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 September 7, 2006. - The addition is approved with the following conditions: The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, .and its expansion area,.must be _..' - ... .. � .lfidinCdliied. ._...... ._ _..n,. .. ...... _:_ _. = - -.._ ,.. .v .... .,......_ ..._.......... " � .. _.._... _ : ...._..._ . _ , 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets; etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. 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, Mike Luke Public Health Sanitarian ML:cj cc: B.I. (T)Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 w zc 01. A r a �° ��; I kot PF IA #A P, �/ r for &a, %-ZAP 61 t4 IN C4 1h N N bN 'b a 4 1 ck 60 t) (b %lb SHERLITA AMLER, MD, MS, FAAP Commissioner of Health � ' -G V i�7d'i'Y"t�►'Si'l V�i'.li \l�1li� RI�1� ivl�Sl i� . • • u � � �'`•~ • .. , ROBERT I BONDI County Executive Associate Commissioner of Health DEPARTMENT 'OF HEALT i S Geneva Road, Brewster, New York 10509 ADDITION APPLICATION STREET 3o5 LA kC .D2+ vE W IV A-M 1._ TOWN PuT'WAAA VALLC . TAX MAP# 03,'�S NAME 4ol. >GtJ06(24 I CALMAO PHONE � 4 528 44pj-3 PCHD# -- O MAILING ADDRESS 565 LQjegr D62W15, L'A1 -6 PCE(05(e-(LL- 1J -Y- 105" DESCRIPTION OF ADDITION Pevv 15x-10 M>r>moN Tv. K(,re—"Go 4 670r(zy NUMBER OF EXISTING BEDROOMS PROPOSED #. OF BEDROOMS 3 (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., 1 Geneva Rd, BrewEt r., :NY 10509, Phone: (845) 278- 61.30. .fl. Certified check or money order for $100.00. „/2. Sketches of existing floor plan (drawn to scale, all living area including basement) 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 locations 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 Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6I30 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 -7 ,0-1L VL L.1 I SKERLITA AMLER, MD, MS, FAAP , Commissioner of Health LORETTA MOUNAK RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count ROBERT J. BONDI County Executive Re:fiLut-4oL-pc-t3i3Etz414"6AL.m&il (Owner's Name) Tax Map #: e'5 - & 9- S - '5 3, Address: -*305 LAW-E D2tvGb (-Aie-g: pCElGSictLty Town: L%-rtjAA&- VALLC--Y, Kj'y Year Built: 1'7) 5 0 According- to records maintained by the Town, the above noted dwelling, i�'nce W. -.1n.corf1p ' 1011-Tovni QQdq- is not in compliance with Town Code. The Legal Bedroom Count is: 3 This information has been obtained from: Certificate of Occupancy: Other. "ULDG- --'bEP4-, 'TILE- 3) _PL.AQS -61 1114 Building Inspector Date Environmental Healtb (845) 278-6130 Fax (845) 278-7921 '210 4442 Far Mil 77R-6q 26 WIC (845) 278-6678 c - r IV ig r4 a M 07 JOIN r4y 0,0 I'll j.'00.V9 u rt ti cp r If ;p s M S r4 '-1-1 t-A S-A 0 9 a 0.7111-:� %.2L 14 9 21 0 s r447 1.1 v 0 's I I d. w. if A SP o C4 (dvvr) � 100,55 �l f . IA jL. -,j 94 Jtt rA "Ov So) A t;-rS lXXTtOP5­70 om 95 1 D'50'46% a Fj:*Il D-0. WASJ�� �C'4' L: A I& 0. P P, is 14 J.. w vj v 9zAw:W--- PY,, 57 (' 9- :144) '-;44 -0. 1 &4(, _�O-V.w *4 _-v a t I s' Ne n v v a•- .o n+ I I 1 - n lfAW ILIT61aI;µ ffwF I 'blNil -14 I sue"' �yl G oVCM �. - - -- pry• I I e c G II 'I c BEDRMd2 '3ED2Md3 GI V I N4 PUTNAM COUNTY DEPARTMENT OF HiEOM HAUSE PLANS APPROVED FOR BEDROOM COUNT ONLY: — - – -- 3 BEDROOMS E x I. S. T. I N 4 . D E G le- 91fnabn Tift Date - a ui t= ar M .as . 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