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Home My WebLink About4116DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.73 -2 -12 BOX 31 ar :;:i. `I No 'l I roo I SIMI I IN &or 1 6 - _, t r x�' 61l `ti No do 0 momm 6m UL 04116 SITE LOCATION-j' OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT._ _ DIVISION OF ENVIRONMENTAL -HEALTH SERVICES - -- - - -- - PROPOSAL"FOR SEWAGE y1SPO-SAL*SYSTEM IEPAI _ OFFICIAL USE ONLY PERSON INTERVIEWED Q► 2 n 6- ea o PCHD Complaint # I I ame & Kelationstup i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER P,,r j rz�; o C� EgC ra is K nG'+ PHONE ADDRESS 3 & Lnc6 o,,4 REGISTRATION# -M D 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. I, as ov.,ner, o eported age t of owner agree to the conditions stated on this form. SIGNATURE TITLE 1 rA3R (a f)P� 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 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 DATE f 1 j j 4 4 F- ,.4 1 averse r4 N • ; a • 9 �i .,e p 'P t Homeowner: Diane Can 78 Traverse Road Lake Peekskill, 10537 (845) 528 -0169 Town of Putnam Valley Tax Map Number: 83.73 -2 -12 Ihmcription of Repair to System: Installation of 3 Infiltrators wlGravel Instaver: Philip Leonforte Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 FEB 14,2005 01:36P 84573605"71 PTJTNAM COUNTY HEALTH DEPARTMENT }10NISION' blit- i V i `riNENTAt HEALTX SSMC ^ ," -� . page 1 �> ONLY SITE LOCA OWNER'S l MAILING `A PERSON' INTERVIEWED n 0— PCHD Complaint # NOW suons Z1 -e., awner, t,• etc. DATE . _ TYPE.FACILTTY .� PROPOSED INSTALLER) �q PHONE ADDRESS —3 ST�RATION# PropQW (include sketch locating all adjacent wells): NOTE: Repair must be in . 4mg location and dif same type as onginei sewage dispose) system .Different location may require submittal of proposal from tticensed professional ectgineer or registered architect. � t2 -ao -os 1 I, as owner, o eporied age to owner/ agree to the conditions stated',on this form. ......_..:.. ...S�Gr!n'r[1r.�� - r _,�iT`i.i >• i ('�yO�a�r� f�E?�". .UAT. A: .-. ....... .. ,., ..- . _ Pro proved with the'foik : ng' contliii6i 1. Frociirerrient of any`fiown permit, Itapplicable: 2. 'Submission of as built repair sketch in duplicate showing: a Owner's n' ame 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 abb�re proposal and conditions. Proposal appimv Inspector's Signaturc & Title DATE COPIES: White (PCHDI Yellow (To" BI); Pink (applicant) . PC -RP 9910. FEB -14 -2005 .11ON 14: fD N al m (A now N O O DJwD (• { o � - _ �doa1r311,105�7 , •- w Ilm vim,. . TIM moo Ntmibcr: 83.73 -2-12 :. of spak to Vie; Phinp . -es; ... - a�n = Rocb�i Inc, . NY 10624, • [1 i_"S) 71 co .p I 'j it fD N c (- averse i t 6 �•" Diane 78 Traverse Road Lake Peekskill, 10537 (845) 528-0169 Town of Puwam Valley Tax Map Number: 83.73 -2 -12 Description ion of Repair to System: Installation of 3 Infiltrators w /Gravel lastaUer. Philip Leonforte Pwcisioa.Excavating Inc. 3 Rochambeau Road Gwrison, NY 10524 (645) 736.0571 a: tT Qhz /05 e. Q Public Health Director 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 June 7, 1999 Amy Klein 78 Traverse Rd. Lake Peekskill NY 10537 Re: Addition - Klein- Traverse Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.73 -2 -12 Dear Ms. Klein: 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 June 7, 1999. 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 main m!nsd: 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 a• C . p Mr. William Hedges Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 RE: Attic Expansion 78 Traverse Road, Lake Peekskill Tax Map 83.73 -2 -12 r Y,: "yr .:.f .. ... .Y. y.. "ar4 ^t� . +'�v; r� -.y:.r .j.:. .. • ... Amy L. Klein 78 Traverse Road Lake Peekskill, New York 10537 May 20, 1999 Dear Mr. Hedges: Enclosed please find a copy of my survey, the bedroom count form, a copy of the existing layout (for main floor and attic) and 2 copies of the proposed plans for each floor (main and attic). Also enclosed is a money order for the $100.00 fee. What we are proposing to do is to eliminate the bedroom on the main level to create a living room/dining area and convert the attic space to a bedroom. If possible, would you kindly fax a copy of your decision to my office (914) 528 -2566 as we are trying to get on the Putnam Valley Zoning Board's June agenda. You can contact me either at work (914) 528 -4410 or at home (914) 526 -4367 if you have any questions or need any further information. Your work on this matter is greatly appreciated. Thank you very much. Sincerely, aw)Q, AMY L. KLEIN 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 Re: -�11tJ Residence Tax Map Town ?w�jaw BRUCE R. FOLEY, R.S: Acting Public Health Director Gentlemen: According to records maintained by the To`Nm, the above noted dwelling IS IS NOT in compliance Nvith Town code and the total number of bedrooms on record is o This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: ✓ �1" 9� OTHER ro Building Inspector , . , PUTNAIVI COUNTY DEPARTMENT OF HEALTH z Z DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project 7 1 frvv1f�< (T)(V) �(/ TM# Year of Construction Size of Parcel I SECTION-B.' OPOGRAPHY (Please check all appropriate boxes) 1. lly ❑RoWng ntt�e p Slope LamG entle Slop e ❑ lat 2. ❑Evidence of wetland ID -ow area subject to flooding ❑Bodies of water ❑Drainage ditches Rock outcrop YES LQ 3 P roperty lines i evident? ❑ 1 4. Water courses exist on, or adjacent to par 5. Existing individual wells within. 200ft of the existing SSTS? L� ❑ SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) I.- Physical character of existing SSTS area. . A. []Level Ge;Moderately Sloe teep slope B. []Well drained well drained ❑Somewhat poorly drained ❑Poorly drained 1 C. Area/a4ailable for SSTS. (Primary & Reserve) Extremely limited []Somewhat limited ❑Adequate ft x ft 0 D. INSP Inspector CTION Date Ins . P No ex-idence of failure ❑Evidence of failure ®Evidence of seasonal failure (Indicate No �r �I N Gl 3 ' (1) Indicate location of SSTS s�i� I" --------------------------- - - - - -- - - - - - -- A. Size and type of septic tank gallons Metal MConcrete Plastic 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 OPWS []Shared well Ofn-dividual well OMug ®Casing a above ground COMMENTS:� REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: EXts47*tj) pace HOOK Plate. x Is. s Space 4 t 2 2 -x Cl'. T spac.c J d cp q� pe. pul-�NiXql DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; � 1 w BEDROOMS J w Signature & Title Date N 1 _-u dose I c lose-+ Slearoorn- y . 10. cl so. h g5.6 KI� Chexi 01, 11' b'' ,c q c)v- 9 ina Floor plan e�14*03 yy r y� .I �: , .. _. .. -' ,� .- e ._ 3 -..._ .w. �.. e ..- ..�.•�`,T . � ... -. o. •be ...� . -. - . .. w ., a .. .. -: •i. — : i ++...,.. i, ..ww -w., n...o.•- S /06•/O' 1l Y F >rt - . qtr• .. S �. . v, - ... Lh CO 4 g �m `io C.,f VJ'G D �' � -- " 45ph.�Co�c,i ,CU 0 � r b_ I Y t LOT 43 6 C•