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Home My WebLink About4124DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.74 -1 -4 BOX 32 04124 ., ei1j 1 Lif ' I 04124 PUl'NAM OOUNTY HEALTH DEPARTMENT DIVJSION OF ENVIRONMENTAL HEALTH SERVICES y PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR X CSR' S NAME ! ' ; C" k %✓' J H °\ h S /,0 ✓ PHONE SITE LOCATION l po " w f d w; Ve- S D TM# . sZ?-V/-7 5 MAILING ADDRESS 1- !� P k5 I: 1 ) / o E � .J PERSON INTERVIEWED PM Ca gAaint # Name & Relationship (i.e, owner tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER 6 &I tA � � � `�.'' , G � h� � PHONE 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 suhnittal of proposal from licensed professional engineer or registered architect. Proposal approved -'I'— I Proposal Disapproved Inspector's Signature & Title L 1 , (-TJ pt� _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 cmWnents 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, reported agent of owner agree to the above conditions. SIGNATURE TITLE CP16: Vbite (MD); YAlc w (Tan ED; Pink (.k#1a nt) p �`-7 4 Sc Proposal approved -'I'— I Proposal Disapproved Inspector's Signature & Title L 1 , (-TJ pt� _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 cmWnents 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, reported agent of owner agree to the above conditions. SIGNATURE TITLE CP16: Vbite (MD); YAlc w (Tan ED; Pink (.k#1a nt) 7r, Sf jl�j BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva . Road . Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. - Associate Public Health Director Director of Patient Services 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 September 7, 1999 Cyran Hausler 11 Point Dr. South Lake Peekskill, NY Re: Addition- Hausler - Point Dr. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 83.74 -1 -4 Dear Mr. Hausler: 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 September 7, 1999 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Two without prior approval by tHs depar<meut. . .. . 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Vallev. If you have any questions, please contact me at your convenience. Very truly yours _ William Hedges WH:kg Senior Public Health Sanitarian cc:BI .. P DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 BRUCE R. _,FO - - ` PubW Health Director PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) STREET' cat J ' . �,c) TOWN _E&hLjX MAP #, r � 7 /V — NAME ' pu PHONEQN. S'10- 39 /,9CHD # MAILING ADDRESS—! ( pot (oj'a iL �` c) t._ �7 Y K..Sk c I I DESCRIPTION OF ADDITION 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 the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva -Rd., Brewster, NY 10509, Phone 278 -6130. �ertified 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 �VllilllVl �✓ Oh �-K %� T l 'dl t Feb 98 V a 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: ,,Z 7V 1 Residence Tax Map Town BRUCE R. FOLEY, R.S. Acting Public .Health Director Gentlemen: According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is 02 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Building Inspector A . P rv-- ;� �1 Ir y YC Ol LJ. # 64 6 07, • �,5,_i� ll� C.) q ��. ��, C�, s ,� s rv-- ;� �1 Ir y YC Ol LJ. # 64 6 07, • �,5,_i� ll� C.) q ��. ��, C�, s ,� �o s. 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