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HomeMy WebLinkAbout4186DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.80 -1 -1 BOX 32 rl wo Fri ,' :�.T I JL.. , '' 07/07/2010 JUL-OT-?.010 01:54 19737646404 ALLCOUNTY PAGE 02102 02:8aPM FROM- ENVIRONIENTAL HEALTH 8462787921 T -382 P.002/002 F -030 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PRCI AL �W,R.SEWAGE TREJ TMENT S- STEM_REPAIR Internal Use Only- PERMIT it JZ — 16 % /O ❑ • Repair Parana issued In NO 5 VMS ❑ Repair Bnyd'S Corner&. W. BMY=h Croton Falls Rog. Not in Watershod Debated wWn or IGt— ❑ Repair within 2170 fa, of a+ watem*urw or D wasand Q Joint Review SITE LOCATION .3 kf)CNERT SrkSET' TOWN �s Es,�ItL. NY. TM # $3 OWNER'S NAME C. A Ag L-- W o f— r � PHONE # ,B�S-6 z,'=3 99 MAILINQADDRESS 3 E c 14iEot 1` 57 4.Afff p_6A(Sk1441,,_, 114, -Y!_° APPLICANT �C.4 R 0,L W o 4. r- X p W W E X Yr -Name A Refariomhfp (.e.. owner, tenant, coralftWr) DATE 7 7.1 JQ FACILITY TYPE PCHD COMPLAWT # PROPOSED INSTALLER CA .QrH d AP E PHONE 0 1.90 o - i12 c`Gv'ti, � tLn; lca._ REGISTRaTIQN !I- ICENSE # — 9-B(o ADDRESS m A AL �1 Muff, ern�I (I ndude a soperate Sketch kidv irtg property lines, all edit weRs within 200 IM 91 repair and the loMort or existing and proposed system) NOTE: The Department may require subm ttai of proposai from licensed pmfesslanal depending on the naWM and extent of the repair. cv' ♦m z 4 z d 1, as owner,agree to the conditions stated on this form sir.NATum TITLE D ^f DATIA J p (ownw) I, the septic Installer, agree to aomply with the conditions of this permit for the sepfh: system repair SIGXATUR ��.. -- TITLE r .e'� DATE 17 -7- ;V>10 onstalle" , PECaesa! $22MOd with tbQ MIOM09 ao Man$ 1. Proctooment of any Town Permit, if applicaft. 2. Subrrtiasien of ae built nVWr aketch by the Septic syst, M WgOer within 3o days of tiw repair, in duplle t3 shmhg: a Owner's nerve, She Street Nam, Town atW Tax Map number 6, Location of installed compments tied to two fbted pains a Stmt description (e.g.. 1230 gal. Cb CMW septic tank, etc,) d. lnrs' name and phone number 3, Syaleta repair to be parkwmed in a3coordanc e with_the above proposal and condWons 4. The proposed $STS repair is comWared a hest fit d9sign and there is no guamrdge to ttte duration at which rite compieted Si9TS repair wig function. 5. No contpl W work W to be bacltfilted until as<udtoAWIon to do so has been obtained firom the Department. Approved L:" Proposal Denied Z/411 /o /oZ ~^ Date Etrnira n COPIES; PCHD : Owner: Installer PC-RP 99ML Rev. 2117 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Use Only PERMIT # IC-- /l `7 - l0 Li ,,XK- Repair Permit issued in last 5 years 29- Not in Watershed ❑ J4 Repair within Boyd's Comers, w. Branch or Croton Falls Res. Delegated ❑ i& Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION -3 f E�cNE�7 .STRCEr TOWN pg 1<,E Sl< /LG. Ny. TM # 8'3.8o - OWNER'S NAME CAROL- LJ o L FF PHONE # 84 5-52$ 3699 MAILING ADDRESS 3 QEICHERT -$T, L,AKc PC&E<SK /LL, N—Y, 10537 APPLICANT C,4 R d L W o L. F f- - O W r✓ £P, Name & Relationship (i.e., owner, tenant, contractor) DATE 7 7 /© FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER EARTH CARE- PHONE # Aa mRAtE ADDRESS REGISTRATION /LICENSE # �eg /d 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 professional depending on the nature and extent of the repair. I, as owner,agree to the conditions stated on this form l SIGNATURE -- TITLE DATE -7 /-1 ! o (ownar) ? - I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE DATE (Ins�ll� Proposal apwpy -ad with the follgmdl: q conditions: 1. Procurement of any Town Permit, if applicable. 2.. Submission of as bulk 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 Tau Map number b. Location of installed components bed to two fixed 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 fit design and there is no guarantee to the duration at which the completed SSTS repair will function. '5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. Proposal Approved 0' Proposal Denied ❑ 7/7//0 !;2- ZI Z o Inspector's Signature & Title Date' Expiration Date Re it 2rop2sal is in com lianoe with applicable codes Yes O No jg COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 07/07/2010 01:54 19737646404 ALLCOUNTY PAGE 01/02 flws1e-trawmitW- To. Gene Eanbcare•All County Division 99 Maple Grange Road Vernon, NJ 07462 800- 428.6166 973. 764 -6404 Fax Fax: 845- 278 -7921 From: Christina Wynne Date: 7/7/2010 Re; Wolff -3 Reichert Street Phges: 2 including cover CC: ❑ Urgent X For ReMew Q Please Comment , ❑ Please Reply ❑ Please Recycle • • • • Hello Gene, Please find the completed permit application with signature for Carol Wolff at 3 Reichert Street in Lake Peekskill, NY. Please advise if and when permit is approved. I can be reached at 500 -428- 6166 x 104 or cwynnc @eaTthcare,us Thank you very much, Sincerely, Christina Wynne EarthCare -Ali County Division Customer Service/Installation & Repairs 973- 764 -6100 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 FAX COVER SHEET Date: 7 Z 7 // D To: d:.47:'r N 0-,4 izC Imo'- (dz© Z F From: Gene D. Reed Putnam County Department of Health ZFor our y information For your review As'discussed ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Fax #: ? 7 3 7a / - No. Pages: z (including cover sheet) Please respond Attached as requested Please call Notes /Messages �1�a5,e *i // a y � —:'"n s A-'- !/ t r1 -- I S !) -,- In the event of transmission /reception difficulties please contact this office at (845) 278 -6130, ext. 2261 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 Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SEPTIC PUMPING - REPAIRS - INSTALLATION Site Address Name: Address: Home Phone: Cross Street: County: Twp. Work Phone: Map Coord Site: Wk Order: Date: Billina Address Name: Address: City /State: Home Phone: Work Phone: Zip: Cell Phone:. Payment: Check # :�Z t-� Credit Card: Amex ❑ Discover ❑ MasterCard ❑ Visa ❑ Oth,?- Card #: Septic System Evaluation & Proposed Action SYSTEM 1 O: Tank Type: Conc etal ❑ Plastic ❑rCess ❑ Tank Size: Shape: Depth to Top: to Access: Drainage System: Field ❑ Trench ❑ Pits AD ❑ Other / Dousing Tank / Pump: Yes ❑ No CONDITION Yes No 'Suggest Aeration Qperating Level OK bove elow f Draineld Run Back Yes o" Yes No Suggest Tank Replacement Heavy Sludge Yes Lo? System Saturated Yes Suggest Riser Toilet Flushed Yes No Outlet Baffle oo Bad Inlet Baffle _ Good •• Bad Clogged Ing E Outl `: s ; - ,,; No 'Comments/Notes Customer's Signature. f Driver's Signature Customer Disclosure: in the event of payment delinquency, EARTHCARE is a consumer reporting company, In accordance with the Fair Debt Reporting and Fair Debt Collection Practices. Reasonable costs associated with the collection of past due or delinquent accounts are the full responsibility of the customer. EARTHCARE, All County Division, will not assume responsibility for damage to driveway or any off road damage. Exp. Date: RECOMMENDATIONS: Recommend Additive Yes No 'Suggest Aeration Yes . No ' Suggest Outlet Cleaning Yes No %ggest Inlet Cleaning Yes No Suggest Tank Replacement Yes No Suggest Lid Replacement Yes No Suggest Riser Yes No Suggest Reg Maintenance Yes No Next Date: CLEANING: Sept Gres Lch Sldg FIELD SP 6 9 Digging /Labor Gal Cleaned Line Inlet Outlet Treatment' Cover /Lid Baffle Truck Charge Miscellaneous r EMERGENCY CHARGE Billing Address EarthCare -All County Div. 99 Maple Grange Road Vernon, NJ 07462 EC103707 -2 d� ZC I - (5,- —0 Sub Total Tax 7 Total Amt Paid 6l. A x `BRUCE 'K - "FOLLY' Public Health Director Y LORETTk IV amARI' tb ., 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 August 12, 1999 Carol Wolff 3 Reichert Street Putnam Valley NY Re: Addition- Wolff - Reichert Street No Increases in Number of Bedrooms (T) Putnam Valley Tax 9 83.80 -1 -1 Dear Ms. Wolff: 91.24 -1 -14 I have received and reviewed the plans for the Replacement of the Residence destroyed by Fire .:on June 4, 1999. The proposal for the Replacement has been approved as per plans. bearing the approval stamp form this Department dated August 12, 1999 .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. 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 Valle If you have any questions, please contact me at your convenience. Very tru�y--yours, William Hedges WH:kg Senior Public Health Sanitarian cc: BI .. - -- __-c' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fai (914) 278-7921 Date: l z BRUCE ' R. F_ OLEY - Publ#c' °hfealtlt Director ' To: �iG �'�/ �G� Fax # `� '5- / s No. Pages (Including cover sheet) . From:' Putnam County Environmental, Health Notes/Messages AS e7 In the event of transmission/reception difficulties, please contact this office. 8 -11 -1999 1:36PM FROM LAKELANDLUMBER 2451451 P_2 s .1 ._ a - ,.. t':♦ _. r, r. en. ;: 'mil ..fin» r s- ... . '.• 1.. a _ � �_ ♦ •. _ .. .: t Q9 t Q9 1 s — '-- 04Rb1�tYMARtE�AGN(iIV- -• -- - .___..._ Public, Slate of New York R on o. Comm on Expires June g -11 -1999 1.37PM FROM LAKELANDLUMBER 2451451 4 1 i s P. 4 v • O 3 8*-6 91 - BEDROOM 43 >= aas u I � � a 1. K17cf4c 1 DININri RWM o � � 4 - LiVING ROON ' �¢ ' • POYER ?r -e• x ar -s• 945 Sf 4 sr :o .I•. — .b -- — — — -- _ LINTY DEPARTMENT OF MUP ,LANS APPROVED FOR BEDROOM COUNT ONLY; .- ,.BEDROOMS Signature &Title ..w ,........_..._ ._,t9�$o► to a: r \• I a N J M I T Zi5 � I I LO 4 9 y 1 1 } � � 1 : ' , TO/ I N OF YALL EY BUNNEY ASSOCIATES �?o Tie, ,F•F, C041IV ' ����,�. i�•::' - d:'•s, •: 191 WOMAN AV[. to MAIM STEEEY '; .::. �,. �� . NEW 4 � I c S•CALE.' /' rifO GATE' M.9Y2g /969 2// T//FlU2 14 1NCi -4v5 111E BLOCK CO AS OO SNOlNN ON MAP ENT /TLED •4AirE PEEKSi( /LLB SEC7110W O» S/f /O.tfAf- �rO �<< F /LEO. /N r//E- 9V'412-,0VANI Gb!/NTY CLe--1PAe49 OF•F /CE MAy PO /929 AS MAP Nd /65C. 1 .ON i. _rA/� 1 'YOVJL T Zi5 � I I LO 4 9 y 1 1 } � � 1 1- 0 T2 /3 , LOT2 /2 V /LOT2 // w� f0 ti� V L �.•�� Cat v°7 s,2P ya. IslApDIN "Ail certificat4ons hereon aro valld' for the imp and copies thereof only if said asap ;;r copies bear tAe impreseed sea: of the survoyor rhese signature appeare hereon." CENT /F /EO TO sYe4'UR 17'Y T /TLE ANO OVARANT✓ COMPANY A/VO TO P6EKSIf /LL �pT�io;, 3At//N68 BA/rK• suRvEY of PRoPEl�'rr PREQAREO FOR CHAM4 ES R. *0 CAROL AWOLr SITUATE /N L�4Ivc * PE`EXSA01LL SURVEYED er TRtpARED DY : ' , TO/ I N OF YALL EY BUNNEY ASSOCIATES iO�s3, C041IV ' ENGINEERS a-SURVEYORS i�•::' - d:'•s, •: 191 WOMAN AV[. to MAIM STEEEY '; .::. �,. �� . NEW 4 � PREM /SES SHOWN //E,Q60N 6E /NG LOTS ! S•CALE.' /' rifO GATE' M.9Y2g /969 2// T//FlU2 14 1NCi -4v5 111E BLOCK CO AS OO SNOlNN ON MAP ENT /TLED •4AirE PEEKSi( /LLB SEC7110W O» S/f /O.tfAf- �rO �<< F /LEO. /N r//E- 9V'412-,0VANI Gb!/NTY CLe--1PAe49 OF•F /CE MAy PO /929 AS MAP Nd /65C. 1 .ON 1- 0 T2 /3 , LOT2 /2 V /LOT2 // w� f0 ti� V L �.•�� Cat v°7 s,2P ya. IslApDIN "Ail certificat4ons hereon aro valld' for the imp and copies thereof only if said asap ;;r copies bear tAe impreseed sea: of the survoyor rhese signature appeare hereon." CENT /F /EO TO sYe4'UR 17'Y T /TLE ANO OVARANT✓ COMPANY A/VO TO P6EKSIf /LL �pT�io;, 3At//N68 BA/rK• suRvEY of PRoPEl�'rr PREQAREO FOR CHAM4 ES R. *0 CAROL AWOLr SITUATE /N L�4Ivc * PE`EXSA01LL SURVEYED er TRtpARED DY : ' , TO/ I N OF YALL EY BUNNEY ASSOCIATES ,�wl/TNAM /0(/T/VA�I C041IV ' ENGINEERS a-SURVEYORS i�•::' - d:'•s, •: 191 WOMAN AV[. to MAIM STEEEY '; .::. �,. �� . NEW YORK . KATONAN. NEW YORK 1014 MKSKILI. NTW' YORK 103% ! S•CALE.' /' rifO GATE' M.9Y2g /969 0 �a 8-11-1999 1:38PM FROM LAKELANDLUMBER 2451451 P.6 AV,