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HomeMy WebLinkAbout4407DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -9 BOX 33 oil J r ;i n r 1 . ■ tt l3k go ti, r , 04407 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,w�.ae•iivxr%'1 ^,.�i: � .'.: ';J ._ •., -_''.:. -, -"•: ,1: 'CaS': .a a1 .:_:. �.. - .._... ,'� -i.- r• 9 ' _. _ PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME L t zC"o"/ O PHONE SITE LOCATION TM# MAILING ADDRESS 7 G1/# / 7-,!= oF-'� - �`'L � Tiri�r' mss/ !/.} L PERSON INTERVIEWED Pal) Complaint # Name &Relationship (i.e, owner, tenant, etc.) DATE TYPE FACILITY PROPOSED INST i tl iq L i r R y �.4)dLc vu ,9 PHA 6Z IS. 5' 0, - po_P (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. ...__ Inspector's ture & Proposal Disapproved Proposal approved with the followincr 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. Date 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, or reported agent of owner agree to the above conditions. SIGNATURE e Gam- t� TITLE Gr1 yc c'J`_ DATE ?ZPS: V&te (P HD); YeUcw (fin ED; Pink (AAn liamt) LORETTA MOLINARI R.N., M.S.N. Public Health Director 9. ROBERT J. BONDI County Executive 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 /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Lezcano. 9 White Rd. Putnam Valley, NY 10579 October 15, 2003 Re: Addition — Lezcano, White Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #84.11 -1 -9 Dear Mr. & Mrs. Lezcano: 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 October 14, 2003. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at two without prior approval by this 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 p ieqmits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Pu Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke MLam Public Health Sanitarian cc:BI PUTNAM COUNTY HEALTH DEPARTMENT a. DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR`S39M DISPOSAL SYSTEM REPAIR N` , 0`VNER' S NAME ,,Q e!1/,,91N� D ' d�r,e/S.i PHWE E o SITE IACATION TM# MAILING ADDRESS 9 W111 rGC /—'W T�47 k/. ' c 4 /04-7!P PERSON INTERVIEWED PCHD Camplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY / PROPOSED nwAuER Itt) Ae- 1 F T�90LOoy S [C.11:' PHONE 0 5­7 Pro a ( 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 NYC Inspector's ture & Proposal Disapproved /-, Date roposal 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' diem. x 6' deep dzywells 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, or reported agent of owner agree to the above conditions. SIGNATURE e --d TITLE B-(,� Q/) DATE [P1ES: Hhite (MB); YeUrw Obn BI); Pink (Aalia nt) } i 1 i t } j e. - 7-/fx 84{, } is .r ,T r 1 o� r; T I 9 AAO K ® F Voas1!5 vg e �- 370 CLA n { 0 livo- C"(107,111.3 i } r p 4 F A5 ¢¢►► "I Y-1 TA AI LF EG¢4 eti . _ - BRUCE R.: FOLF, =. �• Public Health Director DEPARTMENT OF HEALTH LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 Whf /;r e1. TOWN. yf}i_c, ,cY TXMAP# ,/fRrnfir/luo �- �1.92/�9 NAME L c z e_AN o PHONE PCHD# c" i- a 3 MAILING ADDRESS 9 k1 H i TE 21= 14 C c. & . Z iw Z log 7 � DESCRIPTION OF ADDITION G 'l Hooic= 4-�,b d FLooi2 t / 2oork A— ester 6W.7 NI U:NI.BER OF EXISTING BEDROOMS a PROPOSED # OF BEDROOMS a7 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Pen-nit) 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 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 4) *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. OFF7CE USE Comments Feb98 BFhoase;uidelines Public Health Director ��'iit�TTA �1vfGLINARI KN% 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) 278 -6082 Fax (845) 278 - 6648 August 26, 2003 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 9 White Road Residence Tax Map 84.11-1-9 Town of Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling IS xx -.. __... IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: xxx OTHER del. DejWty Zoning Inspector BFhouseguidelines 9 w . f„., s ;e_ —.,.- -. .. � . �_ ... ._ • . ..o... ..y`..1:. +.c, -1 =P•�_ a'_ _,�.2.t.���.r• � J•J.`�0 4" .7, • .. .�.�;,dr4;"':.s': `e-.: a.: n •r � ..: �;: °- Ott.^ 71fx �z Pvtir'' I/� LA •� `t- � �-� c32� C. c} �7 u: z ��T G -r�dl• to "� u f ice - 6-c-L o uh. e-o ti ..Z,y�Grilt �,1 -!•y< � �l' "l�i�G' C,Z- G4t', W"��- {.f75 � �r V G{i`L K.�'1�'� � ��G�9 �''�t'.d�?7't L GL o ear . o z3 -A aq `.4 .arm u 0a.-�- R 9-C IlkIce— rm_. G l t7 A41 ti4 vb! i a 4-,- ae- �4,7Lel r'G �ttl''r�� el Gt�tiYL NCO S G'I 5. Cad �c, L .L1fr,.,� cyY=ti -F�- 1 �n ✓� s� -�2- � �� �- ry,���T ��.�. � L-Q/— / . 1. CS'TRAE,ET STAKE . .:fTgKE O i ` ' .i cS 60'22'E /30.00" / � `r• 390" 77" ....... N a Q i ro 19' m 2 O 0 q I I &G. 75' �q ' k3 \ t \ az.Bo' a•� h �. '\ —Alf, Q '`� *?�J ��- : F'REiy1 /JES 1HOn/N HSREON B2 //Vq Z x � Q JUNN /NGOAL E H0�1ES, "-fA /O iY1,SP, 1-// /L -AO TH //V E 0 PUTNq/yJ COU/(Ty' v 5 J C�ER.YS OFF /GE o/V NOY /9, /95/` � DoT' 2/, 936 S F. ,�J • { =.C). e 2 �S•gIH � I / /� •, •w /RB FE�ycE GE.vE�PgLLy oAi LiNE.� 1 �URY �Y �F l�R�/���T/ ! JT9KE / x/39'39' /STS/ /30.0/' 1" Pf7EPAREO I-OR AWN C*V j 404 SAM �_ ' �, /� • Tw /N qJN FoRiY/ERcy S /L.� EG'K � .s /TvAT,E %N Towiv of 4 T . _ - GUARANTEED TO HOME TITLE DIVISION, � 106171VX7 Y covNTy CHICAGO 'TITLE INSURANCE CO',TPANI', IN NEW YORK SURVEYED & PREPARED BY - ACCORDANCE WITH THE mviIMI M SAN. ALEXANDER BUNNEY DARDS FOR THE TITLE SURVEYS OF THE NIEW LAND SURVEYOR. P.G. YORK STATE LAND TITLE ASSOCIATION ` O WOODSBRIDGE ROAD ROUTE 117 KATONAH. NEW YORK 10536 PEE'KSK /LL SF,'y /NGS.B�9NK �:' ,7. APsxa -w(�f F� may% �, ioSirvrn e c Iry cnG�FCCrnr.1 FILE NO. T- 7r�;6- 1 ,' i T0141T OF PUTNAM VAILET ZftURS LOG AYD REPORT Foss I . . I WELL WCATION street section block lot YELL OWN WELL DRI - , Z DETAILS -YIELD TEST • WATER TtEVEL . SCREEN DETAILS—— en g-h: feet Bailed or Pum ped_2KErs_,i..-_, Mdasure from land Static;.:- ft surface') Make: - 7. 7 )i.ajheter:�,d-� Incb' es. Y i e' I d :-;261- GPM dheb:�-Bail ci*r f t, -Lenkth -Ft lot-' sizb-' :_� - '. Diamdter_'. In ,AL DEPTH OF WELL IfY Feet epth From 'Give description of forma-3ion penetrated, such .as:. peat, round Surface silt, sand,* gravel, clay,, hardpan., shale, sands , ton'e, ranite, etc. Include size of gravel (diameter and sand fine; medium, course);_ color: of- material-; structure- - (Loose, packed, ce.men-ited.i .6of t;, bard) : (Ex.,. Of -to 27 fl;!- -d 1 .2? f t. to 134 f t g fit_ to et -'Formation -Descriptiont.- Sketch -.exact Iocation of.- well to. -.least two permenant Landmarks ;e Well Completed_ _ k-.a —Date of Report Well Driller ,lL- -- signature t 2 C19,1 0 W91-76 EXI S714 & 3 k ETC Al TIV 9r V�9 L L G y AIV (os- 7? we 7 x 19219 "o S,019dE d OA7e6E la fl> -,A.4 ni5 LLEX Al/ 104-7 J ( 3iD ILI 0 t IS, E P L A INS, AP Fr 0 VE D, F 0 F,, DEDROorvi COUNT CINLY: E 1) RUO 0 MS; q- --2 Y- 0-7 AO 9 a —fu r iT T T Dite, -lp 44� LIJ AO 9 a —fu r iT T T Dite, -lp Wet L . 1k; .. 15 44� IS --A Wet L . 1k; .. 15 w. T E7 R IJA L I- COUNTI DEEPARTIMENT OF HEALTIf .0 HGUSE RAIIS APP�Rf$N-Eg f,,-,j3 INS eo' & R Ve Date do, (17 N, s. O wiry Pw F/V M�W Net,/ ?11?5&AWF1qr /Ixq N o L 6,g re T✓ li4 T4Foej oe evre I C> ra CD Fl CD LU o tA L4- L! Cl 1. J I I C> ra CD Fl CD LU o cc L4- L! Cl 1. J I C> ra CD Fl CD LU o cc I �� e.�.�� rte. �� ��° ��• ��.e e� r.. s-r WH RE ET - A WANE -{ POLE _ UTI TY RES S60 22'E 13D.90' w " Mr �o to IKPWE' Col. 9 ° p W!PiNE VT ON t� qt�E° _• C; 'S� 24' WIALK WANE IV 98.846.6' a ° a7.5'PRLDa, y r,PORCH% OiP.� WANE 1 STORY g �� ♦t. 'S; AME HOUSE $ . 7.Tb•': 98.5' i8!P " �F�gI��TIHA :60T1G W.ftxCir ... 27.4 FF 8 1 4b $' PROPOSE= & b 1.46Y yyqq�� flE 7461f I f�GH a ao , p4 r t a R� Mai ff3. .. PVNE SHED IYPMtE 1.2'VX 90.7' 8u 4�-0 9 Goat. %�'j W{' 1 C G&•A��t.- jSvR- D.oJ►-'D r'� X00 ovif* c'i o M 32° No QED WALNUT 90.7' f w PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY SITE LOCATION �'9 OH / 7C 91, f V Et494 G/ L C e TM# Y - OWNER'S NAME o �/y1A(c�l�A `OS_T PHONE �5/s Z �' Z MAILING ADDRESS 9 Gy# /TtF RA, PERSON INTERVIEWED VW,1V E 4 PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. DATE -mil- o2 0,0 SG TYPE FACILITY R Fs EN T/A L PROPOSED INSTALLER �� U PHONE ADDRESS REGISTRATION# Pro_ nosal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 1Jkt l..-$, ".2 ci r has owner, or reported agent of owner;agr6e to -the conditions stated ori'this form. r SIGNATURE 1���% Ae-CCOV-d TITLE OWX &I DATE � - �- 040 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 99NE -7 a DATE it r% t NE ne Pt4,rH1q,m V41- L E y v y lo s-7 t:- A41 C;2 t-I W JOOV C.-C-L -I DV Fvc, To�iN AI STREET WHITE S W PINE POLE UTI /Y INRE S60'22'E 130.00' A e l w. E WPoNf y4• �s n b WELL 0.X411). o WA i NC 9�. ^ �y WP�i'NE•aA6` I 'STONTE�C� ,�C 4 n •. C WPINE Wµ K ._.. - Ce.. _. .r.•....... ... .. nr set s. ��•.,. 98646,8'., _, +• �A . ..........:.r::.:..:: .. ... _ . - n`.PROP P'aP.- .- WPINE ... �. . i.. 27.5'PROP. 21.8' .. . TORY ONCRE7E'I:. ? AAIE HOUSE 8 �i:`PRMOSE�D'� 3 0 :GARAGE:' .•' .. .. _ ;,,- .. +.,,: gas• 38 W.PIN • * '` _._ bxt 6Sh4 5E9f ti, W� L/4* -So be 3 i'- LHOJBA� ., W.PINE# •:.;� - � .., '•• • •�" 4u � • 'plspcSED 16eo 1an4•: 1 •.C, : ' ` miL- 27. s' FF- - GI 46.3' 1.4'W PROPOSED t ^b R 71E `- YJ I'll 8_E[ t, 3• &18' �Op, •- Ex I' ' Gw-• t ' o .r' -P& 4movE:D, PME 4Y.n�N� SHED ,cp 7l� b ..�.. �Mhn� i -- .f• B•Y � . / IP9JE W ! 90.7' �c 5x4 w9-: i •Qhj. J GI° Mph. IB•TW. W.PWE �, IL' G SvuRalr� 00 •,,, p ' 32' 2' WALNUT NcSf 90.7' � x 00 = co � EDGE �• � � !O ASH N5939'15•W 130.01' 14 &18 MASH NOWORFORMERLYSCOTTS \ \,1iT iiH �-•v+ OF 151 F .4EVINSONBTIAT) µ `� --- LOT 4 SUBDIVISION MAP PREPARED FOR ALJAYCOMi