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HomeMy WebLinkAbout0453DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -30 BOX 6 00262 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OWNER'S NAME SITE LOCATION HOME - IP04 Z-) V TM# 19L-1- jy PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER PHONEc�`5 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.__ Proposal approved Proposal Disapproved Proposal approved with the following conditions: Date 1. Procurement of any Town perm t, 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 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 TITLE VQThSz DATE IM: Hhite (PCHD); Ydlcw (Tim HI); Pink GgAimnt) '�Brewste 0 BRUCE R. FOLEY Public Health Director Joe Calabrese 898 Rt. 311 Patterson NY 12563 Dear Mr. Calabrese: 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 March 31, 1999 Re: Addition- Calabrese - RT 311 No Increases in Number of Bedrooms (T) Patterson Tax 92 -1 -14 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 March 31, 1999 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at _ Four 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 Patterson. If you have any questions, please contact meat your convenience. Very truly yours William Hedges WH:kg Senior Public Health Sanitarian cc: BI 3rr a Ca�bresQ__ z. I - rY. n v� Dower I� .. . Cl N . - .. C-F� PUTNAM COUNTY' DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; 6EDRIOG- vl,S 4 0 1 1 M a P ! -.-N vi Cus�'i; lY D pf,P �, -IENT OF HEALTH HOUSE PLANS Are' C'NED FOR BEDROOLA CO-UNIT ONLY; I� CI T M � 7° , (•i P;` ,EPAR T rv1ENT OF HEALT HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDRO 9 Signature & Title ate oc E t f T gR 0 ar\ fi c'l �o N r �� - c)� �' r � i � ,� °(� C %� ! ' ^ i L Xv� i 2��` -t-U'� �0.t`l�\ `�l'UU fYl TC� �C� � � �.� t._.._.... ....� � � _. � .- t-• ---� -'--` BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 =6130 ADDITION APPLICATION - (RESIDENTIAL ONLY)% STREET: 1 ,311 TOWN TX MAP # NAME: e_- &d- =—PHONE ?C ' Go ��� PCHD PERMIT #�.C� MAILI ADDRESS r °' / Description of Addition c, fit% Number of existing bedrooms 7 Proposed numlSer of bedrooms 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 DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. 1. Certified Check for $100.00. 2: Sketch of existing floor plan (alb 1irig area >>nclud�n;g baGemerit' if any) Non - professional drawing is acceptable. 3. Sketch ofl-proposed floor, -p-1 and Non professional drawing is acceptable. 4. Copy of survey showing well and septic location, to the best.of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line. Any questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 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: esidence Tax Map o /-Al Gentlemen: BRUCE R. FOLEY. R.S. Acting Public Health Director According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance vith Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: uilding Inspector. 34NERIS NAME SITE I=TION E PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENEAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR A LA ?:0z ES PHONE TO 00 a PERSON INTERVIEWED Pam) CaVlaint # Name & Relationship (i.e, owneriteriant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER PHONE 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 .. .... ..... .. rWisterq�d architect. —4 114 Proposal approved Proposal Disapproved 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 Nam, 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 tankl.•three precast 60 diam. x 61 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 TITLE DATE PAS: - 'Wifte (MY; Yellow (fin HL); Pink (Appliamt) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project 81 � 6- 7 + (T)(V) TM# L = v Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. [Hilly Molling ❑Steep Slope [Gen le Slope ❑Flat 2. ❑Evidence of wetland ❑Low area subject to flooding ❑Bodies of water ©Drainage ditches Mock outcrop o•� YES NO 3. Property lines evident? U� 0 P Y 4. Water courses exist on, or djacent to parcel: ❑ J 5. Existing individual wells within 200ft of the existing SSTS? L� O SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT.SYSTEM(SSTS) 1. Physical character of existing SSTS area. . / 1. A. ❑Level oxentle SloP e ❑Steep slope n� B. ❑Well drained � oderately well drained []Somewhat poorly drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited ❑Somewhat limited / f . [Adequate ft x ft D. INSPECTION Date Inspector Mo evidence of failure OEvidence of failure ❑Evidence of seasonal failure t• ML ---=--=--------------------------=---------------------------------------------------------- (Indicate North) Lk 4 s lc HOUSE Ve O (1) Indicate location of SSTS A. Size and type of septic tank gallons Metal ❑ O 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 [3PWS ®Shared well 31ndividual well Mrilled []Dug OCasing, above ground COMINIENTS REPAIRS ONLY: Status: As Built Inspection Required: As Built Inspection Done: (addrep) As Built Submitted: Inspector: r] loc " P10 p7bukjD Sc✓TT4 o. c-' EASr o. 01' IQp/J PILI C, 0-1- c� o,' n t�\(( PIU �7 AP m' r - 2Coa�{O SF! I S" I I'- oo" vJ o. S98 A -ZEST ` VIAU> L-E 932: W ry 0 X o ' Q 10 670 l . IgPn�J' 2�.2g ' Y -tiE• 2'1.gµ• .. I �. N 1 Jay I 12G-I R I-1 I��n IPE �jrj(o °- S I •OCS 1Ci �� 10l. 00 Go�u�N o.oti EAST o. 01 2ocJT -- Wo. 31 t op PeoPEZTY J0'SEPN slTVaTE I� Tr->vjQ cr PA- rTEZ601,1 PuTQAM Cam, Y Sc.4 I_ E I'' NO Ju1�1 E. l l , 1982 4 . 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