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34. -5-48
BOX 15
01593
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01593
BRUCE R. FOLEY
Public
Waltman
c/o Matt Stewart
290 Farm to Market Rd.
Brewster NY 10509
Dear Mr. Waltman:
LORETTA MOLINARI RN.,..M.S.N.
Associaie ` Public' Health Directtor '
Director of Patient Services
DEPARTNENT 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 September 21, 1999
Re: Addition- Waltman - Farm to Market Rd.
No Increases in Number of Bedrooms
(T) lnVa*ey Tax # 34 -5 -48
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 September 20. 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
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 Philipstown.
If you have any questions, please contact me at your convenience.
Very truly yours
Michael Luke
ML:kg Public Health Technician
cc: BI
BRUCE � R: • oL-EY-
Public Health Director
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road'
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
PHONE PCHD#
G ADDRESS ! e � �.e�� Z 9 0 r ✓ /
DESCRIPTION OF ADDITION
NUMBER.OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS G
(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.
1. Certified 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 #)
* 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
Comments
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
Gentlemen:
BRUCE R. FOLEY, R.S.
Acting Public .Health Director
Re:f L ,
Residence
Tax Map"/(-, J 1-401
Town
According to records maintained by the ToNNri, the above noted dwelling
IS
IS NOT '
in compliance with To,,tin code and the total number of bedrooms on record
is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
Building Ins
PUTNAM COUNTY DEPARTMENT OF HEALTH L
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDIVUDAL ADDITION/REPAIR FORM
SECTION A: GENERAL INFORMATION
Name of Project z.9 0 1` 4 v"u"d (T m L Tvl#
Year of Construction Size of Parcel
SECTION -'B.- TOPOGRAPHY (Please check all appropriate boxes)
1. 17H, ❑Rollin . Ste: Slope ❑Gentle Slope ❑Fat
2. 3Evdence
of wetland ❑Low area subject to flooding ❑Bodies of water
❑Drainage ditches 0Rock outcro
a P
YES NO
3. Property lines - evident? -- - ❑ lam'
4. Water courses exist on, or adjacent to parcel: ❑
5. Existing individual wells within 200ft of the existing SSTS? L ❑
SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS)
1. Physical character of existing SSTS area.
A. ❑Level C3/Gentle'Slolpe ❑Steep slope
B. ❑Well drained L�Moderately well drained
❑Somewhat poorly drained ❑Poorly drained
C. Area available for SSTS. (Primary & Reserve)
❑Extremely limited C3 Somewhat limited Adequate ft x ft
D. INSPECTION Date t Inspector
Cleo e�idence of failure Evidence of failure Evidence of seasonal failure
s
-3
N
n
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J
I " 6 e- — .
(1) Indicate location of SSTS
A. Size and type of septic tank gallons
(Iletal Cloncrete OPlastic
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)
�S r
SECTION E. EXISTING NVATER SUPP6-In
DPWS Shared well dividual well
Milled []Duc'r 11asing above round
4—f-e /b g
C0NIENTS : � Cr(a 5 ' s ,fie,,,, c�9 � "J' c-4 i
REPAIRS ONLY: Status:
As Built Inspection Required: As Built Submitted:
As Built Inspection Done: Inspector:
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