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41.09 -1 -15
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02292
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SHERLITA AMLER, MD,. MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Moy
170 Lake Shore Rd.
Putnam Valley, NY 10579
Dear Mr. Moy:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
February 28, 2005
Re: Addition — Moy, Lake Shore Rd.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #41.9 -1 -15
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 February 25, 2005. 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.
1'` All plurribing'fixtures must be upiiated witlf water saving devices, i.e:; iiew loWflush
toilets, restrictors for shower heads and faucets, etc.
Any permits or variances required are the. responsibility of the applicant and the jurisdiction
of the Town of Putnam Valley.
If you have any questions, please contact me at your convenience.
ML: lm
cc: BI (T) Putnam Valley
Sincerely,
Michael Luke
Public Health Sanitarian
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
•� a
'LORETTA MOLINARI
Public Health Director
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 - 6559 .WIC (845) 278 - 6678 Fax (845) 278 - L5
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
PROPOSED ADDITION APPLICATION SIDENTIAL ONLYI
STREET 170 1,014f 5'A o Ye Rol TOWN u7�n�m /� jX MAP #
NAME MOW PHONE S-a-? 093 (a PCHD #
MAILING ADDRESS 70. /0e�o?
DESCRIPTION OF ADDITION -`un rcx>m re�� �vv r►n� Loxt '>��ti -.ck
Add .- 7. SA
NUMBER OF EXISTING BEDROOMS-3 PROPOSED # OF BEDROOMS 3
(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-Counfy Saiiiwy —Cdde.
Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd.;
Brewster, NY-10509, Phone 278 -6130.
r... .
1. Certified check or money order f 1100.00
2. Sketches of existing floor plan (dra .ale, 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 ofsurvey 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
Comments
Fob 98
s
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
I 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
2/16/05
Putnam County Dept, of Health
1 Geneva Road
Brewster, NY 10509
ROBERT J. BONDI
County Executive
Re: MOY - -170 Lake Shore Rd.
Residence
Tax Map 41 - 9-1 -15
Townes f p u� � ,� eT
To Whom It May Concern:
According to records maintained by the Town, the above noted dwelling,
..... 4 . �_ Xis- ..� _.. ...� .... .. ...- .. - . .. � .—. -.. _ .. . - .. .. - ....... .. -.r,.. � .. ... .. .. __ ... >....... .. .. .. -. r. r —. ..
IS NOT
In compliance with Town code and the total number of bedrooms on record is 3
This information has been obtained from:
CERTIFICATE OF OCCUPANCY: xx
ASSESSORS RECORD: xx
OTHER:
As s i s t. Building Inspector
JOHN W. ALLEN
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
225 -0310
PROPOSAL FOR, SEWAGE DISPOSAL...SYSTEK REPAIR
OWNER'S NAME
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ro 5 JYJ
PHONE
SITE 1=TION
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MAILING ADDRESS
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sue. PCHD Complaint $
Name & Relationship (i.e, owner,tenant, etc.)
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q,3 TYPE FACILITY
C-1 reL7t PHONE 6�� 1 %
Pro (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 fran licensed professional engineer or
registered architect.
IJ -D K24OAr2
Proposal approryect'_�, _
&
Proposal Disapproved
,Aplf c
?VI4&Z
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 Name, Town and Tax Map number.
c. Location of installed canponents 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
drywalls 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 a ree to the above conditions.
SIGNATURE TITLE
][ S: Vbite (PCD): YeUcw (T-,vn ED; Pink (Applicant)
DATE « -A sa
David Moy 170 Lake Shore Rd Putnam Valley
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David Moy 170 Lake Shore Rd Putnam Valley
Tax map # 41.9-1-15
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HOUS.E. PLANS APPROVED FOR
BED NLY.
3—BEDROOMS
5igf►ature Title Hate
David Moy - 170 Lake Shore Rd Putnam Valley
Tax map # 41.9 -1 -15
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