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Home My WebLink About2305DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -1 -29 BOX 20 L I' i' .T. ds Nor IN �' '` ,� I, 1. i ' , IL 02305 t PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SITE LOCATION i(- 7 Zk,SA e re R P, OWNER'S NAME / �7 MAILING ADDRESS fir,* 1 e , zV,C3-- �� t,"� . OFFICIAL USE ONLY /�-c�2/3 -°3 PERSON INTERVIEWED i1 ",V � J ''�� PCHD Complaint # ame & Relationship .., own nant, etc. DATE TYPE FACILITY J-� S PROPOSED INSTALLER /5 *4/20a�) PHONE 22 7 —V5?� -- ADDRESS/5— �—%REGISTRATION# � 0 o a (include sketch locating all adjacent wells): V- 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 architec s/ I, as owner or reported agent of owne a ee to the conditions stated on this form. SIGNATURE �✓ TITLE / "%�e-S/ -140' r DATE Proposal approved vih_ _ _ _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 gala Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be erformed in accordance with the above proposal and conditions. Proposal approved -71 r7e3 's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML �C 5B PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR SITE LOCATION (0 7 OWNER'S NAME MAILING ADDRESS TV-T) PERSON INTERVIEWED ame DATE f- : PVjtr el 1► L owner, OFFICIAL. USE ONLY �-i 6- --v TM# "1 f 0 `�► %n PHONE PCHD Complaint # TYPE FACILITY ,f r PROPOSED INSTALLER Lt/ PHONE a SIS- ADDRESS u -s �Gg /� �).9i . (�L;�f . ! e' ?`7' REGISTRATION# �3 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. LAG s', E� ^tom T 7-4�, o -tA 9 I, as owner, o reported agent of owner agree to the conditions stated on this form. ''/ SIGNATURE TITLES DATE Z _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 ar ' DA 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 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Dave & Lisa Spittal 64 Lakeshore Road Putnam Valley, NY 10579 Dear Mr. & Mrs. Spittal: February 25, 2004 Re: Addition - Spittal, 64 Lakeshore Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #41.10 -1 -29 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, 2004. 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 If you have any questions, please contact me at your convenience. �Very truly ygurs William Hedges WH:lm Senior Public Health Sanitarian cc:BI(T)Putnam Valley 0 tRUCE R. FOLEY ublte Health Director DEP.AP'T MNT ' 4F 1EAL TH 1 Geneva Road Brewster, New York 10509' LORETTA 'MOLINAIU RN,; M.S.N. Asroctate Publle Health Dfrector Dirtetar of Patient Services EnV)rOnfientat Health (R4S) 278 6130 ••Fax (84S) 278.7921 �. Nursing 6trvlcu' (84S) 218 - 6SS8 WIC (94S)279-6674 Fax(845)279-602S Early leterventien (845)278.60)4' Preschool (845)2186082 Fex(845)278.6648• ADDITION APPLICAJ 0) E TIAL.Qzg4m STREET �5 TOWN ,.. ;:TXMAP #_ Y4PNE Pa-Mg NiALLIi\.G ADDRESS. DESCRIPTION OF ADDITIQN . 5(.;t NUMBER Of tMST}NG BEDROOMS ' PROPOSED # OF BED}ZOOMS (FROM CERT. OF OCCUPANCY OR t , CERTIFICATION FROM BUILDING JNSPECTOR)' 1' I 'Any addition which is considered a,6�droom requires formal , ;pproval'ciplaiz (Construction Petmit) prepaxcdby a Professional )rnginecr or Rcuistered Aiciiitec[ m.accordarice with applicable sections of the Putnam County Sanitary Cbde. Please submit this form pzd the following to Putnam County Health Dcpt :, 4 Geneva Road, Brewster, :NY 10509, Phone 278 -6130; 1. Certified check or money. orderfoi $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 plant (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. 9. Copy. of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFEU USE :. Comments ' r Kun : r HK NU. : 8455;28 f022 Jan. 04 2004 06: 03PM P1 a David and Lisa Spittal �rn►''// 64 Lake Shore Road �c \1US • C4�� l5 Putnam Valley, NY 10579,�� p(y 845- 528 - 7022.. 11 Q VUU °I604Ch A Fax Cover Letter: To: UA Iva, 0'� D N� From: Date: A& Regarding: 140--- 11 . r.. # of Pages: n. -c BRUCE R. FOLEY LOREM MOLINARI R-N., M.S.N. Public Health Director �� YOt�t Associote Public Health Director Director of Patitnt Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Eavironmcotal Hcaltb (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 - 6SS8 WIC(945)278-6678 Fax (845) 278.6085 Early Intcrrcnrion (845) 278 - 6014 Prtscbool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: ��J t l Y A �---. Residence Tax I 41 • ` a I Town U T-�j Ay-, V Gentlemen: 1 According to records maintained by.the Town, the above noted dwelling IS 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: OTHER f /C� I Building Inspector BFhouseguidelines 3