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02320
PUTNAM COUNTY HEALTH DEPAR'IIMENr
DIVISION OF ENVIRONMENTAL HEALTH SERVICES p'
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR M o
OWNER' S NAME
��'i Its'- CCU
PHONE 2
3"7y7_
SITE LOCATION
2 4 lA U' �- � 3 � �
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�2 %
MAILING ADDRESS ,
`� V A- (-,L C4 r N41
101 S 17"?
PERSON INTERVIEWED
PCHD Cariplaint #
Name & Relationship (i.e,
cwner,tenant, etc.)
DATE
TYPE FACILITY
PROPOSED INST
C P f+ C- e tir
PHONEi
REGISTRATION # 31.
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
s Signature &
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 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 '/4-L ( DATE q
MIS: ftte (PAD); Ye11cw (fin ffi); Pink (P,pp 1amt)
e
LORETTA MOLINARI
Public Health Director
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
January 15, 2004
Howard
43 Arbutus Street
Putnam Valley, NY 10579
ROBERT J. BONDI
County Executive
Re: Addition Howard, 43 Arbutus St.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM#41.10 -2 -37
Dear Ms. Howard:
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 January 14, 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 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.
NCI -:lrrt
cc:pj (T)Putnam Valley
Very truly yours,
Michael Luke .
Public Health Sanitarian
BRUCE R. FOLEY
�.. .... ..Public Hearih"'Di'rectoi
.... :-.,.._. LQRETTA•: � .I�iLbi.R�1R#= �N•.,- MS:N:4��.' �:•'.;`'
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
ADDITION APPLICATION (RESIDENTIAL ONLY
L1I- 10 .o2-- 3-1
STREET rhu �
NATME ! y %T/ Aj G11'(IG . PHONE 845 /So'ZS - /.ZS`� P CHD# f� O �D -O `f
MAILING ADDRESS
DESCRIPTION OF ADDITION Metz" 0-rLh &"C -
\jU IBER OF EXISTING BBDRooMS_ PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (qonstruction Permit)
prepared by a Professional Engineer or Registered Architect in.accordance with applicable sections af.th: -
Putnam County Sanitary Code.
Please submit ihis 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 #)
*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
Feb98
BFhouseguidelines
BRUCE R. FOLEY
- _Public &a_10 _ Director ._
LORETTA _MOLINARI. R-N., M.S.N
- _ - - - - . -- r 4L� '' -" - — - -- _ksociale 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
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: ` 3
Residence
Tax Mapq 11
_
Gentlemen: Town
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 3
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
V
OTHER
uilding s ctor
BFhouseguidelines
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STAMP:
REVISIONS DATE:..
PROJECT:
HOWARD RESIDENCE
43 ARBUTUS STREET
PUTNAM VALLEY, NY
10579
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DRAWING TITLE:
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STAMP:
REVISIONS.- DATE:
PROJECT:
HOWARD RESIDENCE
43 ARBUTUS
PUTNAM VALLEY, NY
10579
DRAWING TITLE:
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