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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
*F'
ROBERT J. BONDI
County Executive,
LORETTA MOLINARI, RN, MSN ROBERT MORRIS, PE
Associate Commissioner of Health Director of Environmental
Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
Re: '7 b tL" P L L D `-S (Owner's Name)
Tax Map #: y/ D " 2 — Y Z.-
Address: r T 6 `x
Town:
9
Year Built:
According.to records maintained by- the - Town, -the above noted dwelling - -- --
Is C/ in compliance with Town Code.
Is not
in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Other: 455e5 5-0 ✓'5"
ng Inspect r Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921 .
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 228 -2847 Fax (845) 228 -1580
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Joan Billows
53 Arbutus St.
Putnam Valley,.NY 10579
Dear Ms. Billows:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
November 18, 2008
Re: Addition- A- 207 -08
No Increase in Number of Bedrooms.
53 Arbutus St.
(T) Putnam Valley, T.M. # 41.10 -2 -42
I have received and reviewed the revised 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 November 18, 2008. 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 --- A1l-plu -rhh - fig - tunes- mus�be- updated `•with�vate-r= savitrg=devices-, ::e:,--neW-low-flush- .:. -
toilets, restrictors for shower heads and faucets etc.
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
Any other 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 (845) 278 -6130, ext. 2261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
N r' HO 'E PLANS APPROVED FOR BEDROOM COUNT 094A
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N El BEDRQOPJIS���
° AL UBSEQUENT REVIS10WALTERATIONS TO THESE HOUSE
PL S MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Joan Billows
53 Arbutus St.
Putnam Valley, NY 10579
Dear Ms. Billows:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
November 10, 2008
Re: Addition- A- 207 -08
No Increase in Number of Bedrooms
53 Arbutus St.
(T) Putnam Valley, T.M. # 41.10 -2 -42
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 November 10, 2008. 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. - ",U'plumbing fixtufes must be updat6d'wifh -wafer- saviiig'devices, i.e:, new low
toilets, restrictors for shower heads and faucets etc.
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
Any other 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 (845) 278 -6130, ext. 2261.
Sincerely,
/�
.�1 - 6a,
ene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
4
SHERLLTAAMLER,.MD, MS, FAAP
Commissioner of Health •
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Health
-ROBERT J.. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION
RESIDENTIAL ONLY
STREET 6:5 &NL m St- TOWN P V., TAX MAP #
NAME 1�C1Y1 TJi I I0w_$ PHONE PCHD # _� —� �l
MAILING
ADDRESS 53 Ar: hufm S4, Pufnd M V_s___110 4 �X S 10-S 7 1
DESCRIPTION OF
ADDITION enUo,�ed ski r Wd l V'Ie v✓ be Danes
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OF 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.
Pleaae suVinit-tliis'foriri and"the following -to Putnam County Health Dept.; 'l Geneva Rd -.;Brewster, NY-10509,"
Phone: (845) 278 -6130.
1 Certified Check or money order for $100.00.
"Sketches of existing floor plan (drawn to scale, all living area including basement)
Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) * Non-
/professional sketches are acceptable.
A41 opy of survey showing well and septic locations to the best of your knowledge. Include date of
installation if know. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal
bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278.6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278.6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 225 -2847 Fax (845) 225 -1580
A'!)'l A I J1* UP ij vz rp, r uA n
SCALE 30 ,
DA TE- DEC'E�BER 2', 7,9 98
ified, as noted and limited below, only to
MICHAEL A. & SUSAN P. PRINCE
TIME" Y TITLE SERVICE-'::-), LTD. Title No. TCP--12582
MARINE MIDLAND MORTGAGE 6"ORPORA770N. ITS SUCCESSORS
AND /OR ASSIGNS
The surveyor's seal, signature and an y certification appearing hereon
signify thot, to the best of his knowledge and belief, this survey was
prepared in accordance with the minimum st'andards for land surveys
os set forth ,,n the Code of Practice -adop.tec' by the New York State
Assoc;cfion of Professional 'Land Survejwrs, Irc,.
Certifications shah .ruo only to the person for whore? this survey was
prepared, and or, his behalf, to the title cotzipany, lending institution
and goveromeptal agency listed hereon; said certifications are not -'I'n-
fended to to additionai -title comiponie.s, ;lending institutions, sub-
sequent owriers or futore con,4roct vendees.
Prep,ared by-
Baxle-r
P. 0. Br�x 14 7
Al&w "`ork 10547
FY)one 1.914i 62-1-8562
S
N, r. !S ilic. No, 4,94J4
�r�ikh�- �z�'Y'
T07AL AREA =-- 60"56",
1.j904 A,',, '51
Only copies ies o,," the original oi, this surve,., f�,ictp
surve_yors embossed sea.l.and hi,,�f. 6jonature
sidered as valid true copies
Underground ifnproverrients, strLiq'iure-, L,,th*J,11*�-,
ony easements related thereto, are
.noted.
Unauthorized alteration or ad(-,Y itior! to
land surveyors seal is a violat!aa of
the New York ._'3tote Educafior, Law.
TOXY OF PUTNAM V � , k1
mil) T iT Ai - OF PTIT/VA 11/1
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iron r,.-,d found
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ti cub.-e • -. �
v tit, rsvi�P :y
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eU,Sf 3,•�;P �f nnS ttU._jep;
____...__ n icy •, „
4 ✓lt J 7.>o.`h this
P� �t ��W, �. The premises shown hereon being .lands identified as Lots 70 �c it
:
p ` on —
and a portion of Lot ¢9 as shown: on a map entitled "SUBDl49SION .i
OF ROARING BROOK LAKE, MAP -1. SECTION- -'C ": said maD filed 0
"CtC:'i '' itr?1?is a fd the Putnom,, County Clerk's Office on =Jule 28, 1945 as Mori ^10.
Lo 1- 70 and portion of Lot hg were conveyed to tin.'icheal A. P_
Prince ;n Liber 1048, Poge 27 of deeds; Lot 71, lands formerlf. o` r.
L ;eberrnon as per Liber 457, Page,, 38 ? has reputedly been conveyed
of try the County of Putnam to Princ5. Ne deed of record canveying t
said Loi-_ ?t to Prince was 'furnished at the time of this survey
1v 6_3-27
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
,` - / qC1 - os--
YES
NO
Internal Use Only
1 X �- IltG`t
❑
❑
Repair Permit issued in last 5 years
❑ Not in Watershed
❑
❑
Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ Delegated
❑
❑
Repair within 200 ft. of a watercourse or DEC - mapped wetland
❑ Joint Review
SITE LOCATION .5 i3 , Zq jGIS 40 flu Vejl e TM # 1,1a - 2-
OWNER'S NAME �i4r LLCJIci�� PHONE #
MAILING ADDRESS .5�,, �c� s ,4Ly,•
APPLICANT
Name & Relationship (i. , ow tenant, contractor)
DATE '/� 2 -�5� FACILITY TYPE v�� S PCHD COMPLAINT #
PROPOSED INSTALLER ,� �Gw frG -Q- PHONE # Z.Z7 q,'u S'
ADDRESS ( 7,oI t/,yl REGISTRATION /LICENSE # 172—
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Dfferent location and proposed pump systems will require submittal of proposal from licensed professional
eigineer or registered architect.
I,as owner, or reported agent of own r agree to the conditions stated on this form
9GNATURr. TITLE
ko op sal approved with the 4110 winp conditions:
i Procurement of any Town Permit, if applicable.
i 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
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
i System repair to be performed in cordance with the
above proposal and conditions
fi sal Approved Proposal Denied
spector's Signature & Title Date
,'OPIES: White (PCHD); Yello (Town BI); Pink (Installer), Orange (Applicant)
1C-RP 99ML
lev. 8/05
DATE
X01or
Ilk
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it ffI
14 n
Jo
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOIL SEWAGE IDISPOSAL SYSTEM REP AIR �_ -6® -0 5'
OFFICIAL USE ONLY
SITE LOCATION Arbutus, Putnam valley TM#
X11,1 U- JW04g-
OWNER'S NAME joan Billows PHONE 845-528-2922
MAILING ADDRESS Arbutus, Putnam Valley, "NY 10579
PERSON INTERVIEWED PCHD Complaint #
ame & Ke-lationshiD i.e., owner, tenant, etc.
DATE
TYPE FACILITY
PROPOSED INSTALLER Pizzella Brothers, Inc. PHONE 914 - 739 -3405
ADDRESS 7 Dogwood Road, Cortlandt, NY 1 §KdSTRATION# 36 -04 vl
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.
VWi -" O'dL
1,- as-owher, orxeported agen f o er agree to the conditions f ted on this form.
SIGNATURE TITLE i DATE?S�I I l�
Proposal approved with the following conditions:
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 ormed in accordance with the above proposal and conditions.
Pro osal approved
14�l.
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
DATE
B F ELEMENTARY 246 7668
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08/24/06 03:39pm P. 001
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AUG-24-2005 WED 14:35 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P.
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IN
AUG-24-2005 WED 14:35 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P.
v *
LOT 56
L0T 55
S
L(j fi• S-50,
i
iy
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N. V
SL-RVE, Y OF PROPERTY °°'-°
PREPARED FOR
MICHEAL A • PRINCE:.— LOT 69
LOT 53
r°°,q al.0
LOT S2
' Dec
yyn•r,0 3s0.;.9•
T �5
�V� P. PRINCE
7O
SUSAN
PROPERTY St TUA TE IN
LOT 7
TOTrX OF PUTNAM VALLEY =_ ° = �• x x '
r r
COUNTY OF PUTNAM
'ST. TE OF NEW YORK I t a
.S •'.'1 °09'00° 11'
—SCALE.- 1"
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!t DA TE' DECEMBER 21, 1998 a a
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Certified. as noted and limited below, only to: j0°� / (11{x, iI. popt UI �f•
- MICHAEL A. & SUSAN P. PRINCE - •� / I B; 4 Y "wry 5U�'7jy �a
- llyrt y ARE SERVICES LID. ( litle No. 7CP- 12582 ) _ • 00° E r f r ,Il rr•�` r / /�, j� °+ y
MARINE MIDLANDMOR7GAGf CORPORA AON, ITS SUCCESSORS i �•5h �11�j'� {{1�yf -/�/ \� 610 AND /OR ASSIGNS \• y
ti V -y • • I L, rI0
JAe surveyor's seal - signature and any cerflrcotion appearing hereon �� ° • o n e r' \ �'7ry 017, '
signity that, to the best or his knowledge and betiel, this survey was
prepared in accordance with the minimum standards for land surveys L Y f ""O" °• ».O °', • . '
as set forth in the Code of Practice adopted by the New York State r °j"'• . °'
Association of Professional Land Surveyors, Inc. / / � •"Oj °' 4•hy„ sow pQ +r. � � -
Certircations shall Mn only to the person for whom this survey was F
567 S0.
TOTAL AREA = 60,T. \� �•'
prepared and on his behalf, to the title company, lending institution " •r`:;
and governmental agency listed hereon: said cerflffcotions ore not in- ( 1.J904 ACRES )
fended to run to =671ionol title companies, lending institutions. sub- -
sequent owners ur future contract vendees.
Only copies of the original of this survey mop .narked with both this The premises shown hereon being /ands identified as Gate 70 & 7`
Prepared by�� surveyors embossed seal and his signature in red ink shot! be rnn=
/' + and o portion of Lot 69 05 shown on o mop entitled SU80MSION \ -
s;dersd os valid true copies.
• OF ROAR /NC BROOK LAKE. MAP -1. SECAON -C'; sold mop freed in
Baxter Land. Surveying, P. C. / r ' / the Putnam Count clerk's Office on Ad 28, 1945 as Ma No. Job -C.
Underground improvements, structures, utilities o' encroochmen fs, and Y X p
P. 0. Box 147 any easements related thereld are not shown hereon unless otherwise
Mahopac, New Yolk 10541 noted I Lot 70 and portion of Lot 69 were conveyed to Micheal A. & Susan P.
i It Prince in Liber 1048. Page 27 of deeds,- Lot 71, lands formerly of
Unauthorized alfeiation or addition to a survey mop Aeorhg o licensed t
Lieberman as per L1Der 457, Page 387, has reputedly been conveyed
land surveyor's seal is a violation of Section 7209, Sub - Division ? of , f Dy fAe County a/ Putnam fo Prince. No deed of record con veyn9
Phone: (914) 62f -8562 �R06�rE. SAXTR, RLSL the New York State Education Low. sod Lot 71 to Prince was furnished of the time of this survey.
N.':S. L,[ No 49434
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PROPOSED WESTELEVAT ION
Scale: yommix-on
B I LLOWS: ADDITION AND ALTERATION TO REWD 'WE
DESIGN DEVELOPMENT
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SERGE YOUNG
Arcditeal
79 East wam street
Bwml, Now York 125M
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OROSED NORTH ELEVATION
B1 L L O W S: ADDl*n0N AND ALTERATION TO RESIDENCE
DESIGN DEVELOPMENT
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945.898A228
. PU TNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # )11—o I
Located at (To r Village
Subdivision name Subd. Lot # Tax Map
�4% /�# Blocky Lot
Date Subdivision Approved Renewal Revision
Owner /Applicant Name Date of Previous Approval
Mailing Address 00 -,Y oXWG,e r Zip
Amount of Fee Enclosed A9-v -f !i'd's VWL—/tc
Building Type Lot Area / No. of Bedrooms Design Flow GPD
El Fill Section Only Depth 3. 0 Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of /J, gallon septic tank and
Other Requirements:
To be constructed by
Water Supply•
�G jD Address
Public Supply From
Address
PiiV46 Supply,Drilleday
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E. R.A. Date
Address f'i GG, �; ✓�� ��'.� _ License #/
APPROVED FOR CONSTRUC'T'ION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. Appr d'fbr discharge of domestic sanitary sewage only.
�,� /�/
By: .� - Title: Date: 2
White copy - HD File; Yellow copy - Building Inspector; Pink copy --0-w`ner, Orange copy - Design P ofessio al
Form CP -97
4 t
Public Health Director
.t OREi' x "ivlOS:iT ARi R.N.; M. .N.
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) 228!- 6108 Fax (845) 278 - 6648
April 30, 2001
Dan Donahue, P. E.
120 Breckenridge Road
Mahopac, NY 10541
Re: Addition - M. Prince
Arbutus Road
No increase in Number of Bedrooms
(T) Putnam Valley TM #14.10 -2 -42
Dear Dan: -
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 April 30, 2001. The addition is approved with the following
conditions:
L. 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.
4. The SSTS must be expanded as shown on plans prepared by Dan Donahue_ and approved
by this Department on April 30, 2001.
If you have any questions, please contact me at your convenience.
WH/JP
cc: BI
Very truly yo ,
William Hedges
Sr. Public Health Sanitarian
zalo r .2840
f
N r .
' y
R NOOK
1a4 x 1s ! PORCH
`•� 1488 7086 ties 2810 7810 2840
4089 C r:
y .
5
23
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ENTRY LIVING
i 173x97 18'8x14'9
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FAMILY t BATH LAUNDRY
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DINING DECK
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v 2840 5040 2840 3044 3044 3044 3044
06 LIVING AREA
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LIVING AREA
1274 sq ft
2 7
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P6i1v1ium coow �'La3:�1� LiL.i 1 ; ?L 31.�AL
HOUSE PLk%,S APPRO= Fob
BED ROOM COUNT ONLY; ,
FJROOMS
k
9
a' D
i
April 19, 2001
DANIELS. DONAHUE, P.E.
•... c /1vUC: A /11. AA�i3 .�eiV \3$1 V.9.:e8:.�.6� — .,. .. -' a,....
120 Breckenridge Road
Mahopac, N.Y. 10541
914- 628 -7576
� D
Putnam County Department of Health
Geneva Road
Brewster N.Y. 10509
Att: Mr. Wm. Hedges
RE: SSTS. Addition
Property of Prince
Arbutus Road-
Putnam Valley,
Dear Mr. Hedges:
Enclosed herewith please find the following:
1. Form PC -1
2. SSTS application
3. Design data sheet
4. Letter of authorization
5. Fee in the amount of $100.00
6. Short. EAF :. .....:. .
7. Three copies of construction plans
9. Two sets of house plans.
I:
Daniel I Donahue, P.E.
Site Sanitary • Environmental
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
:_,-.:..:,. �... �.. �:... �.,„ f...... rr.:. x. �:--..o..: x�. �_-. �` APPI: ICATIONFORAPPit�OVAL` 'OP`P�;AI+1S`F011t•���:.:, <: -,� :..- .......:. __:... � ..t....
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: jt2ile -e
2.
Name of project: sj6yA,E
rx-w&- r.aF s
3.
Locatitgv:
4.
Design Professional:&JAt O &L
J. ZWY,44(1r
5.
Address: 144
6. Drainage Basin: A 4 i, &q
7. Type of Project: ,� �� 17
_ Private/Residential Food Service
Apartments Institutional
Office Building Realty Subdivision
Commercial
Mobile Home Park
Other (specify)
8. Is this project subject to State,Environmental Quality Review (SEQR)?
Type Status (check one) ....................... ............................... Type I Exempt
Type II Unlisted y
9. Is a Draft Environmental Impact Statement (DEIS) required?—.: ,4L
10. Has DEIS been completed and found acceptable by Lead Agency? ............... All .41
11. Name of Lead'Agency
12. Is this project in an area under the control of local planning, zoning, or other
offi cials, ordina�ices? �::: ..........................:.:............:.... .............:.: ::.........:... s. _
13. If so, have plans been submitted to such authorities? ........ ............................... N 0
14. Has preliminary approval been granted by such authorities? Date grinnted: _
15. Type of Sewage Treatment System Discharge ................. _ surface water Ygroundwater
16. If surface water discharge, what is the stream class designation? .................... N //1
17. Waters index number (surface) ........................................... ............................... _A,M
18. Is project located near a public water supply system? ....... ............................... &4
19. If yes, name of water supply Distance to water supply
20. Is project site near a public sewage collection or treatment system? ................ /10
21. Name of sewage system Distance to sewage system
22. Date test holes observed 23. Name of Health Inspector
24. Project design flow (gallons per day) ...............
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... �o
26. Has SPDES Application been submitted to local DEC office? ......................... NI&
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? //o
28. Wetlands ID Number .......................
29. Is Wetlands Permit required? ....................................... ............................ I......... Al y
Has application been made to Town or Local DEC office? ...............................
30. Does project require a DEC Stream Disturbance Permit? .. ...............................
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................ YesV)
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes(&
DESCRIBE:
33. Is there a local master plan on file with the Town or Village? .........................
34: Are community water and/or sewer- facilities planned to 'be developed within
15 years in or adjacent to protect site? ................................ ............................... A V
35. Are any sewage treatment areas in excess of 15% slope? . ............................... /116
36. Tax Map ID Number .......................... ............................... MaPZ16&L Block a Lot `�-•-
37. • Approved plans are to be returned to ..... Applicant _J Design Professional
NOTE: All atians for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent &S' ent, land need not be sent in duplicate to the DEP, although the project may require DEP
..
approvae S prior to final approval by the Department. Projects within the watershed may also
require i&vieA and approval of other aspects of a project, such as stormwater plans or the creation of
�impery aom, and the project applicant should obtain the appropriate forms Tor such activities from
-DEP an "'it. these fortes to DEP for review and approval.
If the app$ ions signed by a person other than the applicant shown in Item 1.,the application must
be, accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby afrm, under penalty of perjury, that information provided on this form is true
to the best of my knowledge and belief. False statenaents.:rnade herein are punishable as
a Class A misdemeanor pursuant to Section 21P.45 of. the, Feral Law.
SIGNATURES & OFFICIAL TITLES: R�/► c- °�� v�
Mkiling Atli cess ..:.: :.:::..............:..........- _ ._........ _ _... -- . _ -..
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION Of ENVIRONMENTAL HEALTH_ SERVICES,
71
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Addressj
Located at (Street) Tax Map/
t-& Block Lot
(indicate nearest cross street)
Mtmicipality_. fv At4 /j,. e Watershed
SOIL PERCOLATION TEST DATA
Date of Pre-soaking Date of Percolation Test _A?X/"e.
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurementsto be made from top of hole.
Form DD-97
17
2
3
d- 7
17
4
5
4-
J_:
2
%z
3
;/Z-
2—
4
5
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurementsto be made from top of hole.
Form DD-97
1.51
2.0'
2.5'
3.0'
3.5'
4.0'
4.5'
5.01
5.5'
6.0'
6.51
7.0'
7.5'
8.0'
8.51
9.50
10.01
le-
Indicate level at which groundwater is encountered AMA/0-
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered dze
Deep hole observations made by: Date -�651-e'l
Design Professional Name: �/V V, 4J
Address: loX-7,1 9,.,- v ,� of �
Signature
Design Professional's Seal
s.1; 7-ron
t: L
0.49
OF NE
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES,
DEPTH
�UULM40.
G.L.
0.5
—1 .6 Aj 614
1.0
1.51
2.0'
2.5'
3.0'
3.5'
4.0'
4.5'
5.01
5.5'
6.0'
6.51
7.0'
7.5'
8.0'
8.51
9.50
10.01
le-
Indicate level at which groundwater is encountered AMA/0-
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered dze
Deep hole observations made by: Date -�651-e'l
Design Professional Name: �/V V, 4J
Address: loX-7,1 9,.,- v ,� of �
Signature
Design Professional's Seal
s.1; 7-ron
t: L
0.49
OF NE
!4.161(1187) —Text 12
PROJECT I.D. NUMBER 617.21 SEAR
Appandlx C
State Environmental Quatity_Ro. iew
SHORT ENVIRONMENTAL ASSEBSMENT FORM V .
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT !SPONSOR
T. PROJEQT NAME
3. PROJECT LOCATION: �,,,
Municipality `,1 �"�'_` `� �e ( County t-j_�)f
4. PRECISE LOCATION (Street address and.road Intersections, prominent landmarks, etc., or provide map)
6. IS PROPOSED ACTION:
N a w ❑Expansion E] Modificationlalterstion
6. DESCRIBE PROJECT BRIEFLY:
& -Q,u a 77e 7 is ou d) Fv- t 01 ,y 'e) i t
,f "4v01? #-Ai iv i /.1/'t, ; a41114 R !' VI-N t P9t
7. AMOUNT OF LANG AFFECTED:
Initially & / _ acres Ultimately acres
B. WILL PROFOSEED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ❑ No It No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
JvReslcentia! G Industrial ❑ Commercial ❑ Agriculture ❑ PaWlPoresUOpen space Cl Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL
STATE OR LOCAL)? r
Yes ❑ No I! yes, list agency(a) and permluapprovata L �) f� .
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
13 yes No It yes, list agency name and permltlapproval
12. AS 'A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
(] Yes Adho
i CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Date:
ADDlicanUsponsor name:
Signature:
It the action is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION. EXCEED ANY TYPE I THRESHOLD IN 6 NYCRA, PART`llit.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes (DRo
B. WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.0. It No, a negative declaration
may be superseded by another Involved agency.
❑ Yes , Ram
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, It legible)
Ct. Existing sir quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion, drainage or flooding 0ioblims ?..Explain briefly:
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna, fish, shetllish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
Ct. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly.
NOW e
CS. Growth, subsequent development, or related activities likely to be induced .py the proposed action? Explain briefly.
3 CD
144:s ? Lang if, short term, cumulative, or other effects not Identified In C1-CS? Explain briefly.
:>
tt;;ir� -•-i � �.
c3
��
ttter i meets (including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THER "e, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
Yes Uib It Yes, explain briefly
PART Ili — DETERMINATION OF'SiGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect. Identified above, determine whether It Is substantial, large, impoflant or otherwise significant.
Each effect should be assessed In connection with Its (a) setting ().e. urban or rural); (b) probability of occurring; (c) duration; (d)
Irreversibility; (e) geographic scope; and (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed.
C1 Check this box If you have Identified one or more potentially large or'significant adverse impacts which MAY
occur. Then procesdcdirectly to ;the FULL EAF and/or prepare a positide declaration.
Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in s'y,slgnifirant adverse environmental Impacts
AND provide dn'attachments as- necessary, the reasons supporting this determination:
.t
Name of Lead Agency
tint or yye name of Gspons a Officer in lea Agency Title of esponsi a Officer
rxv- .- �.,. -, � :.. <. . .. ..... _ a•.:......, .�.,. , -:.. .. •,: . <..,.�..:_z•, _'...... ,�.vx ,., o >•- •or "s.,: .. :.aaa,: -.y= _.:. _-. ,,.,w .s•.. _:. .-...�.•s ,e,,.. .. r..4._
ignature of Responsible Officeflm Lee Agency Signature of Preparef Of differ"t from respons
ible officer)
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r r s': \<;: i1 [ +. -a r. r-3. +�':t �- rr u'.'[['. c�.xa_T.vtvc�[ -Y '.: r.'s:. -r -: y^^�<-- :�.^ -,w: T�.cw-.�_.. ...e n . ... >. s ra.fs 1s... +a a_[e. �.-. +1 -..L r .. .c_wN.+Tr:.[ -�I.e ... r_ .. �a � < >!— ..�1a.'s.r.l✓'cr.. � : a
RE: Property of
Located at
LETTER OF AUTHORIZATION
GP I ax Map # . 4d-7- - +2 Block
Subdivision of
Subdivision Lot #
Gentlemen:
Filed Map #
Date Filed
This letter is to authorize 'DAN tnL T Niq Hxr Pr.
Lot
a duly licensed Professional Engineer ✓ or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations'as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam County Sanitary Code. :... .
Countersigned:;�
P.E., R.A., #
Mailing Address l�%A' ,ec -,4 ,, .ri
State% Zips
Telephone:��'
Very truly yours,
Si ed: v4��1
(Owner of Property)
Mailing Address: / ��L✓l ��
State
Telephone:
Form LA -97
I
a a Sheet of
* PUTNAM COUNTY DEPARTMENT OF 1FIEALTII
DI- VISION ;O, -FE W RONMEN =I'A -L HEATLH- SERVICES
Ft� YOB FIELD ACTIVITY REPORT
NAME* y TAI;
Street A1;�, ��c Tow
PERSON IN CHARGE
State Zip
Name and Title / ell
TYPE OF FACILITY:
FINDINGS'. 1 �i�2 u2�s� ✓-Y- -� ��� A?�p-
Signature and Title
RFPl1RT RFr-FT FT) RY•
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
D .,..
7 - - - - - - - - - - - ---- \
41
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00 SOO
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cli
N. N- I lu
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57
15.00 51
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OW
o
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
.DIVISION OF,EIVyjRQI�10' E� I_,�— � - T.:��I.SFRYIG
tjr YOB nT rn FIELD ACTIVITY REPORT
Tel:
Street Town ^� Stage , Zip
PERSON IN CHARGE
Name and Title
TYPE OF FACILITY:
FINDINGS:T�tsa
2.�s� ✓- _-�.
°� �G�il�%
ay ,- �Z'�
/-
1 7 Zr'
G r� GAL /f
f
�_.� �/ '� �"`�
�` v%� -,�-•-
ly
(� � /
Signature and Title
REPORT RECEIVED .RY:
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
Rev.
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
.._. LORETTA MO'LINARI,.RN MSN
Associate Commissioner of Health
Joan Billows
53 Arbutus Street
Putnam Valley, NY 10579
Dear Ms. Billows:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
- ROBERT
Director of Environmental Health
November 16, 2007
Re: Addition — A- 171 -07
No Increase in Number of Bedrooms
53 Arbutus Street
(T) Putnam Valley, T.M. # 41.10 -2 -42
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 the Department dated November 15, 2007. 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.
4. This Department recommends .you contact your local Duilding.Department to ensure{:.:: _
f setbacks and other current codes can be met.
5. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
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 at (845) 278 -6130, ext. 2261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:ens
cc: BI (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
'IV /01 /4VVf IV.LO
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PUTNAM COUNTY DEPARTMENT OF HEALTH'
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
J BEDROOMS 4 -1-71,07
•CtA -:0-' q1 110 -2 —�2
ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
07
SI ATURF & TITLE
ramt
11/15/2007 14:42 FAX
_. n-. ..vim .. �...+ s. a<-. wvmva.rs.�.- .-- ._c,_,..._....,�_. cn.a •.r ,r .i<, v _-_. u,.,. x-_�.. ... ..s �.- �,r.v. �n _..__...:III �< . �e.. � x.�. u.. .. s -c �:rc.�'-tv...-
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PUTNAM COUNTY DEPARTMENT OF HEALTH
LOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOMS A — 177 l — O
.LL SUBSEQUENT REVISION ALT RATIONS 0 THESE HOUSE
LANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
GNATURE & T!TI -E
BILLOWS:
ADDITION AND ALTERATION TO RESIDENCE
53 Arbutus Street
Putnam Valley, New York 10579
REVISED BASEMENT /FOUNDATION PLAN
U
0AIU0!
Scale: Y=T-O"
SERGE YOUNG
grchltect
I
79 East wluvW SbVDt
Drawn By SY
Beacon, New York 12506
848.838.4229
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PUTNAM COUNTY DEPARTMENT OF HEALTH
LOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOMS A — 177 l — O
.LL SUBSEQUENT REVISION ALT RATIONS 0 THESE HOUSE
LANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
GNATURE & T!TI -E
BILLOWS:
ADDITION AND ALTERATION TO RESIDENCE
53 Arbutus Street
Putnam Valley, New York 10579
REVISED BASEMENT /FOUNDATION PLAN
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Scale: Y=T-O"
SERGE YOUNG
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Date: 11.06.07
79 East wluvW SbVDt
Drawn By SY
Beacon, New York 12506
848.838.4229
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
October 26, 2007
Joan Billows
53 Arbutus Street
Putnam Valley, NY 10579
Dear Ms. Billows:
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Proposed Addition — A- 171 -07
53 Arbutus Street
Putnam Valley, T.M. # 41.10 -2 -42
I have received and reviewed the plans .for the proposed addition at the above mentioned
residence.- Based on the information submitted, the above mentioned addition cannot be
approved for the following reasons:
1. Per plans and survey provided, it appears the proposed addition and deck will encroach
upon the existing septic tank.
2. All rooms on the proposed floor plan need to be labeled and dimensioned. (Your plans
have been returned for our use ):W
3. Please provide two foil sets of proposed floor plans.
If you have any questions, please contact me at your convenience.
GDR: ens
Sincerely,
Gene D. Reed
Sr. Environmental Engineering Aide
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
Nov 01 07 01:52p BUILDING DEPT
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
9145268806 p•2
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal edroom Count
Re: BILLOWS
Tax Map #: ' 41-10-2-42
Address: 53 Arbutus St.
Town: Putnam Valley
Year Built: 1950
ROBERT J. BONDI
County Executive
(Owner's Name)
According to records maintained by the Town, the above noted dwelling,
is xx in compliance with Town Code.
is not in compliance with Town Code.
The Legal Bedroom Count is: -1
This information has been obtained from:
Certificate of Occupancy: C-0-4-20-03-296 4 d d i t i n)
Other: Building File,
11/1/07
-"Building Inspec or Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278-6678
Nursing Home Care Fax (845) 278 -6085
Nov 01 07 01:53p BUILDING DEPT 9145268806 p,3
CERTIFICATE OF OCCUPANCY
CERTIFICATE NO: 2003 -296 DATE: 10/3/2003
PER MT NO: 2003 -306
TAX MAP 0 : 00/41.10 -2 -42
LOCATION: 53 ARBUTUS ST
ISSUED TO : PRINCE MICHAEL A &
SUSAN P
53 ARBUTUS ST
PUTNAM VALLEY NY 10579
This certificate covers the construction of:
ADDITION /ALTERATION
COVERT SCREEN PORCH TO
LIVABLE SPACE (DINING ROOM)
(182 SF)
The applicant having heretofore filed an application for a building permit
pursuant to the Town Code, Sanitary Code, the Uniform Building & Fire
Code and the Laws in effect in the Town of Putnam Valley, Putnam County,
NY, having paid the required fee therefor and the undersigned having by
` --- -personal'inspeofion ascertained'that.improvement of the proposed--structure -
is in compliance with the requirements of the laws as aforementioned; that
the said work and materials meet every requirement of the laws as
aforementioned and that the premises have now been fully completed and
are ready for occupancy pursuant to the provisions of law. Now, therefore,
the Certificate of Occupancy is hereby issued under the seal of the Town of
Putnam Valley.
TOWN OF PUTNAM VALLEY, NY
By s
Code Enforcement Officer
I
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
-County Executive
DEPARTMENT 'OF HEALTH
1 Geneva Road, Brewster, New York 10509 gip.:
IS
ADDITION APPLICATION RESIDENTIAL ONLY
j .
STREET �9rbok,5 S�. TOWN I�cc%!a TAX MAP# �2.'�•.
NAME ✓ �5� ,8 I /IO W5 PHONE g o� g o2 PCIiD# 1�
MAILING
ADDRESS 53
cSf' Pufn am * 11 -e y I y 10-S `7,q
DESCRIPTION OF
ADDITION eh C/OS PG, . p rlC�7 91 /Y
NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS—
(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 Dep_t:; -1 Geneva Rd, . -
Brewster, NY 10509, Phone: (845) 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)
3.
1�w�ts of- proposed, floor plan (drawn to scale — with name, street and tax map #)
*Non - professional sketches are acceptable -
4. Copy of survey in well and septic locations 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.
Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Healtb (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
Q b
i
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT. OF HEALTH
1 GENEVA ROAD
BREWSTER, NY 10509
To Whom It May Concern:
Re: seL Lo \nl C
Residence
ROBERT J. BONDI
County Executive
TAX MAP#
TOWN &Tg"AfA V
According to ecords maintained by the Town, the above noted dwelling,
-IN COMPL IANCE WITU TOWN- CODE...
IS NOT IN COMPLIANCE WITH TOWN CODE
LEGAL BEDROOM COUNT IS
N9
This information has been obtained from/ :
CERTIFICATE OF OCCUPANCY:
�ASS�SSnfZSoiZ
OTHER: �
Building Inspector
Date
CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
lm
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
FROM FAX NO. Jul. 12 2005 11:32AM P1
AIM Ieaa�m ®!9A'i rn ®MlAwwwr��wiwlN,,, w�bmp (mww�rrs ®orYew ®ws ®�srwm ®wrybtw�
DATE; - 07; - 07112- / () F: 5 -,;?7g , i
TO: ` 3 A
OIANir:
_ iea l ` ' �-- C-C U v-, Ste. _
F O Ljo r 11 ou P�O�iE: S�t� G f�� l
TOTAL PAGES (MC]LVDING COVER PAGR) Tw O
GENT ❑ FOR REVIEW ❑ PLEASE REPLY
COMMENTS:
3663 LEE ROAD,. JEFFERSON 'VALLEY, NY 10535
TELEPHONE: 914- %2.022 FAX: 914-962 -0149
B"CK & WffiTE COPIEPCOUM COPMkSi IPPING 5Mv1UKb
MAnAOX SERVICES *POSTAL SERVICES *FAX SENDING AND RECEIVING
T11_ -12 -2005 TUE 11:28 TEL:845- 278-7921 NAME:PUTNRM COUNTY DEPARTMENT OF P. 1
1oseJ '
eVH��
p • //11,, I ��, •'Ifs � 1,
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PUTNAIVI COUNTY DE ARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY,
BEDROOMS
ALL SUBSEQUENT REVISIONfALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBMITTED TO THE PCDOH. FOR APPROVAL
f J C eI � L-P
lg
5I ATURE TITLE DATE
FROM FAX NO.
J
L
JUL -12 -2005 TUE 11:30 TEL:845- 278 -7921 "
Jul. 12 2005 11:34AM P4
V
d
NAME:PUTNAM COUNTY DEPARTMENT OF P. 4
FROM :PIZZELLA BROS FAX NO. Aug. 24 2005 09:28AM P1
Augtast 24, 2045
Putnam County Health Department
Joseph Paravati
Assistant Public Health Engineer.
1 Geneva Road
Brewster, New York 1OS09
Fax: 845- 278 -7921
Re: Joan Billows — Septic tank replacement
.35'Arbutus, Putnam Valley, NY
Dear Joe,
In response to your phone call this manning rega din the tank replacement at the Billows
residence:
There is not enough room to got a wwrete tuck in. In order to safely get a tank
past�the house I would need to bring- in a lot -of fili'and build a raft.- This-Would ; ....,
cost a lot of money that she does not have.
R urding the adjacent wells. t do not have, this infomation because it is a tank
replacement and does not involve the fields. Please contact Ms. Billows for this
information.
cc: loan Billows
AUG -24 -2005 WED 10:03 TEL:845 -278 -7921. NAME:PUTNAM COUNTY DEPARTMENT OF P. 1
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
July 19, 2005
Joan Billows
53 Arbutus Street
Putnam Valley, NY 10579
Dear Ms. Billows:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
Re: Addition — Approval - Billows
No Increase in Number of Bedrooms
53 Arbutus Street
(T) Putnam Valley, T.M. #41.10 -2 -4
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 the Department dated July 18, 2005. 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 ". "'Ail pluriibirig'fixtures must "be "updated with w�'tefsa`ving de "vices'(�e. nev`�low'flush" ° "'
toilets, restrictors for shower heads and faucets etc.).
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
5. Town records indicate that the legal bedroom count is three. Another bedroom can be
added without an increase or change in the SSTS, but an application must be submitted to
this Department for review.
Any other 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.
Very truly yours,
oseph S. Paravati
Assistant Public Health Engineer
JSP: cw
cc: Building Inspector, (T) Putnam Valley
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
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
iY
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT. OF HEALTH
1 GENEVA ROAD
BREWSTER, NY 10509
To Whom It May Concern:
Re: 1_ L fin.' C
Residence
ROBERT J. BONDI
County Executive
TAX MAP#
TOWN &TR-ArA ALA F— Y
According to ecords maintained bythe Town, the above noted dwelling,
- Il`; COM- PLIANCE VU- .T- H -TO'� .N-C.
..._ -- -�- -• - - -- -Ifs -- _ .._._ _.� ...� -------- -
IS NOT IN COMPLIANCE WITH TOWN CODE
LEGAL BEDROOM COUNT IS
This information hds'been obtained from) :
CERTIFICATE OF OCCUPANCY: �+
OTHER:
Building Inspector
Date
CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Im 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
Department-of Health
1 Geneva Road
Brewster, NY 10509
53 Arbutus Street
Putnam Valley, NY 10579
Tax Map# 41.10 -2 -42
Dear Joseph Pavaroti:
Enclosed are f loor plans and application which state the use of the new
space afforded by the raised roof over the dining room is for a bedroom
and bathroom. Previous application did not state use of space and I had
problem with the zoning board. This should resolve the discrepancy
between the Health Department Application and the Zoning Variance
Application.
Sincerely yours,
f�
Joan Billows
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
I Geneva Road
Brewster, New York 10509
LORETTA
Associate Public Health Director
Director of Patient Services
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)
STREET 5 � 74Ybt�t� � TOWNL" � -�I
N/��i Jco-n 31 II c9u%�PHONE PCHM
MAILING ADDRESS
DESCRIPTION OF ADDITION ba Gh�-I
\TLIBER OF EXISTING BEDROOMS__ `�__PR0 4ED Pr OF BEDROOM0, 1 �j .t1
(FROM CERT. OF OCCUPANCY OR "`- rol raft)
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. ked roo;it —
v. Please submit this-form and 4.hefellowineto Putna n� 6unty-Halth Dept.,'4 Geneva lroid, rewster,
10509, Phone 278 -6130.
Certified check or money order for $100.00.
Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non= professional sketches are acceptable.
Two sets of proposed floor plan (drawn to scale, with name, street, and tax map f')
*Non- professional sketches are acceptable.
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.
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 Heat_ Director = :..:_u ...: .
LO_ RETTA ; MOLWARF R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTNrENT. 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Re: � 3 Uq1w-
Residence
Tax Map f?- – 41
Town. 52�
According o 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
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BRUCE . R. FOLEY
Public Health`-Direcloi
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
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 ONL)l
STREET Y�(.� �.TT TOWN X MAP# lo
q3& os
NAvIE _)(! � � I �� dt t) PHONE �� `� �' 1°2 CHD#
MAILI\TG ADDRESS
DESCRIPTION OF ADDITION
ices �9
o ✓er' d�n1oe
MBER OF EXISTING BEDROOMSPROPOSED # OF BEDROOMW ,rte 04 1i.f0 i
(FROM CERT. OF OCCUPANCY OR rp-8 vY�
CERTIFICATION FROM BUILDING INSPECTOR) 4
*Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) Y�
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code. k ed roo nL-
Please submit this form and the following to Putnam County - Health Dept., 4 Geneva Road, Brewster, NY �aihYUO6�`'
10509, Phone 278 -6130. exc t
1. Certified check or money order for $100.00.. Q c_e�
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non= professional sketches are acceptable. -»
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
*Non - professional sketches are acceptable.
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept'. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
BFhouseo idelines
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' • GOT 53
. 714 ` �-� �„ n a . • LOT 5z
�; 1 l I
OT
4 41
St, "R EY OF PROPERTY -r° .�r°.• =r��: n 4� —".'— w
r
PREPARED FOR \ 0 1 I ',
MICH.EAL A . PRINCE ; LOT 69 ''` � �.•. � `� � � � j
SUSAN P. PRINCE' D a • �$� ' �."� o
GOT `i
. � PROPERTY SITUA TE IN � .1 °z LL
TO T1TN ' OF P UTNAIIT VALLEY =r oa. x k GOT q> °
COUNTY OF PUTNAM °
S'TA TE OF NE 11" YORK
S 1 1•0s'00' 1T t
11 SCALE 1' = 30'
i fv ti v q
(
DA TE: DECEMBER 21, 1998 n ° 1 ;J 1 1 F7111 # \ a a
... ° f.
41 Ab
Certified, as noted and 7imifed below, only to: ' � �'!:I a� s 6! U• �:
- MICHAEL A. & SUS V P. PRINCE •°�q0
- TIMELY TIRE SERVI •ES LID. (Tfle No. TCP -12582
- MARINE MIDLAND MORTGAGE CORPORATION, ITS SUCCESSORS 11vr'6
AND /OR ASSIGNS
�1�� 4,rnal ,eenj
The fy th)t. t seal, signature and any certi(rcoliel t this ing hereon �� 1 r
p epoy d in to the best it th know /edge and belie!, this nd surtey
su was eO sr r • \Jh',UU•
prepared in accordance w ;fA the minimum standards for land surveys
Or set forth in the Code of Practice adopted by the New York State
Association of Professional Land Surtrmrs, Inc. \ +b. 01 ••0.,bi•Ja " ^.,.0 sr �\
Cerfircolions shall run oily to the person for whom this survey was •
prepared, and on his 6efio /f, to the title company, lending institution TOTAL AREA = 60,567 SO. F'T.
and gorommenlol ogencty listed hereon; said certifications ore not in �� •,,: -,
(ended to run to addilignol title companies, lending institutions, sub- (1.3904 ACRES) \
sepuenf owners or fulum contract v es f
ende. rawer, r.. L.I. 41 • u 1
Only copies of the original of this survey mop marked with both this \
Prepared by. � surveyors embossed seal and his signature in red ink shall be con - The Premises shown hereon ibeing lands ;den fired 'as Lots 70 & 71
/ sidered as valid true copies. and o portion of Lot 69 os {shown on a map entitled 'SUBDIVISION
Baxter Land Surveying, P.C. "", I Or ROARING BROOK LAKE, MAP -1, SECDON -C•;- said mop riled in \
j Al Underground Improvements, struclures, utilities a- encroochmeofs, and, the Putnam County Clerk's Office on .Ally 28, 1945 as Mop No. J08 -C.
P. �. BOX 14i any easements related thereto are not shown hereon unless otherwise'
Mahopac, New York 10541 noted of 70 and portion of Lot 69 were con.e7ed to.Micheo/ A• & Susan P.
•'r vrince in Libel 1048• Page 27 of deeds; Lot 71, lands formerly of
Unauthorized o/te/afion or addition to o sur,et, mop hearing a licensed - Lieberman as per Libor 457,1'Poye J87, has repu(edly been conveved
4� (( land surveyw•s seal s o violation of Section 7204 Sub - Division 2 of Qy the County of Putnam to Prince. No deed of record con` YM9
P•[Ione: (914) 621 -8562 Rosmr E. BAxlm F.LS the New York Stdte Educotion Low. sold Lot 71 to Prince was furnished of the time of this survey,
} N•'S tic No 494J4 y
It frr No 4't -Jt;l
+jv
F
V
SHERLITA AMLER, MD, MS, FAAP _ _ -
"" Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
ROBERT J. BONDI
County Executive
Re: j3' k16L p S (Owner's Name)
Tax Map #: �j I , 10 � '1 X
Address: 133 Aj bd;,-4-,V. s 3+
Town: Rt.T 6Lvs -,. 10 & 79'
Year Built:
According to records maintained by the Town, the above noted dwelling,
is M` in compliance with Town Code.
is not in compliance with Town Code.
- .
The Legal Bedroom Count is: This information has been obtained from:
Certificate of Occupancy: n
Other: Sse-s -s ys uA j
Building Inspector
Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI .
A J ( County Executive
,OBERT MORRIS, PE
Directo &ofEnvironmental Health
DEPARTMENT OF HEALTH'
1 Geneva Road, Brewster, New York 10509
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ADDITION APPLICATION RESIDENTIAL ONLY
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STREET S o 1 TOWN �c, Arn AX MAP#�� pia
NAME aci h 'Dr I lO LZ S PHONE $4 6 -& A",;lCt aPCHD# , ` I ' Li 7
MAILING
ADDRESS 53
i'QCiX fTF � vu�
DESCRIPTION OF
ADDITION �Pa9 /laSb,�rr
77
6-AB)
NUMBER OF EXISTING BEDROOMS c� PROPOSED # OF BEDROOMS
(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., 1 Geneva Rd,
Brewster, NY 10509, Phone:, (845) 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)
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 locations 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 Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
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LOT �5 r
r ,y`;: ? ;To n' LOT 54 LOT
53 /
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s'I,—. e o, w 52
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S7, R i'EY OF PROPERTY
PREPARED, FOR
1VMICHEAL A. PRINCE o i
LOT 69 ,." d•° rb �, o
SUSAN P. PRINCE ��- ° W 9•I0F f� L��i ,o
PROPERTY SITUA TE IN
TO TrAT OF PUTNAM VALLEY m -� �«• LOT �> .
CO UNT Y OF PUTNAM w =
STA TE OF NEW YORK
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SCALE. I- = X G �%; ��eee&4 a�). \ 2 :5s' .en e1 0 o i
t r�a1' w..as• . 1 1
,.,ter NO N O A
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DATE DECEMBER, 21, 1998 n
n, 5
53 °1:i 'O(1" 1F'�'e r r� `f O zn
Certified, as noted ;iad limited below, only to: FjO�7�'10 EI s ot�r, d}
MICHAEL A. rY SUSAN P. PRINCE 118; y p` 0' -�i; 0 07. Sa
- TIMELY 77TLE SERNCES, I.M. ( Ttle No. FCP- 12581) E 1 `� r e \7 yv -
- MARINE MIDLAND MORTGAGE CORPORA 770N, ITS SUCCESSORS 56 00
AND /OR ASSIGNS - Ile
.r V,rr9 ^err
The sur e,)w's seal, signature and any certification appearing hereon /.9,
-
signify trial• to the best of his knowledge and belief. this survey was UU
prepared in accordance with the minimum standards for land surreys
as set forth in the Code of Practice adopted by the New York State
Association of Professional Land Surveyors Inc. / \ ° .'e'• e. �mvn., „ \
/ SxMr N, a.r a \
Certirrotions sholl ram only to the person for whom this surrey wos
prepared. and on his. behalf, to the title company, lending institution TOTAL AREA = 60,567 SO. FT
and governmental ar;ency listed hereon: said certifications ore not in- ( 1.3904 ACRES) \�
tended to run to additional UMe companies, lending institutions sub-
sequent owners or future contract vendees.
Only copies of the original of this survey mop marked with both this rho premises shown hereon being fonds identified as Lots 70 & 71
surveyors embossed seal and his signature in red ink shot/ be con -
Prepored by . t /• 1 - and o portion of Lot 69 as shown on a mop entitled SU80fN510N -
f sidsred as valid true topics Or ROARING BROOK LAKE, MAP -1, SECTION- C' i said mop filed in
Bailer Land sumeyin.g, P. C. 7 Underground improvements• structures, utilities o• encroachments. and. the Putnam County Clerk's Office on Jily 28, 7945 as Mop No. J06 -C.
P. O. Box 147 l any easements related thereto, ore not shown hereon unless otherwise-,
Mohopoc, New York 10541 noted '� Lot 70 and portion of Lot 69 were conveyed to Micheal A. dr Susan P.
Prince in Liber 1048• Pogo 17 of deeds. • Lot 71, lands formerly of
Unwthorired olle/o6on or addition to o survey mop hearing o licensed 1 Lieberman as per Liber 457, Page 387, has reputedly been conveyed
r land surveyor's seal is o violation of Section 7208 Sub - Division 1 of by the County of Putnam to Prince. No deed of record conveymg _
Phone: (914) 621 -8.562 ' Ro6Rrr.. a4xim P.LS the New York State Education Low. sokt Lot 71 to Prince was furnished of the time of this survey.
N.`S tic No 494J4
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�- TOWN OF PUTNAM VALLEY
OFFICE OF BUILDING & ZONING
265 Oseawana Lake Road
Putnam Valley, NY 10579
AM, MENDED CERTIFICATE OF COMPLIANCE
Certificate No: 2011 -97 Date of Issue: 6/10/2011
Permit No: 2007 -5.1.1
Tax Map No: 41.- 10 -2 -42
Location: 53 Atbutus_St
Parcel Owner : - Billows Joan'
53 Arbutus St
Pifnam Valley NY l'6579'
4 ;,..
A_ DDMON 1ST FL (280 SF), AND REAR DECK (201 SF):.
TO REMAIN AS T ikkC —B DROOMS.
a ED 1!0 14/13,.
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rs 4 xF
_..- .Thy applicant havmg heretofore i
Code, the Uniform Building A Eii
Putnam County, NY, having paid;
ascertained that improvement off
aforemenrtoned; that the said'.
that the premises have now been'i
Now, therefore, the Certificate of
VALLEY.
stion ihWdii g permit pursuant to the Town Code, Sanitary
the.Y avvs m,ffect,in =the TOWN OF PUTNA1v1 VALLEY,
%:therefor and th''e undersigned having by personal inspection
structure is tn�compiiance antl the requirements of the laws as
als me�t�every requirement of thelaws as aforementioned; and
ted =and are:ready for'oceupancypursuant lathe - provisions of law.
is hereby issued under the, seal of the TOWN OF PUTNAM
TOWN"OF PUTNAM VALLEY
BY z�A
Code Enforcement Officer