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61.-2-17
BOX 23
02707
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02707
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF �1�tY-IRONMENTAL HEALTH SERVICES
PERMIT # q0 � d
Located at 227 Canopus Hollow Road own or Village Putnam Valley
Subdivision name
Date Subdivision Approved
Subd. Lot # - Tax Map 61.- Block 2 Lot 17
Renewal Revision
Owner /Applicant Name M A R I U S & L O U I S A F L O R E A Date of Previous Approval
Mailing Address 227 Canopus Hollow Road, Putnam Valley, NY
Amount of Fee Enclosed $300.00
10579
Zip-
Building Type I F a m. R e s i d. Lot Area 10.1 No. of Bedrooms 6 Design Flow GPD 9 0 0
acres
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
LAIJIiNU - I,UUU T
Separate Sewerage System to consist of NEW- 1,000 gallon septic tank and EXISTING 429 L . F . x 2 4'
wide leaching Trenches + 429 L.F. x 24" WIDE leaching trenches (NEW)
Other Requirements
To be constructed by
Water Supply:
To Be Determined Address
Public Supply From
Address
;c d iii _ S-T 1 N G -
a ,.�V .r�. a _r, eS s_
I represent that I am wholly and completely responsible for the design and
separate sewage treatments sy tem described above will be constructed
accordance with the standards, rules and regulations of the Putna
thereof a "Certificate of Construction Compliance" satisfactory oQ e�
Department, and a written guarantee will be furnished the owns �s
builder will place in good operatinzoondition any p of said s
immediately following the d the ijAance of the.�al o e. ert �
oar
TMR r,?P�Q
system or any
Signed: T H
ORS L. STRA
P.E.
of the proposed system(s) and that the
approved amendment thereto and in
f Health, and that on completion
rector will be submitted to the
p or ssigns. by the builder, that said
ing the period of two (2) years
on Compliance of the original
•h
Date 6/21/01
Address 61 Mnore Avenue, Mt. Kisco, NY 10549 License# 8129
APPROVED FOR CONSTRUCTION:. 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. ApprquedJor discharge of domestic sanitary sewage only.
Date:
Title: S
By: �
rte copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Desig Professional
Form CP -97
BRUCE R. FOLEY
_ LORE'1TA M.OLINARI R.N.,..M.S N.
ssociate Public Heahh Director
A
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 ONLYI
STREET CA"PlPf AU-00
f MAP.9
.
k^ r r
TTMRF.R 0F.MaSTING BEDROOMS PROPOSED # OF BEDROOMS
N
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUU DING 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.
Pfease subrmt taus form and t6flowing "to 1'ufifi m Couffy -Tiea all Dept.; 4 verieva Road; Bf&w tdf, `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 4)
*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
LORETTA MOLWARI RN., M S.N.
Director of Patient Services
DEPARTMENT OF HEALTH
I Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845)278 - 192 1
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:
Residence
Tax Map —4--
Town a Nm Itiazi
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS X
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
BFhouseguidelines
"7131 dto
Building Inspector