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62.13 -2 -5
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PUTNAM COUNTY HEALTH DEPARTMENT X
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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OWNER'S NAME ")I
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SITE LOCATION (u of
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PERSON INTERVIEWED
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PCHD Canplaint # r �_
Name & Relationship (i.e, owner tenant, etc.)
DATE 1 'Z ° (o
TYPE FACILITY L e e c -k I .-y c; i 6
PROPOSED INSTALLER Ceti
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REGISTRATION #
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.
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:df's Signature &
led 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
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
MAN
Date
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(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
[, as owner, or reported agent of owner agree to the above conditions.
iIGNATURE � 'j'" TITLE 't,/!� ?�aJ�T o(� 16ATE
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SIIERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
.'Assoc'iare't.'ommissioner of Neaitli - ° - " " "-
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
` '" " "uirecror of Gnvironriientai ti"eaitn ' ` -'�
DEPARTMENT OF HEALTH � f
1 Geneva Road. Brewster, New York 10509 ' ` i [
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DDITION APPLICATION RESIDENTIAL ONLY
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STREET l cif` SId�Yc��d�J2� l! TOWN_R1LvJQJ1AX MAP #
NAME NA ,0) A S J AI M). PHONE PCHD# "J
MAILING
ADDRESS
DESCRIPTION OF
ADDITION I, DJIN 6 G I yl176IZD d-M
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NUMBER OF EXISTING BEDROOMS' off- : PROPOSED# OF BEDROOMS oZ
(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, to be
shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin
-
3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
* Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA -1)
4. Copy of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department 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
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 =1580
Law Office
BOLGER, HINZ & ZUTT, P.C.
.. r.O. Box 8
11 Oscawana Lake Road
Putnam Valley, New York 10579
(845) 528 -4410
Fax No. (845) 528 -2566
Harold W. Hinz William I Bolger
William A. Zutt (1942 -2006)
November 30, 2011
Putnam County Health Department
1 Geneva Road
Brewster, NY 10509
RE: 124 West Shore Drive
Putnam Valley, NY
Dear Sir/Madam,
I am the attorney for the Estate of Nadia Shaw and am trying to obtain Board of Health
approval for an enclosed sunporch/living room which was added to the house possibly in the
60's. Enclosed is the application, sketches, survey and bedroom count from the Putnam Valley
building department, together with a check for $100.00
We are attempting to close on the sale of this house before Christmas so anything that
can be done to expedite this would be greatly appreciated.
As the house is vacant, please address all correspondence to me at the above address and
if we need to talk, please call meat (845) 528 -4410. Thank you.
Very truly yours,
2BO R, HINZ ZUTT, P.C.
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REBECCA W111KNBERG, RN, BSN
Public Health Director
ROBERT MORRIS, PE
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December .13, 2011
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
Fax # (845) 278 -7921
Nadia Shaw
124 West Shore Drive
Putnam Valley, NY 10579
Dear Ms. Shaw:
Re: Addition- A- 155 -11
MARYELLEN ODELL
County Executive
No Increase in Number of Bedrooms
124 West Shore Drive
(T) Putnam Valley, T.M. 62.13 -2 -5
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 December 13, 2011. 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. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets,
restrictors for shower heads and faucets etc.
_4., Th s- Dep a(rocommends y 0 u contact 'Cur loc.^.:
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Existing Floor Plan-First Floor I I I I I
,I/,Z , Putnam Valley, NY 10579
TM# 62.13-2-5 +++
Name: SHAW
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= 2 feet
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34 feet
11 2.feet I I I I I I I I I I I I I I I I I I I 1 1 121 feet I I
I I I I I I I I I I Stairs to basement descend from right to left I I 110 feet I I
40 feet
1 Square = 2 feet
,HERLITA ANILER, MD9 MS, FAAP
Commissioner. of Health
LORETTAMOLINARi,RNvMSN. - -
Associaie Commissioner of Health
ROBERT J. BONDI
.County Executive
:CBE.L. INIGRRiS,.
Director ofEnvironmental Health
DEPARTMENT OF HEALTH
I Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: SHAW (Owner's Name)
Tax Map # 62.13-295
.
Address: 124 .West. Shore Drive
Town: Putnam Valley
Year Built:. 1950
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: 2
This information has been obtained from:
"Certificate of .Occupancy:`
Other:' Assessor's Files
The plans for the proposed addition are considered:
New Construction
XX Addition to existing house only
Teardown and /or re -build allowed under Town Regulations
B. j .. g Inspector ...John H. Landi Date
6. '
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
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
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