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62.18 -1 -20
BOX 25
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BRUCE R FOLEY
Jennifer Yard
66 Columbus Ave.
Putnam Valley NY 10579
Dear Ms. Yard:
LORETTA MOLINARI R.N., M.S.N.
Public .Y;ss,h- Di; Liar
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 -6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
August 27, 1999
Re: Addition- Yard - Columbus Ave.
No Increases in Number of Bedrooms
(T) Putnam Valley Tax # 62.18 -1 -20
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 August 27,1999 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.
-All plumbing* music be updated with water-saving devices, i:e., new1o,w -
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 Putnam Vallev.
If you have any questions, please contact me at your convenience.
ML:kg
cc: BI
Very truly yours,
Michael Luke
Public Health Technician
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� �►SGASED �t515f��6 poRCrj �ti
-Z FALARC,6 fftA t4W6K) JU406 ROOM
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
REMO 1t. WALt,
2 BEDROOMS
Signature at Titie Date
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
BRUCE R. FOLEY I
... A!bli,; - Maltk , re`ctbr
PROPOSED ADDITION APPLICATION (gESIDENTIAL ONLY)
STREET WWAM P46. TOWN MJ94M TX MAP #. 61.16 —1- 2.0
NAME jaiQ YA , PHONE 0" PCHD # 1k" � T
• fa fa
NUMBER OF EXISTING BE]
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
# OF BEDROOMS
*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 thus form and -the following to Putnarri-County H alth 15ept.', 4 Geneva Rd. -----
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
Feb 98
DEPARTMENT OF HEALTH
Division. Of . Environmental Health Services
4 Geneva ' Road, Brewster, New York 10509
(914) 278 -6130
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: 5• y4izo
Residence
BRUCE R. FOLEY, R.S.
Acting Public .Health Director
Tax Map G2 , IS - !- 20
Town
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS
IS NOT
in compliance Nvith Town code and the total number of bedrooms on record
is z
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER '�3 �- -A
_ V"VeC'
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Building Inspect r
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F. -�. � _ . : ;\ r_ � . s.. -. vv , r. . .e • . .. . . �.fF"a� ....a.... .. . rn v... � _ . :.:1 .:. �. r.•... . . ♦. ..• „ «., v . .. . .•.f:•t a•....aMS.iµ
PUTNAM COUNTY DEPARTMENT OF HEALTH z
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDNUDAL ADDITION/REPAIR FORM
SECTION A: GENERAL INFORMATION
Name of Project 66 6 /L,4- b, &e (T)(V)
Year of Construction
P
Size of Parcel
.TM-,g,
SECTION`B: TOPOGRAPHY (Please check all appropriate boxes)
1. L.0 1l y ORolling . ateep Slope entle Slope ❑Flat
2. ❑Evidence of wetland Clow area subject to flooding ❑Bodies of water
LJDrainage ditches URock outcrop
YES NO /
3. Property lines evident? ❑ LJ'
4. Water courses exist on, or adjacent to parcel: ❑ l�
S. Existing individual wells within 200ft of the existing SSTS? L�J ❑
SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS)
1. Physical character of existing SSTS area.
A. ❑Level Gentle Slope ❑Steep slope
B. ❑Well drained 0/moderately well drained
❑Somewhat poorly drained ❑Poorly drained
C. Area available for SSTS. (Primary & Reserve)
❑Extremely limited USomewhat limited ❑Adequate ft x ft
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.. N .r .-, _ .. fir. w •+rtT•c .. l�+ .
D. INSPECTION Date 2 7 / / Inspector
P _
\ o e% idence of failure ®Evidence of failure ®Evidence of seasonal f ilure
(Indicate North)
U HOUR
--------- - - - - -- ----- ------------------------------------------------------------ 7 -- -----------
(1) Indicate location of SSTS
A. Size and type of septic tank gallons
'Metal OConcrete nPlastic
B. Type of absorption area
1. Fields ft. 2. Pits 3. Gallies ft.
(2) Indicate setbacks, front street, backyard, and side yard dimensions
(3) Show location of well
(4) Show location of driveway
(5) Note physical features (steep slopes, rock outcrops, streams /wetlands)
SECTION E. EXISTING WATER SUPPLY
OPWS MShared well
XIMM MV
]REPAIRS ONLY: Status:
As Built Inspection Required:
19/Individual well
O'Casabove ground
ing Ubrilled ®Dua' e and
As Built Submitted:
As Built Inspection Done: Inspector:
1 61
CD
IA4046 9001A
wuo�fo FORM
28'3'
..........
Q'Tu 64,,00Ac
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PUTNAM f"WW HEALTH DEPAR'IlflWW
DIVISION OF ENVIRONMENPAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
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OWNER'S NAME l y (h (r-ea Vag,) 4 5,9 koxia 6 cote Z` PHONE
SITE LOCATION (c Co L V e,,Q of I% u c- Tip
MAILING ADDRESS P�j '7'H 6-Al L) off- c LZ V
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE �!' 7 1W -- TYPE FACILITY
�:,• 'twom Izc "0
PHONE
REGISTRATION #
Pro (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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Std /yl a Plt/f -rf 90'r C - f -1FX Tp
Proposal approved
Inspector's Signature & Title
Proposal Disapproved
roposal 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 canponents 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 �� b]ATE -7//11/6
XEM: Vbite (P HW; YeUc w (M:kn HE); Pink (An licent)
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= U.JJO t/— AI.KL�
CERTIFIED TO:
TRI —STATE ABSTRACT, INC. F 949,225P
PREMISES HEREIN SHOWN BEING
PART OF LOTS 20 AND 21 AS SHOWN
MANUFACTURERS AND TRADERS TRUST
A CERTAIN MAP ENTITLED "REVISED
SURVEY OF PROPERTY
COMPANY
MAP OF LAUREL WOOD MANOR ", SAID
MAP FILED IN THE OFFICE OF THE
PREPARED FOR
OFFICE OF THE PUTNAM COUNTY
SURVEYED: JANUARY 1 1 , 1994
CLERK EPTEMBER 11, 1922. AS
JENNIFER YARD
BROUGHT TO DATE
36.
BROUGHT TO DATE
TOWN OF PUTNAM VALLEY TAX MAP NO.
AND
62.18 -1 —20
SANDRA B LAN C 0
Certifications hereon are valid for Bank.
J S. RO M EO P C
Co. do Owners for this transaction
. t
on Certlfleatlons are not transferable
only
SITUATED IN
to subsequent bank• title co. or owner,.
CONSULT /NCENC /NEERS
All certification, hereon are valid for this
TOWN OF PUTNAM VALLEY
& L.41V0 SU1fVf'r0t?S
map and copies thereof only If sold map
1 NORTHRIDGE ROAD
or copies bear the Impressed Seal of the
Surveyor whose signature appears hereon.
COUNTY OF PUTNAM
PEEKSKILL, NY 10566
..It is hereby certified that this survey
STATE OF NEW YORK
(914)737-1056
was prepared in accordance with the
existing Code of Practice of Land
Surveyors by the New York State
SCALE: 1 " = 20'
Imo'
Assoclotlon of Professional Land Surveyors.
b OHN C. HOFFM41NN, L.S.
NEW YORK STATE LICENSE No. 48355
Lice ration this map by other than a
ensed Land d Surveyor Is a violation
SURVEYED AS IN POSSESSION
Encroachments below grade, If any not shown
of New York State Law.