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631- 589 -8100
62.25 -1 -41
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03056
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88UCE R. FOLEY, R.S.
Acting Public Health 0 :.e:
DEPARTMENT OE HEALTH
Division Oi Environmental Health Services
Geneva Road, 6rev:5ter, Nev; York 10509
(91 4.) _278-6130
^OITION _SIDENTIAL &,I Y)
SIRE T : 8►C�U&Aa TOWN' TX D! A D r
��=�� c:�JL�Z�}/IYJ� l:.(/��ff.(� P ;O \ =J► S'Z� -6005 PCHD PERM ?T L)
a
,ILING ADDRESS
Description of Add it ion iQ X _1_ i'4jaz +a0_/1
�:u�b_r of existing bed -oc;:s 3 'ro =used number of bedrooms
from Certificate of Occupancy or
Certification from 6uildir,-: Inspector
A.ny addition which is considered a re:;uires formal approval of plans
(Construction Permit). prep ared by a Professional Engineer or Registered Architect
In accordance with aoolicable sections G-, the Putnam County Sanitary Code.
Please submit this form and the follcurl to PUTKM COUIMY HEALTH DEPARTMENT,
.' .` 4 GEN'=VA ROAD,»BREWST� ?, N'� 10509, Phonzl 275 -51.30 With ;tnz:following� information.
1. Certified Check for $100.00.
2. Sketch of ex,istiny floc- plan (all living area including basement, if any)
Non- professional drawino is acceptable.
3. Sketch of proposed floor plan. fit" r� 11
Non professional drawinE is acceptable , .)
4. Copy of survey showing well and septic location, to the best of your
-knowledge. Include date of installation if known.
Include all wells and septic systems within 200 feet of property line. Any
questions please contact this office.
5. Copy of Certificate of Occupancy from Tarn or Certification from Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
,r
I
application
` August 1995
July 1996 (Revised)
v
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9
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
March 13, 1998
Suzanne Crew
45 Hiawatha Road
Putnam Valley NY 10578
�- Re: addition - Crew, Hiawatha Road
No Increase in Number of Bedrooms
(T) Putnam Valley TM# 62.25 -1 -41
Dear %,,Ir. Crew:
R
BRUCE. R,.. FOLEY
Public Health Director
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 latest revision date of March
12, 1998 and this Department's approval stamp.
Based on"the information submitted, the above mentioned 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.
Approval is granted for sewage disposal only. 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, f
Michael Luke
ML:tn Public Health Technician
cc: BI (T)
I. .
UIIUCC It FOLCY, 1I .S.
Acting Public Mold% Uur•,:tor
DL•PARTMCNT Of HEALTH
Division Of l:nvironmcntal I-ICZ1101 Services
4 Geneva Road, Brewster, New York 10S09
(91,1) 2711 -6130
I'utnam County Dept. of Health
4 Gcneva Road
Brewster, NY 10509
RC: C'n�.� f1i411ia /�d
Residence
Wax Maur 6 12Y- 1— 1111
T 2
vO;
Gentlemen:
According to records mainlaincd by the "I•own, the above noted dwelling
IS
IS NOT.
in on )1lilllcc with To\vn code ,Ind the total numbcr of bedrooms on record
This information has beer► obtained from:
CERTIFICATE OTC OCCUPANCY:
ASSESSORS RECORD:
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Date ....:.... 5/.34 ............. .......:19....80 TOWN OF PUTNAM VALLEY 80-
. N. o 5260
Zorn District..........RL .. .................... PERMIT RECORD
Application is hereby made for ........ .. ....... IMIM SANI.TUY Permit Work to start... AT .... Q.MCE ........
Description ... 3 SEEPAGE PI TS ..... .. .............................. ............. ,........
Location of Premises — Street or Road .................... I3 .AWATFIA•. RD,, , ,TM 3.1. =2 -$ ,• ..
.. ..........................
SEC.
.... ...................... BLOCK .......................... LOT ........... ............ FRONTAGE ......... ... .... .... Depth Rear .................. ..
ACRES (other description) or number of square feet ........... ... ......................... .
SUBDIVISION NAME a IV.. E. ................ ...............................
OWNER . CQRY...CREW .................................................... ............................... ADDRESS ... RD. �k.3.,.....PUTNAM ... VALLE.Y.,. IN. .Y.. .......... ...
Dimension of Building
" Width -Depth' " ' 'Stories'.*
Type Foundation ... ............... ....................
Size & Use Each ........................
Room with Window Area .. ......
......................... ........
Sewerage Type .....
Size of Septic Tank.... . ..... ....... .
Lineal Ft. Drainage .............. .. ......
Size of Dry Wells ....
Plumbing
Description ........ ... ....... .
Well
Description ............... ................ ..........
AdditionalInformation ............. ........................................ .: ................................................. ........
:.......`...................................:....................._.... ............................... .
This application must be accompanied by a copy of surveyors map and complete .plans, specifications and all information required
by the Zoning Ordinance`'an' Sanitary Code of the Town of Putnam Valley when requested by inspector.
Fee $ ..... ..........: Estimated .................... Building Cost $
Total Livable Area 1500,...........
$ ....... 1.Q...O.Q............ Sanitary
Date Zoning Board Approval
$ ..... ............................... Plumbing
c ui„11
USE
CONST.
ROOFING
LAND
1 .Family
Wood
Wood Shingle
Paved
2 Famiily
Steel
Asb. Shingle
Dirt
Log Cabin
Brick
Tile
Oiled
Bungalow
Concrete
Metal
Swamp
Apartment
Stone
Brook
Store
FNDTNS.
INTERIOR
Lake F.
Store & Apt.
Stone
Rooms
Dams
Store & Office
Concrete
Apt. Rooms
Sw. Pools
Office
Blocks
Apt.
Ten. Courts
Gas Station
Brick
Attic Open
Garage
Piers
Attic Finished
OTHER BLDGS.
EXT. WALLS
PORCHES
Barns
BASEMENT
Wood
X Front
Shacks
Part
Brick
X Side
Cottages
Full
Brick Van.
X Rear
Bungalows
Cement Floor
—
Log
X Encl.
Electric
Finished Finished
Shingle
MISC.
-�
P� hone ^�
Garage B. In.
Comp.
Plot Plan
Furnace
Field Stone
Driveway
I e
/0/ ME No.
/0/
00
19-'
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//0/
G, ho
/01 0,9.
/ /'Of
/01(
4 or 55- ""0'
-- .00
/ / N
3F401 rV
Fa.ma 1-60 ,
-Ty
4 LOT 5)
ro
03
ft4 44
A
-qe4r,
4F?E'A OF LOT 11-4 - 4.307 s o. F'r.
AREA Op"LOTS
113 a 114 4 20,4974 37.P'7'•
/ TOTAL AREA --ma.fer 50.pr.
bo.
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8Q 0,
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SURVEY OF PROPERTY
PREPARED FOR
(,O/ZY 0 SUZAAJAJE CIZ6")
SITUATE IN THE
7-6 LO A-) 0 r- 1-U -rA)AM VA CLe/
PUTNAM COUNTY NEW YORK
SCALE n. = qO 1987
NOTES:
1. All certifications are valid for this map and Copies thereof
on%.v i!!ne said map or copies bear the impressed seal of the
487 Surveyor whose sigrialure appears hereon.
P. Alteration of this document. except by -3 licensed Land
'Jurve-vor. is '!legal.
This map and copies thereof are cemi. ;ed to the abo.e-
named owner and the title comoany and lending nsti•
7,:,o,i990 ro J lution(s; named hereon, and to those parties onty
slo-%j w,-ed,-u Acr Aj j#oJw
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SCALE I in = Y0 It tss?
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Ni)i FS '
411 ctWdicalrons die valid tot this map and copies thereol
only It the sell! lhdp Of COPIUS Dein the impressed seal of the
Surveyur whose signature appears hereon.
? Alteration of this document, except by a licensed Land
Surveyor. Is illegal
i lma maN and cupie!, lhereol are certified lu the above
narneu owner and the title company and lending msli-
tulionjsi ndmed hereon -,ind to those parties only.
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e
01Z Y S z AAAvE CIZ6U)
SITUATE IN THE
Tp cJrJ o,-- ?U T.VHH U LLt
PUTNAM COUNTY NEW YORK
SCALE I in = Y0 It tss?
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.r �... �nr +N, s ✓�.vc ra., teen :. <. a x.. ..,.. arden•, r. «i P� i .<.
Ni)i FS '
411 ctWdicalrons die valid tot this map and copies thereol
only It the sell! lhdp Of COPIUS Dein the impressed seal of the
Surveyur whose signature appears hereon.
? Alteration of this document, except by a licensed Land
Surveyor. Is illegal
i lma maN and cupie!, lhereol are certified lu the above
narneu owner and the title company and lending msli-
tulionjsi ndmed hereon -,ind to those parties only.
Y ,Orj ir) 'rY E / /y/t SNO.wu Ni tce«+ ^to, A! Jna.W
6. rAP 4✓7' 71.fa "14s'i vsz4✓ iwA FAJ7 •V° /,w
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MAY -03 -2002 00:59 LJ MARCHESE INC
}
845 446 5738 P.01/04
I
A F
U. MARONESE CNEV181.11, INC.
BODE 2-N1 PYET -OFFICE BON 1800
FORT M /Ni60NER1, NEW YORK 19922
PHO!mE [M51446.4118�
[831416 -5738
COMPINNY
A
mounflo nm CIilE1 pme
SENT BY:
_ S'
Pages?- 'lease Call
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MAY -03 -2002 01:00 LJ MARCHESE INC
845 446 5738 P.02/04
VRO)EI:Y I.D. AlUAdBEPt
NtW'VORK STATE DEPARTMENT Of ENVIRONMENTAL CONSERAT1Ord
° -.91VIS1014 OF REGULATORY AFFAIRS ^`
State Environmental Cuallty RaVIOW
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I I'mJoct Information (To be completed by Applicant or Project sponsoo
9. Wlefirillsportw
2. Project Name
&. Project lotatbre !
munklpality ® County nA 1 ey. C- :7 r
4. to prro�pposed action:
l�Jl F7�v ® i:Mpanslon NAodiricatbMesieratian
$. DeDcrtt project brieflr. .
Ia Plet ise location (road i+dtesBelioni promineNt land f. etc, er provide M
� J l-�i 1� G� A0 A 6
P 5 C.iq VJAAJA ZAl�C46AD f I4r'a-Wa e- CL— A0 A4)
9 Amount of land affected;
Initially acre$ Lrltinrately Acres
.p Will prepared action comply with esistina zoning at other existing land use sestrictionsl
® ®
Yes No It No, describe briefly o
a
o
1'
0. What Is present land use in ykinity of p►ojectl : ..
7 _ .. pgrieul[ute .. _.. ... Perlilandtopon spate
ftelid@ntia-1 " "•� Industrial �..t.ommiki7- ❑ .• Othel
�elclibe:
90. Does action involve a prrmitlapprovol, or funding. now or uitinmatrly, from any other governmental Agency (Federal, state or Wall!
0 ® list
Yes No If yes, agenct(s) and permillapprovall a
o
99 Does any aspect of 04 action have a currently valid Wthit of npptovalf of
list
Yes red No If yes, agency name and prrmiyepproval type
98. As rrnull of propond action will eaistin$ permitlappoval require modification?
El yet 0 No
I CERTIFY THAT THHE IN�FORMATION PROVIDED ABOVE IS TRUF TO THE 515T EST OF My KKOWLEOGE
A alln � Date:
AppfieanNspenser names _
Signature:
0
IB Rho action Is In the Coastal Ares,, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
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SURVEY OF PROPERTY
PREPARED FOR
C olt i S.0 ZAE C (46W
SITUATE IN THE
PUTNAM COUNTY NEW YORK
SCALE 1 in. `/a ft. 1937
M k. GORR the surveyor who made.this map, certify NOTES:
aurvey shown hereon was completed byme on 1. All certifications are valid for this map and copies
1942' 'A hat this map was completed by me only it the said map or cop /es bear the Impressed so
,us ✓cr3,�.e ar±',
.1987 surveyor whose signature appears hereon.
,this.survoy has boon propared in accordance with the 2. Alteration of this document, except by a licensed L
Code of Practice for Land •Survoys adopted by The New Surveyor, is illegal.
3..rhis map and copies thereof are certitied to the ab
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ReWserp UL.1" a a9,1sso To. lution(s) named hereon; and to those parties only.
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pUTNAM COUN'I"Y .
ENVIRONMENTAL HEALTH
1 GENEVA ROAD
BREWSTER, NEW YORK 10509.
Pone: 1- 845 -278 -6130
Fax: 1-845-278-7921
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