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03061
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03061
PUTNAM COUNTY HEALTH DEPARTMENTS '�'�" INC t
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DIVISION OF ENVIRONMENTAL HEALTH SERVICES rSO v g PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
YES' NO // Internal Use Only
❑ Q 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 15- 41 A W rk� H ,4 K 9 TM # OWNERS NAME ALPRE 0 4 64iz i L& psu-f*t PHONE # 526 r-38ol-
MAILING ADDRESS T/Y0&1 U i4 L L��i
APPLICANT 94WA120 G gA c rut!
Name & Relationship (i.e., owner, tenant, contractor)
DATE 3 1 1-0 0 iv . FACILITY TYPE LZ PCHD COMPLAINT #
PROPOSED INSTALLER ,4. 6 6 F-.2 i PHONE # $-F r-
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ADDRESS u 'TN /}`k L/K LL < /Nt-f • REGISTRATION /LICENSE # G ( 3
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.
Different location and proposed pump systems will require submittal of proposal from licensed professional
engineer or registered architect. r5'�C �Tc+( A ?Th< N Iz 0
Zn _ R"La r F SIT E& (- '1'4 N k wlNt&/ /,,ISO AA L 4S.4 y
I, as owner, or re orted agent of o ner agree to the conditions stated on this form
SIGNATURE TITLE 14,61pw
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owners 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
3. System repair to be performed in acco ce with the
above proposal and conditions.
31peccctors sa;Ap�p,roved Proposal Denied
- mix. 3
Signature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
DATE 2ll
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
r LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
January 12, 2006
Gloria LaPolla
15 Hiawatha Road
Putnam Valley, NY 10579
Dear Ms. LaPolla:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re
ROBERT J. BONDI
County Executive
Addition — Approval - LaPolla
No Increase in Number of Bedrooms
15 Hiawatha Road
(T) Putnam Valley, T.M. 1 62.26 -1 -12
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 January 11, 2006. The. addition is approved with the following
conditions:
1. 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.
_:.�•: —All' �1lirr11�1n�T ijxi� rl'� ,nliwo� l,e,��'af� 1 i t io }ar `:Y R �+�ac �.' o . 1 -
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toilets, restrictors for shower heads and faucets etc.).
4. Please be advised that the approval doesn't in any way grant approval for multi - family
use or the accessory apartment. The approval has been granted because the total number
of potential bedrooms is four including the two kitchens.
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 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 meat your convenience
Very truly y urs,
Joseph S. Paravati Jr.
Assistant Public Health Engineer
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cc: Building Inspector, (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
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PUTNAM COUNTY DEPAIRTkIENT OF WEALTH
HOUSE PIAN;i :'Wrl"ROVED FOR' BEDIZZ01,31d Cou,TT ON
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ALL SUBSEQUIL'-1,al-;" -j!qikLTEl-IA"J"()l\TS TO THFSE I-IOUSE
PLANS MUST BE SUP, 71111j"I'll"D TO THE PCI)OH FOR APPROVAL
VURE & TITLE DA.
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY,
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ALL SUBSEQUENT ITIEVISIONIALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBT-dITTED TO THE PCDOH FOR APPROVAL
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY,
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ALL SUBSEQUENT ITIEVISIONIALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBT-dITTED 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
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ADDITION APPLICATION RESIDENTIAL ONLY
STREET TOWN n. TAX MAP #� '
NAME00f M t o ! c 11 A PRONE S'= l4. 3 ' PCHD#A v3Y) rtj
MAILING
ADDRESS
IDESCRIIPTION OF
ADDITION
NUMBER OF EXISTING BEDROOMS V 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.
k -
Please submit this f,)rw- and the following to_Putpar County Health Dept., 1 Geneva Rd.
Brewster, NY 1O5U9, Phone: ($45) x78= 613U.r"
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
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648
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SHERLITA AMLER, MD, MS, VAAP
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: pw
Residence
ROBERT J. BONDI
County.- Executive
TAX MAP# &
TOWN PUT �r► V �.� �,
According to records maintained by the Town, the above noted dwelling,
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IS NOT IN COMPLIANCE WITH TOWN CODE
LEGAL BEDROOM COUNT IS `7
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
OTHER: 4-'9& E s S m X! S I t_
Building Inspector
Date
CERT'IF'ICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
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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
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SHERLITA AMLER, MD, MS, FAAP
Commissioner. of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
December 20, 2005
Gloria LaPolla
15. Hiawatha Road
Ptnam Valley, NY 10579
Dear Ms. LaPolla:
DEPARTMENT OF .HEALTH
1 Geneva: Road,. Brewster, New York 10509
Re: Addition — LaPolla
15 Hiawatha Road
(T) Putnam Valley, T.M. 62.26 -1 -12
ROBERTJ. BONDI
County Executive
I have received and reviewed the plans for the proposed* addition to the above - mentioned residence.
Based on the information submitted, the above mentioned addition cannot be approved for the
following reasons:
1. The proposed addition can't be approved because the existing accessory apartment
constitutes a change of use, that is, the house is now a multiple family house, not a single
family residence. Since this arrangement was never approved by this Department, any
_ .. .addition nroposed. would have to account for the acces,5nry..abpartrlent.
"
2'.- The legai bedroom count-Or the dwelling"is four. Thh potential bedroom count of9your - -�
proposed addition is six.
3. The addition of a potential bedroom(s) requires this Department's approval.of a revised
septic system plan from a professional engineer.
Please revise the proposed floor plan to reflect no more than four potential bedrooms or have a
professional engineer or registered architect design a sub - surface sewage treatment system meeting
present code requirements.
If you have any questions, please contact me at your convenience.
JP:cw
Sincerely,
los'eph S. Paravati Jr.
Assistant Public Health Engineer
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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