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HomeMy WebLinkAbout3072DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.26 -1-45 BOX 25 03072 .� `. 6t I `l EN L r I on ■' 71' . - ' ' "'i ' ■ 03072 P AM CQ DEPARTMENT OF HEALTH `. 3 f En ­ UNTY� s ono vtro I imen 12, ' 3 IC GF. IS 4-­�. Z" .;,Town or N P —Bloch Lot 17. T - T"! at 0. t 7' S, loot wDer APp Name # ry, ­p :�Q_ 0 P 7ti' iz- t, Pe t_js Date' id V, �{p'AJQ RS bot Address Pirate 7FOrage System 7711 n T, Water S L 0 %b ,, I k Silo V; _;;.LPubffC , !Ipl, , JY'Fr6161 Ad&m private. So Control Bees a d! M -7= '3 Has Garbage Grin ja�: ledY ­Miiiber of Be&66 to a. serving y .0 certify that the syst i� lisi�d,sery the above :Premise#:.�!�rs­ construct .�q": on the r plans of the completed,work with the ac rd a filed plan, lards; and r Abe P a and the permit issu the ssu� of-w4Wi.ari attached) and in accordance I I , "Cd6n Health C q&F -R.A A . ddress /\% 'License 149. V parson PccUpylr served 6� ths'�bdve i�s6W(Q �shijI:.�ror6`ptIy',;a.kq,wch Action as maybe n"Siry 9 0 1 t secure the co�rectlon. of y.un�anitary Py' yrern so$ so unitaij ewer, beconm ;Approval ��of; stern. shill e null.and.461d'as on'ii rt Iic WPOIj ifi6rrkei -.:�:Utii iii6rovals are &I of 0", ul F n "* ava11ab1e.anC a APPT �00,�AUPPIIY �! -1 t t of ch: 6 or.,c A'Age,When in - Ine'l udgrnen 0 o6j" modification nan 7It la YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #.' 32.406568 CLIENT #3 4893 NON STAT PROC PAGE I ---------- 11 -1--- --NIL I ------- I-- -------- -------------------------I4.----NN------- HONORS, TIM DATE/TIME TAKENS 04/20/95 07030 1180 MIDLAND AVE APT 2A DATE/TIME REC'Ds 04/20/95 15 45 SRONXVILLE, NY 10708 REPORT DATE: 04/25/95 PHONE: (914)-779-6837 SAMPI-ING, SITEIR 47 WENOAH RD OUTSIDE SPIGOT SAMPLE TYPE...s POTABLE PUTNAM VALLEY, NY PRESERYATIVESS NONE COLD BY9 TIM HONORS -TEMPERATURE ..s < 4C NOTES...9 COLIFORM METHS. MF --------------------------------------- --------------------------------------- DATE FLAG PROCEDURE RESULT NORMAL – RANGE 04/21/95 MFT. COLIFORM ABSENT /1,00 ML ABSENT COMMENTS00 RACT THESE RESULTS INDICATE THAT-THE WAT WAS ,(WAS NOT) OF A SATISFACTORY SANITARY DUAL ITY ACCOR'rTN!!3 O)THE NEW YORK STATE AND EPA FEDERAL. DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME 00 COLLECTION. SUBMITTED –w – -------------- — Albert H. Padovani7 M.T.(ASCP) Director ELAP# 10323 PRII'NAM COWN DEPAI -,`f FNT OF f11 ?J1I,N-1 DMSION OF ENVIRONMaTAL HEALTH SERVICES _ i x �.`o'nv.:.. a -:gym; - .�o.'a:p�- :k,:- °. � .:•:��-r: - =.. -. - ...co,a. _, - _ _�_a� .....:; -�: �:�:;::r�:.�.- -.r:s;o ..•+�..:;::a+� ...y:; 5.;.::::s� •... - ='- w�.ee:c..::.��.�..'.:d.: +.. Owner or Purchaser of.Building Section Block Lot Building Constructed by E�00 OA H �D Location - Street. J Sut�iivision Name Municipality Subdivision Lot # Building Type GUARANrEC OF SUBSURFACE: SO AGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two y ars inniediately following the date of approval of the " Certificate .o. - ,Construction. Compliance" .for the savage d.i51?osal system, or any .__..__.o.Ye� all "5 "u 'eVLy'Ii� CU Silt.'ii �y5f tiiij- except wile:te "t;" i fciii ie ""IE0 caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the Director of the Division of E:nvironinental Health Services Department of 11calth as to whether or not the failure of the caused by the the sysLau. willful or negligent act of the occupant of th e Dated this day of S— 191 Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) '1 ?ce, v.y ;1 \Y N UN, rev. 9/85 mk the determination of of the Putnam County system to operate was building utilizing Corporation Name (if Corp.) Address j @►0Tl. WGLL UVrlrLGiiV" Az-rvaL DEPARTMENT. OF HEALTH �_.ce: � •[u,�'y�.. ..s� .�...:.. e..r.. -: •.. ,t r L a �,y'� -.- ..... �!Y3:. w_1:.` >S Mme... .6 :v, -a.,. _. va. Cw.- ..v ias:._• PUTNAM 'COUNTY DEPARTMENT OF HEALTH Office Use Only c.:: �• a.: �.. y�:. :aa��ii.w+a- .•n.k..c.- ...-.. r.. -. _..._.... WELL LOCATION STREET AOURESS: '11WNIVILUIC17CRY TAX GRID NUMBER: I f 416 WELL OWNER NAME: ADD S: ' / 7; i» 4- c k 47 /6zd Q- PtIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary 8�ESIDENTIAL U P BLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED SINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S� gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE .gal. REASON FOR DRILLING ❑ PLACE EXISTING SUPPLY ❑ []ADDITIONAL ADDITIONAL SUPPLY (EW SUPPLY (NEW DWELLING) . []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 3 Lfy ft STATIC WATER LEVEL 30 ft. DATE MEASURED a DRILLING EQUIPMENT OTARY ❑ COMPRESSED AIR. PERCUSSION ❑ DUG ❑ WELL POINT. ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED U- PEN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASI NG DETAILS TOTAL LENGTH _ a! ft- MATERIALS: ta-STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE ,5 ft. - JOINTS: ❑ WELDED THREADED ❑ OTHER DIAMETER in. SEAL: QICEMENT GROUT ❑BENTONITE ❑OTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE: ❑ YES LINER: 0 YES �Ne SCREEN DETAILS I DIAMETER (in) 7SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 YES ONO SECOND GRAVEL PACK O YES 0 NO GRAVEL SIZE DIAMETER OF PACK In. TOP DEPTH -ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: O PUMPED tests were done is in- QOMPRESSED AIR , formation attached? O. BAILED O OTHER ; ❑ YES 0 NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- mete FORMATION OESCRIPnON COE ft. WELL DEPTH ft. DURATION hr. min. DRAWDOWN It. YIELD gpm. Surface WATER O CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE CAPACITY GAT.. WELL DRILLER NAME DATE ADORES i" o Y� 6t ,r t& i1��S lIG" �l +� C) �� ��A (A MiI !V� PUMP INFORMATION TYPE - n�� : �tiQ �'' - CAPACITY MAKER - r i t ,1 t 41 s DEPTH 3 v 6 MODEL VOLTAGES , HP NOV ,:"00,e,M C�. WbLL UUr1rLL11VD4 Mr?"Al DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH 'Office Use Only WELL L,0CATIQN V. STREET ADDRESS: TDWN/ ILLAQ1 lCIIy TAX GRID NU&ISER: �q 16 n10 6/1" A, XlZI /oS- /4 p WELL.OWNER. NAME: AOOR S: 7i Ph et� 4- kn"l L L k q17 L,2�, ;1 O'k JJ[��-PBIVATE 0 P 8 LIC U USE OF WELI ' ;secondary; RfESIDENTIAL ❑ SUPPLY 0 AIR/CONO./HEAT PUMP 0 ABANDONED BUSINESS USINESS 0 FARM ❑ TEST /OBSERVATION 0 OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND BY 0 MOUNT WUSIE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING: ! CIR/EPLACE EXISTING SUPPLY ❑TEST/OBSERVIATION ❑ADDITIONAL SUPPLY EW SUPPLY (NEW JY,4ELLING) ❑DEEPEN EXISTING WELL DEPTH DATA . 3 �v WELL DEPTH ft. [STATIC WATER LEVEL. ��ft. DATE MEASURED ,,kQQIPMENT!.. 040TARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): E. PEo­ ❑ SCREENED U16PEN END CASING ❑ OPEN HOLE IN BEDROCK 0 OTHER i ;CASING PET. ILS TOTAL L� NGTH ft- MATERIALS: Q-STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE ` ,5 ft. JorffS: ❑ WELDED E),THREADED 0 OTHER in. DIAMETER SEAL: RfEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT Ib./ft. I DR!VE SHOE. 0 YES CLW"j' LI ER: 0 YES NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (it) DEVELOPED? FIRST 0 YES ONO SECOND G AVEL PACK 0 YES 0 NO GRAVEL SIZE. DIAMETER OF PACK —in. TOP DEPTH ft. BOTTOM Dm — ft. WELL YIELD TEST .1 It detailed pumping (k�l METHO PUMPED 1 tests were done is in- 0, 60MP AiSSED AIR 1 formation attached? 0:'EIAILEO'� 0 OTHER IOYES ONO .11 more de-,ailed formation descriptions or sieve analyses WELL LOG if availj fe, please attach. DEPTH FROM SURFACE water ing We " Dia M. in FbAMA'nON DESCRIPTION CODE it. WELL OEM , , DURATION hr. min. DRAWDOWN It. YIELD Land surlace J, .5 3 C) WATER CLEAR TEMP. W I QA UA QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 No STORAGE TANK: TYPE CAPACITY GAS.. WELL DRILLER NAME A ADORES i Vor C) b's (41 PUMP INFORMATION I TYPE . �."Vloz CAPACITY MAKER r_uA POS DEPTH 3 o 5 Moo MODEL VOLTAGE2,-h— HP _�zz s' (FM. N71040'W) BO. N"W $ g 7 . ,. It I _$ iP Po— µ n_ u- µ, 0 12 ti 0 0 b O w q ro U b w ul sp a e . A r 0 s O s I 4 I � 1 s � 2 O. 3 4 I _$ iP Po— µ n_ u- µ, 0 12 ti 0 0 b O w q ro U b w ul sp a e . A r 0 s O s I 4 I � 1 s � 2 0 f� 25.7 M O n m' This is to certify that the sewage disposal system we o constructed as indicated on this plan and . that tt system was inspected by me before it was cove ed over. The system was constructed in accordanc with all the rules and regulations of the Putnam Cou ty Department of Health. m. 1 <1<0"F gA � O�RII 4Q� @i FREDERICK A. ZENZ i \ 292 MAIN ST. NELSONVILLE, N.Y. 1051 �2s s No ,e. O SEPARATION DISTANCES /IV FEET I 1813 • a 61710*1*11djaltalal 14 113 it Iff In to ao y • so 24 s6 g1h'K ;Q5 63 68 13 S9 4 "r 53• S1 63 t, 72 o ., - . ..�... ' 45' 3 3b 6i ; i2 77 81~ 28 96 4t 46 53 59 6s 71 li t1 AS BUILT SURVEY BY BADEY 8 WATSON. L.S. u e. �m � p � e I' e f I W me I , f � 4 i Putnam County Department of Realth Division of Environmental !Rea lth Services Approved as noted for conformance with 8pp1, •e Rules and Regulations of the Coun jeaa�l�thh Department. _ Signature k Title Da o AS —BUILT SEPTIC PLAN prepared for HONORS RESIDENCE WENONAH ROAD SCALE: 1".30' TOWN OF PUTNAM VALLEY 5/10/95 PUTNAM COUNTY, N.Y. M • 62.26 B 1 L 45 C� O �• N YI 'E - 0) :0. Y C � ' N � O 0 f� 25.7 M O n m' This is to certify that the sewage disposal system we o constructed as indicated on this plan and . that tt system was inspected by me before it was cove ed over. The system was constructed in accordanc with all the rules and regulations of the Putnam Cou ty Department of Health. m. 1 <1<0"F gA � O�RII 4Q� @i FREDERICK A. ZENZ i \ 292 MAIN ST. NELSONVILLE, N.Y. 1051 �2s s No ,e. O SEPARATION DISTANCES /IV FEET I 1813 • a 61710*1*11djaltalal 14 113 it Iff In to ao y • so 24 s6 g1h'K ;Q5 63 68 13 S9 4 "r 53• S1 63 t, 72 o ., - . ..�... ' 45' 3 3b 6i ; i2 77 81~ 28 96 4t 46 53 59 6s 71 li t1 AS BUILT SURVEY BY BADEY 8 WATSON. L.S. u e. �m � p � e I' e f I W me I , f � 4 i Putnam County Department of Realth Division of Environmental !Rea lth Services Approved as noted for conformance with 8pp1, •e Rules and Regulations of the Coun jeaa�l�thh Department. _ Signature k Title Da o AS —BUILT SEPTIC PLAN prepared for HONORS RESIDENCE WENONAH ROAD SCALE: 1".30' TOWN OF PUTNAM VALLEY 5/10/95 PUTNAM COUNTY, N.Y. M • 62.26 B 1 L 45 W1 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 +� iehlk !Yeakh •Dircc nr PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) STREET \4,1 e,n0 A(A SO— TOWN 4A, MAP NAME , \44 i A 1. PHON � IPCHD # MAILING ADDRESS DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS 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. lease submit this form and the following to Putnam County Health Dept., 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 #) 'Y * 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 - . if ..r _ - s... .. . .. .. . �.� w � .�......p •Y . • N.. i -. v...n --.. . Meryl Kubrick 49 Wenonah Road Putnam Valley NY Dear Mr. Kubrick: DEPAR.TNMNT OF BEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 19, 1998 10579 Re: Addition - Kubrick, Wenonah Road Increase in Number of Bedrooms (T) Putnam Valley, TM# 62.26 -1 -45 BRUCE R. FOLEY 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 November 19, 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. _..:... _ _.._ ....:...:. .. . The afea -u 't ie existing sewage ` dispo -sai 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. 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, William Hedges Sr. Public Health Sanitarian WH:tn cc: BI (T) 0 ;�. � +.a •s�.,.v .`.ter .o- ..+.r =� ,.,am.'n . . �. ..n•Lr. - � ._. _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project �/ 7 m, v ,,&4 d (T)(V) e. V ' TM# Year of Construction Size of ParcelTC( SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Milly ORolling ❑Steep Slope ❑Gentle Slope DFlat 2. ❑Evidence of wetland Clow area subject to flooding ❑Bodies of water ODrainage ditches ORock outcrop XES. � 3. Property lines evident? 4-. Water-couises exist'bn, or adjacent*to parcel 5. Existing individual wells within 200ft of the existing SSTS? �'. ❑ SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. ULevel ❑Gentle Sloe ❑P Stec slope ' P P e B. ❑Well drained Moderately well drained ❑Somewhat poorly drained OPoorly drained C. Area available for SSTS. (Primary & Reserve) ®Extremely limited 01slomewhat limited ❑Adequate ft x ft N Z7D, ,e-. .. .e• .c+.: r r. . r L .a �.! a --e'a^: Y' 3 . i K .a W.e.c.v.rt i �— . .- ..e..- ..e A• v ..• • - .�_f.p s. +a�:rC^•.. .'C sC.r �.0 D. INSPECTION Date Y . Inspector 3No evidence of failure ®Evidence of failure ®Evidence of seasonal failure. N 5 H V --------------------=---------------------=-------- - - - - -- ;­ -------------------------:----- (Indicate North) v Y HOUSE 1 15) J, I f r sx ------------=----------------------------------------------------------------------------- - - - - -- (1) Indicate location of SSTS . A. Size and type of septic tank gallons Metal OConcrete ®Plastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. — ictdivate setbadks,- frbnt'stieef "ff( ar-d -and side and dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams/wetlands) SEC'T'ION E. EXISTING NVATER SUPPLY [jPWS []Shared well Mdividual well [)Drilled 171Dug [lasing abo-ve ground COMMENTS e-, vG REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection Done: Inspector: (nrldrPn) -INK, IL % 1 40- VW t --Ain ewe "I I M C+ 9 CD RO Ci. pi A + kRm;ow- X _C\N 62,2-6 — I - ys M 0 ::a C/I O co, En z H 0 0.0 C: z �a -3 t-I 0 K C7 e m z *-3 0 62,2-6 — I - ys 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 Gentlemen: BRUCE R. FOLEY, R.S. Acting Public Health Director Re:. I 1 16 Residence A V - Tax Map Town Ir According to records maintained by the Town, the above noted dwelling 0 IS NOT in compliance-with o,"m code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER '�YcJS Building Inspector cx lial vo *1 fi �: anw, 1q i :i .y i� t. i; �r •iK r r r Q` r 6 { �s /�o o kv� r,% } 711{ : t i f a T-7 -7 El L Q` r 6 { �s /�o o kv� r,% } 711{ : t i .92K Iwo. OM two. W Vl CON sm 3 C� m LIS, )-k-A il".. pro Poe -tea • �,� �t- �C t`w� »N \� �Sa F'7�''�M 4,f •S r1 ° •. '� Ai,�. � _ !t 4 }•,•• �� ids : r ;ice � �� ' � Wes" - o-- � .N•���• .O a r `�+p� � ;4y� ter' --• �i('�•�• � :f1 j 1 w, l _ _. � - - za -•+tea _ 'y _ t+ -+4rf�b i . ° � `y ;'S ' i f c, r ��.;: * `ti, •,. t., r- a��yp� �,� ^t '� ^A „- •.r,�._..,y r � fe .,.stir k� _ '`yy$��;j.ertt'r.4 °• � �� Y� 'r ate'^ `' r r;+ w ,� �r � �. � +ri- `� 'F.•'�I^.i�,% / F x �' �'L''� i R ", MENEM �,� �t- �C t`w� »N \� �Sa F'7�''�M 4,f •S r1 ° •. '� Ai,�. � _ !t 4 }•,•• �� ids : r ;ice � �� ' � Wes" - o-- � .N•���• .O a r `�+p� � ;4y� ter' --• �i('�•�• � :f1 j 1 w, l _ _. � - - za -•+tea _ 'y _ t+ -+4rf�b i . ° � `y ;'S ' i f c, r ��.;: * `ti, •,. t., r- a��yp� �,� ^t '� ^A „- •.r,�._..,y r � fe .,.stir k� _ '`yy$��;j.ertt'r.4 °• � �� d SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . v � r .a •.:.d.4L. T .r. c.O+t v.J "hpca w_.yye�_.+se[. rc�..r -._ - lY LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive `-+r_ �. .0 V.T.•. T..a:fT+ � .ni Ya ... _. T .. •vwa..wa 1 . .. � • � ..r . .. .r ...r tti DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 41'? Wen.On-A U 2O TOWN wft , Va-h TAX MAP# O 44 NAME ,`m I&ot;5 PHONEVr,�Q& 3S�a PCHD #_ MAILING ADDRESS DESCRIPTION OF m ADDITION ADt) S"C fey n : Wig�4WS NUMBER OF EXISTING BEDROOMS_PROPOSED # OF BEDROOMS A_ Aw c' (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, B ffWsi:ef,- N`Y °-10-50 9; PhUnc:'(a453)"2 °'o =5 30 . 1. _Cert><fied check or money order for 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 r SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN . Associate Commissioner of Health PUTNAM COUNTY DEPT I GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York .10509 OF HEALTH Re: Residence TAX MAP# TOWN According to records maintained by the Town, the above noted dwelling, ROBERT J. BONDI County Executive. IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Building Inspector. Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225-5186 Fax (845) 225-5418 lm 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 SHERLITA AMLER, MD, NIS�FAA,P ° ` "" oirimissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 15, 2005 Tim Honors 47 Wenorah Road Putnam Valley, NY 10579 Dear Mr. Honors: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI county zecutive .,,. Addition — Approval - Honors No Increase in Number of Bedrooms 47 Wenorah Road (T) Putnam Valley, T.M. 62.26 -1 -45 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 September 15, 2005. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval.by this Department. 1 _The-area of the existing se gage d spos4l.$);steziR and its expansion area.must.be..___ - - maintained. 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. T obert ly yo Morris, PE Senior Public Health Engineer RM:cw cc: Building Inspector, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 Nx 7> J. 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