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62.71 -1 -1
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMEWrAL HEALTH SERVICES
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PROPOSAL FOR SE91GE DISPOSAL SYSTEM REPAIR
PHONE
SITE I=TION . �ri ,�,n �v �� 7M _ 19 4
MAILING ADDRESS
PERSON INTER nEWED PCHD Camplaint #
Name &.Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER PHONE
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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Proposal Disapproved
Date
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. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g.,.1250 gala concrete septic tank, three precast 6' diam. 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 own or the above conditions.
SIGNNTEJRE TITLE.
PIES: ftte (PQHD); YeUcw (Tvm BD); Pink (A 2iamt)
�Z� plete Site Development P.O. Box 226
Shrub Oak
New York 10588
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PUTNAM CONTRACTING
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PUTNAM COUNTY DEPARTMENT OF HE&TH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY,
BEDROOMS
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Signature & e
Date
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY, 1
-2—BEDROOMS
Signature & Title Date
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LORETTA MOLINARI R.N., M.S.N.
Acting Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
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
Jason Hallock
23 Shawnee Rd.
Putnam Valley, NY 10579
Dear Mr. Hallock:
ROBERT J. BONDI
County Executive
June 27, 2003
Re: Addition - Hallock, Shawnee Rd.
No Increase in Number of Bedrooms
(T)Putnam Valley, TM #62.71 -1 -1
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 June 26, 2003. The addition is approved with the following conditions.
1. The total number of bedrooms must remain at two without prior approval by this
iPriprtment:
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.
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,
Michael Luke
ML:lm Public Health Technician
cc:BI
of
BRUCE R.. FOL EY
Public Health Director
- L Rt:ih' rviili.iTiARI
Actociate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (94S)279-6130 Fax(84S)278-Ml
Nursing Services (845) 278.6558 WIC (945)278-6678 Fax(845)278-6085
Early intervention (945)279-6014 Preschool (845) 278 -6082 Far (845) 278.6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
1. Of LUOrk PHONE OPCHD# A, w:
MAILING ADDRESS
DESCRIPTION OF
5-79
Sprxce,
NUiaER OF EXISTING BEDROOMS_ PROPOSED # OF BEDROOMS Mot' e i,,•�,.s� �J
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BU1I DING 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., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified check or money order for $100.00. .
41 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 #1)
•Non - professional sketches are acceptable.
t� 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.
Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
Whousepidelines
FOLEY � LORETTA MOLINARI RN., M.S.N.
Director
Director of Patient Services
DEPARTMENT OF HEALTH
I Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intcrvention (845)279-6014 Preschool (845) 278 -6082 Fax (84 5) 278 -6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
June 20, 2003
Re: 16��
b
Residence
Tax Map
Town
According to records maintained by the Town, the above noted dwelling
IS V
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in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD: 1/
OTHER
Building Inspector
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Stone Wall Generally On Line
The location of underground improvements, or
encroachments hereon, if any exhvi are not
Unauthorized alteration addition to a survey certified or shown.
map bearing a Licensed- and Surveyors seal is
a violation of Section 7208, Subdivision 2 of
the New York State Education Low.
Only copies from the original of this survey
marked with an original of the land surveyors 's
embossed seal shall be considered to be valid
true copies.
Possession only as indicated
I Richard 0. Jordan jr. the surveyor who made this map, do herfeiy certify
that this survey was completed on May 11, 2003 and this map Sias
completed on May 11, 2003
It is hereby certified that this survey was prepared in accordance with the
existing Standards of Practice for land surveys adopted by the
New York State Association of Professional Land Surveyors. t,
Certifications indicated hereon shall run only to the persons for whom- the
survey is prepared, and on their behalf to the title company, gorurnmental
agency and lending. institution listed hereon, and to the assignee. of the
lending institution.. Certifications are not transferable to additional institutions
or subsequent ownem.
SURVEY OF
PROPERTY PREPARED FOR
JASON & KATHLEEN HALL..00K
IN THE
TOWN OF PUTNAM VALLEY
Scale: 1 "= 20' Ma" 1 1, 20-0,3—
Being Lots 129 and 130 on 'Modified Map No. 2 of
Abele Park, Oscowano Lake'. Fled in the Putnam
County Clerks Office on Aug. 25, 1926 as Map -No.
66
Richard D. Jordan Jr. ',5 Seneca Rd. Putnam Valley, N.Y. 10579