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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM R PAIR
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YES NO Internal Use Only �L /
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❑ lye 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
Lil
SITE LOCATION yu
OWNER'S NAME ) - PHON E #
MAILING ADDRESS %---) � A-[� Lz � _ - 7% o-4k i
APPLICANT S, �G •' t- J ��.�% /I/ C ' `
Name & Relationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE 1647. PCHD COMPLAINT #
PROPOSED INSTALLER et) S1,1 � A)"e7 l ���� �P4ONE #
ADDRESS ` �' �aX % IVllelY IREGISTW ON /LICENSE # I J
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. ,,QQ
CIA
of
I, as owner, or reR910 agent agree to the conditions st d on this form
SIGNATUR TITLE [r DATE �%
Proposal approved with the following conditions:
rocurement of any Town Permit, if applicable.
C2�.ubmission 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
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to be performed in accordance with the
above proposal and conditions
Pro sal Appro d Pro sal Denied q bo /4)(.
Vs—pector's Signature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
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R . ' PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES s
-PROPOSAL FOR..SEWAGE DIS .OSAL.SYSTEM -REPAIR
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YES ..., , NO".' Internal'Use Only'
❑ ®� Repair Permit Issued in last 5 years ❑ . Not in Watershed
❑ ❑ Repair within Boyd's Comers, W: Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 20011. of a watercourse or DEC - mapped wetland . ❑ Joint Review
A A �:• i
SITE .LOCATION
. OWNER'S NAME
MAILING ADDRESS
APPLICANT A
Name & Relationship (i.e., owner, tenant, contractor)
DATE. %+ b 6 i=ACILITY TYPE. /40S - PCHD COMPLAINT #
(f � cc
PROPOSED INSTALLER 6V, US rd O PFi(JNE#
ADDRESS G.' d� X n ltAREGISTRATION /LICENSE #
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 to 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.
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/� .i /�1Ct. .,r9RTi..%. Jw C f' -. i. ��" !iJ/ �'i" � b�•�O f ✓` .
I, as owner, or rep agent of own r agree to the conditions shed on this form
SIGNATUR _�_ TITLE
Proposal approved with the following conditions; .
1 Procurement of any Town Permit, if applicable.
D2. ubmissiort 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 accordance with the
above' proposal and conditions
Pro sa! Appro d Pro sal Denied
4-1 /to
I pector's Signature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
o %, A m r.
DATE r A b t .
id
i
APR 1.5 2006 t
YES:, NO
SITE LOCATION
OWNER'S NAME
p MAILING ADDRESS �Z
t
PUTNAM COUNTY HEALTh DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Interhal' Use On'
Sim
Repair Permit issued In last 5 years ❑ . NOt in Watershed
❑ Repair.within Boyd's Comers, K Branch or Croton Falls Res. ❑ Delegated
❑ Repair within 200 ft, of a watercourse or DEC - mapped wetland _ ❑ Joint Review
a _
APPLICANT
Name &
PHONE # —► -z.G `d
DATE Z.' a b FACILITY TYPE. J�� PCHD COMPLAINT #
PROPOSED INSTALLER __.
prvPrT pt -iaNE #
ADDRESS C1.' 63 X S� n C � EGISTRATION /LICENSE # �C� �0b
r
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 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. ,�q
I, as owner, or
to the conditions
TITLE 1l�,
Proposal approved with the following conditions:
1 Procurement of any Town Permit, if applicable.
C�)a- ubmissioq:of as built repair sketch in duplicate showing:
Owner's 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 accordance with the
above proposal and conditions.
Pro sal Approv d Pro sal Denied -
L r O )
01—pleclol' s Signature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
0— alnG
DATE r: A �
APR 13 2006. .
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SURVEY OF PROPERrY
SITUATE IN THE
TOWN OF pUTNAM VALLEY
pUTNAA4 C.OUNTY
GENERAL'
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57KS
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SURVEY OF PROPERrY
SITUATE IN THE
TOWN OF pUTNAM VALLEY
pUTNAA4 C.OUNTY
GENERAL'
AI
SHERLITA AMLER, MD, MS, FAAP
- . COAT 3iSS Onef' of lrealth q:
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Joel Greenberg
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
May 25, 2006
ROBERT J. BONDI
County Executive _
ROBERT MORRIS, PE
Director of Environmental Health
2 Muscoot Road North
Mahopac, New York 10541
Re: Addition Approval — Keating
No Increase in Number of Bedrooms
462 Peekskill Hollow Road
(T) Putnam Valley, TM# 71-2 -11
Dear Mr. Greenberg:
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 May 24, 2006. The 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.
4. 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 me at your convenience.
Very truly yours,
Mike Luke
Public Health Sanitarian
ML:cj
cc: B.I. (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 InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648
V-„
_.__SHERLITA AMLER, MD, MS, FW
"--: „- Coititi Is-S- &n ii of rHertliff' ' = ”'
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509 ,
ADDITION APPLICATION
RESIDENTIAL ONLY
STREET Lj I- U- A04Celd I'd TOWN A�Pk, TAX 1VIAP#
NAME &,p P � / j r� .% PHONE PCHD# - /.S! -+d
MAILING
ADDRESS
4 D -.. /. el, J ,-, (✓
1r,
DESCRIPTION OF
ADDITION
NUMBER OF EXISTING BEDROOMS3__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.
:.. - __... °� ._ == I'3ease svirirt tinsori�e✓folloWig trras�un+Iellir-Deptc; -t>eva « --
Brewster, NY 10509, Phone: (845) 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)
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
1
SHERL- ITA,- A1M[LER, MA,MS, FA.AP..
w Commissioner of. f Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
Re: PE7"NT 10 C--- (Owner's Name)
Tax Map #: 7 3. - `Z
Address: 4G 'L QCIE 1ZS -J::�l 0-
Town: AA TN A m VALL "�
Year Built: J C �L9
According to records maintained by the Town, the above noted dwelling,
is `Y in compliance with Town Code.
is not in compliance with Town Code. _
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Other: +2� .i f t.._C-7-
5 )S o
Building Inspector Date
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
County Executive
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
- °LORETTA MOLIIVARI,YtN; MSN
Associate. Commissioner of Health
Philip Keating
462 Peekskill Hollow Rd.
Putnam Valley, NY 10579
Dear Mr. Keating:
ROBERT J. BONDI
County Executive
.e. .. _. ems.... -VFV Mn..r •'. y +.,r. ♦.d �. r a
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
October 9, 2009
Re: Addition- A- 149 -09
No Increase in Number of Bedrooms
462 Peekskill Hollow Rd.
(T) Putnam Valley, T.M. # 71-2 -11
I have received and reviewed the plans for the proposed addition to the above- mentioned
- - - -- -- -resi" "deuce. The proposal for . e ad I on as been approve —as per p ans fiearmg tTie approval - - - - -- - -- - - --
stamp from this Department dated October 6, 2009. The 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 faucet$. etc....,
"'I'hi's Department recommends you contact your local Building Department to ensure
setbacks and other current codes can be met.
5. This 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 me at (845) 278 -6130, ext. 43261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:lm
cc: BI (T) PV
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
Nursing Home Care Fax (845) 278 -6085 WIC (845).278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
/%
a
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
= tOkE T- fkMOLI 4kI;9 ki4, If ISNM
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
ADDITION APPLICATION
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
4,
RESIDENTIAL ONLY
STREET C � � �`�iCC,�'[�to TOWN A/� *! k_TAX MAP #
NAME T1 PHONE PCHD#
MAILING
ADDRESS �'G 2-
ur
�� / d-f-X
DESCRIPTION OF
ADDITION �� �' (�lJ� 2' GJ ceaL.�' A' ° a?
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.
Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 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, -to -be
(Se`Seci3c of Buiefin crfed). n -use of` eac°
"Jhbwn`and'd meirsioned`a*d mpe
HA -1)
3.. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA -1)
4. Copy of survey showing all well and, septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. .Copy of Certificate of.Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling:
OFFICE USE
COMMENTS
5.
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
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
A
,.SH.ERJ,,ITA-AMLEP, MD; MS, FAA.P
Commissioner. of Health
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS; P
-Director of Environmental Health
DEPARTMENT OF HEALTH
I Geneva Road. Brewstei, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: P� �- K[aTj N 6-
(Owner's Name)
Tax Map
Address: 4L Z Rf-i 14-S k- I LL_ He ubw
T6_vn_.
Year Built:.
According,to records maintained by the Town, the above noted dwelling,
is in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of .Occupancy:
Other:- NS S li-so. IZ I LIC
The plans for the proposed addition are considered:
New Construction
Addition to existing house -only
Teardown and/or re-build allowed under Town Regulations
Building 1.nspeptQf
6.
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
Nursing Home Care Fax (845).278 -6085 WIC (845) 278-6679
Early Intervention / Preschool (845) 228-2847 Fax (845) 225,1580
10/06/2009 11:52 8455289489 KEATING INS PAGE_ 01/02
. .... yr �T.w • -. yr. a. ,.6•a.• .mac» .. we -� - .�.... :�.. a -. N+ iC .i .r+r ..• ', r ,� "'� r"
.Philip I Keating Jr.
462 Peekskill Hollow R.d.
Putnam Valley, MY 10579
October 6, 2009
Putnam County Realth Dept.
A.tt: Gene Reed
Re: Basement Plan
Dear Gene:
As per our conversation attached is basement plan for 462 Peekskill Hollow road. in Putnam Valley. J have
given you the dimensions and T trust all that is needed. If there is anything missing, please let me know.
,I understand this is the last thing you need in connection with my application and plans for an addition over
the attached 2 car garage. When you are finished with the review, I would be happy to pick up the signed
plans.
Thank you for your time and cooperation.
a Si re ,
i eatL
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM F
YES NO Internal Use Only
❑ Repair Permit issued in last 5 years
❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ ❑ Repair within 200 ft of a watercourse or DEC - mapped wetland
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
is
APPLICANT
❑ Not in Watershed 1
❑ ' Delegated
❑ Joint Review
Name & Relationship (i.e., owner, tenant, contractor)
DATE /' FACILI TYPE PS' PCHD COMPLAINT # r�
PROPOSED INSTALLER�o (jS ��,/ L v1V-rt- `;PF(ONE #
ADDRESS �' �ttiX �� /���` 0E01ISTRAfION /LICENSE #6� It
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. ® / /
I, as owner, or
SIGNA
C S P,Q'T/C
40
N
'L4, c2, '" ` % r; x, 0�,
;✓3°h
agent vG ? agree to the conditions s d on this form
/ S — TITLE DATE
Proposal approved with the following conditions:
rocurement of any Town Permit, if applicable.
2. Aubmission 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
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' name and phone number
3. System repair to be performed in ac rdance with the
above proposal and conditions
Pro sal Appro d Pro sal Denied
I Spector's Signature & Title Date
COPIES: White (PCHD); Yellow (Town 131); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
Ov
NEW ADDITION
NEW ADDITION
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10/06/2009 11:52 8455289489 KEATING INS PAGE 02/02
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P %NAM COU ITY L :.Pr";RTMEiI T OF 1 -ICAL i 1H
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
A - 1�
BEDROOMS � _ o q
ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE
PLANS MUST BE SUB TTED TO THE PCDOH FOR APPROVAL
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SIGNATURE & TITLE 'DATE
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P %NAM COU ITY L :.Pr";RTMEiI T OF 1 -ICAL i 1H
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
A - 1�
BEDROOMS � _ o q
ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE
PLANS MUST BE SUB TTED TO THE PCDOH FOR APPROVAL
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SIGNATURE & TITLE 'DATE
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4' -0"
23' -71
10'- 7"
NOTE, "
REMOVE EXISTING ROOF AND
SHEATHING IN ITS ENTIRETY
TO MAKE WAY FOR FOR NEW
EXISTING DECKM°
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3' -0" 3' -0" k 3' -0"
I
11 r
o CONSTRUCTION REMOVE EXISTING DOOR, N It EXISTING KITCHEN, O
FRAME AND HARDWARE
IN ITS ENTIRETY FOR LINENS CHIM. EXISTING
NEW TRIMMED OPNG. ASTER
B rn 1 ALIGN FINISHED FLOOR BATHROOM F ,-7.
v~i LEVELS CTYPJ
C3 EXISTING
TO OUTLET OR CEILING �'- -_ -- LOWER HALL
z �?' FIXTURE PER OWNER - - - -- -------------------
o I NEW LIVING ROOM _j ° DN,
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REMOVE EXISTING
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J cu FRAME, HARDWARE AND r t DTI
NEW WOOD BURNING STOVE SILL FRAMING IN ITS III NEW DINING ROOM 13WROOK -A
BY OWNER. PROVIDE FLOOR/ ENTIRETY FOR NEW 5' -0' III (EXISTING LIVING ROOM)
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