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BOX 26
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PUTNAM OOUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
K `PROP05AL Fbk 'SF
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MWIS NAME 3A-rvveS V go uu_t4 PH=
SITE LOCATION
MAILING ADDRESS 3J S 7 3
REGI
Props
NOTE: Repair must be in same
Different location may require
registered architect.
PC HD Canplaint #
Wry
location and of same type a
submittal of proposal from
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PHCNE ag-2�& '-at �c7 5
original sewage disposal system.
licensed professional engineer our
G(C i!l- t6 ok ✓ o we&
A-NrV - 4.- LOGO-7-L6 -- Nth
Proposal approved; Proposal Disapproved
J
is Signature & Title
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. Goner'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 gal. concrete septic tank, three precast 6' diem. 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 owner, or reported agent of owner agree to. .the above conditions.
SIGNATURE TITLE (9 (Al Mt CA, MTE
nus: ftte (P v; Yeucw (un Sr); Pink agiimnt)
PC -RP 97
O�.T -? 9 -18 Ni01i i; �c8 PM PUNAY .,TY ENV HEALTH FAX N0. !',11'7717M P. ?
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BALTCB- -R: FOLEiY.. ._ . .
Public Health Director
DEPARTMENT OF HEALTH
• Division of Ehvironmental Health Services
4 Geneva Road IRK
•� Brewster. New York 10509
Tel. (9 r4) 278 - 6130 Far (914) 278 - 7921
PROPOSED ADDITION A2?L1CAj1ON ( RESIDENTIAL QNLY)
ST RE 44u'_ eLSU (l Nil( WNi V� Tx AzaP # 7 3- ('
NAME v Ate` j3 aQ PHONE 3.1%- SOd t PCHD # . ff c� D d —?I
MAILING ADDRESS �4y ` S « ice � U'e-t -t io S %cj
DESCRIPTION OF ADDITION_ ary "li,- CO,5&1'l�J(aVX1�
NUMBER OF EXISTING BEDROOMS 2- PROPOSED # OF BEDROOMSS�°�'�t
(PROM 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.
_._VIOAatr= Si?13Li11t. fbrm and the following,to Putnam County Health.Dept., 4 Geneva Rd;;_. .
Brewster, NY 10509, Phone 27 &6130,
1. Certified check or money order for $ /V%14. /V%14. 100.00 ,�,,n qvkip
, ,
2. Sketches of existing floor plan (drawn to scale, all living area including basement wezy " G�
Non - professional sketches are acceptable a� 5,�t��
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 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.
D. ,
Comments
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 2 8 - 7 21
October 28, 1998
James Brown
444 Peekskill Hollow Road
Putnam Valley NY 10579
Re: Addition - Brown, Peekskill Hollow Road
Increase in Number of Bedrooms
(T) Putnam Valley, TM# 73 -2 -14
Dear Mr. Brown:
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
October 28, 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 two without prior approval by this
:......._ .,. _.., �..:. _ .
--,Department.--..
2' 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, restructures 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
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HOUSE PLANTS APPROVED FOR
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10/19/1998 10:17 6179260691 . CLASSIC RESTORATIONS PAGE 02
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* BRUCE R. FOLEY. R.5
Acting • Public health a,recter
DEPARTMENT OF HEALTH
Division OF Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 273 -6130
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Fie:
Residence
Tax Map %3_7--7/-
To ».r)
Gentlemen:
Y
According to records maintained by the Town, the above noted 6-mllirg
in compliance,wiitth�Toown code and. the total number of bedrooms on record
15 —I-iFV6�'
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD: _
OTHER C I (�. Z nscl.
,
Building Ins ctar
OCT- 18 -9:3 06:3? PM RYKERSON 617 441 2e11 P.01
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