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-...._ ....BRUCE R. FOL EY - . . . . -
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puliCJc "`]Yealtli. Director
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel.' (914) 278-6130.. Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET TOWN 244 Ao%,' TX MAP .# ' I4 , •- - S I
NAMEt-a 9p� -
MAILING .ADDRESS 9<2 LdvJ M A Ho ad ee /O .S /
DESCRIPTION OF ADDITION L y �--
NUMBER OF EXISTING BEDROOMS L 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., 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 #)
* 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 .
Feb 98
Public Health Director
LORD i`iti' 'iJLINisRI "F( PV.; 1'�/1.S:lv`:
Associate Public Health Director
Director. of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster,, New York 10509
Environmental Health (914) 278 - 6130. Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
February 23, 2000
To: Phyllis Spaccarelli
.258 Wood St.
Mahopac, NY Re: Addition- Spaccarelli, Wood St.
No Increases in Number of Bedrooms
(T)PV TM #74. -1 -51
Dear Ms. Spaccarelli:
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 form this Department dated 2/23/00 The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at three without prior approval
_bv this devartment. _-
~ 2. ~ The area of the existing sewage disposal system, and its expansion area, must be u y
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 ]Exam and Waiting Rooms may not be used for or considered bedrooms.
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:kg Public Health Technician
cc: BI
14 JAN-18-2000 16:35
PUTNAM COUNW JMRM UWARTMW
DIVISION OF ENVIROMMEMM MMM S&MCES
REPM
P.02
WMIS NAM
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MAILTAG ADEMS
PERsom na?RVIEWM PCIED COAP18 t #
-Noe & Relationship (i.e, owier,teMnt, etc.)
DATE TM FACILITY
PROW
REGISTRATION #
EF92REL(include sketch locating,all adjacent wells):
NOMi Repair most be in same location and of same type as original sewage disposal artem.
iom enqu-ma or
Zf ' xe;t location may require subnittal of proposal from licensed professional
registered architect.
proppeal appr 1 Disapproved
5-
buqxctorls Signature 9 itle Dane .
with the following conditions:
1. Procurewt of any Ttom pemitt if applicaue.
2.'&,1:m4asicn of as built MMif sketch in duplicate showing:
a. Owner I s Anne.
b. Site Street Name, Town and Tax Map number.
c. Location of installed =Wmts tied to two fixed points (e.g. ,horse corners) .
d. System description (e.g., 1250 gal. corxxete septic tank, three precast 61 dian. x 61 doe
. drywalls swromded by one foot + gravel)
6. Installer's now and wober.
3. System repair to be perfonved. in accordance with the above, proposal and conditions.
I, as owners, or owner agree to the above oonditions.
Z-- lele"
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JAN -18 -2000 16:36 P.03
--EAST 2 ._ ...n,..n .y.,�...M.., R
DR. JOHN ALEXANDER
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TOTAL P.03
A
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OWNER'S NAME
SITE
PUTNAM 00UNTY HEALTH DEPARTMERr
DIVISION OF HEALTH SERVICES
PROPOSAL FOR SEWAdE DISPOSAL SYSTEM REPAIR
PHONE J '��'" ;
TO
MAILING ADDRESS "f- > .,."l�i,��' G /� `��1�
PERSON INTERVIEWED l~ PCHD Canpl.aint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE /� � �! TYPE FACILITY.
?
REGISTRATION #
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.
A a1w . / / ®Q -- /-4, ' -
�,✓ 'd\- . fir -- ---7, /-07 �- 7-2r ow r? 47-e0,' -0 '9'
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Proposal approved .L� o sal Disapproved
Inspector's Signature & Title
With
conditions:
Date
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 canponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
dxywells 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 repor g owner agree to the above conditions.
SIGNATURE TITLE DATE
1"L�S: Mibe (:D); YeUaw 03kn ED; Pink (AFpluent)
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--EAST RSHMLL &IROPRACTIC, PC
DR. JOHN.Al-EXANDER,
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HfJUSF PLANS APPROVED FOR
I j zeal°: -1
t3C;DRDOM COUNT ONLY;
f BEDROOMS
In4.attTjsIE} Date
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