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Home My WebLink About3796DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.08 -1 -31 BOX 29 �,. - :' OL 91 .�� : -r , L -. J rg '� * '. 4 �. ..r . ;, o, � e r ''I - ' v 1 z I ' 03796 �• O 't t`A__ LORETTA MOLINARI R.N., M.S.N. Public Health Director ROBERT J. BONDI County Executive 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 Michael Mosny 243 Locust Ave. Cortlandt Manor, NY 10567 August 15, 2003 Re: Addition — Mosny, Breezy Park Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #83.8 -1 -31 Dear Mr. Mosny: 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 August 14, 2003 . The addition is approved with the following conditions. 1. The total number of bedrooms must remain at two 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. 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 trul s, Michael Luke ML:lm Public Health Technician cc:BI BRUCE R. FOLEY �r_, Public Health Director L-O rPk `i 6tR4ARI RN.; Associate 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 u ADDITION APPLICATION (RESIDENTIAL ONLY) STREET 2. Z- 8 /v,-- Z c OWN i MAPg --''31 NAv1E 01ciI,AG o PHO /y ��67 G CHD# MAILINTG ADDRESS 24? I— oG o ,54= +tee- ,oA� (Ao j! - A4 MA A/ r. DESCRIPTION OF ADDITION SS� \TLti1BER OF EXISTING BEDROOMS_),- PROPOSED # OF BEDROOMS 2— (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. T 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. . 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 Feb98 Khouseguidelines if 1 BRUCE R. FOLEY Public Health .Director -- - . DEPARTMENT OF 1 Geneva Road Brewster, New York LORETTA MOLINARI R-N., M.S :N- - r .r;.�-;,;ssociate Public -hWitfi'DWitor° Director of Patient Services P41-1941 _ Gj 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 -7921 Nursing Services (845) 278 - 6558 WIC (94 5) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re: c a �jf2eZ �c)fi r Residence Tax Ma g2 ` -1 -3 Town r am o.l Iet_1 According o records maintained b e Town, the above noted dwelling IS IS -NOT.. �.. in compliance with T wn code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Building Inspector BFhouseguidelines PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY ITE LOCATION '� ' '�'Z ` I� (� TM# 31 OWNER'S NAME �' 1`t '!' r z S'i in iu A`.1 PHONE MAILING ADDRESS fV-g-1''*?--- A4 C PERSON INTERVIEWED PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. - DATE 7/ ' ��. `� TYPE FACILITY'] N `'PROPOSED INSTALLER PHONE 42 Vs7 S ADDRESS ��6;� fgio `9 � . - ;�. A j J/',QLJ_Z.Y : rv.V Ad REGISTRATION# -1 V 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. Ni 1, as owner, ort eported agent of owner agree to the conditions stated on this form. SIGNATURE TITLE 41 g A4_,7" 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 DATE v 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., 1256 gal. Concrete septic tank, three precast 6' diam. X G deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapprove Inspector's Signature & Title COPIES: White (PCIID); Yellow (Town BI); Pink (applicant) PC -RP 99ML YZ DATE e c-.s S66o30'OO"E WASHINGTON STREET 100.00FT LL F- LL 0 q 0 C! :--?0,000 V--SQ. FT. 0 0 0 0 --'b.459 4-/- ACRt�V Or CIA 119) —6) r,1 20 121, 6-0�1 �100 — — — — — — — — — — — r99 2. 1' 9.2- r FRAME F FRAME DrWELUNG DWELLING CONC. PAD 77— ON-LINE C. M.Y. RET. WALL z 0 0 Cl) a Cl) N N U) z C.M.U. WALL 0 N�pe(30'00"W 100.00 FT' GRASS TRAVELED WAY f/k/a PARK STREET BREEZY"PARK ROAD 50 FEET WIDE R.O.W. — — — — — — — — — — — — — CERTIFIED TO: R.G. AGENCY PREMISES SHOWN HEREON BEING LOTS 100, 101, 120 & 121 AS. SHOWN ON A CERTAIN PLAT ENTITLED "BREEZY POINT SURVEY OF PROPERTY PARK"SAID PLAT WAS FILED IN THE SURVEYED: JULY 7, 2003 OFFICE OF THE PUTNAM COUNTY CLERK PREPARED FOR ON APRIL 17,1930 AS MAP 128. BROUGHT TO DATE & CERTIFIED TO BROUGHT TO DATE TAX MAP 83.8 - I - 27, 28 & 31 TOWN OF PUTNAM VALLEY MICHAEL MOSNY certifications hereon are valid for Bank, MATTHEW A NOVIELLP, P.C. ritl' Co. & Owners for this transaction only Certifications are not transferable SITUATED IN CONSULTINI� ENGINEERIN to subsequent bank, title co. or owners. & LAND SURVEYING All certifications hereon are valid for this TOWN OF PUTNAM VALLEY 77 HUGHSON ROAD map and copies thereof only if said map or copies bear th Impressed seal of the CARMEL, NY 10512 Surveyor whose signature appears hereon. COUNTY OF PUTNAM (845)_,M�-5-4004 "It is hereby cartified that this survey STATE OF NEWYORK was prepared in accordance with the existing Cod, of Praoitice of Land Surveyors by 1Z New York State SCALE: 1 20' 0 20 by: MATTHEW A. NOVIELLO, P.E., L.S. Association of professional Land Surveyqr�_ c7T;;;� Alteration of this map by oter than- a SURVEYED AS M POSSESSION NEW YCtRK STATE LICENSE ' No 500M Licensed Land Surveyor is violation Encroachmeks below W-id6, if o ny not shown of New York State Law. (03-160-21)