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l PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
E' Yp PROPOSAL FOR SIXM DISPOSAL SYSTEM REPAIR c'
OWNER'S NAME ;1 3 {z -r` A tt i A R f4 f, '- JA wTc S PHONE S f .y
SITE LOCATION i f= t04 A Q A N t-� �'� - c :� °- C <7
MAILING ADDRESS' -T-+�e 4s'l C -t-CT„ tQ
PERSON INTERVIEWED PCHD Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER =t-�w A-X 0 G AAr, eA-' f PHONE
REGISTRATION # Y ('
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 apprcFed Proposal Disapproved
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s Signatur & Ti • e y Fly to
toposal 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 canponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' &am. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be perfonned in accordance with the above proposal and conditions.
[, as owner,, or reported agent of owner agree to the above conditions.
iIGNATURE TITLE -1 DATE
MES: Wiite (MD); Ye]lcow (Ram ED; Pink (Anliamt)
- r To Pum_am County-Health Dent. -
. - �*c'R QI- O• e. . •. - -..a .: '� K'A Q�. O-i. t. s eYa:_......... M ./ r . .. — .�•.. r.rr
Att: Bill Hedges
From: Robert and Marianne DeSantis
Subj: Sewage Disposal Repair Permit
15 Floradan Rd
Putnam Valley, NY 10579
TM# 83.12 -3 -19
Enclosed please find our application for Sewage Disposal Repair. I have tried repeatedly to
reach your office and have left messages for both yourself and Mr. Bzynski however as of
today I have recieved no response.
Please understand that this is an EMERGENCY repair, as our system is not functioning at all!!
Mr. Gragert is ready to begin work. immediately; upon your approval.
Please fax back your response to me c/o Putnam Valley Town Hall - 526 -2130
If you should require any further information you can contact me at 526 -2121.
Your prompt attention to this request is appreciated.
Sincerely,
Marianne & Robert DeSantis
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BRUCE R. FOLEY, R.S.
Acting Public Health Director
DEPARTMENT OF HEALTH
�S Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
PROPOSED ADDITION APPLICATI�ON - (RESIDENTIAL ONLY
STREET: y� 4. h /�c/ / TOWN # 'e, 3'
'e
NAME: D e S d f &HONE .1.2 `r% �� �� PCHD PERMIT #
MAILING ADDRESS
ova/&
Description of Addition ' ✓ CGn �� y /
Number of existing bedrooms 2-;,— Proposed number of bedrooms
from Certificate of Occupancy or
Certification from Building Inspector
/-2 /q
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 DEPARTMENT,
4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information.
V_i0l_' :Cer.tifi -ed Check' for $1'00x70..
Sketch of existin .floor plan ( all living area including basement , if any)
Non- professional drawing is acceptable.
eao Sketch of proposed floor plan.'. 1
Non professional drawing is acceptable. ��'S..
Copy of survey showing well and septic location, to the best of your
- knowledge. Include date of installation if known.
Include all wells and septic systems within 200 feet of property line. Any
questions please contact this office.
. Copy of Certificate of Occupancy from Town or Certification from Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
application
August 1995
July 1996 (Revised)
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New ' York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
February 18, 1998
Robert & Marianne DeSantis
15 Floradan Road
Putnam Valley NY 10579
Re: Addition - DeSantis 15 Floradan Road
No Increase in Number of Bedrooms
(T) Putnam Valley TM# 83.12 -3 -19
Dear Mr. & Mrs. DeSantis:
BRUCE . R .. FOLEY
hib is tieai ?h Direcior
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
February 17, 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 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, -Le., new low flush
toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. 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.
ML `tn
cc: BI (T)
Very truly yours,
Michael Luke
Public Health Technician
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
BRUCE R. FOLEY.. R.S.
Acting Public Health . Director
}
Putnam County Dept. of Health
4 Geneva Road
Brewster,,NY 10509 .t/
Residence
Tax M�.l;c -1 l
To"m
Gentlemen:
According to records maintained by the ToNNm, the above noted dwelling
.IS-
IS NOT
in co p fiance with Town code and the total number of bedrooms on record
is -- ,_C_
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
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Building In ctor
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