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Home My WebLink About3857DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -42 BOX 30 03857 jrr ` l : 1� ., 6 ,` J < < ' r !` -_ 69 }� ,, 16j Lr .'- -7 ` 03857 SITE LOCATION r� PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use LA/ "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 OWNER'S NAME MAILING ADDRESS APPLICANT TOWN Name & Relationship (i.e., oy6ner, tenant, PERMR- # /,,. Z - 3-6 9 - %% p of in Watershed ❑ Joint Review TM # PHONE# %4s- 035nj DATE 17--(2--) �, FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER 03oy,�_ ]--K(_ PHONE # N - W - ADDRESS Obu"HCe rA+�kykr REGISTRATION /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 system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree to the conditions stated on this form SIGNATURE TITLE oto h,e_y- DATE 12_-1L-J( (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE c %� TITLE (fir DATE 12- J-2-// (installer) Proposal approved with the following conditions: ; 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled -until authorization to do so has been obtained from the Department. Proposal Approved Inspector's Signature & Repair proposal is in co INTERNAL USE ONLY Proposal Denied with applicable codes 2 Datc, Ex (ration Val Yes C-1' No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health . Thomas Browne 11 Brook St. Putnam Valley, NY 10579 Dear Mr. Browne: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 11, 2006 ROBERT I BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition Approval, A- 127 -06 No Increases in Number of Bedrooms Browne, 11 Brook St. (T)Putnam Valley, TM #83.12 -3 -42 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 11, 2006. 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- plutnbfrig fixtures must be' updated with water saving devices, i.e., new low A flush toilets, restrictors for shower heads and faucets, etc. 4. This 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. 2261. Very t�nihvwnn/r�c, Gene D. Reed GR: lm Senior Engineering Aide cc:BI (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 b, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET/ &j y T _TOWN �L AX MAP# 3 . a -5° y� _U L V NAME_'ff0 &0Q:jQLf PHONE MAILING ADDRESS DESCRIPTION OF el-4ft& 2' &rb2oatir -to &*T70a,^ ADDITION M*Jb e:-� I SY1N <, &60949(4 Ova "EoA ce-6 b $ k 6Git PA-ria j A00 2Wb Ft-06(t 13E01L NUMBER OF EXISTING BEDROOMS r 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.1)ept.,1 Geneva Rd,,, Brewster; NY' 10505, 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 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP— Commissioner of Health LORETT'A MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 ®� N � Re: Residence To Whom It May Concern: ROBERT J. BONDI County. Executive_ . TAX MAP# TOWN PU I-M Am VALL6- According to re ords maintained by the Town, the above noted dwelling, !N CODE.* IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS Z This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: A SSES5 og" s iz� Building Inspector -31 I � o(' Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Im 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 1� OQ �3 Z � 2 a: v' n•• HOUSE PLANS APPROVED FGR BEDROOM COUNT ONLY ,. BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS T4 TWX. SE HOUSE PLANS MUST BE SUBMITTED TQ' THE PCUW -MR ARPROVAI r K TITL E DATE 1. i`.._, SIGNATURE & y. J J 1 a 25'8 r t_ PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY ! . BEDROOMS 1 ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE; PLANS MUST BE S�UBBMMIITTTTEED TO THE PCDOH FOR APPROVAL e '?�_``_(/G —'/-sue SIGNATURE & I I TLE n i7 z 1. r . i f 39' 8"— f i �I 1� Qc sr 7�vm4s ggocjN6 l /3/looK ST, pu i Nary V��6y, Iv` y loS'� 5 MAP l� i r 5, -211 I; O ,_ r- ��DRcxM 31 2n;r. I5 nAT14 too C� - 'Y 2' n X Cr n ' _� 3r -Orr X 6r -pn 3, 4" $= 0 "�'1' -6„ 3' 8„ 4'-10n� /4.On 14' i; -4" p G- I "UtNG OOM/ 0IMIN6 90 N o� r- o . r 0„ x 6-" 14' 4" 4, -5 „_ 20' -11„ XIS -1 V6 FLOok PL , '4 �t LJ ti .y(y ORCNAR,Q ROAD t � 11) �v�a�, r Co-C. BLOCK PAT /O METgL � \ i9 SNEO l\ V 3. 75' �5tvke 66 °3B "W SURVEYED & PREPARED BY BUNNEY ASSOCIATES ENGINEERS & SURVEYORS 156 KATONAH AVE. • ... MN AI E KATONAH, NEW YORK 10536 PEEKS L. NEW 100 5 o. oo cPT'�G S j�S T�Nls .4,K � �P,�ieOX I M�T� Sfofce o? 6.60" 4 ... _� CE,PJ /� /.EO TO TflE SECU,2 /TY T /TLE- � _ GUFI.2ANT}i COry/.oF7Ny l N h �� 26. -9 y House // oo Co-C. BLOCK PAT /O METgL � \ i9 SNEO l\ V 3. 75' �5tvke 66 °3B "W SURVEYED & PREPARED BY BUNNEY ASSOCIATES ENGINEERS & SURVEYORS 156 KATONAH AVE. • ... MN AI E KATONAH, NEW YORK 10536 PEEKS L. NEW 100 5 o. oo cPT'�G S j�S T�Nls .4,K � �P,�ieOX I M�T� Sfofce o? 6.60" 4 ... _� CE,PJ /� /.EO TO TflE SECU,2 /TY T /TLE- � _ GUFI.2ANT}i COry/.oF7Ny RA -1 PARK AREA 100. 00 ..,... of �' :.. ... . .. ...... .. , , , . . . •t su,�v�r of p ORE/Pl�' N I N � � P,2.EPA2E0 F0.2 �till S /rUAr� //V 0 ro WN 0*4 .4R&rAA9" VAL&CY olJT�v/q� coUrvTY f .; a f � 1 SURVEYED AS IN POSSESSION i e, f i is c5C F�L : / " = 20 " 4700 <30, /,96 8 BROUGHT TO OATS S'EPT. 27 /972 pa FILE ;No. 7 - -7o&- 6q l N h 26. -9 y RA -1 PARK AREA 100. 00 ..,... of �' :.. ... . .. ...... .. , , , . . . •t su,�v�r of p ORE/Pl�' N I N � � P,2.EPA2E0 F0.2 �till S /rUAr� //V 0 ro WN 0*4 .4R&rAA9" VAL&CY olJT�v/q� coUrvTY f .; a f � 1 SURVEYED AS IN POSSESSION i e, f i is c5C F�L : / " = 20 " 4700 <30, /,96 8 BROUGHT TO OATS S'EPT. 27 /972 pa FILE ;No. 7 - -7o&- 6q