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631- 589 -8100
83.12 -3 -44
BOX 30
03859
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BRUCE R. FOLEY
Public Health Director
LORETTA MOLWARI R.N., M.S.N.
Associate. -Public Health •.Director
"'" "'Director of'Pafiihi `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
October 11, 2000
Desiree Gonzales
3 7 Orchard Road
Putnam Valley NY 10579
Re: Addition - Gonzales
Increase in Number of Bedrooms
(T) Putnam Valley, TM# 83.12 -3 -44
Dear Mr. Gonzales:
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 11, 2000 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 byjbis .-
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, 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.
WH:tn
cc: BI (T) Putnam Valley
ery., rues
William Hedges
Sr. Public Health Sanitarian
v -
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278 - 6130 F= (914) 278 - 7921
BRUCE R FOLEY
Public Health Director
PROPOSED ADDITIONI APPLICATION (RESIDENTIAL ONLY)
STREET
N
MAILLINIG ADDRESS
DESCRIPTION OF ADDITION
1D579
ir'UitiIBER OF EXISTING BEDROOMIS a PROPOSED r OF BEDROOM Z--'
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FR0'N1 BUILDING MPECTOR) .
*Any addition which is considered a bedroom requires formal approval of plans (Construction
Perrrut)_prepared by a Professional. Engineer or. Registered Architect in accordance
-With
ahp'icable °sections of the Putnam County Sanitary Code. ;
Please submit this form and th.- 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 i
* 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
Z
DEPARTMENT 0, HEALTH
Division , Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130 i
Putnam County Dept. of Health
4 Geneva Road /
— D 3<� -- -
.Brewster, 105 9 _: _ _ ---- - - - - -- -
rz
Re: 5 .
Residence
Tax Map
own
Gentlemen:
According to records maintained by the TotiNm, the above noted dwelling -
IS
IS NOT
in compliance with Town code and the total number of bedrooms on record
is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
e
V111
Z'o
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
i
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OFFICIAL USE ONLY
i2E 449 .D A,(), TM#
EAP (0, PHONE
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e., owner, tenant, etc.)
DATE /45 In q, TYPE FACILITY
PROPOSEIIINSTALLER PHONE
ac '( 6, W/4 0 (_ ,P
ADDRESS ,►. 1 z�T. s �:� ^ 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.
1, as owner; or reported agent-of owner agree to the conditions stated on this form.
SIGNATURE TITLE A(0-
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 < [ /6 y
b. Site Street Name, Town and Tax Map number.
C. Location of installed components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposalapproved�
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
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LAND SURVEYOR. P.C'. ^^ T� ^LRMO
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