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Home My WebLink About3871DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.12 -3 -68 BOX 30 . , ail L F , 03871 S. IR 01*M I S NAME J cis cp t j -�i L5 L8 2A I0 e-B L.5 PHONE S � c' SITE LOCATION * "pR,J E=m—:5 To d 3./�7 - 3 MAILING ADDRESS 3c 1-�AFZ + nOO-ng All, \%L L�.`�( PERSON INTERVIEWED PCEID Camplaint $ Name &Relationship (i.e, avner, tenant, etc.) DATE TYPE FACILITY 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. Proposal armed 's Signature & Title Proposal Disapproved PK - l� Date Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate shaving: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed camponents 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 drywells 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, SIGNATURE ZZ7 or reported agent of owner gree to the above conditions. TITLE �j�;-Ai/t/t-�(�:1c3 Z.- DATE f f PIS: (White (PAD): YeUc w Mvin SI); Pink Qqi iamt) NO �;. - -" GLNERACCOWWACTOR 36 LINDSAY LANE PUTNAM VALLEY, NY 10579 (914) 528-2290 La 2- 41 i WK 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 O BRUCE . R. FOLEY, 'Public" Healih` Director F STREET 3b 7A pTr)i ou rN P D TOWN P. V. TX MAP #'93. L Z ' 3 -(P 9 _ #joN NAMEaos� F- ,,4 s, -bE(3" FR HONE S 12 -2. -3 11 PCHD # wk. it 534.53r)p MAILING ADDRESS 3& bn funlo[,c7l P-b- f uTo'q M Nfi LLr'-f' Q\j I65-- gq DESCRIPTION OF ADDITION Ek-Lo sg7 b 1=ot2 .3 5Eg5ok) Loo rn NUMBER OF EXISTING BEDROOMS 3 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. " Piease subrriit 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 5100.00 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 F C�Ga. a s ,� BRUCE R. FOLEY DEPARTMENT OF HEALTH Division of Environmental Health ,Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 October 2, 1998 Joseph and Debra Forbes 36 Dartmouth Road Putnam Valley NY 10579 Re: Addition - Forbes, Dartmouth Road No Increase in Number of Bedrooms (T) Putnam Valley, TM# 83.12 -3 -68 Dear Mr. and Mrs. Forbes: 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 1, 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, i.e., 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. Very trul _______ .._. - .......... William Hedges WH:tn Senior Public Health Sanitarian cc: BI (T) �./ .. ...1: N . - � .i>.• r <' a p "xz-. w. � r +ms..µ ^.Cf^'2.' .... DEPARTMENT OF HEALTH Division ; Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re: FO y �'e-. 3 Residence BRUCE R. FOLEY, R.S. Acting Public ;.Health Director Tax Map Town According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance with own code and the total number of bedrooms on record is i �3) This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER C Building I pector GENERAL CONTRACTOR 36 L1,46S ml�Ae PUTNAM VALLEY. NY 10579- (914) 528.2290 m I I ITE LOCATION AILING ADDRESS Rp Pu-r► A--, PHONE TO ERSON INTERVIEWED PaM Complaint L-111, Name & Relationship (i.e, owner,tenant, etc.) ATE TYPE FACILITY ROPOSED INSTALLER PHONE Toposal (include sketch locating all adjacent wells) : OM: Repair must be in same location and of same type as original sewage disposal syitii.'; iifferent location may require submittal of proposal from licensed professional, engineet.;:,ai*-,z:�. -egistered architect. Proposal approved K. Proposal Disapproved !/A -� A; lnsp6ctorls Signature Title Date 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. 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., 1250 gal. concrete septic tank, three precast 61 di M x`6'. deep drywells surrounded by one foot + gravel) . e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditionsi as owner, or reported agent of owner agree to the above conditiont. SIGNATURE Z\ TITLE MM *!be (MU); YeUcw (Ttvin BI); Pink (AnaUamt) S e -asor h. BATH ROOM &Vzoo m 4. 1 a f __. L' r v r i�G..Roc' 3�'L_.. ,. 13.E-0 Roo e PUTNAM COUNTY DEPARTMENT OF HEA�,TH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; EDROOYIS .. is Signature Title a�; ;.a S"�'a � gE.[��OQ Y► 1 .. 1 4AL1< I.«L �._ - ---� GLotSEr ...� , 5,11 X 4,3„ �? 5 01 ,. i 4: 5 Fc) 3( A.rMovc'�t .R D s PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; .r._3EDROOMS f `! Signature & TiL -le ate { CO KC R E?F— A A PPRAX � 1-41 S �N i y Lw_L_ t. :... I SoMEWH/AT _ J F/-Nc- E_..... j I WA L-I<A 13 LG . j CoNCr��c SPA.GE CRAW L jt r (� o - F6 _... 3cP t:) RT.►�- �9ui.1 -J .P. �. GA5EVIEN -T _ ........__.. i n, x3 • I -3