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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
SITE LOCATION-&-„
OWNER'S NAME_
MAILING ADDRESS
OFFICIAL USE ONLY
e A&I1 4— � TM#
Ile-11G,4ke PHONE
PERSON INTERVIEWED 61 e fL PCHD Complaint #.
Name & Relationship (i.e., owner, tenant, etc.
DATE
TYPE FACILITY
PROPOSED INSTALLER (> al17.P'Z--' PHONE
ADDRESS
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.
I; _a5 ia��&, or *tp r11 =ed agent `f wnn er /q%�(///pj /y�. ec :ta 4.hn condition, stated on t-h.IS .form.
v L
SIGNATL 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 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.
Proposal approved_�iS
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99NIL
2—
DATE
BRUCE R FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
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
February 11, 2003
Velichko
62 Oscawana Lake Rd.
Putnam Valley, NY 10509
Re: Addition - Velichko, Oscawana Lake Rd.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #83.16 -1 -16
Dear Mr. & Mrs. Velichko:
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. Februar._10 2003 The 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.
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:lm
Very truly yours,
Michael Luke
Public Health Technician
-- - BRUCE R. FOLEY
'Public Tie6lih director
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 (84S) 278 - 6085 t
Early Intervention (845) 278 - 6014 Preschool (845) 278.6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
[c STREET 6,,t- JSCek41anA. OWN I/- lle . TX MAPS# C3 , /6 -- % /fa
4;k10 At., 4 �-
NAME Lglia k y PHONE 9 `S 4119 -%/ 3 L- _PCHD# A31-
MAILING ADDRESS 15A9"i=-
11" ,P00"n Jt-IZ r irk toms. W 1 >rGr�6'G� v't J✓
DESCRIPTION OF ADDITION, v lA An LPve%
7 e44
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Ally 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.
_ ._ .._ �_ _.. 9 _.- .• P:e�e�:�-�st ti�is�'oI�:I•�nd -tii�, €dilo.r:ng -�;t Pu�lam�:b;�r.�r I:ei�lL�� wept., 4 ver.�;ra Road;•Erews`�r;•I�"Y�- ..... _.° ....°°
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 9)
*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.
OFTWE USE
Comments
i
BFhouseguidelines
BRUCE R. FOLEY
�'� ~~ 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
October 17, 2002
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: 62 Oscawana Lake Road
Residence
Tax Map 83.16 -1 -16
Town of Putnam Valley
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS xx
-.
in compliance with Town code and the total number of bedrooms on record is 3
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
BFhouseguidelines
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Deputy Zoning Inspector
Stephen Velichko
62 Oscawana Lake Road
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. Stephen Velichko
62 Oscawana Lake Road
Tax Map # 83.16-1-16
First Floor (Proposed Renovation)
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62 Oscawana Lake Road
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Tax Map # 83.16 -1 -16
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Tax Map -# 83.16-1-16
First Floor (Proposed Renovation)
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