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Home My WebLink About3894DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -28 BOX 30 IN Nei J T 141 'T� i 1 ;, �■ 16 IN, ' ' - ; - 4t.' 1, f LORETTA MOLINARI Public Health Director 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Samuel Villagomez 105 N. Riverside Ave. Croton -on- Hudson, NY 10520 Dear Mr: Villagomez: May 4, 2004 ROBERT J. BONDI County Executive Re: Addition - Villagomez, 39 Brookdale Rd. No Increases in Number of Bedrooms (T) Putnam Valley, TM #83.16 -1 -28 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 4, 2004. 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 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. Very truly yours, o's) William Hedges Senior Public Health Sanitarian Cn 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 - 608S Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET 39 brooW61IC �Oad TOWN TUf m VC11 1, y TX "I ' 1 � -2 NAB &mt)d V 1 huq r' nCZ PHONE e q l 4) q 03 - b55 a P CHD# A MAILI�TG ADDRESS I o5 N . Ayers► roc, Ave— Cyv1Uv1- I- t�- r�ls�n� n(Y 1052-0 DESCRIPTION OF ADDITION AVdjt oA b one c fifv d!�Iorn5 adding . Dru Ixlfhmom, 5ma.11. iaohdrq �Oom artoL a clokr, a150 and addition. -!v fW din, room . NI--!\,IBER OF EXISTING BEDROOMS Z. PROPOSED # OF BEDROOMS Z (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUU DING 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 Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. ,/1. Certified check or money oar ec foi $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. ` 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. ,i4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseo idelines l ' I BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R-N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 -7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re Gentlemen: y =/r #P 5 C -q- Residence Tax Map Town �c+ -�i,.► ✓��r According to records maintained by the Town, the above noted dwelling JS IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER !� Building Inspector BFhouseguidelines Apr 10 04 09:42a a•! s kw6.y I'7['a•"4CI�tY B�OOXO,Q�L� C.A.�p,Eilp.?, /MC A • F Q o �► ®4 6 IS Pffrs AIRCO or =UMN" AS$OCIATItS CAhO SIJRVeyogg ' *AL RIOW °Y netos ""_ sty S°LEyIVINS�fRx 10360 M • 01C W ��7�t 1 Iy faa a . f4e b�f c� n 9: 7-e j �tYS yab @MAUrj'O'rXgO ALYEI*AT /Da► Q+Z A em /'ric" To A iPt - AV►r'tle'ARl ig A ifiteoiStra CAMD 6KRVEYPR 3 S¢K 13 n WOLATtOH QR SK71oW 7pQy� Jug sus.orvo461O E. or 7Nc q► YO7l.c ST�l Cr FOVCAT�o�v N Q—qW. THE LOOA7/ONOPUNDeR6R1UMD E1 /MPJENT54/r ICROAC1fMEN43 COyey� ' 16 AeeyIFPS74 Aqp NoY teer,�ata p.l 6 n II pjbl II. II II II p __i__ II II II II II I II II I 4 f , Ii W/D I BAf 1.� I' 1 I tgIQH% C� e f r i i 7' SUD62 i ,TANS APPROVED FOR Cm COUNT ONLY; O >.c f.ati e &TSt2a f - -- "All certifications hereon are valid for the map and copies thereof only if said map or copies bear the impressed seal of the surveyor whose signature appears hereon." Certificatiunsandhal,: ,,Il run onh!othC•e�3 indlviauals and Insi:;rr on. stown he:cwn. Said eertrtl,.�tions :!0 a;.t ro ..'..• /Yrow o.a Fo4t..ra��s� feraDle to um-1al, HUGH L- EMiLLE REAlIVALLS fo- .yt,OCY ,9A700,C,0A1_& GAf.E'oE/r�.S, /.Yc. I ' .Sri,r�.• N�8'.j7.30E' 95.00 STONE •• WALL S7.4ArF I� o'V O• SO iHeG -WELL A � V Q @ 0 v O• SO .6IA dT MALL 28:37'30 IV g SURVEYED 6 PREPARED BY BUNNEY ASSOCIATES .LAND SURVEYORS RURAL ROUTE 62 FIELDS LANE NORTH SALEM, NEW YORK 10560 -r /go'ru/ _D e-Re �L N. V. . LIC. NO. 49332 EDGE 4:9a. 7.2 UNAUTHORIZED ALTERATION OR ADDITION TO A SURVE t MAP SEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7203, SUB- DIVISION 2, OF THE NEW YORK STATE EDUCATION LAW. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS, IF ANY EXIST, ARE NOT CERTIFIED. C� -WELL 0 u a l►,� OI � Q 4 V I Z5.0, � `t( Jrare •, 0 uvB /O v PARC /NG 1 r .6IA dT MALL 28:37'30 IV g SURVEYED 6 PREPARED BY BUNNEY ASSOCIATES .LAND SURVEYORS RURAL ROUTE 62 FIELDS LANE NORTH SALEM, NEW YORK 10560 -r /go'ru/ _D e-Re �L N. V. . LIC. NO. 49332 EDGE 4:9a. 7.2 UNAUTHORIZED ALTERATION OR ADDITION TO A SURVE t MAP SEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7203, SUB- DIVISION 2, OF THE NEW YORK STATE EDUCATION LAW. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS, IF ANY EXIST, ARE NOT CERTIFIED. C� -WELL 0 u a l►,� OI U Fe F 4 V I Z5.0, nZ uvB /O .6IA dT MALL 28:37'30 IV g SURVEYED 6 PREPARED BY BUNNEY ASSOCIATES .LAND SURVEYORS RURAL ROUTE 62 FIELDS LANE NORTH SALEM, NEW YORK 10560 -r /go'ru/ _D e-Re �L N. V. . LIC. NO. 49332 EDGE 4:9a. 7.2 UNAUTHORIZED ALTERATION OR ADDITION TO A SURVE t MAP SEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7203, SUB- DIVISION 2, OF THE NEW YORK STATE EDUCATION LAW. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS, IF ANY EXIST, ARE NOT CERTIFIED. SITE LOCATION j` OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY a q q _0 TM# 8'j. Flo— I"z8 PERSON INTERVIEWED 2,i' OA Yilla Z- COOM ex\ PCHD Complaint # Name a ons p i.e., owner, tenant-,etc.) DATE }' l r' o� TYPE FACILITY / FA.K %/y PROPOSED INSTALLER 5,e I %C " ttpM o. �J�l�ft PHONE l9 /y1 S�o3 -(oSS-4 ADDRESS 105 N. ?�Ver.tid,e AklQ. - Cro+p j 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. `FiQ lhc-e- Olo Sem 'PAN1k. W i-k-tn. oEW k.000 Q0.164 +#N0JC- AAZo Or(A i 1, as bwner, or reported gent of owner'agreefo the conditions stated on this form. ' SIGNATURE .TITLE 49A&✓JFR DATE s 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 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' dam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title I&TE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML