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83.72 -1 -17
BOX 31
11-1:
LORETTA MOLINARI
Public Health Director
ROBERT J. BONDI
County Executive
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
Cardinale
P.O. Box 269
Putnam Valley, NY10579
Dear Mr. Cardinale:
July 1, 2004
Re: Addition — Cardinale, 2 Ridgeciest Rd.
No Increase in Number of Bedrooms
(T) Putnam Valley, TM #83.72 -1 -17
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 June 30, 2004 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 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
cc: BI (T)Putnam Valley
Sincerely,
Ochael Luke
Public Health Sanitarian
0
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
OFFICIAL USE ONLY
,a?as- -o
PHONE r-/S' 8'' O
PERSON INTERVIEWED PCHD Complaint #
ame Relationship i.e., owner, tenant, etc.
DATE � L30 ®� TYPE FACILITY
PROPOSED INSTALLER (42ygeP 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, as owner, or r iarte Z27
agree to the conditi fo�n�s' stated 'on this"goim.
SIGMA TITLE �INY ���
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
DATE �2 — �V
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 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
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99M L
/3n /oy
DATE
..BRUCE R. FOLEY .
" P1Dfic "'Fie671h'Diiector
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Associate Public Health Director
Director of Patient Services
%Azf��
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 6
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
ADDITION APPLICATION SIDENTIAL ONLY)
STREET v r PSG' TOWN Adolft mag gr?
;vTA &VjAdh - 6kdhA HONE IBS -S"a8- 9109 PCHD# ,I Zz& -�
MAILING ADDRESS
DESCRIPTION OF ADDITION %VLCo&: `h JR40 di L'1';
3 NUMBER OF EXISTING BEDROOMS3—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 Dept., 4 Geneva Road, Brewster, NY
10500, 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. ✓fwo 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
Feb98
BFhouseguidelines
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BRUCE R. FOLEY .ETi'A. MQL.
_P-ubAc Y... �rl;�...!?i�es . .: .. s .... -- . -,.: � associate Public Director
S, LC2
"" -� Y Off`•
f Director of Patient Services
DEPART MNT 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 - 608S
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Re: 1 A4tgftl
Residence
Tax Map :i?5 --:k2- —1 !1-
Town
According to records maintained by the Town, the above noted dwelling
IS
i's 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: tl
OTHER
BFhouseguidelines
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SITE LOCATIONs::J
OWNER'S NAME
MAILING ADDRESS
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES.
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAI
OFFICIAL USE ONLY
eR,-,?Q5 —0
Z - 7 '
PHONE
PERSON INTERVIEWED PCHD Complaint
Naine & Re-la-11—on-sEp—Ti-e-, owner, tenant, etc.)
DATE (.0/150/0
TYPE FACILITY
PROPOSED INSTALLER 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.
as owner, or r ed a t agree to the"con'difions stated on this form.
SIGNATURE TITLE —nA41f
DATE &e-�72o�-6 �.
Proposal =roved 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 4�1�
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC-RP 99M
13 4)1,D
DATE
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