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84.11 -1 -9
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OWNER'S NAME L t zC"o"/ O PHONE
SITE LOCATION
TM#
MAILING ADDRESS 7 G1/# / 7-,!= oF-'� - �`'L � Tiri�r' mss/ !/.} L
PERSON INTERVIEWED Pal) Complaint #
Name &Relationship (i.e, owner, tenant, etc.)
DATE TYPE FACILITY
PROPOSED INST i tl iq L i r R y �.4)dLc vu ,9 PHA 6Z
IS. 5' 0, -
po_P (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.
...__
Inspector's
ture &
Proposal Disapproved
Proposal approved with the followincr 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.
Date
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
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, or reported agent of owner agree to the above conditions.
SIGNATURE e Gam- t� TITLE Gr1 yc c'J`_ DATE
?ZPS: V&te (P HD); YeUcw (fin ED; Pink (AAn liamt)
LORETTA MOLINARI R.N., M.S.N.
Public Health Director
9.
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
Lezcano.
9 White Rd.
Putnam Valley, NY 10579
October 15, 2003
Re: Addition — Lezcano, White Rd.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #84.11 -1 -9
Dear Mr. & Mrs. Lezcano:
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 October 14, 2003. The addition is approved with the following conditions.
1. The total number of bedrooms must remain at two without prior approval by this
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 p ieqmits or variances required are the responsibility of the applicant and the jurisdiction of
the Town of Pu Valley.
If you have any questions, please contact me at your convenience.
Very truly yours,
Michael Luke
MLam Public Health Sanitarian
cc:BI
PUTNAM COUNTY HEALTH DEPARTMENT
a. DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR`S39M DISPOSAL SYSTEM REPAIR N` ,
0`VNER' S NAME ,,Q e!1/,,91N� D ' d�r,e/S.i PHWE E o
SITE IACATION TM#
MAILING ADDRESS 9 W111 rGC /—'W T�47 k/. ' c 4 /04-7!P
PERSON INTERVIEWED PCHD Camplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY /
PROPOSED nwAuER Itt) Ae- 1 F T�90LOoy S [C.11:' PHONE 0 57
Pro a ( 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
NYC
Inspector's
ture &
Proposal Disapproved
/-,
Date
roposal 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 6' diem. x 6' deep
dzywells 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,
or reported agent of owner agree
to the above conditions.
SIGNATURE
e --d
TITLE B-(,� Q/)
DATE
[P1ES: Hhite (MB); YeUrw Obn BI); Pink (Aalia nt)
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_ - BRUCE R.: FOLF, =. �•
Public Health Director
DEPARTMENT OF HEALTH
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
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
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET Whf /;r e1. TOWN. yf}i_c, ,cY TXMAP#
,/fRrnfir/luo �- �1.92/�9
NAME L c z e_AN o PHONE PCHD# c" i- a 3
MAILING ADDRESS 9 k1 H i TE 21= 14 C c. & . Z iw Z log 7 �
DESCRIPTION OF ADDITION G 'l Hooic= 4-�,b d FLooi2 t / 2oork A— ester 6W.7
NI U:NI.BER OF EXISTING BEDROOMS a PROPOSED # OF BEDROOMS a7
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction Pen-nit)
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 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 4)
*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.
OFF7CE USE
Comments
Feb98
BFhoase;uidelines
Public Health Director
��'iit�TTA �1vfGLINARI
KN% M.S.N.
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
August 26, 2003
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: 9 White Road
Residence
Tax Map 84.11-1-9
Town of Putnam Valley
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS xx -.. __...
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: xxx
OTHER
del.
DejWty Zoning Inspector
BFhouseguidelines
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
OFFICIAL USE ONLY
SITE LOCATION �'9 OH / 7C 91, f V Et494 G/ L C e TM# Y -
OWNER'S NAME o �/y1A(c�l�A `OS_T PHONE �5/s Z �' Z
MAILING ADDRESS 9 Gy# /TtF RA,
PERSON INTERVIEWED VW,1V E 4 PCHD Complaint #
Name & Relationship i.e., owner, tenant, etc.
DATE -mil- o2 0,0 SG TYPE FACILITY R Fs EN T/A L
PROPOSED INSTALLER �� U PHONE
ADDRESS REGISTRATION#
Pro_ nosal (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.
1Jkt l..-$, ".2 ci
r
has owner, or reported agent of owner;agr6e to -the conditions stated ori'this form. r
SIGNATURE 1���% Ae-CCOV-d TITLE OWX &I DATE � - �- 040
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
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99NE
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