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84.19 -1 -3
BOX 34
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
-RE TA M01,12NARI, RN,.MSN
Associate Commissioner of Health
April 14, 2005
Florence & Leroy Lewis Rice
34 Mill Street
Putnam Valley, NY 10549
Dear Mr. and Mrs. Lewis -Rice:
ROBERT J. BONDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re: Addition - 34 Mill Street
No Increase in Number of Bedrooms
(T) Putnam Valley, T.M. # 84.19 -1 -3
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 April 14, 2005. 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).
4. The relocation of the' septic tank must be completed according to the repair permit R- 57 -05,
including an inspection of the new tank by this Department and the abandonment of the old
tank.
5. The sunroom must remain unheated. If heat is ever to be added, then this Department must
be notified and a new application must be submitted for review.
If you have any questions, please contact me at your convenience.
Si cerely;
oseph S. Paravati Jr.
Assistant Public Health Engineer
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Cc: Building Inspector, Putnam Valley
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
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OFFICIAL USE ONLY
J- - 0�5-
SITE LOCATION_ 31 +`11 si' P
A A4m V,04V TM# $�• ��l -�- 3
OWNER'S NAME'i:10rekce /,-Fo4 Le�:S- r?;c� PHONE , `1S) S�9 -6675
MAILING ADDRESS
PERSON INTERVIEWED JAa. -I" 411F�- PCHD Complaint # Ay 14-
-Tame & Relationship (i.e., owner, tenant, etc.)
DATE NP( L TYPE FACILITY�s�'��
PROPOSED INSTALLER PHONEjgy5') USy- X37
ADDRESS6 0 e � 03REGISTRATION#
Proposal (include sketch locating all a jacent 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. \
1/-C_,�5V7 r-*V
L-as-owner;-orj-r� rted agent. f owner agree-to -the- conditions stated -on this form. - - -. -• _ ___ _.__,_ _ __....
SIGNATURE . " TITLE DATE " �3 -vs
1. Prdcurement 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 L' ep
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s Signature & Title ATE
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
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PUTNAM COUNTY DEPARTMENT OF HEALT11
HOUSE PLANS APPROVED FOR BEDROoA-j COUNT ONLY
EED I 'I 00IMS
ALL SUBS'EQUEN'T 1 1 TE! A TIONS TO TT-IrSE HOUSE
PLANS MUST BE SUBI,11 "QED TO THE PCDOI! FOR APPROVAL
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ATURE & TITLE
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DATE
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Floor Plan for:
Lewis/Rice
34 Miff Street
Putnam Valley, NY
17112-1
04
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PUTNAM COUNTY DEPARTMENT OF HEALT11
HOUSE PLANS APPROVED FOR BEDROoA-j COUNT ONLY
EED I 'I 00IMS
ALL SUBS'EQUEN'T 1 1 TE! A TIONS TO TT-IrSE HOUSE
PLANS MUST BE SUBI,11 "QED TO THE PCDOI! FOR APPROVAL
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ATURE & TITLE
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SURVEY OF °ROPEF:'TY `{
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All certifications hereon are valid fof thit 4PHN SALVATORE M.EO
map..and cepies, thereof only if said reap �,_ %unsuiting Enginccr r,�and,Sursroyvr -rU s sW o PU.�LAPA VALLEY
cop` s bear the impressed seal of the sur- t "`r"
voy r whose signature apoean horoon.
1. NORTHRIE ROAD- �:IJf�W9 CO :LINTY
FEEK�SKiLL. N. .-Y. NEW' YORK
"Itis hereby certified tRat thin surrey was / Y(,_ t LL
prepared: in accordailie wit existing ;, ri _
!L_—r' `. `I'n E. & L. S. NYS LIC. NO. d7846X -•X
E�i' a of Practice for Landf Survey dop4e�. - A
SCALE: 1 "
_ b* tho Now York State �lssoeiati o1 i el T ,
kM%tiiSACMMENTS BELOW GRADE IF ANY NOT SHOWN SURVEYED AS IN POSSESSION
fossional Land Surveyors" t
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TOWN OF PUTNAM VALLEY
PUTNAM COUNTY, NEW YORK
APPLICATION FOR DRILLED WELL
Date 101 17 Uo
OWNER LESd 1.. tNI\A
ADDRESS M It, t. ai-p, L ET
WELL LOCATION
SEC. BLOCK LOT
WELL DRILLER P- F. 3 F-A. L P t b S u s i =1.) Q. .
ADDRESS �{ P UT N ,tern k c- Nt.s E 6 R it w Si eR , 1 S j- i o 5 o9
Signed .OL
Owner f-r agent_
APPROVED
Building, Zoning 8t Sanitary Inspector
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI,_RN,. MSN
Associate Commissioner o HealihM�
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ADDITION APPLICATION RESIDENTIAL ONLY
STREET 3 �� r'� �� TOWN CAI ct rn - Ie TAX MAP#
NAME L e j i s K i C Q__ PHONE .59 o-0 - 6;& 7 PCHD# A ?3-0"T
MAILING
ADDRESS 3q. n rnyin liG� <eu %Uy
DESCRIPTION OF
ADDITION 3 yea Sn ,n 2 y` c L o s v- F e
NUMBER OF EXISTING BEDROOMS 2— PROPOSED # OF BEDROOMS Z
(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., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 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)
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 locations 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 Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
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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
1
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
Putnam County Dept. of Health
1 Geneva Road
Brewster, NY" 10509
To Whom It May Concern:
March 22, 2005
ROBERT J. BONDI
County Executive
Re: 34 Mill Street
Residence
Tax Map 84.19 -1 -3
Town of itn m V 11 y
According to records maintained by the Town, the above noted dwelling,
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:
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