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84.19 -1 -41
BOX 34
04507
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BRUCE R. FOLEY
Flealih'
Elliot Pine
16 Nob Hill
Putnam Valley, NY 10579
Dear Mr. Pine:
LORETTA MOLINARI R.N., M.S.N.
- • �^ •'' °-� ' dssociafe�'�u31ic �i1'eallh D'ractor- '- • -�
Director of Patient - Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
March 3, 1999
Re: Addition- Pine - \Nob Hill
No Increases in Number of Bedrooms
(T) Putnam Valley Tax # 84.19 -1 -41
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 form this Department dated March 3; 1999 The addition is approved with' the following
conditions.
1. The total number of bedrooms must remain ai hree wi'tliout�prior'ap pro val
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.
WH:kg
Very trul M11
William Hedges
Senior Public Health Sanitarian
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278 - 7921
BRUCE R. FOLEY
- -b'rc: Fle "alit °Iiirecior
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET ®� I l G TOWN 6 ��r TX MAP
NAME �= � ` C' PHONB�ZI ?_q CHD # o✓ /'"
MAILING ADDRESS
DESCRIPTION OF ADDITION�`��
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING rNSPECTOR)
*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-th. following to P_u_ tn'a" rm County Health 17ept., 4 Geneva Rd:,
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 #)
* 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
Feb 98
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DL'f AR*I'Mf:N-r Of I-ILnLTH
Division' -O( Invironmcntal Health Services
4 Geneva Road, t)rcwster, New York 10509
(9 "1-1) 2/8 -6.130
I't l •► Cunt Inc ii of I-Ic•�Ith
4 Geneva Road
Brewster, NY 10509
RCSIdCnCC
Tax Mill)
Flit-
Gelltletllcn:
According t records 1 aintalllcd by the Town, the above noted dwelling
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PUTNAM COUNTY DEPARTMENT ON HEALTH 7
Division of Environmental Health Services, Carmel, .N. Y. 10512
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM {T j F'11tII>zn1 Valley
ii 16 Oi Fi11 'Ponds Subdiv! sloe - ,Section Bne Town or outage.
ij
rp-st ssa. a o+' nob hill near cul -de -sac Tax Map( 120, Pte �THlock 05.
Located at 1 '
F1 rj Owner L F,ti,rr'1r i t a ^ rp, Q} 7`l1 f` ? n1!! C mr -)s -_� T Mr! ^ Tax Map ;Lot 0 is Subd. A 1628
.4. Separate Sewerage System built by �RnP.r S3 i?eneral eontrP Ctc=dr _ill Street, � �`. Ytttnat+s
of 2 f t o' ;v� ide �;rerlch Valley, n +0579
G ' Consisting of 900 Gal. Septic Tank and '
t ?. c•� 1a., anea Subdivision t.• integrates 01o✓ :Lang @tC
.,
Other requirements .i2�- _ ^►y
f� 1, ill Ponds. 2ter Comrar.7
Water Supply: " Public Supply From
Private Supply Drilled By
F `
Address
° ~i�7 f':1 -0 LE: residential = i-r� =A (� ) lisp
9 _S�-::. °° No. of Bedrooms I Dste Permit Issued
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Building Type r
fire --rani =gig cornr:leten• -;- a ..'ai.zing, saris r3ctO: y
Has Erosion Control Been Completed?
.%
!,ard 'ol' .7rass in �: r
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I certify that the system(s) as listed serving the above premises were constructed essentially'as shown on the plans of the completed work ( copies
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of which are attached) , and in accordance with the standards, rules and regulations in accorddncefff��{ith ttthhee (filed plan, and the rmit issued by the
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Putnam County Department Of Health.
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t t i =1� 1 . r tt=i�:' 1' a /�• i"r'�(J�� :1 iii ..:. W.E. 2 R.A.
Date Certified by � - � "' "'�' ,
v.
Address - 3: i _ .Ti _ 6: r' G'_ �: - O.; 0 License No. - a.?
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
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conditions resulting from such usage. Approval of the separate sewerage system shalt become hull and /�oid as soon as a public sanitary sewer becomes
(;
available and the approval of the private water supply shall become nytl and void when a public watsY supply becomes available. Such approvals are
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subject to modification or change when, in the judgment of the Commissioner of Health, sue15 revocation, motllfieation or change Is necessary.
X11
Date By t. Title
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SubdAic r is both owner,, general
contractor., and sanitary system
Installer, (see name :& address belcm) (T') rutnam Vall ®,y'
her or YurcEaser o u1 _ing Munr.c::p a I i Ty
Tax.���a��d' k'1`..:IIr.^
i8 ona� ruc tE jJ _ O
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KNOB. HILT off MILL ROAD in- bill Ponds
Subdivis3.on (:Filed Yap # 1628) Block 05
os "a t 1 0n - 3 UP ®® oc
One family residential
,/ three 3 bedrooms a 16
A� ng Type o t
GUARANTY OF SEPARATE .S01AGE "YSTEM
I -represent that I air, wholly and c.-)ripletaly responsible for the
location, workmanship, material, coristi.uctio: :id ?rairage of the sewage
disposal system serving th- above described property, and that it has been.
constructed as shown on the approved plan or approved amendment thereto,
and in accordance Kith t::,, standards, rules and regulations of the.. Putnam,
County Department of Health, and P:areby guaranty to the owner, his, succee-
sore, heirs or assigns , to p 'l.ar.e in good operating condition any part of
.said system cor'strdet !d by nie i•rhictl fa-ils to. operate for a period of two
yedrs .Immediately follo,.ging ttie 'dat; of initial use of the sewage disposal
sy-stem, or any repairs made by me to such svrsten, except where the failure
to operate ,properly is caused by the willful or negligent act of the I occu-
pant of the building ut;ili zing t}:e systam.
The underai.g,rioa further, agrees to accapt as conclusive the de-
termiaation of the Director of the Division of H�ivirorunental Health Ser-
vices of the Putnam County Department of Healt!i as to whether or notl the
failure of the system t.r, operate -was caused by the willful or negligent
act df the occupant of the building utilizing the system.
'Date(i this,. ,,�JgLt `:: day o 19 _SignaturQ _. <
Joseph Mar e. i. a �Prds�ident
As Owner., General Contractor, & Sanitary Title Inc.
System Installer, etc.1 f° corporation, give name D
and address)
RFD # 39 Mill Street
_ _ _ _ _ _ - _ _ _ _ _ _ _ - - - - - Pu train -ilslley'� -ffy- 1-0579- -
THREE: (3) TDOPIES ARE REQU'lHED WITH THREE (3) ' COPIES OF FINAL PLAN'S BUORZ
CERTIFICATE OF COMPT,ETION WILL BE 18SUED•
GUARANTOR JS RBQUjhgP To FZi,F� pL ATE Of FIRST USE OF SY ..
- - - -
Division of EnvironmenLal Health Services, Putnam County Department of Health
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PUT0AM G;;Liwr" CrEF; fi7h,tENT OF HEALTH
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I BEDROOM COUNT OF +LY;
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