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BRUCE R. FOLEY
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509.
LORETTA: MO.LINARI R.N.,. M.S.N. .
Associate ' Public Health Director -
Director of Patient Services
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648
October 26, 1999
Stephen Lachowicz
6 Boniewood Dr.
Mahopac NY 10541
Re: Addition- Lachowicz- Boniewood Dr.
No Increases in Number of Bedrooms
(T) Putnam Valley Tax # 85,42-4
Dear Mr. Lachowicz:
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 26-.1999 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 other permits or variances required are the responsibility of the applicant and the jurisdiction
of the Town of Putnam Vallev.
If you have any questions, please contact me at your convenience.
Very truly yours;
Michael Luke
ML:kg Public Health Technician
cc: BI
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Public Health Director
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (ItFSIDENTiAL ONLY)
STREET 30 N 1' r7 000-D Ile • TOWN a T9a //F TX MAP # .- . Z-o 2-
NAM1TMoh�—o� 4q6Ai Qw/e e PHONls,S' -38ft PCHD #
MAILING ADDRESS
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DESCRIPTION OF ADDITION -ZZ-Y /dSC rX)J ivy
NUMBER OF EXISTING BEDROOMS 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 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
7 Osy/
Feb 98
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PUTNAM COUNTY DEPARTMENT OF HEALTH L
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDiVUDAL ADDITION/REPAIR FORM
SECTION A: GENERAL INFORMATION
Name of Project_(; ��'^ `�,, ,ocQ r T TMrr
Year of Construction Size of Parcel '
SECTIONt." TOPOGRAPHY (Please check all appropriate boxes)
1. ❑Hilly ORolling ❑Steep Slope Mentle Slope ❑Flat
2. ❑Evidence of wetland ❑Low area subject to flooding ❑Bodies of water
❑Drainage ditches ❑Rock outcrop
YES NO
3. Property lines evident?
4. Water courses exist on, or adjacent to parcel: ❑ ��
5. Existing individual wells within 200ft of the existing SSTS? L� ❑
SECTION C.' EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS)
1. Physical character of existing SSTS area.
A. ❑Level mentle [XSloP e ❑Stee P slo P e
/
B. ❑Well drained oderately well drained
[]Somewhat poorly drained ❑Poorly drained
C. Area available for SSTS. (Primary & Reserve)
DExtremely limited ❑Somewhat limited RAdequate ft x ft
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It' I OLLY'' IZ $
Aclinp,l'ub1 Uur, for
DEPARTMENT Of 1- 11- ALTI-I
Division. Of bivironment:il 11cal.th Scrvlces;; !
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4 Geneva Road, 0rewster, .-Ncw York .70509
27076'13V'
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I'utllanl County Dcllt. of Health
4 Gcneva Road
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Brcwstcr, NY 10509
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Accord.ill to records Illal.11taincd by the "I'own, tic above. n.otcd dwcllinS
IS •
IS NOT
ill Compliance with
Town Code and the total
IlUmbci'.of•bcdrooms,on rccoi'd"
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This information has
been obtained ri -bm:
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CERTIFICATE OF
OCCUPANCY:
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OTHER
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PUTNAM COUNTY HEALTH DEPAR24M DIVISION OF ENVIR 3o�
AL HEALTH SERVICES
P �PD. SAL l DJiD. ' 9&94GLLISP L - YDS Ad:6 d d\SlAnk • Rv...' • • ... • !' • • D
ova° S $� � �I I' t aiy CJ ei a Z--- PHME f/�✓�^ � 5
SITE LOCATION 6 5-367N 4 &.4.9P D rPAl mo 110 L,e zf— l y
NAILING ADDRESS A4 46300r—
PERSON INTERVIEWED S !!�,- 'god erg PCHD Camplasint 0
Rime & Relationship (i.e, owner,tenant, etc.)
DATE /V TYPE FACILITY��'
PROPOSED INSTALLER ! "e X43 4 0 A 9 F PHONE
REGISTRATION #
Fro (include sketch locating all adjacent wells):
Rte: 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.
4422 N9W s�54-'L,`6 ORO— QC&d0"2V4(
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_Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
20 Submission of as built repair sketch in duplicate showing:
ao owner's name.
bo Site Street Name,, Town and Tax leap number.
co Location of installed components tied to two fixed points (eogo,house corners).
do System description (e.g., 1250 gale concrete septic tank, three precast 61 diam. x 61 deep
drywells surrounded by one foot ¢ gravel).
eo 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.
SIGN&74/diz TITLE Ailq 6e DATE Ld
MB: White (PaID) a Yellcw (Mmm HE); Pink (Appli,®nt)
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s 1 OUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
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. i BEDROOMS
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HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
BEDROOMS
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HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
BEDROOMS
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