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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -1 -7 BOX 19 02238 go go go go III jr go 1' . ! ti N o .� r�, .. . �.. ; `' 0 111 lam , 02238 REBECCA WMINBERG, RN, BSN Public Health Director . 1= ROBERTMOJ1Mj'E -. - Director of Emvfromnental Health 'DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808-1390 Fax # (845) 278 -7921 May 10, 2012 Donna Lovell 255 Lake Shore Road Putnam Valley, NY 10579 Re: Addition — A- 066 -12 No Increase in Number of Bedrooms 255 Lake Shore Road (T) Putnam Valley, T.M. 41.6 -1 -7 Dear Ms. Lovell: MARYELLEN ODELL Cowity &ecuttve This Department has 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 May 10, 2012. The addition is approved with the following conditions: 1 3. 4. 5. The total number of bedrooms must remain at.three without prior approval by this Department. The area. of the existing sewage disposal systgT!and_its expan ion area must be maintained All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies. having jurisdiction. This approval is valid for two (2) years and expires on May 10, 2014. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, M7,L R j� , Gene D. Reed Senior Engineering Aide GDR:cw cc: BI (T) Putnam Valley REBECCA WnTENBERG, RN, BSl® Public Health Director ROBERT M®gt % PE Director ofErevironmeWd Health Donna Lovell 255 Lake Shore Road Putnam Valley, NY 10579 Re: Addition — A- 066 -12 No Increase in Number of Bedrooms 255 Lake Shore Road (T) Putnam Valley, T.M. 41.6 -1 -7 Dear Ms. Lovell: Courtly Executive This Department has 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 May 10, 2012. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at.three without prior approval by this Department. a...Ofahe:existing sewage.disposal ystem.and.itis:expansiori 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 ... 4. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies. having jurisdiction. 5. This approval is valid for two (2) years and expires on May 10, 2014. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, 'TR_ Gene D. Reed Senior Engineering Aide GDR:cw cc: BI (T) Putnam Valley REBECCA WITTENBERG, RN, BSN Public Health Director ROBERT MORRIS; PE` "" ` Director ofEmironmental Health MARYELLEN ODELL - ,✓" =�^ �....,. County Executive.. ..� .... DEPARTMENT OF HEnT 1 Geneva Road, Brewster, New York 1050 "'�*W Phone # (845) 808 -1390 Fax # (845) 278 -7921 ADDITION APPLICATION RESIDENTIAL ONLY STREET �� 1� P �laI1YP TOWN AX MAP # W L -1- 7 NAME �( o vun Vi- ( PHONE yf5 - S fib' d 2a Sr-" PCHD# f ' Z ' MAILING ADDRESS DESCRIPTION OFD ADDITION Yvt rS� ��a Stir, �n d 5— *NUMBER OF EXISTING BEDROOMS _� NUMBER OF PROPOSED NEW BEDROOMS 0 * (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., l Geneva Rd,, Brewster, NY 10509, Phone: (845) 808 - 1390': ` _....._.::..... _.....> . _ .... �.' 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS 4. REBECCA WrrrENBERG, RK, IBSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health DEPARTAIENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone ## (845) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: Lovell (Owner's Name) Tax Map # 41.6 -1 -7 Address: 255 Lake Shore Rd. Town: Putnam Valley Year Built: 1997 According to records maintained by the Town, the above noted dwelling, is xx in compliance with Town Code. MARYELLEN O DELL County Executive .. _. � -lis ^not . ._::in compliance with - T own Code.....:. _ _ ... _._ .... __ . _._....... _ ._ . _ ... _..... . The Legal Bedroom Count is: 3 This information has been obtained from: Certificate of Occupancy: CO # 9 7 - 3 4 Other: The plans for the proposed addition are considered: xx , Addition to existing house only Teardown and/or re -build allowed under Town Regulations 'Oo-5A ding Inspector Date 5. i r � F 04- �-- ...........' 8 R o_i 6 r -r> p� d� O v� � o � � 2 °s s z f ( Q nP Y OF F SITUATE IN PuTts COUNT) PREPARED e>Y BUNNEY A55OC1ATE5 B Rouc LAND 5URVEYOR5 RURAL ROUTE #2 FIELDS LANE NORTH SALEM, NEW YORK 10560 f i 0 NORTH AMERICAN 11W LABORATORIES, INC. i ®� CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 97 -0551 CLIENT: ,Joel Lawrence Greenberg ATTN Lovell job 2, Muscoot Road North Mahopac NY 10541 SAMPLING LOCATION: ' Kitchen tap: West Lake Shore Dr, Putnam Valley NY COLLECTED BY: P. Garcia DATE COLLECTED: 01/24/97 TIME COLLECTED: 1:45 PM DATE RECEIVED: 01/24/97 DATE OF REPORT: 01/27/97 ANALYTE RESULT'' UM TS MAX CNTMT LEVEL *" M1rTHOD ANALYZED Total Coliform E. Coll _ Absent Absent �.__.._ Must be "Absent" Must be "Absent" SM18(9223) SM18(9223) 01/24/97 01/24/97 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality fox .the tests performed, was: ACCEPTABLE NOT ACCEPTABLE. _ _....... NYS ELAP #11218 Maryann Fasano, Assistant Laboratory Director CT Lab Approval #.PH -0171 ` Underlined results are unacceptable according to health department and /or US EP.A. codes. " Maximum Contaminant Level (maximt.wa permissible concentration allowed by health department and /or US EPA codes). i 0 618 Clock Tower Commons, Brewster, NY' 10509-9241/ 914-278-7600/ Pax 914 -278 -7754 / E-mail: NoAmLab®aol.com �110 i ii _��� /�'_����� ;r♦'�' 'lullI,, i �* TT �+l F: ki o1 94TO l i��Oli. ♦ TTT AT T'' W. Y WL'LL lrVr1rLziiV1V rtr•rVnt DEPARTMENT OF HEALTH Division Of. Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: T6WN7vILE7U1CIIy,, :. TAX GRlO NUMBER: C J r p WELL OWNER NAME: o N ADDRESS: Orzi5t e.5 l� ©U F-- (,� PBIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary Gb RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM 0! TEST/ OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑'STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/ OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY' COMPRESSED, AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. L9 OPEN HOLE IN BEDROCK O OTHER .CASING DETAILS TOTAL LENGTH_, ft. MATERIALS: 9STEEL . O PLASTIC - O OTHER LENGTH.BELOW GRADE fit. JOINTS: ❑ WELDED THREADED ❑ OTHER DIAMETER in. SEAL: CEMENT GROUT ❑ BENTONITE ❑0TH R WEIGHT PER FOOT 7 Ib. /ft. DRIVE SHOE YES 0 NO LINER: O YES NO SCREEN DETAILS OIAMETER jin) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST. O YES ONO HOURS SECOND _ .. .. ; .,. GRAVEL PACK a YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM It. WELL YIELD TEST I If detailed pumping METHOD: O PUMPED tests were done is in- O COMPRESSED AIR I formation attached? O BAILED 0 OTHER 0 YES 0 NO 1�1ELL LOG �I more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water sear- ing We11 0'a- Meter FORMATION DESCRIPTION cooE, ft. It. WELL DEPTH IL DURATION hr, min. • DRAWOOWN It, YIELD gpm. Surface s 1 S g� 0/ 7 et- O CLOUDY HARDNESS O COLORED ANALYZED? O YES 0 NO NALYSIS ATTACHED? O YES. ONO rMAKER CLEAR TEMP. STORAGE TANK: TYPE C20- � CAPACITY GAL. INFORMATION CAPACITY �.2 _! DEPTH VOLTAGI� H WELL DRILLER NAME DATE/O S Aoo6ESST M. HYATT SONS, INC. Well Drilling SIGfiRTURE Rite. 3 11 R. R. 2 Box 171A � � sae PAT'I'r: :01N, �i`t:r `ORK\ 12563 _ ..... — .._a, — GREENBERG TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 11/13/96 PUTNAM COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 ROBERT MORRIS DONNA LOVELL (BEER) ® PRINTS El SPECIFICATIONS [l SHOP DWGS El SAMPLES [l OTHER 91. _APPROVAL,._.. [l YOUR USE ® REVIEW F1 COMMENTS COMMENTS: ENCLOSED PLEASE FIND APPLICATION FOR CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM. FROM J09L GR;;g;NBARG. R.A. COPIES TO: — ., M-C -10-1996 12.'59 JOEL L.GREEhBERG ARCHT. 914 628 2807 P.02 let tu OC 0 Zt w Q ® d � i M � YV TOTAL P.02 i NOU -05 -1996 15:41 JOEL L.GREENBERG ARCHT.. A R C H I T E C T 2 MU5C00T ROAD NORTH MAHOPAC, NEW YORK 90549 ;spa) saass�3 FAX (s14) 029,aeo7 November 5, 1996 Robert Dorris Putnam County Department of Health 8 Geneva Road 13rewster, New York 10509 Re: Anita Beer Lakeshore Road Putnam Valley, New York 10579 PV 56-87 T.M. # 41.6 -1 -7 914 628 2807 P.02 Dear Mr. Morris, This is to inform you that the fill at the above mentioned site was Please contact me if you have any questions. TOTAL P.02 DEPARTMENT OF!HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y: 10512 (914) 225 -3641 APPLICATION T0. CONSTRUC A....�IATE - -- .�._......._ .... R WELL PCHD PERMIT # PV -56 -8 WELL LOCATION Street Address LAKE 'SHORE DRIVE, Town/Village/City Tax PUTDIAM VALLEY 9-9-99 Grid Number WELL OWNER Name ANITA BEER Address 7 LEXINGTON ZPrivate Public USE OF WELL 1 - primary 2 - secondary 9 RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP CI FARM D TEST /OBSERVATION b INSTITUTIONAL ❑ STAND -BY D ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 200 gal REASON FOR DRILLING SNEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑ REPLACE EXISTING SUPPLY a DEEPEN EXISTING WELL DTEST /OBSERVATION DETAILED REASON FOR DRILLING NEW RESIDENCE WELL TYPE DRILLED DRIVEN ODUG GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES __X NO IF WELL IS LOCATED IN,A REALTY SUBDIVISION, NAME OF SUBDIVISION: ROARING BROOK Lot No. 473 WATER WELL CONTRACTOR: Name N. ANDERSON Address: gAg , •R STRFF.T PTTTTTAM TSTAT.T IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ___X _NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY DISTANCE TO PROPERTY.. FROM NEAREST. WATER MAIN:. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION 00�s A E 6/19/89 (date) gnatq PERMIT', TO CONSTRUCT A WATER WELL This permit to construct one water well as stet forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on,a form provided by the Putnam County Health Department. Date of Issue: , --7-1' 19 mim6L Date of Expiration: 19_ Permit Issulg T11 al Permit is Non - Transferrable 0 8/86 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.__._ .. Date 6/12/87 Re: Property of ANITA BEER Located at LAKE SHORE ROAD WEST (T) PUTNAM VALLEY Section 9 Block 2 Lot 22 Subdivision of ROARING BROOK LAKE - FIFTH MAP Subdv. Lot # 473 Filed Map # 3082 Date 7/1/49 Gentlemen: This letter is to authorize JOEL L. GREENBERG a duly licensed professional engineer or registered architect XX (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connectio.n,. with this .matter and to supervise the construction of-.sa d system or systems in conformity with the provisions of Article 145 or 147, Education Law a Public Health Law, and the Putnam County Sani- ERED .4 C` tary Code. �\g'� RENCE GR Fti�j o @� Very truly yours, Signed Elm�bt yg Counters gn d: • 01105�.,(O� Owner of Property Op NEB 7 LEXINGTON .DRIVE P. E. , R. Address MUSCOOT NORTH,RFD #2,BX 488 Address MAHOPAC, NEW ":YORK 10541 628 -6613 Telephone CROTON- ON- HUDSON,NY10520 Town 271 -3938 Telephone 1 i (Name of ~Owner) COMMENTS S Xgi`i- i= [ON OF ENVIRONMENTAL HEALTH szRv.Lut� REVIEW SHEET - CONSTRUCTION PERMIT �n 'Kit}Qp 1� DATE BY: ( Street Locatiori;).. YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth LF trench provided required' t 60 ft. max. Parellel to contours. s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well ''" permit; PWS letter Var' ce Request 5: -P �Q Legal Subdivision �n � ;\ Subdivision Approval Check Ex approval SSDS Adj. Lots Check ! Wetland (Town /DEC Permit R & D) -� Data On DDS Plans & Permit Sam REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume Dor J Box;Trench /Gallery; Pump'pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results o -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter; Curtain Drains'.(discharge'OK);. ,""Perc & Deep Holes Located Representative of primary and expansion _ EStpansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Syste Property Metes & Bounds ' House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of f 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e)q 15' to Drains - -Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercoi 10' to Water Line (pits -20') 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 1 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION - REPORT. A DATE: / INSP. BY: (Name of Owner) (Street Location) V ✓-/ INITIAL SITE INSPMTION YES NO COPTS . Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location...'..... Willdriveway need cut .............................. Must trees be•removed - note these ................ Deep holes representative of entire SDS area....... Additional deep holes needed...... .. Sufficient SDS area available considering driveway cut, house location, separation distances,etc... aAdjacent wells /septics .......................... ... s Access to proposE D.H. 1 Lot, _ Depth to G.W. Depth to rock _ Soil Descri �. 0 ft. 3 ft. 6 ft. 9 ,ft. .12 ft D.H. 2 Lot Depth to G. W. Depth to rock Soil Descri tior 0 ft. 3 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 3 _ Lot Depth to G. W. Depth to rock 0 ft. 3 ft. 6 ft.. _- f � 6 ft.. 9 ft. �� : �..��; • 9 ft. . 12 ft, u . 12 ft. Soil Description DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ........... ..... .....o.... 10 ft. maintained from property line and 20 ft. from house .............................. Distance well to SSDS (ft.).. .................. Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench.. .......... 15 ft. of peripheral soil horizontally from trench...... Boxes properly set — o ...............a........... Could surface runoff from driveway, roads, ground surface,.etc., channel near SDS area.... Does lot drainage appear OK ,in area of SDSes.....: FINAL GRADNG OF SITE AOCEPTART,Fe....... .... �. SCHOOL DISTRICT LINE -- i SCH- - FIRE DISTRICT LINE WATER DISTRICT LINE LIGHT MSTRICT LINE' PARK DISTRICT LINE SEWER DISTRICT LINE HYDRANT DISTRICT LINE BLOCK NUMBER' PARCEL NJMBER. .' DEED BLOCK 400ER DEED I.OT %uMBER DEED DIMENSION SCALED DIMEN90M CALCULATED AREA r1 E. r_ D . CAL TOWN OF PUTNAM PUTNA COUNTY DATE,AERAL M PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 September 8, 1987 Mr. Joel Greenburg Muscoot North RFD #2, Box 488 Mahopac, NY 10541 Re: Proposed SSDS, Beer Lakeshore Road West (T) Putnam Valley, TM 9 -2 -22 Dear Mr. Greenburg: F\ JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL, Jr., P.E. Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. To ensure the maximum distance is maintained to the / existing wetland on the property, the fill section is I/ be staked by the engineer and inspected by a represent- .. ....ative ..of . this. Department prior to the- placement of fill 2. Delineate fill section on plan.'✓/ 3. Construction note 5 missing. 4. Fill volume and dimensions not noted. 5. Additional deep test hole requried in expansion area. 6. House sewer to be noted as sloping 4 inch per foot. 7. Footing and gutter drain discharge not shown. •� Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ver truly yours, Robert Morris Environmental Health Technician RM : amm DEPARTMENT OF HEALTH Division of Environmental Health Services ,\TWO COUNTY CENTER - CARMEL, N.Y; 10512 (914) 225 -3641 ,..�, :.,..;,.._._. :.,:.. ..APPLICATION__ TO.. CONSTRUCT.. A WATER WELL � .�F/ j PCHD PERMIT x #11L -JO WELL LOCATION Street Address Town Village City Tax Grid Number LAKE ;SHORE DRIVE PUTNAM VALLEY 9 -2 -22 WELL OWNER Name ANITA BEER Address 7 LEXINGTON DR. CROT -ON -HUD NY WPrivate O Public USE OF WELL primary (29. secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP' 0 BUSINESS O FARM ❑ TEST /OBSERVATION 0 INDUSTRIAL b INSTITUTIONAL ❑ STAND -BY ❑ ABANDONED ❑ OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 300 gal REASON FOR DRILLING ® NEW SUPPLY ❑REPLACE EXISTING ❑ PROVIDE ADDITIONAL SUPPLY SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING NEW RESIDENCE WELL TYPE ?DRILLED DRIVEN []DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES XXX NO IF "WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: W_0A rZ_L W G 'BP_Q 1C_ Lot No. 415 WATER WELL CONTRACTOR: Name N. ANDERSON Address: BARGER STREET_,PUT. VA. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XXX NO NAME OF PUBLIC WATER'SUPPLY: N/A _..,. DISTANCR_ TO .PRO,RERTY _ FROM NEAREST WATER MAIN: 1��A TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF'THIS APPLICATION ON S ARA 6/15/87 (date) f nat re) . ?1 I PERMIT, j TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump'the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: Date of Expiration: 91a 19 _ ermit ssu�n9 Official Permit is Non - Transferrable �1 _ i�. 1 t • DEPARTMENT OF HEATH HOUSE PTANS APPROVED PC) ti BEDE00M C06:;T ONLY; - ? • e •. - EDRCCirs ' Date Signature & Title al V. JOEL LAWRENCE GREENBERG Architect • Town Planner Two Muscoot North.• RFD #2 MAHOPAC, NEW YORK 10541 (914) 628 -6613 • FAX'! (914) 628.2807 Town Planner • Putnam Valley, NY (914) 526.3140 - TO MR, LARRY WERPER DEPARTMENT OF HEALTH DIV.OF ENVIRONMENTAL HEALTH SERVICES 110 OLD ROUTE -SIX CENTER CA— RRMP.T., W,V- 10r,19 DATE JOB . .. ATTENTIO Wx_ WE ARE SENDING YOU N Attached ❑ Under separate cover via -the following items: • Shop drawings? For approval Prints ❑ Plans ❑ Samples ❑. Specifications • Copy of letter : ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as 'checked below: K For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 • Resubmit copies for approval • Submit copies for distribution • Return corrected prints 0 PRINTS RETURNED AFTER LOAN TO US _ :. _:_ � :_ X11 s•• •� : + "u -- -•• r COPY TO SIGNED: PRODUCT2404 �ice., GroM, Mm OTan. If enclosures are not as noted, kindly notify) VERY TRULY YOURS PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 Mr. Joel Greenberg, RA RR8, Muscoot North Baldwin Place Road Mahopac, NY 10541 Dear Mr. Greenberg: June 229 1989 Re: Renewal Beer Lake Shore Road West (T) PV - TM #9 -2 -22 Permit # PV -56 -87 L"_ ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Review of plans and. other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered . as follows: �.. - . - - - - - -- -•- -- - 1) Relocate well to p provide 150 feet from proposed septic "' system. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, C.- Lawrence C..Werper LCW:jr Assistant Public Health Engineer JOEL LAWRENCE GREENBERG Architect a Town ' Planner Two Muscoot North,* RFD #2 MAHOPAC, NEW YORK 10541 (914) 628.6613 a FAX (914) 628.2807 Town lanner • Putnam alley, NY _ (914)` 526- 740 TO A44 D )_X �! 0 RJEUTEa OF MUSE DUML > WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE N0. DESCRIPTION THESE 'ARE"TRANSMITTEfl °as, -checked - below: :.. ... :.... _ ..._ ..._�... _... , :... . For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ PROOUCT240.2 J 1M. GMtM, Man 01471. If enclosures are not as noted, kindly notify us at once. f 7 LEXINGTON DRIVE CROTON -ON- HUDSON, N.Y. 10520 Play 109 999.1. ,11r, Jool L. Gre ^nber.,s 2 Tiuscoot :'ort:h R,? D 2 T:,Tanopac, H. '0 10541 Dear Greenberg: As discussed by telephone on I�..Tay.2nd9 please take the necessary steps to renew my Board of Health Approval in good time, I.am referring to Lot 473,. at Roaring; Brook Lake,, `1'he permit will ' expire . 7/17/91. Your fee will be 91 150.00, Thank you very much in advance. Sincerely your, gei. Anita Phi.*Weer. copy to Board .of Heal -th DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 1, 1993 Joel Greenberg 2 Muscoot North Mahopac NY 10541 RE: Proposed SSDS: Beer - Lake Shore Road (T) Putnam Valley Dear Mr. Greenberg: JOHN' KARELL Jr., P.E., M.S. Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows!' 1. Field inspection report, dated 8/3/87, notes ledge at 5 feet. Utilizing a tri- galley system, 3 feet of fill is required. Revise plans accordingly. 2. All existing and proposed SSDS within 200 feet of the proposed. wel l..and, a"l l existing.. and . proposed -wel is --within- - 200 ,feet •of the' ' proposed SSDS are to be shown on the SSDS construction plan. 3. Actual SSDS profile is to be shown on the SSDS construction plan. Typical profiles are not acceptable. 4. Current fill notes required on fill plan have been enclosed. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris Assistant Public Health Engineer RM:mk enc. DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # PV -56 -87 ALL LOCATION Street Address LAKE SHORE DRIVE. Town Village City PUTMAN VALLEY a G Id b r 1 1- NIA WELL .OWNER Name �ANI.TA BEER Mailing Address rivate O Public SE OF WELL 1 - primary - secondary Iff RESIDENTIAL ® BUSINESS 13 INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# O REPLACE EXISTING SUPPLY 19 NEW SUPPLY NEW DWELLING PEOPLE SERVED 4 /EST. 'O TEST /OBSERVATION ® DEEPEN EXISTING WELL OF DAILY USAGE 200 gal CI ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR 'DRILLING FZW RESIDENCE WELL TYPE ®DRILLED DRIVEN []DUG OGRAVEL ®OTHER IS TELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ROARING BROOK Lot No. 473 WATER WELL CONTRACTOR: Name N. ANDERSON Address: BARGER ST. , PUT, VAL. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY:. /,A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: `N /A LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID 5 / ®OAT SEPARATE SHEET '� 4/�1 (date) (sign ture) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth-above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirti� (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: % T 19 Date of Expiration Permit is Non - Transferrable 3/89 19- ;�; Permit White copy: Yellow copy: Issuing Offic HD File Pink copy: Owner Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO ' 'CONSTRUCT A 'WATER --WELL ^-•P - --_ PCHD PERMIT $ PV -54 -87 WELL LOCATION Street Address Town/Village/City Tax Grid Number LAKE SHORE DRIVE PUTNAM;VAL1,EY 41.6 -1 -7 WELL OWNER Name Mailing Address )OPrivate ANITA BEER 7 LEXINGTON DR. , CROTON -ON- HUDSON N.Y. 10520 D Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 ABANDONED 0 BUSINESS 0 FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL 0 INSTITUTIONAL ' O STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4. /EST. OF DAILY USAGE 200 gal C] REPLACE EXISTING SUPPLY O TEST/ OBSERVATION: d ADDITIONAL SUPPLY $] NEW SUPPLY-(NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NEW RESIDENCE WELL TYPE ®DRILLED DRIVEN DUG ®GRAVEL 0OTHER IS WELL SITE SUBJECT TO,FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF 'SUBDIVISION: ROARING BROOK Lot No. 473 WATER WELL CONTRACTOR: ''Name N. ANDERSON Address: BARGER ST., PUT. VALLEY NY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY - DISTANCE-TO- PROPERTY FROM.NEAREST.WATER MAIN:__ LOCATION SKETCH & SOURCES OF CONTAMINATION PR IDED ®ON SEPARATE SHEET MAY 12, 1993 (date) s na u e) PERMIT TO CONSTMICT A WATER WELL j This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty. (30) days of the'completion of water well construction, the applicant shall: 1. Pump.the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. i 3. Submit a Well Completion. Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water -or waste products from such well drilling operations be contained on this property and in suc a manner as not toT rade or oth r e contaminate surface or groundwater. [ Date of Issue: 7 2� 19 1 - 1&440 Date of Expiration 2-1- 19 !?& Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNPM COUNTY DEPARM%ff2U OF HEALTH - DIVISION OF ENVIRONiERM HEALTH SERVICES I1%MIVIDUAL I'D= SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS jG� P • y . FIELD INSPECTION REPORT . DATE: INSP. BY: (Name of Owner) (Street Location INITIAL SITE INSPECTION YES NO CprS Wetlands on /or proximate to property.............. Property lines or corners found ................... Canestimate house location ....................... Will drive,ay need cut ............................ .5 Must trees be- ramved - note these ................ Deep holes representative of entire SDS area...... pL Additional deep holes need...... .. ........... pL, Sufficient SDS area available considering driveway cut, house location, separation distances,etc...i ? :/ Adjacent wells/ septics ............................ Access to nrocoserd well location for drilling..... %L,I D. H. 1 Lot - Depth to G:W. Depth to rock. Soil Descriptio 0 ft. 5v 1L 3 ft. 6 ft. 9 eft. 12 ft FINAL SITE INSPECTION D. H. 2 Lot Depth to G.W. Depth to rock ,.12 ft,. Soil Description D.H. - Deeo Hole G.W.- Grounc4ater D. H. 3 _ Lot Depth to G.W. Depth to rock Soil DescrlDtion 0 ft.' �Y�oiZ 3 ft. Sq� �ca/W wl Soj 6 f t. 9 ft. __..._12 ft. U DATE: INSP.BY: ( YEA NO House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... . Roan allowed for expansion trenches .............. Over 100 ft. from watercourse.. .. ................. Natural soil not stripped or SDS area unnecessarlygraded ............................ 10 ft. maintained fran property line and 20 ft. fran house .............................. l Distance well to SSDS (ft.) ...................... `\ ianber of bedrooms checks ........................ nes, brush, stumps, rubble, etc., greater -� 15 ft. from nearest trench........... peripheral soil horizontally `. nch ..... ............................... .ly set.. . . . ......- runoff frondriveway,roeds, `� :ace, etc., channel. near SDS area... . ainage appear OK-,in area of SDS::...... .JNG OF SITE ACCEPT-4MLE .. CCY7I'S 0 ft. a - 3 ft. �q « 6 ft. 9 ft. ,.12 ft,. Soil Description D.H. - Deeo Hole G.W.- Grounc4ater D. H. 3 _ Lot Depth to G.W. Depth to rock Soil DescrlDtion 0 ft.' �Y�oiZ 3 ft. Sq� �ca/W wl Soj 6 f t. 9 ft. __..._12 ft. U DATE: INSP.BY: ( YEA NO House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable.......... . Roan allowed for expansion trenches .............. Over 100 ft. from watercourse.. .. ................. Natural soil not stripped or SDS area unnecessarlygraded ............................ 10 ft. maintained fran property line and 20 ft. fran house .............................. l Distance well to SSDS (ft.) ...................... `\ ianber of bedrooms checks ........................ nes, brush, stumps, rubble, etc., greater -� 15 ft. from nearest trench........... peripheral soil horizontally `. nch ..... ............................... .ly set.. . . . ......- runoff frondriveway,roeds, `� :ace, etc., channel. near SDS area... . ainage appear OK-,in area of SDS::...... .JNG OF SITE ACCEPT-4MLE .. CCY7I'S DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 `--APP LT CAT I'ON`'TO `CONST�tUCT A�WATER 3WELL'.`..�u.. PCHD PERMIT -.�; WELL LOCATION Street Address LAKE SHORE DRIVE Town/Village/City Tax Grid Number PUTNAM VALLEY 41.6 -1 -7 WELL OWNER Name ANITA BEER 7 Mailing LEXINGTON Address ]O Private DR.;, CROTON- ON- HUDSON, N.Y. D.Public USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify .b INSTITUTIONAL O STAND -BY .O . AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY. USAGE 200 gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ NEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION 13- ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING NEW RESIDENCE WELL TYPE ®DRILLED DRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ROARING BROOK Lot No. WATER WELL CONTRACTOR: Name N. ANDERSON Address: BARGER ST., PUTNAM T IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /f4TY -DISTANCE _. DISTANCE TO PROPERTY-FROM �1EAR8$T. WATER :MAIN: _ _ , ._.... _......... „ .. _._... ,._..... . _. __.._ NSA. .. .. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ ON SEPARATE SHEET NOV. 22, 1995 (date) signat e PERMIT TO CONSTRUCT E This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well diill.igg operations be contained on this property and in such a manner as not to degrade or other ' cont nate surface or groundwater. Date of Issue: 2- 199 Date of Expiration l 19 r Pe it Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller .DEC -20 -1996 12:49 4 rp UJ 9 r D R rn 4 x t7 JOEL L . GREEIBERG ARCHT . 914 628 2807 P.02 0 l TOTAL P.02 lj 60•d ZSL4 LG3 tiY8 aoscb +PauunB vb2t![ sd -sc -gym l TOTAL P.02 PUTNAM COUNTY'.:DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 6/12/87 Re, Property of' DONNA LOVELL Located at LAM SHORE ROAD WEST (T) puTNAm VALL I E I Y Section 9 1 Block _— _Lot 22--- Subdivision o f ROARING BROOK LAKE- FIFTH MAP Subdv. Lot # .47.3 —Filed Map # 3081 - - - -- Date -7/1 /4 ---Date. 7/1/49 Gentlemen: This letter is to authorize JOEL L. GREENBERG a duly licensed professional engineer or registered architect XX (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted'prop.erty in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam C6unty Department of Health, and to sign all necessary papers on my behalf in c-onn-ect'ic'nwith this .rftatfef' and 'to supervise the construction of said system or+systems in con-formity with the provisions of Article 145 or 147, Education Law, the Public HeAlth Law, and the Putnam County Sani- tary Code.' Counter cdc ir P. R. A., 11056 MUSCOOT NORTH,, RFD#2, BX,488 Address 628-6613 Telephone j Very truly yours, Signed Owner of Property 2377 CRESTON AVENUE, APT. 4E Address BRONX, NEW YORK 10468 Town Telephone i • •:I.VI. 1.. •,'.f. y llA..iw r..:.;':.. .,•I. n.. ... :.'1. ': .. .. DIVISION OF ..KEMM• SERVICES,,.'.. DESIGN DATA SLUW- SUBSUFACE SEWAGE DISPOSAL SYST ;: ;,'.......: ,: F1t.E ICU. IM Owner .ANITA BEER ` AddrG.SSS�.'' .7 LEXINGTON DR. ,,.CROT= ON- HUbSON1' y -- I— .520.• : 14=ted at'.(Street) LAKE SHORE ROAD WEST 9 .::.:,Block .2 Lot 22': (indicate nearest cross street) — '• ""' PUTNAM VALLEY :.... ..,..:...,.......:_ ....... Municipality Watershed HUDSON RIVER SOIL PER00=C N TFM DATA -REWIRED TO BE SUHMITM WrM APPLICA7.'IONS . Date of Pre - Soaking May 6, 1987 Date of Test May'-.,6.- 1987 HOLE .. • NCP'IDEEt C.1= TIME PERCOLATION ` ' .: ' PEP=LmON Than Elapse Depth to Water' From '.Water Levu.: No. Time Ground Surface,. .. In;.Ind3es - Soil Rate Start -Stop Min. Start Stop Drop In :.,.: Min/In Drop Inches_ Inches ...._Inches-'.... 112:00. 12:30 30 26 28 �25 `2` 25' 30/? 25 =1 3 ' 3 212:31'1-:01 30 26 28.25 -:2.26.' 30/2.25=130. 3_1:02 1:32 30 26 28.25 2.25 30/2 25 =13.3 5 112:05 12:35 30 26 . 28.2 : 2..2 ;'30%'2.2 =13.6 212 -: 36 1:06 -.. 30 26 28.'2 �':.:.:'. '' ::.::�. 2 : a', :I:'., ?> ...30/'2.2 =13.6 -31:07 1:37 30 25 29:2 :.:' := 2..2...: ;:.';:.`:: °:. 30/2.2 =13.6 4 3 1. Tests to be repeated at same depth until apprad mately • eval soil zates are obtained at each percolation ...test. t�1e, ,All .data ,to' be sutmitted for review. ., 2. 'Depth, measurements to be made fraca' top of hole. re4' 9/85 TEST PIT MiA RFX?UIRED TO BE 'SUBMITTED "WM IPPLICATION DESCRIPTION OF SOILS ENCOUNTERED 'IN -TEST HOLES As 11 7 .„ ° ... " As 9°. 10, . -.- 11° 120 ®® ®� 13° Y gca % AT 1n (f 01600b7 A!TER IS lEt3Q0UNT _ NONE , $KATE LEFT TO WHICFf 61ATtR 1Zv-fL RISES AFTER BEW.ENCOUNTERED NONE DEEP ROLE OBSERVATIONS MADE BY: JOEL L GREENIBERG DATE; May 6, 1987 - - - DESIGN Soil RadtA Used 11-15 Min /1 `° Drop: S o D o U .e Area Provided 5 0 0 0 S F No of moans 3 Septic Tank Capacity - 1000 - gals, TypePRECAST CONC . TRI- GALLERIES , Absorption Area Provided By 150 L.F. MaW l E p q R 2 FT. BANK RUN FILL ���gENce �RF ti�j Other Ham L. GRF ,ENBERG Sggaa. i A ess #2 RX da SM �• 0110 �O MAHOPAC NEW YORK 10541 F OP NE- TM SPA loft USE BY 14" DEPARDWM ONLY: Soil Rate Approvod _`. sq.ft /gala Checked by �� Date Punm OaWY DEPARUMU OF DIVISION OF f' •' ' IE V' HEALTH S&MCES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner DONNA LOVELL Address'2377 CRESTON AVE., APT. 4E, BRONX, N.Y. Located at (Street) LAKE SHORE ROAD WEST Sec. 9 Block 2 Lot 22 10468 (indicate nearest cross street) Municipality PUTNAM VALLEY Watershed HUDSON RIVER SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 11./10/96 Date of Percolation Test 11/11/96 HOLE NUMBER CIS T TIME P PERCOLATION P PERCOLATION Run E Elapse D Depth to Water Fran W Water Level Soil Rate 1 2:18 -2:30 1 12 2 24 .27 3 3 1 12/3 =4 2 2:31 -2:43 1 12 2 24 27 3 3 1 12/3 =4 3 2:44 -2:56 1 12 2 24 27 3 3 1 12/3 =4 4 5 2:20-21 02 12 24 27 3 12/3 =4 2 2:33 =2:45 24 27 3 12/3 -4 3 2:46 -2:58 12 26 27 3 12/3 =4 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth,until approximately equal soil rates are obtained at each percolation test hole. All data to' be subaitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1° 2' 3' 4° 5° 6° 7° 8' 9' 10' 11° 12' 13' 14° INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 11 -15 Min /1" Drop: S.D. Usable Area Provided 5000"'SF No. of Bedroans 3 Septic Tank Capacity 1000 gals. Type PRECAST CONC. MI- GALLERIES Absorption Area Provided By 150 L.F. x 24" width trench Other 'J LPP 1 may DTTKT v- T T TTiCTTT T rq-1 w Name JOEL L. GREENBERG Signatur j J SEAL Addressor MU SCOOT NORTH MAHOPAC, NEW YORK 10541 �" ag'O o� F o� THIS SPACE FOR USE BY HEALTH DEPARTMErPI' ONLY: Soil Rate Approved sq.ft /gal. Checked by Date 1 I r PUTNAM COUNTY DEPARTMENT 0 HEALTH 3186 Division of Environmental Health Services. Carmel. N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF COMPLIAN _ CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit fl PUTNAM VALLEY Located at LAKE SHORE ROAD WEST Town or Village . ._ . dtOAR.ING ..BR .,..LKE ,.., 47.3 .�....,. ,,.....�t. ;..,.. g� —.... ..... ::.... �.< :��. _.... �....-...... �.2�..,......a..,- r..._.,..... Sabdlvielon Nam o �Sabd. Lot IY Tax Map Block Lot Owner /Appllcaat Name ANITA BEER Renewal.! ❑ Revision ❑ Date of Previous Approval Mailing Address 7 LEXINGTON DRIVE Town of, If 10520 Building, Type ONE FAM. RES. Lot Area 1..224 ACRES Fill Section only Li Depth volume Number of Bedrooms — 3 Design Flow G /P /D 600 PCHD Notification to Required When FIB Is completed Separate Sewerage System to consist oil.000 Gallon Septic Tank and 150FT OF TRI- GALLERIES To be constructed by-. RONALD FIORENTINO Address LAKE SHORE RD WEST, PUT. VAL, N1Y10579 Water Supply; ftbltc Supply From Address or: xxxx Private Supply Drilled by N . ANDERSON Address ' BARGER STREET Other Requirements 2FT o BANK RUN FILL represen ha I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above describetl will be constructed as shown on the approved amendment there to and in accordan with the standards, rules 1.41 regu a tuns o e Putnam County Dapartment of Health, and that on completion thereof a "Certificate of con struction o pliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his su ce rs, heirs or assign by the builder, that said builder will place in good operating condition, any part of said sewage disposal system during the perio of two (2) years tm lately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of final system o a y Irs thereto; that the drilled well described above will be located as shown on the approved plan and that said well will be inst letl in ccordan e w t e tandards, r s and regu aTironi of the Putnam County Department of Health. e n A -. / Date APPROVED FOR CONSTRUCTION: This approval expires y revocable for cause or may be amended or modified when a nsidered requires a new p i;, e Approved for disposal of dome is sa r Date (fJ`1 / y/ By i issued nless Construction of the the o missioner of Health. Any for r to water supply only. P,E: _ R.A. _XX X -icense No 11056 Iding has been undertaken and is nge or alteration of construction Title S y4r - _ `"`.---.. K-. a:........,...az,;.•.�.- .x,�c.L <- -.: = fC-rt�...:�..:2•:s7r, ant�:r'prs�cv�'�c =.�' ram'+. �..,.- .qa'T�- ..p.�.c- +�,* -u.:r- . veer. p. �.::.:: tu�w+ G,,.-.ur-- "'--- .,....�.cvr ---a- ..wow^- V.L,a,,a»..c.a•o,aC„�.o III kbm d > Satvfeaa. Clta�. F.Y. H > svUa �t lira CaRT111111CATE OF COEQUANCB ~ ^^PUTNAM. VALLEY KE SHORE _ROAD WEST ears eff >t.bitrl�a. lees ROARING BR o LAKE anal_ jM #' 473 Tin Mp 9 2 1A 22 . Owar /A�■oa�t Fnla>. ANITA BEER > ❑ Bate fib Pamvitin Aproval Kefts 7 LEXINGTON DRIVE T,., CROTON— ON— HUDSON 10520 Aftems Date Subdivision ADD roved Fee Enclosed ® N.Y. Amntrnt ONE PAM. RE S o I," Aaz€€a 1-224 CR E S M Se>dme 0* Vdooae Ntli•r d ®e+i� 3 Datllip Flow G P D 6 0 0 PCHD N•et~I`e a 0a Racy ! F®la oaa/kted Sagaw/e Setlfmo Sysion w aalam, aQ Q D O -GeSaa Salt Yaat< and 150- T_-!T_ 012 E-0-R! GAL16B IE- 8 _ RONALD FIORENTINO Aftlo;aLAKE SHORE RD WEST 12TTT_VAT.- IRY 10579 Wdar Ft Adhow m X Miiie, Si0* Dd5W W N ANDERSON a fl BARGER STREET 2 FT. BANK RUN FILL 1 r•pr•wnt'.tMt 1 am wholly and Completely responsible for the design and kwAtion of line prop0 some described will be constructed as shown on the approved amendment there to and in accordan v County Department of Health. and that on completion thereof a •'Certificate of Construction m be submitted to the Department, and a written guarantee will be furnished the owner, his suc so trine• in pod operatin/ condition 'aony part of said sewage disposal system during nth• porbd ance of the approval of the Certificate of Construction Complienc rut.4he original system or any WIN be toeat•d a$ shown on the approved plan and that said well will M stall in accordAce wit t County Department of Health. Signed Date 6/19/89 TWO MUSCOOT N TH FD #2 C Addres orn(s); 1) that the :o crate saws disposal System the standards, rules an repu ns of this ruinam we" satisfactory to the Commissioner of Healthwill hairs or assigns "b "'the builder. that said builder will 21 yowl, Immnad ly following the date Of the itau- s thereto; 2) t the drilled well deaortb•d above rule mdi)r_eau l, Of the Putnam APPROVED FOR CONSTRUCTION: This approvel -Pines years rom t data issu unless construction of the buifdin revocable for cause or may be am IWNM or modified when sidered a b the mmissioner of Health. Any charge requires a new permit. Aporovsd for ditpOSal Of dom nit ato w r1 supply only. _P.E._ RA. - No 11056 is boon undertaken and Is alteration of construction f� RT61t A1e1 CL`.'f?�e'7 R ?;'�T A .. � , C4► fS�EA1,7�Ti vo\�k I u'1l.odi■o d l:t,32:acu CyUD=:! - 0.19. T . C I 1 •� liiTT.Yr`1A��iYt k. °rn..• Pommel f iii. "•' lriip'}c�: " "lr.` - ^i ►� gt=f3 r PV 56-87 PUTNAM VALLEY Ca LAKE SHORE ROAD WEST 9 111�m C3 (:_�t�!Cll. ".�Yt."S^,7 1'f P'OII BI�II�..p� [AH�OiRd1 fT�IiEfJJi _ V19W 22 (OLD 473 T•: ANITA BEER taAr A{n,.i ae�f Rea.e• Bob 1 1'r•.'auo• AporM Ln'"�= 7 LEXINGTON DRIVE 5tcr�rt{YROTON— ON— HImsnN -22�p 10520 Da1te S_ubd ?v?sion Annxoved _ Fee Enclosed [3 Amnttnt 1 FAM. RES,, j74 ACRES �l �i � x.._600 r b - ��awmMm .i gc�ct..1 nnn 'rr�r� -, T 51LFT�11F RONALD FIORENTINO LAKE SHORE. RD_ WE.ST..p P11T vALoN.Y, p� 10579 C:n x N_ ANDFRGf1N n RARGER SsRRET * , 2 FT BANKR )N FITJ, 0 r0070=41002 1 am MIWOCOy 064 CMWOQOly voc"FIBMCe 907 tho 600100 0914 CDC00011 Of tho 070POMS austom(e); 1) that tho s®Yariito t9wapa dit�osvl ByaQO1r1 CO waf2ru;ac9 ao ra OR too awoucs ornorldnlont thcro to and ill aeewcov� with tho don"da• rulaa a ►i®l1 fla o b (( Gr@ AQ Ctrl N=364 0=3 QC.h, t on cCzwz2E= th=CQ a "CCAllirato of COnMruCtlM 80RC0" m0comtory to the ConlrnHowty of 9101Mmill Co 00=mw t® wi i Q . ciag 0 twogoa cmoatp nitl'bo furhla tca tko a==. his e. h0ia w omeano ®y the ®uildc7. the0 wild baud a aril) Hap .C7P l3Qta� 082EMIM C2V 02A .00 mesl s�"� okgoml ov am 9071n Q40 O erne (a) yrs em Qoly folftail dl th ato of tho itu- C= of 0000 =p7eum 00 = Cc Acgeww of decinnMAI n smian rF CPV VC3V76 20 =001 OPM2 the dvlllod wolf dwwww ebovo vio b mwaco 06 mm= Cm Un C vom acs] mn aoi9 doll vill w stales A Our 61a/Q90r% r oQd me s of tho P0001a CC=q !o t Go C = // %l _ JK e c_-:7 , • Appacv £® cw Comirm uSVIO"h voca Baal oapbca hwe vows kcm Q "o it aJ for ew= e7 Rov oo ow== or -"afiwt nPRM COM10 9 NCE24pry tav eho G�^^i1tlbM 0 R= =90M.. a=6VW fw of h is WOUM�y , C)Wa /07 IeVa Z/ 7 OC 10/80 1 uwC= Construction of the nlimior= of 6 wnci. Any pwapotC7 CUMPU only. TWO P.td. _ W.A. COP40 331056 1 has been unaw"kan an9 is or 06twatwo of cor4rudion -6 c_1l r�gir.s •er F.'.?r'%+er.+te,.s:•raixx! SUal. = ?a `wv. rtreu. (rar.�a4. �'I. 1 1!5 1 .' :r-e ..s: au ?w•. 1u1• !'•*z^adt ! F'4�!lx9iT F'l3'� S4F'®YAk:L' � . _ 1w3AL 57T:�71/ ci LAKE SHORE ROAD WEST 2=1 I'll BR • LAKE ezjo_ pcs 0 473 so UUMOVIZAra 01F COMMUMN- o PV 56 -87 PUTNAM "VALLEY 9 °°° C: r 191130 22 (OLD M 41.6 M=t 1 a 7 (NEW) ANITA BEER MM=d b �° p ' MAY 22, 1991 Dt,� O 7 LEXINGTON DRIVE CROTON -ON- HUDSON 3b 10520 Subdivision A8Rxoved Fee Enclosed ® Amnttnt 9WO 1 FAM • RES , IcS Aum 1.224 ACRES vchrno C9 @Cac= 3 Dixto ]Pb. G ip D 600 IaED wemm m b mm 78 b s ct 1000 ,,, 150 FT, OF TRI- GALLERIES qb, RONALD FIORENTINO _AdWk. LAKE SHORE RD., WEST . r PUT, VAL.; N.Y. 10579 ucc= r 2E;Vb O�= QI X „�., P N , ANDERSON 4mi= BARGER STREE T a Pt"NAM VAT T.RY . N _ Y _ 10 c; 9 09= 2 FT. BANKRUN FILL I rwaicni,:that 1 am cyholly and comp"oly r000nsiboo 407 the dosien an® location of the Orogo systom(�; 1) that the twopwato ¢•r_ w disgp0aal syaQom obono dommel l roil ao eonstrudc>a as u"wn On the aOOrovcd ovnondnw int thoro to and in accwda itst tho standards. rulos a roau ns o ComnQy te:tao4 of Dfxofth, sled that orl eon101e4ion 4hovoo4 0 "CcrtfftCato OP Conatvtcin O lialo;o" Catisfadory to tho Colnariitsssonp of t-0plQharill (' LrSafwt3QC to BOeO OCaltrQrhatt, acad a roviQQOn 4laearontwe tl" ®o l tho orone7, his s5l Co 4 holvaOV aaatpns by Oho ItuiCdwr, that aoifl ttulWl[9 will pl,'CO W 9=9 Gpwatw Con9Hltan any port of mw t 7cgaga 01 sysao durPoq tho gOr ' f (8I vows Immos'10t01y follomileg tho onto of tho Mu- 0= Of tl� ai ao ®f tote CCrtWlCato of Construction Coln011ralleo tho Final syatocA Oro r 2=00:0.2) 000 tho drillCd gall dot VCW9 06M wo oo mzatcA as fSls vw On tmo opp7 ucs lima ona that said wool will bo inst accordrta wit t 12 rats, ru and rqu ws Hof tho Putnoln Countp W$092WM4 Of 09C00084. data MAY 12, 1993 . $gnsd � ®.�.^ c� �. X MUSCOOT ROAD NO OPAC N Y 1 11056 A000-2 uco No A"MOVt:O PrOW CONSTALICTION: This 0OMOtr01 0s18111705 two rCmca@IO for Cau Or may orrlaodcd or modlfiq whan consi rmulroa a �yrl� �OV Oit�owl Of dWnaaltt a Rev. C3V tho to issu unless Construction of the Y by tha om onor of FIo014h. lriny. Drtd/ WIr1 101m woply only. Title 1s tican undertotton and is oltC7ation of Construction 93 PUTNAM COUNTY DEPANITARN[ OF KRALTH - I �' Q DbYlw divh•tasedd Hader Senloee, CaM•1. N.Y. IOSl? 61111 CEW OF COMPLIANCE ooNSTRUC>ROx PEWIM FOR SsWAGE DWOM SYSTEM Pr R PV 56-87 PUTNAM VAELEY L.oeaa LAKE SHORE ROAD WEST Tmm ea VMW S bdlvldi Pl tee ROARING -13R' :-LAKE rat a: L•t.p:. _ . 4 7 3 _. w . Ti Maip;. 4:.1.� 6 ...�_ Blliek .. - 1. m 7... . r ...L Anita Beer Renewed M Rmbbn ❑ OtraedAppYe.at Nall Dace of Prevkna Approval 4/26/94 MAkg Aa&gn7 Lexington Drive Town Croton -On- Hudson 10520 Datg Subdivision Approved Fee Enclosed ❑ Amn,mt- gilaft Type 1 f am. re s . Im Am 1.224 acres Fm Sew oay LJ Big& Voh me Number d Haboom. 3 DoWRa Flow G P D 600 PC® NodDadon is Reggbed Wbea FN I. completed Separate sewage Sate. to etadat d 1 Q OQG&W SM* Tank - 4 150 f t. of t r i– g a l l e r i e s Tobeeaaumewdby Ronald Fiorentino A,&,Lake Shore Rd., West, Putnam Valley, WOW Sappb•1 Pd& Sappty Foils Address. N.Y. 10 5 7 9 en x vl.,f.`soppbDtmedby N. AndersonA�eBarger St., Putnam Valley, N.Y. 10579 eras 2 ft. bankrun fill 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew • dis cal s stem above described will be Constructed as shown on the approved amendment there to and in accordan to the standards, rules an regulations o • County Department of Health, slid that on completion thereof a "C•►tlttcate o struction '1. . rrce•' satisfactory to the Commissioner of H•aahwill be County to the D•paftm•nt; and a written guarantee will be turn no ow his nor hairs or assigns by the bulkier, that said builder will place in goal operating condition any part of said sawage disposal I am during th period t (2) years Im lately following th•dato Of the issu- ance of the approval of the Certificate of Construction Compliance of • original sy r 1rs thereto; that the drilled well described above will be located as shown on the approved plan and that saki well will a install a w th h st ►ds, ru s end r•pu a�i�lions of the Putnam County Department of Health. o.e• Nov. 22, 1995 signed •-� v.E gAXX Address. Muscoot Ro Nor , aho ' ueeris• No 11 0-5 � APPROVED FOR CONSTRUCTION: This approval expires two y s from a date issued n construction of the uildinq has been undertaken and is revocable for sa or may be amended or modified when considered r by the C ones of Health. Any change or alteration of construction r•qutns a n• per t Approver for disposal of domestic santtI. e, and/or p ater supply only. Rev. , f 10/88 oats �— By Title PUTNAM COUNTY DBPARTMM OF HEALTH DlwMm dZisviiamusiolod Red& Servkofl: Cannel. N.Y. 10512 as CER TE OF COMPIIANICE CON9=U.CTION PEW FOR SHWAGB DUPOSAL SYSTEM Peed p PV 56 -87 PUTNAM - VA%L-- EY._..._.... -:...... .. _ ...... Iacat.d at LA E SHORT: ROAD WEST wra or VILW S6sodog Mane ROARING BR. LAKE cWa_ W9 473 Tax Map 41 .6 > 1 rat. 7 Repaid —RI Revlebn ❑ OlraedAppYaat Naas DONNA' LOVELL Dace d Prowbas ApproW 1 -2 -96 MaRlog Ad&ea 2377 CRESTON AVE. , . APT. 4E, . BRONX, N.Y. Town ZIP Datg Subdivision Approved .10468 Fee Enclosed ❑ Amntint- Type 1 FAM. RES.' Lot Area 1 .224 ACRES Section � & vobtme Nataba of Eedrooate 3 DeWV Flow G P D 600 PCHD Nod8codw 4 Regaked When FM Is completed Sogwgia S mmp Systma to comer d— Q —GaDon Sepik Took -ad 1.50 FT_ OF TRT– ,ALTMTF.S T• be •oa.haoced by RONALD FIORENTINO : SLAKE SHORE RD. , WEST, PUTNAM VALLE,'Y, N.Y. , water SW*. Pdit S"* Fina Addrew 10579 an X Pelvpto Shy Deed by IjyATT & SONS Add.. ROUTE 311., R.R. 2, BOX 171 A, PATTERSON. NEW YORK 12563 other Regahemenb 1 represent that 1 am wholly and Completely responsible for the design and location above described will be constructed as shown on the approved amendment there to County D•partnMt of Health, and that on completion thereof a "Certificate be submitted to the Department. and a written guarantee will be furnished place lo good operating condition any pert of sold sewage disposal s Ste ance Of tea approval of the Certificate of Construction. Compllenc of will be located as shown on the approved plan and that said well will b• 1 11 n County Department of Health. Data 11 /11 /96 Signed s); 1) that the separate sewage dl sal s stem b�,yl ndards, rules an regu ns O • tisfactory to the Commissioner of Health will nert��hp assigns by the bulkier, that said builder will two 0) Immediately following the date Of the issu- r4repaKa o; 2) that the drilled well described above y1kj st r0 rubs and rsgu aiiTon! of the Putnam APPROVED FOR CONSTRUCTION: This approval expires two years f►d�n -l1% -V uLrlgsfC2 of tl revocable for cause or may be aminMod or modified when considered necessary by o of It h. r requires a now permit. Approved for disposal of domostic sanitary sewage, and / lt& u4a r y only. Rev. -1 n 10 0 Data By P.E. — R.A. i cansG No 1.1056 ing has been undertaken and is le or alteration of construction ` PUTNAM COUNTY DEPARTMENT OF HEALTH 86 Division of Environmental Health Services, Carmel, N.Y. 10512 ''� Engineer Must Provide P.V.-56-87 P.C.H.D. Permit # 1I11 r' CER TE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PUTNAM VALLEY Town Located AKE SHORE ROAD Tn. Map 41 . 6 Block— r V11ag® Lot 7 Owner /applicant Name DONNA LOVELLA Formerly BEER Subdivision Name RBL Subdv. Lot Nom_ MaWng Address 7 SUSAN LANE Zip 10566 Date Permit Issued / 2 19 6 PEEKSKILL, N.Y. Separate Sewerage System built by COSTA & FERREIR4 Address 66 AR ,YT,T, AVE-0 NEW R.0C RR.T.LE,. _ .-� .1..000 _�...... �.__.:_ -.. .1 44 LF '-TRI= GALLERTES...Nei' %.:.:1.0.80.4- - Consls of Gallon Septic Tank and Water Supply: Public Supply From Address or: X Private Supply Drilled by HYATT Address RTE . 31 1 , RR-2, BOX 171-A Bnuaing Type ONE FAM . RES . Has Erosion Control Been Completed? YES PATTERSON r N.Y. 1 2 5 6 3 Number of Bedrooms 3 Has Garbage Grinder Been Installed? NO Other Requirements I U U u r t-: in r tt H lw K r: K N t i m N K A Iy K K 1 I certify that the system(s) as listed serving the above premises were constructed ease of which are attached), and in accordance with the.standards, rules and A4E ns, in Putnam County Department Of Health. Date 1/24/97 certified by Address 2 MUSCOOT RD. N . VA Any person occupying promises served by the above systems) shall conditions resulting from such usage. Approval of the separate : available and the approval of the ,private water supply shall become subject to mo if on or change when, in the judgment of the Date Z By — as shown 911 the plans of the completed work'( copies nce with _ e„filed plan, and the permit issued by the P.E. R.A. X 41 Llconw No. 1 10 5 6 86th action as may bo noeoacory td I0euro tho correction of any ummnitary i shall bo o null and void no won as a pub((: oanitory mwor becomes when a c %rotor supply bocomce ovollablo. Such approvals are r04�h0oal revocation, modification or ehango is oeosory. ' TItto 77 kj r LoT A'kE A - -- �°• S ..__l�.U: �.- _:IL'T.= "_�>/E_L_h" _..� -r✓ :�: � ....mss.. - - . IN T A. - -w?. ' -. F5 U- I L7:...' w� A P� G ' W f36 286' 2 (7 20° 244 3 566 294 4 270 51° 5 97° 1124 (o 'no 4.26, '] 940 1070 R 0 w� O 0 W 0," z w (7 O 0 P4 >. 8 P. �. w� O `� R J tL�E- U Putnam County Department of Hoslth Division of �nc_roamental Health Services i} {approved as noted for conformaneo with Regulations of the J ►� ap Ica le Ru and ar C y Iiealth Depture t- U1 Da e R Signature &Title 0_ ' THIS IS TO CERTIFY THAT- THE SEWAGE DISPOSAL, SYSTEM WAS .CONSTRUCTED AS INDICATEDNi ON THIS PLAN AND THAT THE SYSTEM WAS .INSPECTED BY 'ME BErORE IT WAS COVERED 'OVER. IMUK,NO Ny T SYSTEM HAS CONSTRUCTED IN ACCORDANCF� WITH, ALL STANDARD RULES AND REGULATIOT� HE. OF TH£_PuTNAM COUNTY DEPARTMENT OF HEALTH D/ _ 1 Ae> J`h: t � R 7> J LANE 3; 5 a2_°` � AKE LOT 473 A M= A G'Z -A 7, 1 r% yN0 SU TOWN PUT SCALE � I" =20'