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02393
CONSTRUCTION PERMIT F
Loca�eci. at,- /�. //L= '''i1.fiLG
Subdivision/74p, .1f �HNOJ
Owner— -1
Building Type =t
''. PUTNAM COUNTY DEPARTMENT OF HEALTH 1
r.
Division of Environmental Health Services, Carmel, N. Y. 10512
i SEWAGE DISPOSAL SYSTEM _ o— ;N /'-' '� , �
i �i
own or village
,�.00k
.FiJ�•,__._ -
�,PCF`C �i�% Lot – Job,,
Address'tL�l
_ •�' Lot Area —
Number of Bedrooms Total Habitable Space 41 �'fi�1 f ` Square Feet
Separate Sewerage System to consist Hof Gal. Septic Tank �� lineal feet Xis .-- width trench
To be constructed by �° �/ �3 Address ) 4o 7_AA VV IIA4 y Ali '
Water Supply: Public Supply From
__�Zprivate Supply to be drilled by
Add
Other Requirements a0/' v`7Wf4
1 represent that I am wholly and completely res'
above described will be constructed as shown o
County Department of Health, and that o
be submitted to the Department, and a
place in good operating condition any
ance of the approval of the Certificate nstr
will be located as shown on the approved n a d th
County Department of Health.
Date "
Address �� ..
APPROVED FOR CONSTRUCTION: Thli app 40
revocable for .cause or may be amend ii or modifi
requires a new permit. Approved or disposal of don
A
Date + By
I location of the proposed system(s); 1) that the separate sewage disposal system
there to and in accordance with the standards, rules an regulations o e Putnam
sate of Construction Compliance" satisfactory to the Commissioner of Healthwill
i ed th'e', owner, his successors, heirs or assigns by the builder, that said builder will
m d'��yy,,44'�ng the period of two (2) years immediately following the date of the issu-
e oplginal system or any repair hereto; 2) `that the drilled well described above
ON i /accordance with the�st Bards, rules and regu a ons of the 'Putnam
P.E. 7 R.A.
License No.
thessued unless construction of the building has been undertaken and Is
sry by the Co;y""__1_ss19ner of Health. Any change or alteration of construction
ge and 'r pr ate supply only.
Title '•'' '
we-
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of<Environmental Health Services, Carmel, N. Y. 10512
�._CONSTRUCTIOM PERMIT 'FOR 'SEWAGE - DISPOSAL _SY9rEIVI � � Q j,��,I QiC
T ILown or Village
I�
Located at OA , section hi? Block 67-
Subdivision Lot 1' X.-- 4
ob
Owner L�
Address GL O
Building Type .i1® �N �" Lot Area ��' ��L
i
Number of Bedrooms Total Habitable Space ✓�2�/ Square Feet
Separate Sewerage System to consist of Gal. Septic Tank /' lineal fee X J ,/ /width trench
To be constructed by 411 r Address ^+
Water Supply: Public Supply From
Private Supply to De drilled by 0 _
Address
Other Requireemmentts,�
I repr6atf -I t I am who dyf. nd c�o}mplete responsible for tK
above described will be constructed as'shown on the approve
County Department of Health, and that on completion t
be submitted to the Department, and a written guaran Jl
place in good operating condition' any part of said se ;Jtl l
ance of the approval of the Certificate of Construct i q� pli
will be located as shown on the approved plan and that sa y(9 wil
County Department of Health.
the proposed system(s); 1) that the separate sewage disposal system
accordance with the standards, rules an regu a ons o e Putnam
1 uct,on Compliance" satisfactory to the Commissioner of Healthwill
&I..issuccessors, heirs or assigns by the builder, that said builder will
ertod of two (2) years immediately following the date of the issu-
m or any repairs thereto; 2) that the drilled well described above
with the stancidZds, rules and regu ffrons of the 'Putnam
Date dt, fo •<.`.
P.E. R.A.
Address '40i License No. = �2,,Z 2,6_�
APPROVED FOR CONSTRUCTION: This approval expires on fr�e issued unless construction of the building has been undertaken and is
revocable for .cause or may be amended or modified when considere y the Commissioner of Health. Any change or alteration of construction
requires a new ermit. Approved for disposal of domestic sanit y sewage and /or ivate water supply only.
//
Date BY - >!.��� ��`�f1i Term 14 /JAhE
i
P[T'g'1VAWCOtJ1�1TY DEPARTMENT OF HEAH.'��
rvices, Carmel, N. y. 10512
17ivlsi
car
Town, Cr Village
CERTIFICATE OF ':CONSTRUCTION j;QMPLIANCE FOR SEV�AGE DISPOS�►1. SYSTEM / �/
CERTIF 1 R %y-1- A � Block
Sc :>
t
—
, 1A �
'Cv l-'o" OJa ; . Job
Located at Lot '!
Owner 1 >`01411'- Address l., *y
Separate Sewerage System built by
1 lineal Feet X s era y
Consisting of -�"-- -Gal. Septic Tank
other requirements 0
Public Supply From
water Supply' 9S61 a,f
Private Supply Drilled BY
Al
Uy- ° ,� Date Permit Issue
Address
O�L No. of Bedrooms_------ -
width trench
Building Type p =
Has Erosion Control Been Completed?
n on the plans of the complet- 7 (cones E 4 U Ith
j as listed serving the above premise
j I certify that the system(s).
` attached), and in accordance with the standards, rules an za
d Cert o.
Date
Address
I y r
person occupying premises served by the above syste s) s a
Any P from such usage. Approval of the .
conditions resulting 1 shall C
available and the approval of the private water eY judgment o
subject to rlpodification or change when, in the ju
BY
Date
as show �e Putnam
ie permit issued by
(ion as may be necessary to secure t
,ecome null and void as soon as a
a `pubi ter supply becomes a
n vocation, modification
PEEKSKILL MEDICAL LABORATORY
879 Crompond'kd -. 96iclay 'Plaza Bldg. X,-A' p t. 1
Peekskill, New York 10566
CITY,
epar men o ea
n of any unsanitary
tary sewer becomes
Such approvals are
s. necessary, /
PE 7-8777
111
RESULTS OF EJtARNIP1AYlON OF WATER DATE COLLECTED
111 /0 DATE RECEIVED
r/
LAGE, TOWN &/OR NAME OF SUPPLY DATE REPORTED
I POINT -"/ "" 761—
'del/
L PER ML: (Agar plate count at 35 C). COLIF�ORM G�RCO/UP (Most probable No, /100m1.) S, TAL
JTS - ppm NITRATES (as N) - ppm IRON, TOTAL - ppm.
(F) - mg,/L
Irhese results indicate that the water was (lecs
- ppm
of a satisfactory sanitary quality when the sample was cIsallected.
`✓ A. H. PADOVANI, M. T. (ASCP)
If,
A
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
UNtY OFFICE BUILDING, CARMEL, !N. Y. 10512
DESIGN DATA SHEET-SEPARATE
'SEWAGE DISPOSAL-SYSTEM
FILE NO.
Owner L_�AR,4ef iLa
Addres's
Number CLOCK TIME
4//,
Located. at (Street Block 2 Lot
nuicate ne-a—re-H —cross 'street)
Municipality/ °!' Wate
rshed ec�o
SOIL PERCOLATION TEST DATA R1
TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
Eiapse
Depth to Water
Water
Levei
No.
Time
From Ground
Surface
in Inches
Soil Pate.
Start -Stop
Min.
Start
Stop Drop in
Min./in drop
Inches
Inches
Inches
zg _0
4-
_3
3 9 S
-2,:)
3
72
2--
2
Z z lexjj- /A/ / W,
4
Notes: 1) T6sts to.be -repeated at same, until' approximately equal soil
rates are obtained at each percolation test hole. Ayy data to be submitted
for review.
2 ) Depth measurements to be ".. made from top of hole.
7811 9
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date 7- % f�
DESIGN
Soil Rate Used Min/l "Drop: S.D. Usable Area Provided
No. of Bedrooms ,S Septic Tank Capacity . Typeiiec�
Absorption Area Pro ded By - L. F. x24" 3�— . ,.f'` width trenc . — Other i'
Address
THIS SPACE FOR USE BY HEALTH DE
Soil Rate Approved Sq.
Late
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST
HOLES
D8PTH
HOLE NO. P
HOLE NO. j'
HOLE
G.L.
'NO.
s g
JiD�t'?.�
•�f �/r�.v
611
12"
4
18"
�a
w
2411
3011
y
3611.
ti
421►
48"
h
54"
6011
A j
6611.
.�
7211
7811 9
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date 7- % f�
DESIGN
Soil Rate Used Min/l "Drop: S.D. Usable Area Provided
No. of Bedrooms ,S Septic Tank Capacity . Typeiiec�
Absorption Area Pro ded By - L. F. x24" 3�— . ,.f'` width trenc . — Other i'
Address
THIS SPACE FOR USE BY HEALTH DE
Soil Rate Approved Sq.
Late
TOWIT OF PUTNAM VALLEY
WILL DRILLERS LOG AND REPORT
]PEEKSKILL HOLLOW ROAD,,
WELL LOCATION
street section block lot
MR, MIhO�
WELL 0,414M
name address city or. town
ANDERSON WELL DRILLING R.D.#3 NARGER ST., PUTNAM VALLEY, N.Y. tO579
WELL D-RILLIM
name address city or town
OT.,,L Dla)"H OF WELL 3001 Feet
T. —ep th from 'Give description of formation pen;trated, such as: peat,
Grownd ")Urf ace sand, gravel, clay,hardpan, shale, sandstone,
ranite, etc. Include size of gravel(diameter and sand
cours.e)', --ure
icolor of.material,,--struct.
(Loose, packed, cemente'a';-'S'6.t't-"'hii:bd)'-.(E:it."Oft, 27 at-z
fine, Packed ellow saud, 27 ft to 134 ft gray granite)
lirre-F —tc;--7ie—e-= 'FoIrmation Descripti'ont Sketch exact location of well to
at least two Dermenant Lbndmarks
hardpan
10 3001 bedrock shist*
to v-4 j.1 Completed 9/5/74 Date Of Report
Well Driller.
signature
Bailed
(Measure from 1 1
d )
surface
Lengh: 211 feet,
or
Pumpedj+Hrs.
Static ft,
Make:
When Bailed
lot
Diameter: 6" Inches
Yield: 4 GPM
:)r Pum ped
Len gth Ft
ize
Kind: steel
:ftDiameter
Inf.
OT.,,L Dla)"H OF WELL 3001 Feet
T. —ep th from 'Give description of formation pen;trated, such as: peat,
Grownd ")Urf ace sand, gravel, clay,hardpan, shale, sandstone,
ranite, etc. Include size of gravel(diameter and sand
cours.e)', --ure
icolor of.material,,--struct.
(Loose, packed, cemente'a';-'S'6.t't-"'hii:bd)'-.(E:it."Oft, 27 at-z
fine, Packed ellow saud, 27 ft to 134 ft gray granite)
lirre-F —tc;--7ie—e-= 'FoIrmation Descripti'ont Sketch exact location of well to
at least two Dermenant Lbndmarks
hardpan
10 3001 bedrock shist*
to v-4 j.1 Completed 9/5/74 Date Of Report
Well Driller.
signature
W4,,ZZ. , 5 /11 `Lo D ' �/4r r! �G !. / /l ✓Fif'` �r L[.E =�/° ...; .
Owner or-Purelaser of building Municipality
Building Constructed by n��,c� %`�f .
r�
Location - Street Block
4
Building Type Lot �-
GUARANTY OF SEPARATE SlIVAGE SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on.
the approved plan or approved amendment thereto, and in accordance with the standards,
rules and regulations of the Putnam County Department of Health, and hereby guaranty
to the owner; his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by .me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal system, or
any repairs made by me to such system, except where the failure to operate'properly
in nAllPPH ht thn tai 11 fill nr. nagl i, crnnt nnt. of tl-ip .nr rm n=nf- of -Flin . hii i l rli ncr 7.; 7.1 ncr . .
The undersigned further agrees to accept as conclusive the determination
of the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the sys.tem .to - operate teas• -
. e.atasod..by -. thee -�ailr h'ar negligent -- -act- of -the occupant -.&f the.:bui-1ding •utilizing• -the - •
system.
Dated this 'go day of 1 4.2c # 19 7J -
Signatur /
Title
(if corporation, give name and addrES's
THREE, (3) COPIES.ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE
OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE. OF DATE OF FIRST USE OF- SYSTEM.
Division of Environmental Health Services, Ritnam County Department of Health
r A a
t�4 air � ry
t /
/ -, 'APPRO�
rt f.
rr ,. f Cfcc aat, �a�c Tea
RIAR'2 51
l I •.11.A
A
V'... T "I i MF1LL1F
n� ' 3 tT { n11S iS to "ef ify that tln
di pml sss "4ai , r� sors;rucke
doted r t; _'rai tfi
E::. .rtv'la Zi�S m f�,��r.t ry 'i t:;re it k4
?A I.4�UN
ever. !I,;,,
l sceotdancn �r�; ;t rules s
loons of Lha utnaci county
TIC lo= 3r:.cWn ,G-,�-ec'7 :-
" -/L.. ` r 412, //9/4r C 07
1
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145
1f�?ZJ •. �..
�r^
NO
I
I i
Re: Addition — A- 140 -14
No Increase in Number of Bedrooms
971 Peekskill Hollow Road
(T) Putnam Valley, T.M. 42. '-3 -12
Dear Mr.- Cerqueria:
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 October 2, 2014. 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 .. .
4. The approval is for the modifications only acid 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 October 2, 2016.
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,
Gene D. Reed
Principal Engineering Aide
GDR:cml
cc: BI (T) Putnam Valley
ALLEN BEALS, M.D., J.D. a 4
„� MARYELLEN ODELL
Commissioner of Health
County Executive'
ROBERT MORRIS, P.E., MPH
Director ofEnvironmental Health
DEPARTMENT
OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
Fax # (845) 278-7921,..,.
October 2, 2014
Jose Cerqueria'
971 Peekskill Hollow Road
Putnam Valley, NY 10579
Re: Addition — A- 140 -14
No Increase in Number of Bedrooms
971 Peekskill Hollow Road
(T) Putnam Valley, T.M. 42. '-3 -12
Dear Mr.- Cerqueria:
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 October 2, 2014. 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 .. .
4. The approval is for the modifications only acid 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 October 2, 2016.
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,
Gene D. Reed
Principal Engineering Aide
GDR:cml
cc: BI (T) Putnam Valley
ALLEN BEA]LS, M.D., J. D. MARYEL]LEN OIIDElL1L
Commissioner of Health `M County Executive
ROBERT MORRIS, P.E. C.� f�, —�i�
Director of Environmental Health I�+-'-J
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
ADDITION APPLICATION - RESIDENTIAL ONLY
Owner's Name: �� �� � _// Owner's Phone
�� #: �l �
CLI� • j's
V� 1 N � /J b
Site Address: 02/&� jjt gau�L) Town: L)AQAkW Tag Map #
Owner's Mailing Adss: ,S4 J�-
Owner's Signature:
Description of Prop )fse9d Addition:
e_
*Number of existing bedrooms: Total number of bedrooms (existing + proposed):
* (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 Department of Health, 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 808 -1390.
1. Certified check or money order for $100.00.
2. Two sets of 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. 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
Rev. July 2013
5.
ALLEN BEALS, M.D., J.D.
Commissioner of Health
R013ERT MORRIS, P.E.
Director of EnvironmentalWealth
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845)'808-1390
Fax # (845) 278 --7921
MARYELLEN ODELL
County Executive
Town Le Bedroom Count & Pro po1rl sed Addition Status
(Owner's Narnre)
Talc Map #.~
Address: �� �P�CS I A _ 4
I
Town,_ �
Year Built: P-14
According t :oblapliance ords maintained by the Town, the above noted dwelling,
is i with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is:
This i ifbnnation has been obtained fr o
Certificate of Occupancy:
Other: U
The plans for the proposed addition are considered:
✓ Additions to existing house only
Tcardovm and/or re -build allowed undet Town Regulations
Building Inspector Date
5.
�a A�
,
52 �Z
N 46° 09'36" W
73.25'
N44 °53'3! "W
49.51'
BUILDING FOOTPRINT
SURVEY
SITUATE IN THE
TOWN OF
PUTNAM VALLEY
PUTNAM COUNTY
s
NEW YORK
w
D
SCALE: 1"=50'
SURVEYED: MAY 29, 2014
s.
Link
Lm Land Surveyors P. c.
21 Clark Place, Suite 1.8 Phone 845-828.5857
Meho a0 NY 10541 F 84
\ - yob y _
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N�
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T W
a� O
• PREMISES ARE DESIGNATED ON THE TAX MAPS FOR THE
TOWN OF PUTNAM VALLEY N 3 I ° 00' 18" W
SECTION;42 BLOCK; 3 LOT;12 38.38' . • \
Street Address: 971 PEEKSKILL HOLLOW ROAD
• PROPERTY AREA:
N 33° 10' 29" W
0 THE PREMISES SHOWN HEREON DESCRIBED IN DEED RECORDED 52.93' -
IN THE PUTNAM COUNTY CLERKS OFFICE UNDER LIBER 1676,
PAGE 98
• SURVEY IS SUBJECT TO ANY STATE OF FACTS WHICH AN
UP -TO -DATE TITLE EXAMINATION MAY DISCLOSE.
• THE OFFSETS SHOWN HEREON ARE NOT INTENDED TO
ESTABLISH PROPERTY LINES FOR THE ERECTION OF
FENCES, STRUCTURES OR ANY OTHER IMPROVEMENTS.
0 ENCROACHMENTS BELOW GRADE AND /OR SUBSURFACE
FEATURES, IF ANY, NOT LOCATED OR SHOWN HEREON.
0 UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP
BEARING A LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION
OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE
EDUCATION LAWS.
° ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED
WITH AN ORIGINAL OF THE LAND SURVEYOR'S SEAL SHALL BE
CONSIDERED TO BE TRUE VALID COPIES.
° THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY
CONDUCTED ON THE DATE SHOWN AND THAT SAID SURVEY WAS
PERFORMED IN ACCORDANCE WITH THE EXISTING' CODE OF
PRACTICE FOR LAND SURVEYS' ADOPTED BY THE NEW YORK
STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.
PREPARED FOR:
JOSE CERQUEIRA
P - . ex 5-621 -0013
N78 °31'57 "W
1 2.83'
Z
0
N p
ERIK J. LINK
NEW YORK STATE LICENSED
LAND SURVEYOR NO, 050542
R
0
(O
s
ROOF OVER 9
WOOD DECK
SLATE \
PLAT.h STEP
SDP
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I,
COPYRIGHT 2014
LINK LAND SURVEYOR P.C. ALL RIGHTS RESERVED. THE UNAUTHORIZED
REPRODUCTION AND OR DISTRIBUTION OF THIS DOCUMENT IS ILLEGAL, AND
IS A VIOLATION UNDER UNITED STATES COPYRIGHT LAWS.