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631- 589 -8100
62.63 -1 -19 & 62.63 -1 -21
BOX 25
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16 JL IL 9
IN - =
03077
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
YES NO/ : Internal Use Only PERMIT #,;i
❑ Q� Repair Permit issued in last 5 years I� t in Watershed
❑ ,Repair within Boyd's Corners, W. Branch or Croton Falls Res. 2 Delegated
El V Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION pj�j CA ;,/e�/t ��OWN P✓fN.lp. �%y 4-7 TM # S1 •- I - r' *z
T
OWNER'S NAME /.��� / ,,� y- Abe f /y q y PHONE #X37 "14 U'
MAILING ADDRESS yn tj,di
APPLICANT 7.6 41- ,j& i
Name & Relationship (i.e., owner, tenant, ontra o
DATE FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER /p, ^2.Zej %j�- /_�/l�,,s ;,i,.•r� PHONE#
ADDRESS ') 0L9cr 4Vyyt) /2/J C;;+,•^*yi►REGISTRATION /LICENSE # 086
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
I, as owner,agr a to the conditions stateg on this form
% <--. Z
SIGNATURE TITLE _ DATE
(owner)
_ _I, the �e iic iP - talla,,,ac ae a comply with the conditions of t! is permit for th_a-•sWic systemn -opair
SIGNATURE y TITLE _ DATE G Iv to
(installer)
Proposal apgro d with the following_ conditions: -,
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the. repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best ft design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfille ntil authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved E31 Proposal Denied ❑
�L2, . cl!-4 W" C/, / /- l
ns ector's Signature & Title Date Expi ation Date
Repair pr000sal is in compliance with applicable codes Yes ❑ No P(
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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FROM :PIZZELLA BROS
FAX NO. :9147883738 Jun. 17 2010 04:18PM P3
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PIZZELLA BROTHERS, INC.
DRAWING NUMBER:
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
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SITE LOCATION till' TOWN P,Jt',vItp, 26 #6' TM # .51 -1 -
OWNER'S NAME ��' � �;�- j� � �y.�4AI PHONE # 732«
MAILING ADDRESS Cc
APPLICANT .368^1 P''7 --X jJ
Name & Relationship (i.e., owner,
DATE &Lmo &L/;o FACILITY TYPE S.,` +.ce 16 /?ayd-, PCHD COMPLAINT #
PROPOSED INSTALLER A-Z aR,,aw /;fj,, s PHONE #
ADDRESS 1)0(4 14iots6) i3 a C,,,ivv7�iA Or e.REGISTRATION /LICENSE # 06
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
I, as owner,agr a to the conditions stated on this form NA I
SIGNATURE I TITLE ( DATE
(owner)
I, the septic in taller, agree to comply with the conditions_ of this permit for the septic system repair
SIGNATURE r / TITLE DATE —6
(installer)
Proposal appro d with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function. .
5. No completed work is to be backfilleontil authorization to do so has been obtained from the Department.
Proposal Approved
nslYector's Signature & Title
is in com
INTERNAL USE ONLY
Proposal Denied
G,
with apmlicable codes
X
&/' / '1' 6 "_
Date
Yes
Lam- l
Exoi ation Date
❑ No
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
t-HA Nu. : y14 /k3H373B May. 31 2010 11 : 48AM P2
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BUILDING PERMIT
��- 5242
`Location of Premises ............ Y%)..... ...... y�� T...f..'-...�.. ..
44�1!•i*. �c.E�J►.Mncw�.... ..... 1• 1,.4."T1C�[�1e+s..�.%- .,5°.- ��... having
,.. ..:.,or ..., .....- ..,.��._., ....- �. a•• ...;..n :.... � ., �•.:_r.;:- - i•a -�e+ut ..a� t• ° ij�a' "c:niby" {,'Sru�na rv,.:3anifaY'. � Lode,.. ...c:
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z Building Code and' the Laws in effect in the Town. of Putnam Valley, Putnam County, New York,'* and. having
paid the required fee in the sum of ..1 t? -. Stu .. ................. .............it appearing from the sai$ application that the
f proposed improvement is intended to and will comply wolf the requireman of the law as aforementioned,
a .S,P.:ra.: rp__ ...... permit is hereby granted; this ...1 :P �f:,...... day of .:....,. ��!t .>.... .. ...................... , 19.K Q
c Additional information ...- . .Y� -� ... ............... . ........ '° �+°"..._.. _..- ........................
., � TOW• -....Of, PUTNAMNA}LkY....NEW •'6ORIC
NOTEt This permit expires one year from / ; / ,r,f —
i - date of issue. _ - _< -'- - By ,.......r,.G L'!! Fi -prF .. , ::.: �.:.�.(��.G+�•: :.e�:WG •t�z7hl,r�LC -t.-
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Inspected by Mr. Whitehill .
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PGTI AN-I COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROMMENTAL HEALTH SERVICES
DESIGN+7 DATA SHEET -'SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner:
Address: %/ CdW4d D
Located at (street): TM 4' Section: Block Lot
Municipality: 1?-e1rWhW ��, Zl %� Watershed-,
SOIL PERCOLATION- TEST DATA
Date of Pre - soaking:
Witnessed by:
Date of Percolation Test:
Hole No.
Run Rio.
Time
Start—
Stop
Elapse
Time
(min.)
Depth to
water from
ground surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
min /inch
1
+
3
4
I
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4
1
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5
I
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5
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2
1 3
1
I
I
4
f
I I
7
!
I
3
4
i 15
r
I
I
I
Notes:
1. Tests to be repeated at same depth unt;l approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < f min for 1 -30 min/inch, < Z min for 31-60 miniinch.
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` 7 DOGWOOD ROAD
CORTLANDT MANOR, NY 10667 �
PHONE: (914) 739 -3405 / FAX: (914) 788.3788
FAX COVER SHEET
DAVE: TOTAL # OF PAGE'S INCLUDING COVER SHEET:,,,��,_;_,,
PLEASE DELIVER THE FOLLOWING TO:
NAME:-
ORGANIZATION: r� c
FAX NO.:
79—
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PHONE NO.:
FROM:
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,49 1
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEATLII SERVICES
FIELD ACTIVITY REPORT,
A T17-1T) T- V 0 6,vialm
Street
Town
State
Zip
PERSON IN CHARGE
n'R TNTFRVTPVJ-PT)-. J a--4 0 0 111:g�le)
Name and Title
TYPE OF FACILITY: 'net
FINDINGS: n� 9/411d ua//> /0:6 J00t RlaA yes ,
OF r
Signature and Title
R'FP0RT'R'F.C-FTVF-1) RV:
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
R P17.
FROM :PIZZELLA BROS
FAX NO. :9147883738 Jan. 14 2011 01:04PM P2
PIZZIELLA 18ROTMRS, INC
7 Dogwood Rd, January 14, 2011
Cortlandt Manor, Now York 10567
(914) 739-3405 FAX (914) 788-3738
LIC, #WC-4149-H91
LIC. #PC•192
Putnam Co6nty Health Department
I Geneva Road
Brewster, NY 10509
ATT: Gene Reed
Mr. Reed,
This letter is to advise that Pizzella Bros. Inc. has performed a test at the residence of Herbert Edelman,
76 Cayuga Road, Putnam Valley NY, 10579, The pump cycle is approximately 22 gallons per cycle.
If you have any questions, please contact me at 914-719-3405.
John Pizzella
President
psi aasrek " u: ,iu:,�ii3ZT.&M.::�F�SZGNATIONt. � ll 62 63 -1-19
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BU {LDING . PERMIT
Location of Premises ..:......... �t .f 1J.G►.d. 2� S I I,Z
-�....ti;,e M- e.:�.zr a`=a. - :v',.a��--: +-. : =r-CS - - ^r+::.. -T' e�.�`»�1 \bn _ _ ..•C _ _ - � v.'. ,• .-..... - ._ _ . ��_ _wo:.wnry .'•: 4;i; v:i � roi.nr•.
«�acrt -i -r w��.. .�.• - h ^Y •�Ktlb Y C� • - u,,.v+=a.C�
..............:....... ' t? 5�,._........' "4°' ....... ..... ................. ........... ,haw
heretofore filed an appiiealiori for 'a:. ..................... permit pursuant to she Zoning Ordinance; Sanilary• Cod
Building Code and' the Laws, in effect in the Town : of Putnam Valley,- Putnam County, .New York,*' and. havir
paid the required fee in the sum of ,,,,,,,,,,,,,,,,,,,,,,,,,,,,it. appearing from the said application that 0
proposed improvemenr is intended to and will comply..willt 16 tequiremen of the* law as eforementione
a .aft!-�.fTF:�..... permit is hereby granted • this ...I �;.,...., day of ... .... . ,. ,. :.................., I9.K
Additional information ..................
......... ...... ... ..... ...........'......,t •,:_ ...,..........TOW..... OF <PUTNAM,IFA�.LEY, ..NEW •'1CgRK
NOTES Tl,is permit exp(iei .one year from ' ,• f G
date of issue:'
ssue: By
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Inspected by Mr:Whitehill.
.116h of Premises
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applicatiO6 for!4' ...... .....
............ ..
Code and' the laws .in. effect._ i
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5242
Reg; Sanitary' Code,
kork,' * and. haying
4plication that the
d,-
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19 0 ed:'thls day v F!� %.: t 1;.. ' I .
This ..........
.......... t.�
-V-A�LEY, - NEW
..........................
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issue:
Additional inf6imation....
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ORK
61* 0A ,et of it To '5.
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PUTNA.vI COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROw -NIENTAL HEALTH SERVICES
DESIGN DATA SHEET -'SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner:
Address: Zol G%i��,�� �0•�/�
Located at (street): TM T Section: _ Block — Lot
Municipality: yr 1,4W VktLCz Watershed:- {le/7—> S&�A/
SOIL PERCOLATTO- TEST DATA.
Date of Pre - soaking:
Witnessed by: _
Date of Percolation Test:-
Hole No.
Run tio.
Time
Start—
Stop
Elapse
Time
(min.)
Depth to
.water from
bound
surface
(inches)
Start Sto_n. _
Water
level drop
in inches
Percolation
Rate
min /inch
Z
I
I
I
I
I 3
I
I
I
I 4
I
( I
I
'
I 5
{ I
I
I
I
I
2
I 3
I
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E 4
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5
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I 3
I
I
j .4.
5 I
I
i 1
I 2
3 I
I I
4
i
1
5
I I
I
{
Notes:
1. Tests to be re eared at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min fer 1-30 min /inch, < 2 min for 3 1 -60 miniinch',.
. <..". �. w:= i^ ub. u-.. F�.. �w. �, es.. y... s., e,...,:.:,.: tzrs.... x�r.... ri;:::. vu.: �,: r,: d... dt: .....x�..�33..,.:»n...�a�,..7., sir.:.:, �., rxw.«_ �+,-: i';, �«. n..., s.. z: �::. �y... aYo! �iEu:. 2:..,. v. �. u.. 3a,!: s: �o-..,.. a.'... t.., e., w,... �. .:,:Y?.;.:.�.�.t�l..�.v,:,....` �, t, aa,+ �, sa .a %4.;z�.:,.:.,.,.taa•.:.::.. x.. ,,,,. x.suema•.d.;tx..aa
.. .. .. .., ".. - ...... TEST PIT DATA ... -.,, ., : ... � .., ,... .._., ,.., .. ..
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
0EPTf HOLE K
G. L.
0.5'
2.0'
2.�
4.0'
4.5'
6.0'
6:5
7.0'
7.5'
9.0'
9.5'
10.0'
HOLE n HOLE # H0L E TM HOLE #
Indicate Level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations.made by:: G tit �F Date
Design Professional Name: os cq�
Address: v
�•» . � JacPc'
i •� 1.
Signature:
Desis7n Professional = Seal
5
121, - " I
4" PVC PIPE (TWP)
3 ROWS O 28 L.F. EACH
OF El - N UNITS SET
IN CONCRETE SAND BED
AROUND & BELOW UNITS
84 L.F. TOTAL UNITS
i�
t�
IF
i
i/Xv
0
=off
EXISTING WELL
INSIDE; BLDG.
LOT 19
EXISTNG
DWELLING
POINT '8'
vBAFFLE
VC FORCEMAIN " CIP SEWER
EX. 1000 GALLON
CONC. SEPTIC TANK
3
\EX. PUMP CHAMBER 8
SEX. SSDA
1
i
OSCAWANA LAKE
1
S 81.30'00" E 37.50' _
TOWN TAX MAP DESIGNATION'
SECTION 6263; BLOCK 1; LOTS 19 6 21
LOT 21
SEPTIC AS -BUILT MEASUREMENTS
t�4STINC
BLDG LOC.
A
B
U,,,s'n NC
w SEP. TANK
10.5'
19'
m PUMP PIT
12.5'
19'
3 D. BOX
10.5'
14.5'
ELJEN 1
15'
22.5'
r ELJEN 2
43'
49.5'
r ELJEN 3
14.5'
17'
•
ELJEN 4
40'
45'
N ELJEN 5
20'
17.5'
ELJEN 6
41'
44'
1 0� ° W7 '
?4. 5 -15-0 � D
SOO 1 f RpA
G AYUG P��':I
•. I
P
SCALE: 1" = 2C,';
.t
. R
SEPTIC PEPAIQ AS - BUILT.
PREPARED FOR
NEQBE2T EDELMAN
LOCATED AT
76 CAYUGA QOAD
TOWN OF PUTNAM VALLEY
PUTNAM COUNTY N. Y
NOVEMBE2 1 2, 2 0 1 0
FROM :PIZZELLA EROS FAX NO. :9147883738 May. 31 2010 11:48AM P2
,AWj3Nl1A711�'..
BUILDING PERMIT
242
Location of Promises ............
..n +a•.]i -at. •v.vtiAafi , �. 1 -�� .._. -.._ .._.« .�.___......_— +•'`�.�- -• -� •r - — ^>CPR }bO.y`e.w
• � :•Sws -+. �vY.�,.eaG�� OY9•�'^+yr a4YC-� "1L' ykl'y��[ %,AA„'�gq'P f�S�t ei.�MFO�S'i^lnin.. 1.CiVi6 'V'Q•�V
.._ _ir
` �W�C�sn ..........:............. of ln!1.._. 0. .. :.R"' ............ ... ...........................;... having
heretofore filed an application for a:. permit pursuant to the Zoning Ordinance, Sanitary Codc,
Building Code and the Laws in effect in the Town . of Putnam Valley, Putnam County, New York; and• having
paid the required fee in the sum of ,-, LQr.. S}' u ............................., it appearing from the said application that the
proposed improvement is intended to and will comply •with tfw requiremenks of the law as aforementioned
a .S.&. A rp .,:..,. permit is haroby granted this .A 0 ,.,., day of `^!� �"�{
1..... �. ........... ..... , loco,
Additional information.,.. 1. r � ... ............... ........ .... ..
/� .. ... . . ....... ........................................................... .........I ...... I..............................
NOTEt This permit expiies one year from OF Y
TO/ /W� Ff?UTNAM� -AFL NEW,-'Y6-
-
date ' of issue.' -•'- -..ti _- _ By , %�
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Inspected by Mt; . Whitehill .
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Sheet--c—of
PUTNAM COUNTY DEPARTMENT OF HEALTH
_ .. •.: . .._�.)�V.dS1<ON•Qr-- ]ENVY;R�NII CIE. N:' I' A] L,- I�E�,T'I,,I<;,,SER,VI�'ES.. - . � - .:t. _ ___
FIELD ACTIVITY REPORT
N A MF ' r el .ate Tel:
Street v Town 11 State Zip
PERSON IN CHARGE �..�
()R TNTFRVTFWFI�: -jo;4o Pjz =rs l%
Name and Title
TYPE OF FACILITY: �� �r�
e.
Signature and Title
RFP(1RT RFCFTVFT) RY:
I acknowledge receipt of this report: SIGNATURE:
02/96
R Gv
Title:
ir. •
7
FROM :PIZZELLA BROS FAX NO. :9147883738 Jan. 14 2011 01:04PM P2
>L ..�vtOSf ". V?n.4':rK^f6 xOr:iCrsa ..tJa=Cswrev vucz,•.- ..�:.1?^v. .or _r'.[�'w..r. �•aT -.ie •�"�.— .�- 4YrW. +. �`.tn �iw�u.`�+rvs_N .•
7 Dogwood Rd. January 14, 2011
Cortland# Manor, Now York 10567
(914) 739 -3405 FAX (914) 788.3738
LICr #WC•4149 -H91
L1C. #PC• 192
Putnam County Health Department
1 Geneva Road
Brewster, NY 10509
ATT: Gene Reed
Mr. Reed,
This letter is to advise that Pizzella Bros. Inc. has performed a test at the residence of Herbert Edelman,
76 Cayuga Road, Putnam Valley NY, 10579. The pump cycle is approximately 22 gallons per cycle.
If you have any questions, please contact me at 914 - 739 -3405.
Than ou,
John Pizzella
President
FROM :PIZZELLA BROS
FAX NO. :9147883738 May. 31 2010 11:47AM P1
..
VILLkLLA �SKU I H'tK�; iv .
,
7 DOGWOOD ROAD
CORTLANDT MANOR, NY 10567
PHONE:: (914) 739 -3405 / FAX: (914) 788.37AS ; � ��• �
FAX COVER 5 H E ET
�� l� 9H
DATE: TOTAL # OF PAGES INCLUDING COVER SHEET:�„�,,_;_,,
PLEASE DELIVER THE FOLLOWING TO:
NAME:
67e tie
C...
ORGANIZATION:
FAX NO.: L 79- r ._1 a
PHONE NO.:
FROM:
NAME:
MESSAGEi a.A!
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IF THERE IS A PROBLEM WITH THIS TRANSMISSION, PLEASE CALL THE TELEPHONE # LISTED ABOVE
�-49
W
0
n
7
2
4' PVC PIPE (TYP)
3 ROWS O 28 L.F. EACH
OF ELJEN UNITS SET
IN CONCRETE SAND BED /
AROUND & BELOW UNITS
84 L.F. TOTAL UNITS
TOWN TAX MAP OES4'NATION:
SECTION 62.63; BLO °1K 1; LOTS 19 !c 21
i'
S J : OSCAWANA LAKE }
9
F
{ S 81'30.00" E 37.50'
INSIDE• Bl
LOT 19
EXISTING
DWELLING
TIE POINT W
PE POINT 'A'�
5
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D.B.
2'
C �4� GIP SEVER
EX. 1000 GALLON
PTI
CONC. SEC TANK
3
EX. PUMP 'CHAMBER g
EX SSOA .
IH
S 85.20'00
GAYVGA
LOT 21
EXISTING
DWELLING
SCALE: 1 " 20'
s
c,
+;
SEPTIC AS —BUILT MEASUREMENTS
BLDG. LOC. A B
e - SEP. TANK 10.5' 19'
t,
)t
m PUMP PIT 12.5' 19'
3 D. BOX 10.5' 14.5'
ELJEN 1 15' 22.5'
i
ELJEN 2 43' 49.5'
r ELJEN 3 14.5' 17'
ELJEN 4 40' 45'
ELJEN 5 20' 17.5'
,.
ELJEN 6 41' 44'
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SEPTIC REPAIR AS
•ti!
— BUST
PREPARED FOR
s�
k— ERBEQT EDELMAN °,;
LOCATED AT
7 6 CAYUGA QCIAD
TOWN OF PUTNAM
VALLEY.
PUTNAM COUNTY
N.
NOVEMBEQ 1 2
2 O a 0
s
psi asw :pnty,� 5ED.:.DESIGNATION:. fE 62.63 -1 -19
BUILDING . PERMIT
�•1 24 2
Location of Promises..: u.�►.ta.._2� ',cYM...... :sl�..�..-....�. +�-..
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_a.T�,}::�tt .......... -
• � ........... ]........�M.... :....Y1C� °+....... ....<a�`.��......�� ��. ........:c.1?� .r. .p.-_�.-.�. :L�o.::in :v�1.. :..�.,•.t• .�..S :,l�:w :e r..��•:::: :.'�.e' w.
heretofore filed an application for 'a '.. permit pursuant to the Zoning Ordinance; Sanitary' Code,
Building Code and' the Laws in effact in the Town .'of Putnam Valley; Putnam County, New York, and• having
paid the required lee in the sum of .......................... . it appearing from the sai4 application that the
proposed improvement is intended to and will comply..wilh the requiromenfl; of the law as aforementioned,'
permit is hereby granted • this ...1'�;.,...., day of ,,.,,...``.... , .... ........... , 19.KO
bl'+ii (6,io
Additional information.... -!� !. : .. ............ :.......: .... ......
. ... ♦. A.l�A.t
U.
... ..........`... :_ TOW ......OF�P.UTNAM.VA�LEX,..NEW 1C6RK
140% This permit expitei one year from
I (Y ryZ�r/
dale of issue: .../'G .......�:Y_Gr....r :.,l.... :..' .X..'� �w.
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Inspected by Mr.Whitehill. „