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73. -1 -29
BOX 26
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f 61 r.9 tirl
03241
%' ,� �J i PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM AM' VAL,. F-
Town or Village
Located at G { f
Subdivision ~Lot
Job
Owner 5; AiQyoQC+J,J 01 Address A0 P ngwn VALLSy
Building Type 5 f k) Q- L.E; Lot Area I ` 2- G 3 Ac -iz m
Number of Bedrooms F "A- Total Habitable Space Square Feet
Separate Sewerage System to consist of Gal. Septic Tank 2t?0 lineal feet X Sin ABS.
width trench
To be constructed by Address %1Mw
Water Supply: Public.Supoly From _
% Private Supply to be drilled by
Other Requirements
I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal sy during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of e o ' 'nal system or y repairs thereto; 2) that the drilled well described above
will be,located as shown on the approved plan and that said well will be inst I d M)rda the standards, rules and regulations of the Putnam
County Department of Health.
Date 3 6, -ig Signed,. P.E. R.A.
Address n+A 4 AVF: k,%'Tof-,Aij N:y O icense No
�a .
j� 042,183
i ---- -;
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable,for.cause or may be amended or modified when consi a ssary b r Commiss' of Health. Any change or alteration of nstruction
requires a new permit. A proved fo�osal of domestic ni ewa o only.
Date By
._� Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
Services Division of Environmental Health • :.Carme% N. _,Y 10512
LCERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM iRi-r:IVAr`1 VALLEY
y R,-- ^( 2 Town or village
P g cj Section R .*1� Block S
p V
Located at -�
ti � ' Qe�l - Job
Owner Q i Lot
�G
[10 �G N ib
Separate Sewerage System built by t f � i f
Consisting of / % f L GaI. Septic Tank - C.? 0 lineal Feet X ? width trench
Other requirements
Water Supply: Public Supply From
Private Supply Drilled By NoRMw�
Address G`� A- V A>11�M &e
Building Type
l�—si�`II y ftC 7= No. of �Oag, w Date Permit Issued --
,/ k A. /CC
Has Erosion Control Been Completed? _ y S � v.('M w�
I certify that the system(s) as listed serving the above premises were were construct a nt' �; _ n .t p s of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, pia n i y issu the Putnam County Department of Health.
Date l 5 N ` Certified by t « %` P.E. R.A.
'
� '�7r�1/J/ { 7�1 ' �� License No.
Address l�
Any person .occupying premises served by the above system(s) shall promptly take irlrt a necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system sha null and void as soon as. a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a public water sup becomes available. Such approvals are
subject to modification or change when, in the judgment of the Com ner f Healt uch revoca ' n,nho/diifi�cation or change is necessary.
Title /
Date _�.' BY
�I
t
SITE LOCATION
OWNER'S NAME
MAILNG ADDRESS
APPLICANT
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
--c V e i t 4 s 171-C-i AL
Name & Relationship (i.e., owner, tenant, contractor)
>y TM # 73 / q
PHONE #
DATE _ .3 % FACILITY TYPE Ige j/ a PCHD COMPLAINT #
PROPOSED INSTALLER ��e ✓e , %1 4 s �uK PHONE #
ADDRESS :3 4o /— r n JS q V e REGISTRATION /LICENSE #
Pro sal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feetof repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Diffrent location and proposed pump systems will require submittal of proposal from licensed professional
enoieer or registered architect.
I, a owner, or reported agent of owner agree to the conditions stated on this form
SiNATUREl,;p Alin_ TITLE DATE 1 -3-D2
Pmosal approved with the following conditions:
1. Procurement of any Town Permit, if applicable.
Submission of as built repair sketch in duplicate showing:
a. Owners name
"b. Site Street Name, Town and Tax Map number
c: Location of installed components tied to two,
wo fixed points
d. System description (e.g., 1250 gal. Concrete septic tank, etc.)
e. Installers' nE ame and phone number
.r' .
3 System repair td be-performed in accordance with the
above proposal and' condition
r
Jpeci®r's Z al Approve d Proposal Denied
`f .0°7 gnature & Title Dat
OPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
C -RP 99ML
�v. 8/05
AC L.l!tti)ALVl.'L w i l e 111r. IVIIi, I L�Il:I'd o L -i � I
PADS FC)R THE TITLE SURVEYS !.!F "TIfF
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1'CItIC 5 "i'A'T1: L.� \i� TIT-i.-j: ^.�St7L: l.I,_r,t .. A�(1� � L-OT 2
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SURVEYED & PREPARED BY
ALEXANDER BUNNEY ;
LAND SURVEYOR. P.C.
20 WOOOSBRIDGE ROAD ROUTE 117
•, i a;
KATONAH. NEW YORK 10536 '
2 F/7 -. F�,P ST,4 ni wn(01'> �i iii nom-, ► i,1i��
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Z.. _� yam. /� - 1 /�•
WA14;;
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SURVEYED & PREPARED BY
ALEXANDER BUNNEY ;
LAND SURVEYOR. P.C.
20 WOOOSBRIDGE ROAD ROUTE 117
•, i a;
KATONAH. NEW YORK 10536 '
2 F/7 -. F�,P ST,4 ni wn(01'> �i iii nom-, ► i,1i��
1
GUARANTY OF SEPARATE SEWAGE-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 succes-
sors, 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
sysu-em, or any repairs made by me to such system, except where. the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam'County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or ne li
act of.the occupant of the uilding utilizing the sysf
Dated this /2 day of '6 19__Z5 Signature
Title
f corporation, give name
and address)
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, Putnam County Department of Health
... _. ..w wwn :. a- .. 4• ........� c�.-M-.w�a�.'....... w�eT ._..r ..�F:��.1F -�
I. � _w r. _.J—v+w. _.- �. v....a.a_�. -. T ".T -�,,, "a -. t.w -- .. -�-+
Owner or
Purc aser
of Buil d i
g Municipality.
1
u in
Section
Const u t
by
Location
Block , J
'Street
1,46
AmILAI
,Q
C7y
Building
Types
Lot
GUARANTY OF SEPARATE SEWAGE-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 succes-
sors, 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
sysu-em, or any repairs made by me to such system, except where. the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam'County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or ne li
act of.the occupant of the uilding utilizing the sysf
Dated this /2 day of '6 19__Z5 Signature
Title
f corporation, give name
and address)
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, Putnam County Department of Health
iN
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61
47,
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PUTNAM COUNTY DEPARTMENT OF HEALTH
MENTAT,= HEALTH SERVI ^E -
Date 3 - 6 - -75
Re: Property of S-rAmvjaco a- L&IL-0 .6 r1►s
Located at C=#4%A c_q Rego - 1300-C -H HIL. 5
Section Block Lot 2
Gentlemen:
This letter is to authorize wtu.j ^NN A'. Kep.N E
a duly licensed professional engineer ��or registered architect
(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
l: VJ111t-Q LiV11 W 11 11 Oilt; ma L Lev anU to. supervise the construction of Said
system or systems in conformity with the provisions of Article 145 or
1.47.,: ,Educa:tion -Law. the Public Health Law. and the,. Putnam C ®panty Sani -__._
tary Code.
Countot 'An�
Cx�f,i
P.E., R.A
223 I<A're/Vr;1� AyxN,%s
Address
k.A►-rdN A lA , /V •Y - 10S3(6
_914- 232- 846lt
Telephone
Very truly yours,
Signed
Owner of Property
Address
Telephone
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
._PROPOSAL FOR SEWAGE DISPOSAL- SYSTEM. _
YES NO Internal Use Only
❑ Repair Permit issued in last 5 years ❑ Not in Watershed
❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 200 ft. of a watercourse or DEC -L041 mapped wetland ❑ Joint Review
SITE LOCATION (�h ,s r G �( k 4 d V TM #
OWNER'S NAME (�5 PHONE #
MAILING ADDRESS `J lU yC _ ,,-
APPLICANT S f-e v
Name & Relationship (i.e., owner, tenant, contractor)
DATE J - 3 - .7 FACILITY TYPE �/ a PCHD COMPLAINT #
PROPOSED INSTALLER �e.;✓ �`? c, s �u fC ' PHONE # c7 40
ADDRESS 3 ( I_r n 0 e REGISTRATION /LICENSE # 1` C -/
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 trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from licensed professional
I, as owner, or reported agent of owner agree to the conditions stated on this form
SIGNATURE �,J,p� �, TITLE DATE J-3-02,
Proposal approved with the following conditions:
1. Procurement of any Town Permit, if applicable. 6
v
Submission of as built repair sketch in duplicate showing:
a. Owner's name
'b. Site Street Name, Town and Tax Map number
c., Location of installed components tied to two fixed points
d ' Sys tem - description (e.g., 1250 gal. Concrete septic tank, etc.)
e. InstalleWs'�rpme and phone number .
3. System repair td 46. erformed in accordance with the
above proposal and si%odition
PFpector's proved Proposal Denied
z J `I 10-7
I ignature & Title P Dat
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE OF, CONSTRUCTION COMPLIANCE FOR SEWAGE - .QI$PQSAL SYSTEM :Puy Al�A 1 r E _ j_v -_Z
- — - -
- , _:_ _ _._. -� ._.. _. �..- •— ..r -�--. � r.- �°'�`..�_ „ __ - —_ �� ,.. � � .. _ ., .
, �j — Town ^ `! or Village
Located at C O U 2 C H ROAD Section � Am Block S
Owner �YA (`� y�/yO.D C 7Li 1—� E iz S tJ C(,�/ �f Lot Job f •+
Separate Sewerage System built by . 7cP�t�G s.i�Gl�J Address .2�1 ��~ �' �%`� 4eCN�e,
! r.
Consisting of ! Z S U. Gal.. Septic Tank Z Q U lineal Feet X �' width trench
Other requirements
Water Supply: Public Supply From.
Private. Supply Drilled By JI/o0, M,ow0. ,g Albyotlow
Address `►�« v y A) A.0 • .
Building Type QAl7r �AM (Lu (� E S• No. of reg NEW Date Permit Issued
Has Erosion Control Been Completed? s �Q M A'
I certify that the system(s) as listed serving the above premises were construct a nt' n t e�p s of the completed work (copies of which are
attached), and in ,accordance with the standards, rules and regulations, pla n is the Putnam County Department of Health.
Date S 7S Certified by'1 "�
Address 7_33 K1-1 7-aeuAW , 1� \ Al License No. 4Z /8-3
�sha �Np Any person .occupying premises served by the above systems) shall promptly take a necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system null and void as soon as a public sanitary sewer ,becomes
available and the approval of the private water supply shall become null and void when a public, water supX4 becomes available. Such 'approvals are
subject to modification or change when, in the judgment of the Co��Z,.h__such Healt revoca ' n, odifiication or change is necessary.
Date! BY TitlegT" _
..... ...1. � ...:: .. .. ..',.v : -. . �. � h _.:....il. ._..:, i. G`c. .... .- ..�LL_.:... _ .._. .r. ..r . ". .. ._... ..r.. ..... .. r... _
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 is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
-The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam* County Department of Health as 'to whether or not the
failure of the system to operate was caused by the willful or neg1i
act of. the occupant of the uilding utilizing the sys c�
Dated this �� day of L�� 19 Signature f
" r�� Titl e
lyl�/ f corporation, give name
- and address)
V '
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMK ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
�l a PUTNAM COUNTY DEPARTMENT OF HEALTH
(l Division of Environmental Health Services, Carmel, N. Y. 10512
CQNSTRUOTION PERMIT FOR SEWAGE DISPOSAL SYSTEM lt'L,&-rNAnn VALLE Y
Town or Village
- Located • at �ej -i'l l (L G_1-j - k. oA - Section Block
y
Subdivision+ H )LL-5- SF—cn T (> hi 1 Lot Z Job
Owner SYA 8 L -0Gtis Address C- H n-t-44 P-0 AD R^—rPOAN, VAtL Y
Building Type Lot Area
Number of Bedrooms F7V,k^ P— Total Habitable Space 2•( vO Square Feet
Separate Sewerage System to consist of Gal. Septic Tank lineal feet X 3L� A`i3S+ width trench
To be constructed by S+A._F; Address ,� �� �• %l +i�+
Water Supply: Public-Supply From
PrivateiSupply to be drilled by
Other Requirements
I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
-above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of the 70n—am .
County Department of Health, and.that on completion thereof 'a "Certificate of Construction Compliance" satisfactory to-the Commissjgner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns. by the builder, that said builder will
place in good operating condition any part of said sewage disposal systAft during the period of two (2) years immediately following the date. of the issu-
ance of the approval of the Certificate of Construction Compliance of F�e o ' 'nai, system or y repairs thereto; 2) 'that the drilied"well described above
will be located as shown on the approved'plan and that said well will be jinstl d n �rd the standards, rules and regulations of the .Putnam
County Department of Health,
Date Signed; P.E. R.A.
Address P � /«T0t.)A" AVa �LAT icense No otJA'14 N,yT /0,5.�� Q42183
� !
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is
revocable for cause or may be amended, or modified when con 'd a ssary b r Commiss', of Health. Any .change or alteration. of:. nstruction
requires a new permit. A proved for• osal of domestic ni ewa o r' only.
a "; � i
Date- ®� BY Title
fp.r
. _
L:U1l11CL L.LUII W.I. Lfl L11-Lb ina L l.et• ails -i to. supervise the construc C1.Url of said
system or systems.in conformity with the provisions of Article 145 or
• _ ° 147; '-Eduoati7on Law, - -tkoe -Pubiic _k'al-th:-La4-..;:a d the PutfraillFCou`
tary Code.
r �Y
Counte = y
moll,
P.E.,
223 1<^'r®HA;4 AyENNE
Address
"-rot-4,A l+1 , N.Y. 105 31*o
X114- 232- 846y-
Telephone
f
Very truly yours, ,1^ - I
Signed
Owner of Property
Address
Telephone
297 Church Rd
Putnam Valley NY 10579
T.M.# 73. -1 -29
Planed addition
Small plan showing proposed additional living space
With in confines of existing garage
II
exsisting family room
16-5" x 18'-6"
M
exsisting Entry
13'4" x 8'-8"
exsisting bed room
13'-4" x 15'
exsisting mud room powder
1 o,-8" x r-1 o" jTom
t4'-4"x5'-4"
CLOSET
4'-5" x 2'-1"
MCLOSET
'7 show T-2" x 2'-6"
'3' -11.,,
HALL L BATH
CLOSET IT-2" x 10'
T-T' x 7'-9"
I
as
O
O
St
II
pantry/Laundry
d)
10'-1" x 10'-10"
-T -30824-
DCV243SR
YM236
I
as
O
O
St
II
..
exsisting Entry
13'-4" x 8'-8"
exsisting family room
15' -5" x 18'-6"
H
O
2
d O
S
0
exsisting bed room
M
0
13'-4 "x15'
�CN4t•
exsisting mud room
powder
10'x° x T -10°
,r,,,gom
4-4"x 64'
CLOSET
4' -5" x 2' -1"
:. «.. :'saes;- .:1 • -
U SET,
.�
. _;, . r_:.,
-�
- .. �.. --�- _ .
-. �- -
3' 7" x 1'-11"
CLOSET
,
--
shOVver
T -2" x 2'-6"
T -11" x 4'
o
I
I
HALL $
33' -2" x 10' -1
BATH
11' -11" x 10' -1"
I
I
CLOSE T
3
I
II
I
GARAGE
- - - - --
fiy
14' -10 "x21'- 3 "r-
I
.y
I
I
pantry/Laundry
-
I
r
2` IV-1"x 10' -10"
I
�=
Imam
(
-
- - - - --
4W wme
am,w
n�oo,
SHERLITAAMLER, MD; MS, FAAP
Commissioner. of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
.County Executive
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: Kne =R P rj,0 (Owner's Name)
Tax Map #. 7 �. ` 2 '
Address: 2a1 %
Town: Ply r t� NA/\, VALL.6,1
Year Built-..-----
j971/
According to records maintained by the Town, the above noted dwelling,
is . �/ in compliance with Town Code.
Is not in compliance with Town Code:
The Legal Bedroom Count is:
- _ his. information has been:obtained from y:. •� i - - -s - - - - .,:..::,.
Certificate of .Occupancy:
Other :L_`D PT. 'r 1L.
The plans for the proposed addition are considered:
r New Construction
J Addition to existing house only
Teardown and /or re -build allowed under Town Regulations
Building Inspector _Date
6. '
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing.Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
-Dave ap� 7• yev'v,��v _ _
v,lT..R �R..� -. t. -- i •. 1 •. S r ,
297 Church Rd
Putnam Valley NY 10579
T.M.# 73. -1 -29
Survey & SSTS plans
Infiltrators installed and approved by BOH in 2006
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pupU A PUMPS & PLUMB .. ING
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'
MERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
January 20,2010
Dave Kappus
297 Church Road
Putnam Valley, NY 10579'
J
ROBERT J. BONDI .
County Executive
ROBERT MORRIS, PE
Director ofEmironmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New, York 10509
Re: Addition- A- 008 -10
No Increase in Number of Bedrooms
297 Church Road
(T) Putnam Valley,'T.M. # 71-1 -29
Dear Mr. Kappus:
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp from this Department dated January 20; 2010. The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at four 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 proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
Any other permits or variances required are the responsibility of the, applicant and the
jurisdiction of the Town of Putnam Valley.
If you have any questions, please contact me at (845) 278 -6130, ext. 43261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI; (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026.
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention /Preschool (845) 228 -2847 Fax (845) 225 -1580
StTERLITA AMLER, MD, MS, FAAP
'Commissioner of Health
ROBERT J. BONDI
County Executive
LORETTA MOLINARI, RN, MSN lei Yp- ROBERT MORRIS, PE
Associate Commissioner of Health Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road-Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET Ch o� TOWN 1AX MAP
NAME yQ PHONE JZ.O � PCHD# .Od -'`o
MAILING
ADDRESS ��I �► li�'�C.�'I j( E0V_)CW1 � I f �j ; �UD
DESCRIPTION OF V e. "1- etC505�tnj �khr�iho powct�ercoop -) b
� �C! 1
ADDITION LR Vn'P ir` i ]x;14' r- /Y) f1).11 i i al t�J r�)/ffl n rO
NUMBER OF EXISTING BEDROOMS* : PROPOSED* # OF BEDROOMS_
ROM-CERT. OF OCCUPANCY OR C TIFICATION FROM BUILDING INSPECTOR
* *Any addition, which is considered a bedroorn 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 ealth Dept., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 278-6130.
/1. Certified check or money order. for $100.00.
" -2: Sketches of existing floor.plan� (drawn to- scale,, all . livin urea including basement, to._be_:.... _ :...,. ;...
'shown and dimensioned and "use of each room`specitied): (See SeUi6fi 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
5.
Environmental. Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 =5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 =1580
• 7
c- � a. W r4c•cr s. rta a?. : w- e�r.T`�a a.r. ay.e• . +. �. _ � .ts+.•:'v �sr .i �aaAn- :n�4.i -�ao +• +ca.� -r r . -. .. -_ ...
- Dade Kap&&-
297 Church Rol
Putnam V. %RRey ICI 10579
T.M. # 73. -1 -29
Full scale plan showing proposed additional living space
With in confines of existing garage
') -- -m UL. I
(- --L)
4
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
., �.•, �,.._._.,... �.,„,,::,. �. �..�- �,,.- :t�€�IV'- �C�FT'ICEt -� ,.,,�;,. -_�. �_.., . _R.�.�,�.P.>,.._.MS -=,t
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner STANV�[000 BVII..pEM Address CE+LAiRGH RDA - �I�sGN HIt-LS
OI rtCN M ��Ls - 3umaly �sieM
Located at (Street cNkr tw ^u Sec. Block Lot 2
Indicate neares cross s reet - MIau+ 14 1" RoM
Municipality e Lk -_rNWM
VAL -.+_ r,-y Watershed J>ZEres�c��t.
20
22
SOIL PERCOLATION TEST
DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
10
4 11: 28 -
11:37
°i
I °I
Hole
2
4.5
Number CLOCK TIME
PERCOLATION
7
PERCOLATION
Run Elapse
Depth to Water
Water Level
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop in
Min. /in drop
Inches Inches
Inches
1 11:01 -11 :11 10
12 I s
3
3
2 11:1 - 11: 20 9 15 1 '► 1 2 4.5
511 :4d -11:54
If
20
22
2
7
10
4 11: 28 -
11:37
°i
I °I
21
2
4.5
511 :4d -11:54
If
20
22
2
7
10
13
17
3
5 U: 5 = ii; 22
7
20
22
2
7
41 z * -Oe- 12:19
13
17
7
311:52 - 1.2:0
lyt
20
22
2
7
41 z * -Oe- 12:19
13
17
512:19 -12:2. 7 19 2a I 7
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 0 HOLE NO. HOLE N0.
st.. Y...w°' 3'af:�.A4.rA.+.: rsa-.^ 1i.. x,��.�EC�'a.g.�.,y�y.- .n.a•... :.era.e.a+.r .. ,: s..o �r T^. r++: n.'CI.'anr..T.ar�+c•.�•;i.:. !�•`n.aw•,.wr. •wiC• /'L iT4aa. ".. Ycl.= '«..+.c .%:n.tsa +...v .,
12"
18"
24.11
30"
361
r
"
`t2
48"
5411
60"
66"
72"
78"
8411
INDICATE LEVEL AT WHICH .GROUND WATER IS ENCOUNTERED NON& 6^+GO-.►r4 -re D
INDICATE LEVEL TOz WHICH WATER LEVEL, RISES AFTER BEING ENCOUNTERED War" C
TESTS MADE Date. 6 - 12 - 7 &
�So ,Rate Used _ 1 rD—ro p: .�: Area�Pr- vded 'S AOO
73 F.-
No. of Bedrooms Ai Septic Tank Capacity 1200 6 = ` °' =�w ., a MA3Q"AJ-
Absorption Area Provided By 2ma L.F.x2411 k:' 3 t trenc
Address 22.3 KAL-MNAA Avg
o
THIS SPACE FOR USE BY HEAL`T'H DEPARTMENT ONLY:
Soil Rate Approved_ Sq. Ft /Gal.' Checked by
Date
7
''All- certifications hereo.mr.are valid for the map and copies
thereof only if said id map. or cornes bear the impressed
seal of the surveyor whose signature appears hereon."
"MIARANTEED TO�tnomTt TITLE DIVISION,
CHICAGO TITLE i4PURANCE C(.),NlPANV, IN
ACCC)RDANCr, WITIJ THE MINIMUM S(-A-,-
DARDS FOR THE Tlf-U WrwFvs uv THE ,v,--w
YORK STATE LANL±frll-!-F ASS(iCIA'Flf.)-," -41W
L JWr11V,5;--5'
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PREA111S,E-,5 SI-10WIV A-IEAPEOIV BEING
LOT /V%F2 ASSI-IOJIVIV 01V'5U0ZWV1S101N1
MAP OF BIRCH I -/ILLS —,5,ECT-101V 1— - 5A IL,)
MAP FILE0 //V 7;-IE CE OF 7-,-IE lc>U 7-,^VAA-1
COUNTY AS A-IA,,=' /,/ F131 7 ON A,1A r—,Fl,
1-973. -
SURVEY OF PROPERTY
,5 / rUA TE /^/ 7WE
OF PUrMAAoof VALLEY
)'='U TIVA M COUIV T Y
f;
NEW YORK
CH41APCAI
SCALE. - I"z,50'
1
ALEXANDER BUNNEY
I
%
&,,? 0 0,:Wqr /-0 Ooq7-E:
66.00
Z—OT IV9 2
72l0 A C.
-706� G, 1-97�5
126'WOODSBRJP
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PREA111S,E-,5 SI-10WIV A-IEAPEOIV BEING
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MAP OF BIRCH I -/ILLS —,5,ECT-101V 1— - 5A IL,)
MAP FILE0 //V 7;-IE CE OF 7-,-IE lc>U 7-,^VAA-1
COUNTY AS A-IA,,=' /,/ F131 7 ON A,1A r—,Fl,
1-973. -
SURVEY OF PROPERTY
,5 / rUA TE /^/ 7WE
OF PUrMAAoof VALLEY
)'='U TIVA M COUIV T Y
f;
NEW YORK
SURVEYED & PREPARED BY
SCALE. - I"z,50'
-E
ALEXANDER BUNNEY
I
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4-14Fy 6,/97.5
LAN[$�SURVEYOR. P.C.
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126'WOODSBRJP
1 � ff ROAD ROUTE I I
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0 'NEW 'YORK 10536
K NAt
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PREPAI'E� FOR S7A1\-1PV000 84-11L,0, S //VC.
"It is hereby certified that this survey was prepared
in accordance with the existing Code of Practice
SURVEYED AS IN POSSESSION
for Land Surveys adopted by the New York State
Association Professional Land Surveyors."
7-
FILE NO.
N S LIC. No 26e94
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