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BOX 26
03261
CERTIFICATE OF C1
:A PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
OCTION COMPLIANCE F_ OR SEWAGE DISPOSAL SYSTEM /eWAI
Town or Village
A X,
fa
1_0111� 2�-, t/"- Block_
Located at
Owner— I — d, %a;.4 4 s,
Separate Sewerage System built 6y
Consisting of 3F —Gal. septic Tank
Other requirements
Water
Build
Has i
I cart
attacl
Date
Any
condi
availa
subje,
Date
Lot
Job
Address
lineal Feet X width trench
f
iS
I
I
to
Ira
1370
YORKTOWN MEDICAL LABORATORY INC.
P.O. DOX
Yorktown Heights, N.Y. 10598
TJ JZL. hear Street
245-3203
i
DATE COLLECTED
RESULTS OF EXAMINATION OF WA-fikR
12/2/2-4
OWNER
DATE RECEIVED
ROBERT HOUSEKEEPER
12/2/?4
CITY, VILLAGE, TOWN VOR NAML OF SUPPLY
DATE REPORTED
CHURCH RD. PUTNAM VALLEY, N.Y!.
12/4/?4
SAMPLING POINT
TAP-- SUNRISE DR. PU NAM V
Y, N.Y.
BACT) RIA'PER ML. (Agar plate count at 350 C).
COLIFORM.GRPUP
(Most, probable No./100ml.)
HARDNESS, TOTAL -ppm
LESS
W 2.2
DETERGENTS - ppm
NITRATES (qsjN).- ppm
i.
IRON, TOTAL - ppm
FLOURIDE (F) - mg./I.
These r6sults'indicate that the water was YES of a
sanitary cfudlity when the sa pl was coll e ' -d.
t ►
')WELL DRILL ;Z-ZS LOG iaTD P,EPORT 121 �7
Well at GrL� 71n --� '?'„►' :,.;: County - ofL /-` - �....,_..
aui 'c3 "l .ia�:
Owner
�1, X� - � . P.O
. .'' Address /t G?
Depth of wcl /S_ti iameter %Yield / as well -disinfecte
ft. in! gpm - yes or no
' - .... _....... ice.._._.....___ _. �........ ...._,
!Amt. of casing above gi-ound'_ �r �. Below. ;rourid,3e� loll seal
in ':' ft packer, cement, grout
Draw a ►:• 11 diagram in the space_. p pyided .below and show she depth of
c::.sing, the wcll-:s,�al, kind and'-thickness of formayions enetrated, water
bearin formations, diameter of drill holes with dotted lines, and
casing s) with solid lined. �...
WELL DIA'.RAM ' FORM&TIONS PEI1 '*TRAT_'jD _ REE". LKS
iari ter, in Depth hind, thickness and Type of well
-.in _ft.__ if wat; r; bearing- drilling mit'aod
Grade Was well dynamited?_,mow
25
1 75
I !
150
� 1 '
200
250
-- - -PUMPING -TEaTS . --
n.; .1 o ..._ q;--.- 0
Static aater
level, in ft.._. __._ ..
r561oW" trade
pumping rate
in gpm
Pumping level in
ft. below trade
Duration of .
WAX-61i AT FIND OF TZ6T :
Clear Cloudy _.. ...'- f`urbid
Pecoill ended depth of pump in 77 -
well, feet b,.-low grade
W,..'LLS IN :61ED & GRAVEL:
Sand Eff. sizes mm
Snmd. e0defsize
Length of screen ft.
Diam. of screen i
Type... of-.-screen _ - —
Screen . Goenines x
�C�ITS:_
OMT __ _...__... _._..
;-aw a sketch of the property
:L the .back..of this sheet locatiog Drilling start::d C�:mp1et ; =d' y
zE W ALL A:E' D ` S_,WAGE DISPOSAL SYS.' -M _
Well Driller_] '
Si ;:nature
Ux:»er or 1Lrchasev of building Mu��.ici.�,i►1:i�ty "-�-
Isuilding Cow true ted by See`�C0n- _ % ,4x f %✓W
Location - Street 13lock ,
3uilding Z 'Ype Lot
GUARANTY OF SEPARATE SE17AGE SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and .drainage of the sewage disposal systfiem.
3ervi_ng the above described property, and that it has been 'constructed as shown on
he approved plan or approved amendment thereto, and in accordance with.the standards.
,t] es and regulations of the Putnam County Department of Health, and hereby guaranty
:o the owner, his successors, heirs or assigns, to place in good operating condition
my part of said system constructed by me Which fails to operate for a period of two
ears immediately- following the date of initial use of the sewage disposal system; or
uny.repairs made by me to such system, except where the failure to operate properly
_s caubeci .L`' the wi lllul of J1E'�' ll�til l ac: L of 4110 OL:i:l.ij.iuil L U
The undersigned further agrees to-accept as conclusive the. determination
if the Director of the Division of Environmental Health Services of the Ritnam County
up, � S� `rr�ri i� _ r� ' _Nn.al f-i� ��e t_.n ;.rl�`�i 1�n?� .tjr _pni rf1F? j c� .1i.Li. f �:,1 _1, '' SV Cf?(T, .:Ci �)i)l'?r�t �f. t >>3 .
!aused by the willful or negligent act of the occupant of the building utilizing. the
system. y .
►aced this day of !�l L -19 S'Signaturet�' c'
Title �' t /A,%,
(if corporation, give name and audresi
-----------------------------------------------------------
'HFZEE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS' BEFORE CERTIFICATE
IF COMPLETION WILL BE ISSUED. .
U1 RMITOR TS RF.OUIRRD T0. FILE NOTICE OF DATE OF FIRST USE OF -SYSTEM.
..- w.-------- - - - - -- --- -- ----------- ....r-------------------------------- ---- -.. -
livision of Environmental Health Services, Putnam. County Department of Health
T.
T Va
' .y • s
CONSTRUCTION PEP
s
_ t
Subdiws�on n �
Owner
.Builds ig .Type.',' -E
Number of Bedrooms
Separate, ,Sewerage[ Systen
To be 'constructed by ,
Water Supply
s r
.oe suomiuea w .uzi
;place in good .'open
ante of -the approvi
will be located as she
County P p maul;
i v fOaYa
APPROVD FOR C.
revocable E for causer
requires a new:, r
Date
Q!
»r= P 'TNAM COUNTY�DEPARTMENT OF HEALTH `
Dfvfsion of- EnviconmentalHealih Services Carmel N: Y 10512
T FOR SEWAGE DISPOSAL SYSTEM R ��TwA►r� Jp,I.��Y.
Town or VIII e
�rri sY' I�Id�ir
5 / Q Job ~a
flit,
�) y
u�S rc_+c E PL ,� Address
�cs�Tl>i�L.: `Lot Area'I `�-'S� "� • '�' N'< � }
D V = Total Habitable Space �°� Square Feet
_11
consist of 'Gal Septic Tank lineal feet X fP width trench ..
3 x
slit Supply From s , i
r
vale 'Supply tp be )
dress; �1.�L
-,< �• y :. ,,^ '` fir-:?' 3" .. s � 1-}
3 �
in d co
mpletely `respo d lion of the roposed systems) 1) thats the seperate� sewage disposal system".
ucted as shown on t en o anil in accordance with the'standards 'rules an regu a ions o t e u nam
Ith, 'and thai -on co f Construction Compliance satisfactory to tnq Commissioner'of Healthwill
Tent, and' a., writ, w = m s_ a owner his wccessors heirs'or assigns by Yhebwlder 'that said 66' lder; will"
dition any `part ` _ yst ring the period of ,two (2) years immediately following the-date of the Jssu'_
Certificate "of C stir ctio _ Vt e'o g' al system`or any,repa�rs''thereto 2) that the dulled, well described above. i
is approved plan a t Sei c Z stall i ccordance °wdh he Stan ds rules and. [egula ions of th✓e 'Putnam'
7 i
N 35
* ' s
Adifress ® '�� � - � ® License No �� /� "'� � •'
CTION This approval'expi . 0 m the date 'issued unless ction of the building has been undertaken and is .`
a amended or: modified when considered neces" y .the Commi er of ealth Any changeeor alteration jo construction:
proved fo_ r A isposal of domestdc i ary ate'
�i r BY T.t
PUTNAM COUNTY DEPARTMENT OF HEALTH.
r� �;=rr�rr�rT nT.. _ r•p*_srTPl1'�Tr��r'ala��':s ���'['F?.. C+T,'Tn?i!C� „�. -... e
Re: Property of
Date. U45c- lS; /97/
Located at f,V4°Z5e lJ,:� ✓'e % 4eA)V OF /"�: ° ✓,y�4 � c c �
seet -en 7771 " Block S Lot 7 V
Gentlemen:
This letter is to authorize,. STANLEY Ja LHRER
a duly licensed .professional engineer or registered architect
(Indical_e_–
to apply for a Construction Permit for a separate sewerage system; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the Commissioner of the Putnam County-
. T1......� y t 01 T77 _l t .] a-• o 1 .i G: ., r. n e� vxr- pa �v msr 1•,.,L,� 1 i
LC�1tL1t111C.tll, Vl lleCLll+h, 4111.1 VV s.Lgil a1..L 11V�Vli� 0J_.Y 1- c6p�._U vtl 1u Jr kj %., cJ.li �n
connection with this matter and.to supervise the construction of.said
system or- with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam.County Sani-
tary Code.
J
Couritersigned:�
P. E. %W. , #j2i� -=�
STUILEY J. LANDR (Seal)
.Address 267 �;.
AMAK N. Y, 10501
245-2645 7 1
rr (
e . ep one
Very truly yours
Signe
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AddVess ,,
2- q
—Telep one'
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INDICA TE ` 1, T � C GR'� :`!i T, } :`r�l `m Lam_% 0 Y�
II DICATE L ,VE_Tj TO t1! :{ :''? 1, E3JEL Dl AFTER 5E=''G E\C0U`TE ED
iEB'�. L "'--A DE 8 �' c��^ ����u'1� Date
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Provided.
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xbsorp, ion *'rea 30ri ��'.!'1 trencn. OLLlQi_
N- ..e� ST LEY I LAN DERV
Address BOX 267 t.E ti�i1 �., ,`.'r." '� -,i SEAL
PliT: a%I CCUNIV' D "? __ -,..T OF CLALT�i ._ _...
So�T DarepJ'_Ove S Ft . /Gal. Checked h;• Dare
LORETTA MOLINARI
Public Health Director
�,.,a...... .....,.,....._..
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 .
Nursing Services (845) 278 - 6558. WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
Jack Levitt
c/o Lee Kennedy, Architect
107 Harwood Ave.
Sleepy Hollow, NY 10591
Dear Mr. Levitt:
February 17, 2004
ROBERT J. BONDI
. County Executive
Re: Addition - Levitt, 22 Sunrise Dr.
No Increases in Number of Bedrooms
(T)Putnam Valley, TM #73. -1 -56
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 February 13, 2004. 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.
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 your convenience.
Very truly yours,
Michael Luke
Public Health Sanitarian
ML:lm
cc:BI (T)Putnam Valley
BRUCE R.. FOLEY_
- ° �?• ti7iirt 'fl`e "5ltt "'f�ir`d�croi' ""
i- "* %� �:ri- �?::,�> �:.����I�`"= tax= .ME3'LP:"t3-r1i� �t:�i `Iv"i S`t�:..�.:�..r -:�:•i :.
vt�� ��4��r Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845)27.8-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 = 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY
Z Z ��lii2�GS� fJ/Z /I/L`— PIJrN��'f S
STREET TOWN TX MAPS
A'�t�I �Yi7� Lei " �✓yN�� 9/4 , 3 Z¢ �P> /D
rr?�1%� i\,TAI� J�C,E G IiCTf PHONE 21Z > - /5,6 57- PCHD#
MAILING ADDRESS Pa:ni'Im //9ZG��/Jlir -r
�o •s�
DESCRIPTION OF ADDITION
NU VIBER OF EXISTING BEDROOMS 4 PROPOSED # OF BEDROOMS ¢
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction Permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
--'Pl ase submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified check or money order for $100.00. .
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
**Non-professional sketches are acceptable.
3. Two sets of proposed floor plan (drawn to scale, with name, Street, and tax map #)
*Non - professional sketches are acceptable.
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
BFhouseguidelines
r
BRUCE R. FOLEY LORETTA MOLINARI R.N_,: M,S.N.
_Public .Health Director _ _ =� f.. =.�. " saso �'e uLiic ;iea/tii` f�ire`c`toi
_.:;. -: ...., _ Director of
Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Re: 22 Suv�ZtS
Residence
Tax Map 7.3. — f _ S °
Town ��'t�. ✓'� �`w/
According to records maintained by the Town, the above noted dwelling
IS
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD.
OTHER
uilding Inspector
BFhouseguidelines
Edward Lee Kennedy Architect
107Harwood Ave Sleepy Hollow NY 10591 T914.524.0810 F914.524.ow www. acanthus, net
v ... ....N 11 • --�... . -. r } ... ... .y s. .. ...1 � � < ♦ .. ...aJ _ .�.< r �. .......- .•Y' .f< ... ..� a .r. .r ...i —. .I. - .. ..y • «
February 10, 2004
Department of Health
Putnam County
4 Geneva Road
Brewster NY 10509
Attention: Michael Luke
Gentlemen:
On behalf of Mr. and Mrs. Jack B. Levitt, 22 Sunrise Drive, Putnam Valley NY, 10579 [ tax map
73 - 1 - 56 ], I am pleased to enclose the Application for Public Health Approval of their renovation
and addition.
The house is a seasonal second residence for a NYC couple in their seventies. With the
exception of an added first floor bathroom, the room count and use remains the same. The scope
of work consists of remodeling the first floor bedrooms and baths, and adding space to
accommodate a sitting area in the master bedroom. A new bathroom will be "inserted" between
two neighboring bedrooms, also adding space to the south end of the house. The work in the
second floor consists solely of adding a dormer to accommodate a larger bathroom.
Enclosed are the following:
1. Letter of Authorization by owner to permit Me to submit this application on their behalf.
2.. Certifia d Check #5851 for $100.
3. Two sets plans showing site with septic location, existing and new floor plans.
4. One copy of the existing survey.
5. Certification of four existing bedrooms.
Please call if you have any questions. Please send approval direct to the Building Department;
265 Oscawana Lake Road; Putnam Valley, NY 10579, or any correspondence to me.
Very trey yours
Architect
Enclosures: as
C:1 Ievittlpmgtll _pcdoh.2104.wpd
.JUN -13 -2003 11:54 SNR
.jack I6: 04(f ld `- iL
305 West 86
New York NY 10024
June 12, 2003
To whom it may concern:
2127686931 P.02i02
This letter authorizes our Architect,
Edward Lee Kennedy
107 Harwood Avenue
Sleepy Hollow NY 10591
914 524 0810
to make all necessary applications for Building and. related Permits including Certificates of
Occupancy, and to represent us before any necessary boards, all with respect to plans prepared
by him for our forthcoming work at:
22 Sunrise Drive
Pi;?„,AtYS Vi;loy NY I /575-i
Yours very truly,
ck B. Levitt Sandra Levitt
G. \_Iev0Vmpt\L_muthortmUon,wpd
TOTAL P.02
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Ifs Is to Mdh that tha sewag a.
ditposal system was eonst o d as irr•
d6ted on this pw and teat the sysW. ,
Wpected by me before It was cmeref,
Itip. IN system was constructed in
uAftnce with in the ralas pad tego•
h*m d tie husi .knnty Dept,
T V-A E Cam-'" "4"a F-I C'> W h! h4, f= k'd: t.� . t '`. . IC J..1 vL -J � J A.,•�.,
GAT '7. 1 P5 0 72
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