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HomeMy WebLinkAbout3264DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -60 BOX 26 03264 ' r -� L 03264 ALLEN IVLDy J.D. Commissioner ofIieafth ROBERT MORRIS, P.E. April 15, 2013 MARS+_ �'rt ODIC` X CountyExecudve . DEPARTMENT OF HEALTH 1 Genega Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 Michael Mitrovich 23 Sunrise Drive Putnam Valley, NY 10579 0 Re: Addition — A- 027 -13 No Increase in Number of Bedrooms 23 Sunrise Drive (T) Putnam Valley, T.M. 73. -1 -60 Dear Mr. Mitrovich: 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 April 12, 2013. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at six without prior approval by this Department. TIv.,geepfthe existing sewage disposal system.a..nd. ts:expansion.area.mmt_he __ w._...a..,:: -v _�__.- �..-,• mauitained: ._` -_...: _ ..... _�..... __ . w..�. �._._ _._.... _- _.�.�.�.....�... __._.. -- _•...� _......_... _ .. __..... _.T .,__ 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 April 12, 2015. 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 Senior Engineering Aide GDR:cw cc: BI (T) Putnam Valley ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 ADDITION APPLICA'T'ION RESIDENTIAL ONLY MARYELLEN ODELL _ County Executive INZOR._ STREET 2 S S Q n r i se V,- i V e✓. TOWN 2 TAX MAP #_ NAME NI i' �,, (l 1 G,�j PHONE f(31 7) G ZQ Jq 194 PCHD# MAILING ADDRESS 2.3 j24�/1�� ti�lo.�79 DESCRIPTION OF ADDITION *NUMBER OF EXISTING BEDROOMS NUMBER OF PROPOSED NEW.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. =Ty ae _ _e ti ene�a - w r.use-su�u.a 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 CONINffiWTS PUTMAM CO PUT CO MAR 2 2 2013 4. MAR L .' DEPARTMENT Of HEALTH OVARTMEN'T 0-° HEALTH N ALLEN BEALS, M.D., J.D. Commissioner of Health V ROBERT MORRIS, P.E. f Director of Environmental Health DEPARTMENT 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: M; :rrovi ch (Owner's Name) Tax Map # 73. -1 -60 Address: 23 Sunrise Drive Town: Putnam Valle Year Built: 1970 According to records maintained by the Town, .the above noted dwelling, is xx incompliance with Town Code.. _.t ;1 r ,..W;Frr1cE 'x'31 ro " zn • -ode. The Legal Bedroom Count is.- 6 This information has been obtained from: Certificate of Occupancy: CO 72-531 Other: The plans for the proposed addition are considered: xx ' Addition to existing house. only Teardown and/or re -build allowed under Town Regulations Building Inspector Date 5. MARYELLEN ODELL County Executive iJate ............. ............... TOWN OF PUTNAM VALLEY 26;bne District ................... .................... PERMIT RECORD NO .................. ... ............. . ..... Permit Work to start ..................................................... C ... . ....................... .6.54,ription ...... ..... co, ..... �.. .... . ........ .. . ... ..... .... i .................................................................................................................................. ir —Street or Road ...... ....... .............. ... ........... /Lalion of Premises ............ ............. n .. * ...... *"**'*'*" .......... ............. * .............. ......... FRONTAGE ........... ................. Rear. SEC . ............ ft ......... BLOCK ................. ........... LOT ...... ....................... ACRES (other description) or number of square feet ..... ................................. .................................................................................................................. SUBDIVISIONNAME ........... . .......... . ... ....... :..: .................. : ................ ** .......... ­* ........... ....... .............. ...... ............ ...... ........... ............. OWNER ........ I.R%rk e - AV\es! .................. .................................. I ........................... ADDRESS .... ....... gimension of Building '3 Width 6 Depth Stories Type Foundation ............................................... Size & Use Each ............................... ...................... Room with Window Area ......... ......................................... ............................................. Sewerage Type ....... ksrg�.. Size of Septic Tank ..... /Z., ...... Lineal Ft. Drainage .................................................... Size of Dry Wells .................................................... Plumbing ................. — Description .................... I ................. BA Well Description - L �1:_ Ad�uto fdln n ... . . f-s4wo .... ..... . ... . This application must be accompanied by a copy of surveyor's map and complete plans, specifications and all information required by the Zoning Ordinance and Sanitary Code of the Town of Putnam Valley when requested by inspector. Estimated Fee $ ...... ;..O� ............... Building cq 1�'t Cost $ Total Livable ........ $.......I..... . to ................. Sanitary able Area .............................. 1. cro Date Zoning Board Approval ... ............. .. . . . ........ . $ .............. V.1 ................ Plumbing $ ............... LQ .... . ....... well Z j K 7777777',,� T, IMNAG, .a^ 7p 1 Per NOT 6E ALTERED IN ANY MANN ER. Iii E112 i I .920=- iT- . C E ATEAV_$__ ' COPY FOR B U1 .THIS COPY OF RTIFI C710f REQUIRED BY THE ING 6 'RY CODE MUST BE SHOWN BELOW OR ON THE ERSE SIDE OF THIS APPLIC11TIONt V USE I / CONST. ROOFING LAND 1/11 Family. VfWood ood Shingle ,Paved 2 Family _�Steel Asb. Shingle i Dirt ILog Cabin Brick Tile i Oiled jBungalaw Concrete Metal Swamp [Apartment tone Brook Store FNDTNS. INTERIOR Lake F. Store & Apt. S one i Rooms Dams Store & Office Concrete s Apt. Rooms Sw. -Pools Office .4locks Apt. jen. Courts as Station Brick Attic Open Piers i Attic Finished OTHER BLDGS. EXT. WALLS PORCHES !Barns BASEMENT; Wood X Front .Shacks rt Brick X Side Cottages full ll I Brick Van. X Rear Bungalows ement Floor Ilog X Encl. Electric Finished Shingle misc. !Phone ,Garage B. In, omp. Plot Plan lFurnace rVT Field Stone Driveway gimension of Building '3 Width 6 Depth Stories Type Foundation ............................................... Size & Use Each ............................... ...................... Room with Window Area ......... ......................................... ............................................. Sewerage Type ....... ksrg�.. Size of Septic Tank ..... /Z., ...... Lineal Ft. Drainage .................................................... Size of Dry Wells .................................................... Plumbing ................. — Description .................... I ................. BA Well Description - L �1:_ Ad�uto fdln n ... . . f-s4wo .... ..... . ... . This application must be accompanied by a copy of surveyor's map and complete plans, specifications and all information required by the Zoning Ordinance and Sanitary Code of the Town of Putnam Valley when requested by inspector. Estimated Fee $ ...... ;..O� ............... Building cq 1�'t Cost $ Total Livable ........ $.......I..... . to ................. Sanitary able Area .............................. 1. cro Date Zoning Board Approval ... ............. .. . . . ........ . $ .............. V.1 ................ Plumbing $ ............... LQ .... . ....... well Z j K 7777777',,� T, IMNAG, .a^ 7p 1 Per NOT 6E ALTERED IN ANY MANN ER. Iii E112 i I .920=- iT- . C E ATEAV_$__ ' COPY FOR B U1 .THIS COPY OF RTIFI C710f REQUIRED BY THE ING 6 'RY CODE MUST BE SHOWN BELOW OR ON THE ERSE SIDE OF THIS APPLIC11TIONt I 1-7 _ xr• ��tl�A u1r'u$ci 3� aimoy aft 3n Iras ae4 aapun pua' 30 'A 2I0. 4��f!1Y --- �I�I A iAlti''IZtL`Id ©�t�ciO,L 1u�iIT3 pazi. ail,11- Xlnp a3 fc{ �{u� ut p�u:ia� Gsal a a par} =.� Zoe aa0 aaa (uuu n o u.)noy aq� ;o I�as aqi aapun panssT .�q -j.iaq si burdnaao jo alaa? va n1 uaar{ 1aTi mo, Mel ;o suoisino.id aqj of }uens.ind Rauednaao toj Spuaa Dlu puu pa�aid ti a,� q sasiivaxd aq� �uiil puu pauoi�uauiaaoje su smui a , So luaivaambaa :�aana Jaui siutaa ;uui puu W-111r, pros aiq� �uq� puu pauotivauTaaoje si, Smuj aql 30 sjualuaainbai aul glrm aauunduioa a asml }s pasodoad aqj ;o ivauTanoaduii ao uoiiaaaa au} gjjjA pop�oaoad ,Cjjuanbasgns suq luuaiiddu aq auiuiaaase uotlaadsut juuos iod {q �uwq pau�isaopun aqj puu .io,�a.iaq� as pa Tinbax aql K ui P cuuu n `Sa u uiuuand jo umol aql ui �aa jR ut sm.uq 0111 puL ap Juinuq :.`}[.T0 j MON `�iuno,) i fi II A p ; j F I 3 i ,Cau}iuu� aaui uipspuiuoZ aqt 0 ilunSand 1lu13d uuT ,111( u a0 uo� uai ddu iii' 3 i aa0 ..... s _.- ........ . � aSTUIaad J 0� uoz cai dd ....o , Sauudnjap Jo a r T 8 CZ •, �� >, .pax: �r r� ��.; r �: V, . S . F �S i 4 'Aiessaaau s, a6ueya ao uollez)! #!pow 'U01 le3on5j vans 'UlleaH io aauolsslw ale slenoidde y:mg algellene sawoaaq AIddns Lalem a!Ignd a uagm p!on sawO3aq camas Ampues 3llgnd a Se woos se Plon pue ❑nu awoaaq Ilegs wags Welluesun ,Cue to agl aimas of Rlessaoau aq AM se uo!lae yons a luaw6pnt 041. #* 9 ;3� ys � lddns jalem alenud all to lenoidde 941 pue algellene #o lenojddy •a6esn y3ns woa# 6ulllnsaa Suoli!Puoa x anoge aUl Aq Panjasssas!. 6 Adnoga.: sa d r _ - - ssalppv ale(] Oil 1 a6k 6!Uawl edap �C1unoj LU ulod aUl •Ag 6anssi irNiad ayl Pu In 'sp,iepuels 341 4l!m aouepaoDae ul pue '(payaelle aJP y3lym io saldoo) Tom palaldwo3 ayl to sueld ayl uo umoys se (Ile!3 s oqe aul 6u!naas palsq se (S)wa{sts ayl le4l Aj!laab I LPalaldwo:) ua38 101luoD uolsoa3 seH Y: -- panssI i!w'ad aleO - - -- ,7'' - swoojpae to 'o IV r; # - - - - - - -- - r -- , v, - adA 6uippn8 - -- - - -- - -- - - ssaaPPV T r"- AE3 Palpia AlddnS alenrad - - 1 wojA I d S a Igdd :Aj d S M gale y3uaal 4lP!m - -- -- — - -- - X 103 A I ea U11 - _ . ,.., 'lue1 :)!Id-)S •lerD -, 10 6u!is!suo:) Ssarppti - - - - - -- -- - r - - -, Cq 11!nq w3isCS a6eaamaS aieiedag — — — - - - - -- -- q o f - -- iaumo r Pale3o3 n W31S-lS _IVSOdSl( 3.9VM3R Nna -')NHlI4IAln'% nlnl I 'in u f4Zmn in , 1 w-,, 71901 A •N 'IOUIJej 'Sa?IAJOS y1/ed" jejuacuuojinu3 jo uoismip H.L'IH3H 30 ZN31VI.21t d3(I JCLM03 WVN.Lnd ^N( :4 • I Li .r k;4r,4 iA • s f •t i AZ J' k r ,4 , E I'tOO M ®EDROOm"�`_ /.0 ... 9 hl L PUTNAM' NOUN T Y DEPARTMENT OF HEALTH t. 2 HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY 6EDRf }OMS MAIti ALL SUBSEOUENTREVISION,ALTERATIONS TO THESE HOUSE PLANS MUST BE cMMITTED TO THE PCDOH FOR APPR Z-'3 Su!+��i.�_:._ - -� -..__ ...._ r �3 'lei 73_... .... SIGNATURE & TIT `E ATE -► is v1 t� i 1 c 1 ;t tv � ooh -�C PUTry r 1 COUNTY DEPARTMENT OF HEALTH HOUSE PLANS PPROVED FOR BEDROOM COUNT ONLY BED$OOMS c,;2-7 - 13 ALL SUBSEOUE gT REVIS!ON /ALTERA,TIONS TO THESE HOUSE PLANS Pl L B SUBMITTED TO THE PCDOH FOR APPROVAL NATURE & TITLE 1 ' 3 � t{ ti3 4 a ,k POTENTR _ oom �at��✓' POTENTIAL BEDROOM..._ v- _._.. ..... ......... - -. - ...- .... .. o �'1IAL --B .� -.. I� ®TENTIAL _ POTENTIAL - ®R®O.61�.... o...` ®I ®i!� ELaoI�... BEDROOM...... L�.._..._. _�I _ ....._:..__...... - -- - - -- ......_... -. ...._..... _. . .? h( 4 i ;t a G new 35"x 48" awnig window frosted a F 0 in living area finish all exterior walls with 2" xps foam insulation 1.5" and 2.5" metal studs and sheebDck ceiling at aprox 84" WIS 35'10 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY CO BEDROOMS A NEW FINISHED BASEMENT ALL SUBSEQUENT REVISIONrALTERATIONS TO THESE HOUSE �/g ■ ■ =�■ 'TANS MUST BE SUBMITTED TO THE PCOOH FOR APPROVAL >IGNA URE & TITLE DATE -low steel beam and ducts below 6'4" 2.3 Sung+ ;t:e jjt . N. y■ 105-75 N new air dud to outside m wH � a v bettuoom T x 11' 8` utility room so existing ac xae move existing lolly column into 2 x 6 bathroom waft as per engineers plan full wall boxing in pipes with access panal II I I w eisting ac ducts below I a I 6' 4" framed in to be 5' high storage II 0,00 , 11 S I , II � box in foundation '• c m " 3 S T4 eD „ Y i° pp it A i� „ f douhNR hung •- existing window 1 11 III 11 I II new dame I W x g• miadw header I I I .0 douse lads studs between Wndw s i7 i l I I ICI— M...� unfinished storage new32114 'x42dhanda72'x4r space. pirxuie wUAcrwto match exts6ng remove existing column 0. and install c channel to beam existing 6' sliding door as per engineers drawing " 0 0 existing oil tanks „ I , I I 35'10 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY CO BEDROOMS A NEW FINISHED BASEMENT ALL SUBSEQUENT REVISIONrALTERATIONS TO THESE HOUSE �/g ■ ■ =�■ 'TANS MUST BE SUBMITTED TO THE PCOOH FOR APPROVAL >IGNA URE & TITLE DATE -low steel beam and ducts below 6'4" 2.3 Sung+ ;t:e jjt . N. y■ 105-75 .1-0 - ON ,.s.. --.r .: .e.- i . :�- -. r_.._. �..c �- ......_e:,.sE..:+�r_...er7 �ZS.r::..:c,�e yew. _- �.u� .>..:.. ���-, `.. .;.__a: ��-1: �% T..�;,_ .= .......� .' .,,�.r .. %. ..:a:z7.: T--. ..uu, .v .� �..n•'a ..-+.ro i�.r.:. 1 O 11 O U N IK o• (a c0 N i; ip F L h6Z ' L L,L L 0 L,LV eisting ac ducts below ; t i PuiZ►4,� Va ley Aly C0 S7�j 6'4" framed in to be 5' high storage existing oil tanks F i4I t � . i J I.r C� _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ • �) I ' I •. �� low steel beam and ducts 5I below 6'4" + existing metal I beam aprox. 6'8" high EXISTING BASEMENT 3/16" existing 6' sliding door a xistinga double hung window ,j •1 . 1' 1� 8�Z • 8,Z 0 L,Lb 0 M I certify that the system(s) as listed serving the ab attached), and in accordance with the stand .r d ly as shown on the plans of the completed work (copies of which are the perAnit issue5h by the Putnam County Department of Health. Date P.E.—R.A. Address —IA UcenseNo. 0, '_3 Any person occupying premises. served by the above s) 1) 11 1 take such action as may be necessary to secure the correction of any unsanitary My conditions resulting from such usage. Approval of t ate se ge system shall become null and Void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall ull and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary. Date -e2e B itle PU71 AM t, OUNTY DEPARTMENT OF HEALTH V, Division of lEnvironmental Health Services, Carmel, N. Y. 10512 C S' SE Town or Village 5ZJ A 0, F- Da W Located at Block Owner— 1 e/ AP4F-s Lot Job Separate Sewerage System built by as �11 12 Address AJ Y, 1000 Gal. Septic Tank 5151 Consisting of lineal Feet X width trench Other requirements Water Supply: Public Supply From Aa DgA cz, --Zlopl-rivate Supply Drilled By ALL-04 N/- Address P;;-xhl A-M KE -5; J aj� m N- 0. of Bedrooms Date Permit Building Type 0 0 Issued Has Erosion Control Been Completed? efj I certify that the system(s) as listed serving the ab attached), and in accordance with the stand .r d ly as shown on the plans of the completed work (copies of which are the perAnit issue5h by the Putnam County Department of Health. Date P.E.—R.A. Address —IA UcenseNo. 0, '_3 Any person occupying premises. served by the above s) 1) 11 1 take such action as may be necessary to secure the correction of any unsanitary My conditions resulting from such usage. Approval of t ate se ge system shall become null and Void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall ull and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health, such revocation, modification or change is necessary. Date -e2e B itle YdELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK . K -_' �c:" C.y nm.a3 .i L; . ol! .1 II - .�•�t *to rl s� .wa o_?� .t o± no. tiq h-I�i+� atnr..- n _. ._ 411 �. '�rp.. ��- :..;x..;�?- ,�'3�:�3y N ! Imo. O��e.�� •:., &q; `ir -. r N- et_::,.... _ .:•.;:� p�'t : �f_.:: .^-�, -.. analysis of water sample indicating water its of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME OUSe eeper ADDRESS LOCATION OF WELL ofT -Church a'/Wt Street) Putnam Valley, N. Y. (Town) (Lot Number) PROPOSED USE OF WELL BUSINESS n L DOMESTIC ❑ ESTABLISHMENT ❑ FARM CI TEST WELL SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER ) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) 3a t DIAMETER (Inches) (� It WEIGHT PER FOOT 1 THREADED ❑ WELDED DRIVE SHOE YES ❑ NO WAS CMG OUTED4 LJ YES NO YIELD TEST HOURS G.P.M. BAILED PUMPED COMPRESSED AIR 7+ 10+ YIELD (G.P.M.) 0+ WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: 155, SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT SIZE DIAMETER (inches71p, GRAVEL ACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feel) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 1' 28' hardpan • 28' 157' bedrock- blue granite i T If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WE Ly COMPLETED 2/11/72 DATE OF REPORT WELL DRILLER (Signature �� BACTI✓RIA'PER'.ML.'(Agar plate cqunt at 35° C)..COLIFORM GROUP,•(Mostr probable. NO: /1OOin1:) less . than '2' 2.. :'HARDNESS, TOTAL ppin DETERGENTS - ppm NITRATES - ppm _" IRON, TOTAL -- pPm �lA M E �, ' ..,. ®vS : 6 e u�qd �; V T'l� I t dpi 1, fi r O'';ner or Purchaser of Building Municipality (is 4 ccemv= -71, Building Constructfd by A, Location - Street -Block kfn & =iA dA- 7' 3 Building Type 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 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- f 1__ s - .n,.rity ,Friar T;cr.7.t pj ii xltai t!j ?�he rier or ZiOt t failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. ,/ /' Dated this day of Auk 19 Signatu Title Ir 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 3h.'��i.,�'..,i"_j-,F r �.ss { e.t�'1 dh r-N at` '.. �`' �+a a ,,.xt -4 4 t. -i s.�" ".•-y, , 5 c a _ k�, x r, x a- ray s•,, s -�.r a� { ::.;,: a t Z.n. i t3 'q ,zPUTNAyM COUNTY IDEPA�RTMENT OF HEALTHti r 5; 3''Division of ±EnwronmenreJ Health Services, Carrr►el �N' Y J10512 ' 4 �•' CONSTR'UCT.ION PERMIT FOR "SEWAGE DISPOSAL SYSTEM r h�frTOW /+����sr^j�IrvJe�'I�js ` 7i 9 -, _:. 'iax �►�'A �;,� s Town or ,V111�9e ass fi L:p• tOJ 3 ^^. CF• 'S.W �:�G 6MY r/ t Lkb+c W'•W.r4 .54" 'Y� �' Q...�8 +► ?..!� Y !Yf r31UCK �.% t . /% C ,,�.0 wa'i'% �Q fu4 �u. a' r- p• a,. .vw va,F .caw lw. }1 .$Ubd1V ISiOn�V "owner Otis. Add'res�f�(JA'Cf� y► N r P Builtlm9 type LOt ,Area o LJ 8 v r Number, ,of Betlrooms _ Total: Habltat%le Space�dULt %Sdf3 Square Feet y i ':Separate Sewerage System. =to consist of OoQ Gal �Septic Tanker�� Ilnea'I feet�X R6 n 3 To be constructed' by l' h trench i Water Supply Public Supply +From * k x rivate Supply to be.,dnlled by �Atldre Other Requirements f o✓ �� x i 1 L, 1 represent. that 1 am wholly and completely Ign and location-,of} the proposetl systems) 1) that th _separate sew g cl sp'osal-syst' , above described will be constructed'assh'o, n e ent there =to and inaccordence with the standards rules an r.egulaions of ;t e u narn County `,Department of. - .Heaith,:and.,th t _ rtlflcate of Construction Compliance satisfactory to the'Commssionerzof_Health.will. s t:. + tie submitted 'to 'the Department, -:and rniihed the owner his successors, helrs.oF. asslgnsjby the tiullder ffiat said tiwlder'wlll' I ;place An < good operating condition. a I _ a _ ystem during;` h`d period of two (2) years immediately followingahedate of then lssu 111 ance1.of the - approval of the-Certifi' C pli f the =or nalksystem.or any rep s, thereto 2)sthat the'dnlled well desc betl above will be •located'as shown on ,the appro .Y pl n— i 111 e i ailed' accordance :w h the andards rulei;antl regula If the Putnam _ County Department Of Health �twf t ) x s y phi L/� Date ed Address• ;LicensetNo APPROVED FOR_, CONSTRUCTION Thin ve>.o ear -from the date 15sued unless aconsfruction "of the'bulldinghas been'undertaken and`.IS a - revocable,for. cause or -ma be amended or mo ered;necessa`ry by,the :Corimrriissloner ` of Health "s Any change or alteration of construction .i requirers a + ew pe It Approved.,,for disposal of domestio aF , se an r .prey water supply only Y Date��� w BY Title I t y FUTNANI COUNTY D ?T:° ,NTT OF K 1,TH OF ENV! DCNME-\-� -AL FE` VIT C E S DIVISION ALTH DESIGN DATA S"I"IE-1 SEPARATE SE,,-'AC-:t DIS-OSAL SYS TE-" FILE NO Nner �-AIJES Address I7oV-0 g;4" /7 Located at "SLre--) Block Lot -7 ci -Z (Indicate nearest cross street) Municipality OWA) Q ",- atershed PEe A� �Ci SOIL PER C 0 L AT I ON TEST DATA REOUIRE- TO BE ED PITH APPLICATT Hole Number CLCCK TINE PERCOI[,ATIO\T PERCOLA TION Run Elapse Dept- to.t'.'Cater .,;atLer Level No. Time From. Ground Sur -ce n Inches Soil Rate L Start Stop Min. Start Stop Drop in Mi n/i n . dr o .-Tnclne-�.---��-.-.-I 2:47 2 4 47 19, 2 -5 3* 10 �jj 2-1 f 4 3 4 'l) Tests to be repeated at same e p -IL h L*7itil approx, tely equal soil rates are oh- tained at each percolation test. hole. All data to he it- sub M LLed for review 2) Depth measv-r e- L op of hole ments L to )e made from top TEST PIT DATA REQUIRED —0E �uLLII1TED .:ITH APPLICATION DESCRIPTIO�i OF,. SOILS E�'- ^UNTERED ? ES.T .HOLES x$ DERTH HOLE NO. )% .HOE \0. � Y HOLE \0. G.L. aIt, 6Tr h ` 12T. ce- 24r` 4 30" a h 36' - • �y 5 4'r A r= 1011 h? _ 66" P A a 8 41 F " INDIC. TE :LFVEL AT WVICri GROUND WATER IS r, C NTTERL�' INDICATE LEL'EL: TO S�,HICH MATER EVEL RIS =S AFTER EE' +' C E \C`O'JNTERED TESiS - M',ADE 3Y ) � � n Date — �,�°7 � .. ' ; ?� •" ,s_ TT � T c:41 _ \row moo' SoiL Rai--e <.se�_� Min./1- ' Drop S:D. __ e °ro. _d IlTo . of �edroo-:s _Septic i'� CG _c _ tyT Gals . Type rpG� ��+•�. Absorption Area Provided Dy,,' r : " �® -.err Width tre:ic' 0-ci i er . STAB .tl �oUUEY E - Narne a4a Y�tl. d Address BOA 267 -e I7 e ..a.0 a { m •v „�'*? tom? e^- xm-r ••,. .:+M 'nx w .e.µ .s. �e PUTN'a,�I COUNTY DEPARYL LE, NT OF HE. LT�{ J Soil Rate Approved Sq. rt./Gal. Checked b-: __ Date