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631- 589 -8100
73.08 -1-41
BOX 27
03397
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FL CONSTRUCT
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Separate sewerage,- Sykem,-:[)Ullts Dy.
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;Other 6requirements
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': Prrvate'SuPp�
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-Building'-TyP6
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j •'I certifythat the systems) es listed servi
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-a d ince, -With: the
-'�i
_
Date
:Any per S66 occupying premises -served 4
resulting conditions from,such,usage.,
11 bi
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'subject ,'to w h(
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TNA-,W*`COUNT-YW' ER'
na H4 hh`,� s
SIQ �.qr,Envirq 'Environmental
P
7 _L F ., E, bAL-AEWAGE.
ra
'Septic %Tank
rorn
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FT ENT OF r HEALTH
M,
Me
-Y T-,'O,'
DISMSAL i
�-V + Town or. V�Ilage
4,V-4 t i
Xi
43 ,width trench
Bedrooms
Daterpqrrnit Iss , U I
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mtiaily.* as shown on the plans of the completed '
;AT1, Putnam`
County ,Departmenz. of Health.
RA.
A
Ice nse 'I-
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such action, as, may.be
n e correction f any unsahltary' shall p nitary ec
iq%ve, 6 omes •
r
when ,a wat supply becomes available Such approvals are.
?of Health, su revo tan,' modrfication or change is
necessary
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LORETTA MOLINARI
Public Health Director
ROBERT J. BONDI
. County Executive
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
Stephen Johnson.
15 Jeane Drive
Putnam Valley, NY 10579
Dear Mr. Johnson:
May 25, 2004
Re: Addition - Johnson, 15 Jeane Dr.
No Increase in Number of Bedrooms
(T) Putnam Valley, TM #73.8 -1 -41
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 May 25, 2004. The addition is approved with
the following conditions:
. eszr..K..v ...- rs...r ...ae..s+.. i. .,..a n. ter. 'T�. wrrr -. _.c- c....�.y........ e- .n.r.. -..... _... ✓,.. .. n.. v._ _-.. .... .-. .e. ap. .r P•�ou
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 .
Rush 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.
WH: lm
cc: BI (T) Putnam Valley
;Very truly y r-- __ _
William Hedges
Senior Public Health Sanitarian
1
LORETTA MOLINARI
Public Health Director
ROBERT J. BONDI
County Executive
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
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET /_,64a �/1 � TOWN PA, a� TY MAP # d � � -- 47(/
NAME d ��� ,St h PHONE5242%6S PCHD #
G ADDRESS 4_0N ��T ��� ( /t f�MAILIN /
DESCRIPTION OF ADDITION
NUMBER OF EXISTS% BEDROOMS3 PROPOSED. # OF BEIDROoms
(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 Engineeroottor'Registered Architect in accordance with
..?pP1, v 'n j , a ojf the bnt am_COI; t eG.alat (,b
�.cab1L •se. tens �� ��_. 1 K.r1 e..n.� ay .,..L.e: -
' Please submit this,form and the following to Putnam County Health Dept., 4 Geneva Rd.,
Brews er, NY 105 9, Phone 278 -6130.
ed 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
Feb 98
BRUCE R. FOLEY
_. ;. Parfi6i! » Y% fi` eriliti��131�c 1G?'�"•��"•;.= ,::=._..t.:�
..: r K:LI2£•t""Ie�C7tINAI Rte, M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARRTMENT. OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845)27&-W8 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (84 S) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY'10509
Gentlemen:
Re: \10h�� o �J
Residence
Tax Map 3 V/
Town
According to records maintained by the Town, the above noted dwelling
IS
' "IS NOT
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 uc Ue
Building Inspector
BFhouseguidelines
,. < ,`"�' -` _ �. ...cti •:-.� ��n- ..a- ....... —�,.� wii;u.`:...a... .. i.o.�- +v+��+�^a' ` �i. � .!eFs�'•.�......w;r+►ri�i�,.:..r :_,:.��.:..�e..
r or Purc aser of BuildinEl Municipality
Building Constructe by
Location - Street
Building Type
LO Z
Section
Block
2 I.9
Lot
GUARANTY OF SEPARATE SEVIAGE 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 sIrstem, 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 :Direetor of the Division of.vironmental Health Ser-
vice'sJ.0.1 EY1e`. -Un'a 'C'oL:rity 7?ep'artire "rat of"?iealtz s tv�w ietner -G2 r. °�t4y :Y �_
failure of the system to operate was caused by the willful or ne ligent
act of the occupant of he building utilizing th system.
Dated this day o 1,192 Signa ure
Title
4 f corpora 1 me give na
and addre s)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPS _,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
:� � � i A �� r f,,,. 4 9 a. dw �'_-•� . p'sF k tii �5 .-s�3 � 4 0"Q
PEEKS'KILL MEDICAL LABORATORY
{
'R`d Maple Terrace Bldg A 25269
z 1879 Crornpond:
{ £ Peekskill New York PE 7-8777
a� +� c ': w.sM'f �F!' .r "�•,t uiz`,a+�
`
- {�'�' : -st.,� i H �.I� l.fri -{,' ,}4w- ,see -�'"y. ,t,� a4+e.o. - .��kfi. <:r w.r+a �v,:K.u.,
,-..F. rca't'rwe+1�."'+„€#' °' ''n•3 �"' `":.mod rx -3•,� ,� t�?� � .:. ,.. .� . �.. � .cs5;�.
'"�'`;'i-`�,�
RESU LTS GOF, EXANtI:NATION OF -WATER -
y
r� T=
} {4 - d ,.,z
2�+-•7
4 OWNER ` s
BUILDERS INo %0 #29
RECEIVED ,
f STREAM 4
l
. • N .�
4 �, -24-2
�)j( CITY VILLAGE TOWN & / NAME OF SUPPLY t - >5
DATE REPORTED ;
}R F E
`4
4 -.
3.
t: }.• _ _ f 44 1,. E. L .�
L � 2.t.. 1 .. .:d
.. .� to
-SAMPLING POINT
T� � '1 s
Y y
C� � '� t , � 4 Y�' L- k •G �1 �i,� % $ "S '� b" ^x.' r'� b y' 1 �* µ
BzAGTERIA PER {MLA �(A'gar plate count at 35 °)COLIFORM
`GROUP (Most probable No /'100m13) z'
�� RESIDUAL,tCHLORINE AS RECORDEDAT'
S HAN
OF
SAMP•I ING POINT: J . POINT TREATMENT
n
�
4
I !
FLOURIDE (F)
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t
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++Jq Y✓b4. t:,.1 'ice {i Y�c*'�.i'� F r �{ l
��
4 Y'.: i•/F.f4. : r:,. ...i Yn'f ea: '1 ..Y�'�5 .r.
�Thes» results mdJcate� that the water •was Yg+►S of a, satisfactory sarntaryquahty when rthe sample was collecied
iz
7 ,
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A: H PADOVANI, M T,,(A5CP)
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WELL COMPUT1ON ,REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING CARMEL, NEW YORK
���r' �orC' pi' s` iv` �Ze' ctsrrrp 'F�teti"n'q�w2M=Miter-�n(f'^ submitted'° to" Eouritji?Ffeahf��E�artrrseFi ^tiigether wi'i:h-la(aora�ary'�repart=oi• `- �'
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
N
E
v
ESS
S
i pi
t Y
'Rt
LOCATION
OF WELL
(No. & Street)
(Town)
(Lot Number)
PROPOSED
USE OF
WELL
DOMESTIC
PUBL
Y
BUSINESS
ESTABLISHMENT
F] INDUSTRIAL
FARM..
AIR
CONDITIONING
,TEST WELL
((SSpe if )
DRILLING
EQUIPMENT
ROTARY
COMPRESSED
AIR PERCUSSION
CABLE
El PERCUSSION
OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
V
WEIGHT PER FOOT
`��
THREADED
D WELDED
DRIVE SHOE
&YES ONO
WAS CASING O TED?
II�J YES � NO
YIELD
TEST
BAILED
n
PUMPED L4J COMPRESSED AIR
HOURS
G.P.M.
YIELD (G.P.M.)
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC (Specify feet)
rr-
DURING YIELD TEST. l feet)
Depth of Completed Well
in feet below Land surface:
� „--
3 tJ
SCREEN
DETAILS
MAKE
LENGTH OPEN
TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (inches) FROM (feet)
TO (feet)
DEPTH FROM LAND
SURFACE
FORMATION DESCRIPTION
Sketch exact
two permanent
location of well with distances,
landmarks.
to
at least
FEET to
,FEET
�O�
V
i
I
V
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
DATE OF
REPORT
WELL DRILLER (Signature)
r
yr
Water Supply:
Other Requirements
Public.Supply From
Private 'Supply to be drilled by
Address
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 o e u nam
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 system 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 the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed ccordance with the standards, rules and regulations of the 'Putnam'
County Depa tint of Health.
Date Sig d P.E. R.A:
Address r License No. 43 84°y
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless con ction of the building has been undertaken and is
revocable for .cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a nqw permit. Approved for disposal of domestic s"tayy sewage. and /or pryivate water supply only.
Date r L-4242 p By Title E'!
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
CONSTRUCTION: PERMIT
FOR
SEWAGE DISPOSAL SYSTEM d
Town or • -illage
_
a�Y,:
✓ a �Located�at
11 c Block '
-
—�,
�'2;
Section
�<%A�
Subdivision E4
L
f Lot Job
Owner ? aE gal �7��L/
-�� * 1�tJ� Address
Building Type ANG
Lot Area 21
Number of Bedrooms
Total Habitable Space „� -�
Square Feet
Separate Sewerage System to consist
of 9c`�oO Gal. Septic Tank 2-e%0 lineal feet X 3
width trench
To be constructed by
Address
Water Supply:
Other Requirements
Public.Supply From
Private 'Supply to be drilled by
Address
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 o e u nam
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 system 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 the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed ccordance with the standards, rules and regulations of the 'Putnam'
County Depa tint of Health.
Date Sig d P.E. R.A:
Address r License No. 43 84°y
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless con ction of the building has been undertaken and is
revocable for .cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a nqw permit. Approved for disposal of domestic s"tayy sewage. and /or pryivate water supply only.
Date r L-4242 p By Title E'!
DEP"-RT T OF 1EALTH
PUTAM N COUNT
-DIVISIOI%T OF E:-VTPONv' _771_ HEALTH SERVICES
Date..4z'C_s4?/
Re: Property of 5TF'qn 13 "Z/4'
Located at
Section Block 1?
Lot—. Z
Gentle-rien:
This 1 e t t e r i s to a u t1no r z zz�
a duly licensed 'professional en, knee._ o'-, recristered architect
(Indicat_-)
S +-
ysn-r- i-0
to apply 'Lolr a Cons ur,1c -,,,ioY_)_ sewelr'a.2��', •
serve. ','ae above noted -p-1--ope-rty 1-1-n- accoi_-'ance -.'Tith s-1,andards, rules
or r--sul--tions: as by of" t-Ine Putnam Cou-nuv
Department, of Heal-1,11, _!7-nd to sign all pappers o.-- b-'ehalf in
an to- sup s.- the ',c'o.stuc- sai-d
52.01 ion; of
conne
M _' j " L' � 1 -1 - I - ' 4-
system or systems in confor 'ty Trith sions of Ar*licle 11-15 or
147, Education Law, . the Public Health Law, az_.J. the Putna-m County Sani-
tary Code.
Counters-, med:
P.E., R.A., 7r
Seal)
Address
Very
ddFes s
Telephone
Very truly yours,
gn
S /X�
:p 1-- 7, y
J
1-11k 3366
Telephone
s
PUTNAM COUNTY DEPART TI NT OF HEALTH
-REACTT':.P ; rZCES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE
Owner Sz �-�, 81,463,02--5 �-,�� Address
Located at (Street ,��- D/, —' i.46� Z sec . Block Lot '
n - nearest c oss s reef
4<nr z i
Municipality Watershed �
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Dep to pia er Water ve
No. Time From Ground Surface in Inches Soil Rate
.Start -Stop Min. Start Stop Drop in Min. /in drop
_ Inches Inches Inches
. 1 //- *mss' /i r - /c? _' 7 l ./o
Ad
3
4
io
1
2
3
Notes: .l) Tests to be repeated at sc?me depth until app �roximate.1i equal soil
rates are obtained at each percolation test hole. A7_ data to e submitted
for review.
2 Depth measurements to be made from top of dole.
TEST ..PIT -DATA REQtTIR.ED. TO...BE :SUBM�TTED� WITH. AP..PLIC,ATIOP�?,
DESCRIPTIOl�T OF "SOILS ENCOUNT {RED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G. L.
611�,� SE„�
12"
1811
2411
3011
3611 Z;219
4211
4811
5411
6011
66"
7211
7811.
84 ,vo LV,
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
DESIGN
Soil_ Rate Used ii is Min/l "Drop: S.D. Usable Area Provided_
No. of Bedrooms -3 Septic Tank Capacity �o Gals. ,, Type /9ASOA/RY
Absorption Area Provided By 4ry L.F.x2 " � rw dtY�, trench.'
Name lgna ure
Address 3 G SEAL"
PE
��Iri1u►111►�
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
Vol �W
howl
INK-0.00",
I th -, �,- .
CAM AN mmm,
Elm 4 A�4
r' lit
;lot AN
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was
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SECT ,cars A -a
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sY`- .'r L'M Tr< 6E CON N ACj- )r,'rlhUr:E ulrin t i:L RULES AND
!` u RLGULATIUN$ Of IHE _RSZj tL 4r!1.__ _. C(iUFJL )c✓A,RTtAcNT
C)t HEALTH.
•
APPROVED 3r'I'LM SHALL N-Ii Bt bACt( F'L,T0 NI IL IN'I L�(th BY Dt.!C,r4
trdGINE:ER ANC THE L�' CAL 1F : fl. F?�
/ 9. GQ.c --'7 , .7"..'.^^ • t ' C :vi 'T J A R I% `
O are', 24 4_FT t.)t 3 FT
AUG201971 ttfir+ O I. ,. PER F-00"'.
�EPT�N .LAYOUT .�
car of S� f.� S�'"'.ST1;M
ti `� OdBtREEi6R: DIVISI OF
ENVIRONMENTAL HEALTH SERVICES J LE. i
M 1!�„ LDrPJ ItK.
i o � REVISIONS :UE.OILGL. A. H AUGFihIFY.Rt-
i -:.
, ASsocI a F-&•
P\,L OF NE- No Oeie 6x T
. - N46.`9 40 S ' / 0.86 E� 4• RH;�'• �� �� lj}- ! f 5ur�e�uts►orl MAP • SEC • A — 5aSwF LL ESTAYt.s
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T PuTNAM Vai (�� N`F 2 = ;_.l _ Dra wn 9Y �I` -z0it �!Anl ersol '
Tax 4AAF G z N�,U NE.ss )% L^_ �� s_id AS ��?.(F �. µ
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Fq
T ro g. r 1,• _ REM. EX. WINDOW �
• ; a ' ` . EXISTING BATHROOM
— EX
— NEa/t/EEOS - -- — - - - -- - -- F — r�-------- - - - - -- ca --
9043 D. _ 3043 D.H.
A N .�^ Af �. rr y i n `; j / + ✓1 •�E)
__, SHOWER �•� C
'�
DOUBLE RAFTERS 5 N '� .r
F2
Lj TRIMMERS SKYLIGHT -,� �3
2065 4o5a
io 3 ?712 x 1W VERSALAM RIDGE BEAM (3100) ` ` 2441. 1-
_ MASTER —BDRM — _._: - -- a 2- 13 /4'xs I i = 2oae
iv 0
1/2" LVL
i� CATHEDRAL CEILING iv
I a
=o
x + +— - - - - -- rr — -- — " - - - — — — — -
N a" ��� I — a REM. EX. WALS
P. 'O I' REM. EX. CLOS.
5' -0"
NEW CLOSET
„+ I I `• � SMOKE ..
DETECTOR (typ)
3 -7' x 10" HDR. J 10,_5„
--3043 D.M.. EX. EX.
BEDROOM BEDROOM
S.A., 14•_3„ i-9111-91L 4,_3„
EX. EX.
KITCHEN DINING
q
ROOM
—- ------ it ------------
1 3668 L 11168
11-1 EX.
+ LIVING
I
I
17-W
1— — - - - -- — — ---- - - - -- — J
22,_0„ — 24;_0
s
4l; EXISTING EXTERIOR WALL
PUTNAM CQQbiPi DVARTMIT BP
" +Ot_rE PLA ^t PROVED FOR
COt N ONLY;
FIRST FLOOR PLANJ 17 o
? SCALE: 1/4" = V— 0"
r" I
n
4
i
BEDROOM COUNT
# OF EXISTING BEDROOM
# OF PROPOSED BEDROC
Sri 6 ��G7