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HomeMy WebLinkAbout3401DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.08 -1 -46 BOX 27 J In ; 1 1 , . 03401 .,,. i,..•+ mrM +ea�r+....,..- .,...,.,..... ..,...ter,. m,•.5.r...:.�.z- yvv- .- •r'mroa - rr.,..;,.., ., ..n,...xrs>s' x" ,T 7-T Y eti /ri 7� Z9 ♦1: 1 PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO ,PROVIDE °PERritr..# I ON CERT FICAT OF CO PLIA C €�Ib Division of Environmental Health Services, Carmel, N. Y..10512 PERMIT CONSTRUCTION PERMIT FOR SEWA E DISPOSAL SYSTEM Town or Vilxe T Locatetl a . yt . _ _. �_ clock; Tax Map Subdivision �r��' G� /7 r3 Suhd. Lot it Z Renewal _❑ Revision _❑ owner /Address ! L�/r^�M 10" ��'' -3 ✓ Date Of Previous Approval i Building Type �s Lot Area /�' �� 9 C Fill Section only ❑ a ' P. it. H. D. Notification Required Number of Bedrooms � Design Flow G /P /D ' "'' 9 Separate Sewerage System to consist of �y•0, 19 Gal. Septic Tank and To be constructed by s Address Water Supply: Public Supply From r Private Supply to be drilled by Address Other Requirements I represent that I am wholly and completely responsible for the design and Ideal above described will be constructed as shown on the approved amendment t6 e' County Department of Health, and that on completion thereof a "Certificate; be submitted to the Department, and a written guarantee will be furnished' place in good operating condition any part of said sewage disposal system ante of the approval of the Certificate of Construction, . Compliance of the will be located as shown on the approved plan and that saidwell will be Installed County Department of Health. Date 49 Signed Address APPROVED FfOR CqNSTRUCTIO N: This"approval expir o Udered m revocable for use r may be amended or modified when .c es r requires n v per pproved for disposal of dome w 9 Date ( /° By Rev. 6/85 ..__ Ion of the 'pro osed system(s); 1) that the separate sewage disposal system to and i �a�a�h the standards, rules an regu a ions o e Putnam of fyc n p'�{s cell satisfactory to the Commissioner of Healthwill t ra�of rs or assigns by the builder, that said builder will d nng,N% $t• Fko) ears Immediately following thedate of the issu- ;g,sn �stem'or an pairs ereto; 2) that the drilled well described above disc 41t11. tf .'sta ds, rules and regu ads of the Putnam � [ P.E. R.A. L,� License No. i y '77 ; I of the building has been undertaken,.and is h. Any change or alteration of construAlon`;;' „.r tly.'��.�� Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property o Located at (T/jf Section �}�, Block Lot. Subdivision of Subdvo Lot # Filed Map # Date Gentlemen: This letter_ is to authorize O C a duly licensed professional engineer V 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 connection with this matter and to supervise the construction of said system or .systems in conformity with the provisions of Article 145 or ~` 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: X ", X Address c7,1� ol Te]lep one 0 Very truly yours, r S'i n e d Owner of Property -- spa- - Address J. Town ��. F - 3 l � Telephone Date Subdvo Lot # Filed Map # Date Gentlemen: This letter_ is to authorize O C a duly licensed professional engineer V 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 connection with this matter and to supervise the construction of said system or .systems in conformity with the provisions of Article 145 or ~` 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: X ", X Address c7,1� ol Te]lep one 0 Very truly yours, r S'i n e d Owner of Property -- spa- - Address J. Town ��. F - 3 l � Telephone PUIMM COUMi'Y . DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMERML HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTER FILE. NO. -- - - -_ - - Owner' e fie, i e: Le ,*rc Address -Located at ( Street) /�� ± G Pv' j, Sec. `� l:: Block Lot (indices nearest crossstre /et) Municipality '00V Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMr= WITH APPLICATIONS Date of Pre= Soaking � . Date of Percolation Test' HOLE N�fl�I$ER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In- Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches ll �r 0 4 5 4 1 2 VVbJ e',e_ -1: 3 ,? 4 NOTES: 1. Tests to be repeated at same depth until appro metely equal soil rates are cbtained:at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATZ UUM TO OF SOILS DEM. HOLE NO. HOLE NO. HOLE NO. G.L." Xez 2' 1 7 A lory -r-weplov fen 31 14' INDICATES -LEVEL AT. WHICH GROUNDWAiM 'IS EN00UNTERED . We;. INDTCAIE *VEL twm WATER LEVEL RISES AFTER BEING ENOOUNTERED. DEEP HOLE OBSERVATIONS MADE BY: DATE DESIGN Soil Rate Used Min/1" Drop: S.D. Usable, Area Provided No of , Bedro a ns Septic Tank Capacity j 67 -Cle' gals. 1)rW Absorption Area Provided BY 3� L.F. x 24" width trench Other Name 7 Sig V2 Address Soil Rate Approved sq.ft/ . gal. Checked by Date E "t-1 4,46 3 12/ 78 �-APPEKDIX B "SHORT MMIRONPUKTAL ASS E§= FORM JNSTRL St In.order to answer the n this 'short EAF is is assumed that the e questions 1. use . freparer wil, currently.aveilable iiiformation concerning * the•-project'and the 1k 1 01 e action" It s' not impacts of th i expected that: additional studiest research 0r.0tKer investigations will be undertaken.. (b) If - any question has been answered Yes the project maybe significant and a, completed Environmental Assessment Form is.necessarys, k (c.). If all questions have been answered No it is likely that this project is pot significant. (d)'" Environmental Assessment d .,I*. Will project result in a large physical change to the project•Site or physically alter more than. 10 acres of land? Yes No 2e Vill.there be a major change to.any unique or ✓ unusual land form found on the site?** Yes No 3• Will project alter or have a large effect on Yes No an existing body'of water? 4 0 .6 4'e Will project have a.potentially large impacb on No groundwater quality? 59 Will project significantly effect drainage flow 'Yes NO on adjacent sites? .6. Will project affect any *threatened or . endangered Z No plant or animal species? .9 .708 7e Will pro ect result in .a VAJOr.adveres effect on air quality? Yes No 8. Will project have a major effect on visual .char- • - alter of,-the-community. or scenic..views.-or vistas_ -to _t m k-tb ei­ iiip6itaA the community? known 0 9* Will projectadversely impact any site or struct- ure, of historic, pre-historid, or paleontological importance or any site designated.'as a critical environmental area by a local agency? e 0 Yes. NO 'Vi4 project have a .ma jor effect on existing or tpukirecreational opportunities? Yes• v**' No (11., Will Project result in major traffic.problems or cause.a major effect to existing transportation ".0 6 Yes No systems? Will project regularly cause objectionable odors, electrical distur noise, glare, vibration, or . the p ance -as -a result of roject's Yes No Will project have any impact on public health or -safety ?. Yes V/ No 14* -Will project iffect the existing 'community by', . directly causing a growth in permanent popula- tion of :more than 5 percent over a One-year period or have a major negative -effect on the 0. EEO,, character e community .-,r:h'eighb6rhOOd h of th No the Yes 15* 1 .:there'.public controversy'concernihg proji s P. T j F REPRESENTING: e 'b PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEfi M DISPOSAL SYSTEMS . REVIEW SHEET - CONSTRUCTION PERMIT _ DATE (Name of ) (Street Location) DOCUMENTS - Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If.--Pined-:Pit. & D Box, Shsizv & Detailed - „-;` House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4” /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Eft- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same 1 PUT'NAM COUNTY DEPART OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS rmff"LIVS C`If& 'REMRT DATE: �(0 le INSP. BY: (Name of Owner (Street Location INITIAL SITE INSPECTION YES NO L COMMENTS Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ...................... Must trees be removed - note these.......... ..... Deep holes representative of entire SDS area...... Additional deep holes needed..... .... ...... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D. H. 1 Lot Depth to G.W. Depth to rock ---- Soil Descri tion 0 ft. 3 ft. 6 ft. 9 f�. D. H. 2 Lot Depth to G.W. Depth to rock Soil Description 0 ft. 3 ft. O IG- 6 it 9 ft/. D. H. -Deep Hole G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock Soil Descri 0 ft. 3 ft. 6 ft. 9 ft'. DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded...... ..... .............. 10 ft. maintained fran property line and. 20 fti from house... ......................... Distance well to SSDS (ft.) ...................... Number of bedroans checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE .................. ti ONE] SITE LOCATION 0 IR PHONE (7 �i/ T!# PERSON INTERVIEWED —PCM-Eemplaint # Name & Relationship (i.e, owner tenant, etc.) DATE TYPE FACILITY Pwposw i%TALLER PH= 6 2k- S7 3 ' 24 - YV (e CP Pro (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal approved Proposal Disapproved Da _ roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. 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 ccmponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywetls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or,r rted a of owner agree to the above conditions. SIGNATURE TITLE TI TF& Mite (MV; YeUc w (T v n BI); Pink (Ani icant) DATE t r,• r f _ -- , " � - fir¢ _ w .w- ..+yA- � -m-c -. ..ara.� .p.� _a ' _,. .;.�- ...�..,- ,.a..._.,.._.w....., _,.. �.�...�.e_ ..gin -_•,�. y _.. //, �._ .... .._. - -. . —,;��• — <j _ , ... .: _. .. v- ...,.. __..._ ._ ._ 'jN � �� � y . �% - ,fir ;a Yv Yl is 4. ! �° 14 NA i �1 J Enr•.. a r= _ .. n•.:._.. ..•.F,�n . _ .� , , c_n,.ti•- s.an. r .. - .._...... ...,.,,,.,� -'��1? ��ir a aril S✓ ............. � : t Rev ',Located at Owner /applicant Name Mail .Addeeee `.r Separate Sewerige SyeI pate �� —� —T— Anv. oirson occuoVO4:0remises'si M _Addri3ea �_ ra � ✓v, of -lthe plena of the completed work ( copies filed. `plan and the .permit issued by the R.A... . a N Cliena o. ' v �o t6eu►e the cdrreotlon of any unwnitaiy noon as a pubs Unitary paler become 6 d,haeo Mai :iwallable Such -aoorovals are i Wkto�vn Medical Laboratory, Inc. ,AB - - -- 321 KearStreet Date Taken: It)- Time Yorktown Heights, N. Y..10598 _ __ Date Re I d - Time • x(914) 245- 2800".. Director: Albert H. Padovani M. T. (ASCP) Collected By : So NAG _ Referred By: T 1 Sample Location: l� U�� d ��7so•� �,� , is ��✓.�rn. V�L� Phone #f L IIOP�s�t' �/ Phone' # Sample Type / J Repeat Test? _ (check each) LABORATORY REPORT ON THE QUALITY OF WATER INORGANIC'--NO-N--METALS mg -.L Acidity. Alkalinity Chloride Detergents, MBAS Hardness, Total Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate Sulfide Sulfite METALS (mg /L) Copper Iron Lead `! Marigahe`s'e " _ Mercury Sodium Zinc MISCELLANEOUS pH (units) _ Color (units) Odor (TON) Turbidity (NTU) MICROBIOLOGICAL CFU /100mL GENERAL BACTERIA Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIrQUE Zotal Coliform Fe.c'al-Coliform: F.ecal.Streptoc.occus MOST PROBABLE NUMBER TECHNIQUE Total Coliform Index Fecal Col-ifdrm `Index _ - • :T KEY .FO .: TERMINOLOGY• CFU = Colony Forming Units CON = Confluent (q.v. TNTC) LT = < = Less Than GT _ > = Greater Than N/A = Not Applicable S/A = .See Attached TNTC= Too Numerous To Count REMARKS /COMMENTS (For Lab Use) _ /Potable N -on- potable STP INF STP EFF Other: Sample Status: (check each) Outgoing HNO3 HC1 _. H2SO4 _ NaOH ZnOAc Na2S203 Other: Incoming. = ✓LE 4 °C GT 4 °C __. pH LE 2 pH GE 9 pH GE 12 _ Other: ELAP No. 10323 ;THESE RESULTS INDICATE "THAT THE WATER SAMPLE (Was) (Wasn't) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING.TO T NEW. ORK STATE PUBLIC DRINKING WATER CODES, FOR THE'PARAMETERS TESTED, AT TH E OF SAMPLE COLLfCTION. THESE RESULTS J NDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A') MEET THE SATISFACTORY CHEMICAL QUALITY STANDARRS'OF THE NEW YORK PUBLIC DRIN NG WATER CODES, FOR THE PARAMETERS TESTED; AT: -THE TIME OF SAMPLE COLLECT Lx l L.� %i i�z� 1ell, Albert, H. Padovgni, M.V' (ASCP), Dinectcr 2 /86(Rvsd7 /.87)RWE j. PUTNAM COLUEY DEPARIMENr OF HEALTH DIVISION -OF ENVIRONMENTAL HEALTH SERVICES AV S 19 Owner. or Purchaser of Building Section Block Lot i` Building Constructed by Location - Street l uon/4 Municipality Building Type Subdivision Names Subdivision Lot # GUARANTM OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee to the owner, his successors, 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 approval of the "Certificate of Construction Compliance" for-the sewage _disposal system,; or any made- b m-tc-=such•-s stem eXCe t where --the =+fai uru -to- o er`att2 ro eYl caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services 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 negligent act of the occupant of he buil g utilizing the system. . Dated is day of 19 General Contractor ( ) - Signature �OIV /DV* -C, Corporation Name (if Corp.) Adair ,�6 ��iCc.�c y ss rev. 9/85 mk Signature Title 90s f4 A) 4 [f�AtCt- So 1�fi7tfi - . Co ration Name (if Corp.) (f9L F,X c__ Address r­1 T.TVT T fInAMT LMTTnTT DVnnDT ��ti ✓� YYJ;AJ.JL VVL "LL L1L 1. 1VLY L \LPL VL \L `1, .• DEPARTMENT OF HEALTH - Divisign Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only . ., . Y a..w.ura. WELL LOCATION STREET AOURESS: wwwl I Y TAX GRIO UMBER: PEEKSKILL HOLLOW ROAD' PUTNAM VALLEY, N. Y. 10579 WELL OWNER NAME: ADDRESS: m PSIVATE ❑ PUBLIC USE OF WELL 1- primary 2 - secondary 0 RESIDENTIAL O PUBLIC,SUPPLY O AIR /COND. /HEAT PUMP. ❑ ABANDONED ❑ BUSINESS .❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY 0 MOUNT OF USE YIELD SOUGHT 5 gal gpm. /NO. PEOPLE SERVED --- / EST. OF DAILY USAGE 500 gal REA90H FOR DRILLING 0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 240' ft. STATIC WATER LEVEL 2L— ft. DATE MEASURED 5/8/89 DRILLING EQUIPMENT q ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG . ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING, OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 147 ft. MATERIALS: 8 STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH..BELOW GRADE 1452_ ft. JOINTS: ❑ WELDED t7 THREADED ❑ OTHER DETAILS DIAMETER 6" in. SEAL: O CEMENT GROUT 0 8ENTONITE ®OTHER WEIGHT PER FOOT 5 Ib. /ft. DRIVE SHOE:ffl YES ❑ NO LINER: ❑ YES 10 NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (1t) DEPTH TO SCREEN (it) DEVELOPED? DETAILS FIRST o YES._,❑ ND _ » _ SECOND.- __ _.. ....... - - - _ .. a ».,. - , _ti : F .- r...._ HOURS ^` T GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER TOP OF PACK in. DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: O PUMPED t tests were done is in- l ® COMPRESSED AIR ,formation attached? O BAILED ❑OTHER i ❑YES ❑ NO �IFLL LQG 1t. more detailed formation descfiptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- I "9 Well Dla- meter FORMATION DESCRIPTION CODE, ft iL WELL DEPTH ft, DURATION hr. min. DRAWOOWN ft. YIELD gpm. Surface 137 v hard an overburden 137 24011 1 bedrock limestone Op. 7+ none 10 WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE LM.r x TRnr. #302 tank CAPACITY 220 gallons GAL. PUMP INFORMATION 1 phase 3 wire TYPE cAPaclrr __�. MAKER GRUNDFOS DEPTH A 220' MODEL 5S0513— VOLTAGE 2M HP .1 WELL DRILLER NAME DATE NORMAN ANDERSON INC r "d /b ADDRESS 152 BARGER STREET slGfnMRE PUTNAM VALLEY, N. Y. 10579 � , u� nw SIRS ICC4- IC)N' �S)Ce, —10 C4vi1� R �/ �✓ 21 p OR. Su`EDIVISICN LOT z � YF.9 NC] CCYkS • 1. SLS.0 -c� DISPOSAL ARF-lk _ b. Fill Date of Plac--nent ' 2:1 barrier . I=- W== AVG.DPTH c. Natural soill not st=n =De3 I • I I d. Stone, bra--a, etc-, create-* than 15' free SLS e. 100 ft_ from water course /wetlands_ I�-I- II_ S�� DISPOSP.L SYS T _ i a_ septic tank size -UAOO 1,250 b. c. d. e. f. a. gestic tank inst�= I I eval 10' mi n in= from four_: anon No 90° bergs, cLe_snoLt wit= 10 ft- of 450 bend DISTRIBLTICN BOX 1. Pal cutler at saw el evation - water test ea 2 Prot-t.� below f_cst 3. M.inittIl t 2 ft-- cr_c? r`l soi? b=— -We= -n box and t= *e lees JUNCTION BOX - vro�iv set MS 1. Izn h reru? rea - V I+C ^_�i_rl II15ial V r 2 Distance to wap = rsc 3. Instt.�l l ea a:' crdinq to plan 4. Dis tanC°_ csnt,---- to c- -it --r 5 Slorz of trench ac=t able 1/16 - 1/32 " /foot. ,N-7 6 10 f=-t fren prcce"v line - 20 feet - four�a'a crs 7. Depth of t=anch < 30 inches fran sar =ace 8. Roan a-1-1 a4ea for Er..arGion, 50 9. Size of c__vel 3/4 - li" i m= I 10- Deoth of crravel L'1 trench 12" minim= �•I I (�) h ( I L I I L! . • Pipe e---ds Ciip - h. 1-i_ ClR DOSE' SYS -S 1. Size of p= ch=bar -- 3. P1ann, vistr? /wad o -- 4 Pc= e=s'! v a= ^e_c=ible manhole t0 arc0.e 5. Firs' b=c haZflea 6. dole w. mes_1t by Emssa th Ds. Ent- estt_ZIISat� Z! cw �.-z Cdcl-e IV. Ec; ..:, P-- F -curse locatea ver &morGtied plans_ b. Nmhsr of be'?rcc s I I t I i I I I V. , .r a. Well lcC}t= as rg--r approval plans b. Distance f,cA SLS a=ete msms'ared I I C. C?s?nq 18" grove orzc =_ _,, C.. Surface dr-a nn.ce a=cL�r..d well acceo -tile. ocE�LL woRsLLI� a. Rmes propp-nlV crcut= b. Ail pices ra*=`aLy b- 26Ciled ( i � c. Pid flu-=h with inside of bc� I SZI d. iackfill material c^nt_ins stones < 4" in diameter I I e. f. 0 -`t ain drain install--d `ac- ordinc; to plan I I I Curtain dam= ri cut=a11 wrote Led & di r. to eYist.wate- -=Ursd g. Footing drains discrtrne awa fran SDS area h. Surface water orot., c—ticn adeo- ate � i. E csi.on c--n=o r)r.zv--,c.ed cn sloLes Qreat_-_r than 15 %- I I_ .; a �S i � 3- � E `, v J,,,l -.� `^ r "t�-F„ * c,,T 5�. ti r�,.`G s 'ta" c 3 t '�' l ,�, � <? a a �' • �. g"``" '; i • - �, 1'I 'b • "` � ; , x ,� PVTtvAM cour>� DEPARTnn,�rrrroFHEAr;Ta e Dlvlsfon of Envlionmental Health ServlceB Carmel, N Y 10511 rs ` Englneee to Provide Pecmit;N o �' yy1f� } r on CERTIFICATE OFTcOMPL1AN� ` q A� a CONSTR CTIONPE FOR SEWAGE DISPOSAL SYSTEM rz F s .,-. YaRZi�ON at Y�Z/ '�Y� .� �4Pf 3>',� yti. rt n ^-.+ ✓ {••. ,+- „>�TOMII,«rOL.- �,11^^ a � xi r •' .. � .. -' SQbdivl ®ion Plsme f � dii? / / Renewal ❑ t Revlelon Ow"F,v pUt�nt Flame /iL. f 1� r Dote o ,jkL ioa ®-,Apfprova�l/ Mol11uS Addr®ss S D�� a��'o✓9j� Towns =/��/7 (/�;.�j �� ` Bvlldhtg rType ,Lot Area v FW :Secdon OWy Depth'Volbme Rlambee of Bedrooms Design Flow G P D PCHD PloHticatloq ig Reataired When FW le �tnpieted Se crate Sewe e;S stem to,ironsist of Gallon Sepdc Tack and To be constiaMed by. ° Addres® Watee Sttpply Pabllc Sttppiy Flom Address oat Private Sopply Dewed by Addree® 1 re0resent that I am wholly ands completely responsible forthe design and IOCaUon of the propose i.Q'F) ipjhe separate .sewage disposal system 6DOVe descnbeG wilLbe constructed as shown on the approved amendment there'ato and m accords �t .a6este ®` {du an regu a ions o a ..0 nam County a Oepartment of Health and that on c mpletYon thereof a i Cert�fuate. of COnstruetio 0 8A�4 �ia4ior tho Commiss�oner.ot Hedlthwlll bo submdted Mto the 'Department $and -a written .guarantee will be furnished the owner hH ice heirs or astiell y: a Du�lrler` that said builder will place ,n goodtoperatjng conddion Rany;`;part of ia�d sewage d�sDOsal systemxtluring the pe fF o'(2 "t; im e$fatel following thod'a of the issu- onCe�Ofz the, .8pprovat of the Cert �f mate,of ConstrucUon_COmphance of the;OngmalY yste or, re - -• s - Ito �a%it ''drilled Well, describetl',ebove arils :be located as shmyn On the approved plan andAhat ssid, well will De Insta11' i Ordane w`;i he-� rules u -a i�'ohs . i<-:t o, he : `Putnam COUnty De `tmont o[ Health'.`— Date' ���7 Signed l i PE RAr ? Address /y� ense No APPROVED FOR CONSTRUCTION Thad approval expuas two y rs h the, date issued unle c tl*jj ®6 '3h ding has'.been undertaken and is revocable for.'Uu' a or,rniy ie �a'mendeo of motldied wnen cons' Bred, - ec ssary" by the ;_Commission - j h nge or'alteration- of-construction requires a w permit. A proved fordisp sal of domestic sand wage -an /or to er s 8E3 °floc Rev:: ' Title -1/87- Date .. p.. ...87 -�' .a. -.-,o .. ..... r,- ..�.w:... �.- t . -� -o _..7 �,,.,�..,. d .'•.. «.. f w ;.� r. _..ia- �p0.._e.,. -. s,.— +P- ,.:..w...a..r.. .d.-. �..- v. «..-.e In DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N:Y. 10512 (114) 225 -3641 AEPLIrAT.ZON. _T,0 CONSTl2LTCT.._A WA'PER WELL - _ ... r - PCHD PERMIT`# vi WELL LOCATION Street Address T wn /Vill e City Tax Grid Number WELL OWNER ,.Name f Address. i N rivate O Public �. ,�!/J!•' /'d t �'� USE OF WELL W6SIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CO D /HEAT PUMP 0 ABANDONED 1 - primary O BUSINESS 0 FARM ❑ TEST /OBSERVATION ❑ OTHER (specify 2- secondary 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE Y ELD SOUGHT. S"' gpm /# PFOPLE SERVED 4 /EST. OF DAILY USAGE dot) gal REASON FOR NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION DRILLING OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DUG ❑ GRAVEL O 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES Y NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 1jewl A ---> Address: % /Yi!✓,3 ' IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 91' NO NAME'OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY rDISTANCE�TO;._ ROPER Y FROM --- NEAREST -WATER -MAIN LOCATION SKETCH & SOURCES.OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ®06N SEPARATE SHEET (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the.well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 8- 3 19 Date of Expiration: - / _19 Permit Issuing Official Permit is Non - Transferrable 8/86 DIVISIU4 OF EM11UZil-NrAL 1it1t All SUNICES DESIGN [BATA StiEET- SUPSUEACE SEWAGE DISPOSAL SYSTR4 FILE 'ND. � , „ § e, ?70 ._.. ._'�ler. ':>" � "'w. -- .;ieSS.- �f ti'� / /�ts': ✓+? c;/4".!r !.•I Lxatc'. A at (Street ! Seco Block (indicate nearest cross street) } Watershed Son TEST DATA RT-"'YJIM TO BE SUMMED WI'.[ii APPLICA7.`IONS W+I. Y Date of °x >_� rr�g _ Date of Per a est MUSF ' C S _a�X TIl E PERCOLATION OL.ATION PE RC'b Run El i;; Deptl to Water. From Water Level No. Ti'M ' Groand Surface In Inches Soi.l�' Star :- Stop Man ;' Sta i Stop Drop In N11nf Ii^ ,z _ fiches , Inches Inches S / ---- -- 0 43 5 ✓f 4 t � � + R � •Y�� 1 t r � s H 5 E 6y' r t w Tests to 1,P.. F eFeated at �Ck z'�YJt:r iiCBt i � a�?prC34�ikitP��i E! "�Lkix .Soli ,fit f� art: obuti.nal at E�>ch percolation test hole. All data to be ,ept n" f lc... -top of Ixal.e, R- TEST PIT DATA REQUIRED TO BE .SUBMITTED WITH APPLICATION a DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES j DEPTH HOLE NO.. ! HOLE)T NO. HOLE NO. 3' 4' 5' 6' 71 8' g' 10' 11' � 12' 13' 14' INDICATE JaUEL AT. WHICH GROUNDWAR.:IS : FNCOUNTERHD,.:- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTE/R %BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: " et // / r DATE: DESIGN Soil Rate Used All. Min /1" Drop: S.D. Usable Area Provided g:sl6ac? No. of Bedrooms Septic Tank Capacity /-> 4 gals. TypEeG </-_17jo'y Absorption'Area Provided By 9*0. L.F. x 24" width trench `! Other Name C Signature 'L ••NE �E� W Address i// ° SEAL 9 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Mr. Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr.. Sullivan: August 31, 1987 Re: Proposed SSDS JOHN SIMMONS,_ M.D. Deputy Commissioner JOHN KARELL. Jr., P.E. Director Sonaro Peekskill Hollow Road (T) Putnam Valley TM #62- 9 -P /08 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. House plans submitted include a utility /storage, room.. with h-obb �,r'obifi �&nd- 1zoft-- rbom: _: _- s y Any of which can be easily converted in' the future to a bed- room, it is the recommendation of this Department the SSDS design be based on 5 bedrooms. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very_ - ,truly yours, Robert Morris Environmental Health Technician RM /jp PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION-OF ENVIRONMENTAL ..HEALTH.SERVICES Date Property of Located at e ev,6 Xz: (T) Subdivision of 41.1 ac/1- / A/ .Section 12- Block Lot z e Subdv..., Lot # Filed Map # Date Gentlemen: letter is to a This l' uthorize____ V'Setzv- 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 connection with t4*-s. !Rq�:tpr and to.:.'.Su, ex vise.. the system or systems in conformity.with the provisions of Article 145 or 147, Education Law, the Public Health Law,, and the Putnam County Sani- tary Code. Very truly yo s, Signed aw Coun ersigne A Mner of Property ee.eo se S P.E., R a Address Pr ?A; Ce K S ess Town 1/4 73 74V 0 Telephone Telephorie VAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF E NVIRONMEN I�A I , H h:A l xn ozmv v v au � �n ►: rt�iY�;�•yi�a�A��'�•'i� : ���t :��+:�+�aia "n.�h��ar.7��:a�ll REVIEW SHEET - C /ON�ST�RUCTION P T - REV DATE IEWED: (Name of Owner) CONQ�iENTS YES NO ( DOCUMENT'S Permit Application Caraorate Resolution - Plans - Three sets s/s Engineers Authorization - Design Data Sheet (DCS) (� SUBDIVISION Deep Hole Log j Perc - Consistent Perc Results (3) Fill - Perc Hole Depth ca House Plans - Two sets Well permit; PWS letter Varian e Request GENERAL ' Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) t Data On DDS Plans & Permit Saner ' REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut �,crtrg; :stter;art?.s -. -L:i rid; (d1s�i�dzge OK) _ ; Perc & Deep Holes Located Representative of primary and expansion 1 Expansion Area;shown;gravity flow,suff. size �. If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil: 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercours► 10' to Water Line (pits -20'.) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 10 DIVISION OF EMIIUk*NI'AL IUTALV SF.IWICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE ND. Omer. - Address 'l' c. ... r. _ - .�....... _ it .V J- 7.l -FY A /.. •.f. ar'...wr.- _ —.'.R - - -. _.w. - .• Located. at (Street) Sec. Block Loth (indicate nearest cross street) —' Municipality Watershed Date of Pre- Soaking f.��Date of Percola ion g' Test 1� HOLE - NU4BER CLOCK TIME . PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 4 5 /t,//j c� f 4 5 er lAr . 4 5 NOTES: 1. .Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 - TEST PIT DA`T'A RMUIRM `i'O LIE SUI M1'1'1'M W1111 APPLICATION DESCRIPTION OF SOILS ENCOUNITM IN TEST HODS DEPTH HOLE NO. HOLE NO. HOLE ND. 1 1' 2.' 4' 5' 6' 7' 8' 9' 10' I1' 12' 13' 14' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENODUNTERED _ DEEP HOLE OBSERVATIONS MADE BY s , t�/ DATE: ®4 J dr _ DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedroams _ Septic Tank Capacity A& gals. Type Aoz5,0,0 r Absorption Area Provided By L.F. x 24" width trench Other Soil Rate Approved _._.:._ k:..� BRUCE R. FOLEY __ ... .. , - , -: . -; ;�'ublic��Heahh•= �ecPor= :rr�., DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 _ Tel. (914) 278-61,30 Fax (914) 278-7921, PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY 6r_ r_�C(06(1140110t"INOWN PVVV-114TXMAP# STREET 4f NAME i)- PHONE PCHD # MAILING ADDRESS DESCRIPTION OF ADDITION s . 'g NUMBER OF EXISTING BEDROOMS 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. and 'the`fcllcving�toutn i-n•-ounty i�i~alth Dirpt.�eneva'Rti:, Brewster,, NY; 10509, Phone 278 -6130. 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 Feb 98 { + Q BRUCE R. FOLEY _�blic - Health DEPARTMENT OF HEALTH Division of Environmental Health .Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 19, 1998 Mr. S onara 486 Peekskill Hollow Road Putnam Valley NY 10579 Re: Addition - Sonara, Peekskill Hollow Road Increase in Number of Bedrooms (T) Putnam Valley, TM# 62.9 -8.2 Dear Mr. Sonara: 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 latest revision date of November 19, 1998 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this . Department. lie urea of the- existrnb sewage dispm — system ;-arid its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restructures 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. VerytNly yours, R. Foley Health Director BRF:tn cc: BI (T) �4 . �,�ky :;+�'�� _., y.. Sr".�.,.�.3T . � �.� j 4 r _fir•.:: �+}7+r t. °!'I5 f •` ` t. �,`�.'i: -� i ;'!4 :jai 'I. + .i:. <.^ti:.a.e. �T,'N, c J -'t .�;v'41' � z1t.YrPh' Ap �� .• .! _.. _......_ ...:- - ...... _ •♦ '.. � � . _ r ... r e CLiiTIFICA'PE OF(CCAIJC'' `" °0ci� Tariil y W /Dck ;Garage Certificate of Occupancy No.......................... `Application No 88 160 4 r t' i'eekskill Hollow Road - TFi;62 -9 8 F.� Location of Premises ..... ... •.t ` .............................. Husein &': Pa it$IEE S'o'n: ara of .11 Qld QreAon Rd. Peeksl.I1�: ...................... ........p.... ... • ,:� .........:::. having << heretofore filed ari app lication for a building` permit pursuant, to the Zoning Ordinance; Sanitary Code .in& the Laws & effect in the Town' of Putnam Valley," Putnam County, New; York, having paid., the requ>xed; fee., therefor. and the 'undersigned ,Having. by personal..., inspection: ascertained. that the, a plicant has, Subsequently proceeded`with; the. erection or, improvement of the' propo ed struc pp ture , in,;, compliance:; with. the: requirements; of. the; laws as :', aforementioned and that, the said ,work' and materials met . every,. requirement, of the laws . as aforementioned ` and _that the premises" have now • tieen, fully com leted and are read for occu ancy 'pursuant to :the provisions of _ law, Now, pp y p therefore, this certificate . of occupancy is. hereby: issued under': the seal of .the Town of Putnam Valley (this 16 ' day; of J a n u a r4r .. , 199 0 Not valid unless signed in ink by a duly authorized agent TOWN' >(fTNAM V , N YORK of and under :the seal of the Town of Putnam:. Valley,.. i, �i By °); ^'.Y I/ ....�•..._..T..w+1,•+ ..w.a .. - .�.a.r._ �. �.....+ N. _..Ip J9+w— y ._ ... .s r �...p.�.... T•.w��^.•+v.. r. � ? I i 11 PUTNAM COUNTY'DEPARTME.NT OF, HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES' INITIAL INDIVUDAL ADDITION /REPAIR FORM I. '. .. . . . r. _.. . .. b.:_ s1 SECTION A: GENERAL INFORMATION Name of Project Year of Construction Size'of Parcel 4-.C- " P S SECTION B. TOPOGRAPHY (Please check'all appropriate boxes) t 1. Hilly ORolling. ateep Slope Mentle Slope ®Flat 2. ®Evidence of wetland Clow area subject to flooding ®Bodies of water UDrainaae ditches ORock outcrop YES 1-N-0 3. Property lines evident? �, .. 4. Water courses exist o n adjacent to parcel: , or J P 5. Existing individual wells within 200ft of the existing SSTS? O. SECTION C. EXISTING SUBSURFACE SE`VAGE TREATMENT'SYSTEIVI(SSTS) 1. Physical character of existing SSTS area. A. OLevel Mentle'Slope LJSteep slope B. OWell drained 0/moderately well drained OSomewhat poorly drained OPoorly drained C. Area available for SSTS. (Primary & Reserve) ®Extremely limited ❑Somewhat limited IMequate ft x ft 4, •. Ir. D. INSPECTION Date I Y I Inspector .9 No evidence of failure Evidence ;of failure' .(LJEvidence* of seasonal failure - -- ---- - - -- ----------- - - - -- (Indicate - - - - - - - - - - North) - J I ) Y (� . HOUSE bu <_ "Ibo ?A, 0 --------------------- ------ 0 ----------------------------- (1) Indicate location of SSTS A. Size and type of septic tank 0 0 gallons Metal 0/concrete ®Plastic B. Type of absorption area -, " 1. Fields' - ft. T. Pits 3. Gallies ft. (2) In"di666 setbacks, front street, ackyard, and side yard dimensions (3 )) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams/wetlands) SECTION E. EXISTING WATER SUPPLY DP W S ®Shared well 3 dividual well DDrilled DDug 'above ground COMMENTS 'd s REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted:. As Built Inspection Done: (nr1drP.n) Inspector: y ! , ✓ \ F n ) T y i } Ytr�> !' �} a: ': D%pi iii►'';' Yi' 9� ! d = w y Iyh TOO }1 Elwood !+ 5 l # ,r i ZY 4 4 S t�VO YYx �'{,.:)�{ '�7Ati E.•.i,.'.i �...'c3 ir. ,,. .t l Si n. u . u ✓ . ; i f � .... ., ',... •!'. ..f :.... ,..,.wo.., .... ..a.. � .� .. '": t .... 1: , v � Y J t i e v NASDAQ YYx �'{,.:)�{ '�7Ati E.•.i,.'.i �...'c3 ir. ,,. .t l Si n. u . u ✓ . ; i f � .... ., ',... •!'. ..f :.... ,..,.wo.., .... ..a.. � .� .. '": t .... tat . ;1 Putnam County Department of Healtn Avis i o Y E nme4tpl ealth Serdioee a .; ipproved as noted YoT conformance with ' the } applicable Rules..and Regulations of g- ?utnam County Health Department.. 'tanature d, Tit e Dq *ar.. i t r ii /� 1 � ✓ S'�d.:.JC � �fvh s 4 y 3 h P CU r�-f coo C1.4 i e di 'eposal Byetem tl that the sewa8 byhie is to:,certify YBn•,and that_ the eyet B8 indlcated•'On ti an, ao�ered. over L 1 aii'Y7� ts'd /Y?C�ry�►. 01� / f Gted eoriss ma. before it;wus• nSpected.by Id f �- - F t'was contitructed i n accamnCounty Dcgar went of the Fu, , r ' lations t o° spade &nd regu . Depart^ T 4 ' .State and 'the Flea Yor_., F Ep';YO Iv. t � 0 wtv-z' Al' h �i a E.Tai , - ., d.r _r tat . 9 �1. . 1 { f, 1 1 3 5 a� 4 S 141' Y e. /✓� S7R � £6-�Ld 0/1'1 i. �a ✓ f C_�+r � are s..i r �O'17 ivl . .� SL ' PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; J _ s�6EDROOMS o Sig t.m &Tito ate V 1L - - - --- -- - - -- H 5' { {w n� a-: a w � s 3 l6 Q 3 J3 3 � �J s 3� 1� � .. -- d - -0 -- 10 - 0• \ II � `• I I 'x I I I NOTE: BLDR. TO ADD LALLI COL?,.` J I I & SPREAD FOOTIPlG 0 'THIS -.LOCA'TI01J F - Ili jA II cc — I I Ln i aId A EXISTINO GRADE LEVEL mh L m 1 .l - �+ NEW DECK (CONTEMPORARY a 'o 0 I i c fn, o K Z NEW DECK a (CONTEMP.. RAIL) . p I NE IA I I D II I RE AO E ANDW; --7 REMOVE DOOR 2 -6L NEVI j - -...— 2965 I HUTCH I w i �\ (NUP 3 N RA L): o DINING ., DN_ LINE OF LEVEL OVER CC o II I;. II g II ®RKFST. -- i REA4DVFl I 0 0 11 o io.I,I <n .... - �I v 3 II in. W i KITCHEN C °I DESK I (BY OTHERS) j -- - -L� - -- J T.B.D. LIhJE OF FLAT CLG:., I ' III � PA aTRY ' l (NEW) ' XI TIP G T I4S EXISTING DECK I NEW DECK UP f (SAVE) � (CONTEMPORARY. RAIL) I j � I , i + 6' -0' 20'-0" I. LOWER LEVEL PLAN