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631- 589 -8100
73.20 -1 -6
BOX 28
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�; '� l PUTNAM COUNTY DEPARTMENT OF HEALTH &Rm r �1l'- g�
Imo, U
y Division of Environmental Health Services, Carmel, N. Y. 10512
i; bONSTRUCTION PERMIT 'FOR SEWAGE DISPOSAL SYSTEM
Tow "Y
-
or Village
Subdivisi n '
Owner 11X1A V13
Building Type
Number of Bedrooms .
Separate Sewerage Sy:
To be constructed by
Water Supply: Public St-1. P—
Private. S
Address
i" Lot Area t°LIl ',I
A
Design Flow - 0 M1 v,.
congst of � � Gal. Septic Tank
Other Requirements
Lot • Job
Address '
Total Habitable Space Square Feet
and
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 i mediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any re irs they a; 2) that the drilled well described above
will be located as sh n on t e approved plan and that said well will be installed i a r an with t s�,r regulaiTons of the Putnam
County Department f Hjeal .
Da te P.E. V R.A.
Address N License No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unle nstruction of the building has been undertaken and is
revocable for cause or may be amended or modified when consi necessary by th Com stoner of Health. Any change or alteration of construction
requires a new per Appprroyved for disposal of domesti sanitar wage, r pri ��onl
Date'— ~ V By Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
C;: —F- MEN7� I ��ALTA SERVICES
Date
Re: Property of Ili A A
Located at
Section Block Lot�
Gentlemen:
This letter is to authorize
a duly licensed professional engineer or register architect
(Indicate)
to apply fo.r a Construction Permit fora separate sewerage systbm; to
serve the above noted property in accordance with the standards, rules
or regulations as promulgated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matt_ er and
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 yours,
gne d
Owner of Property
tow
fe-lephone
Address
Telephone
PUTNAM COUNTY.DEPARTMENT OF HEALTH
DIVISION QF.ENVIRONMENTAL HEALTH SERVICES
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COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE
SEWAGE DISPOSAL SYSTEM
FILE NO.
Owner
Address Qu f1�
Located at (Stree
016d
6A UL Sec-. (0 Block Lot
ica a
nearest cross s ree
Municipalit WAAAk
Watershed
SOIL PERCOLATION
TES
DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Number CLOCK TIME
PERCOLATION
PERCOLATION
apse
p -o Water
Water EFvef
No. Time
From Ground Surface
in Inches
Soil Rate.
Start -Stop Min'.
Start Stop
Drop in
Min'. /in drop
Inches Inches
Inches
3N.I4 -- of i2 ._
H
211 �.t" y�.: C3 `8 _ ..p- l8 � .. - _ -_ �l9 � �'` `�� .. _ • ___ . _ � - ..
Notes: 1) Te'gts to be repeated at same depth until a roximately equal soil
rates are obtained at each percolation test hole. All data to bye submitted
for review.
2) Depth measurements to be made from top of hole.
1iJwJ1 A! 1•Y 1JJ1J L1.:�� �� .� _. _ � .. - 4 ��r�4�/. �1,✓ _ ��� � t:....: _� ..
DESIGN ...
Drop: S. D. Usable Are
Soil Rate Used Min/1 " a Provided yo C7
No. of Bedrooms Septic Tank Capacity 97i� Gals. Type
Absorption Area..P ov ded_ By._L.F.x24. ".. th tr
Ot
W. —Sighaturm�
Address fox. -:w SEAL
THIS
SPACE FOR USE
BY HEALTH DEPARTMENT
ONLY:
Soil
Rate Approved
Sq. Ft /Gal.
Checked by Late
SITE LOCATION `
OWNER'S NAME
MAILING ADDRESS
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPUSA�T1VTrR�:YAIR�
PERSON INTERVIEWED
DATE
PROPOSED INSTALLER
ADDRESS
OFFICIAL USE ONLY
.(0 ,3 -0/
TM# :7120 / -
PHONE
PCHD Complaint #.
REGISTRATION#
Proposal (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.
nc- conditoi,s�st�
SIGNATURE TITLE C04) ftl'� DATE 17 b
Proposal 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 components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
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25'R.O.W. ACCESS EASEMENT
Reserved To Lot I For Ingress y .22 2
and Egress, OrnedInFee
By Lot 2.
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IET-. -LANE
PARCEL SHOWN HEREON KNOWN AS PORTION OF LOT No. I M
ON SUBDIVISION MAP ENTITLED Louis MailuzYO Jr. Subdivision ,
FILED IN COUNTY CLERK'S OFFICE ON Oct. 31,1977
AS MAP No. 1 622.
SUBJECT TO ELECTRIC AND /OR TELEPHONE CO.
�U
CERTIF ICATiONS INDICATi.10 HEREON SIGNIFY THIS SURVEY
WAS PRCPARED IN ACCORDANCE WITH THE EXIS T INf; CODE
OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW
YORK srArE ASSOCIATION OF PROFESSIONAL LANG
SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY TO
TIiC, PCRSOPv F OR WFIOM THE SURVEY !S PREPAREn. AND
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4 MA- COLIC. F IU.EO
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Co 4,
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IET-. -LANE
PARCEL SHOWN HEREON KNOWN AS PORTION OF LOT No. I M
ON SUBDIVISION MAP ENTITLED Louis MailuzYO Jr. Subdivision ,
FILED IN COUNTY CLERK'S OFFICE ON Oct. 31,1977
AS MAP No. 1 622.
SUBJECT TO ELECTRIC AND /OR TELEPHONE CO.
�U
CERTIF ICATiONS INDICATi.10 HEREON SIGNIFY THIS SURVEY
WAS PRCPARED IN ACCORDANCE WITH THE EXIS T INf; CODE
OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW
YORK srArE ASSOCIATION OF PROFESSIONAL LANG
SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY TO
TIiC, PCRSOPv F OR WFIOM THE SURVEY !S PREPAREn. AND
iIK "llC it F LEY • ". .. ;; .:
Public Health Director
.rae :�A rcl�.gT w:la�c� V. A '.D. . .n . � - � . ��.5 •.> .� ...
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
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/Preschool (845)278-6014 Fax (845) 278 - 6648
October 28, 2002
Patricia Carey
53 Somerset Lane
Putnam Valley, NY 10579
Re: Addition - Carey, 53 Somerset Ln
No Increases in Number of Bedrooms
(T)Putnam Valley, TM#73.20 -1 -6
Dear Ms. Carey:
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 October 28, 2002 . The addition is approved with the
following conditions:
. �.
.-.. .. �- _..._.� .. - ►. ....T..'..he t(ttii nl_7l"bei' b b:. . = ',u\ �ry.v _ . a ii 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 your
William Hedges
WH:lm Senior Public Health Sanitarian
cc: BI
Q d vn ~`
Public Health Director
01' ik MUUivAlt! iCK, M.S.N.
Associate Public Health Director
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
ADDITION APPLICATION ,(RESIDENTIAL ONLY
STREET 5S J? &Maf�¢ bnC TOWN am � X MAP# 73- �`� - L
NAB PMA-71 PHONE PCHD# A, �
MAILING ADDRESS
0
Conte Dl.ac b(o q�4 .4-0-dd -Itz � . A%r>?-Z
DESCRIPTION OF ADDITION Ihode_ .2 b.e&m is �y -S.Q.d pmd ?I= a eu l) ✓rvt ra-po �-
� btu
\TUNMER 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. _
Please 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
BRUCE R. FOLEY
Public Health Dire-F
DEPARTMENT OF HEALTH
I Geneva Road
Brewster, New York 10509
LORETTA. MQL,INARI R-N., M SN-
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 —6558 WIC (845) 278 - 6678 Fax (945) 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: ,
9/16/02
Re: 53 Somerset Lane
Residence
Tax Map 73.20-1-6
Town of Putnam Valley
According to records maintained by the Town, the above noted dwellinc,
IS xx
NO
F:
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE I OF OCCUPANCY: xxx
I
ASSESSORS RECORD: xxx
OTHER
in
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Oct 16 02 02:32p BUILDING DEPT 9145268806 p.2
TOWN TAX MAP DATA TITLE No. RGP 706464
se'Chon 69, Block 3, part Of Lot 4.
ON-
.7. 4
KO
CO
well 10
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Tip
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n 11\0
25.1
.,R.O.W. ACCESS EASEMENT i
Reserved To Lot I For Ingress y
aind Egress, owned In Fee 22.2
By Lot 2.
!'� 0 W
tip
74-35'
V,
1� Goya
-5100
0
IS _00
Portion of Lot I
1.000 Ac.
(43, 560 S.F.)
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69.1
of St. FR.
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Oct 18 02 02:'32p BUILDING DEPT 9145268806 P.1
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Tor Fax: -2 9 - 4 2,
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Re: Pages:
CC:
U rgent For Review P lease Comment P lease Reply P lease Recycle
• • • . . • • • • . • • • • •
kinME'- 01 JTk1nM rni WTV r)M 'MCKIT nrr 0
0
i SANE
?s..;': -. t. c• o7^• �`:± �. r^.. �+ r�7T.rm.saz�:a��.aarr5- `°��Ci'. �' -. - -�.r`t:
PARCEL SHOWN HEREON KNOWN AS PORTION OF LOT No. I
ON SUBDIVISION MAP ENTITLED Louis Mal luzzo Jr. Subd i0sion ,
' -ILED IN COUNTY CLERK'S OFFICE ON Oct. 51,1977
QS MAP No.1622.
SUBJECT TO ELECTRIC ANOIOR TELEPHONE CO.
:ASEMENTS• IF ANY, FOR OVERHEAD AND /OR
.)NDERGROUND SERVICE.
;URVEYED AS IN POSSESSION, (No Lines of Possession
,ther Than Indicated).
UBSTRUCTURES AND/OR IHEIR ENCROACHMENTS
;ELOW GRADE. IF ANY, NOT SHOWN.
!OUSE OFFSETS 'AKIN TO WOOD OR BLOCK SIDING.
70PE9TY CORNERS STAKED.
HIS SURVEY IS HEREBY CERTIFIED ONLY TO:
i. John Eduard and Gertrude C. Oethen
2. Security Title and Guaranty Co. For Policy No.RGP 706464
3. Intercounty Mortgagee Corp.
J. HENRY CARPENTER & CO.
CIVIL ENGINEERING & LAND SURVEYING
YORKTOWN HEIGHTS, N. Y.
J. Merry Carpenter & Co. Do Hereby Certify That on MU-9 119-R
Survey of The Premises Shown Hereon Was Made and That This Map
Made rryAOWcardante With The rDeid Notelet said Survey.I
SEABOLDT, P.L.S. -NO.
C£RTirlI ATiON; IND;CAT -3 HEREON SIGNIIY THIS SL,RVEY
-"S r'RLPARED It, ACCORDANCE 1IIi7H THE EX:STING, CODE
OF P4ACTICL FOR LAND SLIR✓E1S ADOPTED SY THF..NE ✓Y
YORK STATE ASSCCIATiON Or PROr-_Sr1I0NAL LANE,
SURVEYORS. '.;AID Cr".RTI! NATIONS SMALL RUN (;NLY I C.
?HE PLRSON FOR WHOM THE SURVEY :S PREPARED AND
ON H!S SF HAL" TO THE 'ITLF COMPANY. GOVERNMENTAL
AGENCY AND LENDING, INS, ITLi110N LISTED HEREON, AND TO
THE ASSIGNEES or THE LENDINi, INSTITUTION CUR? 1! ICATtG1`4;
ARE N01 1RANSFE^APLE 70 ADD)TiJNAL INSTITLITIONS OR
SUBSEQUENT OWNERS.
SURVEY OF PROPERTY
F'RE.P ARf G FOR
John Edward and Gertrude C. Oetken
LOCATED IN
TOWN OF PUTNAM VALLEY
P UTN A M COUNTY, N.Y.
All Ce r:ificat ions Hereon are Valid for Th,s -Map and Copes rr.ereof
Only if Said Map or Copies Bear The impressed Seal of The Surveyor
Whose Signature Appears Hereon.
Alteration of This Map Other Than by + Liconsad Land Sr.rveyor is dlegel.
. SCALE: 1"= 50t DATE: SEPT. 10,1982
SURVEY No.: 16360 ,FILE: 12958
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