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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.10 -1 -37 BOX 28 03612 Ilia ,� in ., ■ ,• _7 , .4 6 • r -, lip ti = lar e a lm All i:ia L 03612 .P PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE F li ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # �Z 11 �� Located at 248 S>A' 'Cr 15;-1 • Town or Village P,447hftV411 Owner /Applicant Name b l !p.aaIU-0 Tax Map ko Block _ Lot _ Formerly Mailing Address. Date Construction Permit Issued by PCHD Subdivision Name ��Pf'�°8� 19- 17 -ATeS, Subd. Lot # Zip O Separate Sewerage System built by Address I?D Consisting of 2,50 Gallon Septic Tank and 600 W d PF— i2g XG eg Other Requirements: Water Suuoly: ,::,WA r, / / Public Supply From. Address or: Private Supply Drilled by avxT, Address - BuPIding Type-.._. ..��'''1�A ,_ �. IIas erosion control been complaMd? Number of Bedrooms �- Has garbage grinder been installed ? , I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations off* Poaounty Department of Health. Date: Address Certified by P.E. L/ R.A. License # Any person occupying premises served by the, above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modif at n or change when, in a judgment of the Public Health Director, such revocatio , odi do r g i n essary. t By: Title: Date: 1 �® `1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMIPLETION REPORT Well Location Street Address: Z C"" . Town/Village: `�/( �e Tax Grid # Mali ,/J Block % Lot(s) j Well Owner: Name: Address: 1 &A r� Use of Well: 1-primary 2-secondary Residential Public Supply Air cond/heat pump Irri tion Business Farm + Test/monitoring Other(specify) Industrial Institutional Standby Drilling (Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _)L Open hole in bedrock Other Casing Details Total length _ dl ft. Length below grade _ft. Diameter '7 in. Weight per footIb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _Z Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes _ No Liner _ Yes XNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped _X Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet - � -rcct Well Log If more detailed information descriptions or Sieve anu:yscsf.. are available, please attach. Depth Fro tn Surface Water Bearing Well Diameter(in) )Formation Description fft. ft. Land Surface 7 If yield was tested at different depths during drilling, ' list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type �, Capacity Depth _2ppc Model _ Voltage HP T Tank Type -X Volumer4.`�, Date Well Completed %5 DD Putnam County Certification No. 1 W7 Date of 5eport 7/,;Z 1)6 Well Driller (signature) . 1VQD"11'IE: bAact location of well wttn atstances to at least two permanent lanVmarxs w ue pruviuru un a bupa►atuccvpiau. Well Drillees Name D4 r Address: /V /9' . e 311/� Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 . . - "I al YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Height 10598� _N.Y. �� ' Albert H. Padovaniv Director LAB #: 32.007646 CLIENT #: 11705 NON STAT PROC PAGE 1 MIRABILIO, JOHN DATE/TIME TAKEN: 11/24/00 09:00A 1 RICHMOND RD. DATE/TIME REC'D: 11/24/00 01:20P POUGHKEEPSIE, NY 12603 REPORT DATE: 12/04/00 PHONE: (914)-471-5199 SAMPLING SITE: BARGER ST. : PUTNAM VALLEY, NY COL'D BY: JOHN MIAABILIO NOTES..,: KIT TAP ' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT - NORMAL - RANGE ' METHOD PUTNAM CNTY PROFILE 11/24/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 11/24/00 LEAD (IMS) Q ppb 0-15 ppb 9101 11/24/00 NITRATE NITROG 1.46 MG/L 0 - 10 9139 11/24/00 NITRITE NITROG <0.01 MG/L N/A 9146 11/24/00 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 11/24/00 MANGANESE (Mn) <0.010MG/L 0-0.3 mg/1 2037 11/24/00 SODIUM (Na) 7.98 MG/L N/A 11/24/00 pH 5.3 UNITS 6.5-8.5 9043 11/24/00 HARDNESS,TOTAL 240 MG/L N/A 11/24/00 ALKALINITY (AS 14.0 MG/L N/A '_11/24/00 -TURBII)ITY (TUR� � � .� < ���,' T ` 075`NTU ' , COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A � SATISFACTORY SANITARY QUALITY ACCORDING—T�'THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS | TESTED, AT THE TIME OF COLLECTION. | Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value ' combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. ` YML ENVIRONMENTAL SERVICES 321 Kear Street ...... � Yorkt ~,. . ' ^ ights , N . Y . 10598 ' | Albert H. Padovani, Director ' LAB #: 32.007646 CLIENT #: 11705 NON STAT PROC PAGE 2 MIRABILIO, JOHN DATE/TIME TAKEN: 11/24/00 09:00A 1 RICHMOND RD. DATE/TIME REC'D: 11124/00 01:20P POUGH|EEPSIE, NY 12603 REPORT'DATE: 12/04/00 PHONE: (914)-471-5199 SAMPLING SITE: BAR8ER ST. : PUTNAM VALLEY, NY COL'D BY: JOHN MIRABILIO NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE300 MG/L MODERATELY- HARD WATER:-7O_140 MG/L _' _:MG/L MILLIGRAM PER LITER' HARD-WATCr'�-\��(Y-' 80- 0 MG/i (� ����n��/��Y�ni"-"'ip7-��-��7L-I SUBMITTED BY: Director EI-AP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �'c� rl +� V✓� 112/403! Lt'J 'lq- / -37 Owner or Purchaser of Building Tax Map Block Lot Building Constructed by ?.6 &� =j-, Location - Street �1 4�Y,04 1 Building Type Pjr,h4mc Tow illage . ►e � s Subdivision Name 1 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described. property, and that is 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 treatment 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 occupant of the building utilizing the system. _ The undersigned further agrees to accept as conclusive the determination of the Public Health Director 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 the builoigg utilizing the system. Dated/'IV4o h ( Day _ flearU�) Signature: Owner) 'Signature Corporation Name (if corporation) Title: Corporation Name (if corporation) Address: tGh m end , 2�. I� �ePg State Zip State Zip 1?-60 Form GS -97 NOV-28-00 T U E 8:28 WILLIAM -> B E S H A R A T P.01 - .,... .� ..- .. ..rte- ... PUTNAM COUNTY DEPARTMENT OF HEALTH DMSIDN OF ENVIRONMENTAL HEALTH SERVICES AT'T'ENTION W AIDAM ❑ GENF, 1 EO _FOR FMtAL INS CTIO For: Fill All information must be fully completed prior to any Trenches 1. inspections being made. PCHD Cons on Permit Looted: j er (T' Owner/Applicant Name-(3 fi,,- 1Lt0 Tlvq Formerly: Subdivision Nariae: Subdivision Lot # _ Is system fill completed? e°� Date: Is system complete? Date: Is system constructed as per plans? _ __ Is well drilled? S 1 pate; Is well located as per plans? 6 5�, - Are erosion Control measures in place! 9L) ham, V4Ae f0 Block. Lot i cl.� 1,, 9- /o I certify that the system(s), as listed, at the above premises has been constructed and I have inspeied and verified their completion in accordance with the Issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putn :County Department of Health. Date: Certified by: i?>1 _A DeYgn Professional Address: o bp 4A0AL Lie. Comments: Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �:..; ; ..:....._.:_.: >:. - CUARANTEE'OF"S TBSURFACB'SEWA:G ]E"I'REA`TM E' NI' SYS'rEM �n +� Y✓1 i (Zi�br L�� 24.. io 37 Owner or Purchaser of Building Tax Map Block Lot b kh Y41 aAl2.rU a Building Constructed by Z46. (3A"ier si . Location - Street a tov,14 I Building Type Town/tillage' eMSA S Subdivision Name 1 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 treatment 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director 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 the buil ' g utilizing the system. Dated/'1 Iqp& / 10,, Day _.,f - AarW Signature: Owner) 'Signature Corporation Name (if corporation) Address: K &A m 6n PO4� State (. Zip 12� 0.1— Title: Corporation Name (if corporation) Address: (%Z�v� oo ;h6,pge; State Zip I Z6 o j Form GS -97 W B R UTC-B. Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH' I Geneva Road Brewster, New York. 10509 Environmental Health (914) 278 - 6130. Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 0% KWIVI E TAX MAP NUMBER: E911 ADDRESS: TOWN: The Putnam County Department of of Construction Compliance unless. the above form is.completed, i.e., a legal E911 address is assigned by an authorized town official.--This-form-is-to-be -With the a' pliciatioii for a Cirtificate of Construction cCom phance, . ..... ...... (E911 VERFRNO ,a LI a C, t` 2 q - PUTNAM COUNTY DEPARTMENT F HEALTH t Co DIVISION OF ENVIRONMENTAL HEA TH SERVICES FINAL SITE INSPECTION .Date: y �_'�� Inspected b Street Lo•c:.� -.o. _ . -- ._..�'.' -' =,r... ,. ._. ........, ., Town J{ Permit. # I) %4' - ZZ-99 TM # Subdivision Lot # p 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. I ZZ Widths Avg.Dpth � c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. SeyonQe System• a. Septic tank size -1,000 .....1,250 other .............. P .. b. Septic tank installed leve .. ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renc es TLength required Length installed42co 2. Pistance to water o rse measured Ft.......... 4 %stq� �e a d' , o plan ......... ...............4. opof tre eptable 1/16 -1/32" /foot ............. 10 ft. from prop line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. om aA. for xpansion, 100 % ......................... Si e oWl',-f a l� l Y? diam t er-c ...lean. . 31 9: g ra�velr i-tre -b -2-' in , 1 ........:..::...: 10. i e ends ca pp . .. ........... . g. Bump or Dosed Svsterds I ©-11 1. Sized pamp cham'b ;, ..... �° :. :4....;,...... �,?..1. 2. Overflow tank............ A ....t ...........�� .................. 3. Alarm, visual/au � o .................... ............................... 4. Pump easily acces ible manhole to grade ................. 5. First box baffle' d .................... ...... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle...... III. ouse/Buildiri a.. House located per approved plans...,. .................. .. b Number of bedrooms .............. ............................... IV. Well. a. Well located as per approved plans ............... ............. b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... .......... ...................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. _ Erosion A� d� IMAM 10MAM =a'� r rte' Ir lower ---- -� OVA= loon NWA . w w� iii ��.�i� �.�•,..?;�.r. I" l I � •� '� � ( (�� t '� I � [h � �" •ti 6 � 1 � � E � I (1> I I I � •�, I t 1DRVIfSffGN OF IEN RONM ENTAIL HIEAL7H SER` C 5 {`/ /�`L�l/yw►l •.q�1/ CONSTRUCTION PERMIT '..FOR SEWAGE '� R EA'T'M ENT SYSTEM PERMIT # ���° 2� - 9� � 1 7 ..d J Located at Town or Village �!A0 Subdivision name - Subd. Lot # J— Tax Map 74. /0 Block _L_ Lot ' Date Subdivision Approved : cs /9 Renewal Revision Owner /Applicant Name a1 cl co Date of Previous Approval (F7// P /a -� Mailing Address Amount of Fee Enclosed Zip Building Type &/Q-nIAA- Fill Lot Area Z03 No. of Bedrooms 4 Design Flow GPD ®' Section Only Depth Volume PCHIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETEIID --- - - -- l Sej2arate Sewerafo stem to consist of 1260 gallon septic tank and 800 �T 2 � 01 oF- WOL0. e n i .4Ic W Other Requirements: To be constructed by A Wateir Su Il : Public Supply From Address, ®nt:.... _- .'rfivate'Supply-Driiled by.: A ddress- I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s s m described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date B I 9 0 0 License # 1A;Z).5-0S APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en consi ered n cessary by Public Health Director. Any revision or alteration of the approved plan requires a new p i Appr ed fo sc ge o omestic sanitary sew a only. By: Title: Date: .7 U if White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Kodssionall 0 Form CP-97 1 _. Slice of PUT-NAM COUNTY DEPARTMENT OF HEALTH .....,..., Did 'ISION'OF'ENV]rRONMENTAL'�FiEATL-Tf SERVICES:...:- :._.., -" FIELD ACTIVITY REPORT Street - - Town PERSON IN CHARGE r%n Xxlr- rrnXr=x7Krnr%. �1® Zip 1 (v - ........ -- 1 D -- ._..__....._ - - -�- ,ow v TN4PRC T(1R`v_ Signature and Title RFPCIRT RFrF.TVFT) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title; `' `` PUTNAM COUNTY DEPART`IENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPE CTION ..•Date _ �.._ ...,... ' a ---..- 4'x'.11 .... r.. .: r•r. ..�-: . .. ea r ` ....: Inspecte . y . Street Lo o plc,✓ Owner V'�1 tz A-�', 1 0 Town Permit # TM 9_ 7 �1. (— I — 37 Subdivision Lot # 1. Sewage SvsteiA Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth •.7 c. Natural soil not stripped ............... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. SeiviRe Svstem a. Sep-tic tank size -1,000 ......... 1,250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distdbution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renT ches T. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ...:.....:........ 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1 %" diameter clean..: .... .... ...... - ° 9-. =Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems 11. Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ :: ............... .. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HousefflujldLUg a.. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... . IV. Well - a. Well located as per approved plans . ............................... b. Distance from STS area measured.' ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... . V.,.x. ,.,.....,.I ,,.,,.raoa __ . COMMENTS 11 1 114 ?�_i�sA� o � % �' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF .ENVIRONMENTAL HEALTH SERVICES CONSTRUCTgION PE GE TREATMENT SYSTEM PERMIT # Located at or Village . f A4,1 l/eee- l/ e y Subdivision nameP et-0 �2r-�, Subd. Lot # Tax Map' , / Block Lot Date Subdivision Approved Owner /Applicant Name �/ U4 �1 �� �� f Z, U Renewal Revision Date of Previous Approval MailQ Address 1 P(G!-( HG )V j) A P � .Cl /�!f Zip 1,2 �! Amount of Fee Enclosed ,.2622, w f S4! rr Building Type /Nj2th � I y Lot Area df' G6a No. of Bedrooms Design Flow GPD Fill Section Only Depths r Volume 0 0 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of f i ('Z gallon septic tank and G or- a 4=, /.1 -t r1AC Other Requirements: To be constructed by -/� Address Water St pply: Public Supply From Address _ or:_ Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs th reto. Signed: P.E. R.A. Date Address �� !3 �G���+ �� o%c- /e� �G'/��/J� �i`'y License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the.Public.Health Director. Any revision or alteration of the approved plan requires a new pe t. App ved for isc ar of domestic sanitary sewage only. By: N Title: Date: q 'Vhite copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I acknowledge receipt of this r6port: SIGNATURE;` 02/96 Title: Slice_ t of *: * PbTN, &M COUNTY DEPARTMENT 0YREALTII ;;. ISI � 3trcDi '`t�l� i :;I: � v ,iti t L 11EA"Y,';I UI... VKMS'" III" IV ACTIVITY REPORT 1L,0� NAME* ADDRES S', Street w Town St a Zip PERSON IN CHARGE Name and Title TYPE "OF FA IL J- - -TY FINDINGS. ie-4 " L �1 _ co I acknowledge receipt of this r6port: SIGNATURE;` 02/96 Title: OCT-1Z-00 P R I 0:1Z WILLIAM- 3-BESHARAT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM U GENE MUES1 FOR FINAL For: Fill All information must be fully completed prior to any Trenches _ inspections being made. PCHD Construction Permit # r Located:er (� %-/0' v l(A �q /% Owner /Applicant Name: oh ✓1 in, R� - 5(1-r. -0 TM Block � Lot Formerly: Subdivision, Name: _s Subdivision Lot # Is system fill completed? Date: /2 . Is system complete? Date: Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? P - 0 1 T certifv that the evctemlc) AC itetM At thA AhnvP nrPmleAe hae hPPn f-A11Qt nlriari anA T have innnontaA and verified their completion in accordance with the issued PCHD onstruction Perihit and approved plans and the Standards, Rules and Regulations of the Putnan, County Department of Health. Date. 1..r1',u pd by: :. Ddsign Professional Address: 0I444.7� Lic. it Q�-- Comments: Form FIR -99 I IFUTNAM COUNTY DEPARTMENT OF HEALTH DIIW5R(DI (DIF ENVaRGNMIENTAIL HEALTH SIEII WCC�� ' ;..n•...; 9 ?.:�:.. _ .o -,r:r ,�y..ra..w..r:. .,. u7c�s n- n� - - } r.. �...� -�: R. ..... �.: ..e ��. ^�� �.. •:'. . .�. -.� � �.: ��.: .- -s .—,fa �.•_. -•.: e... n•iwT off 'Y•,: -�.. �.. ..; �' P. ... CONSTRUCTION ]CIE GE TREATMENT SYSTEM - t. Located at or Village Subdivision name p,- PJ Subd. Lot # _/_ Tax Map' , / Block Lot —� Date Subdivision Approved / /..), V Owner /Applicant Name iaj �tl rl !1 U Renewal Revision Date of Previous Approval Mailing Address ,6rH6 A(j) A op koe l��F j' Zip Amount of Fee Enclosed, �lj?�_ w f s r=r Building Type / I- y Lot Area �1'v6° No. of Bedrooms Design Flow GPD (Fill Section Only Depth ,' Volume 0 U PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage. ftstem to consist of 14 gallon septic tank and k::!> G_ r- a/= 34 4 7 to- /,t Other Requirements: To be constructed by Address Water Sue��^ Public Supply From -.:.. Address _ _ or:_ Private Supply Drilled by J Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separa sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs th reto. Signed: P.E. R.A. Date Address �� �G1� y► ors o%-� License # ��/ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 't. App ved for isc ar of domestic sanitary sewage only. By: Title: (t/r— Date: 1/7/?C� 'White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional t s Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER. WELL ., .... please print or type .. -PCHD Permit ~# Well Location: Street Address: TownNillage Tax Grid # RAC ''r ff- A,14 e.k r�QIle Map %�_' f Block Lot(s)3 Well Owner: Ne: �ra �'G Address: V'J , . /-- Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation - rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm erved Est. of Daily Usage jDq gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason RA VC- nJ 6 t.IC/ G-r LO r, iY [� for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes y No Name of subdivision �: �e lg r /a Lot No. / Water Well Contractor: P Address: Is Public Water Supply available to site? .................................. ............................... Yes No y Name of Public Water Supply: !q /"I TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provi ed on separ to sheet/plan. .D. -te:_. ` - -- . �►nr iics%ant ►ivri tiara:::. �f_��... -- .. g- - . - -- - I i PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 9/7/Y7 I Permit Issuing Official: Date of Expiration C1J&JC>i Title: Permit is Non- Transferr bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 rJJ �', �, SEE _ DID ISION OF CO�N� E DEPARTMENT pF N�QNMENT.AL HE HEALTH , OATION FpR PRO �C`E8r A WASTE WATER T VAL OF PL ' ANS FOR 1. ATMENT SYSTEM Name and address of ali ppcant:. // .. At 2. Name of projects 4. Design Professional: 3• Location T/V; � fi r ANu 5. Address: 6. Drainage Basin; 14 q%rct �Z ��K.r -fN R /owe. R 7. ZTULZwjeZ ��G �k ,�4� ivy �► - 4 Private/Residential _____Food Service Apartments --___ Commercial Office Building nstitutional Mobile Home Park g Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................................................... Type I Exempt _ Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ` 10. Has DEIS been completed and found acceptable by Lead Agency? 11. Name of Lead Agency _ _ -12 Is tlis o1 . tin:ari ' area urn e_- the tj trolaocal-plamri g, -zoning, or d tlier- � - - - - - - .officials, ordinances? .......................................... ............................... ............ ' _ .. _ . ., ,.b .. _ _ _. .... 13. If so, have plans been submitted to such authorities? ........ .....................•......... No 14. Has preliminary approval been granted by such authorities ?liar Date granted: 15. Type of Sewage Treatment System Discharge .........:....... surface water X, groundwater 16. If surface water discharge, what is the stream class designation? .................... Nit 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... /Vo 19. If yes, name of water supply ,� Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................. NO 21. Name of sewage system A/if Distance to sewage system m6d 22. Date test holes observed l ? a 23. Name of Health Inspector i7_ 24. Project design flow (gallons per day) ...............t ............................................... god 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A& 26. Has SPDES Application been submitted to local DEC office? ......................... R-1 ' N- 27. Is any portion of this project located within a designated town or State wetland ?t1' 28. Wetlands ID Number ........ ............................... .............. ............................... ,.- 29. Is Wetlands Permit required? .............................................. ... ............................. 'V, 6 Has application been made to Town or Local DEC office? ............................... u 30. , Does project require a DEC Stream Disturbance Permit? 4 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landf lling,. sludge application or industrial activity? ............................ Yes/No ®V6 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other,potentially known.source of contamination? ............................... 'Yes/No DESC12I13E: 33.- Is there a local master plan on file with the Town or Village? ......................... . Ar'e om— ma . $t rat dlor. sewer aciviles plantted td be� developed "witli°an_.. __.... years in or adjacent to project site? ............................... ............................... _ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... &® 36. Tax Map ID Number ......................................................... MapAr- / Block / Lot 29 37. Approved plans are to be returned to ..... Applicant Ae Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department.. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant 'shown in Item l .,the application must be accompanied by atetter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under pena1ty ,0f perjmry9 ghat infdrmation provided on this fora is gate to the best of my knowledge and belle, . ` false statements madq herein are punishable as a Class A misdemeanor pursuant to Section. 210.43 a 'Pe 1 La SIGNATURES & OFFICIAL TITLES. - Mailing Address: .... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner M I-tf 41 Address I 4e, iii, cm IPZ, I;De"2 4 kilo r, Located at (Street) Tax Map�/..,( Block Lot (indicate nearest cross street-) Municipality p� Ile y.. Watershed -'Ra SOIL PERCOLATION TEST DATA.. Date of Pre-s6aking Date of Percolation Test q4ALel H6J9 , ..:. :. :' . :. . .... ..................... . . : Start , . Start 6 �o J/ ........ .... .... lU 2 C� -3 4 16 ll u ?6 ay oL r 6 5 2 lo 3 26 7 r Ycf c7'-6 4 31k,'? r' 5 .2 4 7 5 NOTES: 1. Tests . to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min/inch; s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements-to be made from top of hole. Form DD-97 TEST PIT DATA -DESCR PTION OF SOILS ENCOUNTERED IN TEST ]MOLES X ..,:> DEPTH: HOLE NO. -� . -T HOLED... .. "I�OL>✓ I�b:, `:.:v .�... - :...� ;� _ . G.L. 0.5' 1.0' 1.5' 2.0' . 2.5' 3.0' 3.5' 4.0' 4.51. 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' . 8.0' 8.5' - - ,....9.0' 10.0' C11. all Indicate level at which groundwater is encountered Hog % Indicate level at which mottling is observed 3 .G i %'i Indicate level to which water level rises after being encountered Ale Deep hole observations made by: /7. ODAlVit(r-S Date /- P/J/ Design Professional Name: �41v,r G -'4 J- AW 114-4 AE Address: 1-.ec, ,<�s•t Signature: Design Professional's Seal "0,i' U� � '9� fin• 4IIW _. 14 -.1 GA ('Jd 1) - - I-ex 1 1 [ PROJCCT 1.1) NUI.18ER 617.21 SEAR Appendix C State Environmental Quality Review ENVIRONMENT-AL ASSES'gMftNT*'FWIM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) I APPLICANT /SPONSOR 2 PROJECT NAME PROJECT LCNCAT!Ot; County a. PRECISE LOCATION 7(f�.Icl address and roagtntersectrons, prominent landmarks. etc., of provide map) 5 IS PROPOSED ACTION. New ❑ Expansion C3 Modification/alteration 6. DESCRIBE PROJECT BRIEFLY- 7. AMOUNT jF; LAND AFFECTED: I I nitially =J4_*A_Q_tr_ acres Ultimately acres 8 WILL PROPOSED ACTION CJOMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes No It No. describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe' -10:' DOES'ACI'ICN INVOLVE n PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY iFE DERAL. STATE OR LOCAL)? (0yes FI No I( yes, fist agency(s) and permitlapprovals P L, D, r 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No It yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes L J No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE V DaW Applicant/sponsor name: Signature: -------- It the action is in the Coastal Area, and you are a state agency, complete the I Coastal Assessment Form before proceeding with this assessment I OVER I PART II—ENVIRONMENTAL ASSESSMENT (lo iii; complel[Od b;, A. DOES ACTION EXCEED ANY TYPL I THRESHOI.t; IN ti NYCRH, FART 617 12? If yep, ::,r! r•.cutty riwi'eSS and use the FULL EAF, CJ Yes LNo 6 WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIOL D FOR UNLISTED ACTIOt1S IN ti NY(, I', R. Pr -FAT 61760 If No, a negative declaiatlon may be superseded by another involved agency S DeNo C (:Ol1CD ACTION RESUt..I IN ANY ADVERSE EFf ,ECTS ASSOCIATED WITH THF'I OIAf :A'.!NG ;Anrn :' s lv,nit•ir,, if legible) C l Ex'sling au quality, surface Or q!oundwalet Quahly or quantity, noise levels. Cxr Sittig traffic GG :I,' +ns, SJlyd waste prOduCtiOn Or diSpOSdi. polent-al for erosion, drainage or flooding problems? Explain briefly' C2 Aesi!ietrc. agricnllu!3f, 3rchaR010 �, :a :~- ;Lnrn- ,,i ulher natural or r:ullura! rosOu(r:,.s. Ot cominurCy )! '1,Ugrt;,OrhOOd characte(? Expf;)m br,o!I} C3 Vegetation or fauna, hsn, shelli!sh ;c m•nduf(! ")ec-ps. Srgrl!ficanl habitats. or Iht-�aiened or enoangered species'? Explatn briefly r H 0 e � rf C4 A community's existing plans cr goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. �G /V C5. Growth, subsequent development, o, related activities likely to be induced by the proposed ac!ion) Explain briefly. Ve C6. Long term, short term, cumulative. o, other eftects.no.t,'Igentlfied in CI-05? Explain briefly. C ?. Other impacts (including chpri&S in use of either quantity or type of energy) ?,Erxplai.n•bi,e!ty t D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes No If Yes, explain brrelly PART III -- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in. connection with its (a) setting (i.e. urban or tural); (o) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. r ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts ANY provide on attachments as necessary, the reasons supporting this determination: —`\ Name o -Lead Print or Type Name �ponsi le O icef in Lca Agency Title of Respond le O i<er Signature sponsi e Officer in Lead Agency E Signature of Preparer (If di event Ir om responsi Ie o e r) - 4— GK i I I• l r W. c. ,A KN )tA J 1.1 JAJ -Q 0'' (_r 4—.4 01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at 1� f je,6 00, e IF TN ArWifm I/Aur Tax Map # - !t) Block ^L� Lot Subdivision. of Subdivision Lot # Filed Map # o,?L4 Date Filed Gentlemen: This letter is to authorize - a duty licensed Professional Engineer _aZ or Registered Architect to apply for the required wastewater treatment and/or water supply.permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction' of said wastewater tretment and/or water supply systems in conformity with the provisions of Article lay and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code_ Very truly you , Countersigned: Signed: P.E., R.A.; ,# Y ner of Propeny) Mailing Ad dre ss �. v4 Ste- �Mail Address: r State _ Zip 16 State Zip /� d� 3 Telephone: Telephone: C. Form LA -97 PicDANIEL J. DO AH UE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 914 -628 -7576 fie. E Z- 6r 4wy PUTNAM COUNTY DEPARTMENT' OF HEALTH ROUSE PLANS APPROVED FOR BEDROOM COUNT ONLY„ 1 i BEDROOMS ALL SUBSEQUENT REVISIONJALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE P('DOH FOR APPROVAL l SIGNATL7ItF. TITLE �( _ � � DATE Vm ... �� Nry CL o s . om o O o w o - \ 'to 40 w _ G+ 1 Z •t 1 i 0 C x 1 a t� r ti v w 0 7� C7 L. 7 s • 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. LETTER OF AUTHORIZATION RE: Property of � 0 Located at 5,4 rZa �, 5 U o T/V Tax Map # :74 i O Block Lot 3_Z Subdivision of Subdivision Lot # _Filed Map # 9b,4D Date Filed 0 Gentlemen: This letter is to authorize PZ"-'> 1/ F—I&D (L eset 4 a duly licensed Professional Engineer I L,,,or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above-noted property, in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and /or water supply systems in conformity with .he provisions of Article 145 and/or 147 of the Education Law, the -Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # ,� S Mailing Address Po 9S-0 0;+140,04-c State ` Zip J C64 I Telephone:7� Very truly Signed: of Property) g Address: �mAd 10P. d 5re State 0'/ Zip Telephone: _A-11619 2 €Z sed Z E 100 00 Form LA -97 7. SUBDIVISZDN-IJAP .OF SECTION . B, r-` ACRES ARA $,r ( filed July 20, '1971 as Mop No. 1222 —A ) \:q f1o!�+istbg w proposed mUS or s pjk +1• e'aitAin minbnum separation diston y rsavirod DY Me .b ... putnart County MMfn. DrlaortmenC as pr j%ws0gation and locations Pwfamed oY proFct anq nor: �g dd, :9--d t j s , ?� Pl-,gly TO TAL.'-_Z7IF'.AKEA' Si Pte. o / 0� 1' 6 ►' NDARY to IL W7L S" AL o" x..670 70µ1i OF pUTNAY VALLEY _ _ - / O+ C R£GULArO ft 7LAN05 \ ,Tilt J �i. rn -0. 690 - ::' /�,: - = `-� -__ ��' "i�:' •; jai •660 •��•�.� � �, �'��� � .•� -� 0' 10 r i \ 660 O r • � .CONTROL LOT > N� �o NS 0 NOS `e' �11t0�oc/ - o e °q, N � as 1 _ 51 F . 6.7 Acre f _ % a. _ ..gam 2.3 ,� ��� 1�....r- .,.... 1013 Sq. o� a Y LOT 2 - 2.9206 Acres 1�0 ...._.:.__._.._..... _ :.. oaf. .. .�_ .. _ 1�0 ' •p ' t GOP OPOyEO PR t4 1)0 �oa�rt e�d Q flan os(d rn c- 2 9� X11 r 1 0. m ed ^ _ la0 ProOr�ii 1g0 N \ w. 1y0 rcd• / n dror ! g M� 20.00 Wolos,d 201'00 100 Mon l •- 5 3t 16 31'p0• an L R = 700.00 do � 20 79 N JZ� }0 b E bound STR °Y'9nAtn `aod mcd a ns ol9alo�e '"alt s0vafov�l7 PsS�.raIN� a Ot St m"Outal,an3 kid -n,4 --nit Li ,4 Cold T Lj LI,1 ;(JLClcy U"ptW6M:A Ox 116114" Ion of Environmental Health Servioeh ved as noted for o nf rmance with cable 0 R ations of 06 Cc Pjt1 q 2jO LAT->•;,• OF -Iqg- IIZ- �4 LA L 4 - RLDY F-k R; K'S P-7 IQ, f Yin 7.J Fe ILL _--O Ir, 'AP q HIP— —,tLt,- 30 Fr AEG I z <o 00 7D' Ito IG L 0�' 114 270 4, 77' ua 64' 7 120, LD, C,4'- 40 07 1 RLDY F-k R; K'S P-7 IQ, f Yin 7.J Fe ILL _--O Ir, 'AP q HIP— —,tLt,- 30 Fr AEG I z <o 00 6 k; - v K - : 11IVI5'101 . �P OF SECTION 'B, - o.:...:: CLOCAVORRA. ACRES -( fled July..20, 1971f'as Mop No. 1222 -A ) .. \: Ali &,IftaV or G+�ad wells or wptk sym�s ItAie mmlmum ,fepoldtitY, distances reWirod 7-70 puhimri Lovnfy NsaltA. OgoartmanG as per Gwstigotian and locohaws porton^ed by proper e: O y� Win\\ �' �. -' n1�' 8° ytl•3oAdt On'rowoy \ 1 v ... 4 60•V ' � go� �'z,r o,td�o P Off, a' v 15�. �Btw�My.: •rt. t�tnd- SSt� �1 a \�1.: �5 is stNMAv0�i .` ..! AL tJ� .� ��- _ �-- - - - --I 610 - \a PU7NAAf VALLEY �� _ - ,11� i_�� -680 1-0 TOWN OF a' 0 µEp AN05 J/ • REGULATED � �. !„ � j ` i0' '�i 59 N .. Y' �.•., $erg ; �/ z100 � ._�`, . '' • x,610 Un o 660 ' - • ` W 0iN �, �.Tt 70 o m TOWN i c � ' �� . Cott 7ROL � 3 R 690 LOT > Z 1 2.3267 Acres ,9 101,351 Sq. Ft. o\ LOT 2 = 2.9205 Acres o 727,220 Sq. Ft. 3 o. �R 0 ao O a o eg e m 0 R 1 Co n a SSOP O s O Z 0 Q m 2 1 � o O40 1 2 .cG 0p05E0 5,e SLred v4 .1tte' °� e 1}0 a yche eto`r piopse 110 n ,r 5• tla A J it �osee ' p x915 s Sys I % i �+ r U I l P/-, Q N l ed SG �'Y— Ot �•0 pro "� 4` F 0 00 ^. 20 P0fesstp X50 MoieUeo 2010 w Fyr� III J3 i 0 .. van 5 1 3� 25 0/ 0 11 dory; j6.3�00+ .78 . t( 00 oo"d fore 1 Mon. D L 201 t ' 0 pa i99 he t 70 0.00 _ N 32'0 ' esis t io wall 'red or ona � ^ se o °` el R s o a0� -roily., 10cot 56. d dam ` c- LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 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 July 15, 2004 Impellizeri 248 Barger St. Putnam Valley, NY 10579 Re: Addition — Impellizeri, Barger St. No Increase in Number of Bedrooms (T) Putnam Valley TM #74.10 -1 -37 Dear Mr. & Mrs. Impellizeri: 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 July 15, 2004 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval by this -Department. ` — - `2 . sewage- disposal- systerrr,-and-its expansiori 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 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. ML:hn cc: BI (T) Putnam Valley Sincerely, p Michael Luke Public Health Sanitarian BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R_N., M.S.N. Associate Public Health Director Director of Patient. Services DEPARTMENT OF HEALTH I 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) 218 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET %r�✓ TOWN 4 /7 fr /,1 �� TX "9_ r 3� / % 7 3y ;4,t NAMF %h fC/�r /ne lf,%• xoNE ,PyS'- �'r� %/d`� PCHD# A -RR g -o MAILING ADDRESS Ali' 5-1- R� t<0�jm U49.v may/ DESCRIPTION OF ADDITION 1171te S�Gj�t4 - .Ala it e oy f-lecIv -1 C MBER OF EXISTING BEDROOMS-1 —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), ,. •.._ __ _ .. _ _ _.p rared by'.a�Professir�nal F��zneer or.R:egistered- Architect in uccordazce a�ntli- applicable sectic�lu oftiie _:. Putnam County Sanitary Code. Please submit this foram and the following to Putnam County Health Dept., 4 Geneva Road Brewster, NY Phone 278 -6130. Certified check or money oidec foc $100.00. Sketches of existing floor plan (drawn to scale, all living area including basement) '*Non-professional sketches are acceptable. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *Non- professional sketches are acceptable. 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. Copy of Cert. Of Occupancy from Town or)Certification from Buildinsr De tp with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 BFhouseguidelines Jul 01 04 10:46a BUILDING DEPT 9145268806 P•1 r ' oG� . .... _....... .. ... " . _..,��a tr 1 BRUCE R. FOLEY LORETTA MOL)NARI RN., M.S.N. Public Health Director �� Associate Public Heath Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York I0509 Environmental 11c2lth (845)279-6130 Fax (845) 278 - 7921 Nurslag Services (84S) 278 - 6558 WIC(94S)219-6679 Fax(94S)279-608S Early Intervention (845)279-6014 Prembool (845) 278.6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road ✓ _ Brewster, NY 10509 Re:_JV Residence Tax Map %• J Q 11 J7 Town P ' t1. Gentlemen: 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 Building Inspector BFhouseguidelines O' VINYL TECH, M. Sunrooms &Spas ® E S O E 668 Dutchess Turnpike _ -_P.O. Box 3235 ^ Poughkeepsie, NY 12603 . (845) 454 -0037 FAX (845) 454 - 0157 Town of Putnam Valley 265 Oscawana Lake Rd. Putnam Valley, NY 10579 Attn: Building Dept. Health Dept. Re: Proposed Sunroom Impellizeri, John & Charlene 248 Barger St. Putnam Valley, NY 10579 To Whom It May Concern: June 28, 2004 Vinyl Tech, Inc. proposes to remove the existing 10' X 19' deck on the rear of the Impellizeri's home and construct a 12' X 20' deck in its place. We then propose to construct a three- season sunroom also measuring 12' X 20' on top of the newly constructed deck. Please see the attached deck and sunroom drawings for construction details. you, A. Field v o www.valleyviewdesign.com i i s . T ` � L �� J .� e �, T� ,� V,+ , �� \\ `,.. �� �1 ' ON f �i t ! 1�� h0 ��� �. •. is ,� ,. i .r:'. ,` a� 2� t mI m 39' -10" 35-6 11M'-5" 28'-1 1/2" 14' -3" +24-20- 3465 34652 3465 3465 34' -1 1/2" 20' -2" 8DH7244- 3/3618RT 3465 48' -0" 38' -0" 27' -0" 15' -0" WINDOW d 12' 7/12 DORMER New York Note' To the best of my kno Aadga, belief and professional judgement ' L this Fnctory Manufactured Home (FMH) plan has been epprowed , SIDEWRLL= 2x6 from n system set of FMH plans previousN approved by &a MRRR WRLL= 2x3 Roolcetion No. 1387, Manufeclurer's No. 1387. Expiration Dn a S -S-0O, which -has not been modified tit any cranes . CLG HGT= $' -0" 2 the energy portion of this FMH plan has been pr ared usbg Pert S of the New York Stele Energy Conservation Construction Code (Energy Code) and is in full compliance with the Energy Code ". i i ! 3465 M 6'-0" REV: 4 -18 -00 DM PRENER l(.� ((�� ULDER� A DM OF 6l 7ling r 4 -5 -00 DM P.O. Box 337 • Mncy. Pa mse • (7n) 54e -896 10 -14 -99 JG I TRIPLE -M / CYRRN �T4536 2 STY FLOOR PLRN W/ DUCT'S 8 -6 wrf ar. ORTE: SCALE: JLG 117 -11 -99 1/4 " =1' -0" 01JG. N0: 000 I ---- - - - - -- 5' -0" - 0 11' -1 1/2" , 1' -7" I OEPLH TUB 48 0018 1 TFI ry 030 BATH 2 A MLA- , ..1 ' I m I > Q1 I I OR 2 BR 2 � I V42 � O I t ,d\JV%== OV60O 18 ;�61 � 3 30 30 ; R `) 30 30 i ' CD (D o }. \5) m I I CO I I 2- 20'x15 ML 2- 15'x20 ML 3D - — — St{iP LOOSE GIP. T4S RREP � 18' -0 1/2" UP/4 SHP L005E GYP. T¢s ry,==30 t i N f I I ..,.. . i to 9'-11 L/2" In - , m m I 1 )p I CP bp .. BR 1 �RHIL ! OR cn By 81. DR N _ (OPEN TP BELOW) 19' -0" 13-7" 17-3 1/2 "" -° 1 _ I r7 3465 3465 34' -1 1/2" 20' -2" 8DH7244- 3/3618RT 3465 48' -0" 38' -0" 27' -0" 15' -0" WINDOW d 12' 7/12 DORMER New York Note' To the best of my kno Aadga, belief and professional judgement ' L this Fnctory Manufactured Home (FMH) plan has been epprowed , SIDEWRLL= 2x6 from n system set of FMH plans previousN approved by &a MRRR WRLL= 2x3 Roolcetion No. 1387, Manufeclurer's No. 1387. Expiration Dn a S -S-0O, which -has not been modified tit any cranes . CLG HGT= $' -0" 2 the energy portion of this FMH plan has been pr ared usbg Pert S of the New York Stele Energy Conservation Construction Code (Energy Code) and is in full compliance with the Energy Code ". i i ! 3465 M 6'-0" REV: 4 -18 -00 DM PRENER l(.� ((�� ULDER� A DM OF 6l 7ling r 4 -5 -00 DM P.O. Box 337 • Mncy. Pa mse • (7n) 54e -896 10 -14 -99 JG I TRIPLE -M / CYRRN �T4536 2 STY FLOOR PLRN W/ DUCT'S 8 -6 wrf ar. ORTE: SCALE: JLG 117 -11 -99 1/4 " =1' -0" 01JG. N0: 000 45-11 1/2" 3�- 22'-7 112" 3037 t I 3465 72VINYL 34652 W364-2 I Q Wj Ll 7'-0" CO :0 U=L > KlTQHF -cn I cn 48WS 3-7" I 5'-3 1/2" C? Ell 191-91 3465 3465 7 5FRENCH 3465 3465 34-" 1 11 20'-2" 1S' -0" 6'-0" W2442 W3642 SIDEWRLL= 2x6 N,, York Not,: MRRR WRLL= 2x4 62+ - - - - - h - To tha best of y knowledge, belief and profe-k9W!Pd9affMt CLG HGT= 9'-0" PRENER BUILDERS DM 4-5-00 Dm L L", Factory wf4ctwed H— (FMW plan has bje-F -P �:, 22'-1 1/2" �w. a—� � P.O. Box 337 WM. Pa 17755 (717) 546-69�5 1044-99 JG i from . system of FMH 'a R ation No. 1387, Mamfacter',P= 147,= LRBEL TRIPLE-M CYPRN DATFOPISE AIME: 4536 O.MN-5-00, wtdch-has not b— n�odfled in any mamer. DESIGN SNOW LORD= 40 2 the nl,?gs�o.rlbn.,f this F "P Cd. Pert . ,. T "" "been 5 of Y E..�� Cone ROOF= 5/12 24-"oc i STY FLOOR PLRN W/ DUCT PLM Na: 518-6 Energy Code) and is in ftd conipfiance with the Energy Cod, DES T= PUTNRM, NY > Mr. No, 000 03 II r Il cro u in co NOOE I FAMILY RM c:) 0- 2 2" - - - - - - - - - - - - -- - - Ju 5. =2 5' L/2" C) V2 I < : ' - B 2 N TAR 5 BY BLDR a . 0 01 C, LIVING RM s i 4, V EOYER (01 TO FIBOVE) 7 4 3465 3465 7 5FRENCH 3465 3465 34-" 1 11 20'-2" 1S' -0" 6'-0" SIDEWRLL= 2x6 N,, York Not,: MRRR WRLL= 2x4 —4-'-'18-00 To tha best of y knowledge, belief and profe-k9W!Pd9affMt CLG HGT= 9'-0" PRENER BUILDERS DM 4-5-00 Dm L L", Factory wf4ctwed H— (FMW plan has bje-F -P �:, RDDTL BSMT COL �w. a—� � P.O. Box 337 WM. Pa 17755 (717) 546-69�5 1044-99 JG i from . system of FMH 'a R ation No. 1387, Mamfacter',P= 147,= LRBEL TRIPLE-M CYPRN DATFOPISE AIME: 4536 O.MN-5-00, wtdch-has not b— n�odfled in any mamer. DESIGN SNOW LORD= 40 2 the nl,?gs�o.rlbn.,f this F "P Cd. Pert . ,. T "" "been 5 of Y E..�� Cone ROOF= 5/12 24-"oc i STY FLOOR PLRN W/ DUCT PLM Na: 518-6 Energy Code) and is in ftd conipfiance with the Energy Cod, DES T= PUTNRM, NY I CAM DWK Br[ G 10 -11 -99 1/4 " =1: -0" I -1 Mr. No, 000 -- G' T -I9" I 24 1 hour fire rated i — self closing metal door. i.i Garage Door 9' ! Stud.bearing wall with 5/3" fire rated wallboard on both sides. — —� - - -- 2 f 2' I 2. Garage Door 9' I i I � 3' -9" L_ w Pressure Treated Wooden Deck W 10' 72" Sliding DG61- - - - — - - — - - 17' l 1/2" - - — 26' -4" � ' F a Cut or expansion joint to control cracking. , , 7 20 LW12 x 40 I Beam welded at both ends to steel bearing plates. Railing (both sides) 3' - - --j -- -Op - -- 1 54' A i 32" x windows (5) IT-9" 13' -9" 45' -11 1/2" 32' -4" 22' -7 1/2" 3037 3465 72VINYL 34652 p,'L LJ3642 l I W2442 W3642 - - -- - - -- D 22' -1 1 1r' 00 l �- Ln iLQL ■ I - - o N l m II ^ in KITCHEN m II NOOK FAMILY RM x c" m° -7 1/2" , 2' -0" 2 2" 48 WS d• Fot-14 3624 U <NfV 6 T -9" 3' -7" 3-3 1/2" 2' a—LI 2" 3' -7" 2 0 3 -1" p In too vl T _ F— - -- CD DINING RM TAR BY BLDR r:_�:: ; r .0 LIVING RM `'.= — FOYER (OPEN To ABOVE) 3465 3465 75FIRENCH 342-1 11Z' PUTNAMCOUjMOEPARTMENT 01 HEADS 39' -0" 27' -0" HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; Nev York Note: BEDROOMS To the beat of my imowledge. belief and profasslom ydgertldd L Wv Factory Manufactured Noma L=l1FD plan hart been approved �3. O from a ayatem set of FM)i plaru pren'oualy approved by DFiCR. s � 7 5 ( K. q�,o�o etion No. 1387, Mnnufacturer'a No. Li87, txprollca Sipalure R Title Date s �5-OD' v"d' has not been modfled h arty ne'v'er. 2 the mrorgy portion of lhia FMN plan hart been red vt, - Part 5 of the Nev York State Energy Conservntlon Coniruetlon Code (Eroroy Code) and is in fle conV&, o with the Energy Code-. 3465 20' -2" . 1 15' -0" SIDEWALL= 2x6 MRRR WRLL= 2x4 CLG HGT= 9' -0" RDDTL 8SMT COL - n LABEL - DESIGN SNOW LORD= 40 ROOF= 5/12 24 "oc OEST= PUTNAM, NY 3465 f ^� PREMIER BUILDERS A M O Yl T NOb" IC PA. Box 337 ' AtM. Pa 17756 - (759 U61M TRIPLE -M / CYRAN 1 STY FLOOR PLAN W/ DUCT owN JLG eA 10 -11 -99 1 r- bo J- 01, -u 4-8--1 111-j — 4 424-20- 33-10" 35'-6 lzol-s" 28--1 1/2" 16-7 1/21 4._3-- tt t t 34652 3465 3465 3465 8OH7244-3/3618RT i 3465 34'-1 1/2" t 20--2-- PUTNAM 00 M�i DEPARTMENTI(*Wp 38'-0'! 27'-0" YY HOUSE PLANS APPROVED FOR WINDOW & 1Z 7/12 OORmER BEDROOM COUNT -ONLY; -!K—BEDROOMS' To the best of my tcnovladga, belief and professional Judgement L 11h F6cloy M Otu;&d =a (FP�H) plan has been approved SIDEWALL= 2X6 .t.. :,tW1 of F an$ eviou dp=ed b OHM fro'" a y sOrN � 1%, y MRRR WRLL= 2x3 R 5th� No. 1387, Manufacturer's Expiration CLG HGT= 8'-0" DMCS-5-00, vNch has not been mdfied in any manner. 2. the energy portion of this s1H p lan has pro red wing Part 5 of he Now York 'te tEn ., " :..=.n g, ,.,.n Code (Energy Code) and Is in ful cornpUdnca with the Energy Code". J4-bb 1 U-10" C:) :1 PREMIER BUILDERS A VM OF ♦XA 'T MX= HC P.O. Box 337 MjW. P2 9756 - M 646-6915 TRIPLE-M CYRRN 2 STY FLOOR PLRN W1 DUCT "ilr 1"7ri-ii-qq ls0l:L/E4:"=l'-0 4-18-00 DM I 4-5-00 DM 10-14-99 JG OHI NvAv- I MM316 45 L- - - - - - - - 111-1 1/2" 2 DEPUi TUB �-CDIS U) n: T TF-1 00 QRTH 2 21:111T QR4- V42 30 4 30 30 Rte) 30 30 30 CD M m C) cr, R f 2-21, 2-2O"xlSr ML 2-16*xW ML 30,--- SFUP LOOSE GTP TKM AREA 18`0 1/2" 14 1/ ul SK? I GYP. InIM FVZE�Fl to j 00 CO. 9'�ll 1/2" In �l ���� zo BE I r z F3R 2 BY cli 9L Lr) (OPEN TP BELOW) j CIO 191-01, 13-7 I7'-3 1/2" t. 3465 3465 8OH7244-3/3618RT i 3465 34'-1 1/2" t 20--2-- PUTNAM 00 M�i DEPARTMENTI(*Wp 38'-0'! 27'-0" YY HOUSE PLANS APPROVED FOR WINDOW & 1Z 7/12 OORmER BEDROOM COUNT -ONLY; -!K—BEDROOMS' To the best of my tcnovladga, belief and professional Judgement L 11h F6cloy M Otu;&d =a (FP�H) plan has been approved SIDEWALL= 2X6 .t.. :,tW1 of F an$ eviou dp=ed b OHM fro'" a y sOrN � 1%, y MRRR WRLL= 2x3 R 5th� No. 1387, Manufacturer's Expiration CLG HGT= 8'-0" DMCS-5-00, vNch has not been mdfied in any manner. 2. the energy portion of this s1H p lan has pro red wing Part 5 of he Now York 'te tEn ., " :..=.n g, ,.,.n Code (Energy Code) and Is in ful cornpUdnca with the Energy Code". J4-bb 1 U-10" C:) :1 PREMIER BUILDERS A VM OF ♦XA 'T MX= HC P.O. Box 337 MjW. P2 9756 - M 646-6915 TRIPLE-M CYRRN 2 STY FLOOR PLRN W1 DUCT "ilr 1"7ri-ii-qq ls0l:L/E4:"=l'-0 4-18-00 DM I 4-5-00 DM 10-14-99 JG OHI NvAv- I MM316 45 I hour fire rated self closing metal door. 3' Garage Door Stud bearing wall with 5/8" fire rated wallboard on bothsides. I I 1 ' �, 2' 7' -- — 2 2 2 .J • Garage Door PUTNAM COUNTY DEPARTMENT OF HF/1LTH HOUSE PLANS APPROVED FOR r ; BEDROOM COUNT ONLY' BEDROOMS a,So Date Signa & Me 4 � I I j'. I Ai I --- Cut or expansion joint to control cracking. I ' ' 7 20 I L W 12 x 40 I Beam welded at both ! f ends to steel bearing plates. : I I I I I 3 Railing (both sides) I ! � 32" x windows (5) ; Up _� I ------------ - - - - -- 6, - - - -- -- 6,_ 54' i I 9 --rk - * 7ello 1— 3 7 4-f 1 54'-0" N Q) 60 45-1 1/2" f 16' -7 1/2' I{ 48' -1 J.- 39' -10" 35' -6 1!�' -5" 28' -1 1/2" 14' -T. .1 4242(g) aaFc; 34652 3465 8UH7244-3/351URT 34' -1 1/2" 38' -0" 27-0" wu\oow e 17 7/12 DORMER Nov York Note.' To the best of my knWedge, befief and profess" ydgarwnt L thb Factory Manufactured Home IFMM plan has bean epppr���m�ad from a system sal of FMH ppiInnnnyy pravwualy approved by O)![.X. {�p�catbn No. 1387, Manufacturer's No. 1367, txp'vetbn Oale S-5-M which has not been modfied 'n any roamer. 2 the energy portion of this FMH plan has been - �prepnred using Part 5 of the New York State Errergy Conservetion',Gomtruction Code (Energy Code) and is in fun camp6nnce with the Eiorgy Code ) a. SIDEWALL= 2x6 MARR WALL= 2x3 CLG HGT= 8' -0" 4-J-UU UI'1 10 -14 -99 JG 34652 in cn x II C) 7'-9" 3-7" 5'-3 1/2" 2' "5[ L(2" 3' -7" 2 5'-4" L 48'-0" 39'-0" 27*-0" 45-11 1/2" 32'-4" 22'-7 112" 6'-0" 3037 3465 3' -1" 72VINYL ,l, W3642 DW W24-42 W3642 821, D2 MRRR WRLL= 2x4 PREMIER B UIL DERS 22'-1 112" UV2 4 To the best of my kmAodge, belief end professional yidgement 'V— B/WF1 4--S-00 DM 1. this Factory Manufactured Home (FMH) plan has been dpPmved b I - < 1 030: 62T x from a system set of F " o by DHCP- R at[ No. 1387, M..fdC�.r.'Ilp'le�P�"397�pgpi'l:tllOn LRBEL - • TRIPLE-M CYRRN ORTFSPSE NIME. 4536 DaCcEi-onW. vNch has not been modfled in any manner. 2 the energy portion of this FMM n -rr, 1 9 Part 5 Nev York State on Cod. Energy =n,& ,��% DESIGN SNOW LORD= 40 ROOF= 5/12 24"oc 1 STY FLOOR PLRN W1 DUCT PLF" "'I: 518-6 of , .1.,, (Energy Code) end is in full compfiaIxa with the Energy COd"`•, DEST= PUTNRM, NY SCALE 1' 'JIG car - 1/: .=J._O.. 10 11-99 4 DWC, 'Au 000 00 0 I. DINING EM CP TA iff BY SLOR' . .......... b KITCHEN u FAMILY RM LIVING R M V-7 112" 2 112" 48WS FOYER - ---- -- 20 (OPEN TO RBOVE) IIW3624 1. 34652 in cn x II C) 191-81, 3465 3465 75FRENCH 3465 3465 in 7'-9" 3-7" 5'-3 1/2" 2' "5[ L(2" 3' -7" 2 5'-4" L 48'-0" 39'-0" 27*-0" 6'-0" 3' -1" SIDEWRLL= 2x6 Nev York Note: MRRR WRLL= 2x4 PREMIER B UIL DERS cr) UV2 4 To the best of my kmAodge, belief end professional yidgement CLG HGT= 9'-0" 4--S-00 DM 1. this Factory Manufactured Home (FMH) plan has been dpPmved b I - < 1 030: 62T x from a system set of F " o by DHCP- R at[ No. 1387, M..fdC�.r.'Ilp'le�P�"397�pgpi'l:tllOn LRBEL - • TRIPLE-M CYRRN ORTFSPSE NIME. 4536 DaCcEi-onW. vNch has not been modfled in any manner. 2 the energy portion of this FMM n -rr, 1 9 Part 5 Nev York State on Cod. Energy =n,& ,��% DESIGN SNOW LORD= 40 ROOF= 5/12 24"oc 1 STY FLOOR PLRN W1 DUCT PLF" "'I: 518-6 of , .1.,, (Energy Code) end is in full compfiaIxa with the Energy COd"`•, DEST= PUTNRM, NY SCALE 1' 'JIG car - 1/: .=J._O.. 10 11-99 4 DWC, 'Au 000 zo I. DINING EM TA iff BY SLOR' . .......... . LIVING R M FOYER (OPEN TO RBOVE) 191-81, 3465 3465 75FRENCH 3465 3465 in 1. t 48'-0" 39'-0" 27*-0" 6'-0" SIDEWRLL= 2x6 Nev York Note: MRRR WRLL= 2x4 PREMIER B UIL DERS REV; 4-18-00 DM To the best of my kmAodge, belief end professional yidgement CLG HGT= 9'-0" 4--S-00 DM 1. this Factory Manufactured Home (FMH) plan has been dpPmved RDDTL 6SMT COL P.O. Box 337 Mm y, P2 77756 (717) 546-6915 10-14-99 JG • from a system set of F " o by DHCP- R at[ No. 1387, M..fdC�.r.'Ilp'le�P�"397�pgpi'l:tllOn LRBEL - • TRIPLE-M CYRRN ORTFSPSE NIME. 4536 DaCcEi-onW. vNch has not been modfled in any manner. 2 the energy portion of this FMM n -rr, 1 9 Part 5 Nev York State on Cod. Energy =n,& ,��% DESIGN SNOW LORD= 40 ROOF= 5/12 24"oc 1 STY FLOOR PLRN W1 DUCT PLF" "'I: 518-6 of , .1.,, (Energy Code) end is in full compfiaIxa with the Energy COd"`•, DEST= PUTNRM, NY SCALE 1' 'JIG car - 1/: .=J._O.. 10 11-99 4 DWC, 'Au 000 L 01, 2' 8' 8' Pressure Treated Wooden Deck I 10, with 2 Cantilever 6' 10, Jr—t- T-9" 24' — 72" Sliding Door 17-1 1/2" I hour fire rated self closing metal door. 3' Garage Door 9, I Stud bearing wall with 5/8" fire rated Cut or expansion joint to control cracking. wallboard on both sides. 7' 7' 7' 7 20' li 2' 2' 2. E I LW 12 x 40 1 Beam welded at both ends to steel bearing, plates. Garage Door I. 3' Railing (both sides) 32" x windows (5) 3'_9 - -- - -- — -- - -- J- 6, — -- — -- ---- -- i. 54' 13'-9" IT-9" SHERLITA AMLER, MD, MS, FAAP Commissioner of Health-:- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 John Impellizeri 248 Barger Street Putnam Valley, New York 10579 Dear Mr. Impellizeri: December 11, 2006 ROBERT J. BONDI ; . gynty &xecutive ROBERT MORRIS, PE Director of Environmental Health Re: Addition Approval — Impellizeri No Increase in Number of Bedrooms 248 Barger Street (T) Putnam Valley, TM# 74.10 -1 -37 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 December 11, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Mike Luke Public Health Sanitarian ML:cj cc: B.I. (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 OCT -21 -2005 09:31 FROM :PUTNAM COUNTY DEPART 845 -278 -7921 SIMMLITA AMLER, MID, MS, FAAP . Conu�irsiohcr ojflealt>a LORE 8 Y A MOF+61 AR!, PEN. MSitl Associate CY>'ntwwtoirergftlealth DEPARTMENT OF HEALTH 1. Geneva !toad, Brewster, New York 10509 TO;95268B06 Ps3 /4 ROBERT J. BONDI ADDITIONAUL TT 0 It1ESIDEiVT IL i STREET 2��' �o1r_— _N s + TOipp P(4,4n Ow VV- At TAX MA P0. 7 —J71 NAME ADDRREESS_. DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMkl—CATION PROPOSED N OF BEDROOMS � (FROM CERT. OF OCCUPANCY OR FROM BUILDING INSPEC 1708) Q"Aay addition which is comiderod a bedroom regn m formal approval of plans (Construction permit) prepared by a Professional Enpmr or Registered Arichitc et in Accordance with applicable sectiona of the Putnam: County Sanitary Code. Please submit this ibnn and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 279-6130. :.... - a ocd ix wf� y froer -for 10®:Of.t . Cc7dfW� . 2. Sketches of existing floor plan (drawn to scale, all bving area Including basement) 3. Two Bets of proposed floor plan (drawn to scale — with name, street and tax map #) j *Non - professional sketches are acceptable .4. Copy of survey showing well and septic joeations to the best of your knowledge. Include date of installation if down. Label all wells and septic systems within 200 feet i of the property line, Contact this office with any questions. 5. Copy of Certificate of Occupancy from Towle or CcrdArAtion from Building Dept. with legal bc&wm count of dwelling. ! •'t0 YCE U, Sir COPVXNTS w�5 Raviroarnemad ileattb (845) 27A -6130, Fax (845) 279 -7921 Numing Servlees (845) 279 -058 WIC (845) 278 -66711 Fax (845) 278.6985 (Early InterventioutPraahool (845) 278-66014 Fax (845) 278 -6648 OCT- 21-2005 09:31 FROM:PUTNAM COLINTY DEPART 845 -278 -7921 TO:95268806 P:4/4 SlfiL.ItI.Y!'AANILF. MS;JRA P Commissioner of Heahh LORETTA MOLINARL RK MSN Associate Commissioner ofNealth County Executive i DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Leal Bedroom Count f Re: IMPELLI ZERI (Owner's Name) Tax Map # - 7410-1-17 v "A.ddress: 24A 'RgrOPY .Sfrpet I Town: put;3 azM Vallpy Year Built: � n n � j According to records maintained by the Town, the above noted dwelling, IS xx in compliance with Town Code. is not in compliance with Town Code, The Legal Bedroom Count is: L v ' TW information bas been obtained from: Certificate of Occupancy: 12/21/2000 Other- Assist. Building Inspector. . , John W . A 1.1 en 11/29/06 Date £eviromaenod Health (945) 278 -6130 Fax (845) 278.7921 Nursing Services ($41) 278 -6558 Fax (845) 278.6026 WIC (945) 278 -6678 i Nursing Rome Care Fax (845) 278 -6085 Early laterveotionlPreschool ($45) 278.5014 Fax (845) 278-6648 I PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE ]DISPOSAL SYSTEM REPAID OFFICIAL USE ONLY ♦ r L1J� SITE LOCATION 2 611 13 6/ TM# OWNER'S NAME PHONE MAILING ADDRESS . �;7 c/ PERSON INTERVIEWED U PCHD Complaint # —fie I& Relationship (i.e., owner, tenant, etc. I+ �1"I TYPE FACILITY PROPOSED INSTALLER,�I ,5 PHONE_ ADDRESS �G� 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. I, as owner, or re orte agent o er agree to the conditions stated on this form. r � SIGNATURE TITLE DATE 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 approvedy is Signature & Title ZDAd/ COPIES: white (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML 70 - - ff- J. z '07 1` %KM Cw* C)Gpwtmrd of Healsh 4,7 —,A, rouimi.An ^4 Environmental Health S.GrVIOG - a rvoted V'I� \A X , / /,t, — for conformance wfth 3 ulations of the W Auk% a6d Reg Depattment I , f 1*4 1 2-15'OzY E- S A 0� 3 ............... vig lip 0 +0 70 - - ff- J. z '07 1` %KM Cw* C)Gpwtmrd of Healsh 4,7 —,A, rouimi.An ^4 Environmental Health S.GrVIOG - a rvoted V'I� \A X , / /,t, — for conformance wfth 3 ulations of the W Auk% a6d Reg Depattment I , f 1*4 1 2-15'OzY E- S A f • i P • L e 1.^ a ILA L� lit TAr1�(� JV 42. 4 4041 b 11 3b, 62 Ac TLC 1 � D ,IV-talon off' Environmental Health Servioeb approved ate noted for oonform&nce with ipplApable; Was and Rp Oul qtionv of the i"Mco "I '74 'AR Lrn 1 (20— Lr Lt S 4ET- I _i IQ T", I.-- - - il- 104 1 10 40 )JO 40 i 17A 4d i S2' 1/7 JIS7 4ET- I r I , Pro Basement Floor Plan 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2�0 77 28 2 9 30 31 32 33 S d ng Glass Door 40 41 42 43 44 45 W 4dow 49 50 51 52 26 0 15 Er "eaerdl��lelTenkaCloset 24 2 , r =h �VY�a e Softer�i :u� em - 23 3 awl _ tr ? 22 q i4� 9 g�' �ry 21 6 g ',G s`'' ttti 20 7 Gerage� �r _ sa t 18 8 t •+ �,�' u ce, fir• � ��� 17 .• 9 s {* m�a �� 88U1fOOT 10 Uf_�� s n y x F Tub FINISHED SPACE 16 15 die " {ru4�� s�( Sink av Wood 14 12.,E w.r -£`e� - # 1y r9 yr _` `�' ;1'Y'.i' ' a{s'. trt':`a='.fi StOVe 13 14:. t 12 15 16?5 9 17 " rr Y s New 8 I 18 s� r jj� r ye Stairs 7 19 Gera9 a ran 6 20 -„ k s O71 ask' 5 21 �.�, ls. f +err �5., ��� .rr X ° � � � q °. 22 vx { pz 3 i. 23 �� s s 2 1, 52 51 50 49 8 7 6 5 4 3 2 1 0 48 47 48 45 44 43 42 41 40 39 38 37 36 35 34 33 32131113012912812712919 5 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 t ` VU NAIA COUNT( LE PART h TENT OF HEALTH I HOUSE PRAMS APPROI 'J L /EG/ROOiA C01:NT ? B��UiiO�OjiSa' • Signature & Title Date i I. � 1 e fi 39' -10" 35' -6 1)38' -5" 4242 0 fi fi fi ,v :r 4 I h m � �•b 4, n fi 28' -1 1/2" ':3(465 16' -7 1/2" fi 14' -3" 34652 1 3465 ,r 3465 34' -1 112 2 i %:'Ys' PUTNAA4 COUNTY DEPARTMENT# 1 3H � 38' -0" HOUSE PLANS APPROVED FOR BEDROOM pOUNT ONLY; Ne,, YOrk mate: BEOAOMS To the best of my Imoviedge, belief e rn -tom ,�1 /JAS /Z / // /Ob /' L thh Factory Manufactured Home from n rystem set of FMH plans pre katbn No. 1387. Mwfneiurer's No. ate Da 55-00. vhich has not been modFl 818 .This 2. the energy portion of tNs FMH plan Part 5 of the Nev York State Energy (Energy Code) and Is m ful compliance - -- 5-0 - -- - a 11' -i` 1/2 2'- 13'-9" 1' -7" i 1 DEPL TB CD18 y I 1 TF 1 I a cN cli b BRTH 2 A i n I BE 2 O m 1 N42 y m in OV60O 18 cli . 30 30 ; R`) 30 30 t C3 m I I o I I m I I 0 J 2- 20"x19' ML 2-16"x2(( ML SHP LOOSE GYP. TKS RRER ' 18'-0 1/2" 11 1 511>P LOOSE GM. Try WMA N 9' -11 1/2" cl� 00 �I - I o L HE 2 rn BE 1 Raft 8Y BL DR PG-�n�T No. I. • .d to ' (OPEN TP BELOW) 19' -0" 13' -7" 1T -3 1/2";D" - A 3465 ,r 3465 34' -1 112 2 i %:'Ys' PUTNAA4 COUNTY DEPARTMENT# 1 3H � 38' -0" HOUSE PLANS APPROVED FOR BEDROOM pOUNT ONLY; Ne,, YOrk mate: BEOAOMS To the best of my Imoviedge, belief e rn -tom ,�1 /JAS /Z / // /Ob /' L thh Factory Manufactured Home from n rystem set of FMH plans pre katbn No. 1387. Mwfneiurer's No. ate Da 55-00. vhich has not been modFl 818 .This 2. the energy portion of tNs FMH plan Part 5 of the Nev York State Energy (Energy Code) and Is m ful compliance BOH7244- 3/3618RT y ---- 3 3465 34' -1 112 2 i %:'Ys' 20' -2" 27'-0" WN4DOW a 12 7/12 DORMEfi' .. v ..sa. •.:i Me beenr� .;;,�... Cth the no Co Cod4rtia e with the Elrorglr;rC,ode•. ^.i. .t t 3465 6'-0" A `; ; ,� kLV: PREMIER BUILDERS 4 -18 -00 DM . one ar MACY NO= M 4 -5 -00 DM ROL Bev 337 • AAM. Pa MM ' (71A 546 -M 10 -14 -99 JC TRIPLE -M' / CYRAN 4536 2 STY FLOOR PLAN W/ DUCT PLFN 8 -6 aJLG 01n -11 -99 91//4 " =1' -0" buc 000_ 39' -4 112" ' ZT-G 1/4" 17' -1 1/2", 6' -6" 45-11 112" 32' -4" 22' -7 1/2" , t 3037 :' I 3465 72VINYL 34652 t` i - - - ea W3642 j p- _ ® ®� 1 2 2 W2441 -1364 - '; 9' -4" ! . D W c.'r�P DW e24 22'-1 1/2" Ny O 00 ° An co KITCHEN 'x FAMILY RM i m 1 r i• 1 1 o �; 48WS 2 2 " i ` - - - - - - - - RW3524 U2496 T -9" S -3 1/2" 3 __________ - to N 17 cn L ti T. U c 1 iJ� DATE DINING RM i __ r x. r PERMIT NO. � q, - - - - i i - m _ LIVING RM �7G _ in . 1 1 FOYER - = ` k .. ' -(OPEN TO fi80VE) C3 t4, ,! 3465 3465 75FRENCH , • 3465 3465 34"=1 1/2" Rc L :�NI`ED TO PUiXAM COUNTY DEPARTMENT Ok@ALTH 39'-0" 27' -0" I i ,. ;. HOUSE PLANS APPROVED FOR 5= ' ?DEWS = 2"6 BEDROOM COUNT ONLY, ?� BEDROOMS New Ye k Nets To the beat of my Imovledge, beeef and professional }Idgwn t s RRR. WALL= 2X4 ; ;. CLG 'HGT= 9' -0" p ! PREMIER BUILDERS REV: 4 -18 -00 DM � �p -c "-w� L this Feat�pprryy Manufactured Flame TM plan :ms been approved / L l "l o r from, syskein aet oP FMH plans previanly approved by OHM �atJan ADOTL SSMT COL - a EL - ■- A ac ? YN.ry 70!(K P.O. 6mt 337 . N MIM ' (7171 546-846 4 -5 -00 OM 10 -14 -99 JG No. 1351, Memlfacturer's Fb. 1387, [;xpcatbn Dnke 55-0D vkch has not bean modfbd n DESIGN SNOW TRIPLE -M CYRRN / SWalln any Ruiner. LORD= 4 0 4536 2 the eu+ergy porHan of ttia FMH plan has bear, prepared uaig $/12 24 "OC Part 5 of the New York State Energy Comerrjl p Comirvctbn Code 1 STY FLOOR PLAN W/ DUCT 518_6 (Energy Code) and is h fU0 comp8ance with the, Energy Code'. �DEST= PUTNRM, NY own Br: oaTe sale ow Nw i.: s JLG 10 -11 -99 1/4 " =1' 0 000 ' i t 170ti, Re f0 as A , Do. i Of, O oJP IQ 4, �; / Surveyors Notes: 1. This survey is subjec 2. Subsurface structure and date of this survey, 3. Surveyed as per dee / existing monument four 4:The alteration of this misleading, confusing z buyers. An other licens� survey plat prepared by cons. man. jd. i DATED 3/25/94 FROM \ PROFESSIONAL LAN, 5. Subject to any condi ways /easements of rec 170ti, Re f0 as A , Do. i Of, O oJP IQ 0 t. Currant RasPmPnt Flnnr Plan i 01 11 21 31 41 51-61 71 81 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25, 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Window ! Sliding Glass Door Window '. flF ' Water,Heater gWe Fiek 25 Qv Water =Soften( ste n i 24 22 Ut>liy Room, 21 Gera Door,: 20 � r 19 18 _ 17 UNFINISHED SPACE 16 �I 15 13 12 d F { Zt 10 a Gregg Door ,° Stairs 8 'as. _ ��iaa�34 h zed f 4 T I Tank 6 z Y -b �V 4 UT' L 5 2 0 52 51.50.49 48 47: 4.6 ,45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 a: 1 � r W��,�:� -Il t, r, is s f I �1: