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631- 589 -8100
74.14 -1 -14
BOX 29
03657
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03657
/�fq� *'�
Address C ;
License No.
Any person occupying premises served by the above syste �shpri{p►pt�� a such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the Sep stem 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 modification or change when, in the Judgment of the Commissioner of Health, such revocati , modification or change is necessary,
, 6 Date ��— By C
Title -�
-� PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of
Environmental Health Services, Carmel, N. Y. 10512
CERTIFICATE. OF CONSTRUCTION COMPS IANCE FQR SEWAGE - ^lSPOSAL SYSTFA7
4-1
Division of Environmental Health Services, Carmel, N. Y. 10512
Town or Village !�
Located at — �� •h jo:�_
Tax Map Block
Owner o s ee f4 N, I V E s
�]�
Lot
Separate Sewerage System built by JIB% r.il
____ 1 ob
w 1�!{ 1 $ Address l�y4l
"...9_ . �76'l�f�-
Consisting of
..^^
(C7A A ���j$��E'
Gal. Septic Tank
and iLl
P ,'
Other requirements
Located at � ,q/3,1
0C
Water Supply: Public Supply From
J
Private Supply Drilled By
��
LAZ. ® C
Address
Job
Building Type 4 i
�a
f Bedrooms Date Permit Issuetl
> '
Has Erosion Control Been Completed?
Owner ase_p%
Building Type
I certify that the system(s) as listed serving the
Address
V'
1-
above
attached), and in accordance with the standards, r
s85 c u d
- yeas shown on the plans S -the completed work (copies of which are
d r ffl pt
711/69
the permit issu by Putnam County
Department of Health.
Date 1C
va-
236 lineal
Jb
feet X L
c
P. E. R.A.
/�fq� *'�
Address C ;
License No.
Any person occupying premises served by the above syste �shpri{p►pt�� a such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the Sep stem 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 modification or change when, in the Judgment of the Commissioner of Health, such revocati , modification or change is necessary,
, 6 Date ��— By C
Title -�
Water Supply: Public Supply From
Private Supply to be drilled by
...5s o 46-44
Other Requirements
ua! BCE /A; O Z-
I represent that I am wholly and completely responsible for the f the proposed system(s); 1) that the' separate sewage disposal system
above described will be constructed as shown on the approved • n accordance with the standards, rules and regulations oT t e u nam
County Department of Health, and that on completion th ifleat uction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarant u ' h q his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said se sa du eriod of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Constructio i - e i ai m or any repairs t ereto; 2) that the drilled well described above
will be located as shown on the approved plan and that sai will a�' cc I& a with the Sta rds, rules and regula i� ons of the Putnam
County Department of Healt
Date 7 77 g >'...,+, _
P.E. R.A.
Address I —w
APPROVED FOR CONSTRUCTION: This approval expires o E
revocable for cause or may be amended or modified when consid e
requires a new / permit. Approved for disposal of domestic
Date 13 / 6 By
License No. =5 °--
sued unless construction of the building has been undertaken and is
he Co issioner of Health. Any change or alteration of construction
3r ivat wa sulZply only.
Title �Cjwsl�'Y
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
�ONST^DG7ION- P-
E13-Il I-T-- FOR- SE4'IiAC-E - DiSPOSAL.:SYSTEM - = -
"...9_ . �76'l�f�-
Ir ,I�� /
C7�
Town or Village
'
Located at � ,q/3,1
0C
'fin
Block
Subdivision
LAZ. ® C
Lot /�'
Job
��J4CS
> '
�
Owner ase_p%
Building Type
-i 0-i— w f /�1 L
I- Lot Area S7
Address
V'
1-
Number of Bedrooms
Total Habitable Space
�.
`) �e� odd
Square Feet
n
Separate Sewerage System tg consist of 2_ D Gal. Septic Tank
236 lineal
Jb
feet X L
width trench
To be constructed by
��'
Address Ur ��
- t
Water Supply: Public Supply From
Private Supply to be drilled by
...5s o 46-44
Other Requirements
ua! BCE /A; O Z-
I represent that I am wholly and completely responsible for the f the proposed system(s); 1) that the' separate sewage disposal system
above described will be constructed as shown on the approved • n accordance with the standards, rules and regulations oT t e u nam
County Department of Health, and that on completion th ifleat uction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarant u ' h q his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said se sa du eriod of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Constructio i - e i ai m or any repairs t ereto; 2) that the drilled well described above
will be located as shown on the approved plan and that sai will a�' cc I& a with the Sta rds, rules and regula i� ons of the Putnam
County Department of Healt
Date 7 77 g >'...,+, _
P.E. R.A.
Address I —w
APPROVED FOR CONSTRUCTION: This approval expires o E
revocable for cause or may be amended or modified when consid e
requires a new / permit. Approved for disposal of domestic
Date 13 / 6 By
License No. =5 °--
sued unless construction of the building has been undertaken and is
he Co issioner of Health. Any change or alteration of construction
3r ivat wa sulZply only.
Title �Cjwsl�'Y
Owner or Purchaser of Building Municipality
Build�'i"ng
Constructed by
Location - Street Block
S 10 F A; °r-, AL _ `5
Building Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the'sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
_
_ :.vises. o f the: P_: -tnam ,Coursty ep_artment, of _Heal u i_:as..:t� .w_r, 'h r* `o.r. .ring t. e'
..._ - failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this day of ���% 19G Signature -�
Title
If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
PUTNAM OF I.1rAr,Tii
O
DIVTSTn\ op. r\i'f i')`�. �E' \Tr1r, 11F11T,TI1 Si'rtV[CF S
Date 1 - 3
Re: Property of jose. f'H %�iZ e�x
Located at 2oc,+C 1�,z106 / y►rni or- .4Al
n (' 8 Block f
c-,. Lot
Gentlemen:
This letter is to authorize STANLEY J. LAN ®ER -
a duly licensed professional engineer ` or registered architect
(Indicate)
to apply for a Construction Permit for a separate secaage system; to
serve the above noted property in accordance with the standards, rules .
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary - papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 14S or
147, Education Law, the Public Health Law, and the Putnam County Sani-
Very truly yours,
Signed
Owner of Property`.
Co tersigned/ '� 'C6le'�l
P E. Rte. Address
• s
RT , 11.1 ,
MER
������r�sA. 'elephone
ess
BOX. 267
AW
Telephone h` /vimho.
A
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
•. e.- r•vor'w•e. ^c+..�c: •.V .; ..' . -..,s: �rt.'Ga..' ... -, a .. �. � .... .. .� -.
LORETTA MOLINARI, RN, MSN
Associate Commissioner. of Health
ROBERT J. BONDI
_ County F..xecudlve:._: ...._ .
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 105.09
ROBERT MORRIS, PE
Director o Environmental Health
ADDITION APPLICATION RESIDENTIAL ONLY
STREET 24 sHAm "Cm -b TOWN 120TN44% AUej TAX MAP#
NAME GSA t'2 (_ ;3I Mi ek PHONE LW S) S28 - 7 JUS PCHD# ( '
Cell (911) .3 q!,� -X6105 i
MAILING
ADDRESS Z9 SMM1zdfX - aIvE ?vTAmm V*c Lz-y t4Y ( 0s77
DESCRIPTION OF
ADDITION r lm SH 13A 5 6mEAl r Torzno&i
NUMBER OF EXISTING BEDROOMS _4__ 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:Uept.:1. Geneva:Rd�
✓1. Certified check or money order for $100.00.
Sketches of existing floor plan (drawn to scale, all living area including basement)
3. Two sets of proposed floor plan (drawn to scale -. with name, street and tax map #)
*Non- professional sketches are acceptable .
f4. Copy of survey showing well and septic locations 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.
,15. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
- OkETU MOLINARL IRN;`Cvijty
Associate Commissioner of Health
February 17, 2009
Carl Patrick
29 Shamrock Drive
Putnam Valley, NY 10579
Dear Mr. Patrick:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. -BOND[
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Addition- A- 020 -69
No Increase in Number of Bedrooms
29 Shamrock Drive
(T) Putnam Valley, T. M. # 74.14 -1 -14
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 February 17, 2009. 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 up0ated with water saving devices, i.e., new low flush
"toilets; eArfctors for shower beans and faucets etc. - -�
4. This 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 (845) 278 -6130, ext. 2261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -51.86 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,
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 16509
Town Legal Bedroom Count
Re: PATRICK (Owner's Name)
Tax Map #: 74-14-1-14
Address: 99 Shamrock Drive
Town: Putnam Valley
Year Built:
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: 4
This information has been obtained from:
Certificate of Occupancy: 76 -1029 (attached).
Other:
l Inspector V Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
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
County Executive
A
I
....................... t 19 ... 7.6 TOWN OF PUTNAM VALLEY
N9 76-3 32
e-Dyifk, 2.,
.....................
of -and under f..Vie `siod f To'
ceffmw Fkw L" x End 4 1 FE�I�edrk Plumbing 2)6baths,, laundry
finished Description ...........................................................
x shingle shake AM. Phone
Stone Driveway veway Qlascript .............. ............................... 7-
ion, .........
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Gwage �Alan ...rotary:4r 1-1-ed per—
Field Plot
Additional Information ..... 4BR.j!4—DR. KIT .FAM R. 2 FIREPLACES. 1 DBL VANITY
............ ............ I ................................................ ...... I ............................................................ I .............................................................
This application must be accompanied by a copy of surveyor's map and complete plans, specifications and all information required
by the Zoning Ordinance and Sanitary Code of the Town of Putnam Valley when requested by. inspector.
Fee $ ........ Building Estimated
Area 2016 s.f. Cost .44..,00.0..—...
$ .......... .00.'sanitary �Aea
. .. ......
Date Zoning Board Approval ................ . ......................... ............. ...... ....... .
................. Plurnbiag
$ ................ 15..1)0. well
------------------------------------------------------
MANAGER
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COPY FOR BUILDING DEPARTMENT. THIS COPY OF CMFICAU IMN NOT BE ALTERED IN. ANY MMMER.
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE�BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner.,1 Address
Located at Street
"Al �/� ec,� ki✓ � Block � Lot
indicate nearest cross,s ree
Munici pa lit Y,� ,. -,. � Watershed��srL %�a.,-V
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run
apse
Depth to Water
Water ve
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
1.40
2
5
Notes: 1) Te'�ts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
Address -AUNWAI
THIS SPACE FOR USE BY HEALTH DEPART -N
Soil Rate Approved Sq. Ft/Ca- y Date
TEST PIT DATA REQUIRED
TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE 'No.
HOLE NO.
HOLE
G.L.
14-
4-
611
121f
1-7
1811
24"
4
3011
1#1
3 6 it
4211
48
4
5411
6011
0
66
72
7811
41
A/6)
INDICATE
LEVEL AT WHICH GROUND WATER
IS ENCOUNTERED
,INDICATE
LEVEL TO WHICH ,�R LEVEL
EL RISES AFTER BEING
ENCOUNTERED
TESTS MADE BY
Date
DESIGN
Soil Rate Used Min/lf'Drop:
S.D. Usable Area Provided j/
No. of Bedrooms .4 Septic Tank Capacity /ZJ.'-v Gals. Type Pre' c i,
Absorption Area Provided *_Z-46
L.F.x24" 5b"
width -t-r—en—cH-.
STANLEY I LM
Other
7.77ff -
Address -AUNWAI
THIS SPACE FOR USE BY HEALTH DEPART -N
Soil Rate Approved Sq. Ft/Ca- y Date
* PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
» COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
OwnerJo-'i-remA HbLES Address � &Qe &a *"r P1JT9A,'1
,�AN ^tr •.. T
Located -at (Street 51'4A1� Aor_c4- Qgwk =:_ s. !off Block Lot
kindica e nearest cross street)
Municipalit RJTWA jg Watershed 1"� SK�LC t'f'at.�.y�✓ b�2oc,�
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
_.
L
Number CLOCK TIME
PERCOLATION
PERCOLATION
apse
Depth to Water
a er ve
No.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop in
Min. /in drop
Inches
Inches
Inches
I ' � 1415
4S
4.3
4-6
49
3
19
14-
4-6,
47
4
Pu i .144-1 [.. !
_.
L
jx s:3 °Z.a'l Z =c► �3 X51, S"3 ¢ - -101 .
4
1
nal-wW
Notes: 1) Tuts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) bepth measurements to be made from top of hole.
1
nal-wW
Notes: 1) Tuts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) bepth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS FNCOUNTERED IN TEST HOLES
DEPTH
HOLE NO. P%
G.L.
6"
J L�
12"
18"
a
4
24"
14"Jo flro&A �'
30 t'
36..
A:: ;.
`t2"
48"
5411
6o"
66"
72 l
78„
84
J y T
HOLE .NO.
H
q
a
HOLE NO P66 Z
A
i
r.
INDICATE LEVEL AT WHICH GROUND WATER IS .ENCOUNTERED
INDICATE LEVEL TO WHICH. AT R -LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY E - Date lli� '-'7,
DESIGN
Soil Mate Used M r/l "Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity -a Gals. Typed,
Absorption Area Provi d'By L.F.x2411 36" width trench.
other
r.
Address
THIS SPACE FOR USE BY HEALTH
Soil Rate Approved Sq. No.3 d by Date
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