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HomeMy WebLinkAbout3687DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -16 BOX 29 03687 . ,}. 1 Ir - L . :g 0 �- . - , f �'!' . . . , J6 ..��. 03687 I/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION- OgkMIT FOR SEWAGE TREATMENT SYST PERMIT # �--- o Located at L Town or Village 4 Alz Va ll� Subdivision name Subd. Lot # Tax Map Block f Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name Le) U/S d-e✓ lbe Date of Previous Approval Mailing Address -Came r ; T' ?/G , !' y G 61 �� Zip Amount of Fee Enclosed ©� Building Type A d1/14`ot Area No. of Bedrooms Design Flow GPD �I Fill Section Only Depth Volume II PCHD NOTIFICATION IS REQUIRED WHEN FILL IS UUMPLl:TED Il 05 C--X) Separate Sewerage System to consist of S­0 gallon septic tank and J 7.o 2 9'T (PP.6,P) Other Requirements: To be constructed by Water Supply: Public Supply From Address Address Private-Supply-Drilled by--- . ddre - - _ . _..._:....... - 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 Director /Commissioner 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 7/1,s-// License # 5"327 , 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 Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. B v itle: Date: 7/.-) 7 J— Wopy - HD File; Yellow copy - Buildil'ig Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 JOHN KARELL, JR., P.E. 121 CUSHMAN ROAD PATTERSON, NEW YORK, 12563 845- 878 -7894 FAX 845 878 4939 iack4911nyahoo.com August 20, 2012 Gene Reed Putnam County Department of Health RESPONSE TO COMMENTS GENE REED DATED AUGUST 6, 2012 1. The existing septic tank is 1000 gallons. A 750 gallon septic tank is proposed. 2. There are no adjoining wells within 200 feet of the proposed septic, except as shown on this plan. A note to that effect has been provided on the plan. 3. The topo line indicated a 5 -is correct. This topography was confirmed in the field by the ter. Jo ell, Jr., P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..,..,.:...; X APPS J€CA "t' ®1v FOIE APi'RO%AI `0F PL- AN$-JHOR " . - A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant, 40 y ®S h C, P v 4LAA!m Lla Name of Project: D-e L �XA -C, d i A 3. Location: TN: (! dy0 Vf � � 4. Design Professional: 9�2 h �q L4@ tCZ1 5. Address: 12-1 &S rA A H id 6. Drainage Basir. e`�b �,J ✓� �a� ��� N f 2 7. Tyne of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No `t'6-9 Type Status (check one) ............................:......... ............................... Type I Exempt Type H Unlisted A 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No �V 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....................................................... ............................... . Yes/No 0 O 13....... If so, have plans been submitted to such authorities? .................................. Yes/No 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of sewage treatment system discharge ........................ surface water >X groundwater 16. If surface water discharge, what is the stream class designation? .......................... 17. Waters index number (surface) .............................................................. I.............. 18. 19. 20. 21. 22. 24. Is project located near a public water supply system? . ............................... Yes/No No If yes, name of water supply Distance to water supply Is project site near a public sewage collection or treatment system? .......... Yes/No pid Name of sewage system °° Distance to sew - a system Date test holes observed 'I �' 23 Project design flow (gallons per day) ................... g Name of Health Inspectors &e-1 ....... 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No R! V ` 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No Rev. 11/02 Form PC g. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/N( JJ 6 :. "Wetlands ID number ............................................ .......................................................... Is Wetlands Permit reauired? ............... .... Yes/No Has application been made to Town or Local DEC Yes/No ........................... 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .......................................... .........................Yes/No 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 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? . ........................Yes/No, 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No 0 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No N 0 36. Tax Map ID Number .............. ............................... Map -7 Y, Block �_ Lot 37. Approved plans are to be returned to ................ Applicant Design Professional _ - -NOTE: A41 applications for rEVicw a:t3 approval ofa r�ew SSTs to. be located within the NYYC-Watershed sha:: be sent to the Department. and need not be sent in duplicate to the DEP. although the proiect may reauirc E%F" 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 pens or the creation of impervious surfaces, and the proiect applicant should obtain the appropriate forms for sii�h 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 IteT 1, the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply 'with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to -the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFIC24L TITLES: Mailing Address: ........................... Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ .. ,. .t .t'. a- :�•ir. ;•._. 4i -.n`.. S.e :. -.: .:vin.. ,��: .. r.i .. ., .. � .._ ... c.. _i� :�•�n_:•� yy .L .. n iw4 P. -� v .r ➢!.'i YP "'. r. ri ... .. Yl:i .<v. . LETTER OF AUTHORIZATION RE: Property of L o U i l� Located at 4+D S 6 74 �e TN Q Ljka M y a +�e V Tax Map # 7 / Bloci ! Lot 1 , Subdivision of Subdivision Lot # Filed Map # '° Date Filed Gentlemen: kA This letter is to authorize �A n re l � ,. J r f a duly licensed Professional Engineer 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 rq behalf in connection with this matter and to supervise the construction of said wastewater tretmegj and/or water supply systems in conformity with the provisions of Article 145 and/or .147 of the Education Law, the Public Health Law, and the Putnam Co Code. Countersigned: P.E., R.A., # -5" Mailing Address Pao d State _A Zip /Z- 3 Telephone: W 7 P 7 9f a Very truly yours, _Signed: (Owner of Property) Mailing Address: `YF.1 Vail" State / i Zip /Qj- 7 Telephone: `/ -N—S- Z. `°' 69/ qS• Form LA -97 REBECCA WITTENBERG, RN, BSN Public Health Director RORER ]T iVi€ RRI3; PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845 ) 808 -1390 Fax # (845) 278 -7921 ADDITION APPLICATION RESIDENTIAL ONLY MARYELLEN ODELL County Executive Dim . M.J. M!M STREET '1V WW5K15,Pr LAAlf TOWN RZW4719!/ OyTAX MAP #074,17 - /- Ifo NAME _/-0V/5 b rM4, 0&,P,5ENE PHONE ?/4i •52-2 -4195, PCHD# MAILING 46) 56A"eK sz'P' 411AJ' ADDRESS rCLVAI Qi— FYJ7'7 1Vn V44A6�,, At// 16579 DESCRIPTION OF IVOW 2�'® r-l( , 1Wv1 -71o7v (xecAat7.rAj � ADDITION /V!7" X71'6 / ST ptooi'C *NUMBER OF EXISTING BEDROOMS 3; NUMBER OF PROPOSED NEW BEDROOMS J * (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, _._ _... �....__... Brewster, I'4-Y 1.0509; Phare:- (o45.)-8fl8 =1390. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale - with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE r COMMENTS A/C Aj /e-6 e Vt. �:C�4' 4. i ABECCA WMENBERG, RN, BSN j.. Public Health Director ROBERT IMORRtS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845:) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: Del. Bene (Owner's Name) Tax Map# 74.17 -1 -16 Address: 40 Somerset Lane Town: Putnam Valley Year Built: 1952 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: 3 This information has been obtained from: Certificate of Occupancy: C0 #1988 -54 & C0112001 -207 Other: The plans for the proposed addition are considered: xx Addition to existing house only Teardown and/or re -build allowed under Town Regulations 'e�5;A 9128132 wilding Inspector , John H. Landi Date 5. AURYELLEN ODELL County Executive or CE-KI"TIFICATE OF COMPLIANCEHOCCUPANCY CERTIFICATE NO.: 2001-207 PERMIT NO.: 2000- 380 'I'M#: 74.17-1-16 DATE: October 16, 2001 LOCATION: 40 SOMERSET LANE ISSUED TO: DEL BENE LOUIS & GAIL T hi f -i the r-1:3 t r I -LC L First Floor Addition (611 sf); Second Story Addition (1309 sf); 1st Floor Renovation; Front Porch (181 x 6); Balcony (81 x 161). The arp'Lic-artt ha 1[ 4 r)q heretofon--- filed an --a-upl4LcatLon for a bui.1,Ji perm t pursuant to- t i--L e Town S 's In i t a r y c. &� the U n i f o r I �tL Bu,`L-Iciirl"T & Fire anti the Laws in effect in the Town of Putnam Putnam t%1Y, having paid ti-le required fee therefor a rl c1 i um,Jersigned havirig r:,y pezL o i- al ii -t3p2ctio ascertai ned t hat the a p p 11 a, ri t i-t a s subsequent'Lv proceeded with t rl e e r -C t i (-) rl c, r r e q - - lnei I- s f 4 -1 laws as aroreinentiol,le—.; 1 tlf-lat. s,aid arid materials met every of tiiie law--- anci that tjla preR!13�--S have Fjj-iV co.iq?leted ar-od are rE--aci-,Vr for ,>,_r:- t-quancy pursuanit to the prc)�,;islons therefore, 4 3 this of corcLC)J-iarice/ccc.t-�,rian--, 'i under the e -�f Putnai,,L Vall, al �-,f t�-Ie Totfn c TOWN OF PUTNAM VALLEYI. N, Y-'- By: CODE ENFORCEMENT OFFICER v CERTIFICATE OF OCCUPANCY - A D D I 1-101\, ,dicate of Occupancy No....§A7� .. Application No.... �X� 8j-1412 p cy /'�.:.:..... PP nation of Premises ...Somerset Lane : ..........:: : x°:: ° : :: Y.... ..' L4' UeIBe1 :............... .......... .............40..._..omer - r- .......... - I�u Jy. of... I..!, s�X? .. ............tn�rn...4.�a.�.l.ey aving heretofore filed, an application for a building permit pursuant to the Zoning Ordinance, Sanitary Code and the Ioi* in effect in the Town of Putnam Valley, Putnam County, New York, having paid the .required f1E Werefor and the undersigned having by personal inspection ascertained that the appplicant has s,�} _�,� equently proceeded with the erection or improvement of the proposed struc- ture in compliance 4ith:the requirements of the laws as aforementioned and that the said work and materials ' met every requirement of the laws as aforementioned and that the premises have now been fully c$� and are ready for occupancy pursuant to the provisions of law, Now, - zee _this o occupancy is hereby issued under the seal of the Town of Putnam Valley-;this, day of .. ..Auil ................... 193.. Not valid unka signed in ink by a duly authorized agent TOWN 07fTNAN VALLE ORK of and under the seal of the Town of Putnam Valley. By.... ---.. ' . ............................... I -' _ v 0 D b0 40,b p qcp st vc 0 ®® t a - + i M V.0"alf, 0 IV 14 1 _1 rh __.. .. R S Ins 99 A/ Gam? ®33 ®dO ti j6. t ;nam County Depetit:ntrt t�f H�aait, ~ =sion of , nvjronmp.ntPJ Health Service t tANC. --ed,as noted fc?r Cl\P!1 -Jr zlf e W ar[.ocAc v� :-. blaRulles an i cf ih SLOG. � a n Coto r.ment. a sign�iure & T g05om6�p.5-f---T L � �w V,�y N� I THIS IS TO CERTIFY TH S PLAN AND THAT THE SYa " I INDICATED ON WAS COVERED OVER. THE SYSTEM WAS CO STANDARDS, RULES AND REGULATIONS OF' HEALTH AND THE NEW YORK STATE bEPARI REBECCA w1TTENBERG, RN,. BSN Public Health Director ROBERT MOR1 % PE Director ofEnviromnentd Health March 19, 2012 DEPARTM ENT . OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Louis & Gail DelBene 40 Somerset Lane Putnam Valley, NY 10579 Dear Mr. & Mrs. DelBene: MARYE11,11' y ODEU County Encuft Re: Addition- A- 042 -12 - DelBene 40 Somerset Lane (T) Putnam Valley, T.M. 74.17 -1 -16 I have received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons. i 1. The proposed new rec room is considered a potential bedroom. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from•a professional engineer for four bedrooms.. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, Gene Dee d Senior Engineering Aide GDR:cw March 19, 2012 Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 Attn: Gene D. Reed Re: 40 Somerset Lane Putnam Valley, NY Dear Mr. Reed: Please be advised that the proposed addition above our present dining room /living room is to be used for the sole purpose of a family room /playroom area. This is why we have a balcony over the first floor, a spiral staircase for accessibility from the first floor and no bathrooms have been planned and will never be installed. The reasoning that this can be a future bedroom is incorrect and this letter is to certify that I we will never change its use now or in the future. (Louis Del Bene) 3��� (Gail Del Bene Sworn 4 bc4-,�r e.. me- Date 19 Date l X02 DOROTHEA McHUGH NOTARY PUBLIC, STATE OF NEW YORK No. 01 M06080737 QUALIFIED IN WESTCHESTER COUNTY MY COMMISSION EXPIRES SEPT. 23, 2q 13 Nil E,r Ow N MoM-9. W�K-atG PWP�' ol -4g=, TK C� t 15Z I s -; :; <� .� :i ;: _ �_ .; �` ,�; . � - - =- :, 9 -- 3'b�.. _ �_ .; �` MEMORY TRANSMISSION REPORT FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER 930 TIME MAR -1572.0.12 - QI ;.45PM TEL NUMBER 845218 NAME ENVIRONMENTAL HEALTH 930 MAR-15 01:44PM 82784865 001 MAR-15 01:45PM MAR-15 01:45PM 001 OK *** SUCCESSFUL TX NOT ICE *** CS B OF A Xx r_l9,Qr_rmS-r,_T:_?.%:: (cim-cle: arle) L (73 (Z n T-1 C) Al 4w Realty s.ulz)d_t "ISion A-sbuilt Iii P_ rrl e of 0 =4_e; Own mz- lLF a -milzabia, =L: lzeaz- built: /!2 Othetr- identifying Information: 2 4f7d:7 Spr=t:��aj Person File iw�r.C,07L,�rxs prwzesset h:ti,: Du.ts: LC - y: Led: - >a.... ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 August 6, 2012 Fax # (845) 278 -7921 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: MARYELLEN ODELL County Executive Re: Proposed SSTS Res. of: Louis & Gail Delbene 40 Somerset Lane (T) Putnam Valley, TM 74.17 -1 -16 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows. 1. Previous plans. submitted to this Department indicate a 1,000 gallon septic tank exists for this residence. Please provide documentation to show that it has been replaced with the 1,250 gallon as shown. 2. All adjoining wells need to be shown on the plan.a-.-.. -, 3. Per previously submitted plans, it appears topo line 95 is to be line 94. Is this correct? The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. . Upon receipt of a submission, revised to reflect the above comment, this application will be considered further. Sincerely, b Gene D. Reed Sr. Environmental Health Engineering Aide GDR: cw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEA�TI-I SERVICES :-- DESIGN' .BATA SHEET SL S ACE SEWAGE 1'I� ;A' Mi:Ni SYSTEM Owner oU t ! � Address 110 56 A4X'5P 7® LAfV&C 11 V7A1%1'M 1//i -U_.S7 r 1--' S7` Located at (Street) 44 U So Mt'-j?_S� T Ld9-Pyr,- Tax Map -7 J Block _g^ Lot I 1 (indicate nearest cross street) Municipality PV T UA M VA-UL.-Sy ( ) Watershed 4 J,650d 6-% V E-P_ I SOIL PERCOLATION TEST DATAt Date of Pre - soaking 5) Date of Percolation Test No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water, From.,Geound Surface (Inches) Start Stop Water Level IDrop In Inches Percolation Rate Min/Inch P1 1 10� o3® 3® 4 rte. 2 . t030 it" 3a 7..'L ZOO 3 �lq S 3 i 1 Ov 30 30 2.71, 1-014 y 3 3 4 5 1 2 4 5 1 2 3 4 5 IN U I ✓N: 1. T ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hq�e. Form DD -97 Pg. 1 of 2 Indicate level at which groundwater is encountered Now Indicate level at which mottling is observed MOM Indicate level to which water level rises after being encountered 0 D Deep hole observations made by: 4C. , 1� Date 's- / 2/ Design Professional Name: 77 � 2-k ("a CV) W-A. V..' 14�;iljl PJ� Signature: Design Professional =s Seal 1 ': TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -_. DEPTH ..HOLE NO. NO. . HOLENO. - - ..G.L. r--- ....HOLE ®fib A 0.5' a s 1.0' S lj 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Now Indicate level at which mottling is observed MOM Indicate level to which water level rises after being encountered 0 D Deep hole observations made by: 4C. , 1� Date 's- / 2/ Design Professional Name: 77 � 2-k ("a CV) W-A. V..' 14�;iljl PJ� Signature: Design Professional =s Seal 1 ': EMfll We- ,Mwag a;T Li OJE COUNTY DEPARTMENT OF HEALIlf- J41,1 -1 PLATS IIIOIEI FOR BEDROOM COUNT ONLY. — BEDROOMS 4 -Tko 74.o-i-tr. TALL SUBSEQUENT REVISION/ALTERATIONS TO THESE Hv('-;E PLAA-i MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL I,/WT DOW) M N zop FLOCA-1 V. aao NOTES: --Ad 10 MIN.) ---------- ---------- %NM lw-c�m, _ICJ I NMI iFLAN I-FLOOK, N � MONO. 1 o 4 1 s p mr,� mi i �IAL hl L woo - -- ' � I iw � Ik.,,taaePa�m S p w_ ei S �9'4f 6 i - , Ip \AAl COUNTY DEPARTMENT OF HEALTH auwvu m. - i "±ieUSY, PIAANS APPROVED FOR BEDROOM COUNT ONLY, 2 4 YIIEDNOOets 7740- 7417-(-eL t ALL SUBSEQUENT REVISION(ALTERATIONS TO THESE HVC`SP —PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL 17 A Al !' i ROOM Frzusx- moarw¢.mowscxmm.e ' snow nmo w... �.wo mw u.uxua wnoows • traaz -' . - lKlme. PL` I AA! -I COUNTY DEPARTMENT OF HEA131i � 49-:MPO w�+canspaml�suPn,rv®r . . FUViKai'tcrnl i1NIafPJ SWM s Ineut.lJln1 9rxq, CN +G) 400SP, PLANS APPROVED FOR BEDROOM COUNT ONLY, N f3 041 RFDROON S ; v -, IJA40 7Y r 7 ALL:SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE' -- r PLANti UU.:'P BE SUBMITTED TO THE PCllOH FOR APPROVAL r PO T } BEDRO W zy. 7JPeN REG. RM _ yj Rpy V l ;tenor 1'n . FSVhAVC ZGtI�! :I!O i• T +� s. i, •o I t i I i _ I T -- T.Q1tTC Q� �3 • 1 �i A�Nb �7 �GH'rSIDE.t:LEVAT1QNi C _Pt4PZT_I�FhfZb1.EVATION �;: �� • -I`o 5�. i • , !fib ' — �'�. -- -- LIA - - - - -- - - -- r +ham T HL E�7t TION -- -- - -IOO a i I T .v= zo � . ASPH40 T;„ OR/vE O ° CE,PTJFFIELD O/VL Y TO � °t o \ ` PSq�DL 3 / 1-011 1S 4. R0.S�A.c%vE D�LBE.UE `sue B G? F'PcSr AMERJC4A/j /TLE R, LI CDM.o<sfvy LOT /9 v m � 3. IW4-1? /r/E .1W14C>L4/V.1� Bt.c/k /T5 _fe )4RC4=100 AC � 4/v0 4t S GrUS. QOP. 78= p V J\ PRE/YJJSES f- /E,4EON BE//t/G a L-07 /9 AS PER /YIAP BvTiJc Ep "SECT /O.V A' 0/ PU7iVAA ACRES SA /O /1/%4 P F/L EO /it/ T/-/E. c N,014. M/ COLJIITY CLE,QK;5 OA-. -I-V--4, car (1 057 45 &W /D ,V 8/5. (/ 27 °33!10 E aace� �'�s.o" 3J/. /4' O ,. "I�SN CONC. - Eps Y +■ HLOCK 3 BLDG, 4. TITLE N° -� 'n /y caG /es from the origin /of this survey marked wNh on original of the ,no surveyor s inked seat of his embossed see/ sho // be considered to be Wd true copies. 2BERT E BAXTER B ASSOC. and Surveyors and Planners O. Box 298 R D. /, Box 277 -C 7hopac, N. Y. Hopewell Jcl, N Y 9 -2800 221-1192 „ -- 1-2 / Of NEW Ya c'tP�0F,0.t E. 8, f�9� �i p.j 4943" SURVEY OF PROPERTY — SITUATE IN THE Certifications hereon signify that this'survey was prepared in accordance with the TOWN O� RIJ7�/.4.0 VWZ LE. existing Code of Practice for Lard Surveys adopted by the Ww York Stale Assoc. at Professional Land Sarveyors. Said certifications shall run only to theperson for whom the survey is prepared, and air his behalf to the fills company, governmentO/ 10v 7 / V4 //'/ CoLJ / V T Y agency and lending institution fisted hereon, and to the assignees of the lending in- stilation. Certifications ore not tronsferob /e to addil/ono/ institutions or to sub- sequent owners. NEW YORK Unauthonred a/teratlon or addition to a. survey map bearing o licensed land surveyors SCALE /ri =4� _DATE: IJ�C. 9, Aq° 54 seal is a violation of Section 7209, Sub -dtw% ton 2, of the hew York State Education Low. MONUMENTAT /ON SET MRQ. l6 -, f9B5 NEW YORK CITY DEPARTMENT OF ENVIRONMENTAL PROTECTION NOTES 1_.N0 RESERVOIR OR RESERVOOR STEM EXISTS WITHIN 500 FEET OF THE PROPOSED SSDS UNLESS SHOWN ON THESE- PLANS. 2 NO DEC WETLAND OR SURFACE WATERCOURSE WITHIN 200 FEET OF PROPOSED SSDS UNLESS SHOWN ON THESE PLANS. 3- A 100 YEAR FLOOD PLAIN DOES NOT EXIST K ON TFyIS PROPERTY OR WITHIN 250 OF THE PROPOSED SSDS. 4- ALL WATERCOURSES, STREAMS AND WETLANDS WITHIN 250 FEET OF THIS SSDS ARE SHOWN ON THESE PLANS. USDA SOIL TYPES IN THE VICINITY OF THE PRWF OSED SSDS AREAS FOLLOWS: 7 90 MIRAFI 140 FABRIC PRE- STIGHED TO INDU5TRIAL NETTING AND PRE- 5TAPLED TO PRE- WEATHERED OAK P05T (14 POSTS / 100' ROLL) T - : FiL`ER FABRIC - GON�TRUGTION'SPEGIPIGATION51 ; N }I'� 1. FILTER FABRIC, TO EE EMBEDDED IN a 50L A MIN. OF b'. 2. INSPECTION SHALL BE FREQUENT AND REPAIR OR REPLACEMENT SHALL 5E 0P, / : I Q MADE PROMPTLY AS NEEDED. Q 1 3- SILT FENCE TO BE REMOVED AT END OF *RAVEL ANCHOR 4 GONSTRUGTION BUT NOT BEFORE ALL LENGTH OP' DISTURBED AREAS ARE STABILIZED AND FENCC VE6ITATED. I r. 51LT FENCE DETAIL, N.T.5: . m ®A ®amaa �vrnx k � O�r30 SSDS Pte_ y 1wIpI 4 JOHN KARMLL lli v poem 4 121 CUSHMAN ROAD - - wI=XA/ VC) RK 12�►63 n.ARDri000 POST ; °05T LENGTH 4' -n ": S. Putnam COUntq D D epartment of $ealtli .Division of Environmental Health Servioee Approved as noted for oonformanoe ieith I}.Z•0 applioable Rules an Re Bulatione of the epartmen 4� 8ieaature A Title ., D e_� I r- 7i 1 I J) MINI MUM oFic- rJAL CLAY - fILT SJi PAM1FIG U GRAVEL �I'I C UR TA I f ' DE-TA (LI wT w alt D 15TR 16"1 0 Imp I{I- 11I✓flll =l ;1111 = vnU� TREATED LUMBER ,P rw 6" FABRIC Pi4 r1r'66 FOR TOE -IN / C UR TA I f ' DE-TA (LI wT w alt D 15TR PIAI - 4) ,5. e7"33 A "k 40 IP, *0 Vb g. k 9 Uj to Y A '41 f D 44 W W WO ro V i f C 777 CLI 7' 0- A/ 27 °33X40 CO VC. BLOCK SLOG. 14. All stonewalls in and \Nitliin 10 I'cet void rcplaGcd with similar on site soil. 15. A copy of the house plans submitted to I ,AI,n for a building permit, must be sut the bedroom count. achi( dens 2. Site relai 3. The sew DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Faa (914) 278 - 7921 PROPOSED ADDITION APPLICATIONT (RESIDENTIAL ONLY) 13.K9 is R -FOLEY Public Health Director STREET 5yP7e—A_s& —r c4-A;6- TOWN TX MAP # %iE /% — /— / & NAME ' 6 v,.s /_JEA_;eF PHONE PCHD # MAILIi1GADDRESS %U ,SCD,47&7LSL7` �1 ho DESCRIPTION OF ADDITION dt1 �, NUMBER OF EXISTING BEDROOMS aZ PROPOSED # OF BEDROOMS J (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUU DING 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. Y Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *. Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 j _ DEPARTMENT OF HEALTH Division, Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: BRUCE R. FOLEY, R.S. Acting Public .Health Director Re: f�'el &amp Residence Tax Map Y To`tin According to records maintained by the ToNtirn, the above noted dwelling �. .. _..+-.. TCC _�_. _. .... .. _,,, ,.c_._ �... ..... a .s...... �. ...�._ _ ...o. .�_ _.. ...a. _. .. a.. IS NOT in compliance Nvith Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Rnilrlina TncnPCtnr BRUCE R. FOLEY `= .PublAF Health. Director DEPARTNIENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health "_DiiectoF''' Director of Patient Services 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 May 19, 2000 Louis Delbene Somerset Lane Putnam Valley NY Re: Addition- Delbene- Somerset Lane No Increases in Number of Bedrooms (T) Tax # 74.17 -1 -16 Dear Mr. Delbene: 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 form this Department dated _May 19, 2000 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Three without prior approval by _jhis.depaarnent _ _ ........_.... _. 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,, 1. e:, new low flush toilets, restrictors for shower heads and faucets, etc. 4. The sewage disposal system must be constructed and inspected by this Dept. prior to the issuance of a C.O. 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 ours,_ William Hedges WH :kg Senior Public Health Sanitarian cc:BI �, •1' :I�!• x.31• . •�1 i� ' O CWMI S NAND �o v/S j�, /oy D L�y,tl PH= SITE M.MION S jf AY E�r-S e,-T q / 7- MAILM ADDRESS `fo -r-0r71& V-Se7 PERSON INTERVIEWED PC® Camplaint # DATE �,(��� & Relationship (i.e, owner, tenant, etc.) TYPE FACILITY PROPOSED IrsTALLER PHONE 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. d/ Proposal approved Proposal Disapproved ,Inspector's Signature & Title �te 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 canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. ,!jw�:W W-7: 7- 1 Ji 4ner agree to the above conditions. • DATE ��.►_ �..._ _. Tr= ! J.� I ' : Rite (PCHD) j eUcy \J bn E)0 Plik - •pliant) PC -RP 97 s PUTNAM COUNTY REPART,MENT OF HEAD M HOUSE PLANS APPROVED F09 BEDROOM COU-NT ONLY; ��igttature & 71t1� �±�� I.lwhr I vrwle.r R -x rb. wW. I.. 1 —tl, rceK I I I I I I I ----=-- ------------------------- - - - - -� — - - - -� —- - - - --- ------------ 1�.- - - - - -� Front Elevation Addition For . Louis 4 Gayle Delbene 40 ` ,e t Lme Putnam Volley New York R. Barra Goewey AIA Architects Pc. 234 Lexington Ave Mt Klsw, New York (ql4) 666 -3858 - Job • gg81 II>, 10. Iggq f' 4 -_ t y L i - -- -- - ____ - FI; i i i : e•Q LJ- -LJ- '� „a,,,,.• .,u� y: b, ,I : � c��:B ° s Gravel Bocce - ry� 4 v.q�ll I 9 t eve: royvr �.�. is •', 3 a�ia.u.�e� �aw« a!'il I . _ �� i i � uz• oa Irv- -L� .4-r I;L_ •'� ----v— Neva - -.- -- r vs /j�, Foundation Plon } y i4: f - -1 LJ i � ryra �esc,+c r 111111. F ir5t F I cor Plan LGbGND i i . Bo�con4 a •� New /jig Second Floor Plan 1 s e Lo, t :9 - s �� ;I I a . M. Bedroom —4-* IAII _III w� , III IIt rten9 For 1 1 •y-0 N. I � 1 a s'd'ro�Lel / I I I I 1 1 •'4 m New /jig Second Floor Plan 1 of O I !I M n Lj ---------- 5ide Elevation --------------------------- L ------------------------------ -- /--- - - - - -5 gear Elevation -j ::=gym , . 9 II I i1 ,���� iiil 'I I il: I II�� ':ii Ali 71 iL ------------ ---------------- ----------------------------- 5 1 �cl e- Elevation -�elvo V, 0 �n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DES - G1N-DATA - -S ET-�- SLTiBSURk'AEE SrEWAGE,TREATMENT. S T : , -. _ -L:::..:.., - Owner �0'.) Address q O S I-ZyZeA — Located at (Street) S y�e� Tax Map7 Block ( Lot � b (indicate nearest cross street) Municipality 4P.W �LLLC—�f Drainage Basin O!.Sd X/ J '� Date of Pre - soaking SOIL PERCOLATION TEST DATA Hole No. Run No. Time Start -Stop Ela se Time �lYlin.) De th to Water ]rom Ground Surface (Inches) Start . Stop Water Level Drop In Inches Percolation Rate Min/Inch i l q° � 3a 3 a Z7 3I 3" 1Y � 2 7 60 v �i IVY 3 j(?� y' Q' V T3 /-t-- Z-1 4 5 2 2_77 3 1-1 �� 3 Vy 4. 5 1 2 412-0of- 3 ' 4 5 14MI : 1.. -bests to be repeated at same depth until approximately equal percvMuUu IULUO C+V, -- percolation test hole. (i.e. s 1 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 G.L. 0.5' 1.0' 1.5' 2.0' 2.5' . 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' S 6.5'. 7.0' 7.5' 8.0' 8.5' 9.0' 9:5' .. 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO._ HOLE N0. u H Ski Ww SMUof Ldp 2 Indicate level at which groundwater is encountered '�-�- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: i(k-J,,,Q,;(,,r Date S' Cod Design Professional Name: Address: I-),( L Signature: Design Professional's Seal BRUCE R. FOLEY Public. - •Health Di- rector. - DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509. LORETTA MOLINARI R.N., M.S.N. . ilsA 'Puh(tc.#�t+(l1x,izeclor.. ..._ Director of Patient Services 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 April 19, 2000 Louis Delbone 40 Somerset Lane Putnam Valley NY Re: Addition - Delbone- 40 Somerset Lane (T) Putnam Valley Tax # 74.17 -1 -16 Dear Mr. Delbone: I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A master bedroom suite Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The sewage disposal system was originally constructed for a 3]Y_QBedroom residence only. .._ 2._The,legal..bedroom.count.for the_dwelling.is__�Q . The Otential bedroom eount:of - - - ._ .....:.. .. ...,.:, .._��.. proposed'additionis'FOUR. ...,...... _ .._ .... � __._ ......._ _ ..._... .� _..._ _...................._....�._ 3. The addition of a potential bedroom requires this department's approval of a revised septic system plan from a professional engineer. Please revised the proposed floor plan to reflect no more than TWO potential bedrooms or have a professional engineer or registered architect design a sub- surface sewage treatment system meeting present code requirements. , If you have any questions, please contact me at your convenience'. WH :kg Very truly your William Hedges Senior Public Health Sanitarian Only copies from the original of this survey monied with an original of fhe land surveyor s inked seal or his embossed seal shall is considered to be valid true copies. ROBERT E. BAXTER 8 ASSOC. Land Surveyors and Planners P. O. Box 298 R. D. /, Box 277 -C Mahopoc, N. Y. Hopewell Act., N. Y. 628 -2800 221-1192 z i Certifications hereon signify that this survey was prepared in accordance with the existing Code of Practice for Load Surveys adopted by the At?w York Srale Assoc. of Professional Land Surveyors. Said certificaf fls shall run only to theperson for whom the survey is prepored�, ondon his behalf to the title company, governmental agency and lending institution listed hereon, and to the assignees or the lending in- slilulian. Certifications ore not lransterob /e /o additional institutions of fo sub- sequent owners. ' Uiwalhorrzed alteration or add.,tion 10 a surveymop bearing alfcensed land saxweyor s seal is o watatian of Secl1on7,?g9,Sab- divisi0n 2, of the AL-w runt Stots Education Low. Underground easements, structures and /or encroachments, If ally, 001 shown hereon. CERT /F /ELF OiVLy 7T0' /. GO.0 /S A. _' R0.SC-A,c%vE y; 17ELBE.C/E L? F /R,Sj 441ER /C4AI %/%Lt< /.VSL/•PA.t/CE CD/f'/PQNy a 3. A,14,,? /rvE M/pL4AID 0,4,, l<-, /%S S LJCC�SS ORS Q,t/p �J.� /G.t/S . oREM1SES /- 1EREON:, BE /.VG 4-07- 19 AS PER MAP EC/� /TLEp "SECTION A' O/� PUTiI-e�AiY/ ACf—E6 u' 5A 10 A-74IO F /LEA /.v 7./lE P417A141W C04J.(1 jY CLERKS SURVEY OF PROPERTY SITUATE IN THE— ;.. 17-04WN 0/` P&7AO*� WU4 fov Ti 4M' COLJIV T Y NEW YORK SCAL E I "_-42' DATE.-,C)_-C. M0NUMBNrq -r1b V SDT PREPARE'O FOR LOUIS fi` R0,5,F,4 1A.P� Z,)_-Z-34-440 r r r V. 27'33 40 AV.. / ^P/" *%%Q p vv 14 I S �'•� Rf � B S , P/N If A-1,41 f I I OFZ / V E AS,- 4 LT rliD I v p� y� V 1 ti �0 P b0 &6;.(p0 I v�p FyC•�� �.J I Qw > 1 W cow,:. f �! 1 8 Q UK, a Y 4 1. 6 3 v ¢Q1► 4wr4 h `�$ GuY CFO CA e LB Z 10 h N � a,o�v : • h o r �Q,�. ( •r_ 1 farad.. E trs, 4 VJ h � rR N4 /4. /N RI f car :'ram Cn irlty Depps. coi ct Haalih �- SNEOs ion of "r. Ivirr n�' .,• sLatb melvice i J £0 W BLORt r l i Cc and .iD;lf: of the 'tmont. N7 �V1 r1'1 \�Q✓llly t i�lilif' q 5iFAtur8 A Tine I.d�11 �` DGLB•� \ 4f0St 4ETs-P--TL4N�e-�, \1 THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS, CONSTRUCTED AS r> INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE bEPARTMENT OF HEALTH. v 0 h -AS— BUILT IWACI IDMICKITC No A B REMARKS 2� $0. -11 D—BaX gj . EN iJ � Gov E 1 oq t o W. 11q 8 rti� 121 13 ' l0 111 I'L'L II 11\ 127 ' a 1 b IZ2 13 100 14 ci N 1� V4M 7y,i7- -�� rH IR KAr MLL, JR. ' sg- 121 COSHMAN ROAD s-1% -7(94 ' PAT,ERSON, NEWYORK12563 D EL,g�N--' x.+us wevt�ns, Sa+ist?rrT I s 30 c� F i •K `i A S P N Gtl L T �D 1 CONC. . IN I srae ` �k IQ 1 .,ere, 1 v N i ,�0� p ( cohr -blk Ap" h Vj N \ a tj Pr" llr AW ` /L /N y i ,4Pcar 1112,7033 'ao "E i ROLEt' I CO BLO0 CK SLOG. P/N I \� o guy 3 3tp J O O .. I. n n P Piiv ? ? W W h h y 0 h 14. All stonewalls in and v void replaced with simila 15. A copy of the house plan: lilinppgg for a building perm VCrlly the bedroom count. PEnMM COMM HEALTH DWARTMENP DIVISION OF ENVIRONMENTAL ;. .....- ...per. - ._.-- •.P.w 4 -• -i.r -..:. . • � r r • -•. -- .• p ��" V HEALTH SERVICES PROPOSAL FOR SERGE DISPOSAL SYSTEM REPAII2O /� OWNER'S NAM Gov %S �o �� y p G �� y PHONE SITE IACATION S���T i �}'J�/�i 7W 7(1,17--1-14- MAIISNG ADDRESS `f0 r�rn s�7 � ti ' VA-&5Y, N.)/, , PERSON INTERVIEMM PCB Casplaint 1 tATE ,dame & Relationship (i.e, owner, tenant, etc.) I U TYPE FACILITY PROPOSED neTALLEIt PHONE 2Z REGISTRATION # Proposal (include sketch locating all adjacent wells): NO-M: _Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fram licensed professional engineer or registered architect. Proposal approved Proposal Disapproved Inspector's Signature & Title to 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 corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywerlls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or rted er agree to the above conditions. SIGNATURE TITLE 5 I S/ d IpgM Write MM Yellow Can HO; Pink L%pli®nt) nr nn n-7 I � 1. RESIDENTIAL SITE INQUIRY v DATEn. 372000 PUTNAM VACLEY 74.17-1-16 ROLL SEC TA PARCEL PRPCLS 110 1 FAMILY RES Dli-*]... I OUJ: ::: 3-. TOTAL RES SITES I LAND 40 SOMERSEU LAKE TOTAL COM SITES 0 TOTAL SAL S I T E 0 1 E S 1- 1) E N ('-'E "I D AT V/96 TYPE LAND AND BLD I BL_ DS. STYLE RANCH YEAR BUIL j[PRICE 1 EXT•ALL MAT WOOD STORIES I . ....... , 1 -1"E . ...... I R AVERAGE G Apt —w--- ARE 11 PROPERTY CLASS I FAMILY,RES' I HEAT TYPE HOT WTR/STM IST STORY ZONING RI NO. OF FIREPLACES 1 2ND STORY SEWER PRIVATE I NO. OF BATHROOMS 1.0 1/2 STORY 11 WATER PRIVATE NO. OF BEDROOMS 2 3/4 STORY UTILITIES ELECTRIC ATT. GAR. CAPACITY FIN BASMT li NEIGHBORHOOD 74407 BAS. OAR. CAPACITY TOTAL SFLA . .................. I MPRO Y E MEN T TYPE SIZEI SIZE2 OUAN i TYPE FRNT DPTH ACRES 1011. PORCH.OPEN 256 1 101 PRIME SITE 1.00 102 GAR.1.0 DET 220 103 SHED,MACHIlea 192 ...... TOTAL IMPROVEMENT ITEMS TOTAL LAND ITEMS I RE§ -WE WAT 'LE--7—F9"G0—TO—XREM- RPS07562 CERTIFICATE OF OCCUPANCY Certificate of Occupancy No.... ?:.? ... .......Application No..........:........... Location of Premises ...............le.".. ...... 't ?rr....... .. ... ......................`.... `....I.......... .. ............................... ?s lJ� E. fie !ze ............................ of ........... �,r�erY.�:.! ...L: - .. �' ?�.';: ;'..Y.> .1..,. � � g heretofore filed an application for a building permit pursuant to the Zoning Ordinance, Sanitary Code and the Laws in effect in the Town' of Putnam Valley, Putnam County, New York, having paid the required fee;.,therefor and the- undersigned having by personal inspection ascertained that i•. the applicant has subsequently proceeded with the erection or. improvement of the proposed struc- ture in compliance with the requirements of the laws as, aforementioned and that the said work and materials met / every requirement of the laws as aforementioned aid that the premises have now, been fully .completed and- are ready for occupancy pursuant to the provisions of law, Now, therefore, this °certificate of occupancy is hereby issued under the seal; of the Town of Putnam Valley this . ..... F;. day of .... ....: `:' .::..:::.................... Not valid unless signed in ink by a duly authorized agent TOWN OF PYTNA 1VI VALLE W YORK !'f of and under the seal of the Town of Putnam Valley. is By ... /, ............ r .T a { L , . i i 'c <.i. n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN'T'AL -HEALT-H,-SE-RV,10ES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at Town or Village 1AvA ��LLL Owner /Applicant Name 6-0 L// 'J O&�( IS x--AJ 6 Tax Map 1 `� • 1 % Block I_ Lot 1 b Formerly Subdivision Name Subd. Lot # // // Mailing Address 4-16 `����`� %,�fyf�7 Zip Date Construction Permit Issued by PCHD ' - I (q h,v oV l c-44 -, ' Separate Sewerage System built by w 14 p RV-4U tL - t*CR O/d4kddress P,-IT V/�7�'! �✓�'l.(. _ , . Consisting of eXI STlN G2 Gallon Septic Tank and . 3 (d d z-F-i -fit t-W CJ¢ Other Requirements: b BOX Water Supply: Public Supply From. Address or: Private Supply Drilled by Address Building Type °W O� ,O Has erosion contro �x l been completed? Number of Bedrooms 3 Has garbage grinder been installed? 0 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 regulatiops of tie Putpam County Department of Health. Date: 10 L3041 Certified by P.E. %\ R.A. De ` Professional) Address 2 C" Sd %�' License # 7 Any person occupying premises served by the above systems) 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 modification or change when, in the judgment of the Public Health Director, such revocation, odic ion or c ge is necessary. By: ff Title: Date: '710 9 /Cir White opy - HD File; ellow copy - Building Inspector; Pink copy - Owner; range copy - Design Pr es sion Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Vo SO M( Y&7- 44&L3' Location - Street Building Type 7 V, ./ 7 ( Tax Map Block Lot l pu�'/u am TownNillage Subdivision Name 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 building utilizing the system. Dated: Month 6 Day Y 0 Year D r General Contractor (Owner) - Signature - c 6G , Corporation Name (if corporation) Address: 7 9 eAmeg Signature: Title: r, v Corporation Name (if corporation) Address: State Zip j(3577__. State Zip Form GS -97