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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -13 BOX 29 03750 � m I ire �� JN �i J% 03750 777 ��� ,PUTNA14i COUNTY Dl " .. Divi.lion.of Enwronmentsl, Head r •. , CERTIFICATE- OF, ;CO TRUCT,ION COMPUAN,CE ,FOR SEW, Located at dr /iu / "%�1 Co. .. %7Ld /:ice,, Fomier`_ly 9 ,Owner �'►/� B �! �' Sepalate ewerage System bu by � r Consisting of Q�11 Oal Septic Tank and ,r Other, requirements - ' WaterSupply Public Supply Flom F -. YY private •: upply Drllled By, a ,�s Address c Building <TyPe / )ii::n! a /�'�L -zo r r N Has Erosion Control I been Completedt 1_ A. :S I certify that. "the syatem(s) as listed servingalie aboveipremiaes weie { of which are attached) and in accordance with the standards rules and •Putnam county Department. Of Health s re y.,o, e s S, ,Gate ' * ert�fied D u 'Any person occupying premises served wt above systems) shell; prompt r conditions resulting from such usage. Approval of the separate sewerage available'and�tlie approval of the -.private water supply shell: become', null ar F1� = wbjeet'to modification `or change -when In,theh'judgment d the Comeni 4 llJ( ;� Date [tTMENT OF h�iEALTH ervices, lmei, N ` }Y 105t2 Permit DISPOSAL: SYSTEM- !7laY�. - o Town or Village `j °4 Tax,, Map ' ' Block Tax' -Flap Lot # ,. Subd- ">Lot 4 3 { J`. - 1 Bedrooms Date Permit Issustl d W ructed assent "shown ori�the plane of, the completed work (copies latdns cla - the 'filed plan and the permit issued by `the tit. e.o P eI� APE 4' RA !j Lkdnse No e , lon _, neeessi seeun the correction of any, unsanitary IM co a' null and_ von n: aIs p a'ublk sanitary se "or ' becomes id w_. eeomss- iVSilable. ='Such; approvals are '> ; rc of t = Qtr odifieetion or change��is necsstary • 1 (orktown Medical Laboratory, Inc. LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203 321 hear Street ❑ 201 BUTTONWOOD AVE., PEEKSKILL. N.Y. 10566 737.8777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666.3335 .(914) 245 -3203 ❑ STONELEIGH AVE. (NEAR HOSPITAL), C MEL, N. Y,10512 278.9330 Director: Albert H. Padovani M. T. (ASCP) - _ (— f DATE RECEIVED: /01 A) ����= ' DATE REPORTED: _ SAMPLE SOURCE: /17 Lab # ���� REFERRED BY: L �'� / J Collector: OF- LABORATORY REPORT mg/L ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY ; P= .......... A- •••• — ❑ ANTIMONY BACTERIA, TOTAL /mL ...... I...!>s... ......... ............. ❑ ARSENIC ❑ BOD, 5 DAY ..... :........................................................ ❑ BARIUM ....................................... ............................... ❑ BROMIDE ............................ ............................... ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ............................ ................:............... ❑ BORON ........................................ ............................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ............................... ❑ COD ...................................... ............................... ❑ CALCIUM .............. ............................... ...................... ❑ COLOR (units) ................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ..................... ❑ CHROMIUM (hezavalent) ❑ DETERGENT, ANIONIC • ..... .... . .......................... ❑ COBALT .................................... ............................... ❑_FLUORIDE ............................ .......... .I.................... ❑ COPPER .................................... :.............................. ❑ HARDNESS ............................ ..........................:.... ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ❑ IRON ................. OMFT COLIFORM COUNT/ 100 ml ....0 ..................... ❑ LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM :.............................. ............................... ❑ NITROGEN, KJELDAHL .............: ❑ MANGANESE .............. ................................ ............................... ❑ NITROGEN, NITRATE ......... ............................... . ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ..... ............................... ..... ::.... .. ❑NICKEL - ..... ..... .... ...................... C7DCn (LiII'1 t S j ....:.... ....:.....: ........ .:.....:..... :.. L) PALLADIUM ...... ............................... ......... .... ...... ❑ OIL & GREASE .. ..:............................ : ........... ❑ POTASSIUM ❑ pH (units) ... ............................... ❑ RHODIUM ......................:............. .......................:....... ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... .................:............. ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ...............:............... ❑ PHOSPHATE (total) ................ ..................1............ ❑ SODIUM ........................................ ................................ ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... O TIN ............................................ .............:................. ❑ SOLIDS, SUSPENDED . ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED. ............. ............................... ❑ ....................................,............... ............................... . ❑ SOLIDS, TOTAL ............1 .................+EMAR .................................................. ............................... ❑ SOLIDS, VOLATILE ................. ................................ KS:... ..AJ•�'IiDJJM. CD1JYQM..QRG.AXI X$..AR NOT ❑ SPECIFIC CONDUCTANCE (uhmo s / cm) ............... ..PRESENT.,..WE..WDJ ..&TI•gL.IMCQ •S.TERI.LIZATION ❑ SULFATE ............................ ......I......................... ❑ ...... 0] ?-- THE..WEM.BEr.A. ..0Y..TJIE.JI W- B.ACMUAL ❑ SULFIDE ............................................................ ❑ ........ COUNT .v............................................................... ❑ SULFITE ............................. ............................... ❑ ..............:.:................................... ............................... ❑ SURFACTANTS ..................... ............................... ❑ ........................ ......................... ............................... ❑ TURBIDITY ( NTU) ........................ :.................:.... ❑ .................:....................,............. ............................... THESE RESULTS INDICATE THAT THE WATER WAS' OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED THESE RESULTS INDICATE THAT THE WATER DI MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED WHEN THE SAMPLE AS .CO LECTED.' N/A = not applicable Albert H. Padovani M.T. (ASC ), Director "r\ WELL.COMPLETION REPORT Office Use Only la ..e DEPARTMENT OF HEALTH � , Division_ Of Environmental Health Services c OF HEALTH PUTNAM COUNTY DEPARTMENT STREET ADDRESS. . TAX GRID NUMBER: WELL LOCATION WELL OWNER jNME` ADDRESS: PRIVATE � _ PuBUC USE OF WELL RE IDENTIAL ❑ PUBLIC SUPPLY ❑AIR /COND. /HEAT PUMP ❑ABANDONED 1 - primary ❑ BUSINESS O FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE ZZA YIELD SOUGHT _�� gpm. /N0. PEOPLE SERVED —� EST. OF DAILY USAGE o gal. REASON FOR EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST IOBSERVATION NOREPLACE DRILLING EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WATER LEVEL / ft. °z r� WELL DEPTH °'�� ft. STATIC DATE MEASURED DRILLING ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT /0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 1 ❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH o ft. MATERIALS: TEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE ft. JOINTS: ❑ WELDED ,THREADED ❑ OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT ❑ BENTONITE . UTHER DETAILS WEIGHT PER FOOT — �s Ib.lft_ DRIVE SHOE YES ❑ NO I LINER: ❑YES-�EW0 DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN DETAILS -- - FIRST Q. YES .ONO..... . . . -:. SECOND' - _ ........ :. ... HOURS . . GRAVEL PACK O YES GRAVEL DIAMETER TOP BOTTOM O NO SIZE OF PACK in. DEPTH ft- DEPTH It. WELL YIELD TEST If detailed pumping it more detailed formation descriptions or sieve analyses WELL LOG are available. please attach. M HOD: O PUMPED t tests were done is in- DEPTH FROM Well COMPRESSED AIR ; formation attached? SURFACE Be air Dia- FORMATION OESCRIPTION CODE ft fL O BAILED ❑ OTHER ❑ YES 0 NO in9 neter WELL DEPTH DURATION DRAWOOWN YIELD Land Surface It. hr. min. ft. 9Cm d do ' /s' WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY � GAL. Y PUMP INFORMATION S! TYPE CAPACITY _ d WELL DRt NAME D �� 0'a 3 MAKER DEPTHd� y ki MODEL VOLTAGE HP I -H /06,,7 > P,UTNAM COUN`N DEPARTMENT OF _ HEAL'TH _ . ,. ...e. .. s F DIVISION' OF ENVIR01',*2 iQiAL"'HE ALTH' SERVICES' a, �A A be Owner or Purchaser of Building ]6 lC. 1-3 1 L1�� P -S Building Constructed by . Location - Street _P07yj A� Municipality 10 0 174 Building Type Section Block Lot Subdivision Name Ak Subdivision # GUPYJU TEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate -for- a- period: of : two: years imnedi.atel following the -date ,of :approval of the '''Certificate of Construction Compliance'' for tfie 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 occupant of the building utilizing the system. , The undersigned further agrees to accept as conclusive the determination of the Director of the Division of E,nvironinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this @ day of � 1�_ 19,59 Signature Title 7) NV -\Ac �Z �rS .�pC, General Contractor (Owner) - Signature A� Corporation Name (if Corp.) Address rev. 9/85 - mk [ Corporation Name (if Corp.) TA - INOR WOWTSCHUK f TELEPHONE TOWN JUSTICE - - t sa -aoso C...o- ARTHUR BUR STEIN, TOWN JUSTICE TOWN JUSTICE COURT TOWN OF PUTNAM VALLEY TOWN HALL • PUTNAM VALLEY, N.Y. 10579 John & Theresa Mabe 139 Wood St. Mahopac, N.Y.- 10541 September 26,1988 RE: ILLEGAL OCCUPANCY Your case requires a personal court appearance. Kindly appear at the Town Hall, Oscawana Lake Road on: THURSDAY MORNING,, OCTOBER 6th,1988 at 10:00 AM FOR ALL PURPOSES. This is to inform you that an adjournment of your case has been granted to: Yours truly, TOWN OF PUTNAM VALLEY Town Justice PV JC /FORM #7 cc/ Deputy Insp. Mahoney rl County Executive DEPARTMENT OF HEALTH JOHN SIMMONS, M.D. Deputy Commissioner Division Of Environmental Health Services August 22, 1986 John & Theresa Mabe. RD #4, Wood Street Mahopac, New York 10541 Bar Vic Blrs., Inc. SDS- RE: Construction Compliance Wood St. Dear Mr.. & Mrs. Mabe: PV -.TM 65-2-5 Recently . an inspection of the sewage disposal system and well serving the above captioned residence was conducted by a,representative ' of this Department. Subsequent review of Depart-mental files indicates that a Certificate of Construction Compliance has not been issued for the completed sewage system, therefore, final approval of the construction of these facilities was not granted. While we realize the difficulty involved in locating older records, at this time it is requested that you attempt to locate the-following materials and forward copies to this Department to complete our files: 1. Well, log from well driller. 2. Bacteriological analysis. of water supply. 3. As-built plan prepared by the designing engineer or architect. Procurement of these necessary documents may be facilitated by contacting the well driller, engineer,, former owner and./or Town. -Yo)u,-should -be aware float ,ojr of approval. of - the''-s6fa4e And water u s pply facilities serving this property may be required relative to future sale or refinancing of the property. Therefore, . it is in your best interests to obtain the above-captioned documents. If there are any questions or this Department can be of any assistance in this matter, you can call the writer or Mr. Hodgens at 225-3838/3833. JK:mk cc: E/A Frank Sullivan, PE M. O'Dell, BI (T)PV File Very trulyl yours,. alp Jr.,, P.E. Director Environmental Health Services A V. F/1./jk/jay-4 wer per TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 October 20, 1988 Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Re: Compliance SSDS - Bar Vic Blrs Wood Street (T) Putnam Valley TM #65 -2 -5 Review of plans and other supporting documents submitted at this time relative to the above - captioned project -has been completed. Comments are offered as follows: Plans must include a legend, which reads as follows: "This is to certify that the sewage disposal system was constructed as indicated on this plan and that the system was inspected by me before it was covered over. The system was con- structed.-in. - accordance. wir -h all,, standard rules and -regulations -of the Putnam -.: . County`Departmerit ' of'Health and the Necv York State Department of Health." Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Lawrence C. Werper /tom Assistant Public Health Engineer LCW /jz cc: John & Theresa Mabe RD#4, Wood Street Mahopac, New York 10541 PETER C. ALEXANDERSON County Executive . DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 October 12, 1988 Joseph F. Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: ENID L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS. M.D. Deputy Commissioner JOHN KARELL Jr;, P.E. Director Re: Compliance SSDS - Bar Vic Blrs Wood Street (T) Putnam Valley TM#65 -2 -5 Review of plans and other supporting documents submitted at this.time relative to the above - captioned project has been completed. Comments are offered as follows: " " " "` A - E�rti�ed check'or `oank- 'money order - °in' °the "amount oi: °$'L`5:00 - payable to- ..ttie .. Putnam County Department of Health is necessary to process your compliance. Upon receipt of a submission,.revised to reflect the above comments, this application will be considered further. Very truly yours, ,/�, 1 . V Lawrence C. Werper Assistant Public Health Engineer LCW/ j z cc: John & Theresa Mabe RD #4, Wood Street Mahopac, New York 10541 ,- i' i 140we. ik 4 ,548 Ns . 4 3S1 -4010 Ackv-4 Fvide l® e D Yorktown 'Medical Laboratory, In_c. _ ALBERT 11. 1P`ADOVAIVI Pt T. (AST) "ter • ,. _. ., a>i Director P.O. Box 99 201 Buttonwood Avenue 495 Main Street. 321 Kear Street (Corner of 202, across from Hospital) (Across from Lloyds) Yorktowm Heights, N.Y. 10598 Peekskill, N.Y. 10566 Mount Kisco, N.Y. 10549 (914) 2453203 (914) 737 -8777 (914) 666 -3335 THE MEANING OF THE WATER ANALYSIS REPORT Stonelcigh Avenue (Corner of DrevAle Road) Cmnel, N.Y. 10512 (914) 27 8-9330 This statement has been prepared to help you interpret the WATER ANALYSIS. REPORT you have received. The purpose of this examination is twofold: the.determination of the total number of bacteria present and the specific determination of the presence of members of the COLIFORM group: The item BACTERIA per ml is a measure of the total bacteria present. One quart of water contains 940 ml. One ml of water is added to a nutritive medium which acts as a source of food'for the bacteria. This portion of water sample plus medium is then incubated for 24 hours at 31 °C. At the end of that time, the organisms which have grown and multi- plied are counted. There is no limiting value for this determination but it is of interest in judging the sanitary quality of the -water sample. , Ttie, sec,.ond:.d�termiratiop, tlse COLIFOtRM . GROUP =is ofu;more imQortance zThis group includes several species of� . _. bacteria which are, more or less, normal inhabitants of the intestinal tract of man and many other animals. Copse- . quently, they are found in tremendous numbers in fecal matter and sewage. The organisms of this group are usually not dangerous in themselves but when found they do indicate potentially dangerous contamination since sewage at any time might carry pathogenic or disease producing organisms. The source of this contamination might be a sewage system which is located close to a well or spring. It might also result from failure to protect the water supply from surface drainage or contamination or the entrance of small animals. Any time a water system is repaired or opened up it should be sterilized by the addition of chlorine in some form before being returned to use in order to eliminate any contamination which might have been introduced. Our test is done by "MEMBRANE FILTER TECHNIQUE" or MFT. A negative test is indicated by a value of LESS THAN 1. Any number greater than 1 indicates the presence of COLIFORM organisms and is reason for stating the source of the sample is not satisfactory. The test requires a minimum of 24 to 48 hours and very often 72 -96 hours. It must be understood that the results of this test apply to the water source only at the time of sampling. Unusual conditions, such as heavy rainfall or drought, flooding, changes or additions'to the water system, installation of septic tanks or cesspools to the nearby area might all have an effect on the sanitary quality of the water. Consequently, analyses should be made as often as circumstances warrant. Yorktown Medical Laboratory, Inc. ALBERT 11. PADOVANI M.T. (ASCP) . D! , rrc or P.O. Box 99 201 Buttonwood Avcnuc . 495 M-tin Strcct 321 Kcar Strcct (Coeur of 202, across from Hospital) (Across from Lloyds) Yorktown Hciglits, N.Y. 10598 Peekskill, N.Y. 10566 Mount Kisco, N.Y. 10549 (914) 245-3203 • (914) 737 -8777 (914) 666 -3335 Stondcigli Avcnuc (Corner of Drc% ville Road) C-Lmcl, N.Y.'10512 (914) 2789330 r`• Wells or springs which have been altered, repaired, newly constructed or accidently polluted should be thoroughly cleaned and disinfected before a sample is collected f or a bacterial examination. The side walls of the basin or pipe, the exterior surfaces of the pump cylinder and drop pipe, and the walls and roof above the water line where a basin. is provided, should be scrubbed with. a stiff bristled brush as far as this is possible and washed down With a strong chlorine solution. A satisfactory solution for this purpose can be prepared by dissolving sodium hypochlorite (laundry bleach such as Chlorox,Rose- X,Dazzle, etc.,containing 54o available chlorine) in.:the proportion of one pint to twenty five gallons of water. After cleaning, the well or spring should be disinfected as follows: 1. 14ix two quarts of laundry.bleach in ten gallons of water and pour this solution into the well or spring while it is being pumped. Running the water. 9:uitil ' the `n- zssure..- _dro.ns_ - -in the. pressure: tank •wi .1-1. cause _the pump to... start. Run water from all the taps .in the house, one after the other, until the water at each tap has a strong odor of chlorine. It will be necessary to open the valve or plug in the top of the pressure tank, if provided, in .order to permit the strong chlorine solution to come into contact with the entire inside of the tank. Air must be readmitted and the tank opening closed when pumping is'again started.. This procedure will sterilize the entire distribution system. 2. After this, dissolve two quarts of laundry bleach in ten gallons of water and pour solution into the well or spring. Allow well or spring to stand idle from twelve to twenty four hours and then run water to waste away from grass and shrubbery until the taste and odor of chlorine disappears or is very :faint. Several days should elapse between this treatment and the collection of another sample for bacterial analysis in. order to insure that a rLpresentative sample free from chlorine is secured. Until the water supply is shown to be safe, all-drinking water should be boiled. More information about wells and their disinfection can be obtained from.the following pamphlet available from the Superintendent of Documents, U.S. Government Printing Office, Washington 25, D.C. !'Individual Water Supply Systems" - Public Health Service Publication #24 (25¢) Bar Vic Blrs., Inc. SDS RE: Construction Compliance Wood St. PV - TM 65 -2 -5 Dear Mr.. & Mrs. Mabe:. Recently an inspection of the sewage disposal system and well serving the above captioned residence was conducted by a representative of this Department. Subsequent review of Departmental files indicates that a Certificate of Construction Compliance has not been issued for the completed sewage system, ..therefore, final approval of the construction of these facilities was not granted. While we realize the difficulty involved in locating older records, - at this time it is requested that.you attempt to locate the following materials and forward copies to this Department to canplete our files: 1. Well log fran well driller. 2. Bacteriological analysis of water supply. 3. As -built plan prepared by the.designing engineer or architect. Procurement of these necessary documents may be facilitated by contacting the. well driller, engineer, former owner and/or.Town. . You should be aware that proof of approval of the sewage and water supply facilities serving this property may be required relative to future sale or refinancing of the property. Therefore, it is in your best interests to obtain the above - captioned documents. there are any questions or this Department can be of any assistance in this = matter, you can call the writer or Mr. Hodgens at 225 - 3838/3833. JK:mk cc: A Frank Sullivan, PE M. O'Dell, BI (T)PV File very trul ' your Ii hn Karell, Jr., P.E. Director Environmental Health Services F/1 /jk/jay -4 TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFF IDAVIT .__ 'CORPORATE ''OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: represent that I am an officer or employee of the corporation and am authorized to act for (Name of Corporation) having offices at K�OiZI -H Lcjy -jA r, > V(r /,c- Whose officers are: President: \J, Vice - President: it VQ Name and Address ii Name and Address / I fi�> lZ Secretary:. -gay (Name and Address)' r d . Treasurer: Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this _dam /GL day Signed: of 19 O Title: ZVI Not r .Public ARY ANN WALSig 1 York �/ t�Iota • cf:1ty of N ,, dub: :.., u: Y Quali�ie;t in Cutch's� nt Commission Ex 30,19 pires PAarch 8/84 �1R V'ic. ,5UL -LIVAQ ~ GW)&K. DOrUfTl`ITS house plans O.K. Design data sheet Peres presoaked? I,Lin. 30 perc test depth Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for othep than individ Authorization for engineer Letter.from Water Supply if applicable If variance requested -such noted on plans REVIEV CITf;CK Sln1: ;T apps- DETAILS if change , is proposed, ) Existing contours shown show new-contours) Slopes for driveway cuts, etc. shown 1ater service lire location Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location Septic tank size and conformance to std. 3 B. R. house minimum House setback shown Distribution box ftg. below frost All water within 50 ft. of PL shown Imoets Std. es No O rlar, -and profile All other wells and SDS closer 200' Ia i shown* or- reference made ' Property boundaries (metes and bounds - clearly sh>,rh ;SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P.L. ?01* to Fotuldation walls )0' to Nearest well. . j0' to stream, march, . lake, etc. inel . L5' to Curtain drain 1.0' to water lire (pits -20 .5' to storm drain 0' ' to large trc s .01 froI,1 folincittion to septic tank .5' to pipe from leader drain & . 1'00 71—lig QO COVTOUTE A1FF1DRVIY' aca , LoEct- • s 'p-p7i C' M pansion) i .raid � fa 00 10� 1 J' PUTNAM 'OUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL; N. Y. 10512 DESIGN DATA SHEET- SEPARkTE SEWAGE DISPOSAL SYSTEM FIL E NO. / Owner /�. /r ✓ d�� �ddress ,).j`1.�9 / >. %/e" Located at (Street�� 5 Sec. Block 7 Lot nnddica e neares cross street) Municipality � 4e.✓� Watershed PERCOLATION T��,,ST DATA R9QUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Eiajpse to Water Wa t er I EvEl No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches C12 l J0,9w ve- 4. 5 1 2 3 -., 5 Notes: 1) Tests 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) Depth measi-irements to be made from top of hole. DEPTH G.L. 611 1211 18" 2411 30" 36" 42" 48" 5411 6011 .6611 72-11 7811 84" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. P. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 'ATE -;EVU 'R--BEING:;.ENC OXIINT -I L.-TO.�.WHICH WATER'.'.-LEYI�- RMES-AF TESTS MADE BY Date. Soil Rate Used_ ,:�Vdn/l "Drop: S.D. Usable Area Provided No. of'Bedrooms Septic Tank Capacity Type Absorption Area Provided By_jo,2L-F.x24" w cthxetrench. Address THIS SPACE FOR USE BY fo-,!! bigna-cure Z ' - 1ENA7L DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by -,Date FIEND CJTECK I;LST. 3 Late: ` -L -_.. Ir.�a.b3r� i�Ya✓xti...... INITIAL SITE ST1S�'EC1'TO�: ° " Ycr, No Comments ,Property lines or corn:•ra found . . . . . . . . _ Can estirra.te, house location Will driveway need cut . . . . . . . . ... . . ' _ -- Mu.,it trees be removed -note these Is deep hole representative of entire' SDS area Additional deep holes needed.. . . - _. Sufficient SDS area available considering driveway cut, house location, separation distances, etc. DEEP HOLD DATA . Depth: Water elevation: •�� Rock elevation: %Dt�_ GOB Soils descriT)tion: > -Date : FINALTT. TT—�P1 7-r t�]] //'''' t 1'IJ. AL S_I_` E Ii \S1��lY��irl: Insp. y: House Located uhere shoe -,,n on approved plan SUS located where approved . . . . . . . . . I.r.:n th oft inch rr._aa s uared Width of trench ave ra`;e Slope of tile line and. trench.acceptable.. _ P m- . low ' d :for . expansion= trenchas Over 50 ft. from s;anp,watercour•se Fatural soil not . stripped or SDS area luuiecessurily graded. ... 10 Ft. maintained from prop. line and 20 ft. from house Separation of trench from house, well - -.etc . follows plan - -- - -- - ....... - _----- - - - - -- -- -.. -_. hwnber of bedroomns chocks Stones, brush, • stumps, rubble, etc. greater than 15 ft. from nearest trench 15 Ft - of peripheral soil horizontally from trench ... Junction boxes properly set Could surface run off from driveway, roads, ground surface, etc. channel nca.r SDS area -- Does lot dr. a.irn .c at near 0. K. in area of SDS FINAL GRADDIG Or SITE ACCD1'MBLT mM JOSEPH F. SULLIVAN, P.E. .2972 FERNCREST, DONE,- YORKTOWN HEIGHTS. N. Y. 1059B (914) 962-4248 PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at r 41 _'5 1; ection Block 7 Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize—,-,/ t // rl�j�r• a duly licensed professional engineer,/ or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in c.onnection with this matter and to supervise the construction of said in_- _ron.f_.ormity _with the proVi- Ai_ons,__o.f.. A:rt Cle..::C45-_- .-or.. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: q �'` �. •� �, , "f, -�,R. � . �. 'rte ..f. �y Address =, , .� . Telephone Owner`of Property r- +� r Address Town Telephone rsd ar'f�� 4.L t ; r' Fc^°^'!�ri.„ r- �-•".?.. n PUINA —M COUNTY DEPARTMENT yOF HEALTH F ` Division of Environmental Health Services, Caime% N Y 1051 • CONSTRUCTION PERMIT FOR SEWAGE, DISPOSAL SYSTEM:, Town o' T' vl- + a tv •.r t *' 1 1t1�n '� rj fit." �Gt y Located ets at W a Sub�drvlsan Lot o J a Ck '0 �,..I.C'h wner = is Addrs HLOOd .S t I �. 8uildibg�,TyPe one famr.ly res Lot Area Al ,Number` of m Bedroos. 4 Total Habitable Space Separate;;Sewerage'System to consist of ' °200 Gal Septic Tank 308 lineal To be constructed by r Adiiress F -red Patteson Yorkto� Water SuPPIy Public Supply From Q Private _ Supply to be dialled by Norman .. n de r son _ . s Barger °S.t.reet, . Pwutnam Ual 11 :Other Requirements f ` � /'" � .I represent that above described _wiWb County ,Department :be submitted to ahe .,,pace,, im operaf ante of the approval will be located as;shoi! County Department c 1 ` A.P�r „� a .Date 1 'APPROVED, FOR CO 1 revocable. for cause-or requves a new p I .Date r.. nded oi`.modified when consi tf necessary by 'ahe C ssioner ea 11 I for'.disposal of domestic- niter a "andJor to -w r. ly iq By F+ c K or.nhV �l la9e Block ” �eet,n,Mahopac, N Y ,F 2 ,?500 Square ^Feet .i eel X 3 1 OI I WidW,.tren cht un �He�i ghtrs�` N Y r rate.,sewagea sposal,system lids., egu a ons o e : -, _u nam _, y t�, lib omm�ssioner;of Healthwill n y '� der that said bwlder -will e f 'thedate of the;issu t d II 'well described aboves ns of the Putnam 81:'29 ense _ uilding has been undertaken and is Any ehange`or alteration of,,constructjon THEODORE'LAURENCE STRAUSS ASSOCIATES, P.C. Architects and Planning Consultants Box 417 ® KATONAH, NEW YORK 10536 z.: w::Axea Code491-4)-CE- 2 -5a33 To MR. R. TORTONI Putnam County Dept, of Health Div. of Envrmntl_ Slervices Carmel, New York 10512 GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter LCUTCEDM OF V D aRSEDUML DATE JOB NO. 1 ApEi1.19 6 W ENTIONN-�c- - RE: Olich Submission C9 Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION authorization form cons t uction permit desi n data sheet sets of proposed sewage plans THESE- ARE_TRANSMITYED' as checked below: • For approval • For your use • As requested • For review and comment: ❑ Approved as submitted • Approved as noted • Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS Enclosed please find the sewage disposal submission for Jack Olich for your review and approval. If you have any questions, please do not hesitate to call me at your convenience. Thank you for your assistance in exped'itinq this submission. COPY TO DEFT, OF 1 -;�t�i 'J� SIGNED: r.:maao— x..tn,i.tae.si..sssm e,Im T .s..e If enclosures are not as noted. kindly notifv us at once Gentlemen: --PUT'NAM COUNTY DEPARTMENT —OF°HE911PH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 1 April 1976 Re: Property of Jack Olich o n of Located at Wood Street, Putnam Valley, Mahopac, N.Y. T.M. . 5MXX )OX 62 Block 2 Lot 5 This letter is to authorize Theodore Laurence Strauss a duly licensed professional engineer or registered architect X X X (IndicaT—ey- to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County iepai-turneint- of Hecbitll, and to sign all riece58ary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or EdUca;tll -n� ; -the Public Heal haLs °d;'8i1C -the- utrid bt ii; "Bann tary Code. Countersigned: XXXK.X,X R.A., ## 8129 Theodore Lo Strauss Address LAVR Box 417 Very truly yours, Signed' ner o ropert Address R� e ep one 232 -5033 e ep one . .c F . rtiF ST AlE� 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 Jack 01tch Address Wood Street, Mahopac, New York Located at (Street)Wood St . & Tau ret 5mx.. 62 Block 2 Lot 5 (THEAca e neares cross street) Municipality Town of Putnam Valley Watershed New York City SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number, CLOCK TIME PERCOLATION PERCOLATION .apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Mini. Start Stop Drop in Min. /in drop Inches Inches Inches 1 8:00 -8:39 39 14 17 3 39/3 =13 2 8:40 -9:19 39 14 17 3 39/3 =13 3 9:20 - 9:59 39 1 -4 17 3 3913 =13 4 1'8 :05 -8:47 42 13 16 3 42/3 =14 2 8:48 -9:30 1 +2 13 16 3 42/3 =14 - -3 9 -.31- 10:1,3 42 , 13 16 3 42/3 =14 4 1 F 3 4 5 Notes: 1) Tests to be repeated at same depth until aroximately equal soil rates are obtained at each percolation test hole. A11 pp data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. 3 G.L. toy 6" top soil top soil top soil, 12" sand & some clay sand and some clay sand'and some'cla�r 18" 2411 3011 361f 48" 54 If 60" 66" 72f' 78 tI 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NA TESTS MADE BY Joel L. Greenberg Date March 26, 1976 DESIGN— Soil Rate Used —1 1 -1 51i 1 "Drop: S. D. 7Usable Area Provided 5 , 000 s f No. of Bedrooms 4 Septic Tank Capacity 1,200 Gals.` Type re -cast Absorption Area Provided By 308 L.F.x24" '— widt trench. her A ss ASSOC. bigna Address Box 417 Deer Park Plaza Katonah, New York 1053 THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date gERE� 'q�'C �� yAURgN AY,r 0 � O yOF �0 TMe s-r A' CA rV rV Is - �roorn Q POTENTIA 7m BEDROOM _ -. u 11 11 ��foorti ��roo� -s POT N I. L NTIAL M BEDROO.._ ROOM BE - TLAP I s o£ M, PUTNAM COUNTY DEPAI}TPAENT OF HEALTH I I' HOUSE PLANS APPROVED FOR 1346ROO s'1 COUNT ONLY BEDROOMS {; i -- ALL SUBSEQUENT REVISIONIALTLMATIONS TO THESE HOl SE - - -- 13E SUBMH - F8 TEI SIGNATI It�,E & T ' I F DATE . s. y: n 9'. f S - I ICA 11 PUTNAM COUNTY DEPAI}TPAENT OF HEALTH I I' HOUSE PLANS APPROVED FOR 1346ROO s'1 COUNT ONLY BEDROOMS {; i -- ALL SUBSEQUENT REVISIONIALTLMATIONS TO THESE HOl SE - - -- 13E SUBMH - F8 TEI SIGNATI It�,E & T ' I F DATE . s. y: n 9'. f S .1 r � f EXISTING LOWER LEVEL PLAN SCALE : 1/4!' = 1' -0 vm -woov 51pF$T VAA"®c., 41. 10541 TAX mAr I i AE_NT OF HEALTH IOOM COUNT ONLY /0�/3 ALL SURSEOUEN ( REVISION /A.I_TER,ATIONS TO THESE HOUSE PLANS MUST BE SUL'MIITED TO THE PCOOH FOR APPROVAL SIGNATURE A-1 c D Tr -•fl 'r i j r �I • r. k" I L-Li Da�s HALL F. EL L� 10.5 • -I& St; _t_ F-r1S7 NGCR4MSPACE �. E'xtsTtN� {"ouNO.4 w,... i V12 rEL_4G 1Sa WILLIAM I.TTAPS • — • „�°�" ' i -- -- - - -- t39 Woad �i; i ALLEN BEALS, M.D., J.D. Commissioner ofIieafth ROBERT MORRIS, P.E. �- �,: T3�r .n *,�fErSvirgn�eQts�,Neal�h: February 27, 2013 William Means 139 Wood Street ' Mahopac, NY 10541 Dear Mr. Means: MARYELLEN OD19i LL County Executive DEPARTMENT' OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; ' Fax: (845) 278 -7921 Re: Addition — A- 010 -13 No Increase in Number of Bedrooms' 139 Wood Street (T) Putnam Valley, T.M. 74.19 -2 -13 This Department has 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 27, 2013. The addition is approved with the following conditions: 1. The rat slab poured under the family room addition must be above the elevation of the septic tank riser as shown on plan approvals page three titled "Section A ". _ .. 2. The- total -. number:. of bedrooms,-must remain at three without prior _approval. by °this Department. 3. The area of the existing sewage disposal system and its expansion area must be maintained. 4. All plumbing fixtures must be updated with .water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 5. 'The approval is for the modifications only and does not validate any construction shown I s existing that has not obtained proper approvals from other agencies having jurisdiction. 6. This approval is valid for two (2) years and expires on February 27, 2015. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43 26 1. Respectfully, Gene D. Reed Senior Engineering Aide GDR:cw ADDITION APPLICATION RESIDENTIAL ONLY PUTIVA M VALa y STREET 1171 U 043V2 SHEET TOWN - TAX MAP # "I • .1 °I NAME —W tWam I lrieDN5 PHONE `j�4 � ��•38ou PCHD #En MAILING ADDRESS 11;J DESCRIPTION OF ADDITION #-JX?WV10tJ Of VAAAIL"( POM pV 121PINU %ZCOM W1VVtl0N. NUMBER OF EXISTING BEDROOMS 'J' PROPOSED # OF BEDROOMS V (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, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2.. Sketches of existing floor plan (drawn to scale, all living areaincluding basement, to.be. -, -- - shown and dimeiisioned aiid use of -each room specified). =(See Section3: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 COMMENTS s. SHERLITA AMLER, MD, MS, FAAP - . - _Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health PUTNAM COUNTY DEPT 1 GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 OF HEALTH Re: M Residence ROBERT J. BONDI County.Executive TAX MAP #.��r�`��. TOWN UMcA According to records maintained by the Town, the above noted dwelling, IS ✓ I1 COMPLIANCE WITH TOWN CODE. IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Building Inspector L01 Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 lin Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845),278-6558 WIC (845) 278 -6678 Fax (845) 278 -6085 F,arly Intervention/Preschool (845) 278 -6014 Fax (845) 27R -664R f 1 � 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 ROBERT. J., BONDI .: ._. ... _ County,Executive Re: tine E N (Owner's Name) Tax Map #: 74 , i I — 2—)3 r Address: ) 3 9 WO V-I E-7 Town:_ j� LA T N8 NA V A Ll.- C� Year Built: 01 TS According io records maintained by the Town, the above noted dwelling, is ✓/ in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obt7 from: 'Certificate of Occupancy: Other: Building Inspector 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 Interveution/Preschool (845) 278 -6014 Fax (845) 278 -6648 January 29, 2013 �� + Mr. Gene Reed Putnam County Health Department 1 Geneva Road Brewster, New York 10509 RE: MEANS RESIDENCE ADDITIONS 139 WOOD STREET MAHOPAC, NY 10541 Dear Mr. Reed, Enclosed please find the Application for an Addition as per the Putnam County Department of Health. The packet contains the. application, Bank Check, existing floor plans, the proposed floor plans, the septic plan dated 1/11/85 and the Certificate of Occupancy. The Putnam Valley Building Department faxed me a copy of the C.O. but it seems the bedroom count data was covered. However, I enclosed 2 separate forms showing a Legal Bedroom Count of three (3). 1 met with the Building Inspector on two occasions to discuss the potential addition but the project never went forward. I hope this satisfies the question concerning the bedroom count. . You and I did have an informative conversation regarding the proximity of the septic tank to the proposed addition. I indicated a clay barrier as suggested. I will need further requirvments.in order to implement . -. I will await your department's comments. If you need to reach me via phone, the number is (914) 403 -3806. Sincerely, William J. Means C: \Documents and Settings \williamm.FULLERDANGELO \Desktop \Health Dept -139 wood.doc Jan 2813 04:58p Date .11/8/84 19 _ TC R -1 Zone.. District_ - -: . . , ...e. Application is hereby made for ZU11CLM N OF PUTNA��M++ VALLEY IMIT Description One Family (m deck) Location of Premises- Street or Road Wocid SEC: BLOCK ` LOT ACRES (other description) or number of square SUBDIVISION NAME OWNER Bar —Vic Bldrs. Inc. I I St. TM 65 -2 -5 FRONTAGE feet 10f4l ADDRESS_ USE CONST. A •OFING LAND 1 Family Wood Wood 3hingle Pavad 2 Family Steel Asb.IS hingle Dirt Log Cabin Brick Tile I Oiled Permit Work to start at once P.1 84--i0221 Depth Rear TEL. Same ' Dimension of Building Width Depth Stories Bungalow Concrete Metal Swamp Apartment 13 tone i FAN Gee Family Cp RtIFICATE OF OCC<J � No. 140. , p1 5........Applicatioa Certificate of Occuparuey }good t° et:...... P;' c5°- ..........:...... ................:.............. ....:.:..... ,.. ham Location. of "Premises • -.... 39 lJ.o ot3 5 t .... "... i �?p 3�.i... .....'......... SanitaV Nab e. .....n • fa a building Permit pursuant Pi>ttnam Coun ,Or ew Ycorlc, t „ied..an ��p.)liica �m Valley. N ed' t heretofore a Tovl+d of Pu inspection, ascertain C Code and the- Laws &..effect in! ed'ha�g by personal insP - paid the requited fee,;1herefof aft the .undersign roYement of the propo� said work STrw the a pjkant has sub's,egaen•1y p ed with the erection or meti , pp eonents of the as aforemen�Onednan I that tithe premLSes have ture in compliaace : wi1 b the Teal. rovidow Of law. NOW,.. ' me ,6Vl' y' Flu alit of the la ursuant to the p and materials ,� , read for occupancy p Town of Futuarii >�i�w tieeni fuiUy= coPleted and a issued ender the seal of the To !-�::. A(; ., of oe pang hereby _.._... .. _ .- ._...theTefai �. c a#e .... _ _ . y �.re?ifiGe3." this ! ' day of .... NAM oALLN 1977 YORK Valley d authorized agent TOWN OF P � Not valid unless jm ink by a of Putnam Valley. r... of and under the seal of the: T B _ " Date Zoning Board Approval i.s : UU - Plumbing $ 15.00 Well PLUMB; _.....,.. _.. _ ..,_ . .� . C.O.. B n Cc c i �: & . I i �.,.._ l- v V -a 1 -- #-%W t A146&�, p 10f4l 0 f, 74 — f• 1; 11' -2" MASTEIP BATH O O O 1 N] �(, GUEST BATH 1 JIS" J1 SF 7 i y BEDRO�JM /2 9"AVA9m r �TYJ r J'Jl r J'/J EXISTING UPPER LEVEL PLAN SCALE : 114 V -0 ;t 4 i ;s � b B i { 6b x 6t9 � 17 x J9. } LL OIN/NG R170M ,! .t s i M .a DN G garage ENT/e4NCE � /MNG RDOM' . r 2W Sr 4 _1 � K i j i z3' -s" I I" wood Vlww WAildf -, N`1 to5i1 -Ox W-W A 14.1`1 -24I ? EXISTING LOWER LEVEL PLAN SCALE : 1/4• = l._0 4 139 wood vmm-r mauoea-c 0.1. 10541 TAX 1M& o '14.11 -2,11; Sheet _of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH. DI`'ISIOI! OTfENVI<= I?.,?N.M.E1TI;II::'1'I >El� SE]�2.VICES 'FIELD ACTIVITY REPORT Ai1T1RRC.Q; 139 Gc%ocl S�, l�vTvtc�1+► l/�l(�y Street Town State Zip PERSON IN CHARGE z Name and Title ' TYPE OF FACILITY : FINDINGS:_ ��? 42e��`��� LyJ�.A�e.-�;m✓1 n��a.OP. :vl rtir'• =f� �!`OQc�S�oP o�c.P�.`Y.'oe�/, �© �fU►��5 ®K` �o��e_tyl� y1 ©"T�� �s� oy� v��tor9n�X S- �J�'�ic �c.�P�ecr o�� S� ow.� ch SS7S ,4S - uL.,;6f Signature and Title RFPQRT RRC -F-T F-D RY. I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Sheet of / PUTNAM COUNTY DEPARTMENT OF HEALTH —/-- I2gV)<SIOi,1 OF ENVIRONMl� N7[= AI:;=.t]- ATLII`-S]ECR, -VICES FIELD ACTIVITY REPORT Street Town State Zip PERSON IN CHARGE ()g TNT -FR VTFWFT). Gf/. / /,ate W-e Los Data_ 9z/ 3 Name and Title n TYPE OF FACILITY : S,v,o,l e FINDINGS: aM lL e e v-A Qoc ' vrv� , m ✓I C.leti v�Fx �%Sr�U� �.71i��� Signature and Title RFPnRT RF('FTV-n BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: +i. ;.5 I rat +i 1:! r•� '# I EXISTING GARAGE STAIR EXISTING CRAWL SPACE (EXISTING 2- RAT SLAB) GIRDER 1 --1 F— EXISTING 40 SAN. (ABOVE SLAB) h EXIST. E)GSTINC 200 AMP SERVICE ELEC. 4lo F STAIR PLATFORM % ZCRAWL SPACE CONCRETE SLAB ON 8 MIL POLYETHYLENE VAPOR BARRIER (TURN -UP WALLS) ON 4- COMPACTED GRAVEL \-I',-; x s�pTrc -TvNK l00� 8GL C�eFe) FOUNDATION 11 111 1 — o, — EXISTING SHUTOFF Bx18- -REPLACE DAMAGED 4- PVC TM= LINE - 3' -e -t CRAWL SPACE Z11- CONCRETE SLAB ON 8 MIL POLYETHYLENE VAPOR BARRIER (TURN -UP WALLS) ON 4- COMPACTED GRAVEL DAYLIGHT wIWpM .l.MDNS 13`t u)000 e-t: magoodc-,Nt tasdl TAX MAQ #4 -74. 19 -7 l.- i -�-'�" N � ��\. ` �a�+ r� �...--- �-- � ------ -••il by ......5 M 54:x: hlA.�.M+..a rte' - * �����y r�. .. ,�:iixv. :�..�� .=�yt. L _ _ � i. iM n r .. ::.♦ .� ..rte' •�� . _ ,.. Health and :the 2Se :w Yorl; S 61 e D'epa.x• kment of Health. • 'x' •.f 1- e „ .- .' a'. »...v r 6 �. •� ..' f .r � � .� . r .b. ."4:."r.:. . rx� r fttnam cow.. ,v �,un� rttnent of Rea. VW —siow of ?`' ,il .Health Se: .fpproved ~C)-+.fOrmarice V: appuoAu;- ifirtlo�is o Putnam' . Gc , -axtment:. At 4-i'46 - -W P��A • �+yy� ,y }�yry� . ; w.. .«:•....,..M.r.:..�„�r�.;pn„�i, I.HVp�7Nx..�nv.::wt -wb/u �....wc` :.:.,� , t OFNVW s .. . i ww �...a. - w :n. -y-... '.• w .....�...v .w++ +' Ap, A yea y ��� ��' •;;, ,�� � ` .,� ��� �'�� ..... � .. . r 6` t1t, . . '• �i^• w�nw! p^_«., cws.• �Nf+• wer,+f �+- :•+�.irrx�`Sn...,.w,iw.•I,�. w' . f...+ �. u. w4�..• .- .....,.. +...i+- .........•u...