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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -7 BOX 34 1.6 !rr # I 16r 6 11 Ar bqn L- IL 04451 PUTNAM COUNTY DEPARTMENT O F HEALTH. ENGINEER MUST Division of Environmental Health Services, Carmel, N. Y. 10512 PROVIDE PERMIT # CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley (T) "Town or village 19 LOtated'af�.... _ �Tr.�0Ysr.v,—Lm- b,: So -: a: " p :rim f:~�« %.:e• fiaR Map :- •.9Lm' ..:ter :�= `%yi .. -i� yi , -. '+ -i Joseph DiBenedetto. / Formerly Tax Flap Lot n • Subd. Lot k Owner Separate Sewerage System bu't Howard Gra ert Addreu Oscawana 'Lake Road T2 LF o x4 Gal eries Putnam Valley, NY Consisting of Gal. Septic Tank and Other requirements None Water Supply: Public Supply From X Norman Anderson Private Supply Drilled By Address Barger Street Putnam Valey, NY 10579 Building Type contemporary No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? Yes Has garbage grinder been installed? No • ...�tAl CAlnn.. °m I certify that the system(s) as listed serving the above premises were constructed ease of which are attached), and in accordance with the standards, rules and regulations, in Putnam County Department Of Health. ° s 9e sK Date I April 1, 1986 Address. 1 Notr -thr ms of the completed work ( copies $Jan, and the permit issued by the �4-566 P.E.z7849 _ °License NO. ° Any person occupying premises served by the above systems) shall promptly take such action a °ema�'T secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become �nprvgj�a�n a! a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public W {tDa�f-��f.�aJJ ,, Aepaofnes available. Such approvals. are subject to modification or change when, In the judgment of the mmissioner of Heal h, such rev&@uos& 2flcation or change is necessary. Date -4 �/✓ �I`J Title Rev. 6/85 r .:.,. , WELL,' .: .; MPLETION REPORT y ' PUTNAM COUNTY DiPARTMENT OF ,HEALI eYy:. A<—. :..ter. V' � -.L• • p•..• °DiVlyiD+17 tD'I Eit2N06TiiYilt'::5i ~;FSQAIYP' SIl COUNTY OFFICE BUILDING - CARMELi NEW YOF report is.to.Y%.completed by well /riller. and submitted to County Health Departmenttogether, with, laboratory report If ; a lysis of water `Sample indicating water is of satisfactory.bacterial quality before certificate of construction compliance is: issued :.`. REPORT MUST BE SUBMITTED WITHIN 30 DAYS_ OF WELL „COMPLETION,; . owl"'. E ADDRESS ... LO OF N LL + Street) own) (Lot Number). C ✓ ED L'DOMESTIC ESTABLISHMENT FARM ST WELL F A PUBLIC s'.. AIR ��CONDITIONING a OTHER SUPPLY INDUSTRIAL ...: (Specify) MPRESSED CABLE' HE CO R �;:OT R AIR PERCUSSION NT : OTART PERCUSSION (Spsafy) y LENGTH ( leaf) DIAMETER(Inenes) WEIGHT PER F oQT WELDED jT H READED YES fD.NO j_ �)TE��O. .. HOURS G.P.M.• . / DBAILED " YIELD (O P "M) — "`:PUMPED.:` COMPRESSED AIR W R MEASURE FROM LAND SURFACE "" STATIC,(5pecpyleeq DURING:YIEID TEST feet) ! Depth of Completed Well / (n feet.61aw.Lond.surfacs 5 r _ . MAKE � 4 LENGTH, OPEN TOeAQU1FER (lee D Il5 3lCT'SIZE" DIAMETER (inches, IF GRA Diameter of well including' GRAVEL^S12E (fnchosJ FROM(Igaf) ; TO (fast) PACKE11 gra.el pock .(Inches): DE ►TH M ^IAND,SURFACE DESCRIPTION Sketch exact of wilt wIM dlafancss fo at past t to FEETS FORMATION .., ., , two permanent Nndmuka ..... , .. ..,. .. .. .... .. ... ......... r 1 ' If yield was tested of different depth's' during'dnlling„ list' below GALfONS PER,MINU TE... : .v. l ;. DA WELL GOIu1RLETED: . ...�. '.:� ..�,....� _. . _ ... -- ...__. �� /°✓i ".—. i Jor eph DiBenedetto 19 Owner ®r urc aser o Bui ding Section Soc eph DiBEnedetto 3 r.. ....�Bu'•i:l�iz�" Coil: s�i ;�•uc�(�+ed.� „b�,- .a�..,.::;,� ;�; .;: - ��• . _ ti�:_- X31: ©ek ,_.,,.:,; � . _ - ,� ±.�.�.x.,�,:,:.b - �;�::;:�• °,� �:;. -.; �.�..> Lovers Lane 21.2 Location - Street Lot Putnam Valley None Municipality Subdivision Name Contemporary - Building Type Subdv. Lot ## GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that 'I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner,.his success- ors, reirs or assigns,, to place in good operating condition any part of said 57stem constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal syst ea, or any repairs made.by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant Ef the building utilizing the system. .he undersigned further agrees to accept as conclusive the determin- at ion of._the Director of the Division of Environmental Health Services .:t • .r, tlif Pu.tn4m- C-d�xrity "D°epartment.. af-- H2'Xlth° as°' -°t�--��-�e-th.er--- or..�t.ot•- tb'e•- �a-i1� .• . ur a o? the system to operate was caused by the willful or negligent act of t1Z{ occupant of the building utilizing the syste . 20th January 86, A� Datedthis day of 19 Signature, Title Corporation Name if core.) Address - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THRl-i'1(3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTSICATE OF COMPLETION WILL BE ISSUED. GUAM .6TOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Div :j_jon of Environmental Health Services, Putnam County Department of Health Y 0MLOW n - 1CUIc ai Laboratory, . inc.. LOCATIONS: 321 Kear Street• Yorktown iieights, N. Y. 10598 " (914) 245 -3203 Director: Albert H Padovani M. T. (ASCP) // YV)�f_ S L 4^t x/'414 XJ 121 KEAR ST.; YORKTOWN HEIGHTS, N.Y. 10598 245.3203 b 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737$777 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 6663335 C1 STONELEIGH AVE. (NEAR HOSPITAL). CARQ`�� i, "pro ; . ma�yy__ t � `�'� DATE TAKEN: l'; 2 g's� DATE RECEIVED DATE REPORTED: SAMPLE SOURCE: �/ Lab it REFERRED BY: xoSS J Collector: Sb LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY i = .............••• BACTERIA, TOTFtL /mL ....... l .6 ........................... ... ❑ SOD, 5 DAY ............................ ............................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CXL ORIDE ............................ ............................... ❑ CHLORINE ............................ ............................... ❑ COD .................................... ............................... ❑COLOR ( units) ................. ............................... ❑ CYANIDE ............................ ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ FLUORIDE ............................ ............................... ❑ HARDNESS ............................................................ ❑ MPN COLIFORM COUNT/ 100 ml ............................... MFT COLIFORM COUNT/ 100 ml .............•••• ❑ CONFIRMATORY TEST ............ ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ NITROGEN, KJELDAHL .:.......... ............ .................... ❑ NITROGEN. NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑• ODOR. ( u:1 4• $ /_- , y z: , ............. ❑ OIL & GREASE ........................ ............................... ❑ pH (units) ...................... ............................... ❑ PHENOL ................................ ............................... ❑ PHOSPHATE (ortho) ............................ ................... ❑ PHOSPHATE (condensed) ............ .............:................• ❑ PHOSPHATE (total) ................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ SOLIDS. DISSOLVED ............. ............................... ❑ SOLIDS. TOTAL ..................................................... ❑ SOLIDS, VOLATILE ................: :.............................. ❑ SPECIFIC CONDUCTANCE (uhMO S / Cm) ............... ❑ SULFATE ..................:.......... ............................... ❑ SULFIDE ............................. ............................... ❑ SULFITE ......... ❑ SURFACTANTS ..................... ............................... ❑ TURBIDITY (NTU )..... .. .................... ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC .................................... ............................... ❑ BARIUM . ...................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH .................................... ............................... ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT .................................... ............................... ❑ COPPER ...........:........................ ............................... ❑ GOLD ........................................ ............................... ❑ IRON ........................................ ....:.......................... ❑ LEAD ........................................ ............................... ❑ LITHIUM .................................... ............................... . ❑ MAGNESIUM ................................ ............................... ❑ MANGANESE ................................ ............................... ❑ MERCURY .................................... ............................... ❑ NICKEL ........................................ ............................... ❑ PALLADIUM ❑ POTASSIUM ................................ ............................... ❑ RHODIUM ...................................: ............................... ❑ SELENIUM .................................... ............................... ❑ SILICON .: .................................. ............................... ❑ SILVER ........................................ ............................... ❑ SODIUM ........................................ ............:.................. ❑ TIN ............................................ ............................... ❑ ZINC ........ ................................................................ :.. a.......................... ...................... ............................... ❑ ..... ............... .:............................. ................. ❑ REMARKS: ............................. ........ ............................... ❑ .................................................... ............................... TNTC = Too Numerous To Count = less than (below detectable limits) RS = Recommend Sterilization of Source FSBT = Filtered Sample Before Testing THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN.THE SAMPLE WAS COLLECTED.,y THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART T2) FOR THE PARAMETERS TESTED WHEN THE SAMPLE WA COLLE r N/A = not applicable Albert H. Padovani M.T. JASCPf. Director RWFB 5 Date: _ r. •},] -t x.�?r ,x,. w ••_v. ^'� .a'. .. ••m! .... .. r. s . >. ,f .4,6...w.. -.L0.4'..1 !•e 4-T 0 INITTAL SITE TIISYI:CTI�� ?: r � Yes. No Comments ,Properly lines or corner3 foluid . . . . . . . . Can cstimatc house location . . . . . . . . . . dill driveway need cut . -- Must trees be removed -note these Is deep hole representative of entire SDS area Additional deep holes. needed. Sufficie -rit SL'S. area available considering driveway cut, house location, separation distances., etc. DEFT' 110LIE DATA Dapth: Water elevation: Rock elevation: Pv-V -S Soils descrivption: .. - Date: -zq FINIAL SITE LTS_ ,1 sC_T_10� : Insp . by: House located ul-jere s}.oi.,n on approved plan • . SUS located where approv - -d . . . . . . . •Iength of trench mctasarad 2-5 (o' GA".Zy - Width of trench avera: c Ile Slope of tile line and, trench. acceptable.. _ P�m� 1=o�cd i'U_= ep.nsi:a _trenches.__ Over 50 ft..' from swanp,watercovrse Natural soil not-stripped or SDS area - iuuiecessarily graded r _ 10 Ft. maintained from prop.line and 20 ft. from house Separation of trench from house. well - -etc. - follows plan : -, - -:. -:- . VIrmlber of bedrooms chcck5 . . . . . . . . . . Stones, brush., • stu,.:ps, rubble, etc. greater -: - - -------------- •- -..._. / than 15 ft. from nearest trench 15 Ft. of periVpera,l soil horizontally from trench .. e Junc�ion boxes properly set j Could surface run off from driveway, roads, ground surface, etc, channel near SDS . area ✓ ._ � e Docs lot dr. a inl ,a aurcar 0. K. in area of SDS 5':1:1\AL GPADING OF SITE ACCEPTABLE a LovF -'(Z' S, Lno?, (Pd) RL'VIEW CIII:CK SIR :T DOCUP EDITS House plans 0.K. D_-sign data sheet Peres presoaked? Kin. 30" perc test depth Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for othe�� than individual_ Authorization for engineer Letter from Water Supply.if applicable If variance requested -such noted on plans & apps._ IMcets Std . ( Remark-,' emarks ' es ^ No DETAILS if change " is proposed.) Existing contours shown show new-contours) Slopes for driveway cuts, etc. shown. 1-_ter service line location , Footing drain, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location f Septic tank size and conformance to std. 3 B.R. house minirum House setback shown I Distribution box ftg. below frost All water within 50. ft . of PL shown _ Plan and .profile ,SDS ` .......... X weil °r "pia° SLS "cldser 200' _ shown'or reference made Property boundaries (metes and bounds - clearly sHFX SEPARATION DISTANCES SPECIFIED ON PLAN 10' to P. L. ?0' to Fotuldation walls DO' to Nearest well )0' to stream, march,. lake, etc. L5' to Curtain drain 1.0' to water line (pits -20 .5' to storm drain. .01' to large trc s .0' 1'roill foundation to septic tank .5' to pipe from leader drain & . 1'0 KRvele Pfd- 0 a ` co,)7 -o" 7Wv s3d)s ,k iNA i i - i I /o � ao, . e.�pansion l .< IC19 i i E I'a rl cv UL Ig Re: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date July 8, 1984 Property of Joseph DiBendetto Located at Lovers Lane (T) Putnam Valley. (T)Section 19 Block 3 Lot 21,2 Subdivision of None Subd-%r. Lot # Gentlemen: Filed Map # This letter is to authorize John S. Romeo Date a duly licensed professional engineer X 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 nec"essary papers on my behalf in connection with this matter -and to supervise tli6 'co'n"'struction of said 4- s.ys.t6m-orz�s'y-;st:em-s�--':gin --conformity -with- t-Kep� 147, Education Law, the Public Health; Laww, acid 'the:,-Putnam County Sani- tary Code. Very truly yours, Signed J� �Owner of Property Countersigned: P. E. , RMY, # 27846 Address 1 Northridge Road S. 8U� Address Town Peekskill, NY 10566 Telephone 737 1056 ? 0 278410 4 -11 0 Telephone 00 -, ff NEW PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - COUNTY OFFICE BUILDING;;DAIL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Joseph DiBenedetto Address 3002 Roberts Avenue Bronx; N, Y_ - , - Lovers Lane ^ -- 21 2 Located at (Street se'c. Block' "� " hot" . i Indicate nearest cross street) Putnam .Valey (T) Peekskill Municipality, Watershed - SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS bole Number CLOCK TIME PERCOLATION PERCOLATION Run ,apse 'Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min -An drop Inches Inches Inches (1) 1 1002 10:20 18 18075 21.75 3000 m60oo 2 10 :23 10 :43 20 18.75 21.75 3-000 ... 6067 3 10 :45 11 :05 20 18.75 21075 3000 6067 (2) .l , o-1 09 10:30 21 .:19.50 22.50 3.00 7.00 2 103212 :54� 22 19.50 22.50..... 3.00.. 7.33 s.16' Notes: _19.;x.__. 205.0._.....3;-00 .. :. �_e33,..- Notes: 1) Tests to be repeated at same depth until approximatel equal soil rates are obtained at each percolation test hole. A11 data to �e submitted for review. 2) Depth measurements to be'made from top of hole. 0 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE =L TO WHICH WATER=,LEVEL- RISES.AFTER BEING: ^ENCOUNTERED TESTS MADE BY John S. Romeo Date Ju 14,� 1984. .. ;` D_ ES ,. Soil Rate Used 10 k-i'Vl "Drop: Y ' . `.~ (�sab1 `Idea' "Prod filed No. of Bedrooms ��'� Septic ank Capacity 1200 Gals. Type Masonry Absorption Area Provided By µ4 L. F. x24 x widtt;mtre crl. Name ti onn ;�; , xome o Signature k4,, q7 . Address 1 Northridge Road SEAL ° ® 3. cl Peekskill. NY 1Oft( 09, ° -- ® .° 0 �d��' 2786 m THIS ..SPACE :FOR USE BY HEALTH DEPARTMENT ONLY: °®lf ��. o © Of WEB'0 ° Soil Rate Approved Sq. Ft /Cal .... Checked by ® ®° °tdlue RS EIV . AUG 2119x4 PUTNAM COUNTY gepT. OF HEALTH 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 -- _ _.y; T �gaoil _ _ _ -.. - T.opso.l,; 6" . r . _...Topsoil 12 11 Top soil Topsoil t 18'• - sandyflgravelly', 'sandyflgravel�y,= ;�. sandy.,gravelly.' 2411 loam` loam loam 30" 0 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE =L TO WHICH WATER=,LEVEL- RISES.AFTER BEING: ^ENCOUNTERED TESTS MADE BY John S. Romeo Date Ju 14,� 1984. .. ;` D_ ES ,. Soil Rate Used 10 k-i'Vl "Drop: Y ' . `.~ (�sab1 `Idea' "Prod filed No. of Bedrooms ��'� Septic ank Capacity 1200 Gals. Type Masonry Absorption Area Provided By µ4 L. F. x24 x widtt;mtre crl. Name ti onn ;�; , xome o Signature k4,, q7 . Address 1 Northridge Road SEAL ° ® 3. cl Peekskill. NY 1Oft( 09, ° -- ® .° 0 �d��' 2786 m THIS ..SPACE :FOR USE BY HEALTH DEPARTMENT ONLY: °®lf ��. o © Of WEB'0 ° Soil Rate Approved Sq. Ft /Cal .... Checked by ® ®° °tdlue RS EIV . AUG 2119x4 PUTNAM COUNTY gepT. OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL =,ALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA.SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Joseph DiBenedetto Address3002 Roberts AvenUe,Bronx, N.Y. Located at ( Street Ydicate.overs : Lane, - - �- Sep . -19- Block -, ,3. , ..Lot- -, 21�. 2 n eares cross street) Putnam Valey (T') Peekskill... Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS riot( Number CLOCK TIME PERCOLATION PERCOLATION Run apse. Depth to Water Water Level No. Time From Ground Surface.in Inches Soil Rate Start -Stop Mina Start Stop ..Drop in Min. /in drop Inches.. Inches Inches (4) 1 4:02 4 :17 15 17.75- 20.75 3000 5.00 2 4s20 406 16 17.75 20.75 3.00 5,33 4:4o 4:56 16 179;75 2.75. 3.00 5.33 .5 r ' 2 - '3 5 2 4 5 Notes: 1) Tests to be repeated at same depth until appbroximatelyy equal soil rates are obtained at each percolation test hole. A11 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. 4 HOLE NO.. 5' HOLE NO. TPsM Tops-&I —o 6 -Top 1211 soil 1811 sandy*9gravellyl sandy, gravelly. - loajri 24 loam 0. 0 .L c-, 3011, T 3611 '4211 48 5411. 60" 66 72 78 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED .:None. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY John S. Romeo Date Sept 25, 1984 Soil Rate Used8� 10 Min/l"Drop: S.D. Usable-Area Provided 5000 SF+ No. of Bedrooms 4 Septic Tank Capacity 1200 Gals. Ty masonry 'y pf/� �0 iAbsorption Area Provided By L. F. x24,' w :;d -4.x 4 Galleries 00 w% 41?0 1112 LF of -Name John.S. Romeo Signature kz�� 1 Northridge Road Address SEAL Peekskill, N.Y. Z7%A'J THIS ,SPACE FOR USE BY HEALTH DEPARTMENT ONLY. No 0 0000().000 Soil Rate Approved Sq. Ft/Cal.. Checked by Date R""ECRNVED OCT I 11984 PUTiNIAM COUNTY DEPT. OF ,t Public Health Director - LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 14, 2003 Mr. & Mrs. DiBenetto P.O. Box 686 Putnam Valley, NY 10579 Re: Addition- DiBenetto, 50 Lovers Ln. No Increases in Number of Bedrooms (T)Putnam Valley, TM #84.15 -1 -7 Dear Mr. & Mrs. DiBenetto: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated February 14; 2003. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at our without prior approval by this department. 2. The area of the..e� sting sewage disbosal system, a7.d its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley If you have any questions, please contact me at your convenience. Very truly yours, William Hedges WH:Im Senior Public Health Sanitarian cc:BI 0, , d. BRUCE R: JOI.EY _ Publi'c `Hea'Cfi 'director` DEPARTMENT - OF 1 Geneva Road Brewster, New York HEALTH 10509 L-ORETTA.;MOLINA1tI- RPii, Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 - WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278.6082 Fax (845) 278 - 6648, ADDITION APPLICATION (RESIDENTIAL ONLY) STREET/—,�iy TOWN -'TX MAP# NAlME 41 PHONE c " % ,3%?ZPCHD# MAILING ADDRESS DESCRIPTION OF ADDITION! NUMBER OF EXISTING BEDROOMS�PROPOSED # OF BEDROOM'S (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept:, 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9). *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. OFF7CE USE Comments i Feb98 ; BFhouseguidelines BRUCE R. FOLEY Public Health Director DEPARTMENT 1 Geneva Brewster, New OF Road York HEALTH 10509 LORETTA MOLINARI RN., M.S.N. Director of Patient Services Environmental Health (845)278-6130 ' Fax(845)278-7921 Nursing Services (845)278-6558 , WIC (845)278-6678 Fax(945)278-6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: Re: 94wir -mrm Residence Tax Map OT . Town TrJ r►w� �t -�..�� According to records maintained by the Town, the above noted dwelling IS ✓ IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY:_ ASSESSORS RECORD: !r OTHER Building Inspector BFhouseguidelines Piff NAM COU TY DEPARTMENT OF HEALTH ENGINEER MUST 1� PROVIDE �lvisi of Environmental Health Services, Carmel, N. Y. 10512 �/' q • �. PERMIT # !/ �- Y CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Valley (T) Town or village Located rovers lane Tax Map Block dQ Joat sep D1Benedetto / Owner Formerly Tax Map Lot a Subd. Lot —# _ Separate Sewerage System buyt,p Howard Gra ert F o x4AGa1 Oscawana bake Road �G eries Putnam Valley;• NY Consisting of Gal. Septic Tank and Other requirements None Water Supply: Public Supply From X Norman Anderson Private Supply Drilled By �9 l© AN Address Barger Street Putnam Valey, N ,5 Building Type Contemporary No. of Bedrooms_ Date Permit Issued Hjaf Erosion Control Been Completed? Yes • Has garbage grinder been installed? No •�eee.eek• I certify that the system(s) as listed serving the above premises were constructed ease, of which are attached), and in accordance with the standards, rules and regulations, to Putnam County Department Of Health. • • Date ,April 1, 1986 Address Certifiql by 1 Northr of the completed work ( copies Plan, and the permit issued by the G• • P.E. R. 27846 o •License No e Any person occupying premises served by the above systems) shall promptly take such action a�nr�'It RD'I'Mansis. secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall bscomeety}i�i�n}irvQj ,atof S pu ilie�anitsry sewer becomes available and the approval of the private water supply shall become null and void when a public Nit ,ivai a4ble, Such approvals, are subject to modification or change when, in the judgment- of the mmissioner of Heal wch revac9t)o0,.mWfication or change IS - necessary. Date _` Title — Rev. 6/85 h :.. •. _ _ f� •. 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