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41.10 -2 -16
BOX 20
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02310
ALLEN BEALS, MD., J.D.
Commissioner ofHealth .
MORRISS, P.E' MPH
Director ofEWronmedd Health. -
DE. E.PARTNII+ NT OF. HEALTH
1.. Geneva Road;. Brewster., New York 10509
February 24, 2014 Phone # (845) 8094300 Fax # (845) 278 -7921
MK Equities
45 Sutton Place South
New York, NY 10022
Re: Addition.- A- 02344
No Increase in Number of Bedrooms
544 Lake Shore Road-
Putnam Valley, T.M. 41.10 -2 -16
To whom it.may concern: .
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 24, 2014. The addition is' approved with
the following conditions:
1. The total number of bedrooms must . remain at two without
prior approval by this
Department.
2. The area of the existing sewage disposal system and* expansion area must be
_ ^ . - maintained...
3. All plumbing fixtures must be updated with -water saving devices., i.e., new low flush
toilets, restrictors for shower heads and faucets; etc
4. 4. The approval is for the modifications only and does not validate any construction shown
as existing that has not obtained proper approvals from other agencies having
jurisdiction.
5. This approval is valid for two.(2) years and expires on February 24, 2016.
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. 43261.
Respectfully,
Gene D. Reed
Principal Engineering Aide
GDR:cw
cc: BI (T) Putnam Valley
Michael Piccirillo,.R.A.
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
ADDITION APPLICATION - RFSIDI• .NTlAl. ONLY
Pic H (gs5 z � y6,
hex 6-
Owner's Name: t' U « Le,s Owner's Phone #:
AOr
Site Address:_. L6t K e ���'�� 9(1-Town: �u'� vxQ,,.ax tap #
Owners Mailing Address: s.. ��ti"��. `)�qC C ,�.1� " {` SOD L Z_..
1 _
Owner's Signature:
Description of Proposed Addition: QLU I CUe C 0(Id rhW NO-C Exl �, hnq
rV-Uj is Q mcEctacyuf in Ctrl
*Number of existing bedrooms: a Total number of bedroom~ (c�istin{; ± proposed) r - -. _ .
FROA4- GER=1'. -OF OCCUPANCY OR CERTIFICATION fi'IrUM'I3CIfi;D1NC; fNSPh ( °Ct7R) _. ,. �._ ..�. > ..... _...
* Any addition which is considered a bedroom requires formal approval ofilans (Consu-uction 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 Departrnew of l-lealth. I Geneva Rd,
Brewster, NY 10509, Phone: (845) 508 -1390.
1. Certified check or money order for S 100.00.
?. Two sets of sketches of casting floor plan (drawl, to scale, all living area including basement,
to be shown and dimcns;oned and use of each room specified). (Sec Section 3.c of Bulletin I IA -1)
TWO sets of pr0p0SUd 11001 plalts tdrawu to Scale; ..- %V' nafn;. Street and tax nutp ti)
* Non - professional sketches are acceptable and preferred. (Sc,. Section 3,d Of Bulletin HA -1)
4. Copy of survey showing all well and septic locations on the snhject property to the hest ol'your
knowledge. CO11titCt this office with any questions.
5. Cupy ofCertificatc ufOccup;ulcy fi•um the'1'uwn 0r C;crtilicatiun from the BUddin IDepar1111011
with legal bedroom count of dWC11111 ".
OFFICE USE
COMMENTS
Rev..hily 3013
5
rl
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j
ALLEN BEALS, M.D. J. D.
C'ommissionero Health
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MARYELLEN:QDL?LL
C'ntrntt rac- r•nriii
ROBERT MORRIS, P.F.
Director of Environmental Health
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
ADDITION APPLICATION - RFSIDI• .NTlAl. ONLY
Pic H (gs5 z � y6,
hex 6-
Owner's Name: t' U « Le,s Owner's Phone #:
AOr
Site Address:_. L6t K e ���'�� 9(1-Town: �u'� vxQ,,.ax tap #
Owners Mailing Address: s.. ��ti"��. `)�qC C ,�.1� " {` SOD L Z_..
1 _
Owner's Signature:
Description of Proposed Addition: QLU I CUe C 0(Id rhW NO-C Exl �, hnq
rV-Uj is Q mcEctacyuf in Ctrl
*Number of existing bedrooms: a Total number of bedroom~ (c�istin{; ± proposed) r - -. _ .
FROA4- GER=1'. -OF OCCUPANCY OR CERTIFICATION fi'IrUM'I3CIfi;D1NC; fNSPh ( °Ct7R) _. ,. �._ ..�. > ..... _...
* Any addition which is considered a bedroom requires formal approval ofilans (Consu-uction 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 Departrnew of l-lealth. I Geneva Rd,
Brewster, NY 10509, Phone: (845) 508 -1390.
1. Certified check or money order for S 100.00.
?. Two sets of sketches of casting floor plan (drawl, to scale, all living area including basement,
to be shown and dimcns;oned and use of each room specified). (Sec Section 3.c of Bulletin I IA -1)
TWO sets of pr0p0SUd 11001 plalts tdrawu to Scale; ..- %V' nafn;. Street and tax nutp ti)
* Non - professional sketches are acceptable and preferred. (Sc,. Section 3,d Of Bulletin HA -1)
4. Copy of survey showing all well and septic locations on the snhject property to the hest ol'your
knowledge. CO11titCt this office with any questions.
5. Cupy ofCertificatc ufOccup;ulcy fi•um the'1'uwn 0r C;crtilicatiun from the BUddin IDepar1111011
with legal bedroom count of dWC11111 ".
OFFICE USE
COMMENTS
Rev..hily 3013
5
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
l v11v /�
YES Nd Internal Use Only PERMIT # I
❑ Repair Permit issued in last 5 years VDelegated
ot in Watershed
❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res.
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT
TOWN _r,17'� TM #�,
I �N_1A� PHONE#
4A1LP - 9 Put- U4 a. �
Name & Relationship (i.e., owner, tenant, contractor)
DATE 114-11,o FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER qel m ,off �c -cr F / PHONE # 2LZ2� 6
ADDRESS �'� `�,.,,, }�� v = REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair. Z) „ , ! 1-% _�
I, as owner,agree to the conditions stated on this form
SIGNATURE �� /�'fcv -�_ TITLE DATE 12,11.o O
(owner)
- °I, the septic- installer;- agree to comply with the conditions of -- this - permit for -the septic - system. repair
SIGNATURE 4%�,, — TITLE"'` DATE /V//z)
(installer)
Proposal approved with the following conditions: s
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved Proposal Denied ❑
In pector's 8ignature & itle Date Expiration Date
Repair proposal is in compliance with applicable codes Yes [7 No
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
r'
4
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
l v11v /�
YES Nd Internal Use Only PERMIT # I
❑ Repair Permit issued in last 5 years VDelegated
ot in Watershed
❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res.
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT
TOWN _r,17'� TM #�,
I �N_1A� PHONE#
4A1LP - 9 Put- U4 a. �
Name & Relationship (i.e., owner, tenant, contractor)
DATE 114-11,o FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER qel m ,off �c -cr F / PHONE # 2LZ2� 6
ADDRESS �'� `�,.,,, }�� v = REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair. Z) „ , ! 1-% _�
I, as owner,agree to the conditions stated on this form
SIGNATURE �� /�'fcv -�_ TITLE DATE 12,11.o O
(owner)
- °I, the septic- installer;- agree to comply with the conditions of -- this - permit for -the septic - system. repair
SIGNATURE 4%�,, — TITLE"'` DATE /V//z)
(installer)
Proposal approved with the following conditions: s
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved Proposal Denied ❑
In pector's 8ignature & itle Date Expiration Date
Repair proposal is in compliance with applicable codes Yes [7 No
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
January 20, 2010
James Gualtieri
34 Columbus Ave.
Putnam Valley, NY 10597
Dear Mr. Gualtieri:
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: SSTS Repair — As -Built
544 Lake Shore Road
(T) Putnam Valley, TM # 41.10 -2 -16
This Department is in receipt of your submission of an SSTS as -built plan, regarding the above
referenced property. Please be advised that all SSTS as -built plans submitted to this Department
require measurements to all components of the system from two fixed points (most commonly
house corners). These professional plans are filed with the Health Department and 'are
considered a valuable.source of.information for future reference.
Kindly provide the above noted information on your plan and resubmit it to this Department
within 30 days. If you have any further questions, please contact me at (845) 278 -6130, ext..
43261.
GDR:kly
Sincerely,
� s
Gene D. Reed
Sr. Environmental Health Engineering Aide
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
34 Columbus Ave Putnam Valley N.Y. 10579 914-760 6344
Kevin Manion
544 Lake Shore R.D.
Putnam Valley N.Y. 10579
TM 41.10.2.-16
Date 1/ 7/10
License # 1137
Septic repair
lilt, �r
34 Columbus Ave Putnam Valley N-VA0579 914-7160 6344
Kevin Manion TM 41.10.2.-16 Date 1/ 7/10 -
544 Lake Shore RD. License # 1137
Putnam Valley N.Y. 10579 Septic repair
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Town Legal Bedroom Count & Proposed Addition Status -
Re: Mt (Owner's Name
Tax Map # 41
Address: I jail as rz
Town: DLftD am val?k U
Year Built: 19 '60
According to records maintained by the Town, the above noted dwelling,
is y / in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is: 2,
This information-has been obtaiqed.kQm:._
Certificate of Occupancy:
Other: 6S&
L'GD6 Q7 Gil
The plans for the proposed addition are considered:
Addition to existing house only
Teardown and/or re-build allowed under Town Regulations
A
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2 I �►�-�-
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Builring'Inspector Date
.6.