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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -38 BOX 22 02593 No Ill lose , ry a - .���. of III IN � ll� IN . T . � N NMI 02593 ALLEN BEALS, M.D., J.D. Commissioner of Health Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 22, 2014 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Bruce Allen 36 Breezy Hill Dr. Wingdale, NY 12594 Re: Addition — Approval —A- 066 -14 No Increase in Number of Bedrooms 10 Loos Lane (T) Putnam Valley, TM # 52. -2 -38 Dear Mr. Allen: MARYELLEN ODELL County Executive 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 the Department dated May 20, 2014. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4... T.he: appzoialis :fot.:th6 i;606sed changes::only.._This ap p roval_does. not.validare.:aftv :.-.: construction shown as existing that has not obtained proper approvals. 5. This approval is valid for two (2) years and expires on May 20, 2016. 6. Please be advised that the septic system for the above referenced lot was originally constructed and approved for a three bedroom residence. Any 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. Sincerely, Gene D. Reed Sr. Environmental Engineering Aide GDR:kly cc: BI (T) Putnam Valley MEMORY TRANSMISSION REPORT FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES STATUS FILE NUMBER TIME MAY -1.9 -2014 _12:33PM TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH, 276 MAY -19 12:32PM 88081961 001 MAY -19 12:32PM MAY -19 12:33PM 001 OK 276 * ** SUCCESSFUL TX NOT ICE * ** F� F�� .E�.Er'GRD 242�T'1'_s� G�Z�Llv1�TT �vrrF�.nz co>rrrFr�:• .r1.�cor�,� c�.r�ry�c . n.t7 d .2�.%I CFA G G3�Q_P1� CS E LfRE � L' • - R'ro ra TG: F�x:curc3s Nlfinptaament - - E2�COiz -n TZ-F- ES'I`a_ (circle oae) LOCH TIO1r : _�� �%7`� —o2_f Garrime -vial d' osaJRepa' 1l Sa1t3• Scibdi••isioa bunt Oath r 24axae of O'i-i.,final O•wa9r ME2- %,a2iabie,) ii-G(/L- Strsst: /O G ooh LA�I� " Towa: �vfs� zi» �L�1 Taz 112Fap 0: I'aa.r,bailt tither Zdentif7•ir� Za.Eormatioa: ' Spscdal L'cst'-- uctioau: i2xa3�•nc' bY: Dace• 5' or-so a Fteccivino gle r.-,r•Cr�Zti.� NL Z�iAGENLP] IT TJSE Oi`+ -.I'I- Fro�ass°c bY' L at' " 5 t "s. i 4' S` Q� 4� t z. 7 Z CEII80B! ' 1 e»n.eux��ar�umc f ti" w .� N V Z eee es� — — -- -- -- - -- '- ----'-- -- -- M a r 4 /GO/}Ypill I Vl o �olM4 1! µmw •fcw� Q � Z ttl p W a E 0 0 ° d LiJ 4- { PROPOSED SECOND FLOOR PLAN �= �! ec.c:.r.•. rc L j Q i a. v-1 gE � m SHEET No. EXISTING BASEMENT FLOOR PLAN PROPOSED FIRST FLOOR PLAN ,. 2 ...•.. v.•. ro ant v.- -_ -� ALLEN BEALS, M.D., J. D. MARYELLEN U DEJ1 L Commissioner of Health r r" Countv Executive ROBERT MORRIS, P.E. Director of Environmental Health ® a D i 1 Geneva Road, Brewster, New York 10509 t ` Phone # (845) 808 -1390 AIDIDITION. APPLICATION - RESIDENTIAL ONLY PCIiID#��. rtyr. Owner's Name: ►cNf/(,tI,L U� C Owner's Phone Site Address: a T 16—fa Town: 1/46 Tax Map # 3CL Owner's Mailing Address: 36 6 6 r e e Z )i� 1�t i �r I)r - �a i� Owner's Signature: Description of Proposed Addition: �3 e d �- CL_ 02 *Number of existing bedrooms: a 'Total number of bedrooms (existing + proposed): * (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 Department of Health, 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. 1... Certified check or _money. order for $100.00. .....� _.. _.._� �_.._.. -2... Two sets of 'skerches-of existing-tidor 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. 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 CONM ENTS Rev. July 2013 5. ---b 1� ALLEN BEALS, M.D. =' _ MARYELLEN ODELL ..._r =u_.. CominissibnernofHealth: _ — ...:_ ...Count}?- Executive. _ .. "4 ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (8 45) 808 -1390 Town Leizal Bedroom Count Re: RtIC L I E sJ (Owner's Name) Tax Map # s*2 °2- 35 Address: I (3 Loos `,10j r. Town: �? Q T NA nn V 4116Y Year Built: 101-1 (a According to 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: 9- This information has been obtained from: Certificate of Occupancy: Other: k �--%Dn (0 b t a.,t 1 -6051 S �� The plans for the proposed addition are considered: Addition to existing house only Teardown and/or re -build allowed under Town Regulations a tA 6a� 51 k I W'k Building Inspector Date c- (-I) # ti ni Z- ;Dh f. 97-.7 PROPOSED SECOND FLOOR PLAN SCAM Ifiv. FLOOR PLAN PROPOSED FIRST FLOOR PLAN SCAU: 1/4- "-CF ... . ........ .... , . ... .. til GO cw Iv rry --------- - -------- ----------- r --------------------- - - - - -- :. M- -00" ---------------- ------------------------ 01 1-'3A4A.,Mr.'NT FLOOR PLAN PROPOSED FIRST FLOOR PLAN ........... ........... SCAM 1/4*- V-407" ------- - --- - ------- - ----------------------------- - --- - - DO Z Of 0 0 -i U- 0 Z 0 U W En X W 10 Loe) t-, N v L C E Aoem Z Of 0 0 -i U- 0 Z 0 U W En X W 10 Loe) t-, N v L C E Aoem TOWN OF PUTNAM VALLEY OFFICE OF BUILDING & ZONING 265 Oscawana Lake Road Putnam Valley, NY 10579... CERTIFICATE OF COMPLIANCE Certificate No: 2014-0018 Permit No: 2013-0591 Tax Map No: 52. =2 -38 Location: 10 Loos Lin' Parcel Owner: Loos, Tfid'6dorie 9 Loos Lfi' Putnam Valley'N,Y 10579 Date of Issue: 21712014 '—This -certificate .cover'the construction `of. REMOVE 550 GALLON UST TANK FROM RIGHT SIDE OF PROPERTY AND INSTALL 330 GALLON VEk4ICAL TANK IN The applicant having heretofore filed as application for. a building -nit ode, Sanitary uan.t to the Town Code,--theU niform -Building:-&- Fire'Code and the Lawsj . ft eff&t in the I'OWN OF. I PU: TNAM LEY, Putnam County, NY, having.pd"d-th _r' d fee: therefor the undersigned having ".b'y.:pers - ji inspection paid equire ascertained that improvement oftho d structure is in propose str compliance with the requirements of the laws as aforementioned; that the said work and 'materials meet every ,fe6iibtn6jit.bf the, laws as'dorementioned; and that the premises have now be0ji.:fully :7completed .and are. 4qy for occupancy pursuant to the provisions of law. Now, therefore, the Certificate of:CQr Apliance is hezeby"issued under the seal of f the TOWN OF PUTNAM VALLEY. TOWN OF PUTNAM VALLEY By Code Enforcement Officer 1 -e '€ ;:. :� i ?b i �: a ,TA�0.1� uQ . �i ii Y; l Y "� '�: i' 1 � �''i"U t C�.ra1 -2__ x, ,trtL .. r tr 22 's" �r —�I � I , n X 7 k � F ^ ,k AA tify STor Agt S 7-or -S �P O Sr rA O 9 r .3 -re 00 C L o J er— e1j te OJTW H r• � i Cow= W. op MU44 EX f i �5 z N rt e, r_ A p,� r �yp� mm �s Appwvm ros es e • a�vn.sur.r,ria. �.:. 1NVENT'URY CONTENT SHEET SUBJECT 372800 52: -2-38 OQ . RPS031 /V03/LO50 ACCT #: SHEET 1 PAGE 1017 LOOS THEODORE G & VALERIE ROLL SECT: 1 RES SITES: 1 - - -- LAND SIZE - - -- SALE DATE` TYPE 134 OSCAWANA HEIGHTS RD PROP. CLS: 210 COM SITES: 0 2..27 ACRES SALE PRICE VALID TRANS. CODES (13)ADD ITEM (20)FLD. CHANGE (30)FLD. DELETE (33)DELETE ITEM (43)ICS REQUEST . *BTCH•FM DATE SWIS PARCEL IDENTIFICATION SO CD SITE SITE LAST MAINTAINED: A96 01/25/96 372800 52. -2 -38 OQ R01 PARCEL LAST MAINTAINED': AFM 08/21/02•. CHARACTERISTICS==== =_______!______ = = == =RESIDENCE INFORMATION-=- = == --- = __!= ___ = =__= ====RESIDENCE AREA__.. 1000 PROPERTY CLASS 1'FAMILY RES 210 ! 4000 BUILDING STYLE CAPE COD 04 ! 4190 FIRST STORY 960'. 1010 ROUTE NUMBER ! 4010 NO. OF STORIES 1.5 ! 4200 SECOND STORY 1020 NEIGHBORHOOD 52200 ! 4020 EXTERIOR WALL ALUM /VINYL 03 ! 4210 ADDITIONAL STORY 1030 ZONING CODE R3 ! 4030 YEAR BUILT 1976 ! 4220 HALF STORY 960 , 1040 SEWER TYPE PRIVATE 2 ! 4040 NO. KITCHENS 1 ! 4230 THREE- QUARTER STORY 1050 WATER SUPPLY PRIVATE 2 ! 4050 NO. BATHROOMS 1.0 ! 4240 FINISHED OVER GARAGE 1060 UTILITIES ELECTRIC 3 ! 40b0�NOBEDROOMS��s ;,•,w�--- ,_x_y =-'; �". �_'_'_?2_! 4250 FINISHED ATTIC 1070 DESIRABILITY TYPICAL 2! 4070 NO. FIREPLACES ! 4260 FINISHED BASEMENT 1080 D /GENTRY TYPE INTER REFUSE 2 ! 4080 HEAT TYPE ELECTRIC 4 ! 4270 UNFINISHED HALF STORY 1090 MAILER.CREATED r 0 ! 4090 FUEL TYPE ELECTRIC 3 ! 4280 UNFINISHED 3/4 STORY 1170 NEIGHBORHOOD TYPE RURAL 1 ! 4100 CENTRAL AIR ! 4290 UNFINISHED ROOM 1180 NEIGHBORHOOD RATING AVERAGE 2 ! 4110 BASEMENT TYPE FULL 4 ! 4300 SQUARE.F90T LIV AREA 1440 1190 ROAD TYPE IMPROVED 3 ! 4120 BASMT.GARAGE CAP ! 4310 FINISHED.RECROOM 1200 LASER DISK FRAME NUMBER 000000 ! 4130 CONDITION NORMAL 3 ! 4340 RES PERCENT GOOD ! 4140 GRADE AVERAGE C ! 4350 RES FUNCTIONAL OBSOLESCENCE .., 4150 GRADE ADJUSTMT ! 4160 PORCH TYPE ! , ! 4170 PORCH AREA ! • ! ! 4180 ATTCH.GARAGE CAP ! ! I 1 I I 1 1 1 1 ' 9• I I BREAKDOWNS = === =_______ --- !_____ = = == =ADDITIONAL IMPROVEMENTS— ===______!_______— ----- _________________________ — °_ 3000 LANG NUMBER 01 ! 6000 IMPROVEMENT NUMBER 01 ! 3010 LAND.TYPE PRIME SITE 01 ! 6010 STRUCTURE CODE PORCH,OPEN RP1 ! 3020 FRONT FOOTAGE ! 6020 MEASURE CODE SQUARE FEET 3 3030 DEPTJ! ! 6030 1ST DIMENSION 200 ! 3040 ACREAGE 2.27 ! 6040 2ND DIMENSION ! 3050 SQUARE .FOOTAGE ! 6050 QUANTITY 1 !• 3060 SOIL RATING ! 6060 GRADE AVERAGE C ! 3070 INFLUENCE CODE ! 6070 CONDITION NORMAL 3 ! •�+ 3080 INFLUENCE % ! 6080 YBAR BUILT 1976 ! 3090 DEPTH FACTOR ! "8'090 PERCENT GOOD ! 3120 WTRFNT TYPE ! I _6100 FUNGTIONAL OBSOLESCENCE _ ! I ! 6000 IMPROVEMENT NUMBER ! 02 ! ! '6010 STRUCTURE CODE PORCH,COVERD RP2 ! . ! 6020 MEASURE CODE SQUARE FEET 3 ! . ! 6030 1ST DIMENSION 240 _ 6040 2ND DIMENSION ! ! 5050 QUANTITY 1 ! 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CLERK'S;.OFFICE AS AR oe.atlofieefw M.f.on .n 4wlw b. this 7714VOKSON ROAD fn.P .ne oep.. ew of env w ..w map MAP 2167. CAtiMEL NY. 10612 of oopN. ear en. an ...1 a e,. (846) 228 -4004 / spp.ar. � TOWN OF PU NAM VAU Y ' ."It i1.pna�.erbV O.MMA tn., v,a "—f TAX MAP 62. - 2 -3a �^'eRw In .me.o.wo. wrt en. toes of Frr.uulo. a MATTHBIf A. NOVIBLI,O, P.B., I.S. sue"" °" "" Ye ` sue. ARC`' 2.284 -/-ACRES Awom.UOrl or PlwwsbrM L-w 6unsyor.. m 98.818 -1- SO. FT. fllW YON[ RA1.11Cw1l. 14 .]w/.. All.r.116n e/ ell. 1 p py o1Mer Mn . 6.ve.arnr+a twa. p.e., w ary..et e1l.n,l fFofi/ow~ yor. eWgtiwof� 4 . vloMlon p v omm i ROOT OHl/W R e 32'7.626 FT L�23AO FT N 1w00'0mw 114" FT obit u our cow mm K" FM ROTATION SURVEY OF PRgPERTY PREPARED FOR 8 CERTIFIED TO THEODORE, LOOS AND VALERIE LOOS SRUATED_jk TOWN OF PHIUPSTOWN COUNTY OF PUtNAM STATE OF NEW YORK SCALE 1" • 30•. ' wnerr...rewwa (02- 169-7) C 02=02 1 r rtien`t Stone Sewerage Type Size of Septic Tank FnIDTNS. INTERIOR Lake F. Apt. Stone i Rooms Da ms Office Concrete At.' Rooms p S W. Pools' ., Blocks ' Apt. Ten. Courts tlon Brick _Attic Qpen. ,. ` - Piers Attic Finished OTHER, BLDGS. r _ . ' EXT. WALLS PORCHES Barns ;IM `M_ ENT Wood X Front Shacks " t. Brick X Side Cottages Brick Van. X Rear Bungalows. loor dog X Encl. Electric, Shingles MISC. Phone In Comp.; Plot+Ian.. Furnace, Field Stone Driveway Size & Use Each Room with Window Area Sewerage Type Size of Septic Tank } Lineal Ft. Drainage - Size of Dry Wells Plumbing Description %'. Well Description Irmation _ t must be accompanied by a•copy of sur"veyor's map and complete plans, and all '.information required Ordinance and Sanitary Code of the Town of .Putnam Valley When requested: by. •inspector,. .00 Estimated 41,000. Building Total Livable Area Cost $ •00 Sanitary Date Zoning. Board Approval 7/3/84 66 -63B I, 00 >x 20 ___ weu Total $319.00 T — Bui 1 'g Permit $__JL O Q b .-._ rOjM —H: LANDI Code Enforcement Office: Zoning and Fire Inspector jlandi @putnamvalley.com PATRICIA A. SMITH Deputy Zoning Inspector psmith@putaamvaRey.com DOREEN C. PIACENTE Clerk to the Building Dept. dpiacente@putaamvalley.com Note to file: r� WfLLIAM i lioi R. f-,:%. Code Enforcement Officer bbujarski @putnamval ley. coin Town Of Putnam Valley BUILDING /ZONING DEPARTMENT 265 Oscawana Lake Road Putnam Valley, NY 10579 (845) 526 -2377 phone (845) 526 -8806 fax November 20, 2013 As per Zoning, a Decision and Order denial makes the C/O for the CONVERTED STORAGE BUILDING TO APARTMENT WITH DECK null and void. This residence is considered a 210 (ONE FAMILY) �DrRatri� Deputy Zoning Inspector ( as per John Landi Building Inspector) 2 - 3� io twos U&ne. I Town of Putnam Valley ZONING BOARD OF- APPEALS Putnam Valley, New York DECISION & ORDER Name of Applicant: Theodore & Valerie Loos Address: 9 Loos Lane Putnam Valley, NY 10579 Location of Property: 10 Loos Lane TM# 52. -2 -38 Nature of Request: Request for variance under Article XI, Section 165- 44A(2) of the Zoning Ordinance to increase livable space by more than 20% for the conversion of storage space into second apartment in a building not occupied by the owner. Zone R -3 Date of Advertisement: March 13, 2002 Putnam County News and Recorder Date of Public Hearing: March 21, 2002 Place of Public Hearing: Town Hall, 265 Oscawana Lake Road, Putnam. Valley, New York Members Present: Fred Finger ..................... Chairman HerbOrlando ........... Member Bill Maskiell .................... Vice Chairman Bob Lusardi ............ Member Bob Campo ...............Ad Hoc Member The matter having duly come on to be heard before a duly convened meeting of the Board on the 21st day of March, 2002 and the facts, matters and evidence produced by the applicant, the Zoning Inspector and interested parties having been duly heard, received and considered and due deliberation having been had, the following are the r FINDINGS OF FACT: The subject premises is located in an R -3 Zone with the following setback requirements; Front -501; Rear -501; Side -401; at 10 Loos Lane which is a Private Road. The applicant has requested a variance under Article XI, Section 165- 44A(2) f the Zoning Ordinance to increase livable space by more than 20% for the conversion of storage space into second apartment in a'bAilding not occupied by the owner. Based upon the information submitted, the Zoning Board of Appeals has determined that a . Use Variance is required. THEREFORE, based upon the FINDINGS OF FACT, it is ORDERED, that the application or appeal be, and the same is herebAR based on the following; The applicant has not provided any information or evidence to support a granting of a Use Variance. The decision of the Building and Zoning Inspector is hereby upheld. This application is a Type II action as per SEQRA requirements and therefore, no further action is required as per SEQRA. Dated, Putnam Valley, New York this 25th day of April, 2002. Zoning Clerk nan STATE OF NEW YORK COUNTY OF PUTNAM On the 25`s day of April, 2002, before me personally came Fred Finger, Chairman of the Zoning Board of Appeals of the Town of Putnam Valley, New York, to me known as the individual described in and who executed the foregoing instrument, and acknowle get! that he executed thlq same. J �Y Not M ft Town Cler utn Valley, New York y f r' 2 6OREEN C. PIACENTE Town Clerik Notivy Pubk Stets of New York Commission Pfled In WeeWmtw County No. 804638296 Terre Expirae July 31, MM r< Ia i® �CYnoT rL I MO�1 tl Ow vluMl EXISTING BASEMENT FLOOR PLAN. PROPOSED SECOND FLOOR PLAN 9 PROPOSED FIRST FLOOR PLAN ti v 4; Y ffi W ; N v a�WO Z F W J N � .0 e z Z F O W 4( E c Q g L1J w kn ]E� J v NYSPE /01(666 SHE N P t 'r f' 0 i n. EVE POTAMIAL HEW. WIMIaM Liam BEDROOM - --- ' riurw ranoeu+wm ---------------- P = IAL FERO M r PUTN•M COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY PROPOSED SECOND FLOOR PLAN BEDROOMS 3 ALL SUBSEQUENT REVISIONALTERATIONS TO I FIESE HOU! PLANS MUST BE SUBMITTED 10 THE PGDOH FOR APPROV) L SHINATURE & TITLE DA:11 ()NPA4 VSHF-T� POTENTIAL H ED ROOM EXISTING BASEMENT FLOOR PLAN F�OOPOSED FIRST FLOOR PLAN if LA U) z z 0 cv, z Z 0 L� I E :j I < LL1 t., H to CL F- gli LLJ ,.n < C) u PUTNAM COUNTY ' �. *�r �.' Ofws'ion of'En'vironmenta /;t CERTIF'C TE- OF CONSTRUCTION .COMPLIANCt,'_ dh * Oscawana~ Heights a Road . Located -at - zi1111am owner / Formerly Willard Nichol`sor 4 .Separate Sewerage- System. built by loo:o = _r26 r cons sting, of l3ai 'Septic Tank and Other raquiiejnents -NOne r Water Supplyi Public Supply From ' x Anclersor PrWate Supply Drilled 8y._ A ore Baxger Street r Building :TYPe " Yes N 4 Has Erosion Control Been Completed? F -} I certify, that the systems) as listed serving the above :premises `'•ve `of which�arel attached) , a-nd in'acaordance with the standards rule "s. Putnam County Department -Of Health a December' 11',1 9 8 7_ Da 4, Ceitifled` Add►e;s 1 NorthridgE Any person occupying premises ss►yed by the above system(i)yshall prof ,conditions resultiey_from such usage Approval of- the separate sews r.available,,and,'the approvalof tlie; private water supply sliall'becomenta subject to modifiention or change 'when in the judgment of the C Date - r �ls�errt %�ll�d 16r s 'ARTMENT OF HEALTH Sertncea, Camel, N _Y 10512 F ` permit a . { 3E DSPOSAI8YSTEM PUtnatri .Palley . } v t Town or V(Ilags 'Block : Z Tax MaP Lot ! x"_02 !SUbd -Lot y AddressWiceopN, Road ,PUtnam Va -11}ey of 2rr Trench yr 2 1 lI X11 Drillers " _ � tnam Palley, NY 10579•'. �� R� ^� __�! of Bedrooms Date Permit Issued 77 ,e�ati��s�iyFF9 x 1 nstructed esaentia$�pF�' �hoil+h the completed work ( d6pi_es egulationa iri e ".permit,.iseued by the as © S >a ei k X01" 05� ,. 278.46 L nice No take wi` action as, y464- n the correction of any unsanitary ystem .shall.becom4 nu ��t ��n s, a Pu41ic: aanttary sevve► becomes void wjtef►.a publ(c water wPa� .pecomis availabh. _': S,ueh, approvals ale N. r of calf eh -r lion modification ,or ehange�la necessary. I y f Tim J io' Yxv 'rte is n WELL COMPLETION REPORT Q„ ►� DEPARTMENT OF HEALTH Division Of;- Environmental Health Services W Y PUTNAM COUNTY •DEPARTMENT - OF HEALTH Office Use Only WELL LOCATION STRE- OGRESS: TOWN/VlLL6WbT41Y TAX GRID NUM8ER: I — 7, z WELL OWNER NAME: ADDRESS: 700 RIVATE UBLIC USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ 'FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT - gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE X00 .gal. REASON FOR DRILLING k' NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL I DATE MEASURED �® 9 DRILLING EQUIPMENT I[ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE . ❑ SCREENED ❑ OPEN END CASING 'OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH -� ®' ft MATERIALS: ')KSTEEL O PLASTIC O OTHER LENGTH.BELOW GRADE ft. JOINTS: ❑ WELDED QTHREADED O OTHER DIAMETER in. SEAL: ❑ CEMENT GROUT O BENTONITE N.OTHER WEIGHT PER FOOT /f 1b./ft. I DRIVE SHOE'KYES ONO LINER: OYES' IrNO SCREER DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST_ _ 0. YES ❑NO- _ HOCRS -_ BEGGING_. ,..__.._._.._...__..__._ - -- • -. __ _ _.. _ ., .._ _ _� __...�..�.._:_ GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE; DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED tests were done is in- ff¢COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; YES No WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear• in9 Well Dia' neter FORMATION DESCRIPTION tooE, ft. ft WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD flCm Land Surface 0 WATa ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE .�C —�il.� %"•�� CAPACITY 6 D GAL. /10 PUMP INFORMATION TYPE 3 CAPACITY ` MAKER, DEPTH J/" MODEL " a� VOLTAGE `S HP *z' WEXCSP� A .i DAT Ao 1 `JtGfTT(TURE . ; •r PUTNAM COUWY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. ........ ._ l.c ::: -.: a_c.z•: ^:v..y -: ... -.... ...,.,. �..r�_. � :'.>. ... ... :. .... ems• .:- .....-tr. :- .... ::.:m -.F •.,,. ..M v::... -. �.a.. �s.'7 -. :. .-. .... �,.-rr r,..- -_.. .. -.. n .. - .. -. .. .. s _e William Loos 35 1 202 Owner or Purchaser of Building Section Block Lot William Loos -Building Constructed by Oscawana Heights Road, Location - Street Putnam Valley Municipality 1 & 2 Story block & Frame Building Type 1 Loos Homes Subdivision Name 2 Subdivision Lot # GUARANM OF.SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, worlmianship, 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 immediately following.the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any TM repairs -iriad� by-m 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 Environmental 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 10 day of Dec 19 87 Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 ink Corporation Name (if Corp.) Yorktown 'Medical Laboratory, Inc. LAB - 32.009517 321 Kear Street Date Taken: Time: - �--__- " (914) 245 -3203 Date Reported: DEC.031987 + Director: Albert H. Padovani M. T. (ASCP) Collected By: (��r 1- -� Referred By: Sample Location: U o X GL1L r✓/ ✓ 6 Of�/fi- /�i�G /H� �D• Phone b L f vl �-�� AAA. _ Phone # Sample Type:. % Repeat Test? _ I(check one) _LABORATORY REPORT ON THE BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count (CFU /1.0mL) 3 (Agar Plate 8 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) LZ Total Coliform (CFU /100mL) 0 Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index (per 100mL) Fecal Coliform: MPN Index (per 100mL) OTHER ANALYSES `!Potable Non- potable _ STP INF STP EFF Other Sample Status: (check each) Outgoing Na2S203 Incoming ALE 4 °C _ GT 4 °C _ Other: KEY FOR TERMINOLOGY RDS = Recommend Disinfec- tion of Source TNTC= Too Numerous To Count REMARKS (For Laboratory Use) CON = Confluent (= TNTC). LT = Less Than ( <) GT = Greater Than (>) N/A = Not Applicable LE s Less than or equal to THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NE YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT-THE TIME OF COLLECTION. Albert H. Padovani, 12 /85(RvsdT /8T)RWE mirectivr For Lab Use Only: ® H/C to LAD OFFICE HOURS (Main Lab): 9AM -5PM, Mon. -Fri. 9AM -NOON, Sat. IV. V. Vi. APPENDIX C CC FINAL SITE INSPECTION Date InspectENA by OWNER TM # OR.SUBDIVISION -LGT # - -YESI 1 - Q SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG. DPTH c. Natural soil not stripped d.' Stone, brush, etc., greater than 15' fran SDS, area. e. 100 ft. fran water course/wetlands. SEWAGE DISPOSAL SYSTEM a. Septic tank size -' 1,000, 1,250 b. Se tic tank installed level c. 10' minimum fran foundation d. No 900 bends, cleanout within 10 ft. of 450 bend -D 44 101AC1 jd e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested V �jev_2 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required Length installed 2. Distance to watercourse measured". ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 "/foot. 6. 10 feet from propert y line - 20 feet - foundations 7-. Depth of trench < 30 inches fran surface 8. Rom allowed for expansionj 50% 9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimuu 11. Pipe ends capped h. PUMP OR DOSE SYSTEMS 1. Size bf '15 chaiTber- - - 2. Overflow tank 3. Alarm, visual/audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flo w per cycle I . HOUSE a. House located per approved plans. b. Number of bedrooms WELL a. Well located as p�,E approved plans b. Distance from SDS area measured ft. c. �in 18" above grade. d. Surface drainage around well acceptable. OVERALL WORIOMSHIP a. Boxes properiy grouted b. All pipes partially backfillea c. All pi ,s flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist.watercourse g. T�6H'Ing drains discharge away from SDS area h. Surface water nrotection adequate i. Errosion controi provided on slopes greater than 15%. 1 pV c ) v c r pV c ) v c � � .,I . •. 1. '0'. 5. -I....",',' .., .. , 1_�_ - .. .. , 1, � I;z .1. . ., . ", I �".." 11_1 I - , " -, `*, , 1, .�, �. � , , . _17 r � ." I ii,-..� , - ,�. � .�. -;- ,w . � DO . , - _ . .. 'I' j ....... ;', , . , — , , ,W� % �..� I , ,,,,�-K:vl�, + . - *,l.,''j2_-.,�_, � .....;V., ,44, .4 T �J�- ��l * �ITA* I$ .il--.',�;,.:A��Vlll. # , -- "I, 1� . -, 'I, t , , � Y,iz ',I ". 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PUT N AM BOUNTY �::� y Dwisfon of - Enwro »menial x ' N STRUCTION PERMIT FOR SEWAGE DISPOSAL SY; ana:� Hts' Oscaw Road - 54bdivision TIIlITI, & .Max'gax'e r,' OOS.. t ;Owner /Address Building, Type 2- Got Area Nur ber-of Bedrooms Design Flow c /�.4- + r Separate sewerage i system t a i - J To be :constructed by j r � 2 4^ . 'Water °,Supply Public SuDDIY'Fom i - X Private :Supply to be drilled by } 6 y Address F' Other .Requirements vF E _1g in Wat I' represent that ;1. am wholly and completely responsible for the des�gm '4bQve,idescribed .will be'cbhstructed- ;as shown on the approved amendm County Department of Health on , and that %dn completi thereof a C' Abe, submitted 'to the Qepartmeht, and a . Written guarantee will be i ,aplace ,ie ,good operating condition any pert of said sewage drspo a 8gce of ;the approval of.jffie Cadtif�cate�of; +ConstrueUOn C.lmpfranc v will be located ss shown oh the approved plan end that +said wellwill be County Department of Health g z August 15s 19:86 u; 5 _ ft w hoots • . `" Addiess " � s � A• k APPROVED FOR:?CONSTRUC;fION This a`pprovaj expirei one yea► �cevocabJe for cause or may be amended or rhodifj when oons�deretl l requaes `a mew'.'permit Approved. for tllip * a1 of hibst4c;sanrttiry �r Date Bye `r { '� 3`a t S✓ It' Aug ■ lll�liil� 1* Vi Ai1LAL1 ii, UN CERT` FICA E 40F COMPLIANCE,: Services, Carmel N 'Y 10512b �, PERMIT: �� x - � Putinam Va11ey- T _- m °+Tax :Map 35 - °sloo)c� �� Renewal Revla,I& �a r ��' DateOf Previous Approval � - _ _ �_ , Fill Section -Oply ❑ - - _ - - ye5l P C H D N at i 4' renc Tank antl wi Y Address l ¢' 7, l ;on��iell Drillers �' - n� ree ram° ;sey � - ze �tobe A�removed" } not the propo s�lj that the separate sewage'disposel system s and in accgrcil �lps !rules an :regu a ions o e: ' _ u nom rt C4ostiuct , cRpry �toethe. •ommissignor of �Healthwill, ;, . -_ S'IIU to +owners _!$hagt A _bY�the.buI Wer, that said. builder wring the bjitely follofir hg Ittedate of the issu? riginal sy a st Q 'tgat3he- drilled well described atiove accoidin " t ith3,' nd repo 'he= 1Putri'am . f s�1 �S.:� a Z %a$a x �:" License No 2786" t Iiltei�tsiued urSlOS Coe idl�► .the building;hes been undertaken and is y theComrriissi'brtgrf'Itjur'Any change or alteration of construction nd /or prsvdte water u�1f1'9 °Drily s 4 NI I 4 L- s£ Title } M 5y';, mss'.' -.rte. I Northridge' Road. Pe Y:- 10566._...... August 159 1986 Putnam County Health Dept County Office Building Carmel, N.Y. 10566: ATTENTION: Mike Byzinski Re: Loos Homes lot 2 Public Health'Engineer Dear Sir: Enclosed find.plans for the SSDS for the above lot as well as a permit application for a new drilled well. This was previously applied for in 1982, copy of previous application that was.submitted is enclosed. After the new well has -been installed, the existing water line .connection to the outside water siurce will be disconnected. Your early approval would be appreciated. Ver trul ours JSR: ck y J` y , ° 000000�0�0 A — E� 00 Vohn S. Romeo y @�`�a S. Ro�� o P.E. & L. S. ®8 �° ° a y, y 0 ® 2786' �� .F ® ®��fUFNE���a���•R< 4. 5 _ Notes: 1) Tests to be repeated at same depth until'a roximately 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. PUTNAM COUNTY DEPARTMENT- OF.HEALTH. - DIVISION OF :ENVIRONMENTAL - �HhALTH .SERVICES . COUNTY OFFICE :BUILDIPIG; CARMEL, N. Y: 10512 DESIGN DATA.SHEET SEPARATE SEWAGE.DISPOSALSYSTEM FILE N0.` Owner Margaret:-'& 19111iam Lo.osAddressOsdawana: Hts .Rd Putnam Valley, NY Y 0579 Located at .(Street Ose �.Indicate.nea Sec Block d l:. Lot . 2 e 2 res cross s reet Municipality Putnam Valley (T) ' Watershed Peekskill SOIL PERCOLATION'TEST DATA�REQUIRED TO .BE'SUBMITTEDIWITH'APPLICATIONS Hole _ Number`: CLOCK TIME . - PERCOLATION PERCOLATION 'Ran Eiapse. Depth tp.Water Vater. Level No:: Time -Fr,om_ Ground. Surface in :Inches Soil Rate Start =St.op Mina Start =Stop Drop_ in Min. /in drop :Inches Inches Inches (1 j 1 12; 26 12 -035- 9 :32.00 33� oo x.. 00 9-00 2 12 x,38.12. =w8 10 320 00 33..,00 :. le oo 10. 00 3 12 35' 1 =03 11 3z.00 33000 1.00 ,11000 1.06 1 :17 11 32 • o0 33.00 1.000. 11.00 5 (2) 1 12x31 12=�F1 10 . 28.75.:... .29.:75. 1.00 " : 10. 00 - -2 - 1 2 V 5 12j 5'7. • -.._� z - 28; 5 29_ :75 1iQ 1=12. . .l2 2$0'75 29175 ; . a:0o. 12000 4. 5 _ Notes: 1) Tests to be repeated at same depth until'a roximately 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. INDICATE LEVEL AT ,WHICH' GROUND WATER 'IS ENCOUNTERED None' INDICATE LEVEL TO WHICH,.WATER_.LEVEL. RISES AFTER BEING ENCOUNTERED 7e'0 ft., ..TESTS MADE.BY:. Jnhn S. l��mPO ... .Date March 229 1982 - =- - - 7r ------ DESIGIV ---- Soil Rate Used j., 15MirV Drop: S.D. Usable Area Provided 5000 SF -fir No. of Bedrooms _Septic Tank ,Capacity 1000 Gals`. a Masonr - Absorption Area Provided.By37=,�L.F.x24" X .5- g c , A I —' ® 1 name Address 1 Northridge Road gnaturE SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft: /Cal. Checked by Vwl a m o� ® ® ®9ff of New ra�� • • °� ° Date cc: BI BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 February 4, 2002 Theodore Loos 10 Loos Lane Putnam Valley, NY 10579 Re:. Addition -Loos, 10 Loos Lane No Increases in Number of Bedrooms (T)Putnam Valley,. TM #52 -2 -3 8 Dear Mr. Loos: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The-proposal forthe addition has-been approved as -per-plans bearing the approval - stamp -form this - Department dated February 4, 2002. The addition is approved with the following conditions: One (2) bedroom apartment and one (1) bedroom apartment. 1. The .total number. of - bedrooms. rriust .remain. at. -t ee , without prior approval- - - - by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be 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:hn Senior Public Health Sanitarian cc:BI(T)PUTNAM VALLEY BRUCE. _R..- .FOLEY ,Public Health Director .... ,��... <:_:;._:L•CCIRETTA: = I41QL�IARi: 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET /O k o a s 1, .4 y-e TOWN v . e ✓ TX MAP# 31 � - 3 8' NA1ME �e o o � P •Coos PHONE�y, f =S'2 k - ;l9 9'/ PCHD# - Oo� MAILING ADDRESS q o o s 1 ,A-it) e �v %N �� 1/�J:II� �. ,�c, ! o s''7 DESCRIPTION OF ADDITION Cbu UP 1•.4 I o A) o � i s Ti r: o p v S 7-o v4-6 e T- j- 1y4 -v7-ib e,v 7- NUMBER OF EXISTING BEDROOMS_2_PROPOSED # OF BEDROOMS �l 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 #) *Non - professional sketches are acceptable. 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. K5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguideaes Jan 18 02 10:18a BUILDING DEPT 9145268806 P•1 s BRUCE R. FOLEY Publle Health Director LORMA MOLINARI RN., M.S.N. Aisociate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Hcalth (845) 278 -61 Fax (845) 278 - 7921 Nursing Service: (845) 278 - 6558 WIC (945) 2 ax 278 -6085 Early Intervention (845) 278 - 6014 Preschool (845) 278.6082 Fax (845) 278 - 6648 January 17, 2002 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: IQ Laos Lane Residence Tax Map 52.-2-38 Town of Putnam Valley Gentlemen: _ According to records maintained by the Town, the above noted dwelling IS in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTERCATE OF OCCUPANCY: ASSESSORS RECORD: v OTHER UVAWX BFhouseguidelines Deputy Zoning Inspector store ''& Apt. Stone Rooms,:; Dams -- - - _ - - Store & Office . Concrete Apt. Rooms Sw. Pools.-c-'], L' c Office Blocks Apt: Ten. Courts,. r Gas Station Brick Attic Open Zs Garage; PiersT t`?`. '?.: Attic-Finished OTHER- 'l3LQGS. ,EXT. WALLS "-PORCHES Barns' BASEW NT Wood X Front Shacks Part Brick Full' Brick Van. Clement Floor - -- -' L;og 'l: - X -Side. i Cottages V yi X Rear - l Bungalowsm-ter �X Encl.-^ Electric Finished - -; ahinyie - - Garage B. In 11comp. 7 "IS Phone, Plot Plan F t Field Sto e ` ;, Driveway This app by the 2 Fee $ -- Tt D; $319.( agiRoorriIWith 1l1�ifitlr !�aA�e�a`�L "`{ I or rx)t:; a: w+cll di the ve t`e,,"vgaJe;jYpeza �a.u_ • x In tie ofi'S VfeT &k. )a}` Lineal Ft D�age of Dry�W li or �iumbi��' Description - urnace -r.� ^ ** x *" Wef l . Description - - -- i OOrdi.l'k'.'nces tin the �t�tal3 C2� i�li }a',e of p'ando pleept�iS�'ecicarorrs' �I�ir.�(�(m�+ialtt�itb1required ,ram YOW Agn re ?est�'d by fi'specf� v e or rc Nation 'ts Of mrm hit 6 te' RLivable•Area __ Cost $ -�- Zoning Board Approval''- 73/84 Zi3� Approval" —_ � `- ARAM Approval 6fc "All as, rr* {• � id 1�itN.cy _ .� _ � - j✓ >v r rt ,isy;rl T.+o-�r. 424 • s .. G,�pgf p • -:B.`. 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