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62.15 -1 -27
BOX 24
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OC'ra18 -2012 02:11PM FROM- ENVIRONMENTAL HEALTH 0 1 F-2-53-
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PUTNAM COUNTY HEALTH DEPARTMtN 1 Q d
DIVISION OF ENVIRONMENTAL HEALTH SERVICES o
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
Qom., / Repelr Permit Issued in last 5.year5 tg/Not in Watershed
❑ L`� Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
0 Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
5��_ Putnam Valle 62- 15- -1.-2
SITE LOCATION Lakefront Road TOWN �NI # c_=- . - = - -- ---
OWNER'S NAME Joyini- tl $�,a,zcnpirs PHONE+ 528 -2 57
MAILING ADDRESS
APPLICANT -- zenathan & I C�11`1
Name 8 Relationship (.e., owner, tenant, contractor) Z '
DATE 4 nom? FACILITY TYP6ori y Dwelling PCHD COMPLAINT #
PROPOSED INSTALLER J Mantov i Excavating, Inc 628-4525 —
PHONE #
d b
ADDRESS A95 Kannin"t Will Rd REGISTRATION /LICENSE # 1035/103611126
Mah o pac, NY
Pr_ oposal (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.
onm>>o-e �teei tank with 1000 gal H2@ Concrete Tank, same location.
1, as owner,agree the conditions stated on this form
SIGNATURE TITLE DATE _ 1,0AS /1-Z
(owner)
I, the septic installer, ree to comply with the conditions of this permit for the septic system repair
_ instal ..
SIGNATURE / TITLE DATE
(Installer)
Proposal approved with the Poll no conditions:
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.
S. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Apr ed P osal �eC.6,L Q
7'�. (tt, LL �1
Aim
InsnA ers Sinnature & Tide Date
Lids
COPIES: PCHD, Owner, Installer
PC -RP 99ML
1611
Rev. 2/07
❑ta
J. MANTOVI EXCAVATING, INC.
DBA MAHOPAC SEPTIC
485 KENNICUT HILL ROAD
NIIAHOPAr'-, NEW YORK 10541
kft � ® ®®E
(845) 628 -4526
JOSEPH A. MANTOVI
..v-
of
pE
3a'40
kft � ® ®®E
(845) 628 -4526
JOSEPH A. MANTOVI
..v-
ADDITION APPLICATION
RESIDENTIAL .ON L's
STREET („•3 LkKG Mar noap TOWN 8.TruAMUA 1!4 TAX MAP # 62- iS -W-27
NAME -JDI.1 N SPE1R5 PHONE !a IA- 736.3 66-+ PCHD #�� -1
MAILING
ADDRESS
DESCRIPTION OF
AIUOA N4.
ADDITION k" NONE 0XkC5RAA6 th,"92: . �P fZWJ AO J 8VIL -D /'ZJ *U5
NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS 3
(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,
Br77ertffled , NY 10509, Phone: (845) 278 -6130.
check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be
Shown and dimensioned and use of each room specifed). -(See Section 3.c. of Bulletin
HA -1)
3. Two sets of proposed floor plans (drawn to scale - with name, street and tax map #)
* Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA -1)
4. Copy.of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
s.
� � 9
l
3 071 �.
SHERhITA AMLER, M% MS, FAAP
Commissioner -of Health
LORETT, MOLIN.ARI, RN,. -r�SN .
Associate Commissioner of Health
ROBERT J. BONDI
.County Executive
Director of Environmental Health
DEPARTMENT OF HEALTH.'
1 Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: SPEIRS FAMILY TRUST (Owner's Name)
Tax Map #. 62.15-1-27
Address: 63 Lake Front Road
Town: Putnam Valley
Year Built:. 1940
According to records maintained by the Town, the above noted dwelling,
is . XX in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is. 3
This information has been obtained from:
C ertiticate of .Occupancy:
Other: AGGpggn-r':G RAC`n-rds
The plans for the proposed addition are considered:
New Construction
Addition to existing house only
. XX Teardown and /or re -build allowed under Town Regulations
l 11/22/10
2
/ /
Building tnspe. _tor.. _.. .Date
6. '
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Faz (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
�r File Edit, View Toolbar Window Help
43 WIZ go R2)
raw
;62.15 -1 -27
372000 Putnam Valley
Active R/S:1
School: Putnam Valley I
Spehs Family Trust
Rog Year. X2011 Curr Yr
1 Family Res /Wtrft
Land AV: 120,700
63 Lake Front Rd
Land Size: 135.00 x 140.00
Total AV: 444.000
u Parcel 62.15.1 -27
Site No:� 1
f `f History
Bldg Style: C00_ style �' _� Central Air: �� 1 st Story:
x1250
- Li Assessment
_Old
No. of Stories: 1.5
Bsmt Type: 3 Partial
_J 2nd Stor y :
_
U Spec Dist(s)
-
ExtWall Mal: 03 Alum/vinyl . T.I
r---
Bsmt Gar CapaO
Add Story: .
C3 Description
ActualYi Built 1940
_
Overall Cond: (r3 L Normal
_ 112 Story.
444
Li Owner(s)
Eff Yr Built: (��
Exterior Cond: �w�' .
_ ] 3/4 Story.
F�
0 Images
Yr Remodeled:
Interior Cond: (�_ �._
Fin Over Gar.(
J Gis
1—
No. Kitchens: 1
Constr Grade: r
•
� Fin Attic:
-• CI Site(1)Res
KitchenQual: ( �]
_Good
Grade Adjust: i0
FinBasmt:
11-
QBldg J
(� Bldg
No. Baths: 11 � . No. Half Baths:�0�
Pct Good: � -��
Unfin 112:
]
Funct Obs: r
Unfin 3/4:
fa Imprvmt(s)
rur
dooms: 3
Un fin Rm:
i r Valuation
oms: ;0
Unfin Over
(�
Ll Sale07 /18/07
No. Fireplaces:F
Gar:
-S
-• i� Site (1) Res
ite
Heat Type: �2�Hot air �]
RCN: 453.644 SF LA:
F 1702
Cj
_
Fuel Type: (4 Oil �,�
RCNLD: 272,1 07 Fin Rec Rm:
1
Cj Bldg
C".1 Imprvmt(s)
Run RPS440 Edits: I✓
C.a Valuation
u Sale08/07197
U -Site (1) Ras
f`:i Land(s)
Q Bldg
i_l lmprvmt(s)
L'1 Valuation
EXISTING
35' -3' x
13' -5"
i
,.
--- --- -- -- - --
v
EXISTING
EXISTING
Jill.
12,-3' x 9'-4"
13'-6' x 7' -11"
�1-128-'YRGCM" -4
rd
'
EXISTING
V -0" x 9' -1'
3 1.,
EXISTING
12' -6' x 9' -4"
SPEIRS- 63 LAKEFRONT ROAD
EXISTING FIRST FLOOR PLAN
Sherdita Amler, NM, MS, FAAP a Robert J. Bondi
Commissioner ofHealth 4' •C
County Executive
Robert Morris, PE rL
Director ofEnvironmental Health
H- elifth
1 Geneva Road, Brewster, NY 10509
Office (845) 808 -1390
Fax (845) 808 -1937
January 5, 2011
Cronin Engineering
Keith Staudohar
39 Arlo Lane
Cortlandt Manor, NY 10567
Re: Addition — A- 179 -10
63 Lake Front Road
(T) Putnam Valley, TM # 62.15 -01 -27
Dear Mr. Staudohar:
I have received and reviewed the plans for the proposed addition to the above mentioned
residence. Based on the information submitted, the above mentioned addition cannot be
approved for the following reasons:
• The proposed addition exceeds 50% expansion of the existing square footage.
Please review the proposed floor plan to reflect no._more.than_ 50% or.have. a:nrofsessional
e gm, e..,� reg�stc �irc WuL-ucsig,u a suo =surf c'e'se`wage treatment system meetuig present
code requirements.
Sincerely,
Gene D. Reed
Sr. Engineering Aide
GDR:cw
Date: S\`2
Street Locats:
Town: Quaar.
" 1.- `'Type of System: 6nventiona
]Putnam County Department of Health
Division of Environmental ]:Health Services
SSTS Repair - Final Site Inspection ^ 1� I
Inspected by: MDL Installer: 3 iVl�rcr0VC �Xca �i0
Owner: 40-if-5 C2A S
Repair Permit 4: -119 - TM #
- -
J Alternate ❑Comments: - -�
2. Septic Tank I
Yes
No
N/A
Comments
a. Septic tank size - 1,000 ... 1,250 ... other .... 7
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b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
d. Distribution Box
i. All outlets at same elevation (water tested) ...
ii. Protected below frost .............................
/
L/
iii. Minimum 2 ft. Original soil between box &
I trenches
e. Junction Box - properly set .............. . .........:. .
f Trenches
i. System, completely opened for inspection
ii. Length required Length installed
iii. Pipe slope checked ... ...............................
iv. Installed according to plan .....................
v
v. 10 ft. from property line -.20 ft - foundations ...
vi. Size of gravel '/4 - 1 '/2 " diameter clean .........
vii. Depth of gravel in trench 12" minimum .........
viii. Ends capped .... ...............................
3. Sewage System Area
`/
a. SSTS Area located as per a roved plans
L/
b, Fill section -
c. Distance from water course /wetlands
V-11
4. Overall Workmanship
a. Boxes properly grouted and installed correctly ...........
b. All pipes flush with inside of box .......... . ..............
c. Backfill material contains stones <4" diameter .........
d. Curtain drain & standpipes installed according to plan
e. Curtain drain outfall protected & dir to exist watercourse .
f. Footing drains discharge away from SSTS area .........
g. Erosion control provided ............................
Additional Uomments:
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APP- LICATL %N T(j . rrrTCmr�rrG^' A: T�Jrn.r ..i, L
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PCHD PERMIT 1.
WELL LOCATION
Street Address
CAK'F raver
Town/Village/City Tax
R0 RartVA-m U/f-LCr VU j
Grid NumberT
" °° d
WELL OWNER
Name
WIzi4 om t-. M e
Mailing Address
e fz 5;9m �f.
Private
0 Public
USE OF WELL
1 - primary
2 - secondary
-6 RESIDENTIAL
0 BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O.STAND " =BY; . = . ; _..
O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
�'i m/# PEOPLE SERVED gal
gp � /EST. OF DAILY USAGE ��
REASON FOR
DRILLING
KNEW SUPPLY PROVIDE•ADDITIONAL SUPPLY
O PLACE EXISTING SUPPLY EEPEN EXISTI {NG WELL J L
O TEST /OBSERVATION .
DETAILED
REASON FOR
DRILLING
. 7
!Iekse,vt
%a / 6t/ZME r r
WELL TYPE
DRILLED
❑DRIVEN
®DUG
[]GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES r)< _NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name *Q -easy,d &IeW t9,Pt a_t ova Address :_54,e6•P2 Sr cf1rAh1M i1*t'VV
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _)(_No
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM M REST WATER MAIN
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION ' SEPARAoS6'
(date) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear..
2. Disinfect the well in accordance with the.requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health Department. °j/)� _
Date of Issue: 2 19
Date of Expiration: 2lc. �19 % Permit ssuing f cial
Permit is Non - Transferrable 'White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy:. Well Driller
or w (-, Me v -e K,
63 c0 016e -rKoru7- 9n
PL)CMU &M V 34 LL IZ /0$- -7f
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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
April 29, 1988
Mr, William Co Meyer
63 Lake Front Road
Putnam Valley, New York 10579
Re: Well Permit
Meyer
Lake Front Road
(T) Putnam Valley
Tlvlii 41 -1 -1
Dear Mr. Meyer:
Public Health' Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
An inspection of the above captioned project was conducted by this writer
on April 21, 1988.
- --- Since. -
36-6afy--35 --fE( —d"y from your :'septic
system,
anew proposed well location west of the existing well location
and 65 feet from the septic system is being approved by this Department.
(See attached diagram).,
If you have any questions, please contact the writer at extention 317.
LW: bck
cc: Anderson Well Drilling
Putnam Valley Bldg, Insp.
Very truly yours,
`G�
Lawrence Co Werper
Assistant Public Health Engineer
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION 'OF" ENVIRONMENTAL HEALTH :SERVICES � < ...o....� ....� .
John M. Simmons, M.D. /
Deputy Canmissioner of Health - FIELD ACTIVITY REPORT - Sheet of
INSPECTION
NAME `lG� -' Orig. Routine
/ Orig. Canplain
ADDRESS 41(t �2 ° .r i , � ( Orig. Request
No. Street Town TH No. Canpl iance
Canplaint Comp
MAILING ADDRESS Final
P.O. Box Post Office Zip Code _ Group Illness
Construction
TELEPHONE
G Name and Title
DATE' 0 TYPE FACILITY
TIME ARRIVED /0-- :� 0 TIME LEFT
r , o c)
Reinspection
Field, Sampling Only
Field Conference
Other fl k-&c
Explain
FINDINGS: �2lTi ,L�/ T ` V �'' Vic. �I � � �c.✓.�}-i �� ui�7 �i k7' � � S.(`� �' .
INSPECTOR: C, -
v 1
Siqnature and Ti
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
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