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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
BRUCE R. FOLEY
STREET g 7 S4ra,, \dATOWN �- Na_ � X MAP # 7g S
^ �_
NAME �, \ -' PHONE PCHD # _
9Yo�f
MAILING ADDRESS R 7 tct,
DESCRIPTION OF ADDITION K--_ c,,nA a, Y ck �- (oo rT o M a. Ke— -c e I b 7 7 I
NUMBER OF EXISTING BEDROOMS 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.
tea�6 JCit7ilili �iuS i�iifi zu1C1 V1j_ 11,'01 11UW111g tU "Y"Utrr' CuLuity, Htalai Degt.; 4-G&fieva R .,
Brewster, NY 10509, Phone 278 -6130.
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
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.
OFFICE USE
Comments
Feb 98
-
)Dublic Neaith "Di'rector' r.
i
Philip Ammann
E7 Indian Lake Rd.
Putnam Valley, NY 10579
Dear Mr. Ammann:
F. .
t�Qli��TAy MnI LNART' ,R.N._�?�it.� r3`-
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278-7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 . Fax (914) 278 - 6648
11"f, 11"f, 4 278 6678 F ax 9 4
I
k7 V) (1) . - 6o8s January 25, 1999
I
Re: Addition Ammann, Indian Lk Rd.
No Increases in Number of Bedrooms
(T) Putnam Valley TM# 72 -1 -5
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 form this Department dated January 22,1999. The addition is approved with the following
conditions.
1. The total number of bedrooms must remain at Three _without . -prior: amroval by
r _ -, .... .. .. __�.- s. .... ... �J dep[Ii {iiiLrLL.N .. ......... -o.., .. ..._.o. ._..... .. _ ... .w., -.,�.- ._... _.+... ..v._ ... ..._ . ... _ -� -. ..m. -. .. .�.r...- ..�...�_.._..e .... -.. .. _. .....
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
3. All plumbing fixtures must be updated with wafter 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.
Ifyou have any questions, please contact me at your convenience.
Very truly yours,
William Hedges
WH:kg Senior Public Health Sanitarian
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PUTNAM Co'UNT`� DEPARTMENT OF HE A.
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PUTNAM CO-1 � ,J'F'
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H,0i.JSE PLANS FOR
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(7) v f.') L 13 00 1
ignatarp &
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IIvSPEC` ION Date 2 L Inspector
L�No evide c f
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o a�lure DEvidence of failure Evidence of seasonal failure.
---------- - = - -tiI - -; ----- - - - - ----------------- (Indicate North)
D�,S�
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�S S HOUSE o�
s -'�= - -- - - - - - -- -------------------------------
(1) Indicate location of SSTS
A. Size and type of septic tank gallons
[]Metal []Concrete OPlasti-c
B. Type of absorption area
1. Fields ft. 2. Pits 3. Gallies ft.
(2) Indicate setbacks, -fiont.strecti'tbiA:iij'ard;
- ` (3)Show Iodation of well
(4) Show location of driveway
(5) Note physical features (steep slopes, rock outcrops, streams /wetlands)
SECTION E. EXISTING WATER SUPPLY
DPW
• IU����
0Shared well
2 5-4
1.
01�didual well
ODrilled
❑Dug 9-C-asing above ground
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDIVIDUAL ADDITION / REPAIR FORM
SECTION A. GENERAL INFORMATION
Name of Project -
Year of Construction Size of Parcel
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1. C�Hi 1 Y
ORolling LTStee slope ® slope 11lat
2. 96�idence
of wetlands OLow areas subject to flooding Modies of water
DDrainage ditches E Rock outcrops
YES NO
3. Property lines evident?
4. Water courses exist on, or adjacent to parcel? L
5. Existing individual wells within 200ft of the existing SSTS?
SECTION C.. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS)
1. Physical character of existing SSTS area.
A. OLevel Mentle slope CISteep slope 1 rr
B. OWell drained Moderately well drained
0Some what poorly drained OPoorly drained
C. Area available for SSTS. (Primary. & Reserve) ,
CIE x-tremely limited MIS/omewhat limited (Idequate ft x ft
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RPS075S2
372800 PUTNAM VALLEY
72. -1 -5
87 INDIAN LAKE
- OWNER & MAILING INFO
AMMANN IRENE B & PHILIP
& SUSAN
87 INDIAN LAKE RD EAST
PUTNAM VALLEY NY 10579
NYSRPS ASSESSMENT INQUIRY
SCHOOL PUTNAM VALLEY
PRCLS 210.1 FAMILY RES.
ROAD
MISC
H RS -
1
BANK
- DIMENSIONS '
ACRES 1.00 BOOK 1335
FRONT 175.00 PAGE 87
EXEMPTIONS
CODE AMOUNT PCT INIT
SSI ** CURRENT **
LAND
TOTAL
** PRIOR
DATE
ROLL SEC
TOTAL RES
TOTAL COM
ACCT NO.
SESSMENT DATA -
RES PERCENT
91,000 ** TAXABLE **
187,900 COUNTY
** TOWN
(LAND 91,000 SCHOOL
TOTAL 187,900
SALES INFORMATION
SALE DATE 12/18/95 SALE PRICE
PR OWNER AMMANN IRENE B. & PHILIP
-- SPECIAL DISTRICTS
TERM VLG HC OWN CODE UNITS PCT TYPE
IFDO14
11:13:17
01/20/99
TAXABLE
SITE 1
SITE 0
190300
TOTAL EXEMPTIONS 0
F1 =NEXT PARCEL
F6 =G0 TO INVENTORY
RPS075S1
187,900
187,900
187,900
1
VALUE
TOTAL SPECIAL DISTRICTS 1 -J
F3 =NEXT EXEMPT /SPEC F4 =PREV EXEMPT /SPEC
F9 =G0 TO XREF F10= RETURN TO MENU
11:20:1.5
.. :S.LLB,TE`CT :.._ ; ...... DA=. L71 j 2U/
372800 PUTNAM VALLEY 72. -1 -5 ROLL SEC TAXABLE
PARCEL PRPCLS 210 1 FAMILY RES
AMMANN IRENE B & PHILIP H TOTAL RES SITES 1 LAND 91,000
87 INDIAN LAKE ROAD TOTAL COM SITES 0 TOTAL 187,900
SALES RES SITE 01 RESIDENCE
DATE 12/18/95 TYPE LAND AND BLD BLDG. STYLE OLD STYLE YEAR BUILT 1900
PRICE 1 EXTWALL MAT COMPOSITION STORIES 2.0
SITE GRADE AVERAGE AREAS
PROPERTY CLASS 1 FAMILY RES HEAT TYPE HOT WTR /STM 1ST STORY: 1080
ZONING CD NO. OF FIREPLACES 1 2ND STORY: 592
SEWER. PRIVATE NO. OF BATHROOMS 2,5 1/2 STORY:
WATER PRIVATE NO. OF BEDROOMS 3 3/4 STORY:
UTILITIES. ELECTRIC ATT. GAR. CAPACITY FIN BASMT:
NEIGHBORHOOD 72903 BAS. GAR. CAPACITY TOTAL SFLA: 1672
01
02
03
04
IMPROVEMENT
TYPE SIZE1 SIZE2
18TY BOATHS 23 16
PORCH,OPEN 120
GAR,2.0 DET 614
CARPORT 209
TOTAL IMPROVEMENT
?1 =MORE ITEMS
RPS075S2
QUAN TYPE FRNT DPTH
1 01 WATERFRONT 175
1
1
1
ITEMS 4
F4 =NEXT RES SITE ON FILE
TOTAL LAND
F6 =ASMNT INQUIRY
F9 =G0 TO XREF
ACRES SQR FT
1.00
ITEMS 1
F10 =G0 TO MENU
11:20:17
01 1STY BOATHS
23 16.
1
01 WATERFRONT 175 1.00
02 PORCH,OPEN
120
1
03 GAR,2.0 DET
614
1
04 CARPORT
209
1
�F1
TVZ? «OT��'ME�: .. I :TEl??S= '7:�
,
=MORE ITEMS
F6 =ASMNT INQUIRY F10 =G0 TO MENU
F4 =NEXT RES SITE
ON
FILE F9 =G0 TO XREF
RPS075S2
372800 PUTNAM VALLEY
72. -1 -5
87 INDIAN LAKE
- OWNER & MAILING INFO
AMMANN IRENE B & PHILIP
& SUSAN
87 INDIAN LAKE RD EAST
PUTNAM VALLEY NY 10579
NYSRPS ASSESSMENT INQUIRY
SCHOOL PUTNAM VALLEY
PRCLS 210.1 FAMILY RES.
ROAD
MISC
H RS -
1
BANK
- DIMENSIONS '
ACRES 1.00 BOOK 1335
FRONT 175.00 PAGE 87
EXEMPTIONS
CODE AMOUNT PCT INIT
SSI ** CURRENT **
LAND
TOTAL
** PRIOR
DATE
ROLL SEC
TOTAL RES
TOTAL COM
ACCT NO.
SESSMENT DATA -
RES PERCENT
91,000 ** TAXABLE **
187,900 COUNTY
** TOWN
(LAND 91,000 SCHOOL
TOTAL 187,900
SALES INFORMATION
SALE DATE 12/18/95 SALE PRICE
PR OWNER AMMANN IRENE B. & PHILIP
-- SPECIAL DISTRICTS
TERM VLG HC OWN CODE UNITS PCT TYPE
IFDO14
11:13:17
01/20/99
TAXABLE
SITE 1
SITE 0
190300
TOTAL EXEMPTIONS 0
F1 =NEXT PARCEL
F6 =G0 TO INVENTORY
RPS075S1
187,900
187,900
187,900
1
VALUE
TOTAL SPECIAL DISTRICTS 1 -J
F3 =NEXT EXEMPT /SPEC F4 =PREV EXEMPT /SPEC
F9 =G0 TO XREF F10= RETURN TO MENU
11:20:1.5
.. :S.LLB,TE`CT :.._ ; ...... DA=. L71 j 2U/
372800 PUTNAM VALLEY 72. -1 -5 ROLL SEC TAXABLE
PARCEL PRPCLS 210 1 FAMILY RES
AMMANN IRENE B & PHILIP H TOTAL RES SITES 1 LAND 91,000
87 INDIAN LAKE ROAD TOTAL COM SITES 0 TOTAL 187,900
SALES RES SITE 01 RESIDENCE
DATE 12/18/95 TYPE LAND AND BLD BLDG. STYLE OLD STYLE YEAR BUILT 1900
PRICE 1 EXTWALL MAT COMPOSITION STORIES 2.0
SITE GRADE AVERAGE AREAS
PROPERTY CLASS 1 FAMILY RES HEAT TYPE HOT WTR /STM 1ST STORY: 1080
ZONING CD NO. OF FIREPLACES 1 2ND STORY: 592
SEWER. PRIVATE NO. OF BATHROOMS 2,5 1/2 STORY:
WATER PRIVATE NO. OF BEDROOMS 3 3/4 STORY:
UTILITIES. ELECTRIC ATT. GAR. CAPACITY FIN BASMT:
NEIGHBORHOOD 72903 BAS. GAR. CAPACITY TOTAL SFLA: 1672
01
02
03
04
IMPROVEMENT
TYPE SIZE1 SIZE2
18TY BOATHS 23 16
PORCH,OPEN 120
GAR,2.0 DET 614
CARPORT 209
TOTAL IMPROVEMENT
?1 =MORE ITEMS
RPS075S2
QUAN TYPE FRNT DPTH
1 01 WATERFRONT 175
1
1
1
ITEMS 4
F4 =NEXT RES SITE ON FILE
TOTAL LAND
F6 =ASMNT INQUIRY
F9 =G0 TO XREF
ACRES SQR FT
1.00
ITEMS 1
F10 =G0 TO MENU
11:20:17
OWNS
SITE
MAID
PERSON INTERVIEWED PCHD Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY vv� e_
PROPOSED IlETALLER •41 PHONE
Proposal (include sketch locating all adjacent wells):,
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
r—
C1 V1, 01 C fl n fii 1C `i-- f e1 ct) C
Proposal approved 1 I:- Proposal Disapproved
3 � z
Daier
toposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as gent of owner agree to the above conditions.
SIG N
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