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HomeMy WebLinkAbout4035DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -1 -11 BOX 31 1 ru lil r r 1 ji �, T ■ ♦I r■ I 04035 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICE _PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR - - .... NO Internal Use Only PERMIT Repair Permit issued in last 5 years IZ Not in Watershed Q/ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION _JO U' ", 1,X TOWN L TM # 3 I - 1 OWNER'S NAME PHONE #4% 33� J( b MAILING ADDRESS Q APPLICANT ' i G • _ � 12 1. Name & Relationship (i.e., o nant, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER 1 PHONE # %q 1.. %% _ Rv ( 1 ADDRESS `3 (IVAM 'Y REGISTRATION /LICENSE # /167 Proposal (include a separate sketch locati�ig the hou e, property lines, all adjacent wells wlthln 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. AliLd -h) Jlou-,a � 4D nd .1k 574ru srJ� I, as owner,agree to the conditions stated on this form SIGNATURE 1.z TITLE DATE F/9'40,3 (owner) -1, the septic Instal!, r; -a c . , with the conditions of,this .permit. for the septic system repair _° SIGNATURE TITLE J , DATE / -3 (installer) Proposal approved with the following 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. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. . INTERNAL USE ONLY Pro sa ,),Ap pr v d Ly' Proposal ge�ni g� U �y f GlA/� -.l 3 Inspe or's Signature & Title Date Expiration Date Repair proposal is in compliance with applicable codes Yes ❑� No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 7 Cl? 0) co co t. CD Yailip t U) ca r) 0) o co OD 6 (Y) D- (1) U) t R jA ��GK Y. Date: _ Street U .. Town: { Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Inspection II Inspected t. Mil Installer: t�` lriytt Owner: ` OLL Repair Permit #: - TM i. iype of system: Uonventionai u Alternate u Comments: ,n r` I - "r nil Are- 0 .} 2. Septic Tank Yes No N/A a. Septic tank size —1,000 ... 1,250... other ..... ✓ „Q b. Septic tank installed level ....................... c. 10' minimum from foundation .................. JL d. Distribution Box AV _ e- i O i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f. Trenches i. System completelZ opened for inspection ii. Length required Length installed r O 2 V�, X 40 A iii. Pipe slope checked ... ............................... ✓ iv. Installed according to plan .......:............. / �/ v. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel' /, - 1 %z " diameter clean ......... / V vii. Depth of gravel in trench 12" minimum ......... / _ viii. Ecids ca ed g. Pump or Dosed Systems 3. Sewa e System Area a. SSTS Area located as per a roved plans b. Fill section — c. Distance from water course/wetlands 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 ......... ✓ sour a e e 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 Comments: • C o ^� t& CV) ds' �oSS ►'btt feNve as mNC� �QLrks ,, % 6kjry RFSI Rev - 011312 Sep 1913 10:18a De-Clogg Drain Services Phone: (914) 788-9011 Ea2u (914) 788-9119 9147889119 P.1 VF-CLOC�Ci DRAIN SERVICES, INC. P.O. Box 661 Crompond, N.Y. 10517 West ester _County.: #18236-H06 /4349 Putnam County: #3264141167 lumd: vicogdeclo-drainscom Website- Decloggdrains.com X r'A cove VEIR STMEEr SEND 7,0: Punar-n FROM: V dnt- I ArrENTTON: lie OFFICE LCCArION: OFFICE LOCAT70N: DATE: / FAX NUMBER- z45- F -7 F - -79 2-1 pliONE NumgE?,: q1V 2Z2-3 URGENT REPLY ASAP PLrAsE commENr SEASE REVIEW A;4:FOR youlz jWogwrroN D C3 716tai, pafe4,, COW4.' 3 COMMEN7'S' Pl�a�e � fls &,� (�Lo Nq 7-12 Sep 1913 10:18a De-Clogg Drain Services 9147889119 p.2 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Only PERMIT # OWNER'S NAME Repair Permit issued in last 5 years CY Not in Watershed ❑ ❑ Repair within Boyd's Comers, W- Branch or Croton Falls Res. ❑ Delegated. ov^` ❑ Repair within 200 it. of a watercourse or DEC-mapped wetland ❑ Joint Review SITE LOCATION TOWN TM # OWNER'S NAME PHONE MAILING ADDRESS T I Jr -.1 APPLICANT Name & Relationship (i.e., owne&4enant. contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER. �7 i PHONE# t ADDRESS' .1r," REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feel of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed protessional depending on the nature and extent of the repair. 1, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) the septic in -anditions of this permit for the septic system repail �kqtL - 4t4lkr, ak%f(�,i6xdmplywith the r, SIGNATURE TITLE DATE (Installer) E!PQPOsal approved with the following conditions: t. 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. Ownqr`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 lqe, 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. Lr'r M&I AI I I^ r -11 t1 \1 Gnf \ML -3 r iproppsal;Appr.ov.ed 4 ET Proposal Denied,. ❑ Inspector's Signature & Title' Date Expiration Date ,Repair proposal is in compliance with applicable codes Yes No 0 COPIES: PCHD; Owner; Installer PC-RP 99ML Rev. V07 Sep 0913 08:32p De-Clogg Drain Services 9147889119 p.1 DE-CLOO( DIRAIN SERVICESENC. P.O. Box 661 Phon (914) 788-9011 Crompond, N.Y. 10517 1 Fax" (914) 788 -9119 IL f eft's-, M�Qtch ester Coo #18236 -H06 / #349 E9tHgmCounjj._*3264/#1167 na:d: vices decloggdrains.com 3LIebsite: Decloggedrains-com' EAX COVER ,517"IE'Er SEND r9dam rt_ _o FROM: f C. A 7—r-EN TIO N 'l,-4 t,�t,�,) LCCATION: OFFICE LOCA'rXON: VA 7-E.' �—� % / FAY, NUMBE PYONE NUMBER_ 91Y, 7 �'� i . URGENT 0 REPLY ASAP E] ;,Ls4sEcommuu-r qM9LFASflmvmt; COMMENTS: L Sep 0913 08:32p De -Clogg Drain Services 9147889119 p.2 SEP-09 -2013 01:40PW FROM-ENVIRONMENTAL HEALTH 8452T6Tt21 T -263 P.002/002 F -055 rALIL M.. PUTNAM COUNTY HEALTH DEPARTMENT D _ Dli/ISIQN OF ENVIRONMENTAL HEALTH SERVICE PROPOSAL FOR SEWAGE T13 ATMENT SYSTEM REPAIR YE N Internal Use Only PERMIT N ii' / Repair Permit issued in last 5 years W Not in Watershed ❑ Ls.V Repair within Soyd's Comers, W. Brandt or Croton Falls Res. (] Dele' pted Repair within 200 ft. of a watemourse or DEC -map ed wetland ❑ Joint Review SITE LOCATION TOWN � TM # <? 3 OWNER'S NAME % PHONE #��t I MAILING ADDRESS 1900144 APPUCANT VIC 'PVA lyn Name a RelationsMp [.e.. nent, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # q1LQ 7 C701 t ADDRESS CkYAM Q— lt tY REGISTRATION /LICENSE # a1a� Pro osal (include a separate sketch I catktI thhe1house, 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 an the nature and extent of thTra -k 1, as own er,agree to the conditions stated on this form l - SIGNATURE TITLE DATE R �g 2J,3 (owner) 1, the septic installer, agr c y with the condi6orts of this perms a for t„e septic system repair ' SIGNATURE` TITLE DATE (Installer) PrWgsall,apmoved with the fd!pwing condj1ioDss: 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. Locatlon of installed components tied to two fixed points c. System description (e.g., 125o 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 It design and there Is no guarantee to the duration at which the completed SSTS repair will functian. 5. No completed work is to be bacMilled until authorization to do so has been obtained from the Department INTERNAL USE ONLY Pro a A p v d Pro osal Denim Q ui,n °1l I I I) L-11 c IApe or's Signature & Title Date Expiration Date Repair proposal is in com liance with apAicable codes Yes ml. ' No Cl COPIES: PCHD; Owner: Installer PC -RP 99ML. Rev. 2/07 f E, Sep 0913 08:32p De -Clogg Drain Services 9147889119 p.3 VC U -C-- we l f •• r I -D'F CONSTRUCTION CORPORATION 34 Columbus Ave Putnam Valley. N.Y. 10579 91 4-760 6344 Michael Haack TM 83.66 -1 -11 Date 9/21/09 319 Lake Drive License # 1.137 Lake Peekskill N. Y. 10537 Septic repair A 1 9.4 B 1 24.0 A 2 13.8 B 2 24.6 A 3 26.0 B 3 36.0 A 4 27.6 B 4 32.6 Dc w�l _L�Ke U40- 4r / If r l C.R �-lr, �a'� f?� arm �yaS �enQ 1 -- i 2D(7 XAA 4�J- pro .)AtAtA kA „- ILI j. � �oM 20 r �� �2S _ eof 5-�- __ c�n2 �,G p�� � (.� � QX nS► vp e ac�r' t`n Sanne Qfecx CoareLL r 5 OILCI 14A '1 i Tom a f t di PUTNAM COUNTY HEALTH DEPARTMENT "DIVISI OWOF ENVIRONMENTAL. HEALTH. - SERVICES PROPOSAL FOR -SEWAGE TREATMENT SYSTEM REPAiR Internal Use Only PER MIT ❑ 'Repair Permit issued in last 5 years ❑ tinWa shed ❑ Del� tedter &"/Repair within* Boyd's Comers, W. Branch or Croton.Fall.s, Res.. 13 0/ Repair within 200 ft. of a watercourse or DEC-mapped wetland ❑ Joint Review SITE LOCATION TOWN Lt- � PLEA-5k'Ll.- TM # PHONE# c? I -/ - i-q-4 -91&0 . OWNER'S NAME MAILING ADDRESS LL L. APPLfOANT !+ Name & Relationship (i.e., owner, tenant, contractor) `A)AT 2_ FACILITY ,,-TYPE PCHD COMPLAINT # ECJ W 3 PROPOSED INSTALLER PHONE ADDRESS �5 Y REGISTRATION /LICENSE# li,3"7 Proposal (Include a separate sketch locating the house, property lines, all adjacent wells within 2Q0- feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending onAe. nature and extent of the repair. 41"1 F3—,Le ei, 17 as owner,agree tot ndltio ated on`'this form IL :` TITLE SATE 1, theibpt ins��iior. f ree - red.-t�'O 1pty*th-#,,--�itions of this permit for the septid system repair. Oil SIGNAT. TITLE v?( X DATE (Insta0ler) Proposal approved with the following 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. Owne6 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 tQ.be performed in accordance with the above proposal and conditions .4. The proposed SST9 r6p'air isconsidered a best fit dq-sign and there is no guarantee to the duration at which the completed SST.S, repair w111 Q6tion. 5. No completework is c leddntil authoriz&l6h to logo has be n obtained from the De'pa'rtment. to _,e .1 -f I L� INTERNAL UWONLY Proposal Approved Proposal Denied cf Inspector's S@-hature & Title Dare Expi(ation Dia-te Repair proposal is in complidnce:With applicable codes Yes 0 No 4r COPIES: PCHD; Owner; Installer 0 Gr-1 ir U -T ALTIDEERI CONSTRUCTION; CO! 16 N­­- 34 Columbus Ave Putnam Valley N.Y. 10579 914-760 6344 Michael Haack TM 83.66-1-11 Date 9/21/09 319 Lake Drive License #.1137 Lake Peekskill N. Y. 10537 Septic repair A 1 9.4 B 1 24.0 A 2 13.8 B 2 24.6 A 3 26.0 B 3 36.0 A 4 27.6 B 4 32.6 � 19. 1Ct. e- Dc ,� U C-- well PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. .. PRO O®tAL � ®R tO Adt �REATM8NT SYST18 WREPAR YES CIO Internal Use Only PERMIT # - )--(j ❑ ❑ Repair Permit issued in last 5 years ❑ in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �;,l9 LAA4e Q?.tut TOWN 1, Peekc loci- TM # 155. (06 —1 - OWNER'S NAME M1c.H-ks l_ IA AAcm PHONE# '117- L9.4-97tQ MAILING ADDRESS 319 VM, pCE).c lLL AJV /®s-3-7 APPLICANT a ty, �, a G y QL lfNa,�meC;& Relationship (i.e., owner, tenant, contractor) DATE ' -- _FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER ��p� e� l�V�r �� er. PHONE # l - ADDRESS 3 / Co A,/�/ oi�'f%� REGISTRATION /LICENSE # 113 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. -7-5-0 a.], O gme.., -7--,,t< �o 5 412W t fa Tim se a 165-k Nrsw rte- /-2 4.6 I, as owner,agree to t nditio ted on this form SIGNATURE TITLE DATE 0 a^" n &J _ .. . , I, the septic install r agree to comply with the conditions of this permit permit for the septic system repair SIGNATURE C��-TLE 01 t ce DATE t� (installer) Proposal approved with the following 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. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. Proposal Approved Proposal Denied ❑ . /a-� 0 P� 3 Inspector's Signature & Title Da a t Expi ation gate Repair proposal is in compliance with applicable codes Yes ❑ No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Pe- r- w e-s -- - ------- ...... ........ . ......... .. .3.3 3; t7- 3T .... ...........................__W. MEMORY TRANSMISSION REPORT :. .:+e..r., -, •_ °! +• •B o. + /v• tit oqP'.. -.�. .. , ...,e ....�'- .._..;ay- - .- r.��6� -•L . .: <f ..- �ts- i-- v. %r. o w�• �. t ee��d • <. - • -]�`F� Pad TIME SEP -11 -2009 09:08AM TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 065 DATE SEP -11 09:08AM TO 818455268806 DOCUMENT PAGES 001 START TIME SEP -11 09:08AM END TIME SEP -11 09:08AM SENT PAGES 001 STATUS OK FILE NUMBER 065 * ** SUCCESSFUL TX NOT ICE � ** PUTNAM COUNTY HEALTH DEPARTMENT CUI\/iSiON CaF ENVIRONMENTAL HEALTH SERVICES IJ y Rapalr Permit issued in Last tS years - =1 Not In atershed 1 f_I M Repair within aoyO'a Comerv_ w_ Brunch or Croton Fails Rom. O pelogotod I CJ E3 Ptepnir within 200 ft. of m wateroomr3 or GEC- mappad wetland Q Joint ReviAw BITE LC31CATIQN 9 r - - lc—>=A V .� TOWN Ls PceJCSK•ty.- TM # OWNER'S NAME _ M� G.t,.t -q,� t \ -,n,,.. PHONE # �P /7- Z91f -g77�0 MAILING AOORESS M�t 9 1 - 'Ore. �,� - ^ QC •,��. t-L AJ t/ l n �--a -7 APPLICANT � :: � tnw tai ` j-4-e Nance G geletionmhip �_a_, owner, tonam, contr —toh -- - S..OAT,.,.__... ...::......... _.. : / �:C• FACILITY TYR .._... _ ..__ _ _ .:__ : -. ..' PCFID CO Vl FILM .. hl i" O�•I2�fviSTAeL1 =RR VDi.. ..� �yc �-r' ¢.n ,r a -•-• `•••• - �•PHONE #�/� -r%C D-� 3�� ' -. ADDRESS �a CZ Co Iv h..L �� i/�-'f� FtI= - TRATION /LICENSE # Proposal (include a separate sketch locating the Rouse, property Ilnea, all adjacent wells wM-aln 200 feet of repsar ands t3ha location off exacting and propae0c9 nyatern) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extant of trio repair_ 1. as otnmar.a9ree to ndiLio ted on this form SIGNATUR TITLE GATE 7i O (ownar) 01 If 1, the septic install r agree to compl with t e conditions of this permit for the septic system repair Q SIGNATURE T1TLE Ot GATE (Installer) Proo=ml approved wish the following condtion , l _ Procurement 0f any Town Permit, if appll —ble. 2. Submission of as built repair Sketch by the septic system installer within 30 days of the repair. In duplicate, showing: s. Ownar's name, Site Street Name,, Town and Tax Map number b_ Location of installed components tied to two fixed points c. System description (a_g_, 1290 gat_ Concrete septic tank, atc_) Co- Installere' name and phone number 3. System repair to be, performed in accordance with the above proposal and conditiona a_ Tha proposal SSTS repair is considered n bast £K design and there to no guarantee to the du.ation at which the completed SST9 repair will function_ 5. No completed work is to be beLckflllad until authorization to do so has been obtained from the CNepartment. ANrrERNAL USE ONLY Proposal Approved Q Proposal Denled Inspector's Signature & Titla pate Expiration Data Repair proposel is in com licence with applicable codes Yes Q No O COPIES= PCHD; Owner; Installer PC -RP 99ML Rgy_ 2/07 ....... .......,,•ey. n��v: an ;re � , ' • -. •:. .., �. -.. _ ,. �,.. .... - •r���. n t.... -. -.. .. - • � .. .. .rev.:. : iw ::�` -,. _. 4 � .. . . ... .�..;.�j \ \ \ \ \ v ' \ \ `lV \ \ \ \ � v 1 � CD 00. ob ELIO f in SHERLITA AMLER, MID, MS, FAAP r.. Commissioner oflvedkh=s� LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 13, 2009 Michael Haack 319 Lake Drive Lake Peekskill, NY 10537 Dear Mr. Haack: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONiDI County Executbe - ... ROBERT MORRIS, PE Director of Environmental Health Re: Addition- A- 091 -09 No Increase in Number of Bedrooms 319 Lake Drive (T) Putnam Valley, T.M. # 83.66 -1 -11 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 July 13, 2009. The addition is approved with the following conditions: 1 U C! The total number of bedrooms must remain at two without prior approval by this Department. The. area of; the - existinl; sewage disposal system and its expansion area must be - - _g. _ maintained. All plumbing fixtures must be updated with water saving devices, i.e., new 'low flush toilets, restrictors for shower heads and faucets etc. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals 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 (845) 278 -6130, ext. 43261. Sincerely, �Dr 6-,>,, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley 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 f� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION ROBERT J. BONDI County Executive :. ;a , . .rc .... RESIDENTIAL ONLY STREET 2✓Iq . LAS T,�pa\)G TOWN LAict PeFxsKl LL TAX MAP# NAME IAAACjG PHONE q!7- Z94-97Z0 PCHD# MAILING ADDRESS _31°I LAKE Dm4y & LAKE PGaKSW t.I._ NY ) o S-3-7 DESCRIPTION OF ADDITION A]tu) NUMBER OF EXISTING BEDROOMS' Z PROPOSED # OF BEDROOMS Z= (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, 13rewsier,`TY 10509,Th6ne: (945) 278 =6130. 1. Certified check or money order for $100.00. t1 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 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 locations to the best of your knowledge. Include date of install ation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervetition/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA A1l LER,M D, figs, AAA Commissioner of Health LORETTA MOLINARI,1RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count County Executive Re: Cj L (Owner's Name) Tax Map #: P03, (6 Address. 3 E i V6 Town: f ( TKAM )/ALLE9 Year Built: Accord* om to records maintained by the Town, the above noted dwelling, Is 7 in liance with Town Code. c p in compliance -with Town - `Code:.. The Legal Bedroom Count is: t__ This information has been obtained from: Certificate of Occupancy: Other: LAG :,b& PT '7 P_ Lr C_0 � Building Inspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Transmittal Date: 08.14.09 Company: Heath Department Attn: Gene Reed From: Michael Haack Re: 319 Lake Drive Lake Peekskill, NY Comments ❑ Reviewed ❑ For your Information ❑ Furnish as corrected ❑ Revise and resubmit ® For review and approval ® As requested ❑ Rejected ❑ Submit copies for distribution ❑ Resubmit for record only Gene, See enclosed revised plans and a copy of your letter just for reference. Just as a reminder the rea.; �-viihy.J changed�rhPCP: plans. .to..Hirt:the-.bodroaxnju�t:stairs is-the-N S ° .cc�de:oif not approve a variance for a 7' -0" ceiling. You can reach me at 917- 294 -9720 if you have any questions. Thanks, Michael Haack Jul 02 . 09. 09: 21 a, HU I LD.I NG DEPT SHERLITA ANN LE-R, MI), MS, ,FAAP COMM is�ioner of Health LORETTA MOLINARI, RN, MSN Associate Coianussioner of hleattn _ DEPARTMENT C ,8455268806 p.1 C0I177tV Lxeculwe ROBERT MORRIS, PE Director of Environmental Health . =ALTH Re: T4AA(- (Owner's Name) .. Tax.Map # 83.66 -1 -11 Address: 319 Lake Drive Town: Putnam Valley Year Built: 1947 Accorc:ing to records maintained by the Town, the above noted dwelling, is xx, in compliance with Town Code. Is not in compliance with Town Cade. is: LeQaI 13coo ;n "Count This information has been. obtained from: Certificate of Occupancy: Other:. RIr _ 1)eT t= Permit Rernrd 'The pl;:.ns for the proposed addition are considered: New Construction X Addition to existing house only Teardown and/or re -build allowed under Town Regulations Building Inspector Date Environmental Health (845)278-6130 Fax (845) 278 -792 t Water Supply Section (845) 225 -5186 Fax (845) 22.5 -5418 Nursing Services (845)278-65_58 Fax (845) 278 -6026 Nursing Horne Care Fax (845) 278 -6085 WIC (845) 278 -6678 SHERLITAAMLER, MD, MS, FAAP A Commissioner of. Health LORETTA MOLINARI, RN, MSN Associate Commissioner.ofHealth , July 13, 2009 Michael Haack 319 Lake Drive Lake Peekskill, NY 10537 Dear Mr. Haack.- ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Re:' Addition- A- 091 =09 No Increase in Number of Bedrooms 319 Lake Drive (T) Putnam Valley, T.M. #.83.66 -1 -11 0 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, July 13, 2009. 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 its expansion area must be .; ...._. _.�y maintained: - 3. All plumbing fixtures must be updated with water saving devices, i.e'., new lbw flush toilets, restrictors for shower heads and faucets etc. 4. The approval is for the proposed changes only. This.approval does not validate any construction shown as existing that has not obtained proper approvals 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 (845) 278 -6130, ext. 43261. Sincerely,, . Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley 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 Transmittal Date: 09 -10 -09 Company: heath departmennt Attn: Gene Reed From: Nfichael Haack Re: 319 sake Drive Like Peekskill, NY Comments ❑ Reviewed ❑ For your Information ❑ Furnish as corrected ❑ Revise and resubmit ® For review and approval ® As requested ❑ Rejected ❑ Submit copies for distribution ❑ Resubmit for record only Gene, See enclosed revised plans as requested. What is the next step do I get a letter or something '%fiat i L; risig tc she wilding depa'rtrri -f6r Whers.' f tZe fi.r permit? Thanks, Michael Haack SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 28, 2009 Michael Haack 319 Lake Drive Lake Peekskill, NY 10537 Dear Mr. Haack: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 REVISED ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition- A- 091 -09 No Increase in Number of Bedrooms 319 Lake Drive (T) Putnam Valley, T.M. # 83.66 -1 -11 I have received and reviewed the revised 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 September 28, 2009. 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 its expansion area must be - .naintained. 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. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals 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 (845) 278 -6130, ext. 43261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley 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 PUT NAM (COUNTY DEPARTMENT 07 IH[IEAIL'li'H IiDffWSffCN GIF ENVIRONMENTAL IIIIIEAIL'll'H SIEIERVff(CIES APPLICATION TO CONSTRUCT A. WATER WELL_ - - - please prinYot'typr v' - PCHD Permit # Well Location: Street Address: wn/Village Tax Grid # Map Block Lot(s) Well Owner: Name: ��, �,� Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondarry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply ) drilling New Supply (new dwelling) Deepen xisting Well Detailed Reason � ' � 6 � for Drilling Wclfl Type ti Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Ad ss: Is Public Water Supply avai able to ,site? _619dx/ ro . ,l /.11. es No Name of Public Water Supply: (� /U , % Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be p ided on separate sheet/plan. Date - �' �' pplicant_ Signature: A4/ EL I PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVIED.FOR CONSTRUCTION: This approval expires two years, fr om the date issued unless construction of the well has been completed and inspected by the PCHD and' is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. c ° i W ..�35 00 Date of Issue Permit Issuin Mci Date of Expiration Title: S JAl s Permit is Non- Tr°ansffer°r2ble ., f ;IiO:s White copy - HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 V0J OAA \4.10 G 4 Sheet of * PUTNAM COUNTY DEPARTMENT OF HEALTH .� 61VISION`il W. E- V1kb ilhf& A,7[; IiLKX Q SERF 10ES'` v. FIELD'ACTIVITY REPORT NAB. L�Ie Qr�w -Street., Town to Zip: PERSON IN CHARGE (1R VTRWFT): TNTRR N&yne and Title' - 'TYPE OF FACILITY: Ke 51 ho w s FINDINGS: v� �„►�� At at NJ _ a u,. 5 a� �a r dl 56fl5� PL ;�. y I acknowledge receipt of this report: SIGNATURE: 02 % 9 6 Title; JEANETTE 1VIA96N' 350 West 55h St. New York, NY 10019 212 - 246 -3117 May 13, 2003 Dan Haddon Environmental Protection Agcy. Department of Health 1 Geneva Road Brewster, NY 10509 Dear Dan: Forgive me if I've misspelled your last name, but I left your card in Lake Peekskill. Enclosed.is the information you requested regarding the surrounding wells and septics. I trust it's clear to you but if you have any questions, please call me. I hope it's clear that I don't o a property that you have thoughts of giving me a variance for. Thanks for your help:_ Looking forward to hearing from you. Yours truly, Jeanette Mason Enc. ffrn.:,1 f :an n8 e'•K -I S17 160.03 99 159 Yi !g 332 • ry 7... H=.'; .t.an. -,' - r �'.. =. � s .. _ .-. ..-_,. ,•. -O-z • . --'wig _ —,^ t� 313'•` '. � -' _ _ �.. /354 • / 1 3 a 75.14. 355 oz 356 \ 194.37 loi 5� - (5 31 �.I �' 33' I - _ _ � 104 193.8 !99..96 OS r ` �a /_. _ /06 ✓ 6 43/ X56) -_ t �'k=�. i p ,V / / � ..• tA SL "7, 10 Tq _ 12— 196 � d I3 - - - -_ _ ,• „9 ry � 18C /z �` � f •, Z7 G n - _: Na- .._.c35� UV55P! .S',f�JXf�kY`1OJ14 �' —•s -� �,�•. (212) 246-3117 �� -�� Sal .� ✓�/ ���� � �� =�;- CA) —nol PaL) FY Ile SOB-40 soffl c) & I In /3601 -V IA LEGEND EXISTING PARTITION TO REMAIN r D m 0 m 1 i ;,4701 i . I s HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 TAX MAP #83.66 -1 -11 EXISTING FIRST FLOOR PLAN A01 1 1 LEGEND E I I .q EXISTING PARTITION TO REMAIN :k t �r t'• a t f.� s HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 1053 TAX MAP 1183.66 -1 -11 EXISTING ATTIC PLAN DATE: 8 089 .262 SCAB: - ^^ve• =ra QO -/l LEGEND - EXISTING PARTITION TO REMAIN ' h s NEW PARTITION f � I --L'�' R9IIICEr13�a y7 NO DATE REMARKS ,i 1 ,I r j PRQECT: o t HAACK RESIDENCE C 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 I OP TAX MAP #83.66-1-11 6 - y t EW FULL - 3 HIGH WALL _ j I P TNAM COUNTY DEPARTMENT OF HEALTH HOUSE PIJNS APPROVED FOR BEDROOM COUNT ONLY I I ; PROPOSED FIRST FLOOR PLAN 02 BEDROOMS ALL SUBSEQUENT REVISIOWALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMIT-TED TO THE PCDOH FOR APPROVAL { m + II_� JI DATE 82651® e some 1M =1'Q � 3 SIGNATUR & TITLE DAT i r :1 fi S a r . LEGEND EXISTING PARTITION TO REMAIN -s C NEW PARTITION r =, ;\ r •.I I TNAM COUNTY DEPARTMENT OF HEALTH HOUSE P NS APPROVED FOR BEDROOM COUNT ONLY A - 09/ - ©9 nC BEDROOMS ALL SUBS OUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS M ST BE SUBMITTED TO THE PCDOH FOR APPROVAL 3- Rv& SIG R TITLE ' 09 DATE PROJECT: HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 TAX MAP #83.66 -1 -11 PROPOSED LOFT PLAN MDPI u16. Un 9 AOn 14 LEGEND EXISTING PARTITION TO REMAIN m m PROIECT: HAACK RESIDENCE LAKE = DLLrIO537 -TAX MAP #83.66-1-11 EXISTING FIRST FLOOR PLAN DATE: 8.U2M LEGEND EXISTING PARTITION TO REMAIN :i e • 1 � sawcElmv®a NO DATE REMARKS PROJECT: HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 1053 TAX MAP #83.66.1 -11 EXISTING ATTIC PLAN DATE &142tl9 SCALE; 114= Nr QO2 LEGEND — EXISTING PARTITION TO REMAIN NEW PARTTION r D m 0 m PU NAM COUNTY DEPARTMENT OF HEALTH HOUSE PLAI IS APPROVED FOR BEDROOM COUNT ONLY a- BEDROOMS A - 05V- °9 ALL SUBSEC UENT REVISION/ALTERATIONS TO THESE HOUSE PLANS musr BE SUBMITTED TO THE PCDOH FOR APPROVAL e9 SI NATURE & TITLE DA r ;f 1 O + a BOOKS p�p e "lam �l '--- F- i + z .� - mInommma `- • • d� i t' i. (1 aauxcr:i�xmac :1 , NO DATEJ REMARKS t HAACK RESIDENCE 319 LAKE DRIVE ' LAKE PEEKSKILL, NY 10537 UP !, TAX MAP 083.66.1 -11 J i PROPOSED FIRST FLOOR PLAN ` DATE B.MdI® SCALE ur =ra A03 i a A03 a r� LEGEND :' R EXISTING PARTITION TO REMAIN i, r [ i z C NEW PART. ,ON i T i j� ® A i' PUl NAM COUNTY DEPARTMENT OF HEALTH HOUSE PLAI IS APPROVED FOR BEDROOM COUNT ONLY Z E EDROOMS A ALL SUBSE UENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL � y goR DE A E avuic[I xEieaos NO DATE REMARKS HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 TAX MAP 683.66 -1 -11 PROPOSED LOFT PLAN OATS: 8.1.7009 SCALE: ADZ I f f I I i I v � f I I tD I i _ - I I 3 I e UNFINISHED t I I UNFINISHED ATTIC 48' HIGH KNEE WALL 48` HIGH I (, KNEE WALL .; ATTIC ;y , I I i3 I C y I K— CEILING 7'-6` HIGH - ---V, ;+ I i - `C I � 1 I � 4 avuic[I xEieaos NO DATE REMARKS HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 TAX MAP 683.66 -1 -11 PROPOSED LOFT PLAN OATS: 8.1.7009 SCALE: ADZ I xEieaos NO DATE REMARKS HAACK RESIDENCE 319 LAKE DRIVE LAKE PEEKSKILL, NY 10537 TAX MAP 683.66 -1 -11 PROPOSED LOFT PLAN OATS: 8.1.7009 SCALE: ADZ �., seM[a+nea+rNlcu lmw nfDI ' �ae0.949.7334 _ P/0 83.58• t7 � %0.03.58.1.81 � :4q � Jr` � ` 544 ` `d �r //• /l ,'1^• AV 6 tY a" a 9 F ' i< i i &I 1 182. - FOR ASSESSMENT PURPOSES OILY 1 NOY,TO BE USFA.iOA CONVETANCES J I {T MWEp $TREET AMES -,W.. SEWALL COMPANY ' I , OLD TOWN MAINE I j II /I — OW6 me0. si ii - -�- -- — iP /0�3�•�•2•Y6 _i__ _xelwnu 1 181 .sue, gt' ra / P/0 83.51.1.62 P/0 BS.57•I6J - / 83.57 83.58 PREL'I M I NARY-----.....- - f0 ♦\ a° --- ♦ ♦\ 3, ar 83.64 83.66 :,jt - . q TOWN OF PUTNAM VALLEY 1 - � Ip IS`OlinlGf lIR i'nmlln uR -( — pLOItlEC aG nwr mlap .\ `5;• ` r / /ate � 29' �' 9;,,. •� n $ a {m la (J ia flat aR ul :-� u n an s liv.�.olt•e PUTNAM COUNTY, NW YORK w a np[ paalgl(f Itlif'11111I'1. np 1.IIA O y n rr y 28 /a \`54♦\ ♦ \ \. /a is " +ro . a 1' \O\ 11 ♦ �� \\ `\ ` D 41- _. r: \ ♦\ `gip / ` a ` 5' A. `. Iar \\3\ ♦ \\ IA m t.♦ In \ \ ` yh.� ` trr A Af ` t 14 ` /a �, �+ ` \ yr ` %• .. \ JA , IV X37 m It - -�- -- — iP /0�3�•�•2•Y6 _i__ _xelwnu 1 181 .sue, 83.56 83.57 83.58 PREL'I M I NARY-----.....- - aua. pmlmn --- pm a�aela winualnla Ialp ppp 83.64 83.66 :,jt - . q TOWN OF PUTNAM VALLEY 1 - � Ip IS`OlinlGf lIR i'nmlln uR -( — pLOItlEC aG nwr mlap RH rG pL M.73 83.7 �' 9;,,. •� n $ a {m la (J ia flat aR ul :-� u n an s liv.�.olt•e PUTNAM COUNTY, NW YORK w a np[ paalgl(f Itlif'11111I'1. np 1.IIA "172 i� i I IM I R' �„_ I t F tt` -3�"xcl #S' � f y�• L F�.`i^ �r > r Ti >. r a' � S ,`ti I i fl' Ilr++{ �, i t+ late 1 z riior ij A J h, y4 ►` 4 6A l r r • - 1 �. ` fir, YI ._; . t C ONyIQCCf1BL �x a r..� -s ry i.+.oer w..ry ..a' •e.- br 4L i >' ion` ii05 ivy rd.�� zoo •. " h � - :• i� i rss. • 3 0� �E , �; j !� SURVEY OF'PROPERTY.SITUATE AT• -LAKE: PEEKSKLLL beii� Xots X03 /O- �,�C` /v:5' :B /ac�S6, section E ' - , 'TOWN. OF PUTNAM VALLEY. PUTNAM CO., N. Y. SCALE: Svi•i���C�/�a� LJ�c df� /94, . SURVEYED BY . . J. WILBUR IRISH U -TR ST PEEFF{(((SKILL. N. Y. tp ik: •.m.�ay,bw. •,.� vi ov�.�:a.:L.:fFa�.....,, -.cl ^,. £i-• nn.;w �u�' ..r.,�. �_e�. Op, ii ur.v-.xa @y: s.,•e�w.IL d..w- .. _..- .�..s. �. �_. - - .. � e .gin '�.QQ'� <%"'"• .,.� ` .� v.i L, 14'. LIC. NO. 0772 FILE E BOOK /OGB .PAGE 90 4W