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631- 589 -8100
84.15 -1 -22
BOX 34
y I IL
04467
�.r
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES
= Iftternai Use Onlir y..... - - PERMi'E'* - .
U t'J Repair Permit issued in last 5 years U/Not in Watershed
El Repair within Boyd's Comers, W. Branch or Croton Falls Res. D elegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION q •-j ig-1I 912 .M l-. ap, TOWN %9 TM # 8 4° %S°
OWNER'S NAME Me Qty its_ L,a, 12ec�erLef I4 PHONE# gyl5— Si$- -fo2$o
MAILING ADDRESS q -m U� 1 1 �rZ MJ,, 20, py k1,.aw, l/41 IFrt "M 10 S--7
APPLICANT A n ,may ees 1032 C'oi�%4- r4c�2l
Name !& Relationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE PCHD COMPLAINT # '
PROPOSED INSTALLER "�';Cesa�i. -�; Co�..� -�r� -c i�� PHONE# Q /q- 41(oq -02I.CJ
ADDRESS SJ 3 34 Pee W91< I I AAYREGISTRATION /LICENSE # /032-
f vSlo�
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.
fli'ks
I, as owner,agree to the conditions stated on this form
SIGNATURE'— TITLE yykJAQ -A,--
(owner) -
I, the. septic i I r, re to ph
SIGNATUR
(installer)
with the conditions of this permit for the septic
DATE ICI
ystem repair
ATE
1. Procurement of any Towl(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 backfi ed until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved Proposal Denied ❑
i
Ins ector's Signature & Title Dat Expifation l5ate
/
Repair proposal is in compliance with applicable codes Yes ❑ No Q'
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
' PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PR OSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
-"YES lntemal Use Onl PERMIT# `.
❑ Repair Permit issued in last 5 years rDelegated
of in Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ F Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION q jbl,i/¢ ,9tZ M4% `Z _Q, TOWN PjJr,a,,,, V /(e7 TM # e 4' iS--
OWNER'S NAME PHONE # e 1qS --SZg- 67-80
MAILING ADDRESS C{ - M U 2 t j-, rL 01 J, Q Q R J hoy► 1/A I t?c 4 ".ir.' 10 S'7 q
APPLICANT Yt°i�a��t ctv- l h, fr l a3 2 C'v:�`�-r�Lci -o2 I
Name !& Relationship (i.e., owner, tenant, contractor)
DATE'. FACILITY TYPE PCHD COMPLAINT # '
PROPOSED INSTALLER "�` Ces4�i �� Cotis -�� ����� PHONE # 9 /y-- 4/69 -01 1 q
ADDRESS Pgek,0(<; 110,YREGISTRATION /LICENSE #- /0 *32-
/ vSbr,_
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
111 "a
I, as owner,agree to the conditions stated on this form
,�' 0/' DATE
SIGNATURE ��--� °`' �`� `' '� � �`�� TITLE �'� �
(owner)
I, the septic i II r, re to ply,with the conditions of this permit for the septic ystem repair
. SIGNATUR :.:- - -- - TITI�EC"I C47 DATE •�_ �� '�.. "- __. �.; __�... _r . ...
(installer)
1. Procurement of any TowK Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved lJ
qQmw��_J i
Ins ector's Signature & Title
Repair DroDosal is in compliance with
Proposal Denied
codes
E'
O O
Dat
Yes
%,117-
O No Q'
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
L .✓
.
-
3'
t
S8,
i 4
Q Y` Ao . FA .
P Lktnam \)OA\ey, ,
c
r - CESAMNI CONSTRUCTlONINC_ -
513 Washington St.
Peekskin, NY 10566
Phone (914) 737-0600 Pax (914) 788 -0051
December 3, 2008
Putnam County Dept. of Health
Division of Environmental Health Services
Mr. Gene D. Reed, Engineering Aide
Re: Completed Septic System Sketch - Lapeccerella
Dear Mr. Reed,
Enclosed you will:find a copy of the septic system as built plan. Please do not hesitate
to call me with any questions. Thanks for your
E
4
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
'910 YJ2 'N� -AI AT-IJ J, -E&--
.;,QjYj, —N�(-WkN -(,, MENT .4.1W I, ySF,4V C
FIELD ACTIVITY REPORT
Tel.
ADDRESS:-.5�Aue/kr mt, iv,
Street Town State Zip
PERSON IN CHARGE
ORTNTF-RVTF. T)-. T).q f P z Z!e r,2
Name and Title
TYPE OF FACILITY: lz�
Jr
Signature and Title
RFPORT'RF.CF.TVF.D BY.,
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
P 1017'
Sheet 1 of
PUTNAM COUNTY DEPARTMENT OF HEALTH
- _....� 37�' IaQI `1:OF- ?�NV.DtONMENTAI,-7�IEA'I
i FIELD ACTIVITY REPORT
NAMF L /_ Tel:
Street Town State Zip
PERSON IN CHARGE
()R TNTFR VTFWFT) 4N7W11A) Z 6- 6 -SAX10 G ®n9ms T)atP /O O S{
Name and Title
TYPE OF FACILITY : Z-6- PA j K
FINDINGS:
^.,:.
�O G
Ma i &%5o 3,o' y ,vie
Signature and Title
REPORT RF.CF.TVFT) RV.,
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
u o..
Y.HE !Tai =A -4 ,BT t1AEN
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
THIS CIS ` * T A REPAIR PERMIT
Ali 'inform' Otion`below must
SITE LOCATION q my e l l .e2 M
OWNER'S NAME % I24 (has L 4 K
MAILING ADDRESS
PROPOSED :C ONTRACTORPNSTALLER
ADDRESS !!5Y3 1,olo
— v
'prior to any scheduling
GOWN t't! w, Va, gel TM # Q qd f- / - ;2 J
1 eC-C ?✓-e- I j q (PHONE UP VS -T ?S 62$O
F.
REGISTRATION /LICENSE# /032—
kly.excekseptic
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STREET
GRID
STREET
GRID
STREET
GRID
STREET �
GRID
STREET
GRID
STREET
GRID
STREET *
GRID*
STREET GRID,
.STF
8
Scott Rd ..................
H 8
Topland Rd .............
G 9
Benedict Rd ............
B 7
Beacon Rd ..............
M 4
Dingley Rd
M 5
Huron Ad ................
M 4
Mooney Hill Ad
L 3
Schuyler Rd ............ L 4
;Whip
9
Scout Hill Rd...........
H 7
Tower Rd ................
L 7
Boulevard, The
B 7
Beaver Hill Rd
L 5
Dixon Rd .................
J &
Hutchinson Rd
M 4
Mount Hope Rd
L 5
Schuylkill Ct L.:. 3�
Whitt
9
Secor Or .................
H 8
Trout PI ...................
G 10
Cedar .............
B 6
Bedford Rd .............
M 5
Doansburg Rd
L 5
Inland Ct .................
M 5
Mount Nimham Ct
.. K 5
Scotsdale Rd ...........M - 6,
'!V
WII1V
Willie
8
Sedgewick ..............
K 6
Tulip Ct ....................
J 9
Cherry .....................
B 7
Beechmont Rd
M 4
Doherty Or ..............
M 5
Interstate Hwy 84
... M 4
Nelson Ct ................
L 5
Sebago Rd- :.:.........: M
10
Seminary Hill Rd
L 7
Tulip Rd ..........
J .9
Chestnut .............
B 7
Beehler Rd .............
J 5
Dunwoodje Rd
L 5
Ina Of ......................
M 5
Nepera Rd ..............
L 5
Sedgewick Rd .,. C, 51*66,
9
Seneca Rd ..............
H 10
lUlip Rd ...................
H 10;
Church ..................
_ B 7
Beekman Or ...........
L 4
Dutchess Lake Ct...
L 2
Irvington Rd ............
M 5
Niagra Ct ................
M 4
Seifert U...: E; .......... H. 6:.
Whig
8
Senior Av ................
1 9
Underhill Rd ..........
: _G 6
Constitution Or
B 7
Beverly Rd ..............
M 4
Dykeman Rd ...........
L 6
Jay I ......................
L 5
Nichols ....................
K 6
Seven Hills Lake
Wixo
9
Shallow Stream
Union Valley Rd
9
Cralgside Or ...........
B 6
Birch Point Ct
K 5
East Boyds Rd
J 4
Jeffrey Of ................
K 3
Nichols ...............
L 5
D I r J. 4'
V16cx
Rd
L 9
Union Valley Rd
K 9.
C os a ....................
B 7
Birch Tr ....................
L 6
East Croton Or
M 5
Jessup Ct ...............
L 4
Nichols Pt ...............
L 5
Sheninid6ah Ct
Wool.
6
.......................
Shear Hill Rd ..........
K 8
Upper Lake. Ad
J 6
Depot Sq ................
B 7
Blackberry Of ..........
K 4
East Mountain Rd
.. F 3
Joseph Of ...............
L 5
Nimham Rd
J '4
rSibbqll Ct,.�!.'.� ,
'W60,
i
10
Sherbrooke Rd
G 9
Upper Lake Rd N
I 1 .1
J 6
Riir, River ................
B 7
Bowen Ct ................
L 3
Echo Rd ..................
M 5
Kashmir Ct ..............
J 6
Noonan Or ..............
M 5
Smalley.Come rs
I .� I .
Wo,
.8
_Sherman Rd ...........
G 8
us Route .6 ; .... .......
L 7
Fish ......................
�Fi�hkill
B 7
Bowen Rd ...............
L 4
Elmsford Rd ............
M 5
Katonah Rd ............
M 5
North Horse Pound .
I ; ,
'J" 4
Rd,- . 1 1, �; "
........... !�'
'.:
Wort
8
Sher yl La ...........
K 8
US Route 6 ............
;... J 9
Av ................
B 6
Bradhurst Rd ..........
L 4
Emerson Rd ...........
a
L 5
Kensico Rd .............
M 5
Rd .......................
L
Sjr��y,HollovvCt--: K.
W6rt
8k .
Sh"6huk La ..........
K 9
Valens La
K 6.
Forge date Dr-
(off
Brayton Rd .............
M 5
Fairfield Rd .............
M 5
Kent Acres Rd
K 4
North Knapp Ct
G., 3
'Sol Dr,�,...*.,.:.t*.-;:..� LT �,5
9
Shindegan Rd
L 9
.
Valley Rd ..........
J �7
:.
LujHn'Tir) ............
B 7
Brentwood Rd
M 4
Fairview Of ..............
. L 3
Kent Lake Av ..........
K 3
North Terry Hill Rd
_.L., 4'
,South "Knapp Ct H
Sh6rj Or
H 10
Valley Rd
L -9
.0urnace. .............
I B 71
Brett La ...................
J 3
Fairways Ores
M 6
Kent Shore Or
K 3
Oak Trail ............
L 6,
Y drki
7
..................
Shore La * ................
H 8
Varna La ...............
J 7
Garden
8 7
Brewster Or .............
M 5
Fairways Ct .............
M 6.
Kentview Or ............
J 3
Oakland Rd 1
L.
'South
N
7
S1666nds PI...........
J 8
Veschi Rd ...............
J 6
Grandview Ter
8 .6*
Briarcliff Rd .............'M
5
Fairways Or.............
M 6
Kentwood Or...........
L 4
Ogden.Rd
L 4
lak'e'Rd' K,,.':; 3
Silver Gate I Rd
J 10
Victor La .................
L 8
� Haldane'..................
8 7
Brook Tr ..................
L 6
Farmers Mills Rd
H 4
lqngsridge Ct ..........
L 3
Old Forge Or
H .4
Stiahle'.
9
Someril-filts Rd
L, 9
Vineland Rd ............
G 9.
Hamilton Av ............
5 6,
Bryant Rd ...............
M 4
Farrineirs Mills Rd
K 3
Yitchawan Rd
M 5,
Old, fOr6ard Ct
K � 4,
.y
11 1 1- - 'E"
8,
S6m6isbt Rd L..:.
J 7
Vink Dr,
L . 6
High 1 .......................
B .6,
Bryant Tr . .................
L .6
FirTiall Ct ... ..... ......
L .6
Kittridde Or
'Kn6ficr6st
J �I 6�
Old'Ft6ute 301:�:a�.
J �'5
Ro ute, 52 2 ��4`
10
• South Lake 9
H,,10;
Kembi6,A4,
8 7
�Byrarn Rd.:
'C6ii�el
M 4
Inis
,id
Rd J`��4
1 .1 -�4.
-Ohtdrld�Rd, �M,
'
10
�q
tSjpIIt.Rock
-18
J. :-7,TWafn%4r1ljhtDr�,2.:.;
Nati'Ter W:�� 8
';M:.�S�
Locust R
Ridge
B -6
W,�'7'
1 1:
Kent Cliffs,
""Rd
..
, Fl, M:�, S�
rF �W
!qssa'j_
Laguna'Rdt�'.'�; -
, _ . , "'j, - "' f
�OSceotd Ad.:r
gt�ic�.
' j- ` ;�S �
H6bj
"
7,.
Spring Brb6k Or,
9,
Walnut -Dr, (Fanzb)
G: - 9.
Vilri St
.
8, 7 -
:",: ... ..... ............
Caryi:Rd
"
M 5
i -
Friend La
K' 4
-
W'ulse
- �,' _-,
K 3
'StiiWR66W,13fi,`�-��W, 0
s
'9
Spring
H 10.
10,
Maple Ter '.1.1..�.�..;�.::..
B 4, 61
, Get Briar Rd:
K .4
. Girrilibiri Rd...
M 4
Lake Shore Or E...:.
M 5
5,
�2`� 3
.Main
o
10
Spring 6
H 7-
Watermelon Hill
'
Marfon:Avr ...........
.. 1. B .7
Ciariter Rd:...�
M, 4�
Gatehouse Ct
'Gateway
J 6
: Lake Tir':.� ..............
L 6
P&ksIIpRd
�P64ks
11 2;
S tonegate;
N1,66
9
Spring La ................
G 9
Rd .......................
K 9
Market ................
8 7
Champlain Or
M 4
Ct .............
M 5.
Larch mont Rd
M 5
ki I I � Hollow
-Stu, ylvjes,aljt-� Rd
pear
7
Spruce.Dr ...............
J 7
Waycross Rd ..........
G 9
Morris Av .................
5 6
Chappaqua Rd
M 4
Genbrva Or ..............
M 4
Laurie CL_..............
K 3
- Rd ............
6
`Sunset b
Peel,
7
Stacey La ...............
K 8
Weber Rd ...............
K 8
Mountain Av ...........
8 6
Chatham Rd ...........
M 4
George Jr Or...........
L 5
Leeside Or ..............
L 4
Pelham Or...............
La
5
K 4
Sussex Rd !
-
Pine
9
State Route 6N
H 9
Wellington Or ..........
L 8
Now .........................
B 7
Chauncey Rd ..........
L 5
Gilead Rd ...............
L 5
Lhasa Ct ...........
H 5
Peppers .............
L 6
;
Teconit'stake
9
State Route 301
K 6
Wescott Rd .............
J 8
North .......................
B 7
Chief Nimham CIr
J 4
Gipsy Trill Rd
K 3
Lincoln Or ...............
L 5
Perry Tr ..................
L 4
Pkvv
esea
Spril
9
Stebbins Rd ............
L 9
West ........................
L 6
Northern Av ............
B 7
Chief Nimham Or
J 4
Gipsy Trail Rd
K 5
Linden Rd ...............
M 4
Philipse Rd
4
y.:�,,�
*Rd
'State
9
Stainer Rd ..............
H 8
West Branch Rd
J 9
Oak .........................
B 7
China Circle Ct
J 6
Glass La .................
J 4
Livingston Rd
M 4
Pine Pond Rd
K
Talmadge ..........
Of L 5
Woo
8
Stephanie La ..........
K 10
West Or ...................
H 10
Orchard...................
B 6
China Of .................
J 6
Glenbrook Rd
M 5
Lockwood Rd..........
M 5
Pine Tr.....................
L 6
Teatawn ;;
4.1
Woo
9
Stillwater Rd ...........
H 9
West Lake Blvd
J 8
Parrott .....................
B 6
China Rd ................
J 6
Glendale Ad ...........
L 5
Loggers Ct ..............
H 4
Pinewood Of ...........
K 3
Terry Hill Rd ............ M
9
Stokum Av
H 8
West Lovell .............
K 9
Parsonage ..............
B 6
Church Hill Rd
K 3
Glenwood Rd
M 5
Long Hill Rd ............
G 3
Pioneer Rd .............
K 4
Thornwood Rd M 5
6
..............
Stoneleigh Av
L 7
West Share Or
_ L 8
Paulding Av ............
B 7
Clarkson Ct .............
L 5
Golf Ridge Rd
J 6
Long Mountain Cl
F 3
Placid Or .................
M 5
Tibet Or ................... H 5
9
Stonewall Farm
West Tr
L 7
Pine ........................
B 7
Clarkson Rd............
L 5
Gordon Rd..............
H 5
Longfellow Or
M 4
Pleasant Or.............
M 5
Ticonderoga Rd L 4
Acat
. -
... .... ....................
I
__ ..,
. I
—
.
Q�
1 9
1 i.. Ad
M A
Pntirn Rd
M 5
Tioar Tr .................... L 4
Addi