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631 - 589 -8101)
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BOX 10
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DEPARTMENT OF HEALTH /
Division of Environmental Health Services �l
4 Geneva Road, Brewster, Nesw.York 10509
(914) 278 -6130
----- APE- LICATION- -TO-- CONSTRUCT A- �:AT-ER -E I,L-- ___,_..-- -• -___ - _ -//. y - - - - -- - - - - -- -j - -.
PCHD PERMIT �k►s4`l�T
WELL LOCATION
Street Address
Garland Road,
Town/Village/City Tax Gr Number
Putnam Lake, Brewster, NY ` `"' 7
WELL OWNER
Name
Frank Mengler,
Mailing Address OPri ate
Garland Road, Brewster, NY 10509 0Public
USE OF WELL
1 - primary
2- secondary
® RESIDENTIAL
0 BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__�gal
® REPLACE EXISTING SUPPLY 13 TEST / CBSERVATION 12-ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING 13 DEEPEY EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
Shares well
with neighbor which is inadequate.
WELL TYPE
®DRILLED
DRIVEN []DUG GRAVEL O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name P. F. Beal & Sons, Inc. Address: 4 Putnam Ave, Brewster
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
-DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
11/28/94
ON SEPARATE SHEET � I r/9't (date) signature
Malcolm T. Beal, Jr.
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
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by
of the Putnam County Health
the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this .
property and in su a manner as not to degrade or othEtriii, inI aminate a or groundwater.
Date of Issue• 2G 19
Permit Issuing Date of Expiration 19 g Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp: Orange copy: Well Driller
23
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25
Is
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FOR ASSESSMENT PURPOSES ONLY
REVISIONS
SPECIAL DISTRICT INFORMATION
NOT TO BE USED FOR CONVEYANCES
mL%m ,
JAMES W. SEWALL COMPANY
147 CENTER STREET, OLD TOWN. MAINE
-
1
104-- 14111.4
COUNTY HEALTH DEPAR1XENT
DIVISICN OF _ ENV1Ra4.MCAL HEkLTH SERVICES �•) 1 .
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM! WAIEt
OWNER I S NAME `C dt PH�IE " 1�e, '7 %s�
SITE LOCATION fj r—/ o �' :�'' °�/� / . mss# -z S . y / —1 -2 S—
MAILING ADDRESS
PERSON INTERVIEWED C PCHD complaint #
DATE Se
. D, DID 1 k, . D1
.e, owner, t :rant, etc . )
TYPE FACILITY
REGISTRATION #
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type pis original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect.
1f O I.,-;e,—.- -e �� J< CAS/ i' /l <, ivy l� : b tie /- p // —
Proposal approved Proposal Disapproved
Inspector's Signature & Title Da
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate shming:
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' diem. x 6' sleep
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 owner, or epo agent of owner agree to the above conditions.
SIGNATURE TITLE DATE
PUI'[�1M
VM: indite (MV; Yellow (fin 31); Pink (k#icsnt)
f I
`mod J
BY DATE
CHKD. BY DATE
CLIENT
PROJECT
OFS NO.
SHEET OF
DEPT.
NO.
FORM 561 REV 7 -71
FORM 581 REV 7 -71
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster NY 10509
RE: Proposed addition
Mengler,.Freemont Road
Putnam Lake (T) Patterson
Lot # 3230 -3234
Dear Mr. & Mrs. Mengler:
Public Health Director
July 21, 1994
Review of the plans and other supporting documents submitted relative
to the above captioned project has been completed. Approval cannot be
granted for the following reasons:
1. Separation distance between well and -;:he sewage disposal
system is indicated at 80'. A minimum of 100' is required.
^�_._._.,_____- ..V.__..i � __.... —Ai Au._.�.�:w i•l.a�l �._ tn d,_ttr_.s.nA-ta��+.— (��.s� c9!_-•r''tct`�m-�ir•�u ±ra.r .._ ..
than 100' from existing wells, is not available.
Please submit plans for an addition within the 'S% margin increase for
non - conforming parcels. (i.e., 800 sq. ft. res•dence can expand by 120
sq. ft. for a total of 920 sq. ft.).
IF you have any questions, please contact me at your convenience at
ext. 168.
Very truly your;;,
William Hedges
Sr. Public Health Sanitarian
WH:mk
cc: BI (T) Patterson
AFFLICATICN - ADOITICN - (RESIDENTIAL CNLYI k1z -
�
Name: tv
Street A-1 %�/' '»�Onlf Itd TMI Construction e�q
Mailing Address 27*kewS � h � s• Tcwn FO -D Perm i t
Description of Addition �'d ~L &Ot"W,
Number of existing bedrooms Oz Proposed- number of bedrooms
AJ Square Footage of existing rouse C% q
B) Square Footage of Proposed Addition 7 3 R A
% increase in floor area ( A divided by B) X 100 =
Please submit this form and the following to FUTNAM COUNTY HEALTH GEPARTMENTI, 4
GENEVA TOAD, ERBISTER, NY 10509, Prone 278 -6130 with the following information.
IF THE F%POSED ADDITION IS C--?EATER THAN 15%
CERTIFIED CHECK CR KNEY CEDER
1. CHECK for $100.00
2. Sketch of existing floor plans (all living area including basement, if any)
Ncn- professional drawing
3. Sketch of proposed floor plan.
Non professional drawing
4. Copy of survey showing well and septic location, to.the best of your
knowledge.. Include date of installation if known. Any questions pleas
contact William hedges or Fcbert Morris.
IF THE ADDITICN WILL RESULT IN AN ADDITIONAL BEDFOOM THAN
CERTIFIED CHECK CR MONEY GIFDER
1 CHECK - for. $.100.00
- ---- -- 2. S etci o exi-s i`r "flzx �-( t1 1�� g= c�a= lncl:�di n_gg basement, of try)
Non- professional drawing ~� -
3. Sketch of proposed floor plan.
Non professional drawing
4. Plans for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
OFFICE USE
Comments and /or conditions
Approved by:
Date:
cc: BI (T)
addition
TITLE
A-i i-t;o to
f.
16 9 0 IN
*-og -
jal
M, FA,mly
C AR
GAVA 3
LL-
I
we LL
BED �i
rs
LO
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4
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5
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pbvr H
(CAI sTi jv& SQ. FT. 0.D.
PRoPoszo AC)D-
TOTAL SO PT. ® 1/00
ifjcL4
Re: Proposed addition:
(T)
Dear
Review of plans and other supporting documents submitted at this time relative to
the above — captioned project has been completed. Comments are offered as follows:
1. Separation distance between well and septic is approximately feet,
100 feet is required by today's standards..
2. Expansion area for the existing septic system, 100 feet from the existing
well, is not available.
In light of the foregoing, your application is hereby denied.
It is advised that the proposed addition is revised to meet current standards„
I,may be reached at ext. 320 to discuss this possibility.
SSDSCOMMENTS
Very truly yours,
Robert Morris
Assistant public Health Engineer-
s"te —.so 0
.
t`tjSt.4
lei eLL
0
4'M COG
a .e
.r^
OWNER'S NAME r�
SITE LOCATION
MAILING ADDRESS &'/d
PUTNAM COUN'T'Y HEALTH DEPARTMENT
DIVISION OF I-'_AT TH SF.R—WC.ES
7cm-� 4V -0— 1
p.1:11- wo ��.. You �1•: 1:
PHONE
TO
/?- 3qq- -�y
PERSON INTERVIEWED PCHD Canplaint #
Name & Relationship (i.e, owner tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER -(' 1�;.,n i',4,h -! PHONE
REGISTRATION #�
Pro (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 fran licensed professional engineer or
registered architect.
;#T-1-7-71 1
Inspector
& Ti
Proposal Disapproved
r000sal armroved 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 naive.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
2 C
to
(e.g. ,house corners).
three precast 6' diem. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported agent of owner agree to the abov/ee �conditions.
SIGNATURE TITLE
00P1F'S: V&te (RgO); YeLlcw (Tam BI) o Pink (Ajaliamt)
DATE la' f
DEPARTMENT OF HEA -TH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New, York 10509
(914) 278 -6130
October 19, 1994
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster, New York 10509
Re: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Tax Map 25.41 -1 -2`l
Dear Mr. and Mrs. Mengler:
r-
JOHN KARELL Jr., P.E., M.S.
Public Health Director
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code an6, the standards of the Putnam
County Health Department relative to the design of a subsurface sewage disposal
system and well to serve the above captioned addition has been considered by the
Putnam County Board of Health on October 17, 1994 and has been approved.
Very truly yours,
Dr. Michael' SIt olman
President, Board of Health
MS: BF: pt
cc: John Calbo, BI, (T) Patterson
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
October 19, 1994
Frank & Annemarie MIengler
RD a3 Freemont Road
Brewster, New York 10509
Re: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Tax Map 25.41 -1 -25
Dear fir. and Mrs. Mengler:
JOHN KARELL Jr.. P.E., M.S.
Public Health Director
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code and the standards of the Putnam
County Healti Department relative to the design of a subsurface sewage disposal
system and well to serve the above captioned addition has been considered by the
Putnam Count? Board of Health on October 17, 1994 and has been approved.
Very truly yours,
Dr. Michael Schoolm-an
President, Board of Health
MS:BF:pt
cc: John Calbo, BI, (T) Patterson
r:
DEPARTMENT OF HEALTH
Division Of Environmental Hea th Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
October 19, 1994
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster, New York 10509
Re: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Tax Map 25.41 -1 -25
Dear Mr. and Mrs. Mengler:
JOHN KARELL Jr.. P.E. M.S.
Public Health Director
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code and the standards of the Putnam
County Health Department relative to the design of a subsurface sewage disposal
system and well to serve the above captioned addition has been considered by the
Putnam County Board of Health on October 17, 1994 and has been approved.
Very truly yours,
Dr. Michael Schoolman
President, Board of Health
MS:BF:pt
cc: John Calbo, BI, (T) Patterson
r
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
October 19, 1994
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster, New York 10509
Re: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Tax Map 25..41 -1 -25
Dear Mr. and firs. Mengler:
JOHN KARELL Jr., P.E., M.S.
Public Health Director
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code and the standards of the Putnam
County Health Department relative to the design of a subsurface sewage disposal
system and well to serve the above captioned addition has been considered by the
Putnam County Board of Health on October 17, 1994 and has been approved.
Very truly yours,
Dr. Michael Schoolman
President, Board of Health
MS:BF:pt
cc: John Calbo, BI, (T) Patterson
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster NY 10509
RE: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Lot # 3230 -3234
Dear Mr. & Mrs. Mengler:
lQtl1�xA- J"_. Jr., P.E _.KS. _ _ .._
Public Health Director
July 21, 1994
Review of the plans and other supporting documents submitted relative
to the above captioned project has been completed. Approval cannot be
granted for the following reasons:
1. Separation distance between well and -:he sewage disposal
system is indicated at 80'. A minimum of 100' is required.
-..2. _'Area, ayaj fable t2 exp�tL�- t.l1e_sage�d sal._�semrPafp.r.�
than 100' from existing wells, is not available.
Please submit plans for an addition within the '5% margin increase for
non - conforming parcels. (i.e., 800 sq. ft. res-dence can expand by 120
sq. ft. for a total of 920 sq. ft.).
IF you have any questions, please contact me at your convenience at
ext. 168.
Very truly your:;,
®
William Hedges
Sr. Public Health Sanitarian
WH:mk
cc: BI (T) Patterson
C A P.,
GAVA3e-
J07
7we-LL
BECK
Iq
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It
ry
A 114 C,
Po H
(CA I ST/NCB SQ F rm 19 S C.D.
��T,
PROPOSCD ADD- 00 ll1 sz.
70TA L 'PT.
5C A L
............
August 8, 1994
To:Putnam County Dept. of Health
We are Presently applying for a hardship variance for our
home. The existing structure is only 800sq.ft.. We originally
proposed a 390sq. ft. addition, but would like to reduce the
addition to 260 sq. ft. to be used as a family room. As you
can see on the survey the well is at the corner of the property
line.
Sincerley,
Frank& Anne Marie Mengler
Department of Health September 1, 1994
Re; Variance Request
Name: Mengler
Street: Freemont Rd.
Town: Patterson(T) Putnam Lake
Tax Map:3230 -3234
We are presently applying for a hardship variance for our home.
The existing structure is only 800 sq.ft.. We originally proposed
a 390 sq.ft. addition but would like to reduce the addition to
260 sq.ft.. Please note on the survey map that the distance from
the well which is in the far corner of the property to the fields
is at least 90 ft. not 80 ft.. If this variance is not approved
we will be forced to sell and buy a larger home.
Thank you for your consideration in this matter.
Sincerley,
Frank and Anne arse Mengler
L_l
Vi e,\,j
ov I s il"
tD
Fr
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13
DECK
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SQ F 19 S O.D.
To TA L 54 T-T,
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75' - 6-"F,5-7.
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i
JOHN N. CALBO
Building Inspector
TOWN OF PATTERSON
PUTNAM COUNTY _
PATTERSON. NEW YORK 12563
September 6, 1994
Mr. John Karrell, Jr., P.E.
Department of Health
4 Geneva Road .
Brewster, New York 10509
Dear Mr. Karrell,
The property located at Freemont Road belonging to Mr. & Mrs.
Frank Mengler is a.pre- existing non - conforming single family dwelling.
Any addition must go to the Zoning Board of Appeals after receiving
Board of Health Approval.
If you have any questions, please do not hesitate to contact this
office.
Sincerely,
ohn N. Calbo,
Building Inspector
JNC /cs
- Telephone -
878 -6319
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14.16.4 (2187)—Text 12 t
PROJECT I.D. NUMBER 817.21 SEOR
Appendix C .
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT ;SPONSOR 2. PROJECT NAME
3. PROJECT PROJECT LOCATION::
Municipality P6+i —e vs a -i County 'J -f, /..I VI
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
CC, nrn a +v 'T" P— A 3 r -e W s to YL) B o j-0
`3
5. IS PROPOSED ACTION:
0 nn �
New Expansion ❑ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
)Yes ❑ No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? _
(;%Residential <_ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen space L1 Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
❑Yes No If yes. list agency(s) and permit/approvals
11. DOES ANY ASPECT OF THE ACT, :N HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
❑ Yes kgNc- if yes, 4st acency name and permitlapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑Yes LJNo
I CERTIFY THA THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant1sponsor name: r �l °v v " Date: G
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
PART II— ENV'IROWMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
C1 Yes ❑ No _. -'
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 817.8? If No, a negative declaration
may be superseded by another involved agency:
r Yes r No
C. COULD ACTION RESULT :N ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING. (Answers may be nanowritten. f :egiblel
C.. Existing air quality. surface or groundwater quality or quantity, noise ieveis. existing trarfic patterns. solid 'waste ;roduction or disposal.
potentiai for erosion, drainage or flooding prooiems? Exciain briefly:
C2. Aesthetic. agricultural. archaeological. historic. or other natural or cultural resources: or community or neignbomooc cnaracter? Explain oriefly:
C3. Vegetation or fauna, fisn, snellfisn or wildlife species. significant habitats, or threatened or endangereo species? Exomin briefly:
Ca. A community's existing clans or goals as officially adopted. or a change in use or intensity of use of land or other natural resources? Explain briefly
C5. Growth, subsequent cevelooment, or related activities likely to be induced by the proposed action? Explain briefly.
C5. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly.
C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE: ENVIRONMENTAL iMPAuib?
❑ Yes ❑ No If Yes, explain briefly
PART 111— DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, Important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (I.e. urban or rural); (b) probability of occurring; (c) duration; (d)
Ireversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you have determined, based on the Information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental imps is
AND provide on attachments as necessary, the reasons supporting this determination:
Name of Lead Agency
11
Print or Type Name o Response le Officer in Lead Agency Title of Responsible Officer
_ �. `�_ � -. -_ .ter 'tom .' \':t G... I� �:•,�.i -: S� ..._ ._
Signature of Responsible Officer in Lead Agency
Signatu nr of reparer (if
different fmm response e o icer)
_ �. `�_ � -. -_ .ter 'tom .' \':t G... I� �:•,�.i -: S� ..._ ._
'
APPENDIX 3&
DB3AKIMM OF BEEALIH — DEPARTMM OF ENVIRONMENTAL HEALTH SERVICES
BOARD OF HF.ALIH — DEPARTMENT OF ENVIRONMrrAL HEALL%H SERVICES
BOARD OF HEALTH
V]QJANCE REVIEW CH8CKSHIEET
owner (name)
Sheet location
Required Muteriala
( )
14 Seta Plaoo a/o Professional Engineer or Registered -Azcbitect
(-/
���
�
atter of recoest, 14 copies
( }
Hardship discussed
Specific regulations to.be varied
Letter from Building Department
-
Short Form EAF !
�~7
Rejection Letter from Health Department
.� �
(VT m� locatioo map; scale l" = 400'
Neighbor notice performed properly
Receipts or Proof of Notice provided
� 1 SEQRA Determination
Meeting Date
Denied /
Cmod1tl000
!
Cmuoueoto: /
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It
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.29
Continued On Map No. 8
Map Ca
pp 10!31
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.33 IT
4
DEPARTMENT OF HEALTH -
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
August 22, 1994
Frank and Annmarie Mengler
RD #3 Freemont Road
Brewster, New York 10509
Re: Variance Request
Name: Mengler
Street:Freemont Road
Town: Patterson (T) Putnam Lake
Tax Map 3230 -3234
_.r -„yyau KARE!L_ I=_ac..M.S_ _ -_
Public Health Director
Please be advised that the matter of your request for a variance from certain
provisions of the Putnam County Sanitary Code has been placed on the agenda for
the next meeting of the Board of Health to be held on September 19, 1994 at 7:30
P.M. in our Health Department Conference Room 4 Geneva Road, Brewster, New York.
You or your representative must attend the meeting to present your case.
?�1g^- 121 ::. -c-- -Not -ficatioIl-"
procedure which must be satisfied. The materials required in the "'Procedure for
Variance Request" document must be received in this office by September 16, 1994.
r trul o r
i
ohn Karell, Jr., E.
ublic Health Director
For the Board of Health
JK:pt
cc:JK
File
E
August 22, 1994
Dear Sir:
- .__ -. _._.... ..- ._.___._.J.4NN._K/►9El.hJr., PE.. MS.
Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Re: Variance Request
Name: Mengler
Street: Freemont Road
Town: Patterson (T) Putnam Lake
Tax Map: 3230• -3234
�. -- ---- - - - -.. _n.lease�- -.e -- advise.-- thz _- _ e.q uec t -for a
. . ._ o_._ the__Putnam
County
Santary Code relative to the construction of an addition to the house on
the captioned property which is contiguous to your .property will be heard by the
Putnam County Board of Health on September 19, 1994 at 7:30 P.M. in our Health
Department Conference Room, Geneva Road, Brewster_, New York.
If you have any questions, concerns or information which may bear on our
deliberations, you may appear at this meeting or contact the writer at Ext. 151.
Because scheduling sometime are modified at a late date, if you are planning to
attend this meeting you should contact the Department on the day of the meeting
to assure that this item is still on the agenda.
er tr y P,4jr.,.
are E.
ubli c Health Director
JK:pt
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
BOARD OF HEALTH
Procedure for Variance Request
Public Health Director
Pursuant to the provisions of Article III Section 2, (b) an application for the
installation of an individual sewage disposal system that has been denied by the
Director may be reviewed by the Putnam County Board of Health who may reverse the
decision based upon proof of hardship and with concurrence of the Director that
the proposed sewage disposal system will not create a health hazard by its use.
Individuals wishing to make application to the Board of Health for a variance
must submit a letter, to the Board President, ;Iichael Schoolman, Putnam County
Department of Health, 4 Geneva Road, Brewster, New York which application must
include:
1. In a letter (14 copies)
a) Formally request a variance
b) Fully describe the variance requested and the properties affected by the
Variance, i.e., a reduction in the required 100 foot separation distance
to the Smith well is requested. The proposed separation is 80 ft.
c) Discuss the hardship that will be experienced should the variance not be
granted
2. Provide 14 sets of plans
3. Submit a letter from the local Town Building Department that the property in
questions is a legal building lot. The Board of Health will not consider
variance requests for property that is not a legal building lot from a Town
Zoning standpoint.
4. Short Form EAF
John Karell, Jr., P. t.
Public Health Director
JK:pt
8/93
DEPARTMENT OF HEALT-ri
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, Ne%v York 10512
(914) 225 -0310
BOARD OF HEALTH
VARIANCE REQUESTS
NEIGHBOR NOTIFICATION
:;.iv KARELL Jr- P E. M.S.
PvDI;e Health O;,ector
Beginning January 1, 1989 appeals (petitions) requests to the Board of Health for
a variance from provisions of the Putnam Count), Sanitary Code will not be heard
by the Board until such time as the Director of. Environmental Health Services of
the Department of Health is provided with proof that notification of the date of
the variance hearing was made to all property ewners contiguous to the property
in question. A location map with contiguous properties shc-wn along with the
property e »Lers name and Tax Map $ must also be provided to the Department.
Notification shall mean receipt by each contiguous property owner and the local
municipal Building Inspector of a copy of the attached.not'ficatioa form along
_.__.._-- ,- •.--- _..___..__. e� i- te__n_1.�n__ard.l t_Ce.z- .�eo__u�st?n rarian_c_e. _(see item i1 _
t-- - g __.___ - -- -
(a) (•o) (c) in "Procedure for Variance Request ". _
Proof of receipt of notice by contiguous property o.Uers and the To;.-n official
can include either of the following:
1. Copies of registered mail receipts
2. Copies of the notification form signed by the contiguous property ovners
Notice shall be made at least 7 days prior to the d_te of the meeting and no
earlier than 21 days prior to the meeting.
Failure to provide the Board with adequate documentation of the performance of
the notice may result in the Board delaying action on the request until proper
notice is executed. The proof of notice shall be submitted to the Director of
the Division of Environmental Health Services on or before 2 PM. on the day of
the hearing.
Jig : p t
10/91
14 -16.4 J=7y —Text 12
PROJECT I.O. NUMBER
617.21
Appendix C
State E"Awk wen ., Quallt•1" Review .
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by :applicant or Projec: sponsor)
SEAR
If the action is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding With this assessment
- - - -
1. APPLICANT ;SPONSOR 2. PROJECT NAME
3. PROJECT LOCATION:
Mumctoality County
4. PRECISE LOCATION ;Street access and road intersections. Prominent landmarks. etc_ or prowde maul
5. IS PROPOSED ACTION:
r New r Exoansion r Mooificatiorvalte,wicn
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING .^•R OTHER EXISTING LAND :JSE RESTRICTIONS?
G Yes C No If No. :escnbe onefty
9. WHAT IS PRESENT LAND USE .N VICINITY OF PROJECT?
_
i Residential <_ Indusaiai L Commercial Agriculture _ ParwForestlOcen space ! ' Other
Dewibe.
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FRCM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL
STATE OR LOCAU?
C] Yes [ No Y yes. iist agency(s) and permiWacprovals
11. DOES ANY ASPECT OF THE ACT.:11 HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
13 yes ❑ Nc If yes. 11st arency name and pefmit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMrT(APPROVAL REOUIRE MODIFICATION?
❑ Yes ❑ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
AppllCanUsponsor name: Date:
Signature:
If the action is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding With this assessment
- - - -
----OVER
L r'�i i�� �..`- �y�.�w�N►r�+
-.. !C s+M�.
-. . .a..
_..- .w+w�....
Jr �.sn�!..i y.-.rw 8r� ��..J.:'.
�i��'. ...
- _ rr. ,
R z � _ \ >
>� .....: 4 r
� :_Qb �.. S
.. �_� �.� tt
-.�� ♦ ;;/Z�'a�/fK."�z _�
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review, broceba arre'-3e tra FULL EAF
C3 Yes
S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR. PART 617.5? :! SIC. a negative cecrarauon
may be superseded by another involved agency;
7, ' Yes ' No
C. COULD ACTION RESULT •N ANY ADVERSE EFFECTS ASSOC :ATED WITH "HE FOLLOWING. ;Answers may 7e 'wwwrtc:illifl. ' eC.cret I
Cl. Existing air quality. surface or grounawater quality or quantity. noise revels. existing :rarfic 7attems. solid avas:e _xuruon y olscosal.
- otentral for erosion. ararnage or flooding Proelems? Excfatn briefly:
C2. Aestnetic. agncuitural. arcnaectogtcas, nstortc. or otner natural or cultural resources: or community or neipoornc r = araaar7 Exctam crtetty:
C3. Vegetation or fauna, fisn, snellfisn ar wildlife soecres. significant nacrtats. or threatenea or endangered scec:es? E=2e. = taffy:
C•s. A community's existing clans or goaa as officially adootea. or a change to use or intensity of use of land or otner na -ur.. es.-umes? Fs :rain onefly.
C5. Growth, subsequent --everooment. =r refatea activities :Ikely ;o ce induced -y the pmoosed action? Exclam -net :v.
C6. Ling term, snort term. cumulative, :r other effects not :dentifted in C :-C:? Explain briefly.
C7. Other impacts (Inclueing cnanges :n use of either quantity or type of energy)? Explain briefly.
THERE. OR 1S I'HEmE LIKELY TO' BE. ON T RO V'USS,i' -E_. T`D TO nTE.*!TIAL ADVFRRE. ENVIRONMENTAL IMPACT'S?
❑ Yes CJ No If Yes, explain gnefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identlfled above, determine whether It is substantial, large, imperta or otherwise significant.
Each effect should be assessed in connection with its (a) setting 0.e. urban or rural); (b) probability of o=zUTing; (c) duration; (d)
Irreversibility; (e) geographic scope; and (f1 magnitude. If necessary, add attachments or reference Supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you have determined, based on the information and analysis above =rid any supporting
documentation, that the proposed action WILL NOT result in any significant adverse em*onmental imps.-is
AND provide on attachments as necessary, the reasons supporting this determination:
Name or lead Agency
Pnnt or fype Name of Raponu le C-wer in lead Agency
$vgnatu v of Responsr le Officer .rs lead Agency
,t
Title or Responsrb a C-<_r
ignaturc
of reparer (I d+rferent .7sown ble orricerf
. •. �� ' �
� _i _.�
� is
^ •
ate}
a
_
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.;} .
i �• �.
� -
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'
..� ;
-
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- .m.�,: + .. ♦•.:- :- ..- .- _haw.: •.; -•yv .. Z., :.
�""'- i -.L.r+ y �i:yY�, •
?. :.,''.,
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_
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;
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a� :�;..L
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4 =`�ri�r._+ - r.
? r,
-- - - - JOHN . KARFI,I J,., P.E-,- M.S. -
Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
August 22, 1994
Frank and Annmarie Mengler
RD 7*r"3 Freemont Road
Brewster, New York 10509
Re: Variance Request
Name: Mengler
Street:Freemont Road
Town: Patterson (T) Putnam Lake
Tax Map 3230 -3234
Please be advised that the matter of your request for a variance from certain
provisions of the Putnam County Sanitary Code has been placed on the agenda for
the next meeting of the Board of Health to be held on September 19, 1994 at 7:30
P.M. in our Health Department Conference Room 4 Geneva Road, Brewster, New York.
You or your representative must attend the meeting to present your case.
Y'Gu 'aic-.rc-fcrzcd- . .—t!!:c '.^.E:ed- -!�iTA= .hbC'?'_ ^ tif.; C?tZ( �n�t-- _and___!Var.:�- anceReauest" gh
procedure which must be satisfied. The materials required in the "Procedure for
Variance Request" document must be received in this office by September 16, 1994.
r trul o r
jo'
hn Karell, Jr., E.
ublic Health Director
For the Board of Health
JK:pt
cc:JK
File
August 22, 1994
Dear Sir:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Re: Variance Request
Name: Mengler
Street: Freemont Road
Town: Patterson (T) Putnam Lake
Tax Map: 3230 -:3234
KARELL Jr.. P.E.. M.S._
Public Health erector
_..._..._._.. - - ... - _ _ S c ,,- �_ Sri n . e f r m ��i. . .
P1ec3� -i.7G' au�i`loc�d-- t.�'anr -a --i E`.:..c� a; .�..,� —.c. r•�_ �a�c� - - -- :_e� ..r r�+.: -' s.xc�ns_.n,f -- -the_ 2utnam._
County Santary Code relative to the construction of an addition to the house on
the captioned property which is contiguous to your property will be heard by the
Putnam County Board of Health on September 19, 19'94 at 7:30 P.M. in our Health
Department Conference Room, Geneva Road, Brewster, New York.
If you have any questions, concerns or information which may bear on our
deliberations, you may appear at this meeting or contact the writer at Ext. 151.
Because scheduling sometime are modified at a late date, if you are planning to
attend this meeting you should contact the Department on the day of the meetin.g
to assure that this item is still on the agenda.
jWa AJr
PE.
ublic He alth Director
JK:pt
- -- -1" CA ELI Jr.. P E. M.5
364ane !Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
BOARD OF HEALTH
Procedure for Variance Request
Pursuant to the provisions of Article III Section 2, (b) an applicatioL for the
installation of an individual sewage disposal system that has been den_ =e by the
Director may be reviewed by the Putnam County Board of Health who may r =verse the
decision based upon proof of hardship and with concurrence of the Direc that
the proposed sewage disposal system will not create a health hazard by its use.
Individuals wishing to make application to the Board of Health for a va- =_nce
must submit a letter, to the Board President, Michael Schoolman, Putnam raunty
Department of Health, 4 Geneva Road, Brewster, New York which applicati =n must
include:
. 1. In a letter (14 copies)
a) Formally request a variance
b) Fully describe the variance requested and the properties affected by the
Variance, i.e., a reduction in the required 100 foot separation di stance
to the Smith well is requested. The proposed separation is 80
c) Discuss the hardship that will be experienced should the variance not be
granted
2. Provide 14 sets of plans
3. Submit a letter from the local Town Building Department that the pr:gerty in
questions is a legal building lot. The Board of Health will not cos ider
.variance requests for property that is not a legal building lot frees a Town
Zoning standpoint.
4. Short Form EAF .
OF
John Karell, Jr., P. Lf.
Public Health Director
JK:pt
88(93
J
DEPARTMENT OF HEALTH
Division Of Environmental Flealth Services
110 Old Route Six Center, Carrnel, N'e,.v York
(914) 25 -0310
BOARD Or HEALTH
VARIANCE REQUESTS
N?IGHBOR NC T I?jCATIO_N1
JC'e4 KAREll Jr_ PE. M.S.
p.bl;c Health Ouector
Beginning January 1, 1,039 appeals (petitic =s) requests to the 3oard of Health for
a variance fro-- provisions of t.`_e Putnam County Sanitary Ccde ;:ill not be heard
by the Board until such time as the Direc_cr of Env ronme =tal Health Services of
the Department of Health is provided with proof that noti== cation of the date of
the variance hearing was made to all property owners coat:=uous to the property
in question. location map with contiguous properties s - :- »3 along .; i th the
property ow -aers naze and Tax Mao rust a2sa be provided to the Department.
Notification shall --ean receipt by each co =c_guous propert: owmer and the local
Municipal Building Inspector of a copy of the attached.no__ficatioa form along
f-'` e - 1-at =s.t. - cire�..l.an _zrd_ ] ?-_ ;r.equ °SCE I1 °- . ar° anc °_ (see item r1
(a) (b) (c) in "Procedure for Variance Re :nest ".
Proof of receipt of notice by contiguous property o:.mers acd the To a official
can include either of the folio »ing:
1. Copies of registered mail receipts
2. Copies of the notification form sinned by the contiguous property owners
Notice shall be made at least 7 days prior to the erte of the meeting and no
earlier than 21 days prior to the meeting.
Failure to provide the Board with adequate documentation c_ the performance of
the notice may res::lt in the Board delaying action on the request until proper
notice is executed. The proof of notice shall be submitted to the Director of
the Division of En irornental Health Services on or before 2 P.M. on the day of
the hearing.
J%:pt
10/91
14 -18••4 (2187) —Ten 12
PROJECT I.D. NUMBER
617.21
Appendix C .
Slats Envimnmenrtal-Quality Revievr- -
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION iTo be comoleted by Applicant or Project Sponsor)
SEAR
1. APPLICANT SPONSOR 2. PROJECT NAME
I
3. PROJECT LOCATICN:
Municioality County
4. PRECISE LOCATION ;Street address and road intersections. prominent landmarks, etc.. or provide map)
S. IS PROPOSED ACTION:
New Expansion [ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND 'JSE RESTRICT:CNS?
_ Yes L_ No If No. describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
l Residential L. Industrial Commercial U Agriculture _ ParivFaresVOcen scare _: Otner
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER. GCVEANMENTAL AGENCY (FEDERAL.
STATE IOR LOCAL)?
L r'Yes r No If yes. iist agency(s) and permit approvals
11. DOES ANY ASPECT OF THE ACT.: P1 HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
❑ Yes ❑ N� It yew 11st acency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
Cl Yes ❑ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: Date:
Signature:
If the action Is In the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
~
- .
._ 1
PART If— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. ODES AC71CN EXCEED ANY TYPE I THRESMOt_D IN 8 NYCAR, PART 817.12? if yes. coordinate dinate the review process and use Ine FULL EAF
r Yes L No - - - - -
a_ WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED AC:1ONS IN fi NYCAR. PART 817.87 It !Io. a negative dec:arauon
nay be superseded by another involved agency;
Yes [] NO
C. -=ULD ACTION RESULT N ANY ADVERSE °EFFECTS ASSOCIATED WITH THE ;:CLLOWING.:Answers may be nanowriven. ! egtotet
C:. Existing air quality. surface or groundwater quality or Quantity, noise eves. existing ttartic patterns. solid waste :recucaon or asbosal.
:otentiat for erosion. Drainage or flooaing proctents? Exciam briefly.
CZ Aestnetic. agricultural. arcnaeoiogical. nistoric. or other natural or puiturar fescurces: or community or neignbort:eoq w.arac:er' Exeiain zriefly:
C3. vegetation or fauna, fisn, snellflsn or wildlife species. significant hacitats_ _r threatened or endangered species? Ex :fain cnefly:
Ca. A community's existing :tans or goals as officially adopted. or a change .n use cr intensity of use Of land or other natural resources? Explain priefly.
C`_. Growth, subsequent = e +eiooment. or related activities !Ikeiv !o be incucec --y the proposed action? Explain prtef!v.
Co. Long term, snort term. - umulative, or other effects not !dentifled in C:•Gy? Explain briefly.
C7. Cther impacts (Inc:ueing changes in use of either quantity or type of ener. -p? Explain briefly.
t : I "TFiEiaE OA -I5 iHEnc LIKE?=r 70 .ic- C.^+`ITAC`: EAS`! AE'11TE9 TQ Pn-TE-1 ,A- L.AD- V.EHSE_a. ViRONMENTAL.IMPACTS?.-_-^„-
Cl Yes ❑ No If Yes, explain onefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine wttether it is substantial, large, important or otherwise signific::nt.
Each effect should be assessed in connection with its (a) setting pa urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you have determined, based on the Information and analysis above and any supporting
documentation, that the proposed action WILL NOT result In any significant adverse environmental impsits
AND provide on attachments as necessary, the reasons supporting this determination:
Name of Lead Age-..,Cy
Print or Tvpe Name or risible Otticer in Lead Agency Title of Responsibie Ottrcer
Signature of Responsible Officer in Lead Agency
ignacure of
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank & Annemarie Mengler
RD #3 Freemont Road
Brewster NY 10509
RE: Proposed addition
Mengler, Freemont Road
Putnam Lake (T) Patterson
Lot # 3230 -3234
Dear Mr. & Mrs. Mengler:
+JOHN KARELL Jr.P.E: M.§
Public Health Director
July 21, 1994
Review of the plans and other supporting documents submitted relative
to the above captioned project has been completed. Approval cannot be
granted for the following reasons:
1. Separation distance between well and the sewage disposal
system is indicated at 80'. A minimum of 100' is required.
expand fne' sewage °di sposa i sysl em - greater
than 100' from existing wells, is not available.
Please submit plans for an addition within the 15% margin increase for
non- conforming parcels. (i.e., 800 sq. ft. residence can expand by 120
sq. ft. for a total of 920 sq. ft.).
IF you have any questions, please contact me at your convenience at
ext. 168.
Very truly yours,
William Hedges
Sr. Public Health Sanitarian
WH:mk
cc: BI (T) Patterson
✓'
_ -- - ArFLICATiCN - ACOITiCN - (?ESIOENT IAL ONLY)
Name: !'RA%V l� -� A�va� Mr« lVe►y-tLet. Ft.c4i e I� 7� ��i Year c "f - Orfgirai
i nn Qr�
Street M)3 )"%'eemo.Jf Rj TM.- Construction J7�
Mailing Address R'i-e x-fe r /V • 7• T+cwn FotD Penn: t
Oescripticn of Additicn`
dumber of exist ins bedrooms .2 Proposed number of bedreccns
A) Square Footage of existing house 9
6) Square Footage of Prcpcsed Addition_
% increase in floor area ( A divided by 8) X 100
Please submit this form and the following to FIIrW4 COt1Pn HEALTH DEPARTMENT, 4
GENEVA F.OAD, BRBISTER, NY 105CE, Phone 2 7E -6130 with the following information.
IP TFE PROPOSED ADDITION IS G=EATEF TPA,4 15%
CERTIFIED CHECK OR MCN Y CEDER
1. CHECK for $1CO.CO
2. Sketch of existing f1cor plans (all livin!7 area including basement., if any)
Vcn- professional drawinc
3. Sketch of prcposed floor plan.
Ncn professional drawing
4. Copy of survey showing well and septic location, to the best e` your
krcviledge. Include date of installation ff known. Any questicns please
contact Willian Hedges or Fcbert Morris.
IF THE AODITICN WILL RESULT IN A,! 1-3DI T IC,NLAL EEORC04 THAN
CERTIFIED CHECK OR VONEY C=DEtg
- -- - _.,, rPFCK for _$j 00. 00
2. Sketch of existing floor'p,ans (a1 i�liv�ng a�. .•ne_ -_1ra .Case,ren�, i ary)
Non- professional drawing
3. Sketch of proposed floor plan.
Non professional drawing
4. Plans for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
OFFICE USE
Ow -ments and /or conditions
Approved by:
Date:
cc: 61 (T)
t 1 ;+:�r
TITLE
r�
R
i
6�
5
N
O(A �
>The applicant should hire ' ess "i o"n
'
1 X ng In eer
or'
Regiqti.red . jAfthi t'd6t
" " _
nv estigate�n d"eva evaluate ;the SSDS L ess,wa i ve d t y e . oai�
NWJ"
Locate and excavate each drop box in the system for inspection
Note the hydraulic performance of the system as follows:
Drop box system Observe how many boxes in the system are
receiving flow; i.e., three of six; all six.
Observe flow side to side
the depth of the pit. i.e., say_an 8 foot pit has 4 feet of water
..And 4 feet of free board compared to a full pit.
'Other Sy stems Case by case
DISTRIBUTION DEVICES OR BOXES
These must be evaluated ' to assure Aei'.- proper functioning to
distribute flow to absorption a s.
All systems must be evaluated under flow conditions i.e. water must
`X
be .,run ,: ns
inside the home 'out to the 'system. A
All ssystems mutt be dye tested
kA.. . . . . e
The Health Department may wish to witness all or part of the above, thereYorep
the Public Health Director should be consulted prior to performance of any of the'..;'-
above work.
Qs� 3 �
s��
P AU,- -� ,
,tj�-
OF APPLICATION FOR A
VARIANCI
>The applicant should hire ' ess "i o"n
'
1 X ng In eer
or'
Regiqti.red . jAfthi t'd6t
" " _
nv estigate�n d"eva evaluate ;the SSDS L ess,wa i ve d t y e . oai�
NWJ"
Locate and excavate each drop box in the system for inspection
Note the hydraulic performance of the system as follows:
Drop box system Observe how many boxes in the system are
receiving flow; i.e., three of six; all six.
Observe flow side to side
the depth of the pit. i.e., say_an 8 foot pit has 4 feet of water
..And 4 feet of free board compared to a full pit.
'Other Sy stems Case by case
DISTRIBUTION DEVICES OR BOXES
These must be evaluated ' to assure Aei'.- proper functioning to
distribute flow to absorption a s.
All systems must be evaluated under flow conditions i.e. water must
`X
be .,run ,: ns
inside the home 'out to the 'system. A
All ssystems mutt be dye tested
kA.. . . . . e
The Health Department may wish to witness all or part of the above, thereYorep
the Public Health Director should be consulted prior to performance of any of the'..;'-
above work.
Qs� 3 �
s��
P AU,- -� ,
,tj�-
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION FC ED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
F-1
Yes iL ivo _. - .. - .... _ -- — .
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration
may be supersedeg by another involved agency:*
r Yes 7 No
C. COULD ACTION gESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if Iegibiel
Ct. Existing air quality. surface or groundwater quality or quantity, noise levels, existing traffic patterns. solid waste production or disposal.
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic. agricultural. archaeological, historic. or other natural or cultural resources; or community or neighborhood character? Explain briefly:
A .+d
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly;
04. A community's existing -ians or goals as officially adopted. or a change in use or intensity of use of land or other natural resources? Explain briefly
o
C5. Growth, subsequent development. or related activities likely to be Induced by the proposed action? Explain briefly.
�,�
C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly.
C7. Other impacts (Including changes in use of either quantity or type of energy)? Explain briefly.
t1, �
D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
[I Yes I�.No If Yes, explain briefly I
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure tllat
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY
occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration.
❑ Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental imps its
AND provide on attachments as necessary, the reasons supporting this determination:
Print or Tvpe Na Respo
a �icer in lead Agency
Title o ResponsiiiTTe Officer
Signature o Responsi le O .icer in Lead Agency _ _
: ;;: Signature o Preparer (t i Brent responsi ble off icef)
.W:
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DEPARTMENT OF HEALTH
Division Of Environmental Health SerNTces
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Frank & Anne Marie Mengler
Freemont Road
Patterson, NY 12563
Dear Mr. & Mrs. Mengler:
a
JOHN KARELL -- Jr:. P.E. :'MS:'
Public Health Director
Sectember 29, 1994
Re: Inspection of Sewage Disposal System
Freemont Roac. Putnam Lake
As per your request of Sept. 19, 1994 the existing Se -wage disposal system serving
your residence was inspected by a representative of n-s Department
on Sept. 26, 1994.
I. Location and Area Map indicating the following:
a) Tax Map # Lot 3231 -3234 - 25.41 -1 -25
b) Location Map Enclosed
c) Size of Parcel Enclosed
d) Survey or sketch Enclosed
A. Location-of:, - - -_ —
a) Septic tank X
b) Distribution or junction boxes X
c) Pump chamber or siphon if any N/A
d) Leaching fields, pits or galleys X
e) Available expansion area X
f) Any surrounding wells within 100' of the diszcsal system and the
expansion area (200' down hill) X
g) Individual well X
II. A review of the above mentioned submission and -A field inspection indicate
the following:
1) Septic tank
1) Size of septic tank
2) Type of material
3) General condition
4) Inlet baffle
5) Outlet baffle
6) Depth of Scum
7) Depth of sludge
8) Date of last service
est. 1000 gallon
Concrete _
Good
OK _
OK _
<2"
<2'
six months
a-
d
Distribution System
Pump or siphon
Estimate of Dose
High level alarm if pump
Junction Boxes
N/A
N/A
N/A
Condition of Boxes and Cover #1 N/A
#2 N/A
43 N/A
44 N/A
Distribution Box
a. Number of outlets 3 outlets
b. Distribution to each trench equal OK
c. Condition of Box cover good
Absor=tion Area
Total length of trenches 150
2. Estimate of expansion area % 100 %
3. Size of leaching pits or
galleries N/A
Water Supol Y
1. Public water supply Name V/A
2. Individual well
1. Drilled or dug? Dri led
2. Casing above ground? Nc
4. Depth unknown
5. Yield unknown
Addit;cnal Comment:
Septic system well maintained, cover of septic tank 3" below ground and serviced
routinely.
Distribution box in good repair with estimated 150' of fields with room available
for an additional 150' if necessary.
Disposal area is well drained and.uniform with no evidence of seasonal problems.
William Hedges
Sr. Public Health Sanitarian
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