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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -2 -19 BOX 20 ra 1 r T er ` ` 'T. ' 0 } r Lk �i,■ 02253 PUTNAM COUNTY DEPARTMENT OF HEALTIH IVISION- OF_EN..VIRONMENTAL: HEAL'T'H SERVII IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V - 0 3 - 0 5 &)-0q7CG- Locatedat 446 Lake Shore Rd. Town Ortega Putnam Valley Owner /Applicant Name Thomas G a z z o 1 a Tax Map 41.0 6 Block 2 Lot 18 & 19 Formerly 2nd Map of Subdivision Name R n a r i ng R r n n k Subd. Lot # 3 0 2 & 3 0 3 Mailing Address 38 Arbutus Rd., Putnam Valley, NY Zip 1 Q579 Date Construction Permit Issued by PCHD 4/27/05 36 Meadow Way Separate Sewerage System built by Ken F i o r e n t i n o Address Hopewell Jct. N Y Consisting of 1000 Gallon Septic Tank and 375 LF of 24" Wide Leaching Trenches Other Requirements: Curtain Drain & 2ft. Bank Run +/- for parallel grades Water Supply: Public Supply From, Address 152 Barger Street or: * Private Supply Drilled by Norman Anc1argnn Address Putnam Valley, NY 10579 -. -- - Building-Type• R- esi-dence. • - - Has-erosion-control-been completed ? - -= Yes Number of Bedrooms 2 Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above built plans (copies of which are attache in accordanc plans and the standards, rules and re lati . s of the Pi Date: 1/14/08 Certified by (Design / Address 2 Muscoot Rd. N. , Ma o ac, NYl ses were constructed essentially as shown on the as- the issu P HD Construction Permit and approved Coun Den ent of Health. P.E. R.A. * # 11056 Any person occupying premises served Wthe above system(s) shall promptly t,*e such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: Jil I Los e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: �9 , 6 h-tke S 1,3 -fc. Town/Village: �lL V,, j10' Tax Map # Map Block Lot(s) P S; G Well Owner: Name: Address: Use of Well: 1- Primary 2- Secondary i/- tesidential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Compressed air percussion _Other(specify) Well Type _Screened pen end casing _ Open hole in bedrock _Other Casing Details Total Length ..ft. Length below gradeU,'�t. Diameter in. Weight per foot % b /ft Materials: &,"$teel Plastic Other Joints: Welded ✓ Threaded Other Seal: ment rout Bentonite Other Drive shoe: Yes &,N o Liner: _Yes "o Screen Details Diameter (in) Slot Size Length ft Dept to Screen (ft) Developed? First _Yes No Hours Second We1I Yield Test _Bailed _Pumped_ Compressed Air Hours -- 7 -%� Yield /C% -gpm - Depth Date Measure from and su acestahc specify 3 0 During yIel test ft) Depth o complete we in . ~oc� Well Log If more detailed inforniatlon, _ ... _ _ descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land.Su¢ ace.. _ . - _ ._ .. .... -.: .., .. .. . , d 1,a - - . S UU i If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type, bjoiGi 6 Capacit Depth 390 Model SdS-9 Voltage .IAoj HP— Tank Type Volume Ao Date Well Completed »v ' } X i "{ '£ Y. , _.... .. 1}Nell °Driller PCCertificate # € ��'�NYStatez #k �lzo'�(/ g 'P" eT` 9 A°➢ 'xh.'x f T%t iS .'W itf ✓'k' ✓r ?: Y'h �`i I .'S 51P Pumap'Insta�Ilerf PCyCerfificaYe,' Date,of,Report kK 44NM Well DirllefNam & Addressfi �A .. F ''� Wr "x ^' -.b' 3� ''ACC k x� d� R �x�� W'I�'..� ` 'r .' j v'rXJ' / 1'Q MrE ✓ P H$i .N" y^n5 K A 4 Well$Driller( signature) ,r " 4 j: f K as x 4 "2 Y: is 2 � '..,;" u Installe Name &� *Adtlress x' �> _ P Instal sl nature .... a5i M ..+.4 , f % - six x✓N R Z V M i^ - jnk 93 k ;y'�' � £�R N' y� +:,,.tid4, h 9,&'d°,5 �r S'4 i �' 'f a a ry� u Y R Y xT 3'�k• J? ' 'u NOTE: Exact Location of well with distances to at lebst, two permanent landmarks to be pkvided on a_separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 _..•12/18/2007 16:42 8456282807 JOEL GREENBERG FAut ni PUTNAM COUNTY DEPARTMENT OF HEALTH —D M-- OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM t yI�dVIY4-s (.714ZZc� �Q. Owner or Purchaser of Building JJeS fG4ej ex 1g0J0 /at_ Building Constructed by 41yd /4, 54ve_ 12d. Location. - Street lw� d,,TW Building Type y! , 6 —Z - 19 Tax Map Block Lot PUT �VO4 Oct //fi, TownNillage )VI4 Subdivision Name z Lw Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed .by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the SVStem - The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. G�- Dated: Mon � nay �°K Year o a Signature: '�'� m,/" Title: � a* SqI Contr act - Signature Corporation Name (if corporation) Address:3�j? ) �n State %,�� lC i u �� �, , ,. Zip / s J.3 Corporation Name (if corporation) Address: S� +v f, -s . u Pu -rN�M VAI.U�'f v57� State Zip Form GS -97 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 E911 ADDRESS VERIFICATION FORM OWNER'S NAME: GAllOLA THOMAS & LISA TAX MAP NUMBER: TM# 41.06-2-19 E911 ADDRESS: 446 LAKE SHORE ROAD TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) ROBERT J. BONDI County Executive The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is. to be submitted with the application for a Certificate of Construction Compliance. Y E911 addressverification Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y.'10598 (914) 245 -2800 ....�„r :- ....::- ,. >...�..._.� :: ..,._... �...:_ . Albert .H .. Padovani , Director LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE: 1 of 2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845)- 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D'BY: LISA GAZZOLA TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/26/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 11/27/07 LEAD (IMS) 1.5 ppb 0 -15 ppb SM 18 -19 3113B 11/27./07 NITRATE NITROG 1.55 MG /L 0 - 10 SM18- 20450ONO3 11/28/07 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 11/28/07 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 11/28/07 MANGANESE (Mn) 0.018 MG /L 0 -0.3 mg /1- SM 18 -20 3111B .11/30/07 SODIUM (Na) 79.0 MG /L N/A SM 18 -20 3111B 11/26/07 pH 6.5 UNITS 6.5 -8.5 SM18 -20 4500HB 11/27/07 HARDNESS,TOTAL 234 MG /L N/A SM 18 -20 2340C 11/27/07 ALKALINITY (AS 160 MG /L N/A SM 18 -20 2320B .11/30/07 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS), WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert . H . - Padovani , LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE: 2 of 2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845)- 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: LISA GAZZOLA TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. .Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER _.. HARD. WATER::.. - 1.:.40. -30.0 - MG. /..L.. _ (.1.. grain /gallon_ _ =__17.2, MG /L) SUBMITTED 'BY: Albert H. P dovani, M.T.(ASCP) Director ELAP## 10323 12/18/2007 16:42 8456282807 JULL UKttN0LKU PUTNAM COUNTY DEPARTMENT OF HEALTH _..DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building hies I4e-sArA If0ju lat. Building Constructed by �yd /ed. Location - Street Building Type y! , 6- - - 19 Tax Map Block Lot PuT 04 fliq TownNillage 1-//4 Subdivision Name Z Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval, of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. / Dated: Mon �v� Day R4 Year or) 2 Signature: Title: 5g11 C,60fiftal�� Contract - Signature ci, S, `i t yc l / ,� C.. Corporation Name (if corporation) Address:,,� State %,�e ,w ; �,�, , Y� s% Zip _Z, S J-3 Corporation Name (if corporation) Address: 44� Pk f SO& Pu7N R h\ VALL State Zip 105 79 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y.'10598 (914) 245 -2800 Albe..r.t,. tH;,. ;Radovani ,. Direotor: -. . LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE: 1 of 2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845)- 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: LISA GAZZOLA TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL — RANGE METHOD PUTNAM CNTY PROFILE 11/26/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 11/27/07 LEAD (IMS) 1.5 ppb 0 -15 ppb SM 18 -19 3113B 11/27/07 NITRATE NITROG 1.55 MG /L 0 - 10 SM18- 20450ONO3 11/28/07 NITRITE NITROG <0.01.MG /L 1.0 MG /L SM18- 20450ONO2 11/28/07 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 11/28/07 MANGANESE (Mn) 0.018 MG /L 0 -0.3 mg /l SM 18 -20 3111B 11/30/07 SODIUM (Na) 79.0 MG /L N/A SM 18 -20 3111B 11/26/07 pH 6.5 UNITS 6.5 -8.5 SM18 -20 4500HB 11/27/07 HA.RDNESS,TOTAL 234 MG /L N/A SM 18 -20 2340C 11/27/07 ALKALINITY (AS 160 MG /L N/A SM 18 -20 2320B 11/30/07 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: - ._ .. ... _... ........ __,..._. MFTC THESE RESULTS INDICATE THAT THE WATER (WAS), WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 100i of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium 11 crq --a. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, DirectMor__ . LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE_ 2vofu2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845)- 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: LISA GAZZOLA TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION., BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) SUBMITTED BY: Albert HM.T.(ASCP) Director ELAP# 10323 12/18/2007 16:42 8456282807 JOEL GREENBERG PAGE 01 , V4 L GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building WeS "esAr,< Aviv 4i-. Building Constructed by I-Iyd .5401e- 124-1 Location - Street Building Type Tax Map Block Lot PuT c� Illy TownNillage /V/4 Subdivision Name %�/4 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to opeirate properly is caused by the willful or negligent act of the occupant of the building utilizing the system.. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. O'n Dated: Mon. Day "K Year 42o a Signature:- C - _ Title: Q hV U1✓ St fIt C-Owiemil Contras - Signature Corporation Name (if corporation) Address: 3� ) State 0" et )9, Zip /11? Corporation Name (if corporation) Address: 44(,�' S , u - rtq A t-l� V pl State —zip �� Form GS -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI,'RN, A N -- Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 E911 ADDRESS VERIFICATION FORM OWNER'S NAME: GAllOLA THOMAS & LISA TAX MAP NUMBER: E911 ADDRESS: TOWN: TM# 41.06 -2 -19 446 LAKE SHORE ROAD AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 1211910 7 ROBERT J. BONDI County Executive r The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is. to be submitted with the application for a Certificate of Construction Compliance. a.. E911 addres'sverification Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y.-10598 - .(914) 24;5 - 280_.0 - " Albert k . Padovani', 'Director l r LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE: 1 of 2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845) - 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES:.. NONE COL'D BY: LISA GAZZOLA TEMPERATURE..: < 4C NOTES...: I COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/26/07 MF T. COLIFORM ABSENT /100 ML ABSENT. SM 18 -20 9222B 11/27/07 LEAD (IMS) 1.5 ppb 0- 15',ppb SM 18 -19 3113B 11/27/07:- . NITRAT -E NITROG-. 1'. 55: MG /L 0 - 10 SM18- 20450ONO3 ;,. 11/28/07 NITRITE- NITROG <0.01 MG /L :" '1.0,MG /L 'SM18- 204500NO2 11/28/07 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 11 /28 /07;- .MANGANESE (Mn), 0.018'MG /L 0 -0.3 mg /l SM 18 -20 3111B 11/30/07, SODIUM (Na) 79.0 MG/L' N /A' SM 18 -20 3111B 11/26/07 pH 6.5 UNITS 6.5 -8.5 SM18 -20 4500HB 11/27/07 HARDNESS,TOTAL 234 MG /L N/A SM 18 -20 23400 11/27/07 ALKALINITY (AS 160 MG /L N/A SM 18 -20 2320B 11/30/07 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS), WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn`If both iron and.manganese are present, their:total value combined .shall -not exceed 0.5.mg /L. Na ,No limits for,;-S.odium,.are proscribed.. Suggested guidelines state —,,that for,:people on,-.a:-,sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those'ori-a . moderately restricted diet, a maximum,of270 mg /L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 P,adovani,.�Aixe.00:r_.- - ..... <,� ,. _..� K� ..... -...,.....,. N ..r.:.._.�.. LAB #: 1.706451 CLIENT #: 59367 NON STAT PROC PAGE: 2 of 2 GAZZOLA, LISA DATE /TIME TAKEN: 11/26/07 10:00 38 ARBUTUS STREET DATE /TIME RECD: 11/26/07 10:40 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/03/07 PHONE: (845)- 528 -6976 SAMPLING SITE: 446 LAKESHORE RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: LISA GAZZOLA TEMPERATURE..: <4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF t THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED.AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER X14 Q -:3 0.0' .MG /L - . (-1 SUBMITTED BY: Albert H. P dovani, M.T.(ASCP) Director ELAP# 10323 TWO MUSCOOT ROAD NORTH MAHOPAC, NY 10541 P 845-528 -6613 F 845. 628 -2807 January 24, 2008 Putnam County Department of Health Joseph•S. Paravati, Jr., Assistant Public Health Engineer 1 Geneva Road Brewster, New York 10509 Re: Gazzola, Thomas 446 Lake Shore Road Town of Putnam Valley T.M. # 41.06 -2 -19 Dear Mr. Paravati, The following is in response to your letter dated January 24, 2008: 1. The correct tax map number has been noted. 2. The well pump is Rumfus — Model # 10S05 -9, capacity .10 gallons If you have anyquestions, please do not hesitate to contact me. Very truly yours, *JI ree erg Z0 39Vd 9d3SN3369 X30f L08Z8Z95b8 51:1T 800Z/T£/10 JAN -24 -2008 02:21 PM FROM - ENVIRONMENTAL HEALTH 6452787921 T-369 P.002/002 F-269 SHIERLITA AMLE& MD, MS, iFAAfP � Commissioner of Health �t LORE'i`'t`A► MOLINA,RI, kN,-, EMSN Rssoclate Commissioner of Health Joel Greenbexg, R.A. 2 M l=oot No. RFD 2 Mahopac, NY 30541 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 1 0509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Direcaor of kjrviromttental Hedth--4- -- January 24, 2t0 Re: Construction Compliance - Ga22ola 446 Lake Shore Road, (T) Putnaru Valley (T) Put= Valley, TM # 41.06 -2 -19 Dear Mr. Greenberg: This office has received and reviewed the most recent set of plans for the above - mentioned project_ We would li 'ke to offer the following comments for your review and consideration. 1. The tax chap number on the constmetion compliance form is incorrect. The lot has been _..._ ....._ combined into one lot from two maller lots. The tax map lot # is not ] 8 & 19. 2. The model for' the well, pump has not been provided on the well completion report. This office will continue its review upon consideration of the above- mentioned comments. Please feel free to contact me aE M. 2157 if any questions arise. TSP/kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public l;iealth Engineer Environindattll H alth (845) 278-6130 Fax (845) 278.7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Narshig Strvic*s (845) 278.6558 Fax (845) 373 -6036 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278.6085 Early lnterventiontPrtscilool (845) 278 -6014 Fax (845) 27M648 60 39Vd 9d3SN3MIJ -1301.' L08ZBZ99PB 9T:TT 800Z/T6/T0 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - �N -L01RE i�= MOL- INARI; RN MSN :.:..::. . Associate Commissioner of Health Joel Greenberg, R.A. 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT J. BONDI County Executive :R0BERT.M0RRIS; ,PE._,...: n_...�s Director of Environmental HealthP DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 24, 2008 Re: Construction Compliance - Gazzola 446 Lake Shore Road, (T) Putnam Valley (T) Putnam Valley, TM # 41.06 -2 -19 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. L The -tax map number on the construction compliance form is incorrect.. The -lot has been combined into one lot from two smaller lots. The tax map lot ## is not 18 & 19.' 2. The model for the well pump has not been provided on the well completion report. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer. 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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 •'I� `� ®';• ' ° ^" .�' _ .rr ... _.rt . _ a .rw -.--> ![X: r. - G� �1LC 0. Y `• � 4 � .i TWO MUSCOOT ROAD NORTH MAHOPAC, NY 10541 P 845- 628 -6613 F 845 -628 -2807 ,r i TRANSMITTAL j DATE: JANUARY 16, 2008 ATT: JOE PARAVATI TO: PUTNAM COUNTY DEPT. OF HEALTH s RE: GAZZOLA, THOMAS El:t ? ' As Requested For your use Review Comments DEAR MR. PARAVATI, PLEASE FIND ATTACHED AS —BUILT DRAWING AND DOCUMENTATION. VERY TRULY YOURS, ., JOE FASSACESIA tit .; SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health December 7, 2007 Joel Greenberg, R.A. 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT I BONDI County Executive _..... ............ ... ROBERT-MORRIS; PE -< -t - n,�,:,., -:.:.. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Gazzola Lakeshore Drive (T) Putnam Valley, TM # 41.06 -2 -18 & 19 The above referenced separate sewage treatment system can be backfilled. The bedroom count and well inspection have also been completed today and there are no further comments or concerns. If you have any further questions, please contact me at (845) 278 -6130, ext. 2155. JD:kly Sincerely, 4. eph Digit Environmental Engineering Aide 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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax (845) 278 -6648 12/04/2007 12:50 ATTENTION 8456282807 JOEL GREENBERG PUTNAVit COUNTY DEPAjRT' ?vMNT' OV H1CAL;TH DI'V'ISION Or ENVIRONMENTAL HEALTH SERVICES OJOSEPH 0 GENE PAGE 02 REQUEST FOR.FINAL INSPECTION For: Fill ,y All uiformation must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # rr ,, Located: LA e' 0 (T) O j P� Ahk VALLEY Owner /Applicant Name: ,O LA TM4J.64Block Lot Formerly: Subdivision Name: O.A R- 1t4j�.- 5fQaCge- Subdivision Lot # _. 30 z D Is system fill completed? (�� S Date: LO iI d y Is system complete? �0 S Date: /�Q/07 Is system constructed as per plans? YES Js well drilled? _ YE- _ Date: ,8f 1_1/07 _ Is well located as per plans? S Are erosion control measures in place? I certify that the systern(s), as listed, at the above premises has been constructed and J have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. _ Date: Ab Ce "-tified b PE y• RA, esi professional I Address: AAUSQoo-7 N DQ7' Lic. # 0 7 MA�16PAQ,11 NaY, Comments: Form FIR -99 2j'7 1n7 �paM 12120/2005 09:49 5455282807 JOEL GREENBERG PAGE 01 A i - RJ11/�.BULX S -_ MAHf LiIlfY= Klow T.(S"6 3 F.(5"6202W DATE: r ATTENTION: �' ►N: y FAX Nom: FROMp COMMENTS: i..G � NAG.( �� ��.,. -•f SLcv£. -v, Vl \��CV►[�l l'7�/� ���►.. _���' t C CL�✓/��D v� � fit. TOTAL, HI,NIIDER OF PAGIES IHCLUDIMINTHU TUMI MITTAL SHEET: IF YOU mil°.. RECEIVE ALL PAMS OF TRANSMISSION PLEASE FALL US AS SOON AS POSS�i1L,E® npr -PA -PARS THE F-19:5.- TEL:$45- 278 =7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 37x20' 4.00 eaY oaring Sol k% cmmfe co sp' 14. 00' ook -A, W45' M 6.60 ke j4q 5cr,4,ei. 'D % f 6 L 6g,46, W 14 1 00. m 81.60 jy co wwlor co LOT 2 30 tQ 00 m 9 LOT 303 %V CV AREA .3 .4036 S 61 'j'F, I L L 6895 ACRI' -ro -A 15 0 4 "A m a,, r7l -P Ife z tz CIA d Fri M all Ole ON e 00 too F1 #0 low D E. Ev, F IMY Joel 4p,mcilberg 4� .2 Muscoot Rd N MWlopac�[Y 105 P 41 4`4 "RF Pfft feel#$ jjlm*f46 vw not shown howaffuAlam offtININ na A LM&Fih&JZW 11/01/2006 11:01 :1456232607 JOEL GREENBERG PAGE 02 Cv \ 00 [e�0�� .1 G \� ' `; ` , S, i 'gel all I l r 01D ftd aQ Pau -s 04K a, MAWAO E. ` - �/�►��' \`;�`7B� h � ?b$' �� fry �: �. i 4'SDR3� Soy ao.l)' p� �o F IV 01 gve NOO -1 -2006 WED 10: '? TEL: 845*- 878 - 7 E+21 NAME: PUTNAM COUNTY DEPARTMENT OF P. 2 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 2, 2006 DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 Mr. Billy Crowder Chairman, Putnam Valley Planning Board Town of Putnam Valley Town Hall 265 Oscawana Lake Rd. Putnam.Valley, NY 10579 Re: Proposed SSTS — Gazzolla Lake Shore Road, (T) Putnam Valley T.M. # 41.06 -2 -18 & 19 Dear Mr. Crowder: ROBERT J. BONDI County Executive 'ROBERT MORRIS, "PE.::.;.,__.:_._. - Director of Environmental Health . It has come to the attention of this Department that the curtain drain proposed on the approved plan for the above referenced project needs to be shifted.approximately 5 feet from the property line, as requested by the Putnam Valley Town Engineer, Bill Brickelmeir, PE, of Insite Engineering. Normally, when a revision is requested, a revision application needs to be made and new plans have to be submitted for approval. However, there are some rare-cases when the change is so small that it doesn't effect the SSTS design; (sTighf shifft iri well location; 'for " example). As long as the change is brought to this Department's attention and doesn't effect the SSTS, the change is allowed without revised plans and the new location is shown correctly on the as -built plan. In this particular case, the design professional, Joel Greenburg, R.A., has met with me an it appears that the slight change in curtain drain location is acceptable. Therefore, the construction can proceed according to the original permit. Mr. Greenburg has been advised to closely monitor construction so that all separation distances are met. Please do not hesitate to contact me in any questions arise. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: Joel Greenburg 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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 o noLAWNAANA, A . _4, r_ -- ..- -`1C0NSTRUC 10N PE YT`F0R,9E'`AGE- TREATMENT SYSTEM .. PERMIT # V ''6 3 —0 Located at Lake Shore Road Town or Village Putnam Valley Subdivision name Roaring Brook Subd. Lot # 3303 & Tax Map 41 .06Block 2 Lot 18 & 19 Date Subdivision Approved 7/8/1946 Owner /Applicant Name Thomas Gazzola Renewal Revision Date of Previous Approval Mailing Address 38 Arbutus Road, Putnam Valley, New York Amount of Fee Enclosed $400.00 Building Type Residence Lot Area 30, 00(No. of Bedrooms 2 Zip 10579 Design Flow GPD 4 0 0 Fill Section Only Depth Volume PCI-ID NOTIFICATIQN IS REQUIRED WHEN FILL IS COMPLETED e Separate Sewerage System to consist of 12 5 0 gallon septic tank and 250 LF of 24" wide Leaching Trenches. Other Requirements: Curtain drain and 2 ft, of bank run +/- to make qraparallel To be constructed by Not selected Address Water SuppN: Public Supply From Address ..Private Supply Drilled by .Not.. selected Address - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition art of said sewage treatment system during the period of two (2) years immediately following the datgq the issuan c of thl approval of the Certificate of Construction Compliance of the original system or any_Eepairs thereto I Signed: V,4,f-�/ °- �ij`�'C,d P.E. R.A. x Date 4/22/2005 Address 2 "coot;Xoad North, MA4fbpac, NY 10541 License# 11055 APPROVEIVOR CONSTRUCTION: Th s ap #oval expires two years from the date issued unless construction of the sewage treatment system has been completed alhd4nspected 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 Verm it. Approved- for discharge of domestic sanitary sewaale only. By: l' Title: � Date: 2 ®� White copy - ile, el ow copy - Building Inspector; Pink copy - Owner; ang py - Design Pless, fessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL °PC1 HD'Perri�it�` Well Location: Street Address: TownNillage Tax Grid # Lake Shore Road Putnam Valley Map 41 - 08lock 2 Lot(s)18&19 Well Owner: Name: Address: Thomas Gazzola 38 Arbutus Road, Putnam Valley, NY 10579 Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served __A— Est. of Daily Usage _ 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason New House for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision Roaring Brook Lake Lot No. 302 & 303 Water Well Contractor: Norman Anderson Address: Barger St, Putnam Valley Is Public Water Supply available to site? .................................. ............................... Ye No x Name of Public Water Supply: To illage Distance to property from nearest water main: A Proposed well location & sources of contamination t rovided on ep ate sheet/ Ian. Date: 2 /? 2 2 0 0 5; Applicant Signature: PERMIT TO CONS ' �RU A WATER WELL This permit to construct one water well as set forth e, 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from 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. Date of Issue -4 D Permit Iss ing Off cial: _ Date of Expiration Z �n Title: Permit is Non- Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 qEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver_ feorif RiqUirem4nts'of -Part 75'and-App*endlx*75-A:,--IONYCRR'--- for or Individual Household Sewage Treatment Systems 1. Reason why site does. not meet 1 ONYCRR.Appehdix.75-A (check appropriate box(es)): G-�.�Separation distance cannot be achieved. Excessive. slope. High groundwater; Inadequate depth to bedrock or Impermeable layer. Soil unsuitable. go ther (explain) ... .. ......... .................................................................. .......................................................................... . ... . ................ ...................................................................................................................................................................................................................................... ....................................................................................................................... : ............................................ . ................ .......... ........................................................................................ ; ..................................................................................................................................................................... . ......... ....... 2. Proposed design or conditions of waiyer:' . .................................... yv . . . ...... .. ........................ ...... ....... ...... 6 . ............................ ................................... ...... ... ........................................ ..................... ............... ..... ............. f7— do 3. The proposed design may have the followin*g limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination.• Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ... 4 ............... I ..................................... I ....................................................................................... .................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Deparlment,of Health Administrative nistrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiver was granted. ORIGINAL - Local Health Agency COPY - Applicant/Design Professional BRUCE R. FOLEY Public Health' Director - =" LORETTA - MOL' WART &N." M.S.N. Associate Public Health Director Director of Patient Services t DEPARTMENT OF HEALTH 1 Geneva Road $rewster, New York. 10509 Environmental Health (845) 278 - 6130 . Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: SITE LOCATION: DATE:f�° STAFF PRESENT: - R a. ene Shawn R.- Bill H. SPECIFIC WAVIER.. f REQUEST: t E/ X55 ,W' v-ti /�' %rr�, -.,�00 5V4,6- Slam s Cam. �; ss .DOES . THE PROPOSED " VARIANCE . REQUEST POSE A HEALTH HAZARD ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENIED I7 DENIED REASON FORMENIAL DATE:. 41711 DIRECTO F (SPECWAIVER) w35`tfi� OR t � PART 11 - IMPACT ASSESSMENT To be completed by Lead A enc DC7t =5 FICTION EXCEED'ANYTYPE I THRESH06D IN 6 NYCRR, PART.:617.4 ?.;,.,._lfys srgCrcynate.the review process and use the.FULL EAF. YesNo - ,... <... �..... ............... ..,_ B. WILL ACTION DECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may b superseded by another involved agency. El Yes may C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. v ,9xl Aesthetics, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: / O C4. A community's existing plans 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 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: ww ..................... ..........._............._..... ..............._.__. . ...... ..............._ ...... ...... _............... C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: D.. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL EA CEA ? If es, explain briefly: .. - ......._........_......._. �, �1�, _......0 . E] Yes o - ._...... ... _ ...... E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex lain: El Yes to b10 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 that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance mustevaluate the potential impactof the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL 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 actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination 8:,�, W -/ 49 Na a of Lead Agency D e IJ -Z ;h Sk PC, n t or Type N am Responsible Officer In ea Agency Title of spo Officert Signatu of Res o sible fficer in Lead Agency nature of Preparer (If different from resporigible officer) - JOEL GREENBERG & ASSOCIATES, A.I.A, NCARB 3 ARCHITECTS -PLANNERS -PROJECT MANAGERS 2 MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 T: (845) 628=6613- F:'(845) 628 -2807 E -MAIL: jlgarch. @bestweb.net - April 15, 2005 Mr. Mike Budzinski, P.E., Director of Engineering Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 Re: Thomas Gazzola Lake Shore Road Putnam Valley, New York 10579 T.M. # 41.06 -2 -18 & 19 Dear Mr. Budzinski, I am in receipt of a letter dated April 5, 2005 regarding a waiver determination for Thomas Gazzola. As per the letter, the waiver request was not voted on. One of the reasons was a request by the waiver committee to reduce the house from three to two bedrooms. Please note the following: 1. Mr. Gazzola purchased two tax lots (which are now merged) in order . to have double the area :of most of.the, houses, around -the lake so that he,,,.. could construct a three bedroom house. 2. In. designing the septic system and well for this lot, we did take into account the fact that the lot directly across the street is vacant and we could not propose any improvements that would make the development of that lot impossible. I have just found out today. that the lot in question T.M. 41.06 -2- 36 was merged with the adjacent lot which already has a house, septic and well on it As per Section 165 -43 -B of the Zoning Ordinance of Putnam Valley, "Any abutting nonconforming lots which are owned by the same owner or owners, notwithstanding any subsequent conveyance(s), shall be considered as one merged lot for the purpose of this chapter, unless more than one livable structure exists on the merged lot." As per the attached deeds, these lots are merged and therefore no house can ever be built on Lot #36. 3. We were able to move the septic system closer- to Lake Shore Road so that the primary system for a three bedroom house is 100' from the shore line and the nearest portion of the 100% expansion area is no closer I ® Page 2 April 15, 2005 than 76' from the shore line. Even, a two bedroom house would only provide a 90' mparation between the expansion area and the shoreline. 4. The fact is that this lot is double the area of most of the lots on the lake and that this is a new system with, the primary area 100' from the lake shore. We are providing 100% expansion while the New York State approval only required 50% expansion and a separation distance of 50' to the lake shore while we are providing 76' to the lake shore. I realize that the New York State approval allows us to build on these lots. I also realize that we have to make our best effort to conform as close as possible to today's code. I. believe that this layout does exactly that. The above items were discussed with Joe Paravati and Robert Morris this morning. In addition, we respectfully request a special waiver meeting the week of April 18, 2005 due to the fact that Mr. Gazzola is purchasing a modular home which must be ordered no later than April 30, 2005. If ordered after that date, Mr. Gazzola will have to pay an 8% increase which is over $19,000. Therefore we would appreciate a special waiver meeting so that we can obtain Health Department approval and approvil from the Putnam Valley Zoning Board of Appeals before April 30, 2005. Thank you in advance for your interest and cooperation in this matter. Please contact me soon as possible. rs, Enc. 15 m 9 JOEL GREENBERG & ASSOCIATES, A.I.A, NCARB ARCHITECTS -PLANNERS - PROJECT MANAGERS 2 MUSCOOT ROAD NORTH MAHOPAC; NEW "YORK 10541 T. (845) 628 -6613 F. (845) 628 -2807 E -MAIL: jlgarch @bestweb.net April 15, 2005 Mr. Mike Budzinski, P.E., Director of Engineering Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 Re: Thomas Gazzola Lake Shore Road Putnam Valley, New York 10579 T.M. # 41.06 -2 -18 & 19 Dear Mr. Budzinski, I am in receipt of a letter dated April 5, 2005 regarding a waiver determination for Thomas Gazzola. As per the letter, the waiver request was not voted on. One of the reasons was a request by the waiver committee to reduce the house from three to two bedrooms. Please note the following: - .'1:::. - r. azzola purchased . two .tax. lots (which: are now merged) in order to have double the area of most of the houses around the lake so that he could construct a three bedroom house. 2. In designing the septic system and well for this lot, we did take into account the fact that the lot directly across the street is vacant and we could not propose any improvements that would make the development of that lot impossible. I have just found out today that the lot in question T.M. 41.06 -2- 36 was merged with the adjacent lot which already has a house, septic and well on it As per Section 165 -43 -B of the Zoning Ordinance of Putnam Valley, "Any abutting nonconforming lots which are owned by the same owner or owners, notwithstanding any subsequent conveyance(s), shall be considered as one merged lot for the purpose of this chapter, unless more than one livable structure exists on the merged lot" As per the attached deeds, these lots are merged and therefore. no house can ever be built on Lot #36. 3. We were able to move the septic system closer to Lake Shore Road so that the primary system for a three bedroom house is 100' from the shore line and the nearest portion of the 100% expansion area is no closer a , • Page 2 April 15, 2005 _ than 76' from the shoreline. Even, a two bedroom house would only provide a " " "90' separation between'thd'expansion arrea and the "shore`iine:... _._ 4. The fact is that this lot is double the area of most of the lots on the lake and that this is a new system with the primary area 100' from the lake shore. We are providing 100% expansion while the New York State approval only required 50% expansion and a separation distance of 50' to the lake shore while we are.providing 76' to the lake shore. I realize that even though the New York State approval allows us to build on these lot. I also realize that we have to make our best effort to conform as close as possible to today's code. I believe that this layout does exactly that. The above items were discussed with Joe Paravati and Robert Morris this morning. In addition, we respectfully request a. special waiver meeting the week of April 18, 2005 due to the fact that Mr. Gazzola is purchasing a modular home which must be ordered no later than April 30, 2005. If ordered after that date, Mr. Gazzola will have to pay an 8% increase which is over $19,000. Therefore we would appreciate a special waiver meeting so that we can obtain Health Department approval and approval from the Putnam Valley Zoning Board of Appeals before April 30, 2005. Thank you in advance for your interest and cooperation in this matter. Please contact me Wsoon as possible. rs, Enc. 3 § 165 -40 PUTNAM VALLEY CODE § 165-43 —: §' . •. [_ _ .— 165 -40. i ;Permltti.. .. srig w . authov. .rity: -� • � � •_ �` -� �� • • � "�' � �- The Planning Board may impose additional requirements for parking and loading. § 165 -41. Performance standards. Land uses, structures and parking facilities shall comply with the performance standards as listed in § 165 -73 of this chapter. ARTICLE XI Nonconforming Buildings and Uses § 165 -42. Purpose and intent. A. At the time of the enactment of this chapter, all actual uses, lots and structures in effect in a lawful manner shall remain in effect as is currently pending in respect to same. B. Any building for which a building permit has been issued prior to the enactment or amendment of this chapter and erection of which is in conformity with the plans submitted prior to the enactment shall be commenced within 90 days after the effective date of such enactment or amendment. If such building does not conform to the provisions of this chapter, it shall be a nonconforming use. C. Furthermore, it shall be the. intent of this chapter to provide for the regulation of such existing .uses, lots and structures by specifying the circumstances and conditions under which they may continue to exist, as specified in this article. § 165 -43. Nonconforming lots. _ Any lot which lawfully existed on the effective date of this chapter -and fails to meet the area, shape, frontage or other. applicable requirements of this article shall be considered 'a legal nonconforming lot. Provided that the following requirements are met, a structure may be placed on such lots. A. A structure may be constructed on a legal nonconforming lot, provided that: (1) It meets with the current zoning regulations relating to coverage, setbacks, parking and landscaping for the district in which the lot is located. (2) The Putnam County Health Department has approved the sewage disposal and water supply systems. (3) The appropriate agency has granted approval for any disturbance within any Environmental Management District. B. Any abutting nonconforming lots which are owned by the same owner or owners, notwithstanding any subsequent conveyance(s), shall be considered as one merged lot for the purpose of this chapter, unless more than one livable structure exists on the merged lot. [Amended 6 -26 -2002 by L.L. No. 7 -2002; 12 -18 -2002 by L.L. No. 14 -2002] T'2 SCCC. Zc��sz 10 16590.4 (Cont'd on page 16591) 4 7 -10 -2003 File, *Edit View Toolbar Window Help d 1; O O V k -V m 1.11*9 61-11"t: M; "As M, K, n1i 141X-2-37 372600"r-A" GiUFdanella. Robt J Roll Y;: 2005 FOR SI`�-- -" i -455 Lak6 Shore Rd Land i; 0 0 -171 Parcel 41.6.2-37 Owner Tax Bill:Miail d Lj Assessment C] Spec Dk f'j D escription Owner(s) ei Images -1-1 G is C] Site (1) Res Land(s) Bldg ej Imprvmt(l Valuation Antoinette•-.:.6iW :et No: Prefix 3 �7jjFj Box No:. . dtylT.t4n;- Flew York X., "J ..... ..... .... ........ . ..... Prints the screen ;Start ie RPS Version 4 - [Owne... IP Code 10009- i5a L �1 IIJ ff� Mimall...J I twf M.J.10 r; tw I A.W1.1.1 I all If —;' (FlIe Edit View Toolbar Window Help f X.4 4N W12 Giurdanella, Robert 3 i-� M Parcel 41.6-2-36. C1 Assessment Spec Dist( Description Owner(s) :..C] Images is B-0 Site(1)Res Land(s) Valuation Roll' iar. r?i Owner Tax' B i 0: M'. a Ann GiVida Last N ame)-., rot Inc treet No: 1%6 , D-i 78 IN ew York Prints the screen 0 RIPS Version [Owne... t ..AStar I n 4 v �w�� � �� � �a r'�Tot�IAV �$ � 0 rs` `��A� .4 art tp Z r6l'A 6r Unit Na jAve -11 Zj- I INY w` 41P=Primary i di M4 M -g, , M w,"'. C-g law": iw *-)I I- -File -'Edit View Toolbar Window Help W12 JfTA "J", S. kRffil t I fj 4i :141.6-2-36 .72800 na" i1aff 9 M-1 Roll Tpa!�;,Jzuub 6 iurdanefla, Robert J so EMI I Rififii , e, Ilkik' t6, Parcel 41.6-2-36 11 Total .1 Lan robnViiiiii `466iihbij iW"i`F4 1C i�� MY [�j Assessment Spec Disl Description Owner(s) Images C] G is Sj Site (1) Res Valuation .. - .- I --- I... ft - .- - I _!..I..._.........._..___ � A Drints the screen .AStart J1.1 :1. Ll Land t . ype Site No: 1 Land Tvpe. R Front: r Depth: 'T Acres: r S qfL- Soil Ratinq: r f4 169.00 =59 4)R13S Version 4.- [Land.... I ON qW Rating 2j. hf ,p 11),1'69 Poll & RN 'k TT A .. ILI I I ILI ■..: it 5 ... t v-4t' File `Edit View Toolbar Window Help �N W12 Giurdanella, Robt J Noll Year 411105 A 455 Lake Shore Rd Land Size 0 58 a I Parcel 41.6 -2 -37 Site No::, ,: =) • ej Assessment Bldg Style Ol 'Raricln Spec Dist[ No. of Stones'; 1: Q n Description Ext Wall Mat::*. •,,;' 01 Wood Owner(s) ActualYr Built 1957 " I mages Eff Yr Built 3r1 Gis YrRemodeled -a C] Site (1) Res No. Kitchens-'. 1 Land(s) Kitchen Qual. wpm No. Baths: 2 No HaIF f'l lmprvmt(s) Bath Qual: ej Valuation No. Bedrooms: 2 No. Rooms: 0 No. Fireplaces:1 Heat Type: 12 Hot air Fuel Type 4 Oil Run RPS440 Edits`' �s i. Y 5 h ! YY Y jj Prints the screen ;Q5tart �� tRPS Version 4 - [Resid... r Story 1600 Y, Partial end Story f ��" Nor „�� 112StQry �. �� 31�4fStt�ryFy �;�r.' A, JI �F��l�ttrc { W' Y, Y ��§ Frn,�crrt _'`� Urihr� 1 !2 a ` ; Uhfin 314 >. Unfin Gar #iA 1680 ' Y,p Frn Rec Rm 550 g�x �� a P � Z R'C Yf Vf2�;t IN { , r,ri. r F z r SFIERMA AMLER, MD, MS, FAAP _Comrhlssioner of �iealth , __ "_ ". _, .. LORETTA MOLINAM, RN, MSN Associate Commisxioder of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BOND,I Counry Exucurive March 15, 2005. Joel Greenberg, RA 7 2 Muscoot No. RFD 2 Mahopac, NY 10541 1-4x' Proposed SSTS Renewal -- Gazzola Lake Shore Road . (T) Putnam Valley, T.M. #41.06 -2-18 & 19 Dear Mr. Greenberg: (AI&W& This: office hiss received and reviewed the most recent set of plans for the above l✓ °'� mentioned project. We would like to offer the following comments for your review and "" �� consideration. ` .X The following items do not meet current coda: - a) Proposed SSTS less than 100' ftorn a lake. b) Well less than 15' from the property line. c) Side slopes greater than 1:3. Based'on the above, the application is denied, It is your right to request a waiver for the above Ynentioned items. 2. ' '1 lease provide a copy of valid wetlands permit or a letter from the Town staling none is required. Please also check the Slate Wetlands map for any State wetland on the lot or in the vicinity. If there are wotlands on the property, tile, wetlands with the associatdd 100' buffer needs to bg shown. eighbor notification is required per Bulletin ST -19, Section 4.A. 11. �I! Please provide any 100 year -flood elevation within 200' of the proposed SSTS or ote stating; none exists. Please provide the exact locations for the neighboring wells and septic (Tax Lots 17, 20, 35 and 36). The 265' dimension for the SSTS acrobs the street appears to place it off the property. EuAroamentul Iioalth (845) 278 -6130 Fax (845) 278 -7921 Narsiug 5erviceg (845) 278.6558 WIG (845) 278 -6678 Fax (845) 218 -6085 Early IuterventlualTreschool (845) 278 -6014 Fax (845) 278 -6648 F_/Z *.d 20828296 :01 126L- &E -Sb8 lddd3a A1Nno) wdNlnd ;Xd3 SS ;9i Seen- Si -adw A • P� SFIERMA AMLER, MD, MS, FAAP _Comrhlssioner of �iealth , __ "_ ". _, .. LORETTA MOLINAM, RN, MSN Associate Commisxioder of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BOND,I Counry Exucurive March 15, 2005. Joel Greenberg, RA 7 2 Muscoot No. RFD 2 Mahopac, NY 10541 1-4x' Proposed SSTS Renewal -- Gazzola Lake Shore Road . (T) Putnam Valley, T.M. #41.06 -2-18 & 19 Dear Mr. Greenberg: (AI&W& This: office hiss received and reviewed the most recent set of plans for the above l✓ °'� mentioned project. We would like to offer the following comments for your review and "" �� consideration. ` .X The following items do not meet current coda: - a) Proposed SSTS less than 100' ftorn a lake. b) Well less than 15' from the property line. c) Side slopes greater than 1:3. Based'on the above, the application is denied, It is your right to request a waiver for the above Ynentioned items. 2. ' '1 lease provide a copy of valid wetlands permit or a letter from the Town staling none is required. Please also check the Slate Wetlands map for any State wetland on the lot or in the vicinity. If there are wotlands on the property, tile, wetlands with the associatdd 100' buffer needs to bg shown. eighbor notification is required per Bulletin ST -19, Section 4.A. 11. �I! Please provide any 100 year -flood elevation within 200' of the proposed SSTS or ote stating; none exists. Please provide the exact locations for the neighboring wells and septic (Tax Lots 17, 20, 35 and 36). The 265' dimension for the SSTS acrobs the street appears to place it off the property. EuAroamentul Iioalth (845) 278 -6130 Fax (845) 278 -7921 Narsiug 5erviceg (845) 278.6558 WIG (845) 278 -6678 Fax (845) 218 -6085 Early IuterventlualTreschool (845) 278 -6014 Fax (845) 278 -6648 F_/Z *.d 20828296 :01 126L- &E -Sb8 lddd3a A1Nno) wdNlnd ;Xd3 SS ;9i Seen- Si -adw i 9 I !case provide more silt feuve for the proposed SSTS area. t V - It appears that the proposed SSTS could be rotated so the trunchus are more parallel With the existing contours. This may also help with the proposed fill. .�'1'he proposed 782' contour transitions into cut. •lease provide a minimum label between the SSTS and the proposad catch basin, 40 The SSTS is less than 50' front the open end of -the existing 12" CMP. ... t11Yf 2' of fill is required, why is the first proposed contour at 784' over an existing oontour of 780'? cl f , e primary system is short by approximately 40'. ,Chu proposed grade over the septic tank is 787.5', but the tank location is between the house which is between the 790' and the 788' contour. Please verify the egTading for the house location and the driveway regrading. Please check the new grade in the profile, It doesn't appear to match the plan Stand pipes for the curtain drain, 5' on both sidds, are required. Please also /� provide a detail. l� ease provide basement floor plans. Please show the water service connection. .'his office will continue its review upon consideration of the above mentioned conihients. Please feel free to contact me at ext. 2157 if any questioi)s arise. } Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer v JSP:dw 2 /2'd 10929296:01 i8tid30 A1N(100 WdN10d:WO83 9S;9T Seat -ST-WW SHERLITA AMUR. MD, MS. FAAr ROBERT]. BONDI cb—ini -Ff of Hearrh County B—d. LORETCA MOLINARI. RN, MSN .4 ..dare Carom,-- ofHearrk DEPARTMENT OF HEALTH I Cienrva :said, Hnv —tar, New York 10509 April 5, 2005 Joel Greenberg, RA 2'D4us000t North, RFD ill 'Nfahopac, New York 10541 N, Waiver Determination - Cnuola Lake Shore Road, (n Putnam Valley TMN 41.06 -2 -18 62 19 Dear Mr. Greenberg: The Putnam County Health Department ren 1, -wed cite waiver request for the above regarded project on April 5. 2015. The following dne-unnrion has been made: ❑ Tile Waiver request u:as z :p)nu :'. :,� ❑ The Waiver request was conditional l> approved. However, the revision(s) noted below ,must be completed prior to th;: ot'a penuir. ❑ The Waiver request was denied. A!! eapianarion has been noted below. X Tho Waiver request was not voted on. Explanation noted below. I. Design to be reduci:d ton .,c;hs.nm c:sideuci: to provide more separdtion from the lake. 2. What is the Slants 014hu io, i,cso >:: 1110 sweet (I-ax lot 46)7 Is It totally vacant? The design of the above mfel c.,,;od nut can't make tax lot k 36 unbuddable since this lot also has subdivisiou rights. 3. The fill on the eastern side oP the property line is grater than 3:1. 4. Please provide standard Putnam Cuuniy fill nolas. If there are any questions regarding lh maurr, please contact me at (845) 278.6130, oxt 2157. iincc :uly, Joseph S.Paravari,Jr. Assistant Public Health Engineer JSP:cj I, .. .. Eavhnaelcxlel Huald,(r45)", 186I3U Pox (&15)7,7 &7y21 - ... -. - w _ _ •- Nurelos Service (845)278-6558 "%VIC(845) 278.6678 F4x(845)27 &6085 .. E44Y lamrvr.M./Prefeeccl ()PIS) 2784014 F.. (84S) 27866a8 ..- G�rLTTHISNFi2is JMWEIDW IMOU dO 8DVd ZS2IId x0 : ssznsau Nos : HGOW „SZ.00 : awis GgsdVIM £iv:OT 90 -UdK : Swis IUVILs T/T : SaMd L08ZBZ96 : MOM TZ6L- 8LZ-ST,8 UZI xzGVax dO ZNaKlUVd8G XINn00 WKNSnd • 3iVN VV:OT GUM SOOZ- 9 -HcIV : alva NOIZVWNI N00 ONIMIIS SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health April 5, 2005 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Dear Mr. Greenberg: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive L.,.,/ Re: Waiver Determination — Gazzola Lake Shore Road, (T) Putnam Valley TM# 41.06 -2 -18 & 19 The Putnam County Health Department reviewed the waiver request for the above regarded project on April 5, 2005. The following determination has been made: L X The Waiver request was approved. The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. The Waiver request was denied. An explanation has been noted below. X The Waiver request was not voted on. Explanation noted below. Design to be reduced to a 2 bedroom residence to provide more separation from the cw't "ry / lake. , / What is the status of the lot across the street (tax lot #36)? Is it totally vacant? The design of the above referenced lot can't make tax lot # 36 unbuildable since this lot � k �,� also has subdivision rights. c° / The fill on the eastern side of the property line is greater than 3:1. 5� L i Please provide standard Putnam County fill notes. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. JSP:cj Sincerely, oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health '(845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 "WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road; Brewster, New York 10509 Environmental Health (845) 278 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845)27'8-6014 Fax (845) 278 - 6648 ' FACSIMILE TRANSMITTAL To: Joe-1 �-r' bi ►r�; ! Fax: From: Toe Pcr"Eh' Jr-. -APRE- Date: / f Re: �� ��:%�rS Pages: . Gt-u- . CC: ❑ Urgent (VFor Review ❑ Please Comment ❑ Please Reply ROBERT J. BON.DI County Executive CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only, for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received thus telecopy in error, please immediately notify us by telephone (845- 278 -6130) and destroy all documents associated with this facsimile. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTArMOLINARf ;-RN MSN Associate Commissioner of Health March 15, 2005 Joel Greenberg RA 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal -- Gazzola Lake Shore Road (T) Putnam Valley, T.M. #41.06 -2 -18 & 19 This office has received and reviewed the most recent set of plans for the above mentioned,project. We would like to offer the following comments for your review and consideration. 1. The following items do not meet current code: a) Proposed SSTS less than 100' from a lake. b) Well less than 15' from the property line. c) Side slopes greater than 1:3. Based on the above, the application is denied. It is your right to request a waiver for the above mentioned items. 2. Please provide a copy of a valid wetlands permit or a letter from the Town stating none is required. Please also check the State Wetlands map for any State wetland on the lot or in the vicinity. If there are wetlands on the property, the wetlands with the associated 100' buffer needs to be shown. 3. Neighbor notification is required per Bulletin ST -19, Section 4.A.11. 4. Please provide any 100 year flood elevation within 200' of the proposed SSTS or a note stating none exists. 5. Please provide the exact locations for the neighboring wells and septic (Tax Lots 17, 20, 35 and 36). The 265' dimension for the SSTS across the street appears to place it off the property. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 il IT' 6. Please provide more silt fence for the proposed SSTS area_. - -. 7. It appears -tfiat the proposed SSTS could be rotated so the trenches-are more parallel with the existing contours. This may also help with the proposed fill. 8. The proposed 782' contour transitions into cut. 9. Please provide a minimum label between the SSTS and the proposed catch basin. 10. The SSTS is less than 50' front the open end of the existing 12" CMP. 11. If 2' of fill is required, why is the first proposed contour at 784' over an existing contour of 780'? 12. The primary system is short by approximately 40'. 13. The proposed grade over the septic tank is 787.5', but the tank location is between the house which is between the 790' and the 788' contour. Please verify the regrading for the house location and the driveway regrading. 14. Please check the new grade in the profile. It doesn't appear to match the plan view. 15. Stand pipes for the curtain drain, 5' on both sides, are required. Please also provide a detail. 16. Pease provide basement floor plans. 17. Please show the water service connection. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cw Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer PiTI'NAIYI COUNTY DEj?ARTMENT OF HEALTH Pv DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT: SYSTEMS REVIEW ,SHEET -FOR CONSTRUCTION PERMTT ~ •.` NAME OF OWNER: c: z Z m I STREET LOCATION: C k4 _ S Gtr rr t �dlr REVIEWED.BY: RM, GR, SP SRDATE: 3 1 o 10S _TAX MAP #: (CONBIRMED) Y/. Ei - �� - l si Y M CLY /N DOCUMENTS Y, ( REQUIRED DETAILS ON PLANS CONT'D� IL PERMIT APPLICATION ( HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE. CAST IRON DWELL PERMIT OR PWS LETTER NO BENDS; MAX BENDS 45' W /CLEANOUT PG-97 RE�Or�'ALS -? ETTER OF AUTHORIZATION M�f)ESIGN DATA SHEET (DDS) ORPORATE RESOLUTION HORT RAF . PLANS -THREE SETS E -pTAvS = fw-o ETS ( Q )VARIANC9 REQUEST ON (ZULEGAL SUBDIVISION ' (_JUSUBDIVISION APPROVAL CHECKED UUPERC RATE CUC�_)FILL REQUIRED DEPTH UUCURTAIN DRAIN REQUIRED E�NERAL (_JUZLOCATED.IN NYC WA - ._... UC_�-)PLANS SUBMIT EP NIA_ ( %( _ 1T VTW' _ OrgTn FAPPROVAL, IF REQ'D . EP TEST HOLES OBSERVED KCS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS ,TLANDS_WWN/DEC PERMMIT READ TA ON DDS" PLANS & PERMIT SAME - itYR:. FLOOD ELEVA'iION W1I'2 -tee >IL TESTING LOTS >10 OLD QUIRED •DETAILS ON PLANS ,WAGE SYSTEM PLAN - (NORTH ARROW) DS HYDRAULIC PROFILE RAVTTY FLOW )NSTRtTCTION NOTES i -15 ZSIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED . IIVEWAY & SLOPES, CUT FOOTING/GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES - ,(TITLE BLOCK; OWNERS NAME ADDRESS k TM #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE . LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. DC_JPROPOSED FINISH FLOOR AND s--- RASXM'R_!YT F.L.FV WAN 200' OF SSTS CS- Bc�BGU1�D3�; ,OL FORZOUSE,FF MVENTS: iRxitrTMorn� inn FILL SYSTEMS UST-JEENCH SLOPES• 3:1 TO GRADE (U )FILL PROFILE & DIMENSIONS FILL IN MANSIONt AREA FILL GR ATZR TI3AN2 FEET , 'CLj: j :_ j CLAY BA.RRDM / " l L'CERTIFICATI UUDEPTH G VO L. PLAN FOR R -O.B., k�CLASSFD & ID4rERVIOVS SEPARATION DISTANCE FR'TOE OF SLOPE TRENCH SREAi•6H- �'ROVIDED- �",'3� 60FT MAX. � 7'S %4 ( --)Io °EXPANSION PROVIDED " °`� "' (D1;TA°II,/DUST FREE CkUSHED'STONE OR WASHED GRAVEL COVER SEPARATIONIDISTANCES ON PLAN : FAOM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL `4ti��20' TO FOUNDATION WALLS. E LAKE (far. --I '"') " _TO CATCH BASIN, 35'. STQRMDRAIA, PIPED , ATER - ' TO WATER LINE (pits - 20') ' INTERMITTENT DRAINAGE COURSE 0'/500' RESERYOItt, ETC. 150' GALLEY SYSTEMS 'NON TO LEDGE QUTCROP SEPTIC TANK ' FROM FOUNDATION, So' TO WELL YVELL LS-1. o" e7 •S K� �-i . /I,— UL�REGRADED TO Le ( SLOPE IN SSTS AREA (d � o %) ° 1.170, w REQUIRED DOSZT S STE j C_J _,)PUMP NOTES (!)(_,)DOSE 75% OF P MMEIDOSE VOLUME NOTED C-.JL-)DETAM RCKMAIN, (PIPE TYPE, ETC.) D -BOX SHOWN & DILTAILED 1 DAY STORAGErAZ VE AL.ARM_ CURTAIN DRAIN STANDP ' . ' MIN to CDS='S %, 20' -4 %, 25' -3 %, 35'-16/9, 100%-<:I% 0' Ml[N to CD DISCHARGE/100' with 182 cons day discharge 0' MIN to NON - PERFORATED PIPE SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORZTTA= MOL-INARI,-RN; MSN= :. Associate Commissioner of Health February 23, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 William Maskiell Zoning Board of Appeals Chairmen Town of Putnam Valley . 265 Oscawana Lake Road Putnam Valley, New York 10579 Dear Mr. Maskiell: ROBERT 1 BONDI County Executive Re: Proposed SSTS — Gazzola Lake Shore Road, (T) Putnam Valley TM# 41.06 -2 -18 & 19 This Department recently received an application for the above referenced parcel. The application is currently under review and once all outstanding comments are addressed and any items that require waiver from the current Health Department code are discussed and voted on in a future waiver meeting, it appears that a permit will be granted. Be advised that due to the apparent fact that waivers will be required, the current application may have to be modified to some degree. Also, neighbor notification and proof from the Town that tax lots # 18 & 19 have been combined into one lot is required. Once all the above is satisfied, it appears a permit can be issued. However, this letter is not in any way a guarantee of future approval. Other unforeseen issues could arise that could effect the issuance of permit. Kindly contact me at ext. 2157 if any questions arise. JSP:cj Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Joel Baumwoll IM 2128747145 Ro2/15/05 010:35 AM D 21 Joel Baumwoll 442 Lakeshore Road ..Putnam -Valley NY 10579- v 845 528 5596 212 874 7145 .212 874 8636 (fax) February 14, 2005 Ms. Judy Travis Putnam Valley Zoning Board (Copy sent to J. Paravati, Env. Health Dep) Via Fax Dear Judy, I receiued4 otie.e of a hearing for a. sideline and rearline.'variance for anew one family dwelling proposed by T. Gazzola, to be constructed ,on lot # 3021303, Tax map #41.6 -2 -18 & 19. I also,reeeive.d a copy,of the engineer's plan from Joel Greenberg. I will not be able to attend the hearing scheduled for February 24`h at 7 P.M. However I have some concerns about the proposed plan based on the drawing I received. . .4. -,The proposed-well-site Is in direct line-with ouf well:` T'do riot know what effect thus " wily have on our water supply or quality. Obviously, it is a concern tome. 2: The proposed septic,fields are in>ront of the house in•fairly close proximity to a brook that flows'through the property, and may possibly be a source for our well. Obviously this is a concern to me., 3.. The dwelling. is sited - t 25;feetfrom the property line adjoining our property (lot 304). I am concerned that.tlus.,proximity will denigrate the aesthetic qualities of our property and dwelling, and may also reduce the resale value of our property. The drawing sows considerable room to, the center. of the two lots 302/303 and l,,would ask that plans; be reconsidered to move the house •further from the property sideline.that adjoins our lot 304. I appreciate knowing what:the.progress is'of this application and how I may register any future concerns in a timely fashion. Cordially,.: Joel Riumwoll , FEB -15 -2005 :TUE. 11:30 TEL:845- 278 -7921 riAi`!L FLITNAM COUNTY DEPARTMENT OF P. 2 S,t�T3�M . � 01/26/1995 22:44 2128748636, BAUMWOLL INT.CONSULT PAGE 03 LIU INS • �; * i�:, r :,� � • . `-"�, �• ,y tt r re fr ,� ,.'sue �'�.' ► `• \' -. t�1'...'•', �`'�ti i 4 v ,`' •l �xt 1 lb I ';.;;M all • ail ,��;� � M se 92ozi s 08Z8Z9609 Sid% ST L ip FEB -16- 2005. WED 10:42 TEL:845. -278 -7921 NAME:PUTNAM.000NTY DEPARTMENT OF P. 3 APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Dear Property Owner, Date February 22, 2005 RE: Department of Health Review of Proposed SewageTreatment System for Property Name:Gazzola, Thomas Address: Lake Shore Road TOwn:Putnam Valley Tax Map #: 41.06-2-18 &19 Please be advised that an application fora Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., a If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address:. Tax Map #: Very truly yours, By: Joel Greenberg, AIA Title: Project Architect August 1997 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION Thomas Gazzola Located at Lake Shore Road TN Putnam Valley Tax Map # 41.06 Subdivision of Second Map of Roaring Brook Subdivision Lot # 3 0 2 & 3 0 3 Gentlemen: Block 2 Lots 18 & 19 Filed Map# 308 -E Date Filed July 8,1946 This letter is to authorize JOEL GREENBERG a duly licensed Professional Engineer or Registered Architect x_ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health and-the Putnam County -Sanitary.Code: -- :....:.._ ..__. �.- Countersigned: P.E., R.A., # _ Mailing Address State New York Zip 10541 Telephone: 8 4 5 628-6613 Very truly yo rs, Signed: -�- Awner Prope ) Mailing Address: 38 Arbutus Road Putnam Valley State New York Telephone: 845 5 2 8 - 6 9 7 6 Zip 10579 Form LA -97 PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED,ACTIONS Only„ SEQR PART '1` = PROJECT INFORMATION - (To be completes by Appiicafi .or riuleeeopuMiwi . 1. APPLICANT /SPONSOR 2. PROJECT NAME THOMAS GAZZOLA THOMAS GAZZOLA 1PROJECT LOCATION: PUTNAM- TOWN OF PUTNAM VALLEY Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map LAKE SHORE ROAD 5. IS PROPOSED ACTION: z New Expansion Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 7. AMOUNT OF LAND AFFECTED: Initially 0.69 acres Ultimately 0.69 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes Fs -/]No If no, describe briefly: FRONT AND SIDE YARD VARIANCES REQUIRED 9. WHAT-IS, PRESENT LAND` USE' IN- VICINITY- OF"PROJECT? "(Choose aS MAnylds-apply:) Residential F-1 Industrial D Commercial ❑Agriculture F� Park / Forest / Open Space 0 Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) aYes F�No If yes, list agency name and permit / approval: PUTNAM VALLEY PLANNING BOARD AND BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes �No If yes, list agency name and permit /approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? QYes ✓1 No I CERTIFY THAT THE INFORMATIO PR VIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant ! Spo sor me TH AS GAZ OL Date: September 9, 2004 Signature P� PROJECT ARCHITECT /1-1 f the action is a C stal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment BRUCE R. FOLEY Public Health Director.._ ATTENTION:. DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.&N, Associate Public Health Director Director of Patient Services 'REQUEST FOR FIELD 'TES'T'ING Joe Paravati :k)II'fi8'� o GENE REED Putnam ;Valle 1 :P(i TOWN Y TAY MAP #: SUBDIVISION::"', unar -.in I LOTH: 302.:& .303 rk ',O.`VNER Gus..arid Josephine _Gazzola NYCUEP CRITERIA FOR JOINT' REVIEW ANU WITNESSING OF SOIL'I'ES'I'IN YES NO o Proposed SSTS withni the drainage: basin of `Vest Branch or Boyds Coiner: Reservoirs. _:_.....:_.,._.....Q .. _1 Proposed:SSTS vithiti,500 feet oG -a reservoir, rescr- voii= sterpi or cnti of lake:- 'Proposed SSTS within':200:feet of a watercourse or a DEC wetlitnd. _. 0 o Proposed SSTS design.flow grey a r than 1000 gallons/day or SPDES Permit required. Proposed SSTS. for a Commerical Project. It is the responsibility of the desgn..hrofession�I to provide the above information prior to soil testing. This Department whl` determine the N.YCDEP project status (Joint or Delegated). based on the 'response.." If you answered yes to any of the questions, NYCDEP: must witness the soil testing. This Department, will coordinate a.mut,yally suitable time for yield testing with the PCUOM the Design Professional and NYCDEP. If a projOt has been determined;to be I)elegated based on the above response and. then obsequent information indicates NYCDEP is Te giiircd to witness Ale soil testing, it will be the :sole responsibility of the,design professional to schedule re- witnessing of the' oil testing with NYCUCP. FOR COUNTY USE ONLY DATE:. TIME: CO�IJIENTS: (FIELDTEST) 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION 1 Name of Project 70161 -(T)(V) Aljvham- t/�lf,� County Site Location- Building construction begun Extent Is property within NYC Watershed ? ................. 0 Yes No SECTION B.. TOPOGRAPHY (Please check all appropriate boxes) 1. -Hilly, Rolling a Steep slope 'Gentle 2. a Evidence of wetlands 0 Low area subje} ct to flooding Drainage ditches Rock outcrops 3. Property lines or corners evident ....................... ............................... 4. 'Do water courses exist on or adjoin the-property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6, Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? ................. ............................... slope a Flat' odies of water 'des Er No Yes a No I F>�, Yes M , No =Yes No a Yes r�K Nc extensive fril be necessary for SSTS? ::::: .:::::.:::: :::::::::::::::::... yes, 9. Do filled areas exist within the SSTS area? ........ ........................ ...:.... . 0 Yes. E�g No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil:C�4Sand Q Gravel a Loam 0 Clay a Hardpan Mixture 11. Observed from: a Borings a Bank cut j Backhoe excavations 12. Soil borings /excavations observed by �5 P Tbe,,l. e l�t6 on % 13. Depth'to groundwater f on 3 o 14. Depth to mottling yl a� 5v4 �Yiof���Hf . on 11'1 15. Are test holes representative of primary & reserve areas ...... ............ .................... RRryes a No 16.. Soil percolation tests made by,* oei C� on ( > ,n101iqWg 17. Soil percolation tests witnessed by 9u on SECTION D (on back) Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes No 19. Will groundwater or surface drainage require special consideration? ..................... Yes No 20. Will gullies, ditches, etc:, be filled and watercourses be relocated ? .......................... Q'Yes � No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been m de of the existing or proposed source and facilities? ............................... ......................... Yes No Inspection data P .. ,S 22. Do adjacent wells and/or sews a stems exist? ..................... ............................... es a No 23. Additional comments _ ,`v- Yu', 24. Site observer /inspector and title :R 25. Date(s)-of observation(s)inspection(s) TEST PIT PROFILES . Hole # -L -Lot # Hole # Lot # -Hole # 3 Lot # epth to water _( Depth to water l Depth to water CL; Depth to mottling, - Depth to mottling Depth to mottling i Depth to rocklimp. Depth to rock/imp. Depth to rock/imp. 73 G.L. 15 . G.L. �-- 0.5 0.5 0.5 iJ rl -r >. 1.0 1.0. 1.0 2.0 °- Ce U tii/1 2.0 / - y 2.0 r (l 3.0 3.4 3.0 y .0 w► 4.0 �'� i 4.0 5.0 ..0 6.006 6.0 7.0 7.0 7. 8.0 8.0 8.0 9.0 9.0, 9.0 10.0 10.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APP.LICATIONyORAPPROVAL OF.PLANS FOR A WASTEWATER TREATMENT SYSTEM L 1. Name and address of applicant: Thoma s. Ga z z o 1 a 38 Arbutus Road Putnam Valley. New York 10579 2. Name of project: Thnmas C;a 7zol a 3. Location TN: Putnam Valley 4. Design Professional: -r I Greenberg 5. Address: 2 Muscoot Road North 6. Drainage Basin: Hudson Valley 7. Types of Project: X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Mahopac,. New York 10541 Commercial Mobile Home Park Other (specify). 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... .. .............................. Type .I Exempt Type II Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ` No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... TIT/ A 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning,: or other. Yes _ - - . - 13. If so, have plans been submitted-to, such authorities? ... : ............... : ................ :... 14. Has preliminary approval been granted by such authorities? DdV tranted: No 15. Type of Sewage Treatment System Discharge ................. surface water _groundwater 16.. If surface water discharge, what is the stream class designation? .................... N/A N / A . 17. Waters index number (surface) 18.. Is project located near a public water supply system? ....... ...................:........... No 19. If yes, name .of water. supply N 1 n Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewagesystem -, Distance to sewage system 22. Date test holes observed . ' 7_1 / n 41 23. Name of Health Inspector:Parava't i 24. Project design flow (gallons per day) ................................. ............................... 699 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? �a 28. Wetlands ID Number .............. . ................... ............................... ea ...... ::..,.::.............. _TNT A 29: Is Wetlands Permit required? .................... ................. ............................... Yes ( Permit aiver) Has application been made to Town.or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet .of existing or abandoned landfill, . hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? .......:....................... Yes/No No DESCRIBE: 33. Is. there a local master plan on file with the Town or Village? ....................... ... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... No 35. Are any sewage treatment areas in excess of 15% slope? ................... No 36. Tax Map ID Number .......................... ............................... Map 41 lock 2 Lots 18 & 19 37. Approved plans are to be returned to ..... Applicant xx Design .Professional NDTE:.AII-applications -for review and approval of a7new SSTS`to-be located'wiihin the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious sufaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97.). Failure to'comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class misdemeanor pursuant to Section 210.45 of the Penal,Law. SIGNATURES & OFFICIAL TITLES: Owner Mailing Address: .................................... 38 Arbutus Road "'UTNAM COUNTY DEPARTMENT OF HEALTH OFF DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM 38 Owner Thomas Gazzola Address Ru Arbutus Road t... Valley -, ey, New Vorkl 0579 t) Lake Shore Road 2 Located at (Street, Tax Map" 0' Block Lots 18 & 19 (indicate nearest cross street) Municipality Putnam Valley Watershed Hudson River SOIL PERCOLATION TEST DATA Date of Pre-soaking 7/13/2004 Date of Percolation Test 7/14/2004 Hole No. ....... . ........ : Run No.i. s Sta op: "El 4pseT,ime Min.) Depth t6 V atet:'.''.. .:LFrom Groiund..- Surface Onch6§) ' Star .'Stop :W at a er eve I 'Dro1 pIn Inches Percolation Pate Mh0nch 9-- 9?36 1 9:00 9: 3 0 30 23 25.75 2.75 30/2.75=1Q.9 2.25 2 9: 31 10:01 30 23 25-50 2.50 0 / 2'.;5 12 3 10:0,2 10:32 30 23 25.50 2.50 30/2.50 =1 4 5 'F)- 3 4 5 2 3 9 :- 0- 5....9:35...__ 3 0 23.5- 5--' .2....7.,5 -30[2.;-754=1.0-. 9-- 9?36 10:06 30 23.5 25.75 2.25 30/2.25=13.3 0:07 10:37 30 23.5 25.75 r.25 30/2.25=1P.3 0 4 -1, , ` � 1� h NOTES"-.,'-' 1. Tsts,W b6160 * ed at same depth until approximately equal percolation rates are obtained at each - q - 1 1 4t ic 'Idtion t'st`hole. (i.e. :5 1 min for 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to be 6 e submitted for review. ley ents to be made from top of hole. 2.,, Depth measurem Form DD-97 5 0 4 -1, , ` � 1� h NOTES"-.,'-' 1. Tsts,W b6160 * ed at same depth until approximately equal percolation rates are obtained at each - q - 1 1 4t ic 'Idtion t'st`hole. (i.e. :5 1 min for 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to be 6 e submitted for review. ley ents to be made from top of hole. 2.,, Depth measurem Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES 2 DEPTH' ._ HOLENO. 1 ...: HOLE NO. 2. :: = HOLE NO. 3 _._._.- .r,...._ ._.. G.L. Topsoil 2 ft. Topsoil 1 ft. Topsoil 4" 0.5' 24 -60" 1'2 -72." 3 ft 4-- �-- T. Brown- -- 1.0' T.i ght Brown $ eSr _ sandy loam 1.5' silty Sandy Silty Sandy 3 -5' light brown 2.0 seam wi th Loam with Si 1 ty loam 2.5' Gravel -- arav -e -Ei. S' nark Brown 3.0' Cnarsp sand 3.5' ' . and gravel 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered 4 ft. Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered 4 ft. Deep hole observations made by: Top pa rava t i Date 7/13/2004 Design Professional Name: Joel Greenberg Address:2 Muscoot Road North_ Mahopac, Ne(w \York V0541\. Signature: Design Professional's Seal r, • h � f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES I+'INAL SITE INSPECTION .121 15 —7 Date: Inspected by: Streef-Locati Owner Z� Town L1 A M LL--� Permit # 03 — b # , (j -- 19'+ Subdivision Lot 30 2 + 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped... ................. ............................... d. Stone, brush, etc., greatr than 15' from STS area.......... e'. 100' from water course /wetlands .............. ..................... IL Sewage Svstem a. Septic tank size 1,000 .........1,250... ....other ................ b. " Septic tank installed level ................ ........................ ........ c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3.. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. renc es 1. Length required �� Length installed 2. Distance to watercourse measured 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion., 100 % .................... ..... 8. Size of gravel 3/4 - 11/2' diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... .._._ . _ __ -�10: _.Pipe"ends•ca ed:...::.� ::_..:.:.. - g. Pump or Dose ystems 1. Size of pump chamber ................ ............................... 2. Overflow tahk .......................... .... ............................... 3. Alarm, visual / audio ........ :.......................................... 4. Pump easily accessible, manhole to grade ................. 5. First box ba$ led .......................... ............................... 6. C�yycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans .......................: . b. Number of bedrooms ........... ..............................: '. IV. .W ell Well located as per approved plans . ......:........................ b. Distance from STS area measured ft ........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Worlananship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto. exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :.......................... i. Erosion control provided ................. .............:................. Rev. 12/02 7 � Fill pad located per the approved plan Fill Pad Length Required Length Fill Pad Width Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable ■ Complete items 1 2 =!tern 4 H R •and 3''O complete ; esfiicted-Dellvery is desired, COMPLETE • ON ^ • A si natu g "� ■ Print your "narri` ° " e and address on the reverse- { so that we can return the card to X ❑ A^t ■ Attach this card to the back'of th mailpiece;" or on the fipnt I{ gpg� B Received by (P�fiited Name " 0 Adore ' C Date of DellI'll 1 Article Addressed ' to. D, is deifvery addtas9,�•�^ B YES, enterdel(very i1� address below: O No s £ ZVI 2 3. Se Yoe _ a dill ! Mall Q Express Mall F D Registered Q Retum Rocelot for liAerohandlse Insured Mail o,c.o.D` 4. Restrtcted'DeiiverO (Exha Feel 7003 2260 0002 ;D582_ 91, I :PS Form 3811. February 2004 5 { - , Domestic Return Receipt-, - _ 't02686- e2 -M464p in UNITED STATES POSTAL SERV l ` #i -4 r Fira{�low MaiF Postage:& FeOS Paid �'..'USPS s PisriAt No. G -10- ° Sender: Please pnnt:your name, address,:and.ZIP +4 in this box' :: GREENB & MS GATE$_ GSN "CONSTRUCTION ARP..; r TH MUSCt ROAD NW ..Z = MAN4PAC NEW Y0 10541' :... t� t� 7, ..« - +i iii iili i i3 F# 333 # #; 3f7 3 F`3 3i i!. 3 €i3fi } 3 r-1 ;i �a ; �,: *'' Postmark Here 1 C._ - --- rg .. E f . - Pcs O ru For delivery information visit our webs Ln Certified Fee ° POMP $ {t � G9 ti rll ° Certified Fee m ° C3 Retum Reciept Fee (En dorsementR,equlred) -. c -! -_ ._.. _.._.. _C3 Restricted De"ry Fee (Endorsement Required) r ru I ':Total Postage & Fees $ M O O g.,.d o Bo x Na - - - - -.. -Mie', crry: UP+4 N� cy, Nom. ;i �a ; �,: *'' Postmark Here 1 C._ - --- I ?� CO Ln t Page i "j } ( C3 Certl 1pd Fee j O Retum Reclept Fee {I ( Endorsement ReQ� Restricted DelNery Fee i (Endorsement Required) I ru :. Total POfti. Fees O ° ~GiUmiu-jt i M..._i�py V.; ....._� aox va AqIA D- m Ln FT ^f is , . - Pcs O ru ° C3 Certified Fee ° Return Redept Fee (Endo=mentt Requlred) '- Reslrlcted Delivery Fee' (Emierae►►fent Requite rll nj TOW Postage & Fees' m -_ ._.. _.._.. _C3 I ?� CO Ln t Page i "j } ( C3 Certl 1pd Fee j O Retum Reclept Fee {I ( Endorsement ReQ� Restricted DelNery Fee i (Endorsement Required) I ru :. Total POfti. Fees O ° ~GiUmiu-jt i M..._i�py V.; ....._� aox va AqIA P r 1; r .y i_IV 14 °45 E V lJ 6.60 ke yy L� q 50-_f� �. a° _ ( £L 0 °35` YY 7750 9� _ :f0�0 17.00 7715 81.60 r SEE 5 /fir \� il - -- - - anin9 y r ••�77g.a $D\�'6NGS Ex 157. '�J 57 °J 7' W _ boWAer , ra 176/ i .. - it • , S Go �`.., 775.4 q n9 _ aali 75. Dd • 118 , L.ne 'at _ ��- ° °`•la` SHORF_L1NC - s4 77 2 c 43 6.5? G N_ � sx�snN _.. - 77.74 -•RIP S jtt • f' J- 11 /f•� -._� 778 '— 7e.8 lle. a �71lii G U /n 9/ , O� �0 ED T / 3 02- 7 5 � \ J � � 0 `nes � • r7/er cap " ,FtFY�VAEI &5�( 'I \`•..\'�, \� .�.. �y —.—�S 78o� " //J� t1'!! -�J 0 A Mr N. Op /O /� S75 LF t �6i �c� �37 _ - - -- Bc a' SCI IV �V/DE LEgtN /N6 T2ENGNPI) LOT� \ �,303 ~' D £8 ` rr S �(S r 1 5 # {a �: 788. 2, I V ¢�Y.e 41 7879 � 1 \ ,2 732 1/O' Td \YEIU �" � `� .3,, 4 �'O2,ie o cy st }' f 'C�`... j8CRL �i B� 6/`• � �Br ' %Sb �. Qf� "9r s 71J aC f: 7e4.5 yl•, v I`ve 4>0/'f `;% �Q/ �.4,. : — _ _ ` —1� 't\\ . r"' - *'•B.e. ._ - \ `l t�i1ll p° 5>C9 p ;� �, „ .194"• . 7 ` 1 c 7"�ZCc 6 � . /0 ° 78 L2: q� 784.7 8d9 /. v788. 789. yO 4 o f � {' NS T d r7N6 �.� a S 1A i 0 ° ��:L 1 � '�s6 N�2 - �8'`•'' ,>8$ o` _ s " � cQ� A � r i masonry stone retaining wcil� N 37 '2p E non in concrete ° °� 4.00 recovered W—ter Op� O � 0 00. 29 °20' 0 ae —IV 14.00' N 1 oy�'F �L yF y 9pCy' Q °5 per °o. moo s 1 � 5��'• LOT 302 o ,Q a° 0 ,OOR EXPANSION 0 O4O00' b� 0 ' o o Bo° x 5 _ - ,B- 9O=0X- 0/ -- -- - - - - -- 52 0x (10 }l60.00 ---- __ ° ' ) / i ' •:- \ � o' QR 9 47.00'---- �1 ox spAre in driveway 24.00 _ - - - - -- NK recovered 000ro s (B�_- `c /4 Z9 j• 267 LF of FIELDS / / to `,� arRpc. L , PIR wm 9' 4' MM 0 IML f/roML LA KE 6,0" d / O� r / o' y m aostm Box °a f! � f 1� DD/ /• � ��e' �` �p4�PPo9e i ' S / N / . O �(• L1Def �/ e° �n n %. �.�s gym• ��,,f/f� E 518/ 1_ l/ndergmund improvements: structures, utilities or encroachments, and any easements related thereto, are not shown hereon unless otherwise 1 �o` /�I, AREA = 30,036 SQ. FT. y s ( 0.6895 ACRE) ° 6 head /94 d SITE PLAN BASED ON SURVEY BY: BAXTER LAND SURVEYING, P.C. o\ DATE OF ORIGINAL SURVEY: MARCH 14, 2002 REVISED TO SHOW FOUNDATION ONLY: NOVEMBER 30, 2006 UPDATED TO SHOW IMPROVEMENTS: DECEMBER 29, 2007 N, AS —BUILT SSTS PLAN o' 3 —ro ITE\G— ola(IF)\GAZMA- LOT iAYOUTaS– Wft.b",U16/200ii.-4.15 PM oaO W 6 5 , -N 7.00' N -19.06 X06. 60, spike in small 81. 9' ` : caning birch tree �+ j W 57 °57' �! wau N 51ea5e m retain g e °t ) in . _ poalder' .// ti' a stone .' rs'' air I T EXI 002 STED c° -- y� SHORELINE AS ON MARCH 14, 2 bc LOT 303 �,� �1p o6A' `1 y�c iron pin recovereC PQ o s eaoa +: 4* h /tip/ Nt o On pin recovered; 9 00 60� fence an line 70 / Ito a 0 � • � -:sue; � �T' a� .QO NP 00 06 h PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION F ENVIRONMENTAL HEALTH SERVICES. I+ S(') -OK -OS APPROVE AS NOTED FCR' CONFORMANCE WITH s a Af ^LICABLE RULES AND REGULATIONS OF THE °� °.:g. P `TNAM COUNTY HEALTH DEPARTMENT. AS BUILT LOCATIONS THIS IS TO CERTIFY THAT THESE% B C ITEM DISPOSAL SYSTEM HAS BEEN. 1 25.36 N CONSTRUCTED AS INDICATED ON 1,- -- TANK 2 52.78 THAT I INSPECTED THE SYSTEM BE Roaring BOX WAS COVERED OVER. THE SYSTEM 76.78 X BOX CONSTRUCTED IN ACCORDANCE VI 44.55 72.27 STANDARD RULES AND REGULATIC Brook 43.87 74.41 THE PUTNAM COUNTY DEPARTME� E 6 52.40 HEALTH Lake 0-47' N 075 �� 53.21 87.30 y �e 8 oaO W 6 5 , -N 7.00' N -19.06 X06. 60, spike in small 81. 9' ` : caning birch tree �+ j W 57 °57' �! wau N 51ea5e m retain g e °t ) in . _ poalder' .// ti' a stone .' rs'' air I T EXI 002 STED c° -- y� SHORELINE AS ON MARCH 14, 2 bc LOT 303 �,� �1p o6A' `1 y�c iron pin recovereC PQ o s eaoa +: 4* h /tip/ Nt o On pin recovered; 9 00 60� fence an line 70 / Ito a 0 � • � -:sue; � �T' a� .QO NP 00 06 h PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION F ENVIRONMENTAL HEALTH SERVICES. I+ S(') -OK -OS APPROVE AS NOTED FCR' CONFORMANCE WITH s a Af ^LICABLE RULES AND REGULATIONS OF THE °� °.:g. P `TNAM COUNTY HEALTH DEPARTMENT. ���V/�a7IR1C 2 MUSCOOT ROAD NORTH MAHOPAC NY, 10541 JOb vGxm cou AS -BUILT SST; THOMAS & LISA GA PROJECT ADDRESS 446 UM E SHOW RD PU WMVALLEY, W 10541 TAXWM4192-19 AS -BUILT SSTS ISSUANCE FOR PCHO 16 JAN 07 �\ !RG co w SCALE AS NOTED DRAWN BY AS BUILT LOCATIONS A B C ITEM 1 25.36 34.13 TANK 2 52.78 57.62 x BOX 3 51.84 76.78 X BOX 4 44.55 72.27 BOX 5 43.87 74.41 BOX 6 52.40 84.72 BOX 7 53.21 87.30 BOX 8 77.53 103.2 V) D w U- O 0 z ``' 9 93.47 121.13 10 106.36 135.41 11 107.0 137.3 12 101.69 133.3 13 30.74 64.92 14 32.12 68.61 15 50.99 57.96 WELL ���V/�a7IR1C 2 MUSCOOT ROAD NORTH MAHOPAC NY, 10541 JOb vGxm cou AS -BUILT SST; THOMAS & LISA GA PROJECT ADDRESS 446 UM E SHOW RD PU WMVALLEY, W 10541 TAXWM4192-19 AS -BUILT SSTS ISSUANCE FOR PCHO 16 JAN 07 �\ !RG co w SCALE AS NOTED DRAWN BY 0: "IT PUTNAM COUNTY DEPARTMENT OF HEALTH I'MN DIVISION OF ENVIRONMENTAL HEALTH SERVICES TION ell Permit 93 WELL COMPLETION REPORT Well Location Street Address: A4 Ae. 6 43-f r- b Town/Village: pk& Q-41- V, t ho ITax Map # Map Block Lot(s) GPS Well Owner: Name". Address. J v In CC -2- 7-10 /CL 1 Tt b I-If US ik VA Use of Well: 1- Primary 2-Secondary t/(2esi - dential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional a—Standby Drilling Equipment /Rotary _Cable percussion _Compressed air percussion --Other(specify) Well Type Screened ✓�6pen end casing _ Open hole in bedrock Other Casing Details Total Length Length below gratz Diameter & in. Weight per foot /,�__Ibfft Materials: - VSteel Plastic Other Joints: Welded _L-1 Threaded Other Seal: __LZe-inent grout - Bentonite Other Drive shoe: —Yes '-"No Liner: —Yes "o Screen Details Diameter (in) ISlot Size Length (ft) Dept to Screen (ft) I Developed? First _Yes No Hours _Second Well Yield Test Bailed Pumped VCompressed Air Hours Yield /0 — gpm Depth Date Measure from land su ace - static (specify ft) 30 el test (ft) During yi- Depth of completed well in ft. Well Log If more detailed information desdiptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface. - . /,S, 0 u'a1 ,h t, if 41 0 S v0 Alki _1_1X \ 3 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type6k {,t,o,(V 6A.- Capaci Depth a$o Model Z-M(VS 1 5-11 Voltage DcW HP !� J, Tank Type (A] 04, volume A0 Date Well Completed Well Driller fR&! Certificate NY' State ; ; 'Y Sla i te- Pi ki h-ln*Efi5lls6m FAM !.q NOTP F:Yqr.t I oration of well with distances to at lebst two permanent landmarks to be p, vided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Rev. 3/06 ia DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 September 4, 1991 Vincent Ettari, PE 1065 Spillway Road Shrub Oaks, NY 10588 RE: Mary J. Vacirca Lake Shore Road Putnam Valley, NY 10579 Dear Mr. Ettari: JOHN KARELL Jr., P.E., M.S. Public Health Director I have received and reviewed your request for a variance to the provisions of Article III of the Putnam County Sanitary Code and Article 75 of the State of New York Official Compilation of Codes, Rules and Regulations for the construction of a well and sewage disposal system on the above - mentioned parcel. The following information must be obtained prior to considering your request further. - • - 1: - Please-- submit a -letter from the Town of Putnam Valley concerning - the relocation and extension of the 18" culvert as shown on the plans. 2. Relocate the proposed well a minimum of 100 ft. from all adjacent sewage disposal systems. 3. A letter from the owner, requesting a variance and explaining the nature of the variance and hardship, must be submitted. Once the above mentioned information is received, your request will be considered further. Very truly-yours, William Hedges Sr. Public Health Sanitarian WH:mk P= = ENDEC 9 CE?? !a:T C E --L - Dr, 1C! OF 2:�411 C _ -Rw NTr,._ `:- C" m1Fyj+c I Y-c I NO I DCC Q Pl Gnc _ Three scr-= Data Slaeet (_) per` G:1� L,'`✓4�- --� C- ?- `Ic= Fs_-_' R & VC u_ _' __- Ewc_C7 Lc =. �eC arc. C =_- L-l= =r- F_— 'r= 4 t —& D Ecx- & 200 ft - F_rci =fir =5 & Ec`r_- := let: Ec`. (_c 10' tc "P .L. , Dri�r`:�e-r, L --r:- I`zees, Tc= c= 201 t7 Pc=-Ic =tica Walls 1n0, to Wc—i 1; 200' in D- r._C.D, 150' pi 100' t:3 �L._�..�..'iir j4G'_.== �lLr =: / '' - -ti'- (i 15' t2 l7rc= c =fir__ 1, LAC °_, F=CC =mac rwaz 10' _ II ��' )L)({�- �'�"-- =rte Cam__ =G= C"• -_ R � � I --I -- I GI-- -- I I i I I I I I r I II/ I �'f I c G o -©, I. I 100° x y i 1 c ! I I � I I� _ — - E-rc l^ "c i /i., 1- of -- -� -Vv I i ,. 10 r _ I I Y sLec- 1 I I 1_0 ti_ flee- - _r. I et tr ca "I Pl Gnc _ Three scr-= Data Slaeet (_) per` G:1� L,'`✓4�- --� C- ?- `Ic= Fs_-_' R & VC u_ _' __- Ewc_C7 Lc =. �eC arc. C =_- L-l= =r- F_— 'r= 4 t —& D Ecx- & 200 ft - F_rci =fir =5 & Ec`r_- := let: Ec`. (_c 10' tc "P .L. , Dri�r`:�e-r, L --r:- I`zees, Tc= c= 201 t7 Pc=-Ic =tica Walls 1n0, to Wc—i 1; 200' in D- r._C.D, 150' pi 100' t:3 �L._�..�..'iir j4G'_.== �lLr =: / '' - -ti'- (i 15' t2 l7rc= c =fir__ 1, LAC °_, F=CC =mac rwaz 10' _ II ��' )L)({�- �'�"-- =rte Cam__ =G= C"• -_ R � � DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 -- .-- ...... -- -- - -- - - -- - - :.... ............,..... ... ....:. _, . _ _. _..._ ....._.._ _.._. s.:r APPLICATION " "TO CONSTRU'C�'� ° "W�'�E`12'�WELL"` PCHD PERMIT # WELL LOCATION Street Addr ss e s 40RV_ Name RESIDENTIAL O BUSINESS 13 INDUSTRIAL Town Village- DR Mailing Address ❑ PUBLIC SUPPLY O FARM O INSTITUTIONAL City Tax O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY Grid Number - -I I QWrivate Public ABANDONED O OTHER (specify O OWNER USE OF WELL 1 - primary 2- secondary AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED T /EST. OF DAILY USAGE_,&Pn gal' REASON FOR DRILLING NEW SUPPLY OPROVIDE ADDITIONAL ,SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING -aJ W O lit. r WELL TYPE DRILLED DRIVEN ODUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 4---**ON0 /8G�l y it -5t�� `0`F IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ,,`` SEGONOc M ,4 r Lot No.��3 WATER WELL CONTRACTOR: Name 546,41- Address: gg °<-"is 1_ 2 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: /V TOWN /VIL /CITY Y DISTANCE _TO� PROPERTY "FROM-NEAREST-WATER MAIN: A "' a LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON REAR OF THIS APPLICATION EPWTE.SHEET date U (� t na ture) ���� PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: Date of Expiration: Permit is Non - Transferrable 2/87 19 19 Permit Issuing Official White copy: H. D. File Yellow copy: Building Inspector Pink Copy: Owner Orancte copy: Well Driller jt� APPENDIX L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF Mo HEALTH SERVICES DATE: L221_,LY-�� Z. LZ L 7 RE:, Property of Located at M. S6 ection' Block Lot Z� Subdivision of V SUWv. Lot # 3 0 3 Filed map # _S o 94E bate Z Gentlemen-...' This letter: is to authorize a duly licensed professional engineer ✓ or registered architect (indicate) to apply for a Construction Permit for a heparate sewage system, to serve the above noted property in accordance with the.stan'dards, rules or regulations ab,: promulagated by the. Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to -supervise theconstruction= -of said system or systems in conformity- witfi..the provisions of Article,.145 or 147, Education law, the Public Health law, and the Putnam County Sanitary OM Very truly yours, 12 'n � Countersigned: P.E. R.A. # . / � 37-'J.6cZ roperty' Town 21 14 Telephone Teleph6ne- 19 DESIGN DATA °:SHEET- SUBSUFACE- SllgAGE.DISPOSAL =, .....,.,._... .... FILE.. NO ..__..�..:_.._....:�:_.,...�,.. ... ... owner o7 j Address 3--313 ne ,Q 6114i,11'1r Af ed04- BKo•vx, Ali /o�G .Located at (Street) E sf,/o,4E �/e. Sec. —7 Block / Lot , '! (indicate nearest cross street) 10$1 Municipality ; a2 m 4'1-ey Watershed Xd'loe/;✓G 06 004 SOIL PERCOLATION TEST DATA RDQU.CRED TO BE SUBMITTID WITH APPLICATIONS Date of Pre - Soaking 3/— Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time _ Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches v - / 'o� 3 o�r,;r ��' ` `2 sue" 3 �' /o ;w.;✓ /..;. 3 / • S/ - / U �►ia dt / n �� �'�!% 5 3 / • S/ - / U �►ia dt / n �� �'�!% JAI /��.�.► dy NOTES: 1. Tests to be.repeated are"' obtained at each for T64 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made fran top of hole. 14° INDICATE `LEVEL AT WHICH GROUND6+AM IS ENOOUNTERED ,jam INDICATE LEVEL TO WHICH WATER LEVEL SES AFTER BEING ENCbUNTERED S � , -DE�HOLE OBSERVATIONS MADE BY: �T //¢�� ��ATE: 3 0 _J DESIGN Soil'-= Rate__,Used Min /1" Drop: S.D. Usable Area Provided o d ' No.. of Bedrocros Septic Tank Capacity /OOo gals. Type 'CA AIC_ Absorption. Area Provided By DU L.F. x 24'° width trench Other �U�� A/ T Name l ^/L' Gst/f �. �/ �% Sig of Address ��11 #A oed(• S ..° "11W ' THIS SPACE FOR USE BY HEALTH DEPAR�NP ONLY:t�t���'y Soil Rate Approved sq.ft /gal. Checked by Date. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS-ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE- _ oZ HOLE NO. _ G.L. e_ 0�Gi9irii e o� G T7�J0i� 2' S/G T v'ifi� S /GT L.ofihi S /LT}� Lori �i 31 49 „ ze"pieoe_& 47- 5' �GwTJ 3.s' 6' 'r 7' g° 9' 10' 11° 12° 13' 14° INDICATE `LEVEL AT WHICH GROUND6+AM IS ENOOUNTERED ,jam INDICATE LEVEL TO WHICH WATER LEVEL SES AFTER BEING ENCbUNTERED S � , -DE�HOLE OBSERVATIONS MADE BY: �T //¢�� ��ATE: 3 0 _J DESIGN Soil'-= Rate__,Used Min /1" Drop: S.D. Usable Area Provided o d ' No.. of Bedrocros Septic Tank Capacity /OOo gals. Type 'CA AIC_ Absorption. Area Provided By DU L.F. x 24'° width trench Other �U�� A/ T Name l ^/L' Gst/f �. �/ �% Sig of Address ��11 #A oed(• S ..° "11W ' THIS SPACE FOR USE BY HEALTH DEPAR�NP ONLY:t�t���'y Soil Rate Approved sq.ft /gal. Checked by Date. PUTnM CXXJN'I'Y DEPARTMEM OF HEALTH DIVISION OF ENVIRCNKERML HEALTH SERVICES - DESIGN " "M"' lo; - SHAT= SUBSUFACE° - Sgv7"�DISPOSAI:..SYSTEX4' -- Owner T� L ,� Address A /x ;wv C 401-91ef.✓% ,d,eook BoCoivx, Iv, /o $4G Located at (Street) �,4 ,� --E-_ .SNoQE �R. _ Sec. _� Bloc)c 1_ Loth (indicate nearest cross street) Municipality �4v 7W d 'M 1//� GLE'y Watershed Xa look G '6ieco of SOIL, PERCbLATION TEST DATA RDQUIRED TO BE SUBmiTTED WITH APPLICATIONS Date of Pre- Soaking 7"/.1/ �9i Date of-Pero olation Test 9-131,1 HOLE NUMBER CL= TIME PEROCILATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In MWIn Drop Inches Inches Inches 01 /. -,2o 30ay.; � /-0 �.;✓ /,;. 3 s%� �?.' 3 3q .'i�i.� /� W."i /,40V 4 .2 .-,3y 3 " /� 3�,�ii:� J , r o? 5 2 3 4 5 NOTES: 1. Tests to be repeated' a-re obtained .at each for review. 2. Depth measurements to rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to•be submittlad be made fran top of hole. DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 January 15, 1991 Vincent A. Ettari, P. E. 1065 Spillway Road Shrub Oak, New York 10588 Res Construction Permit Lillian Roberts Lake Shore Road (T) Putnam Valley TM #7 -1 -21 Dear Mr. Ettari: W_ JOHN KARELL Jr., P.E., M.S. Public Health Director Review of plans received prepared by Vincent A. Ettari, P. E. relative to a construction permit for the above captioned property has been completed by the writer. Based upon such review and pursuant to the provisions of Article III of the Putnam County Sanitary Code and Part 75 of the State of New York Official _Compilation of Codes, Rules and Regulations, you are hereby.advised that the - rrciposed methods providing eater sx ipply- aWd-' gfLsrage- disposal-,-are-cnnoidTeii`ed inadequate as set forth below, therefore, approval of these plans cannot be granted. 0 1. The proposed sewage disposal system shows no expansion area available. 100% expansion of the required leaching area is required. 2. The proposed sewage disposal system is 58 feet from the existing well to the north. 100 feet is required. (200 feet if this well is considered in direct line of drainage). 3. The proposed well is 84 feet from the proposed sewage disposal system. This .well is considered within direct line of drainage and therefore 200 feet is required. 4. The septic tank and pump chamber was shown approximately 12 feet from the proposed well. A minimum of 50 feet is required. 5. The proposed septic tank and pump chamber are shown approximately 15 feet from Roaring Brook Lake. A minimum of 50 feet is required. 6. The proposed veil is 72 feet from the existing sewage disposal system to the north. The proposed well is considered within direct line of.drainage of this sewage disposal area and therefore a. minimum of 200 feet separation is required. 7. The sewage disposal system is shown 16 feet from the proposed residence. A minimum of 20 feet is required. 8. A small parking apron is shown essentially off the property. Approval by the Torn of Putnam Valley is required. 9. The sewage disposal system is designed 75 feet from Roaring Brook Lake. A minimum of 200 feet is required. 10. The residence, well, and portions of the sewage disposal system are less than 100 feet from Roaring Brook Lake. Therefore, a wetland permit from the Dept. of Environmental Conservation and /or Putnam Valley is required prior to our approval. 11. The adjacent lot was previously rejected by this Department. Combining these two lots, into one parcel, may result in a design which meets present code requirements. Several other design deficiencies were noted, including the necessary fill section data, house setbacks, notes concerning the construction of future driveways, and proper labeling of required separation distances. Returned herewith please find one copy of the sewage plan. If you have any questions, please call me at ext. 304. 7Z6 ry tr ly y re, n- are , Jr. Public Health Director JK /jp cot Lillian Roberts, 3313 Perry Ave., Bronx, NY 10467 (owner) M JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 May 10, 1991 Vincent Ettari 1065 Spillway Road Shrub Oak, NY 10588 Re: Mary J. Vacirca Lake Shore Road Putnam Valley, NY TM 7 -1 -20 & 21 Dear Mr. Ettari:) Review of plans and other application materials relative to a construction permit for the above - captioned property has been completed by the Department. Based upon such review and pursuant to the provisions of Article III of the Putnam County Sanitary Code and Part 75 of the State of New York Official Compilation of Codes, Rules and Regulations, you are hereby advised that the proposed method of providing water supply and sewage disposal are considered inadequate as set forth below, therefore, approval of these plans cannot be granted: 1. The proposed well is less than 15' from the west property line. 2....The _.pr..opQsed:_4.el..l..is .73' . from the- sewage..disposal . system ..on. the-adjacent- parcel. . .. _. The minimum separation distance is 100 ft. 3. The proposed sewage disposal area provides for 54% expansion area. 100 % expansion area is required. Returned herewith, please find one copy of the sewage system plan. If you have any questions, please call me at ext. 324. V,e y trule yours, �J hn are 1, Jr., E. Public Health Director JK /jp enc. cc: JK File BI (T) PV Q J.t l c ` c 100 GARBAGE BA (TO BE REMOV 'AM R MACADAM R•2 DRIVE 102 Pr),d;?INC, BROO) T - WELL 6 SDA 100' AWAY. cf� NEAREST WELL d SDA OVER 140' AWAY. SS 0.0 W9 PIT CIO FlE49T WELL ROOM - 001".E MAIN NEAREST WELL d SDA OVER 140' AWAY.