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HomeMy WebLinkAbout2315DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -2 -28 BOX 20 V �} l �r TL -� F, - 02315 L +' i 16 V �} l �r TL -� F, - 02315 ® �1 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR 'ES NO Internal Use Only PERMIT# -� ❑ R air Permit issued in last 5 years Ptleegated in Watershed ❑ . Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review _ SITE LOCATION q ;� f S TOWN p V9a-/— TM OWNER'S NAME hu �-Q r c_e)4 ( PHONE # MAILING ADDRESS APPLICANT Z_&_OAA/ 6 Name & Relationship (i.e., owner, tenant, tractor) DATE FACILITY TYPE /, PCHD COMPLAINT # t- PROPOSED INSTALLER Z_eor k-►�0(c' 4 ,04 PHONE # ��� j '2® 3,7 5 ADDRESS 6 ° JA l� r t REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair., I, as owner,agree to the conditions stated on this form SIGNATURE. TITLE (owner) DATE I, the septic installer, a _ o c e conditions of this permit for the septic system repair U SIGNATURE TLE �L7� t � DATE U Zr ZOO (installer) Proposal approved with the following conditions: s 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved 2 Proposal Denied ❑ Pei, " I- Inspector's Signature & itle to Expiration Date Re air proposal is in compliance with applicable codes Yes ❑ No . COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 LORETTA ivfOLINARI- It.N °fvf.S3�f: Acting Public Health Director Director of Patient Services 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) 278 - 6014 Fax (845) 278 - 6648 McSpedon 12 Hunter Lane Elmsford, NY 10523 :.` "KOBER3 J: BONDI County Executive July 22, 2003 Re: Addition -Mc Spedon, 555 Lake Shore Dr. No Increases in Number of Bedrooms (T)Putnam Valley, TM #41.10 -2 -28 Dear Mr. McSpedon: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal .for the addition has been approved as per plans bearing the approval stamp from this Department dated July 21, 2003. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at three without prior approval by this department. r = m-a son _ The -aea. of t . rd - its expaniarea,- -msi be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:lm Public Health Technician cc:BI . t b BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S..N. Associate Public Health Director Director of Patient Services DEPARTMENT . OF HEALTH 1 Geneva Road Brewster, New. York 10509 Environmental Health (845)_278 6130 Fax (8.45) 278 - 7921 Nursing Services (845) 278 --.6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 -6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) Q��c� o� STREET. � 4 SGtDPC �1 TOWN PA �n� X Mt1P# NAB t.1 w -- PH 0 3 O S PCHD# MAILI\TG ADDRESS J AIM DESCRIPTION OF ADDITION NTj-i\.IBER.OF.EXISTING BEDROOMS PROPOSED # OF BEDROOMS U (FRONT CERT. OF OCCUPANCY OR . CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form.and the. following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY _ 10509, Phone 278 - 6130:'.., . 1. Certified check or money order for $100.00.. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert.. Of Occupancy from. Town or Certification from Builditlg Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 - BFhouseouidelines '1 F e: BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public. Health Director Z 4 Associate Public Health Director Director . of Patient Services _ - ar. 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 -.6130 Fax (845) 278 7921 Nursing Services, (845) 278 6558 :.WIG (845) 278 - 6678 Tax(945)278-6085 Early Intervention (845)278-6014 . Preschool (845)278-6082. Faz (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: G l Reskencl Tax ma , ( _ Town Gentlemen: According to records maintained by.the Town, the above noted dwelling IS � _ __ IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER BFhouseguidelines Building Inspector ci t L7r ^) Qj - / • � 4 1 rr'�r T , >• J O �l ®fit 12 ain z • a SW00UG38 - aINO MOD WOO9039 O-i(\Oudv skyld 3SIMH xv3 5T:zT Zvs CooZ/99/to X00 /E00 d _Wojd we80:ll EO- ZI-jhr 04/.26/2003. SAT 1 lob rv,l, i - . ........ --7 PUTNA COUNTY DEPART TMPNTOFIJEAA TU HOUSE PLA ROVED FOR BEDROOM COUNT ONLY, BEDROOMS /o -t I ul m 1. -1 %I rLIV 71 wig -160 "08%0],0..., A Y LORETTA MOLINARIvR.N.,:M.S.N. Acting Public Health Director Director of Patient Services 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) 278 - 6014 Fax (845) 278 - 6648 June 4, 2003 McSpedon 555 Lake Shore Dr. Putnam Valley, NY 10579 Re: Addition - McSpedon, Lake Shore Dr. (T)Putnam Valley, TM#41.10 -2 -28 Dear Mr. McSpedon: County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A finished basement. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. Floor plans for the whole house have not been submitted. If you have any questions, please contact me at your convenience. ML:hn Very truly yours, Michael Luke Public Health Technician .,4 VVV PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV-9-87 Located at 555 LAKESHORE ROAD Owner /Applicant Name GARY HUECKEL Formerly N/A Town or Village TOWN OF PUTNAM VALLEY ` Tax Map 41-10 Block 2 Lot 2 8 Subdivision Name ROARING BROOK - MAP 1 SECT. 3 Subd. Lot # 53 Mailing Address 555 LAKESHORE ROAD, PUTNAM VALLEY, NEW YORK Zip 10579 Date Construction Permit Issued by PCHD .10/17/96 358 PLEASANT RIDGE ROAD Separate Sewerage System built by STEPHEN STAUDER Address POUGHQUAG, N.Y. 12570 Consisting of-` 10 0 0 Gallon Septic Tank and 316 LF OF 2' WIDE LEACHING FIELDS Other Requirements: 750 GAL. PUMP CHAMBER AND PUMP & 3.5 FT. ROB FILL Water Supply: Public Supply From Address i BARGER STREET or: x Private Supply Drilled by /NORMAN ANDERSON Address PUTNAM VALLEY, N.Y. Building Type ONE FAMILY RES I,DENCE Has erosion control been completed? YES Number of Bedrooms 2 % Has garbage grinder been installed? NO yy _ / I certify that the system(s), as listed, serving the built plans (copies of which are attached), in a plans and the standards, rules and re ah Date: 5/22/98 Certified by Address 2 MUSCOOT ROAD NORT were co tructed essentially as shown on the as- ued CHD Construction Permit and approved D nartment of Health. R.E. R.A. X 34& 1 Lic se # 1 1 0 5 6 C) l I &66lqlW Any person occupying premises served by ab =M_n� 1 promptly take such action as may be necessary to secure the correction of any unsanitary con tions rm such usage. Approval of the separate sewage treatment system shall become null and voi F.a 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, modificati vtr m e is necess By� Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Desi rofessional Form CC -97 y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well.Location -,.- - - -_ =- . ...�:: ,.._..... _ Stre ddress•._ . -..:- -' T - r .... Tax Grid -# -�•-_.- ._ _.. _: _. -,r­''- Map Block Lot(s) Well Owner: Na Address: Use of Well: 1- primary 2- secondary Residential . 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 Open end casing Open hole in bedrock Other Casing Details Total length 2 / ft. Length below grade r —u. Diameter �` ". in. Weight per foot ZIb %ft. Materials: teel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: 2S Cement grout _ Bentonite _ Other Drive shoe: 2!CYes No Liner: Yes < No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped 7Compress.ed Air Hours E I Yield /Q gpm Depth Data Measure rom land su ace - static (specify ft) During yield test(ft) -... Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses . are avaiTabte; -` -�' please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface �� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity_ Depth 2-FD Model Voltage A340 HP —11 Tank Type AJ 24 Volumb o P _ Date Well te ; Putnam County Certi tcation No.. Date of Report _. S'r -71-f F, W 1 Driller (signature) Nuvt: Exact location of well wim atstances to at least two permanent4anamarxs to oe proviaeo on a separate sneevptan. Well Drillees Name 741X.t:,� a�9� Signature: Address: Date: W, White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Y;"•� ENVIRONMENTAL SERVICES 321 Koar Street Yorktown Heiw`ts. N.Y. :059w (924; 24� -2603 ani -, D.i: Lin 1. 334 CLIENT � • .- ::.:, h NNNNN -------------- � .'',P� TAT r"FOC PAGE 1 YNNNNNNM N-- w.- ---- -- ^. ANN.VMN ---- --------- A•NNNNNNN N ---- -- Y'IUECKE; r �t1r11" P.O. 3. BiJ!' - DATE / : ii i' ' E T _ 2'' t78 01:30 wAr F 'a tGEFcS . Vii`: 112 9:: RE%'D: 05/2G/• .78 Oies2oc' J% EFuFiT DATE; 05/22/98 PHONE: (9 14-4 J -8922 2524 SAMPLING NG 3: ► E i 355 LAKE SHORE DR. SAMPLE i YP:...: t"'GT43LE PUTNAM VALLEY. N. `�, PRESERVATIVES: NONE 3L' D 9Y: GARY HUECKEL �GTESNN : .:TC:;E'� TAP TEi''ft,ERA- brit..: 4C COLIFW'RM 11ETH: "F h..r -- N NNNNNNNNh h'N .ry yiyry NYNNNNNN NNNN.ti�r•vryyw•IVI,NN NI►NNNNNNN ------ --- •YNNN DF�'E FLAG rROC'ELDURE RESUt.":'/ tOF:;",t�L - RANGE METHOD ^ElcO;'93 Tr COL.FORM, ASSEN- f2ao ::L ASSENT lOJB i ACT ': 'r;ESE ReVULTE. I KUD I LATE T. HAT" -;y:= 'WATER (DHE (wr4s i4- ` OF P. SA 5r F;! F'r Y Oi cra:.: '"'f . N�.COF;: N ;+iEW YORK STATE' ~tiD =` �+ ` tl7E� t4�. DRINKING WATER S T h�NDARDS, FOR i ii-iE PARAMETERS ��l •i Al' 'tom TIME Ct~ AiSer; H,._.caac�,ia:-: i , 7. iASCF Direct-o; ELAP# 10323 J4" U_�c JC.lJJ fV 70a0e_0Vf r'. UG /U'C 4 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM..., ...- GARY HUECKEL Owner or Purchaser of Building Building Constructed by 555 LAKE SHORE ROAD Location - Street ONE FAMILY RESIDENCE 41010 2 28 Tax Map Block Lot TOWN OF PUTNAM VALLEY TownlVillage Subdivision Name Building Type 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: Month 5 Day 22 Year 98 Signature: tNch6�6 Ao�16) Title: SSDS CONTRACTOR Gen Contractor (Owner) - Signature Corporation Naive (if corporation) Corporation Name (if corporation) Address: 555 LAKESHORE DRIVE PUTNAM VALLEY State NEW YORK Zip 10579 Address: 358 Pleasant Ridge Road Poughquag State N.Y. Zip 12570, Form GS -97 ** TOTAL PAGE.02 ** PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location._:._.;.. v Stre. ddress• __ T e: - , Tax-Grid-#,..- Map Block Lot(s) Well Owner: Na Address: 'A Use of Well: 1- primary 2- secondary '>-- Residential 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 Open end casing Open hole in bedrock Other Casing Details Total length �' /�'/��ftt�. Length below grade f 4. Diameter e -" in. Weight per foot lb /ft. Materials: teel _Plastic _ Other Joints: _ Welded X Threaded _ Other Cent grout — Bentonite Other Seal: 2!S, em Drive shoe: ZCYes No Liner _ Yes x No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes —No Hours Second Well Yield Test _ Bailed _ Pumped 74-Compressed Air Hours Yield 16 gpm Depth Data Measure from land su ace- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are 'available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft: Land Surface _ If yield was tested at different depths during drilling, list: Feet Gallons Pei Minute Pump /Storage Tank Information Pump Type gj2A�,Qr Capacity Depth ;F-d Model Voltage ;2.30 HPL-14 Tank Type AJx 2. o Volum Date W-11 lete4 Putnam County Certification No. Date of Report W Il Driller (signature) 2 FTA NOTE: Exact location of well with distances to at least two permanent4anamarxs to be provtaea ✓on a separate sneev(piaan.. Well Drillees Name � r�ax L� rs,E Address: Signature: Date: �- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 GREENBERG ..._.._ Architect TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 MAY 27, 1998 PUT. COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 ADAM STIEBLEING IN GARY HUECKEL 2-94-19 ® PRINTS ® SPECIFICATIONS ® SHOP DWGS 0 SAMPLES El OTHER - Zj APPROVAL ® YOUR USE - 0 REVIEW El COMMENTS COMMENTS: ENCLOSED PLEASE FIND APPLICATION FOR CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SSDS. PLEASE CALL ME IF YOU HAVE ANY COMMENTS OR QUESTIONS. FROM COPIES TO: w � - Ga Hueckel- . 555 Lakeshore Road Putnam Valley, New York 10579 May 29, 1998 Bill Hedges Putnam County Department of Health Terravest Park Geneva Road Brewster, New York 10509 Re: 555 Lakeshore Road Putnam Valley, New York 10579 T.M. # 41.10 -2 -28 Dear Mr. Hedges, Enclosed please find receipt from Yorktown Medical Lab indicating that the additional tests are being done and that they have been paid for. Consider this letter my agreement to take any required measures if the results of any of the tests indicate that remedial action is necessary. Very truly yours, G Hueckel GH:stw Enc. ' YML, Inc. Environmental Services _.. P.O. Box 99, 321 Kear Street Yorktown Hts., N.Y. 10598 -0099- - j OFFICE HOURS:.9AM TO 5PM Monday- Friday 32. E304638 LAB # Date: Name: . r-ro r �r Y Ve G � Address: For Professional Services: -pro ft pvfm y 3vfi 0"-, �Ple 5, � *See note on back for stat T.C. only. FOR RESULTS OR SAMPLE BY PHONE To check on-the current status of a sample, or for verbal results, please- call ONLY between 2PM and 5PM weekdays. The lab staff are able to provide such information.only during this time. To obtain any information over.the phone, . _.. you .MUST provide the lab _number_ as , it appears' bri this receipt:` "No' nfrirmaian will be released - without this number. Please be certain that the quoted turn around.time has elapsed before calling, else your sample results TnAy not be. available. Thank you for your cooperation and your - patronage! FOR RESULTS /STATUS CALL (914)245 -2800 ...... between 2PM and 5PM..Monday- Friday only. 07/10/2002 09:48 8456292B07 JOEL GREENBERG PAGE 01 JOEL GREENBERG, RA, wAm. 2 NIOT ROAD NORTH MAHOPA% NE` W YORK 10541 845 - GM - 6013 FAX 845 - 628 - 2$OT SrIV mu j DATE: ��-- /(9 TO: RE: ATTENTION: FAX NUMBER: FROM: COMMENTS: TOTAL NUMBER OF RAGES INCLUDING THIS TRANSMITTAL. SHEET: 1- .2 IF YOU DON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSIBLE. !AN -4 -2000 TUE 12:38 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 (L LLI W z LLI LLI 0 to I. WWAMC0VMVZrAn%MrGFRkA= 5- Palo mm OR I?VMM MU" Im SLUM MIM vffi�p Smbdhmm Naaae ROARIM PWIM -AWbiL Lot 0 I= 1 Ransil no*k"o MOO 20. 9 VffINGM FAUS 12590 V.Y. !Y -590 Subdivision AR2royrzd Fee 'Enclose 0. Amnunt RMIXT MCF, .2-3r230 SX. Mdftg Too Lot Am no 0. AR APA1199 — Fff swum 6* cy limber of madlea�a - 3 9 P D-W-- 1000 314 LF 2 TT. MIM. LM011M, TR§RWS- To he asombsftd by an Masi. gmlp1m4 DMW by Zj---Amnm-B&RGM g PUTOW VALLETp. N.Y. 10579 DOW -3.5 F.P. or, R,.O.B. FITZ AM VTJW a AND PUMP I, I*Drsmnk that I man 4witalls, -nd ...pleteow remonsiblo tor ma design and Focktiom of the provolodamm(lol. 31 Met the mto da 14l 9 tom 40ail I the W above described win be construct" am shown on ifto approw" amendment than to and In accc 'a � anddird% rules anTr Um3l, mo. zmm on c I " a - the COMWalmlenor of MUKh Will County oww"Ment of ompth, gos; chid an camolal job MONW & "CUU11WO 01"COAltril9ti DID, a A I fattoryi t a* lubmated to the cepartmem. and a wition aLto►nmes will tie irarm fthed 0 owner. :13 h A :111111no by he bulmor. that sold builder wilt Y .he W 1DY 5111100 IN ~ onwal" condition any port of old sawirme diwe 1 415 , 'the 1W 121 years; Imenewd follow" the date of the lau- once of the approval *1 am cintuiciti• or icanaructfan co.mplion: W., I ■ orilgi I " 'of trAMO12) t I the drills* Wo doscrib" 460we in, Will be IMI*d as Shown on the approved Plan And thot old well Will be staff as on Wkth f as r FLLMG am OF the Putnam courtly Owarilmd of ""Im cmis 111ned P.a.- qq,^.,x L 11% Q Address- l W 9c tip- appROVED POP COMT14 UCT I 011h This approval *Kpires two years fr6m do o at 1446 6anstruction of 411i mm t... been undertaken and Is flimidemble for c-um or may tie amen000 or modified When camadwed our by t Co r Filioner of "with, Any chchoo r aiteratica of construction foomirds; It' AllI1W*vWd far 01150oul of 11611:k 66ml proY, vraler supply Gaily. permit; Rev. f ~101s8. Date J 42 Tftlm�ar rtF= Fl 0 LL W F- z D 0 U Z CE: F- D W Z: cr z m C14 m 04 LO L0 00 A I CN EN .4 p- (S) I WWAMC0VMVZrAn%MrGFRkA= 5- Palo mm OR I?VMM MU" Im SLUM MIM vffi�p Smbdhmm Naaae ROARIM PWIM -AWbiL Lot 0 I= 1 Ransil no*k"o MOO 20. 9 VffINGM FAUS 12590 V.Y. !Y -590 Subdivision AR2royrzd Fee 'Enclose 0. Amnunt RMIXT MCF, .2-3r230 SX. Mdftg Too Lot Am no 0. AR APA1199 — Fff swum 6* cy limber of madlea�a - 3 9 P D-W-- 1000 314 LF 2 TT. MIM. LM011M, TR§RWS- To he asombsftd by an Masi. gmlp1m4 DMW by Zj---Amnm-B&RGM g PUTOW VALLETp. N.Y. 10579 DOW -3.5 F.P. or, R,.O.B. FITZ AM VTJW a AND PUMP I, I*Drsmnk that I man 4witalls, -nd ...pleteow remonsiblo tor ma design and Focktiom of the provolodamm(lol. 31 Met the mto da 14l 9 tom 40ail I the W above described win be construct" am shown on ifto approw" amendment than to and In accc 'a � anddird% rules anTr Um3l, mo. zmm on c I " a - the COMWalmlenor of MUKh Will County oww"Ment of ompth, gos; chid an camolal job MONW & "CUU11WO 01"COAltril9ti DID, a A I fattoryi t a* lubmated to the cepartmem. and a wition aLto►nmes will tie irarm fthed 0 owner. :13 h A :111111no by he bulmor. that sold builder wilt Y .he W 1DY 5111100 IN ~ onwal" condition any port of old sawirme diwe 1 415 , 'the 1W 121 years; Imenewd follow" the date of the lau- once of the approval *1 am cintuiciti• or icanaructfan co.mplion: W., I ■ orilgi I " 'of trAMO12) t I the drills* Wo doscrib" 460we in, Will be IMI*d as Shown on the approved Plan And thot old well Will be staff as on Wkth f as r FLLMG am OF the Putnam courtly Owarilmd of ""Im cmis 111ned P.a.- qq,^.,x L 11% Q Address- l W 9c tip- appROVED POP COMT14 UCT I 011h This approval *Kpires two years fr6m do o at 1446 6anstruction of 411i mm t... been undertaken and Is flimidemble for c-um or may tie amen000 or modified When camadwed our by t Co r Filioner of "with, Any chchoo r aiteratica of construction foomirds; It' AllI1W*vWd far 01150oul of 11611:k 66ml proY, vraler supply Gaily. permit; Rev. f ~101s8. Date J 42 Tftlm�ar rtF= Fl 0 LL W F- z D 0 U Z CE: F- D W Z: cr z 07/10/2002 09:48 8456292807 JOEL GREENBERG PAGE 03 Z, �C►dA4^ Coss.. " rawnr wagm. login mod. to light .,: prown.r. sanar lom, .. nes mre art = size, stakes. td :2 -.;6" 3' sastd- fsiceas�.x:g W& - cle stakes to '� ed a saner iriggeasana. a at 4' Pt. at .5 t. V;= -dap.0 -amain - ' stones-Hod. coop _ �.: mom .Tm' I�1 :. • � Tim S G -' ••t�aa�d •$fie . Stmt , ulgg ' . . Zn T t�ies Ercp.ia P'H f1 3 S123 8:34 4,ff:35•• 8::4:6 :1`L . �?•' ZS 2. t. :�f:•3�67 _ a5 •8.T3 6' .' :.,:':22.•'.:,:; :t.; =:' 25 :.• '';:: 3' 8f =�:,�? 3. 3 8.x25: S.3 :7 t! , 25 4 8: 9.;49E 1.1 •2x''' 25 3 t1f3y3w67` JAN -4 -2000 TUE 12:38 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 ---�ROAPMIG—MOOK---�- @evlabn 0 Ovisin/AmIcissill Missive GARY. HUE= Date of P.A. Approval , , 1632 RTE. 9 UsUm Addilew To., WAPPI.NGER,, FALLS ip.y, 12590 z pat p, roviid Subdivision ADR Fee Enclosed[] 4,flUnt, RES DE . NC . E 23j230 S.F. . I& Ana GR FM Seedw 0* Nmmhw of Bedta , 3 Dedgm Flow G P D 600 PCHD Nafflmdosi Is Requlmd Whim FM Is eompliftid. 1000 314 LF OF's2 FT. WIDE LEACHING TRENCHES sepluillft sawomw SY@km to too" of Gagosi Sepift Tmk ud NOT SELB To be by = Addrew Watw Sop*. -P&& Sop* Pno Addnm in X --jidvab DA0 by ILI-Addiialis 'RARGM ST PTITNAM Mii�, N.Y. 10'579 So* F -i C' mvTi il-L- -6 ;-% 'n 'LI-rrT AIM% 1nTITUM f U7%11DL7101 7kWM DTTKM I represent that I am: wholly and.c mpletelly responsible.for the design and locati . on of - the Prop above described will be constructed Shown Orn, the ap . proved ameridmeni there to and 'in accordi County !)apartment -01 Multi% . a" that on completion thereof &'^Csrtificate of Construction be submitted to the Department, and a written guarantee will bit furnished the owner, his,ilL place In good oporstinig 'condlilion any port I of sal 'sou -g- di y u the perldm encisi of the approval of the Cortitkate of Construction Compliance 'it will be located as.shaernen the appiciii plan and that mid will will be Instal County Departines . of Multh. Date Signed_ APPROVED FOR CONSTRUCTION, . this approval expires two years . from revocable for cause or may be amended or modified when considered nlic'esl permit. Approved for disposal of domestic Uri Rev. -/ L0, 6 Ital 1OP/88 Data By I C-1 TT Is Commissioner of Heafthwill P. builder, that said l►uiWer will following thefdat• of the lum- i• drilled well described &be" ,riTM- nsof the Putnam P.E.- R.A. X No is been Undertak•n,and is alteration of construction Title C- a& L, J PUgNA ®UN.T,Y DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # 1 ON CERTLFIC F 0 I CE, Division of Environmental Health Services, Carmel, M. Y. 10512 PERMIT # col STR CTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town t� ,p Town or Located at �--A�F S ►\oQE- 1✓f ►vt Tax MaP14-2- (p Block 7 . t rot Subdivision D A.Q. t t t CE4 Subd. Lot M r'J 3 Renewal _ ❑ Revision _0 Owner /Address Lc-'>%j %5, t& l^JMV -&- S11R.v t� 0. -t_ to v Date of Previous Approval Building Type �ESIf��NGG Lot Area Z LaE Fill Section Only�� - Number of Bedrooms ?:I Design Flow C /P /D 00 P.C. H. D. Notification Required Separate Sewerage System to consist of Gal. Septic Tank and To be constructed by Icofg r aL Address Water Supply. Public Supply From Private Supply to be drilled by 0 F 13E'4l� ;� Sor1S Address Other Requirements 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance.- gY,'.the original system ro� an repairs thereto; 2) that the drilled well described above will be located as shown on tAe approved plan and that said well-will be installed in accordance W i he standards, rule nd regu a iTfions of the Putnam County Department of Health . ,r "'S'i a1 ' "` _ � S fi� A,KB 'I3U pp KEANE COPPEL.MA �. Date 3 —z.� -3 arttl:TTi�T1 `i`Li'fi 96T`N —Tt, 10 ", Red P.E. R.A. �. WIT. - MIC221410549 A PRO#ESSIONA RA'I101� o. tpit License N APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage, and private water supply only. Date rG f ,lT Bv-4- Title Rev. 6/85 KEANE C®PPELMAN ENGINEERS, P.C. 113 Smith Avenue MOUNT KISCO, NEW YORK 10549 TO LIEUVEQ OF UMUSO URL DATE 4 � � /R JOe NO. ATTENTION Ve RE: %9 G lea 81411 we z .5 xz- �. IV ,4i,1 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings rints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 764 AJ 0/4 THESE ARE TRAN M ITTED as checked below: or approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: Im. GMIM aaSL mat, if enclosures are not as noted, kindly notify us at once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMELt N. Y..- 10512....__...,~_. __ t . _ -• DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner .& R ,s Address S "e., y, odu, Vo s 8 ffi Located. at (Street. Sec. 14 Block Z Lot �lndicate neares cross street) Municipality Watershed (L SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking �� _Zq _ g �,. Date of Percolation Test o e Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to a er Water Level. No. Time From Ground Surface in Inches Soil -Rate . Start -StoD Min. Start Stop Drop in Min. /in drop r Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. Inches Inches lncries \. 1 \�'• �n - l o '• lto -24. ... 21 6 Z , 2 0: c-1 - a! -2-t, z4:. 3ko. -%o= `� Z4- Z -7 3 • ���, q. - o. Z7 3 3 lto:so =10 :s3 r 3 . ..:C4 24-- ��l�os -�� •:i4 z.4 �7 � 3 .5 . 3 111:20 :��:�ce �o Z4.. 2-1 3 Z. 2w, -2, 9 24 2-7 � 3 24 2"7 3 3 5 Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. .:� 'i'.�•'� �- APPENDIX B PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRORdENTAL HEALTH SERVICES INDIVIDUAL W1TER SUPPLY & SUBSURFACE SEMM DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT (Name of Owner) CATS i.& trencn proviaea required 60 ft. max. Parellel to contours A V - A'�r� t � I d4 (Street Location) YES NO DOCUMENTS Peumit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth s/s SUBDIVISION Perc (3) Fill cd House Plans - Two sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile -& Dimensions - Volume D or J Box;Trench /Gallery; Ptmip pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results . ,Two- -Foot -Contours Exizting : &-- Prop©sed- Driveway & Slopes Cut Footing /Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pmnped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1/4 " /ft, 4 "0; Type pipe . No Bends; Max. Bends 45° w /cleanout ,SEPARATION DISTANCES SPECIFIED ON PLAN L1;„ia 10' to P.L., Driveway, Large Trees,Top of fi 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Take (inc. expa 15' to Drains - Curtain, Leader, Footing 35'to catch basin,stormdrain,piped watercour 10'. to Water Line (pits -201) - 50' intermittent drainage course —4-. - R7.. -I-- 10' from Foundation; 50' to well 15' Well to PL Well 0- 0 -tthi� ArT 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date, I- 21b, - %-I Re: Property of Located at Section Block Z Lot Subdivision of .�a� �,a®®� Subdv. Lot # S S Filed Map # AA1 Date FOR KEANE COPPEL MA9 Gentlemen: ENGINEERS, P.C. A PROFI SSIONAL CORPORATION This letter is to authoriz�e���s�e F? L ®�t��.�u*a�c�► a duly licensed professional engineer ✓ or registered architect (Indicate to apply for a Construction Permit for to serve the above noted property in accordance with the standards, rules or regulations as promulagat.ed 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 the construction of said _.__ .._...sps em� or sj►s ems n.cvn?rormity° with °tlre - pmv -x skons..of-Art ic.l.e...2.45 or ,. -.. •.:., 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: Owner t7f Property P.E. , R.A. , Address WY.- ►oS 449 'rel.ephone 7,23 ,,el Ve, Address 5�gu b g a kk /i/ i, lo-5-P, P Town Telephone PUMAM COUNTY DEPT OF HEALTH - DIVISION OF E NVIRON4IFNTAL HEALTH SERVICES W! A... INSP ION REPORT .. (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property.............. Property lines or corners found ................... Can estimate house location ....................... Will driveway need cut ............................ Must trees be* removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway �L cut, house location, separation distances,etc... Adjacent wells /septics .................... ......... (� Access to vronosed well location for drillina..... D.H. 1 Lot, D.H. 2 Lot Depth to G.-W. Depth to G.W. Depth to rock Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 3 9 tft. 12 ft. - Sol.L Descri 0 ft. 3 ft., 6 ft. 9 ft. 12 ft. INSP. BY;* D.H. - Deep Hole G.W.- Groundwater D.H. 3 Lot - Depth to G. W. Depth to rock soli 0 ft. 3 ft. 6 ft. 9 ft. __..... - - 12 _ft. DATE: I YES I NO � CC'S - -- - -' - FINAL SITE INSPECTION INSP. BY: House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Room allowed for expansion trenches .............. Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded ............................ 10 ft. maintained from property line and 20 ft. from house.:.. ........................ Distance well to SSDS (f t.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes properly set ............................... Could surface runoff from driveway, roads, ground surface,.etc., channel near SDS area.... Does lot drainage appear OK•,in area of SDS:-:....... FINAL GRADNG OF SITE ACCEPTABI &:.. i — _ PETER C. ALEXANDERSON County Executive .. �.. _.. _ .. ..... - __ . • ..__ -..,mss -_.. - JOHN SIMMONS. M.D. Deputy Commissioner DEPARTMENT OF HEALTH Division Of Environmental Health Services February 23, 1987 Keane - Coppelman Engineers 113 Smith Avenue Mt. Kisco, New York 10549 �t ..'Wrv, Dear Mr. Co PP elman: RE: Proposed SSDS Madera Lake Shore Drive (T) Putnam Valley Tax Map # 14 -2 -6 Review of plans and other supporting- documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: submit another copy of house plans __.. recommend an oversized pump pit with one day storage over high level alarm footing arid" gut'fer" `dr`airis' metes and bounds are lacking 1 show SSDS's and wells on, adjacent lots C /1pn,�r��1� 1\ show clay barrier around fill section submit 3 copies of well permit application Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. . 4 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 Very truly yours, Anne Bittner AB:pt Asst. Public Health Engineer cc:AB JK File . 4 110 OLD ROUTE SIX CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 V ryl k��4� % • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date— Re: Property of- 6.4,eV /2. �✓t1E�/�EL Located at �- A�, K c= S i-f�CD R 1e-=: V /- Section / Block FORLot 4� INANE COPPELMAN Gentlemen: ENGINEERS, P.C. 4 AFE.Or SIGNAL, CORPORATION This letter is to authorize a duly licensed professional engineer V111 or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all nece$sary papers on my behalf in 1:1 mle l L:iuii w.L Lrl Liii5 ma is Let• a;lu ' to. Supervise one construc ciun of said- system or systems in conformity with then provisions of Article 145 or 147, Eduoation Law, the Public Health Law, and the Putnam County Sani- - Code . _ r OR KEANE COPPELMAN ENGINEERS, P.C, A, PROFESSIONAL COr- POF ATION Countersign P. R.A., # ��f '7i Address 1V£,'IiUE N.Y. X.OS.� +, VIM. 941-203- .; Telephone Very truly yours, Signed_ X e of­ Property Cot�rrn�i'�� Address y5yd 7 L9�4) Lf iz - .2544- Telephone 2 -7 8 - 9*-7 KEANE COPPEl MAN ENGINEERS. P.C. • 113 Smith Avenue MOUNT KISCO, NEW YORK 10549 TO e'k NV ll9a /'z WE ARE SENDING YOU Attached ❑ nder separate cover via_ ❑ Shop drawings Prints ❑ Plans ❑ Copy of letter. ❑ Change order ❑ LEETTEa OF TURSEDUML DATE JOB NO. .._ATTENTION ..�. //A _.:.r . _.._ _:._:....... <_7...TO:�._.. _ -__.. RE: &Ae V 2. 14e106.eae- 5,14-0 IZ16 42k2 V AMt7�1 > the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION > 5Sa5 P44A/, Pe Pd='�4 iC_ % G'Oq/s W&; /d A,/ Pe2/f THESE ARE TRANSMITTED'ai checked- below:' • For approval • For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY ❑ Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit -.copies for distribution • Returned for corrections ❑ Return, NW corrected prints ❑ -11 yrc'y. 19 ❑ PRINTS TURNED AFTER LOAN TO US t. Zdr `0 4 44 ,eL 01VA16o ,6)1 441416 A0045e - P &2,Cl- 5 o SIGNED: PRODUCT 2443 ses ix, k* Mm 01471. If enclosures are not as noted, kindly notify us at once. PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Keane & Coppelman Engineers 113 Smith Avenue Mount Kisco, NY 10549 Dear Mr. Coppelman: March 28, 1989 ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Re: Renewal*- Huegkel Lake Shore Drive (T) PV - TM #14 -2 -6 Permit # PV -9 -87 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1) Well permit application must be submitted for renewal. 2) Maximum application rate is 7 GpD/square feet, therefore, .300 linear feet of fields are required, not 250 linear feet. 3) The length divided by the width of the septic tank must be greater than two but less than four; septic tank detail shows less than two. 4) Dimension of fill must be shown on plan. 5) Septic tank and pump pit must be shown on fill section only plans. 6) Pump pit details, septic tank details and well details must be shown on ' .'Fill Section Only" plans. 7) Construction notes missing from plans. 8) Fill notes missing from plans. 9) Depth gauges must be shown on plans. 10) Proposed well appears to be in direct line of drainage of proposed sewage disposal system. A well to septic separation of 200 feet is required. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. LCW: jr Very truly.Yours, x9 awrence C. Werper Assistant Public Health Engineer i3 /�a(F% ,:��81u bin ct� lleaNn ie��avcr� iz,l .P � � .� i , J a�reof� �r I-All S .��tu) �rJ - tuF.Q.Q li�.._.. p A�� �, ssa s - ---- ------- __ �n�� c> �rv�a1 �c 1a��ew n-c,X i�L, 1. IJ �.. -- - - ------ - ---- - ----- ---- - - ----- - ---- -------- - -- --- - ---------------- ,70' Z;''"'_'�tr-` , '---T i -' "ti "°t {{ PUTNAM COUNTY DEPARTMENT OF 3 !L Eo eer to Provide'Permlt N , Division of Environmental Health Servteee Carmel xN Y 1051 r , 7 oe CERTIFICATE OF CO rml i M C STRUCTION PERMIT FOR SEWAGE D ISPOSAL SYSTEM Located ate ���� ��✓o�G ��%1/� 777 -7 Tows or V.Illego s Subdivon Name�� Sabel tLot N Taz Map Block Lot /J /u���Lr Renewal c ` Revteion p Otreer /Applie aet Name C7 AW `Date of Frevloes Appro -al'-' Town Address>G 40� 1V®t�Piw6� .mac, S n! ✓ i259b - Bauaiog Type /2ES1t7E NTH Lot Area .QG ifs Fill Section Only ' Do th Volnme Nember of Bedrooms Destgn Flow G P D tail' P.CHD NotlBcatlon Is"•Regalred Whee Fill li completed ; Separate.Sewerage system to consist of GeDon Septic Tank. "an�i 2 So A %�6�1�;f -! To be constructed by 2o%E/L �W.LI i/FS Address'° r Water Sappl) 1Pdblic Supply Flom e n Address or. PrWate' Supply DrWed by !' ���i SDAtidrees 1/ Other'Renaitemeets �r�Toa�a � ��� 4 6fiiirP- 66,/A/A,BE� iV f6ouGrJS �9f3� /Roo�G %�. h � �uiirr� »5 °barter` ® " "!�v V I rt+p,7esent that l am wholly an0�completelyrespona�ble for theytles,gn and loeation of thakDroposed systems) 1) that the„ se` paratetsewage .�"disposal'?sys4em_. above',descnbed:�w,ll be construc4ed as shown5on the aDD(ovad' amendment thereto andy mpccordance with the standards rules an regu a_.�ons o e u nam -County Department ofy Health Wand that on completion thereof a Ce %t�f�cate -ref ConstrucLOn :Compliance' satisfactory toidhe Comm_�ssioner_ of Healtfiw�ll Deaubm,ttetl; to the Department, antl'a wntten guarantee w,U De furnished the owner' hq wccessors heirs or assigns by the buJoer the idbwlderywilf _. _ �.. pbce in good %operating; cond�fion any part of said sewage disposal system tlurmg the per�oG Of two (2)..years iTmediately;'f011ow�ny th�te�f the �sw ante of the approval of the Certdicate o1 Constructwn Compliance. of tha;or�ginal system or any repairs thereto' 2) that r'I a d.._ will tie located as Shawn on the approved plan and that said well will Deinsta ordance w¢h the' tantlards rules and,,r a .u, r -thei °Puirfam�N County Oepa "rtment of Health ` ° e: �,�•IG4NG P.0 RATIOF License Nor � }' APPROVED FOR CONSTRUCYIQN This approval expires two years from the Aete �ssue0 umess;construcbon of the buJd,ng has been undertaken and is 1. revocable for ;cause or may be amentletl or'modd�eo.when coris,tlsred necessary;tiy the Comm�ssidnei of Health `Any change or alteration Of .CO rIftIUCt 1011- requires a ne per �t: Approved for disposal or Domestic sum y sewage ind or` p1.iv a water wpDly: only ` q. Rev. ,i Oate Tale 1/87 APPEND= B PU NP_^ CCL'Vr`J DE2ARTMaW OF HEALTH - DIVISIG'I OF E_VV- MCNMa?ML IT-AI n SZPVIC._S DD=ML W-A= SujP °r,? & SUESuaFAC✓' SZvA=-- DISFCSAL SYSTEMS .�. ¢- ..:,... r + -wua.� . �. •.•%r: _.... .- ., -.r. r , - ,. -RE=-W, PERMIT - v CC, (Zt'L, aa 4AK 1-� o2bF U2 DATE BY: R..V =;D: G w Ccrxrate Resolution (i�-rme or CNr_ =r) (Street Lcc-m i-cn ) F-hair_ears Authorization C-2�'A—PNTS I YE,:. I NO Ccrxrate Resolution Plans - Threes sets s/= F-hair_ears Authorization D--s-;_--n Data Sheet ( MS') S'urDrrSICN De✓n Hole Lca i� Ccrsisteat Perc Re_u t_ (3) rFill Parc Hole Deoth c� ICI I 0�; I I I I I I nw �� I A4v%, Out 0 I I ICI re=u__ 200 I I I 6J P= �! 7 tJ Crii�tJLSS ( I b D o �)S I "prs� I. S I: I I _ r = SYSTENE i I cl1avba_r?"_ -'?- I I I 10 ft. rill notes n=q sue. i I CeptIn caLC_ es W SI � �.I I 100 vr. flccd elev. Ste.' i 1 200 ft. reservoir, etc. 1_ J ft. t= I I I i I i DCC'�TTFr Permit A -ol i caaticn Ccrxrate Resolution Plans - Threes sets s/= F-hair_ears Authorization D--s-;_--n Data Sheet ( MS') S'urDrrSICN De✓n Hole Lca perc Ccrsisteat Perc Re_u t_ (3) rFill Parc Hole Deoth c� Hcl:Sc P1znS - Two se__ we11 pa --,n.L Variance- R. F--ueS C'tAL La---a -I S di ; S.icn _ S: ^ = °rsicn Auorva- C. -c:cea Ei - .�•r %4G1 SS-US Ad:. Tests C e..1C- Wet_ar d (Tc-A,/DEC Ps= = R & D) Data Cn CGS .Pla':S & D°__ it, Sale Rte; UU-ED DF, -- I c CN ' INS S-_=.vc�ie Sv SL.. q Plan - ( r =1 ar --o ) 5 S s to rvdra, is Pra_ __e - Gravity F-1-1- Fi1I ProfileIIIi*''_CIIS - i•,', —= D or J F:cx; TrenGZ /C=11 cr. ?; P'. uw pit Ce -lac S- ^LC Tank - Size, rrt_il we, 1 Lc+.=i I S.=r- ce L:Lne if Live Ccnst_~�cticn Notes. (crindrr -r te) _.._ . . besien Dat=_: per-- and +.de=c rasuitS Two-Foot Contours Exi sting & P_cccs-4 Driveiav & Sloces Cut Fcctinc C erJ�`lr -�s. -M Drams (c_ =cZarg_e C: {) Perc & Dear, Holes Lcc t Reprasant ti ve or primary and ec..ansicn ECJcTlsicc Arnie- ;shcvil ;_ravltV flacw,sufZ. size I F.mp—e-A Pit & D Ecx Shcw-n & Dezi- ?.fled Hcuse-? No. cf Benroa s Wells & SSDS's w /in 200 ft. of 7ropcse✓ S St, Prcce_* v Metes & Bcur_dv Hcus` Set: ack, Necessary (Tig:lt lot) House Sever - 1 /4 " /ft. 4 "0; rT'Te pig e No Bps; Max. Eends 45° w /c? uncut SER RATION DISVAN— S EPP= = CN PLAN Fields 10' to P . L. , Drive.vav, L -r =e 'I'r S--•S r TcC - or i 20' to Foundation Walls 100' to well; 200' in .L.O.D 150' Pitt. 100' to Stream, Wat__c— jarse, LaK` (Inc- eN- 13' to Ora; ns—Cu t3'_n, Lcda.r, Fcctlnc 35'tc c tch Lasin,stor_=ain,t1re - a W- ,-- ---L 10' to Rater Line (pits -20' ) 50' 1Lte�r iL tLer1 - Qr 2 n..sCe C__ircg S=ot c Ta n ks `10' r =cn Founcla-_lcn; 50' to all 1 -' WaLl to cL DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTIIK FILE NO. Owner Cary Hueckel Address 1632 Rte . 9, Wappinger Falls, 1N.Y D Located at (Street) Lake Shore Road Sec. 41.10 Block 2 Lot 28 (indicate nearest cross street) TOWN_OF'�,PUTNAMT. VALLEY Hudson River municipality _ .. W - Watershed *.1;1&'j6jV�11Vk11111 DIM Date of Pre- Soaking 7/ 2 9/ 9 6 Date of Percolation Test 7/30/96 HOLE 8:22 10 22 NUMBER CI= TIME PERCOLATION 3 PERCOLATION Run Elapse Depth to Water Fran Water Level 3 No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches PTH #1 18:03 8:11 8 22 25 3 8/3 =2.67 8 22 25 3 28:12 8:22 10 22 25 3 10/3 =3.33 3 8:23 8:34 11 22 25 3 11/3 =3.67 4 8:35 8:46 11 22 25 3 11/3 =3.67 5 ?TH # 2 1 8:05 8:13 8 22 25 3 8/3 =2.67 2 8:14 8:25 11 22 25 3 11/3 =3.67 3 8:26 8:37 11 22 25 3 11/3 =3.67 4 8:38 8:49 11 22 25 3 11/3 =3.67 5 1, 2 3 4 NOTES: 1. Tests. to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be suh ittod for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOIIS ENCOUNTERED IN TEST HOLES ,. :.. DEPTH HOLE N0. 1` _ - - 'HOLE NO. zT. 2 HOLE N0. '3 G.L. organic organic organic 1' trown sandy brown, sandy loa m rown, sandy loam 2' loam -mod. comp. mod. to light comp. mod. -eomp- medium large stones small to medium size stones`to 2' -6" 3' sand - increasing stones to ledge sand increasing with ep - e ge at 3.5 ft. with depth -small 4' at 4 ft, stones -mod. comp. 5' 6' 7' 8' 9' 10' 12' 13' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED none INDICATE LEVEL .TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED none DEEP HOLE OBSERVATIONS MADE By: Joel ,Greenberg, R.A. - DATE: 7/30/96 - DESIGN Soil Rate Used 1 -5 Min /1" Drop: S. D. Usable Area Provided 5,00 0 sf. No. of Bedrooms 3 Septic Tank Capacity 1000 gals, Type conc. Absorption Area Provided By 25 00 L.F. x 24" width trench Other 3 f t . bank run fill rte"\ ,��� �e14 E �R cgj Name Joel Greenberg, R.A. Address Two Muscoot Road North Mahopac, New York.10541 FOR USE BY Soil Rate Approved Signature SEAL / ONLY:, 0v WEPT sq.ft /gal. Checked by Date PUTNAM COUNTY'.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 8/12/96 Re Property of GARY HUECKEL - Located at 555 LAKE SHORE ROAD (T) PUTNAM VALLEY Section 41.10 Subdivision of ROARING BROOK LAKE Subdv. Lot # 53 Gentlemen: Filed Map # Block 2 Lot 28 Date This letter is to authorize JOEL GREENBERG a duly licensed professional engineer or registered architect_XK (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with - thia .- mattes• and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public He�L3th Law, and the Putnam County Sani- tary Code. 10 Countersiv e ED qRQ r��RENCE GRFc rs /i� Very truly yours, N /OAD v ' kXZX,R A.COO ,# 2 M NORTH Address v MAHOPAC N.Y. 10541 628 -6613 Telephone — Signed _ ,L� - - - - -- -t° .7 Owner of Property _1632 RTE__ 9 . WAPPINGER FAILS N.Y.12590 - -- Address Town 892 -2524 Telephone — GREENBERG Architect TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 ®;® 8/21/96 PUTNAM COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 ROBERT MORRIS HUECKEL, GARY ® PRINTS CI SPECIFICATIONS CI SHOP DWGS E] SAMPLES Cl OTHER COMMENTS: ENCLOSED PLEASE FIND APPLICATION FOR A CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM. _ZI . APPROVAL-- - Cl YOUR USE 0 REVIEW 0 COMMENTS COMMENTS: ENCLOSED PLEASE FIND APPLICATION FOR A CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM. DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Joel Greenberg 2 Muscoot North RFD #2 Mahopac, NY 10541 Dear Mr Greenberg: BRUCE R. FOLEY, R.S. Acting Public Health Director October 2, 1996 Re: Proposed Construction Permit Hueckel (T) Putnam Valley Review of plans dated September 9, 1996 last revision dated September 24, 1996 and other 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, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. is five feet to the- property -line. -Current codes -requires, 1 fe�f'of s paTatfori from the property line. 2. Expansion area is 177 feet from the proposed well. Current codes requires 200 feet of separation between a SSDS and a well in direct line of drainage. If you have any questions, please call me at ext 166. V e truly yours, Robert Morris, P. E. Public Health Engineer RM/JP OCT -03 -1996 10:53 JOEL L.GREENBERG ARCHT. JOEL GREENBERG, Architect Two Muscoot Road North Mahonac, Neco York 10541 914 -628 -6613 Fox 914 -628 -280,7 DATE: 1 Q 13/96 TIME: 11 a00 A.M. � 'Q: Pt17NAM 00(Am DEFT'. OF HEALTH RE: CARY HUEOM ,ATTENTION: MUXE FaLEYB R.S. FAX NUMBER: 278 -792.1 p FROM: ', COMMENTS: sEE ArkrAcmm LL 914 628 2807 P.01 IF YOU DON'T RECEIVE ALL PAGES OF TRANS11aSSION, PLEASE CALL LAS AS SOONAS POSSIBLE. TOTAL NUMBER OF PAGES (INCLUDING TIZANSIV=AL SKEET): 2 -,4O UV I`1616 -1616 WED M:34 AM PUNAM CTY ENV HEALTH FAX N0. 19142787921 P. 1 DEPARTMENT OF HEALTH Division Of . Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Joel Cnecnbcrg . 2 Muscoot North Mahopac, N Y 10541 Dear Mr. Greenberg: UU' R. Foi.EY; KS, Acting Public Health Director October 16, 1996 Re: Proposed SSDS: Hueckel 555 Lake Shore Road (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as folio «s,: Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, 11 Robert klortis, P. B. Public Health Engineer PJVujP "Tile construction of this sewage disposal system may be subject to Iocal wetlands regulations. You should contact local wetlands officials in this regard.'' 1. Plan is to note all SSDS within 200 feet of the proposed well and all wells within 200 feet \ of the proposed SSDS are noted on. plan or none exists. v 2. Fill.plan is not to show trenches in the profile view. 3. Fill plan title block is to be labeled "Fill Section Only'. Three sets of plans are to be. submitted showing the house, well, septic tank, overflow tank, pump it and fill pad. One ..._.- ..._.. -... ... _ ._._..plan ns•to lso siiismitted•showing�the trenches:° ._. r_..._.. _. _-_ t. _ � .�_.._. _�..._w...... �..._:. ; : _-_ �� _ _ .- �... _. 4. Footing/gutter drain discharge has not been shown on the plan. 5. Plan is to clearly state the well house, and septic system is to be staked by a licensed \ surveyor prior to construction. J 6. House is to be labeled as three bedroom. 7. Property metes and bounds are to be shown on the plan. �l S. Design criteria notes.250 linear feet of fields is required. Revise to note 300 linear feet. 9. Dose volume and dose volume. calculation is to be shown on plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, 11 Robert klortis, P. B. Public Health Engineer PJVujP 5-�J �3 -°1 6 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part.75 and Appendix 75 -A, 10NYCRR < - =_ w...,...,,._... • _..: ��._.,. .:......_... :ems_ _ .:,gin - _ for Indlvidual'Household Sewage Treatment Systems-- Name of Applicant Hueckel Gary No. Street CilylTown State Zip Address 1632 Route 9 Wappingers Falls, NY 1.2590 No. Street City/Town State Zip Site Location ' Lake Shore . Drive Putnam Valley, NY 10579 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil. unsuitable. Other(explain) ..................................................................................................................................................... ............................... _ ..... _ .............................................................................................................................................. ............................... ..... .I .................. ..... _--- .. ...................... :.................................................................... 2. Proposed design or conditions of waiver: . 1.).......5! .... separation. ... from .... the .... proposed ... well .... t.o ... pr.ope.r.ty ... line .. ............................ ............................... . 2.). ....... 17. 7.'. ...of....s.e.p.ar.ati.on ... from-the ... prop.o.s. a .d...we.11...t.o...the....p.ro. posed.... S. S. R. S... ........................I...... Well is in direct line of drainage. .........................................................................................................................................................................................................:...... ......................... .., ....:. 3) .- To r oRer.t.y.. 1ne. - _ . ......... .... ...... . . ... . .. .... . ....... ..... . . ..... ..... .... . . . . ........ ... .. ... ............. .. .... . . ................. .. . . . . ... . . . . ...... ..... . . . .. .... . .. ...... . .. . . .. . .. . .. . ... .. . .... . ..... ....... . ... .... . .. . . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. j Expected design life of the system will be diminished. Operation of sewage system is subject to*mechanical problems. Other(explain) ...................................................................................................................................................................... ............................... .................................... ............................... j Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked b issuing official for a change in conditions for which this waiver was granted. ("t0'FkffS§EtNfAAT' ......... ............................................. ............................... E OF COMMISSIONER of HEALTH ORIGINAL - Local Health Agency COPY - Applicant /Design Professional ( ................... >.............................................. ............................... DATE DOH -1326 (7/92) (GEN -152) NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: DEPARTMENT OF HEALTH Division Of Environmental. Health Services 4 Geneva Road, Brewster, New York 10509 ` (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER Jju-t" L a k� Sly, o p0_ Y- BRUCE R. FOLEY, R.S. Acting Public Health Director SPECIFIC WAIVER I 1 REQUEST: oz- DOES THE PROPOS7D0V'A'2-RIA1E REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? _ ES NO DISCUSSION REQUEST APPROVED OR DENIED APPROVED DENIED REASON FOR DENIAL DATE: %'Z� g �/, 14-16-4(2/87)—Text 12 - PROJECT I.D. NUMBER 617.21 SEAR State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATIO R_x�fAJK Municipality'(, �O County 4. _PRECISE LOCATION (Street address aro road intersections, prominent land arks, etc., or provide map) 5. IS PROPOSED ACTION: ,L�i New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIE LY: 7. AMOUNT OF LAND AFFECTED: 12 79 3 2 v - � Initially y acres ultimately _5 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Des ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE'IN VICINITY OF PROJECT? Residential_ ._0 Industrial.....,; ❑ Commercial ❑ Agriculture ❑ Park /Forest /Open space D Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STAT�R LOCAL)? Yes ❑ No yes, Ilst, ag ncy(s) and permit /approvals 11. DOES ANY AS CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes MNo If yes, list agency name and permit/approval 12. AS A RESULT OFy PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? y ❑ Yes U No I CERTIFY AT THE INFO ON PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE R AT Applicant /spons r name. Date: J Signature: V jactin is in the Coastal A a, and you are a state agency, complete the Coastal Assessment Form before proceeding with this. assessment OVER 1 :RT II— ENVIRONMENTAL ASSESSME14T (To be completed by Agency) r i� GOES _CnON EXCF"D ANY 'YPE i THRESHCL.0 IN 8 NYCAR, PART IS17.1Y? It yes. coorCinate the review oroces3 ano use me :JLL EAF C Yes Na i d. 'HILL ACTON RECEIVE CCt7RGINA7cC REVIEW AS ;gGVICED FOR UNUSTED ACT:CNS IN o NYCAR. ?AFT 4175? J •lo. a togat:ve cec:araucn 'nay be sucersecea, /anc:nec,gs?y - agency. - Ye- C. .,Ct LC 1C7!C:+ .AESUL7 N ANY aCVE=SE . ? =:C'S ASSCC ATED WITH 'HE = CL:C':nNG. Answers .-tav :e -ancwnt ;en. . er,•c•e- E.Xatlrq air - uauty. surrace cr ;rouncrater :;;auto :r zuanaty. noise evels. existing :rarfie :atterrs. scue vaste . =c_c;.cn :r :;s:os41 :otennal ter >-roslon :nmage :r ':occmg :rcwems? _xctmn Cneny: N0 C:. A,e/str.enc. agncuitural. arc::3ecteg:cai. 'usicric.:r otr.er natural or cultural rescurces: -r :ommunity :r - elgnoomcce :'sac;er' = sc:aln - narly- 1 CJ. Vegetation or ,aura. 'isn. 3relifisn ar wrte:ite scec:es. 31gnificact naertats. or 'nreateneo or encangerec scec:es? E=aiin.:r.ere. ND U. A community's exisung :fans cr ; :acs as cr::c:a ty aacctea. or a change in -,se cr r. :enslty of use c �, t✓ arc :r :tCer natural rescurcas? Exctaln cneity I I I I C:. Growtn, suoseauen::eveiocrrent.:r -e:atea ac%vities :Ikeiy !o :e rncucea :y :ne':rcoosea ac;:ca? = Lc:aln :net :y. . i N 0 C5. Lcng term, snort :era_ :ur-uiat:ve. c• _.::er effec :s nct .dentiflec in C:-C!? _cialn Cnatly. No C7. Cther :moacts tlnC:uciny :ranges :n .se of eltner 4uantity cr ;ype of energy)? c: :lain crletty. M D. IS THERE, OR IS THERE LIKELY TO SE. C: NTRCVERSY RELATED TO POTENTIAL ACVt~~SE ENVIRCHMENTAL IMPAC S? rut - LYes. - -.._ `1B.No. _It_Ye5..eXpl4In:nerfy 1+ PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identif led above, determine whether it is substantial, large, Important or otherwise significriit. 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. It necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY :. occur. `Then proceed directly to the FULL !AF and/or prepare „a positive declaration. i- ❑ Check :this box If you have determined, based o' the lnfiormatlon and analysis above and any supporting :'_documentation; that the proposed action WILL N07.reSult in` any significant adverse environmental Impsas D povide`on attachments as necessary, the reasons Lsupporting thisdeterminatlon: ';411`, ": t 1 �idt, ;'+i •.. ti' CR.i T.>°1CT� _ •.: _�' f -t ': [��1%t•: � ;•ei� t:.,�3 �•s, t ,��• .. _ Warne o lea A ::ri .:......; ^.;. t -.�:.• ,�� -'l. :p`: i4 ! e': ..r. ,,ti;.;..�.r�; �'�'.�e v �'ah-= t r. C; +G v.� i `, ar••� 1 'i ` //yA _ • 7 .t.. ,: \.'.•; =� . .� .2•yl -.,i )1 `' =, rte; s. - :1 .'�- 2 � - i - ?'�` .•C:Ly; .•�.:�Y(y4i` at: .J (.. :, � �J{ /p,,� .r T�1(/�[, :': i• r i .•' •'! � ^c '_ :.;7' .;n:•''it . i ,,,, ' .5+>j�.� �r: � i::i5,• �.:i.,; • `• "i �. • �' Pnnt Or Pe N esponslble O tKtr in lead'AQen<Y `- - - -lUe or Responsible OItKC1 cure Re st le ttteer m lead Agency _ cure of reparer (it dill cunt fmn rftpoftuble officef) - ..•... � .. _�..._ •__ .1�y• Y• '•n' ^7r ...... _.. .� ..��..� :. — `J,�� •ter ^ - ••.�t. --�- -r ,:� ••'�`f.^},!'; •F .''- fi ,,:yy. - +,.;T' � L1:.• .F J'Y•.- 7: "'•_ •• '•H_�,r..^ }��??;; t'i�991l''ey 7 :: -.. J. v.:a. i.•5^r_Y�::a.�'^�'.•�:.fi����'y; :` -�.' .r•' :. �'•l'._�� :1- _ •e .r',.. a.'Z- {i�js�.]`4 -- :'' ?�ur�`:.i.;S� ..,!��.•F.:•I�''L:,•�t"`��'y��. .a'S!��,�-- __ , APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL REVIEW .SHEET for CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE _/—/ TAX MAP # DOCUMENTS. Y PERMIT APPLICATION PC -1 WELL PERMIT M PWS LETTER ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS M VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION - M SUBDIVISION APPROVAL CHECKED M PERC RATE M FILL REQUIRED DEPTH M CURTAIN DRAW REQUIRED mSTANDPIPES HEALTH SERVICES SYSTEMS m IF UMPT JD6XS96WN &DETAILED IkI• • AN 200 FT. OF PROPOSED SYSTEM L L J PROTERTY METES & BOUNDS m HOUSE SETBACK NECESSARY (TIGHT LOT) m HOUSE SEWER - 1/4wr. 4 "0; TYPE PIPE =NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS CLAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE Qzi FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE /DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME GENERAL Ep FILL IN EXPANSION AREA X- APPROVAL SSDS ADJ. LOTS ( TOWN/DEC PERMIT REQ ?) VDATA TRENCH ON DDS PLANS & PERMIT SAME LF TRENCH PROVIDED =60 FT MAX -PRE- 1969 -NEIGHBOR NOTIFIFICATION LETTER BVZBA PARALLEL TO CONTOURS 100% EXPANSION PROVIDED - . loaYR :FLOOIS-ELEVATION-...-..<_.. _. ___ _..._.._.:_,.__:._,....:.....,._- .._.._...._...._._.,..:- ..__... _....._...: SEPARATION DISTANCES 'SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS �7ELDS ® SEWAGE SYSTEM PLAN= (NORTH ARROW) ( J I& TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL ® DJ SSDS HYDRAULIC PROFILE GRAVITY FLOW 20' TO FOUNDATION WALLS 15' WELL TO P.L RUCI'if3N N GRINDER NOTE) 100 TO WELL, 200' IN D.L.O.D., 150' PITS m DESIGN DATA: PERC AND DEEP RESULTS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) m TWO -FOOT CONTOURS EXISTING & PROPOSED 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER m DRIVEWAY &SLOPES CUT TnO� A�ITR�LIN ED (PITS-20') m FOOTING/GUTTER/CURTAIN DRAINS ®50 RAWAGE COURSE m EROSION CONTROL; HOUSE,W_ELL, SSDS 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS m EROSION CONTROL NOTE EP 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35'- 1%,100' <1% m PERC & DEEP HOLES LOCATED VEIPTIC 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. m REPRESENTATIVE OF PRIMARY AND EXPANSION TANK m LOCATION MAP m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: OCT -03 -1996 10 :54"7 JOEL L.GREENBERG ARCHT. 914 628 2807 P.02 JOEL L. GREEN13ERG A R C H I T E C T 2 MUSCOOT ROAD NORTH - - MAHOPAC, NEW YORK 10541 (914) 628.13 FAX (914) 62 &2807 October 3, 1996 Robert Morris, P.E., Public Health Engineer Putnam County Department ,of Health 4 Geneva Road Brewster, New York 10509 Re: Construction Permit for Gary Hueckel Lake Shore Road Putnam Valley, New York 10579 T.M. 41.10 -2 -28 Dear Mr. Morris, I am in receipt of your letter dated October 2, 1996, and as per my letter of transmittal dated September 10, 1996, I respectfully request, on behalf of my client, the following variances: 1. Proposed well is 15' from the side property line as required by code but only 5' to the front property line (Lake Shore Road). A variance of 10' is requested. 2. The proposed leaching fields are 205' from the proposed well (200' is required). However, the expansion area is 170' from the proposed well. A variance of 30' is requested. 3. A fill section is required for the leaching area. The toe of the slope is r� uir..ed to be 10' from.the . - ro e - life, Ttte_ ro osal. is_: to be 'n q P P rtY P - P _. y.. . the slope at the property line. A variance for this is requested. I would appreciate your considering these variances as soon as possible. Thanking you in advance for your interest and cooperation. Acting Public Health Director TOTAL P.02 `03 -1996. 10 51 JOEL L.GREENBERG ARCHT. 'DEL GREENBER.G, Architect wn - Muscoot Road North 2'ahopac, Nat; York 10541 4- 628.6613 fox 914- 628 -2807 DATE: TIME: TO: RE: ATTENTION: FAX NYJMBER: FROM: COMMENTS: 10/3/96 11:00 a.m. PUTNAM MUNTY DEPT. OF HFALTH GARY HUEC M ROBERr MOMS 278 -7,921 J= C tG; R.A. SEE - 'ATTACK LE rm. 914 628 2807 P.01 IF YOU DON "T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL .t15 AS SOONAS POSSIBLE. TOTAL NUMBER OI' PAGES. (ZNCLt, lNG TWSI,%I=AL SHEET): ' OCT -03 -1996 10:52 JOEL L.GREENBERG ARCHT. JOEL L. GREENBERG A R C H I T E C T 2 MUSCOOT A(QRD NORTH MAHOPAC.C. NEW YORK 10541 (914)628 -6613 FAX (014) 62&2807 October 3, 1996 Robert Morris, P.E., Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Construction Permit for Gary Hueckel Lake Shore Road Putnam Valley, New York 10579 T.M. 41.10 -2 -28 914 628 2807 P.02 Dear Mr. Morris, 1 am in receipt of your letter dated October 2, 1996, and as per my letter of transmittal dated September 10, 1996, I respectfully request, on behalf of MY client, the following variances: I. Proposed well is 15' from the side property line as required by code but only 5' to the front property line (Lake Shore Road). A variance of 10' is requested. 2. The proposed. leaching fields are 205' from the proposed well (200' is required). However, the expansion area is 170' from the proposed well. A variance of 30' is-requested. 3. A fill section is required for the leaching area. The toe of the slope " is-required to be 10' from the property line.; The proposal. is to begin the slope at the property line. A variance for this is requested. I would appreciate your considering these variances as soon as possible. Thanking you in advance for your interest and cooperation. cc: oruce voiey, mzi. Acting Public Health Director TOTAL P.02 DEPARTMENT-` OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION- TO- CONST -- RISC- T-:-Ft..WATER- -= WELL-: PCHD PERMIT�I�L WELL LOCATION G id Nu r Street Address Town/Village/City TV, LAKE SHORE ROAD PUTNAM VALLEY WELL OWNER Name GARY HUECKEL, Mailing Address ®Private 1632 RTE. 9, WAPPINGER FALLS, N.Y.1259Ob Public USE OF WELL 1 - primary 2- secondary j] RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM 0 TEST /OBSERVATION 0 OTHER (specify, O INSTITUTIONAL O STAND -BY O AMOUNT OF.USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE 150 gal ❑ REPLACE EXISTING SUPPLY O TEST /OBSERVATION LIADDITIONAL SUPPLY $I NEW SUPPLY NEW DWELLING CI DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NEW DWELLING WELL TYPE IX DRILLED DRIVEN ODUG 13 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ROARING BROOK LAKE Lot No. 53 WATER WELL CONTRACTOR: Name NORMAN ANDERSON -Address: BARGER ST . , IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY DISTANCE-TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION ON SEPARATE SHEET 8/12 96 (date) 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 thirt -y (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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dri g operations be contained on this property and in such a manner as not to degrade or of erw s contaminate surface or groundwater. Date of Issue: Date of Expiration Permit is Non - Transferrable 3/89 19 19 Permit Isst.ng Official White loopy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION 'TO CONSTRUCT -A -WATER ' WELL; "` -' —� PCHD PERMIT #. - WELL LOCATION Street Address LA.V-E "JHoeE Town/Village/City Tax Grid Number .ice vT*-1A ALL. WELL OWNER Name �s Address G-Private �_� " a O Public USE OF WELL 0- primary 2 - secondary ,��,. �! - SIDENTIAL ® BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED /EST. OF DAILY USAGE oo gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING o �,., pia c o 3 ��., «-►-� a �- ��.cic�ti.L_, ,�► WELL TYPE DDRILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES ,/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 20/��.�►JCy 3�2oo1L 1.��[ E 1 V_ E Lot No. (p WATER WELL CONTRACTOR: Name P. F, dEa.�. E� �o�►S Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES \,-'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY :DISTANCE TO PROPERTY FROM - NEAREST' WATER MAIN: ' M% LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION P TE E EE SScs DE��r��► (date) (signature) FOR ? KEANE e.+ nfi PERMIT ENGINEERS, P.C. A PROFESSIONAL CORPORATION 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: �i /�� 19 �r��� Date of Expi rati ont'l,�--,_-h /3 19 Fermi t Issui n ff Permit is Non - Transferrable M. DESIGN DATA SHEET- SUBSUFACE S&WE DISPOSAL Owner Gary Hueckel Address 1632 Rte. 9, Wappinger. Falls,. IN Y 12 90 Located at (Street) Lake Shore Road Sec. 41 .10 Block 2 Lot 28 (indicate nearest cross street) MuriiCi 1i TOWN OFt PUTNAMi,�VA, LLEY Hudson River pa ty ;. Watershed SOIL PEROOLATION TEST RATA MU.LREU TO BE SUBMITTED WITH APPLICATIONS Date bf pre- Sbaki.ng 7 / 2 9. / 9 6 Date of Percolation Test 7/30/96 HOLE' �• a+:Zi•�i tits -i%;� Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop. Inches Inches Inches )TH #1 1 8:03 8:11 8 22 25 3 8/3 =2.67. 2 8:12 8:22 10 22 25 3 10/3 =3..33 3 8:23 8:34 11 22 25 3 11/3 =3.67 4 8:35, 8:46. 11 22 25 3 11 /3 =3.67 5 'H # 2 .1 8:05 8:13 8 22 , 2.5 3 8/3=2.67'-.--- i 2 8:14 8:25 11 22 25. 3 11/3 =.3.67 3 8:26 8:37 11 22 .25 3 11/3 =3.67 4 8:38 8:49 11 22 25 3 11/3 =3.67 5 1 2 3 .5 NOTES:. 1. '.Tests to be repeated'at same depth until approximately equal soil rates are.. obtained at each percolation .test hole. . All data to' be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH 13', _141 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED none INDICATE LEVEL. TO WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED none DEEP HOLE OBSERVATIONS MADE By: Joel Greenberg, R.A. DATE: 7/30/96 DESIGN Soil Rate Used 1-5 Min/1" Drop: S.D. Usable Area Provided 51000 sf. No. of Bedroaus 3 Septic Tank Capacity 1000 Absorption Area Provided By 314C.' L.P. x 24" width trench Other -3--s ft. bank run fill & Pump amumm Name... UPe-1 Greenberg, R.A. Signature Address Two Muscoot Road North s7( 1.0541 THIS SPACE FOR USE BY HEATH DEPARTMENT ONLY:, gals. Type conc. /N �Al 00 Of. NF Soil Rate Approved. sq-ft/gal. Checked by Date e 3 G.L. organic organic organic 13rown sandy brown, san y. oam rQwnj.Eiandy loam 21 loam-mod. comp. mod. to light-comp. -mod..-eOmp-medium large stones ...small to medium- -11 SIZ6 sl;iieis� t7 TT 6 31 sand-iricreasitig stones.to ledge sand increasing Vith :depth-lpdge at*.3.5 ft. with depth- small. 41 at 4 ft • stQnes-mod.-c'omP'.. 13', _141 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED none INDICATE LEVEL. TO WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED none DEEP HOLE OBSERVATIONS MADE By: Joel Greenberg, R.A. DATE: 7/30/96 DESIGN Soil Rate Used 1-5 Min/1" Drop: S.D. Usable Area Provided 51000 sf. No. of Bedroaus 3 Septic Tank Capacity 1000 Absorption Area Provided By 314C.' L.P. x 24" width trench Other -3--s ft. bank run fill & Pump amumm Name... UPe-1 Greenberg, R.A. Signature Address Two Muscoot Road North s7( 1.0541 THIS SPACE FOR USE BY HEATH DEPARTMENT ONLY:, gals. Type conc. /N �Al 00 Of. NF Soil Rate Approved. sq-ft/gal. Checked by Date e O eUGIMW UkAffiCy UUpU1'GJ­1AL ul ntnl vu JAvision of Environmental Health Sorvlosc 1pprovod as noted for conformance with LpIdicable 11ules and Regulations of t6 )UtUaM Colmty Du 99z. me t nt. Tula THIS 1O CERTIFY THAT UM SiijkGi DISPOSAL SYSTEM NAB CONSTRUCTED .-hS INDICATED ON THIS, PLAN AND THAT'THE SYSTEM WAS INSPECTED BY--ME- BEFORE - IT,WAS COVEREII)i OVER THE SYSTEM HAS CONSTRUCTED In ACCORDANCE VTTH ALL STANDARD-RULES -:RND REGULATip" OF THE' PUTNAM COUNTY'DEPARTMENT OF HEALTH SHEET NO: CLIENT: DRAWING TITLE: REVI510145: DATE: j PROJECT NO: NEIN RE51PF-NrF- FOR: HUF-r-,<EL JOEL L. GREENHR& ARCHITECT A5 BUILT 5EM6E 5 -22 -q8 D 2 -941q ,)OAR'T' 015PO54 SYSTEM 4 ffli 55 LAKE SHORE RCAI�) Z 2 MFjCWT ROAD NORTH MAHOFAC, N&I YORK 0541 SCALE: t, PM/rHK9 BY: t I,- 0 PUTNAM VALLEY N.Y. 1051q TAX MAP No. 41.10-2-28 MW 62b-6M FAXMW6Z-2W 1'.= 20'-0" j.L.r.,. i.L.rz, :z 00 r'D 00 %0 to > c Ln 4h. w W W is ift I---- = -1 %A1 .91 OF THE' PUTNAM COUNTY'DEPARTMENT OF HEALTH SHEET NO: CLIENT: DRAWING TITLE: REVI510145: DATE: j PROJECT NO: NEIN RE51PF-NrF- FOR: HUF-r-,<EL JOEL L. GREENHR& ARCHITECT A5 BUILT 5EM6E 5 -22 -q8 D 2 -941q ,)OAR'T' 015PO54 SYSTEM 4 ffli 55 LAKE SHORE RCAI�) Z 2 MFjCWT ROAD NORTH MAHOFAC, N&I YORK 0541 SCALE: t, PM/rHK9 BY: t I,- 0 PUTNAM VALLEY N.Y. 1051q TAX MAP No. 41.10-2-28 MW 62b-6M FAXMW6Z-2W 1'.= 20'-0" j.L.r.,. i.L.rz, urq vvU SHELF 3RADE PLYWD I NE GRADE PLYWO uG W/6 MIL ARRIER CONC OPE 1 /8 "!FT 1 EXP JT-- -1 0 EAVE SECTION DET. SCALE: 314" =1'A" 0 iD 10" CS FOUNDATION WALL. — WATERPROOF. __—_— _ —_ —_— ON 20" X 10" CONT POURED CONC FTr- R -19 BATT INSU It• c• PT WD RAILING SYSTEM. TYP. • :•iv, r ,i�'ll: CRAWL SPACE AC 12" CESS DOOR' �� ',24" DIA SONOTUBE ON X 24" X 12" CONC FTG..TYP. O i BASEMENT ' 5 ✓1 L ' t � I 12 I CHIMNEY 12 1J2 GWB PTO TYp } °t� t. Ir 1 ENCLOSL WURAILING W 4 ' P v v 1 � v v Y t� V V - v . \ k SHINGLE CHIMNEY ENCL URE AS PER OWNER. 11 CONT. RIDGE VENT AT CATHED�.tAL CEILING, TYP. S' k; 112" DIA TIE RODS AT 41r - -- AT CATHEDRAL CEILING TYP. 2 X.12 RAFTERS @ 16" O.0 u: `— — W1112" CDX PLYWD SHEATHING,. 15# BLDG FELT v 250# ASPHALT SHINGLES MIN. .� TYP ROOF CONSTRUCTION. { ; R -19 BATT INSULATION-.TYP.. ANDERSON RV2857 SKYLIGHTS -�_- .� -7 - -- --- -- --- - t - R� 2 X 8,, WD STUDS ;{x.16" Q.C. 1!2" COX PLYWD SHEATHING . 0 15#BLDGfELT: SHINGLES, COL0h2 & STYLE M AS PER OWNER. TYP. .2 X 8 PT WD FLR ,FOISTS D16 "O.C. W /2X6•PTWD ECKING 44- -- ---- _— _— T - -_ —_ PT WD RAILING SYSTEM. TYP. CRAWL SPACE AC 12" CESS DOOR' �� ',24" DIA SONOTUBE ON X 24" X 12" CONC FTG..TYP. O i BASEMENT ' 5 ✓1 L '