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HomeMy WebLinkAbout2540DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -24.1 BOX 22 02540 LJ Jr. A. ., b# ` qr 6 t '� , F . 02540 1 y BRUCE 1K. _FOLEY _:- public Health Lairectvr L_ ORETTA _MOLINARI RN„ 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 (845) 278 - 7921 Nursing Services (845) 278 6558 WIC (845) 278 - 6678 Fax (845) 278 - 78 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 26082 Fax (845) 278 - 6 ADDITION APPLICATION (RESIDENTIAL ONLY O STREET ?0 S i V i� TOWN. A\hcir t CI XMAP.# NAl "C"�x J \ PHONE �f - - y 3G - �3 � e PCHD# -0 5 MA UNIG ADDRESS 30 S M ec; �` V DESCRIPTION OF ADDITION V\1-\ ��-S -e ,via r`i_ NUMBER OF EXISTING BEDROOMS 4 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Pulnam County Sanitary Code. Please submit this foriii 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 Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Mow ceidelines r' Ate_ LORETTA MOLINARI Public Health. Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Envlronniental Health (845) 278 - 6130 Fax (845)278 -1921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678. Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845)278 - 6648 Putnam County Dept.. of Health ( C1 0-K- 1 Geneva Road Brewster, NY 10509 Re:�l?OIIY! a Residence ROBERT L BONDI C=ry Executive Tax Map g) . 0 —1 7 o7 . Town__2uhnamn V o L To Whom It May Concern: According to records maintained by the Town, the above noted dwelling, Ts 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: `3 "" houseguidehes 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 Swansen 30 Silleck Blvd. Putnam Valley, NY 10579 Dear Mr. Swansen: ROBERT J. BONDI County Executive February 28, 2005 Re: Addition — Swansen, Silleck Blvd. (T)Putnam Valley, TM #51.19 -1 -24.1 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The office is a potential bedroom. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is five. - .....,-3: - The -addition -of. a-potential bedroom. requires -this Department' -s- approval of a revised.,. septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions,'please contact me at your convenience. 1 41 t Sincerely, Michael Luke Public Health Sanitarian Environmental Health (845) 278 -6130 Fax (845) 278 77921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 IT6 3'5 47 —T 1'8"4{.1'8'41 Laundry Compute Room Y) ;hen Bathroom UP cn ning 30M Living Room PUTNAM COUNlY DEPARTMENT OF HIAUTH HOUSE PLANS APPROVED FOR BEDR.00i'v! COUNT ONLY; pifl)-Oms -fYS 3 t -7 �5'�T,Yaftm I Ift 5'8"4 V 3'6'5 — 141 24'1 "1 m m HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; N O_ m v "v iEALTH � BEDROOMS "i^ nature & Title Date 0 Maw.07 05 09:06a Paul Swansen yci...ti �t 845- 526 -2376 F--- — L.aPL '-'jam• –• —Yl •--- r...._ ..._.__ — � –_4Sl .. I I •y I I I ekl,_ I r ' F•— •V6-- - � —ae —. L.LL.E = �L.OGL•IZ.OL,L= PUTNAM COUNTY DEPARTMENT OF HEALTH N(7USE M ANS ApRROVED FOR BEDROOM COON i ONEY; T GEDRCK) I Y . 317 jo5 Signature &Title - — Date p.2 i d wW m As z n� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Swansen 30 Sil.leck Blvd. Putnam Valley, NY 10579 Dear Mr. Swansen: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive March 7, 2005 Re: Addition — Swansen, Silleck Blvd. No Increases in Number of Bedrooms (T) Putnam Valley, TM #51.19 -1 -2 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 March 7, 2005. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must 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 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. ML: lm cc: BI (T)Putnam Valley Sincerely, Michael Luke L. Public Health Sanitarian 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 r/ P UTNAM COUNTY DEPAR TMENT OF HEALTH �l CE IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at v S 1LLPL -K 1� Town or Village PVT 1U&:!:1 V4--L J , Owner /Applicant Name P � � w Sr--)0 Tax Map 5 , I �) Block Lot Formerly Subdivision Name P41)L Subd. Lot # i Mailing Address '; y pIr Zip OC Date Construction Permit Issued by PCHD Separate Sewerage System built by Ca ,.�t'/'_4ai, y C Address L6X Ki i .. Consisting of v Gallon Septic Tank and ! Mb JJ /s , t Other Requirements: Water Suppllv: Public Supply From, Address or: Private Supply Drilled by Address 1571 Building. Type AV0� Has erosion control been`comileted.� " "'�" - Number of Bedrooms �1 Has garbage grinder been installed? 9 G I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), 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: '7, -7 Certified by Address P.E. L/ R.A. # 6527S2 Any person occupying premises served by the above system(s) shall promptly take 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 w_ hen, in the judgment of the Public Health Director, such revocation, modificaftion or chan a is necessary. B — Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Professional Form CC -97 a� COQ. " �� W �4 • WP:LL UU1"1rLZ11U1v Rr•rUAi DEPARTMENT OF HEALTH ...-Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET AOURESS: 11ANjy1UAWcIIy i TAX GRID NUMBER: WELL LOCATION WELL OWNER N ADDRESS: � PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary fid RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE --- .S'oo YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING J-NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA I WELL DEPTH ft. STATIC WATER LEVEL l`� ft. DATE MEASURED DRILLING EQUIPMENT �4 ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END. CASING. �9 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH fL MATERIALS: `ZSTEEL ❑ PLASTIC O OTHER CASING LENGTH.BELOW GRADE --ft. JOINTS: O WELDED -ZTHREADED O OTHER DETAILS (� %� �� DIAMETER In. SEAL: CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT _LZ Ib. /ft. DRIVE SHOEXYES ❑ NO I LINER: O YES �NO DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN FIRST O YES ONO - .DETAILS- ...... _ SECOND . _. ....__ ._ ; ..:. _.. : _ -. r _= - _ _ ._ _.. _... _...: ... SOURS GRAVEL PACE; O YES O No GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD 7 EST If detailed pumping METHOD: O PUMPED 1 tests Were done is in- OCOMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑YES ONO 'WELL LOG 11f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- i ^9 Welt Dia- mete FORMATION DESCRIPTION CODE. ft. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Surface % WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HIP WELL DRILLER NAME OAj ADDRESS y SIGFntTURE - 1A /-1) dn' N ' � / � YML ENVIRONMENTAL SERVICES 321 KearStreet' w nc=He�ght���lV. -y 598`'''`���`��"��� . (914) 245-2800 Albert H. Padovani, Director LAB #: 87.304941 CLIENT #: 7961 ~~~~~~~~~~~~~~~~~~~*~~~~~~~~~~~~~~~~~~~ SWANSEN, PAUL 30 SILLECK BLVD � 'PUTNAM VALLEY, NY 10579 NON STAT PROC PAGE 1 ------------ ------------­---------------- � DATE/TIME TAKEN: 0 5 DATE/TIME REC'D: -~-j�­30 REPORT DATE: ' 09/19/97 / PHONE: (914)-526'2376 SAMPLING SITE: SAME SAMPLE TYPE..-: POTABLE PRESERVATIVES: NONE COL!D By: PAUL SWANSEN TEMPERATURE..;`;' 4C ' NOTES...: BATHROOM SINK COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ' 09/17/97 MFT. COLIFORM ABSENT /100 ML ABSENT COMMENTS: WAS NOT) OF A BACT THESE RES ULTS IN D I CATE THAT THE WAT SATISFACTORY SANITARY QUALITY ACCORD E NEW YORK STATE ' AND EPA FEDERAL DRINKING WATER STANDAR THE.-PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Alb er H. Padovani, M.T.(ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage g c) `5 Location - Street Subdivision Name _o`t� F7MCy - -A 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 € uarantee 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 � Day Year � Signature: j_ Title: © W t' u &er General Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: -3 p 5, (iQc -a I Uj) 1ey Address: State. Zip 16 577 State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION TM # :3 Cl -,a -- 7// 1 1. Sewage System 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., greater than 15' from STS area.......... e. 100' from water course / wetlands...' .. ............................... II. Sewage System �o s 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 ........... ........:...................... f. ., reennche 1. Length required 5 '© 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 - 1'/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ..................... . ::. .101 Pipe ends capped :...:..:...:::.:....: ::.::.:.. ....- :.....::.:........ g. PumR or Dosed Systems Size o pump chamber ................ ............................... 2. Overflow tank .........................:... ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. ouseBuildin a. House located per approved plans ... ............................... b. Number of bedrooms ........................ y........................... IV. Well a. 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 Workmanship 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided .................. ............................... Rev. 6/97 Date: J `!- S -A- �. Owner' ` ,jP40c•w�� �. Permit # ft) 9 S Subdivision Lot # / V ADVPWf,TY T. PUTNAM COUNTY DEPARTMEM OF HEALTH :..., ,.- .......:- _ DIVISION OF'ENVIROhPAaT hEALTH -SERVICES` v DATE: I I d a RE: Property of RAQ, L SWA�.J $ Ei J Located at SIL K V useQ t,.EVARZ PUT& A-m VA•U Af' Aj`L° (T) S6eetzon 3 �} Block 2 Lot 7. t l Subdivision of � ��- -5 V1 A' S Subdv. Lot # l Filed Map # Date I Zc3� 40 Gentlemen: This letter is to authorize noeeaT S, RArJDALL P. E. a duly licensed professional engineer ✓ (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 Cc nnissioner 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 ccnstruction of said system or systems .in...(;.onformi.ty. with- th_e - - - -- ... provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: �44L4d P.E., R.A., # 51-75L ISTI GQvss RoA40 Address J Very truly yours, Signed �I' ~O•. 521ds 0.� �r -Ali . 66� CAS CQMGJ\� k� y Address ')V\q�,NA vdkev 71 Town q 1-4 — - - x.376 Telephone °) bs . 19 Sr PUTNAM CnUNrY DEPARMaM OF DIVISION OF ENVIRONM7ML HEALTH SERVICES DESIGN DATA- SHEET SU SUrACE;,SFv?GE "DISPOSAI: SYSTEM FILE NO Owner PAWL 5(dA,.)5EU Address 6617 L4*-&, PX,14,,, Located at (Street) S (u -6-k, gul'o A5 C4=✓4,_,4 tW1 4. Nee r: 3¢ Block Z Lot 7, It (indicate nearest cross street) Municipality P Trj47,,% VAtLey Watershed US SOIL PERCOLATION TEST DATA RDOUIRED TO BE SUBKrITED WITH APPLICATIONS Date of Pre - Soaking °1 �6 �� Date of Percolation Test °) l I HOLE NLVEER CJJCR TIME PERCOLATION PERCOLATICN Run Elapse Depth to Water F-rcm Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches inches Inches 1 1Z Q S% 101�h ✓. 7-1 23 2" ISo 2 1V 21 r� 22.31 17A 4 5 -•- 1---- 2 =� =1? °Z�.37 -- • �� -�rv�= ..24 �.._. -- .2 ?r�� _ . -- -- ��` -° -- . - - ��;•77- .. 2 2 :3% -3.o2 2S A,.,, 1-4 � 2.7 3 'S :o r 3.40 -� 2 �++,,,� , Z4 z7 4 `r �a, r;4 4 1:43 -4.17 34 5 NOTES: 1. Tests to be repeated at same depth until apprcximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made frm top of hole. PUI'NM COMM DEPARTMERr OF • DIVISION OF ENVIR0tMMkL HEALTH SERVICES ­M SIGN DP;TA S� SCJP.SC7� G�; ' S'� -E- DIS AL- 5i'S3 i ` FILE NO. Owner PA%)L '$ WAAl5 VV Address Located at (Street) S (t LMK GLUD Z DS M.) AvA- 0 3¢ Block 2 Lot 7 (indicate nearest cross street) Municipality PO A>� V AtL gy Watershed v5C4.j A. j4 L,44Ci— SOIL PERCIOLATION TEST DATA REQUIRED TO BE SUB=TED W= APPLICATIONS Date of Pre - .soaking 1 %, l'j Date of Percolation Test kk HOLE NUMBER, C1= TIME PERCOLATION PERCOLATION 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 't 0/00 2 l l : a2 - ►t; 5Z Z4 it S6)411" 2 ` %p u 13,13 3 ll'. �3 _ t2 �� ZAi� 2G l ` 21�� (3� 33 mu11�,ii 4 5 r� 2 to� 52 — ll; ��� Z1�►,Y 3 l I ". 1� - it: 40 24 14 1,,/ Z*" 17 3 g M l,j/i,J NOTES: 1. Tests to be repeated: are obtai_ned.at each for review. 2. Depth measurements to at same depth until approximately equal soil rates percolation test hole. All data to be submitted be made frm top of hole. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 0 WELL LOCATION Street Address 51 LLKK 9,LU b, Town/Village/City Tax J T►v. LJ. Grid Number _ . 1. WELL OWNER ame Mailing 60&j05 -o Address rivate O Public OF WELL 41 ;-078econdary primary eRESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® BUSINESS O FARM O TEST /OBSERVATION ® INDUSTRIAL b INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify Q AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE �2V Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY MtEW SUPPLY NEW DWELLING ❑ TEST/ OBSERVATION Q ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING -. WELL TYPE DRILLED 13DRIVEN ®DUG ®GRAVED ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES _�NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: PAJL. Lot No. WATER WELL CONTRACTOR: Name An n &ii ai Address: j�,�� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L,�NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO 'PROPERTY FROM NEAREST'WATER MAIN:— LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 0 / 5 []ON SEPARATE SHEET 5 ate) 4�k (signat e) 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril operations be contained on this property and in such a manner as not to degrade or of a w' a conta ate surface or groundwater. Date of Issue:— 19� F-0 71 ;� Date of Expiration 19� Permit Issuing Official Permit is Non- Transferra le White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Jopp- _.. _ BRUCE R. FOLEY. R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 15, 1995 Robert Randall 1551 Cross Road Mohegan Lake, IVY 10547 Re: Proposed SSDS: Swanson Silleck Blvd. (T) Putnam Valley Dear Mr. Randall: 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. Erosion control for the house, well and SSDS is to be sown and detailed on the plan along with a note stating all erosion control measures are to be installed prior to the start of any construction. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, 6�� / *04 W Robert Morris, P. E. Public Health Engineer RM /jp �:r DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 February 15, 1995 Robert J. Randall 1551 Cross Road Mohegan Lake, NY 10547 Dear Mr. Randall: BRUCE R. FOLEY. R.S. Acting. ,Public RE: Proposed SSDS Swanson - Silleck Blvd. Subdivision Lot #1 (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 follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1. Enclosed please find a) the current guidelines, and b) the review sheet used to review SSDS submissions. The pertinent sections -have been highlighted. 2. The subdivision file map number has not been provided. 3. The entire parcel is to be shown at any scale with the SSDS house and well location shown on the same plan. The proposed SSDS area, including the house and the well location is to be shown at the minimum 1" = 30' scale. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Public Health Engineer RM:mk DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (9 14) 278 -6130 December 1, 1994 Mr. Robert Randell 1551 Cross Road Mohegan Lake, NY 10547 Re: Construction permit Dear Mr. Randall: JOHN KARELL Jr., P.E., M.S. Public, Hgalth.4k9Rtgr Pursuant to your request a construction permit for a sewage disposal system, a standard form PC -1 and an application to construct a water well has been enclosed. If you need further assistance please contact the writer at ext. 166. Very truly yours, _Rob ert Morr is , ..P.�._. Public Health Engineer RM /jp JOEL (LAWRENCE GREENBERG TWO MIJSCOOY NORTH, Rf® #2 MA 110FA,C, N[W VORk 10341 994- 628 -6613 • fA X 914 -6211 -21107 JUNE 29, 1990 REPORT TO: PUTNAM VALLEY PLANNING BOARD REGARDING: MEETING OF.MONDAY, JULY 21 1990 2. PAUL SWANSEN SILLECK BOULEVARD & OSCAWANA LAKE ROAD 2 LOT SUBDIVISION AND WETLANDS PERMIT MAP BY BUNNEY ASSOCIATES - .DATED 1/25/90 T.M. #'34-2.7.11 APPLICANT OWNS 6.12 ACRES AND WISHES TO SUBDIVIDE IT INTO 2 LOTS. LOT # 1 WILL CONTAIN 4.00 ACRES AND HAVE A NEW HOUSE ON IT. LOT # 2 WILL HAVE AN AREA OF 2.12 ACRES AND' CONTAINS AN EXISTING HOUSE WHICH WILL REMAIN. THE VIOLATIONS) REGARDING,THE WETLANDS, HAVE BEEN RESOLVED. AT A RECENT WORK SESSION, WE REVIEWED THE MAP AND THE BOARD FELT THAT THE BEST LAYOUT WOULD BE TO HAVE THE NEW LOT CONFORM TO THE INTERIM ZONING AND THE LOT WITH THE EXISTING HOUSE REQUIRING RELIEF FROM INTERIM ZONING. THEREFORE, THE - ::APPLICATION WAS DENIED. THE BOARD MADE'A POSITIVE.... RECOMMENDATION -TO TIDE _ ZONING 90ARD_.0i F APPEALS'AND THE VARIANCE WAS GRANTED. SKETCH APPROVAL WAS GRANTED ON MAY 71 1990. A NEGATIVE S.E.Q.R.A. DECLARATION AND APPROVAL OF THE WETLANDS PERMIT WITH THE STANDARD EROSION CONTROL DETAILS NOTES AND DEED RESTRICTIONS, TO BE PLACED ON THE MAP, ARE IN ORDER.- A NEGATIVE S.E.Q.R.A. DECLARATION AND PRELIMINARY APPROVAL OF THE SUBDIVISION ARE IN ORDER. THE BOARD CAN WAIVE THE FINAL PUBLIC HEARING AND GRANT FINAL APPROVAL SUBJECT TO: 1.' RECREATION FEE - $2,000 CERTIFIED CHECK 2. FINAL SITE DATA NOTES 3. APPROVAL OF THE COUNTY PLANNING BOARD 4. MONUMENTS INSTALLED 5. ROAD DEDICATION IF REQUIRED BY TOWN AND COUNTY `'$ECTePULLY /Si 1 TED, n JOEL / L . GriEENBZKG :STW MEMORY TRANSMISSION REPORT TIME" FE9= 2112161M -'62-02PMI TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 935 DATE FEB-21 02:01PM TO 919142712820 DOCUMENT PAGES 001 START TIME FEB-21 02:01PM END TIM: FEB-21 02:02PM SENT PAGES 001 STATUS OK FILE NUMBER 935 SUCCESSFUL TX NOT ICE O rri 'A —°t, a rl_ flail I gig i-- L .-I 416 CTj Egg -o;llq 'A rri 'A —°t, a rl_ flail I gig i-- L .-I 416 CTj Egg -o;llq NEW YORK STATE H. D. GEN 157 (Rev. 4/73) DEPARTMENT OF HEALTH DE.0 BMW 2.5 DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FOR APPROVAL OF SANITARY FACILITIES FOR REALTY SUBDIVISIONS NOTE: (Law requires that no subdivision or portion thereof shall be sold, leased or rented or any permanent building erected thereon until plans are approved by State Department of Health or Department of Environmental Conservation.) Application is hereby made for the approval of plans for realty subdivision as required by the provisions of Title II of Article 11 of the Public Health Law, and Title 15 of Article 17 of the Environmental Conservation Law. GENERAL INFORMATION 1. Name of subdivision PAOL. JWA-,J.SN Location PVTN" V .4 (-Le-Y n^ /� (Vi llage or Town) 2. Owner _ PAOL S W" -,E7l� (State name of person, company, corporation or association, owning the subdivision) 3. Business address _ Street City 4. Officers _ - (If organized, give names of officers) %�' l /� 5. Total area of entire property 26� 5°)2 rT2 (� '12 Al «/Area of this Section ALL Total number of lots 2 Number of lots in this Section 2 Have plans for previous sections been Approved tj/A Disapproved N 1A Will plans for additional sections be submitted? N9 6. Do you intend to build houses on this subdivision? `t s Do you intend to sell lots only? W 0 ' "" "- "Do"ou intend to build- onTsomelote.ond� sell others - without buildings ? - - 0_ - -=- - - 7. Is this subdivision or any part thereof located in an area under the control of local planning, zoning or other officials? Y_ It so, have these pions been submitted to such authorities? N O Have these plans been approved or disapproved by such governing authority? 8. Nature of soil a "- a" To ?So 1L - 'SAw6 Y LoA-M -fo At"PTH OF -7 -. ct) (Describe to a depth of 10 feet (20 feet if seepage pits are proposed) giving thickness of various strata such as topsoil, clay, By whom determined_ 908EQT T. 14,yOAU QE. loom, sand, gravel, rock, etc.) How determined tocEp PITS 6Z Date determined l f r [ B g NO 9, Topography No0OATFIy SLoPiwG (State whether ground is flat, rolling, steep or gentle slope, etc.) 10. Grading: state depth of maximum cut JJ o j ti maximum fill NOJJt' 11. Depth to water table Max. Min. GVtk 7r1NS5M By whom determined jZ all tFtT S. �/ix Al�y Rt�-- (Give maximum and minimum if is any variation) f How determined c%f" PITS )e,e Date determined g� WATER SERVICE 12. Proposed method of supplying water V -) CL ' (If public supply, give name of municipality, water district or company) Has municipality, district or company agreed to supply water? Q0 13. State approximate distance to nearest public water supply main of municipal system 14. State approximate distances to nearest subsurface disposal systems 15. If a water supply application is required, has the approval from Bureau of Water Regulation, Department of Environmental Conservation been received? N 0 SEWERAGE SERVICE r SSp S W ��2�.?SO GM , SEi?Tic TASKS Sd/o Z�kcl4 ..., . 161 - Pr.apos,-,d. method of:= o!lection end- :d:ispcsahaf Sewaye • -• -.. (Give name of municipality or sewer district if public sewers are to be used) Has municipality, district or compony agreed to provide sewerage facilities? 01D 17. State approximate distance to nearest public sewer main of municipal system NIA (Give name of municipality or sewer district) 18. State approximate distances to nearest well water supplies Zoo I DRAINAGE 19. Are there any low or wet areas that require drainage? IV (yes or no) Are there any watercourses, ditches, ravines which may be filled in? W0 yes or no Is there an existing local drainage plan? Have these plans been approved by drainage officials? Provisions for surface drainage should be shown on plans. GAS TRANSMISSION LINES 20. Does a high pressure gas transmission line pass through or within 300 feet of any lot in this subdivision? If so, has its location been shown accurately upon plans? ADDITIONAL INFORMATION 21. Maximum number of bedrooms in completed house Bedrooms in expansion attic 22. Cellar drainage: Are cellar or footing drains to be installed? If so, show on plans how drainage will be disposed of. 23. Laundry wastes: Are laundry tubs to be located in basement? NO If so, show on plans how waste will be disposed of. It is hereby agreed that if the attached plans dated t or any amendment-or revision thereof, are approved by the State Department of Health or State Department of Environmental Conservation, installation of water supply and sewage disposal facilities will be made in accordance with the details thereof as shown on such approved plans. If the subdivided Lands,_shown on such plans are sold before such installations are mode; it is- agreed -that a I I purchasers of lots will be furnished with a legible reproduction of the approved plans and they will be notified of the necessity of making such instal - lotions in accordance with such approved plans. I CA, u Date Signature I' Official title The Statement must be signed by the owner of the land platted for subdivision or the responsible official of the company or corporation offering the some for sale. TO BE FILLED IN BY PROFESSIONAL ENGINEER OR LAND SURVEYOR* The plans submitted with this application were prepared by me or under my supervision and direction. Individual water and sewerage systems, if shown on plans, were designed after careful and thorough study of local geological and existing sanitary conditions. Name (Give Firm, if any) Address ISSt COZo< License and No. S7- -7S2. Signature *Land Surveyor only if granted exception under Section 7208n of the State Education Law IMPORTANT NOTES I (1) The plans shall show all information required by the State Health Department Bulletin, Planning the Subdivision as Part of the Total Environment, and such other information as moy be required because of special local features or conditions. (2) Plans must be prepared so as to be completely legible and to permit satisfactory reproduction by microfilming prccesses. (3) One white print (either on paper or cloth) shall be submitted for filing with the Department if approved, together with such other tracings or prints as may be required for filing with the county clerk and the subdivision owner. (4) A LOCATION DIAGRAM (scale about 1 "= 3000') showing the situation of the subdivision with respecf.to main . roads, prcminent streams, etc., sholl be included on 'the. plans. - (5) P. KEY MAP (scale about 1" =400') shall be shown on the plans if there are several Sections of the subdivision, outlining the relative location of the subject Section with respect to the rest of the subdivision. (6) Inasmuch as stamp of approval must be placed on face of plans, a space 3" x 6" should be reserved for this purpose. (7) Application must be accompanied by a certified check in the amount of $3.50 per lot made payable to the State of New York. PC -1 F'UTNAM COUNTY DEPARTMENT OP HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant 1'y' C A �A\�1 cs` S 2. Name of Project: vJ A-,j c, 12E511)E"uCO. Location T /V /C: PUTA Ayy L)+L1_P✓ 4. Project Engineer: Kt,p yy r 5. Address: I5 CkoSs 12040 M &HEGtAw LACt . N7' /x547 License Number: SZ7_�;_ 2 Phone: 527- I-S4-o 6. Type gi Project: V Frivate /Resident Apartments Office Building 7.. Is this project subject Type Status (Check bne) ial Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify), to State Environmental Quality Review (SEAR)? Type I:. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of lead Agency 11. Is this project _in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... `��� 12. If so, have plans been submitted to such authorities? X13. Has preliminary approval been granted by such authorities ?�L-�J Date Granted c 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation, ....... ly 4 16. Waters index number (surface) ........................ X1 14 17. Is project, located near a public water supply system? 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance to sewage system 21. Date test _bbl'es _observed: { 22 °: .­1N-ame of .64ea? th.� Inspector:. 23. Project design flow (gallons per day) ...... ............................... 11/93 2. 24.. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? 26. Is any portion of this project located within a designated Town or State wetland? .........................:........ ............................... 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... Q. Has application been made to Town or Local DEC Office? 29. Does project require a DEC Stream Disturbance Permit? ................... 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfi.11ing, sludge application or industrial activity? ........ YES or NO N (� 31. Is project located within 1,000 feet of existence of abandoned landfill, hazar.-dous..a.w ste; s ite, salt .stockpi.le, Jandfi.11, _ sludge disposal site or any other potential known source of contaminaticn? :;YS.or NO- DESCRIBE: 32: Is there a local master plan or file with the Town or Village? ........... Ales 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15-M slope? ........................ ,35. Tax Map ID Number ............... ............................... ........ Z 1� 36. Approved Plans are to.be returned to: Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. 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 t rue to the bes t o f my know ledge and be T i e F. Fa 1 se s to temen is made herein are punishable as a Class A Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: y�, IS :11 Mv MAILING ADDRESS: �3 t?t - 7.7 U%511�1.N1'lU1V um 'Jkjuj.Z CAV -kAm t .� 1111 ZJ, jL INDIC= LEVEL AT WHICH GROUND VATE.R IS ENCOUNTERED rlo,.1l= C�J C 6c1 "T &-e €O .. INDICATE LEVEL TO WHICH WATER LEVEL kISES AF`IHR BEING ENCX7UNZ�12ED , DEEP .HOLE OBS&11;R=ONS WOE BY: DATE: / 5' L= -LQm4 Soil :Rate used 17,?- Min/1" Drop: S. D. Usable Area Provided l24 $S6 PT v No. o (2)c 7 S Be3roans Septic Tank Capacity X56 O gals. Type R fCA,5 t Absorption Area Provided By 50) O L.F. x 24" width trend Other . -- nn a � Y � Name _ K o gE2T S D44 k S aa Ql0 Address kP, l�St c�55 LW THIS S;PAM MR USE BY HEALTH MPAR24ENr ONLY: •,��� qT ����••• NO Soil Rite Approved f + s4- -t/Sal- C7�ecke� �Y Date . -N vrwLC y w ♦eaea. ltadard— o a /Rent Nip: fa* 1 �:� l + gap V a � L�_►." % �+ Dairy ZyN�Rfs s-*o Dab Depth Talons Number it 5whemilimo (9 iJ i " Dedp Flow G PD Pty N*dM=dm Is Reau ed Wbm Pm Is a••mobd s.peew . Sewwa,s] 4 f eo M d Z TPA and— 5 �i c� GaF - Zp o,)—ck 1,S To bu:o..de.ead: Lf �4.�� .rtttiTC..�. t i�C. bfldzd !� iK e'f KzkIT') i _ WNar Stt :_ Pire Frr• Addierr 41111_— Psldite Ste. Dd.d br L 115 A...s r r S fi ryti► Otbar no" I repraent':IMt,I dare whoNy anA eompMtttly responsibM for the desgn "aritlaocation of the piOpofW systemts); 1) tMt .the.separate_a�wr ditpowl slam above deseribesl °will be eaislructe0 as frown on tee aDDrodeO aaneiiafinent there "to and, in acco ► dance vvith;tM standards, rules a rpu ns the Courlty..0opa meflt Of thereof a "Certificate- Of Construction Compiiena" satisfactory-to the Commissioner of mealthwill be "Milled to the. DepaftnMt. and a written `qua►entie will id famished the owner;. his sucoassors; MMs_or assigns ,by the bulkier. that said builder will aslaCe in .,pod olfMatin11 condition any" -61'YIA favva'a 4is"l .syste"m dufk* -the pw.kid of tw0.(2) yetisknnwdl4tely following 1:68date of the look aaa. of i .itpporal of` the CeRHkate of Construction Compllencu of throrginal'system'w.;any rap�Ns thereto; 2) that the drilled well described above WIN be located as Miewn'M.tlie�appowll plan and tlist tild well will tie' "installed: in as COrdan" with standirba, wNS e`aw" requ ai' oiT nT'of the Putnam Catnttr " Rment of HMItA. Date : <, I, b: a Sl a_d P.E. �nR:A. Addra+� License. No 52752. APPROVED FOR CONSTRUCTION: TMs approval eapkef two.y rs f o tAe -, date .i unless construction of the building .has been undertaken and is revocable for • wN r anaY be amwaded or modified when eonsid id rY by the : Issioner of Health. Any change or alteration of construction OJppr .. a water wpply onyx, requires a it, oved for AisooYl Of domestic It age, andlor Rev.. - 10/88 Date S sv Title !8!.O09 :): Paul ' swa) vtiono/ BanA ib5fract Cor ie existing code of pra the New York State A Neyors. run only to those inc :reon under the title p ertifications are not tra 1996 Bunney Assoc I6HTS RESERVED in Is a Violation of Ap ment hown hereoa being Lot / J --- -oeP/7 2 pQ�e P/7 "Subdivision Map prepared S 'warnsen " fi /ea' in the Putnam i j rt n. 't �: i X% Z rn c c rn gobed J. Randall, P.E. 1561 Cross Road LjdW n Lake, NY 10547 914- 528-1840 P � stJ S�6QJ�S�� smuxK �1faI1EV SSDA 4Lga, Scht6: ss ,A SS 'I>A " (b Li Vu.. SEPTIC TANK 5 GP�n y �- ail ; wn.t_ e0 S } 72x,7 of otsim IS- awk a gmj-x l 2. .'ttp of a3s4'tjg 2' ahae %,L cr aatarticjit. t5_' IMttr�l G 58 (' 3 Ydnimm.20' „msin7 -of stet cr wrcugh ictn. 4 10' mini mn gtw2' into nxit.. 1 S Qa]et 4' Wcw O.G min. 6. - Swdtary smis ; c GO 7. Qurd 9=W.awy firm well. i GPM OUT PWr s Not”: tj Stdnda,d inlet Rome. Wm Tee (b Li Vu.. SEPTIC TANK 5 GP�n y wn.t_ e0 S 1. 72x,7 of otsim IS- awk a gmj-x l 2. .'ttp of a3s4'tjg 2' ahae %,L cr aatarticjit. 3 Ydnimm.20' „msin7 -of stet cr wrcugh ictn. 4 10' mini mn gtw2' into nxit.. 1 S Qa]et 4' Wcw O.G min. 6. - Swdtary smis ; 7. Qurd 9=W.awy firm well. i GPM OUT PWr s Not”: tj Stdnda,d inlet Rome. Wm Tee A 2) Two wnvartment ; I 5 1T E / 3) i 4) Re inbroed with.6%6x10 guage were mesh SCALE I I'z "s 0, S) Joints seated with aspt,alt;c®ment or' equal 6) Con6nAe- atrenoth 4000 M-0 28 Gays v 7) Equipped with Potylok Pipe Seals A it n 4ALhBN8 <„ t' s