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HomeMy WebLinkAbout2585DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -30 BOX 22 -A �YA il M Ir OL .,� 5.11 T 11 6,., 02585 `7 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORE'ITA MOLINARI, RN, MSN Associate Commissioner of Health David DiLapi 90 Oscawana Heights Road Putnam Valley, NY 10579 Dear Mr. DiLapi: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, FE Director of Environmental Health September 6, 2007 Re: Addition — A- 181 -07 90 Oscawana Heights Road (T) Putnam Valley, T.M. #52. -2 -30 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. 2. The proposed rooms titled Family Room and Exercise Room are considered by this Department to be potential bedrooms. The legal bedroom county for the dwelling is three. The potential bedroom count of your proposed addition is five. The.addition.ofa,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 three (3) potential bedrooms, or have a professional engineer or registered architect design a subsurface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Sincerely, Gene D. Reed Sr. Environmental Engineering Aide GDR:ens Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 0 r � r , 0 �- \O O n h IV ri O 10 1 .IV _10.00 694L.5SA4 • hwg -� Pte° Q� � ' •� > .Q 9 _ r. l rs \ r ,� S V PA �'WMNWN !Rpm U5 71 hj S--Z-7- * 'IZ w:z e 1 x ANT am si AN SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTF 1 Geneua Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL STREET qO 05CM64 1ici ik /M.TOWN, NAME boo iJ ® + Laa PHONE. ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TAX MAP# SoZ• - 3Q PCHDA IU P 0 -7- MAILING ADDRESS q0 ff ``. ©grat.jewa li�iiG� S ✓1 ` Pulgam Valle% !VY 105-75t DESCRIPTION OF ./ . ADDITION �Q►�d i1Y Pj�! 900M axd C&erci s e Abfrg NUMBER OF EXISTING BEDROOMS_3 _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 Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY :10509, Phone: (845) 278 -6130. Certified check or money order for $100.00. Sketches of existing floor plan (drawn to scale, all living area including basement) / 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 locations 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. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 1 d SHERLITA AMLER,_MD;-MS,_FAAP... . Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. - -.ROBERT J.•-BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count Re: DTLAPT (Owner's Name) Tax Map #: 52.-2-30 Address: 90 Oscawana Heights Road Town: Putnam Valley,, NY Year Built: ? 0 0 0 According to records maintained by the Town, the above noted dwelling, is xx in compliance with Town Code. is not in compliance with Town Code., The Legal Bedroom Count is: 3 This information has been obtained from: Certificate of Occupancy: 00_9 51 0 (copy attached) 5/21/07 As s i s t . Building Inspector John W . Al -e Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 N_ _g ON, ffVf LAX.- �A� _g fl-iis .,.,ertificc-ite covers the COFIS trUC t- ion of: tlew- OnE—fariLi.1y -Residence W/REAR DECK I Family Year Round Three B-P-droarti •1 h- _qpp_j'_ic:-,nt 'having heretofore filed for a bUildil-lg pert-!.it ip.t.ir-3Liant t() the Town a n i ta r ride, the Lill i f.or.-Ill bi.ji.i.di-ng ez Fi.re Code and the Laws in effe•:t in Town of Putnam T , J. C-inty, NY, h-a✓icc - aiiA re- ir -ed fee therefor A1-1d t- 1h 1.11-1deirsigned having by per.3onai ascertained that sub3ecp-tently prc):­eeri,��Jl Hhe erec r. o.i_ p 11 a n T: has or the propo.sed with L'I'le L7 -Dr., the 1. awi3 as a o - r a. C! 3*�_=Iid and (_A ti e aws e RIL 15 e .5 leave no.,, i.-.­en f Lil ­-mpleted and are read;, U a IDUnsttant to rile r o', v 1. 3 j.,,:) n s r .Lard. Nok•,f, -therer:.,,ra, Li i 3 s u 4;-- d undei: tli- �:)f cornpliatic pa nc,�, Tct­jr-) of !Dtitnwrs Va I 1,.e­2, TOWN . OF PLPTNAN4 VALLEY, N. Y. By:. dz)71 CODE ENFORCEMENT OFFICER I This permit included the lower 'level. a im SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health David DiLapi 90 Oscawana Heights Road Putnam Valley, NY 10579 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County- Executive_ ROBERT MORRIS, PE Director of Environmental Health September 21, 2007 Re: Addition — A- 181 -07 No Increase in Number of Bedrooms 90 Oscawana Heights Road Putnam Valley, T.M. # 52. -2 -30 Dear Mr. DiLapi: 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 the Department dated September 20, 2007. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three_ 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 savin - devices i.e. new low flushes, folets, restricfors`foi shower heads and faucets, etc. 4. This Department recommends you contact your local Building Department to ensure setbacks and other current codes can be met. 5. The approval is for the proposed changes only. This approval does not validate any .construction shown as existing that has not obtained proper approvals. 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 at (845) 278 -6130, ext. 2261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:ens cc: BI (T) Putnam Valltgvironmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 _ BRUCE . R _YOLEY Public Health Director Roy Fredriksen, P.E. P.O. Box 950 Mahopac NY 10541 Dear Mr. Fredriksen: :..: ,-, LORETTA: MOLINAR.i RN':; M.S-.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 July 6, 1999 WIC (914) 278 - 6678 Fax (914) 278 - 6085 y Re: Oscawana Height's Road, Lot #3 (T) Putnam Valley, TM# 52 -2 -30 This office has received and reviewed the most recent set of plans of the above - mentioned project. We would like to offer the following comments for your consideration. Documentation: 1) Complete applications to Construct a Water Well, WP -97 2) Submit "New" Design Data. Deeps witnessed on April 12, 1999. .. *Deep Tests *Perc Tests - Design Data Sheet to be completed. 3) Complete form PC -97 * All originals; WP -97, DD -97, PC -97 returned for revision. Plan: 1) Provide note stating "maximum bend in effluent line 450." 2) Show second perc test hole; in area of expansion. *provide design criteria on plan. This office will continue it review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling ABS:tn Assistant Public Health Engineer attachments PUTNAM COUNTY DEPARTMENT OF HEALTH _ .. DIVISION OF ENVIRONMENTAL. DEALT RVICE� APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �l rl oK.AD.44I 9p . �c l i -J41Y1 V4 /4E c/ , N V 2. Name of project: U5,cA 4 a .3 3. Location T/'Cl: V,-��� 4. Design Professional: 5. Address: FO X l� 6. Type of Protect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... 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. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... e,S 12. If so, have plans been submitted to such authorities? .............. ....................... 13. Has preliminary approval been granted by such authorities. cs Date granted: 14. Type of Sewage Treatment System Discharge ................. su 15. If surface water discharge, what is the stream class designation? .................... r-- 16. Waters index number (surface) ........................................... ............................... 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 treatment system? ................ _ �Jj 20. Name of sewage system Distance to sewage system 21. Date test holes observed 411 2 22. Name of Health Inspector AD �� J Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - - Rase nntor e.,.. _ .- .......:z ... PCHD Peririi't Well Location: Street Address: Town/Village Tax Grid # 14 ,_V SZ Block 2 Lot(s)3o Well Owner: Name: Address: 14-IL 60IN i 8 40Z ADAIJ ID, . t-d-Li �J Use of Well: eside ial Public Supply Air /Con eat ump I ' gation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional.�S Amount of Use Yield Sought _ gpm _,k1e ple Served Est. of Daily Usage ga . Reason for Replace Existing S 1 Drilling t,�ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling E vSe Well Type Willed Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ✓ Is well located in a realty subdivision? ...................................... ............................... Yes v No Name of subdivision 0&CAW/}r -1 q 1l ooas Lot No. � Water Well Contractor: % g D. Address: Is Public Water Supply available to site? .................................. ............................... Yes No e__--- Name of Public Water Supply: —"' Town/Village ^ Distance to property from nearest water main: �- Proposed well location &sources of contamination (Zpidp v n sep ate sheet/plan. Date: Applicant Signature: _ _ .. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P; u PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner / Address Located at (Street) 05G is PD. Tax Map 6-2- Block 2 Lot _ 30 indicate nearest cr ss set) Municipality & Watershed - - pg2G K' o�u �3 (a' YiSr 6 ITES: f 71TEsfs'to be repeajid at same depth until approximately equal percolation rates are obtained at ea( ° til�tion 'e t ole. i e s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch All data to be %9 at ( ) submitted. review. 2, bep h`,ii eAitfements to be made from top of hole. Form DD -97 1 2 3 4 5 2 3 4 5 1 2 15 - - pg2G K' o�u �3 (a' YiSr 6 ITES: f 71TEsfs'to be repeajid at same depth until approximately equal percolation rates are obtained at ea( ° til�tion 'e t ole. i e s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch All data to be %9 at ( ) submitted. review. 2, bep h`,ii eAitfements to be made from top of hole. Form DD -97 TEST PIT D DESCRIPTION OF SOILS ENCDI .-DEPTH: -.KI ;E 1140: G.L. 0.5' 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' V t 6.5' V , 7.0' 7.5' 8.0' 8.5' 901 10.0' 2 HOLES HOLI✓NWti =a . �...�.... Indicate level at which groundwater is encountered /,-Jo t-4 —' Indicate level at which mottling is observed Indicate level to which water level rises after being encountered -1 Deep hole observations made by: Apg�SrTer���foDate Design Professional Name: Address: Fo gc % > Signature Design Professional's Seal NE rI .s • 1�0 sp50S PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: (L r1--C>g-"4'r-w4 9p, AfPJ4mV4 Ile V,d \/ 2. Name of project: USCG y(��A i,tlfx-p s- �3 4 -- Design Professional: 6. Type of Project: Private/Residential Apartments Office Building 3. Location TN: 5. Address: 'Po & X 5.S Food Service Institutional Realty Subidvision Z, Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................:.. ............................... 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. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 12. If so, have plans been submitted to such authorities? ........ ............................... e.s 13. Has preliminary approval been granted by such authorities . Date granted: 1�8 . 14. Type of Sewage Treatment System Discharge ................. surface water ✓ndwater 15. If surface water discharge, what is the stream class designation? .................... t--► 16. Waters index number (surface) 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 treatment system? ................ 20. Name of sewage system Distance to sewage system 21. Date test holes observed A 2 22. Name of Health Inspector D4m e Form PC -97 2- 23. Project design flow (gallons per day) ...................... _ 0 C-> 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. Wetlands ID Number ........................................................... ............................... 28. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town of Local DEC office? ......................:. 29. Does project require a DEC Stream Disturbance Permit? .. ............................... Ob 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 0 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... 2.s 33. Are community water and/or sewer facilities planned to be developed within ' r 15, years in or adjacent to project site? ................................. ............................... 14J. 34. Are any sewage treatment areas in excess of 15% slope? . ............................... f43 35. Tax Map ID Number .......................... .....................6......... Map. 2 Block Z Lot 3P 36. Approved plans are to be returned to ..... Applicant L-1'Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: x qs� Mailing Address: ................................... ���� �• �` 10,24- �' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner lI � il'� cs, rHC' Address rig-*0'W - R-P P'"Ti,'f"'V -f1mss! Located at (Street) OSC l cn,4 d'oiaj jS /Lp, Tax Map 52 Block 2 Lot 30 (indicate nearest cross street) Municipality Pu ?nAw1, -1-14 /% Watershed WjDse � 124, de/—' SOIL PERCOLATION TEST DATA Date of Pre - soaking �f 2I Ff Date of Percolation Test 4 ,�3%'� NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 3 t34 r5F Ae 244 3 4 5 _. 6.7 - 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO HOLE NO. In 1 &1 at which groundwater is encountered 140A e, lirel at which mottling is observeda�� 46te evel to which water level rises after being encountered ac l4 U <r q °Whole observations made by: F—, rL -KS &4 1 4Dm 9i'Mi s gff� Date #LZ lyciign&rofessional Name: Address: FO Signature: fc 1 . 05 -4 Design Professional's Seal Or- ME S 2 a . y ti PUTNAM COUNTY DEPARTMENT OF HEALTH �\ IVISION OF ENVIRONMENTAL HEALTH SERVICES C S .G CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM ERMIT # — Z Located at 44 Subdivision name 03c** �cx�vs Subd. Lot # 3 Date Subdivision Approved 61916-7 Owner /Applicant Name 6 /% C�� n4e-s �4 G• Mailing Address Amount of Fee Enclosed -r e� Town or Village �h/ 9�% /-- Tax Map SZ Block Lot 3 Q Renewal Revision Date of Previous Approval Zip lQr.7 Building Type Z-e Val Lot Area No. of Bedrooms .3 Design Flow GPD ,60 o Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /00c:> gallon septic tank and 2'�:?- r -/ " chr" Other Requirements: 0 To be constructed by T-> • Address Water Supply: Public Supply From Address -or - � rivate-Supply D- iilled by .. -- Address-.----- I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto.— Signed: Address R.A. Date & f License # SD D� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew permit. Ap roved o di a of domestic sanitary sew a a only. By: Title: Date: 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 APPLICATION TO CONSTRUCT A NATER. WELL please pdni of type - PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # z!97- Block 2 Lot(s)0 Well Owner: Name: Address: 14b lOP- ig DAB Use of Well: eside ial Public Supply _____..:Ai-/(ond4leat fump I ' gation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage 4R gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling 6 L)S °�- Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ......................... :........................................... Yes L--- No Name of subdivision C25!A- W1+iQg V opal Lot No. _ Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No L, Name of Public Water Supply: —" Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to pr vide n sep ate sheet/plan. Date:: (o Applicant Signature: _ _ .... - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for. cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 7 1,1 Permit Issuing kOfficial: Date of Expiration Title: Permit is lion- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE_ R. FOLEY '- public -Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLIN_ ARI RN., M.S.N. ilssociate Public 'Health 'Ijir'ecror"' ' Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 CT3 //'yl./'�^ - Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Roy Fre lksen, P.E. P.O./cox 950 opac NY 10541 Re Dear Mr. Fredriksen: Oscawana Height's Road, Lot #3 (T) Putnam Valley, TM# 52 -2 -30 July 6, 1999 This office has received and reviewed the most recent set of plans of the above - mentioned project. We would like to offer the following comments for your consideration. Documentation: ��omplete applications to Construct a Water Well, WP -97 �bmit "New" Design Data. Deeps witnessed on April 12, 1999. *Deep Tests - - *Perc Tests - Design Data Sheet to be completed. q1,—'-Complete form PC -97 * All originals; WP -97, DD -97, PC -97 returned for revision. Plan: Zrovide note stating "maximum bend in effluent line 45 0." Show second perc test hole; in area of expansion. 4 {� *provide design criteria on plan. This office will continue it review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling ABS:tn Assistant Public Health Engineer attachments PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: 4. Design Professional: 6. Tvne of P o'ect: Private/Residential Apartments Office Building LL Cod S/ i-10,2. - tcF—i3 3. Location TN: 5. Address: fO &-\ X/ 9� -' V I/ Food Service _ Institutional _ Realty Subidvision Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... 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? ........ ........ _.1.0. Name of Lead.Agency- ;.. 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ...........:............................................. ............................... e,S 12. If so, have plans been submitted to such authorities? ...... ............................... 13. Has preliminary approval been granted by such authorities. Date granted: 14. Type of Sewage Treatment System Discharge ................. su` e°watit}ter 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) 17. Is project located near a public water supply system? ....... ............................... HID 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ 20. Name of sewage system �- Distance to sewage system 21. Date test holes observed 41a f, 7 22. Name of Health Inspector J% /�n� J Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type _ . PCI ID Permit # - Well Location: Street Address: Town/Village Tax Grid # /l w .�Z Block 2 Lots Well Owner: Name: Address: I�L i / 1012 0A".J D 9r'1 Il6 /-J Use of Well: eside ial Public Supply Air /Con eat ump I ' gction 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional tandb Yield Sought_ gpm eople Served Est. of Daily Usage ga . Amount of Use Reason for Replace Existing S Drilling u--'ITe—w Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling 140 L)Se- Well Type Willed Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................:.. Yes L — No Name of subdivision �- . _ Water Well Contractor: % g a. Address: Is Public Water Supply available to site? .................................. ............................... Yes No L__— Name of Public Water Supply: Town/Village Distance to property from nearest water main: "- Proposed well location & sources of contamination to pr gy, ide n sep ate sheet/plan. Date: &14 fl Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �J e ' PUTNAM COUNTY DEPARTMENT OF HEALTH[ DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET = SUBSURg'ACE SEWAGE TREATMENT SYSTEM Owner A Located at (Street) SG W g Tax Map 6-2-Block 2 Lot _3p indicate nearest cr s s •eet) Municipality, �,c h / E Watershed. p 4 Je 2 , SOIL PER Pate of Pre - soaking Date of Percola -Bon Test Lf ]E ise Time Si ��ILG %4b S�;3 a a NOTES: f3 ; :Y esfs'to be repead at same depth until approximately equal percolation rates are obtained at each .,,� cildtion � e j l ole. (i.e. s 1 min for 1 -30 min/inch s 2 min for 31 -60 min/inch) All data to be ;V SUlim' i' a fr , iew. 0 pihA " A `0inents to be made from top of hole. Form DD -97 1 2 3 4 5 1 2 3 4 5 1 2 4.: Lf ]E ise Time Si ��ILG %4b S�;3 a a NOTES: f3 ; :Y esfs'to be repead at same depth until approximately equal percolation rates are obtained at each .,,� cildtion � e j l ole. (i.e. s 1 min for 1 -30 min/inch s 2 min for 31 -60 min/inch) All data to be ;V SUlim' i' a fr , iew. 0 pihA " A `0inents to be made from top of hole. Form DD -97 a � 1 TEST PIT DESCRIPTION OF SOILS ENC.F HOLES E DEPTH HOLE NO. OLENO. _. Z. ,., .......... . 0.5' 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' ` r 6.0' 1 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9,5 10.0' Indicate level at which groundwater is encountered Indicate level level at which mottling is observed Indicate level to which water level rises after being encountered .4-le --- Deep hole observations made by: E Fix 2 j r' _Ado Date 4 /Z .o Design Professional Name: t�R� OF NEB Address: ,� Signature: Design Professional's Seal C,). s� 30505 \� piJTNAM COUNTY DEPARTMENT OF HEALTH - \� 1DI�SI(ON OF ENVIRON.MENTAI, HEALTH. SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #f ^ 12- qq, IT Located at �� �//.� -(�4 (x Town or Village 11'r -q'in t�,4/ LS/ Owner /Applicant Name A l / Czxj t PI rr , Tax Map S2.0 Block Z Lot _ --r Formerly —` Subdivision Name Subd. Lot # Mailing Address 81 K- 10-, Z A CA4 VD b r�H4M VA11AFY H- X Zip /cam Date Construction Permit Issued by PCHD V1/ q i SelRarate Sewerage System built by W� ln,,m � _Address 61 r /0P2�4 P4-ei R Ydair,Y Consisting of () © Gallon Septic Tank and '32p Z �!r -/�D� J �iG�{�S Other Requirements: Ne► Water SupX&: Public Supply From Address or: i/ Private Supply Drilled by Address 3'2 Has erosion control been, completed? . . _..._. _...F3iiildin__..1. -- p Number of Bedrooms 3 Has garbage grinder been installed? k4ss - I certify thatthe system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (opies of which are attached), in accordance with the issued PCHD Construction Permit and approved Plans and * standards, rules and regulationsTraf unty epartment of Health. Date: - Certified by P.E. ✓ R.A. (De Profess {ona Address PCB &x i'! / t�1 • l c�.� 9 i • License # S—D �S'OS- Any person)ccupying premises served by the above systems) shall promptly take such action as may be necessary to secure tb correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment stem shall become null and void as soon as a public sanitary sewer becomes available and the approval of the prime water supply shall become null and void when a public water supply becomes available. Such approvals re subject to modification or change when, in the judgment of the Public Health Director, such revocatio o • cati n c ge 's necessary. i i By: Title: Date: White= cop} HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well locitilo' n lWell q0 Towfi/Vifi�-e: g Tax Grid Map 5rZ, Block Z_ Lot(s) 30 Owner: Name: Address: hN Coun-1­4 yL ' 8' K22-CISL- ers 070-3 Use of Well: 1-primary 2-secondary 7TResidential Public Supply Air condtheat pump irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _ Cable percussion __K Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock Other Casing Details Total length 1, - Length below grade _ ID _ft. Diameter min. Weight per foot lb/ft. Materials: JL Steel _ Plastic Other Joints: Welded _k Threaded Other Seal: V, Cement grout Bentonite Other Drive shoe: Y Yes No ILiner: Yes L< No Screen Details Diameter (in) Slot Size ILength(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hou rs Yield o gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet ads- 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 LAa If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type&__&jM5 Capacity 0 c,,116 o? 4 Depth Ao� Model 416ft Voltage 1-10 HP y 11 , Tank Type &)_03 Vol Tme:OD fr S lof X Date Well Completed Putnam County Certification No. C)3 Date of Report Well D iller (sV*nature) NOTE: Exact location of well.with distahc*es.to at least twopermanent landmarks to be.provi pa separate We-et/plan. Well Driller's Name 1-1-" rc"4 Address: C�aA.*vi X/ /V)� t a S-1 i- Signature: ;&& 4-k Date: _3 -0 --1 7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Da il MA l i 5Z 2. 30 Owner or Purchaser of Auilding Tax Map Block Lot ,411 Ca 44 4�y Building Constructed by 70 q��� . H �� %s R o4 d Location - Street . ?,i4. LtVA, Building Type &'fhe4�,,, Town/Village .S a W o ads Subdivision Name Z07- *3 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 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 -3 Dayg3 Year a COO General Contractor (Owner) - Signature i 0 s Corporation Name (i corporation) Address:1 State /� �(',( ,� 1 y0irt Zip /070 ' Title: 19ress A ! ) Co i , Q 0 rn 25 Corporation Nam if corporation) Address: State AJP Zip /& D3 Form GS -97 _ YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 Albert H. Padovani, Director LAB #: 93.000119 CLIENT #: 11941 NON STAT PROC PAGE 1 ��------------------------------------- -------------------- i ------------------ ALL COUNTY HOMES 28 READE ST. YONKERS, NY 10703 SAMPLING SITE: 90 OSCAWANA HEIGHTS RD. : PUTNAM VALLEY, NY, 10579 COL'D We NICK MAURO NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 03/28/00 MF T. COLIFORM 03/28/00 LEAD (IMS) 03/28/00 NITRATE NITROG 03/28/00 NITRITE NITROG 03/28/00 IRON (Fe) 03/28/00 MANGANESE (Mn) 03/28/00 SODIUM (Na) 03/28/00 pH 03/28/Q) HARDNESS; TOTAL 03/28/00 ALKALINITY (AS 03/28/00�` ^ . TURBIDITY (TUR . DATE/TIME TAKEN: 03/28/00 11:15A DATE/TIME REC'D: 03/28/00 12:00P REPORT DATE: 04/07/00 PHONE: 1914)-447-5282 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE ABSENT /100 ML ABSENT 2.2 ppb 0-15 ppb 4.21 MG/L 0 - 10 0.133 MG/L N/A <0.060 MG/L 0-0.3 mg/l <0.010 MG/L 0-0.3 ±g/l 44.7 MG/L N/A 7.7 UNITS 6.5-8.5 164 MG/L N/A 176 MG/L N/A . , 1,0 NTU COMMENTS: '. BACT THESE RESULTS INDICATE THAT THE WAT� WAS NOT) OF A SATISFACTORY-SANITARY QUALITY ACCORDIN��~�1E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS- TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. . Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. METHOD 1008 9101 9139 9146 2037 2037 9043 ~ YML ENVIRONMENTAL SERVICES 321 Kear Street Yor 10598 ' A��~'/�' ^.' �.~ _... Albert H. Padovani~ Director LAB #: 93.000119 CLIENT #: 11941 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ALL COUNTY HOMES 28 READE ST. YONKERS, NY 10703 SAMPLING SITE: 90 OSCAWANA HEIGHTS RD. : PUTNAM VALLEY, NY, 10579 COL'D BY: NICK MAURO NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 03/28/00 11:15A DATE/TIME REC'D: 03/28/00 12:00P REPORT DATE: 04/07/00 PHONE: (914)-447-5282 SAMPLE TYPE..: POTABLE _ PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD P.11-1 pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM � MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF Mr-3/1 L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L ^ `' MODERATELY HARD WATER: 70-140 MG/L _� MG/L =MILLIGRAM PER LITER' --' ' ., _ SUBMITTED BY Director ELAP# 10323 _ ..-- _.BRUCE iOP:E'€TA.QLARI �ct:N:; ~11�i:S: Public Health Director �� �. - ��� Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 .1E911 ADDRESS VERIFICATIOIeT F )RM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: 0 The Putnam County Department of Health will not issue a Cerrtificate � of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (8911 VERFRM) -BRUCE-,.R. FOLEY _ _ __ _ -..._ - Public Health Director - l Roy Fredriksen, P.E. P.O. Box 950 Mahopac NY 10541 Dear Mr. Fredriksen: - LORETTA _ _ MOLINARI. _RN., . M. S.N.._ r ilssocicte Public" Health Director _'_­­-- Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 July 6, 1999 Re: Oscawana Height's Road, Lot #3 (T) Putnam Valley, TM# 52 -2 -30 This office has received and reviewed the most recent set of plans of the above - mentioned project. We would like to offer the following comments for your consideration. Documentation: 1) Complete applications to Construct a Water Well, WP -97 2) Submit "New" Design Data. Deeps witnessed on April 12, 1999. *Deep..Tests *Perc Tests - Design Data Sheet to be completed. 3) Complete form PC -97 * All originals; WP -97, DD -97, PC -97 returned for revision. Plan: 1) Provide note stating "maximum bend in effluent line 45 °." 2) Show second perc test hole; in area of expansion. *provide design criteria on plan. This office will continue it review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling ABS:tn Assistant Public Health Engineer attachments PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH � INDIVIDUAL WATER SUPPLY & SUBSURFACE SELVAGE TREATd1ENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT r- STREET•LOCATION -- \' 'fE'OF 41V. EREVIEWED BY : RNI, GR, AS, IB, BH A G TAX NTAP 9 DOCUMENTS Y N PERMIT APPLICATION EROSION COQ ITROL:HOUSE,WELL, SSDS PC- PERC & DEEP HOLES LOCATED LL PERMIT WS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION (! TION LOCATION MAP SHEET SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE I I _ SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED REQUIRED DEPTH TAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D ST HOLES OBSERVED PERCS PROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR_ NOTIFICATION LFT7 R RIG?RA EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS Fj Q HOUSE SETBACK NECESSARY (TIGHT LOT) flHOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 15 -WELL TO PL_ -: _. • .,_. 100' TO WELL; 200` IN DLOD,150'PITS I MW,PU/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mPROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: I 1 100 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMIT(S) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATERLINE (pits -20') SEWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. GALLEY SYSTEMS GRAVITY FLOW _150' CONSTRUCTION NOTES 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1° /x100' - <1% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge IT CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTEFJCURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS Y ® LOCATION OF SERVICE CONNECTION I MW,PU/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mPROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OVENVIRONMEN r FAI, ItEALTI-1 SERVICES AFFIDAVIT- CORPORATE O.NVNER APPLICATI( - )N - I -'OR)J RM i TA PITICA] JON SUB M ITTED TOPI JTNAM C,0UNTY 1-11"A LTI 1 DEPARTMENT Public I 1c.i1th Dircctor In dic, mi- itter i..)Vapplicition for: Vepresunt that I mn art officer or employee of the C01-I)OI-atiOn "Ithl 011111 aLith(.)l'i7..ed to act for: 1)(10"it toll: Officers Are: .A(hin,ss- c vo ""ic", -. t'jame: 5 A 111d thm I am zind will he individually responsible For any and all acts of the corporation with respect Ilicapprov,(--11 requested and all subseqiient acts relating Iliereto. EDWARD 'R' NOTARY NOTA' y P!UIBLI�'CC % EW YORK gjTW YORK NO: 30�19788q, " q�, Ty QUALIFIED I 'I 1, 20 eL� C 0 1 3 20 I file Ibis W 4 day of lu!m " Publ,IC Corpm.'Me S( !, - - 1 A `i7 J"-U.TNAM COUNTY DEP ARTMENT OF TTEALTH DIVISION OF ]+ NN' TRONI\TFNrl-Al.,.I.�IEAL" Tt I LFATER OF AZ.11'110RIZATION RF.': Pn.)pt.A.-ty of .3 C - at -.:, C 141"-( --jg, . - - 6�1 - . . . . . . . . . . . ...... "---6 F-lx Map # Block Z Lot Suhdivision of —0Sc — I # — 3 (7,c!1fle111c.w 01 filed Map tl 22% Date Filed 6/q I lis I z Act is to 8111.1iori-m ;f•(lpl(!I ..",SioIlall"flgitl(,Cl./L,--oi-lZegisteredAiciiitect to apply for the required -Nvalcv 0't,at1 ent arid/or water supply pei '(.$) to seine the above-noted property in accordance roles or regolaliims as piomulgated by (lie Public Health Director of t1 v. Putnam ' w'Ity I lt,�110111 Dcpi)[ Iment, and toy sign all necessary papers an my behalf in connection with this -eatment-and/or- water s p.j.2 nwmev and (c) surri'vise the c0nstw(.-.tiPri.of'said was.t.ewater tt u jy.sy%ena, 0 ---&or 147 of the Educalitm Law, the Public Health I I Forr');f V, Nvitti. (1h,(,*p1r Vi'05iff'()T'A111c1e' I ati ".111d 1,w 1) (.'aunty y'Code. Very 7 trblv yo irs, i Sgned: tA /x- P., A . , P' (Owner of Property) r T'A,Hnv Addfeq 60. --- -- C) Mailing Address: 0 I-q - P)( State _ -- lip IC9 , %Y i�. It 14.16 -4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State 'Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM., For UNLISTED ACTIONS Only. PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLI ANT ISPONSOR �i� 2. PROJf q'T, NAME j': e$ i C /C 3. PROJECT LOCATION: `� n Municipality County 4. PRECISE LOCATION (Street addr ss and road Intersections, rominent landmarks, etc., or provide map) ��-0 LTA., V4//�'y DSc AyM ,,J A q'--/C47S I- 3, 5. IS PROPOS= • ^_TION: MK'e-s D Expanslon D Mcdificationialteration E. DESCRIBE PRDJECT BRIEFLY: 7. AMOU ?ri OF LAND AFF=^T'eD: Initial!y acres Ultimately acres 8. W�ILL PROPQ °`D ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ergs D No It No, describe briefly 9. WHAT IS Etii LAND USE IN VICINITY OF PROJECT? esidentia! C Industrial D Commercial D Agriculture Park/Forest/Open space. D Other 1C. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? � Yes D No If yes, Ilst agency(s) and permiUapprovats 11. DOES ANY ASPECT ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes. o If yes, list agency name and permitiapproval 12. AS A RESULT OF PROP ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? D Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponscr name: Date: 1414 Signature: rr• If the action is in the Coastal Area, and you are a state agency, complete* the . Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.124 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No _ .• - . R. wILL<ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency.. ❑ Yes ' ❑ Nb '• C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C7. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production . or disposal, potential for erosion, drainage or flooding problems? Explain briefly C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character) Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: . • s d4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced.by the proposed action? Explain briefly. Co. Long term, short term, cumulative, or other effects not Identified in Ct•C5? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its.(a) setting (i.e. urban or.rural);.(b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a'positive declaration. El Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency. Print or ly;- Name of Responsible Officer in Lead Agency Title o Responsib e Officer ry•- Signature of Responsible Officer in.Lead Agency Signature of Preparer It different from responsible o (iced Date I a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIA.L SITE INSPECTION FORM of SECTION A. GENERAL INFORMATION Name of Project 0Sc. AZ A,,j P, Jo.p? (T)(V) �� County Site Location CDS e AV.-)v-k'A Building construction begun ) Extent �! Is property within NYC Watershed ? ................. a Yes �No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) s X75 1. Hilly Rolling Steep slope Gen e slope F Flat 2. F7 Evidence of wetlands a Low area subject to flooding Bodies of water Drainage ditches Rock outcrops 3. Property lines or comers evident ............ :.......................................... Yes ©No 4. Do water courses exist on or adjoin the property? ............................ F_� Yes rNo 5. Will these affect the design of the sewage system facilities ?............ F7 Yes No 6. Do watershed regulations apply in this development ? ....................... a Yes �No 7 Will extensive grading be necessary? ................. ............................... F7 Yes F2�No 8. Will extensive fill be necessary for SSTS? .. ............................... .... Yes No - _ 9. Do filled areas exist within the SSTS area? ........ ............................... Yes No If yes, what is the condition of the fill? _ SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: U ";; "d [�:] Gravel [oam a Clay F__� Hardpan Nlixture 11. Observed from: a Borings F� Bank cut E24 ckhoe excavations i 12. Soil borings /excavations observed by �� on iL 13. Depth to groundwater on 14. Depth to mottling �� on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by o-r t- rVk'/.5S4-0 1'4 T on 17. Soil percolation tests witnessed by on SECTION D (on back) es F] No c� Form ST -1 _ - $ECT-I.ON. D. --,DRAINAGE _ _.- _ _ .. � _ ,..:. _ -.: 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes 19. Will groundwater or surface drainage require special consideration? ..................... Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ............................... ............................... Yes 0 No Inspection data 22. Do adjacent wells and/or sewage systems exist?.. 23. Additional comments ........ .....:......................... Z Yes F7 No 24. Site observer /inspector and title llj�' _ 017V t-Vlf' 25. Date(s) of observation(s)inspection(s) 21 L- TEST PIT PROFILES �' Hole r _Lot # ____ Hole # Lot # _ Hole # Lot rr Depth to water Depth to water Depth to water Depth to mottling NV'.' Depth to mottling Depth to mottling . Depth to rockiimp. Depth to rock/imp. t Depth to rock/imp. G.L. G.L. G.L. 0.5 �'r_1' ...� S 0.5 ©tf - four ��lc, 0.5 t 1.0 1.0 1.0 2.0 2.0 2.0 3.0 S 3.0� 3.0 4.0 4.0 4.0 5.0 3'-6 �1 5.0 �rr - �( 5.0 6.0 ( 'y 5 pfmo • 6.0 c,.,,., 6.0 7.0 7.0 �_: 7.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 tf tp OQ 7-0 OV o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -� APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM`: 1. Name and address of applicant: ALL 2. Name of project: U° 4. Design Professional: 6. Type of P� roject: Pnvate/Residential Apartments Office Building �l r-1og"4a4 I ,fl_A'4� va1lFki.��/ - Le—j3 3. Location T/V: i14F 5. Address: �O l- cam• x 9S� to Food Service Institutional Realty Subidvision Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... 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? ............... Name. of-Lead Agency. 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... es 12. If so, have plans been submitted to such authorities? ........ ............................... eS 13. Has preliminary approval been granted by such authorities Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water oundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? ....... ............................... LID 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ 20. Name of sewage system Distance to sewage system 21. Date test holes observed 2 22. Name of Health Inspector kmm e� Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please p :int or type _ Permit # Well Location: Street Address: Town/Village Tax Grid # j ' O PV V4&p .52 Block 2 Lot(s�3 0 Well Owner: Name: Address: 191-L 4:e� l & 0a " m".1 D Use of Well: esideAfial Public Supply Air /Con eat Pump I ' gation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _-5- gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling t.-�ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling E TT3 vS Well Type .I Willed Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ........................... ............................... Is well located in a realty subdivision? ........... Yes �� No Name of subdivision Osu V* -1 g k vows Lot No. _ Water Well Contractor: % i7. Address: Is Public Water Supply available to site? .................................. ............................... Yes No _L, Name of Public Water Supply: —' Town/Village Distance to property from nearest water main: _ Proposed well location & sources of contamination to pr vide n sep ate sheet/plan. Date: 6> Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) - 05r-4w4v14 ��14;AR R�p Tax Map SZBlock 2 Lot 30 Aindicate nearest cAs sl&et) Municipality �-Cj h A-m �14 //6 Watershed 0e,2 SOIL PERCOLATION TEST DATA 2 3 4 5 1 2 3 4 5 A"-b 2 NOTES: fed at same depth until approximately equal percolation rates are obtained at each ­T�sts'16 be repsa $41dtion t�e# Pole. (i.e. s I min for 1-30 min/inch, 5 2 min for 31-60 min/inch) All data to be submitted ' " ' -f Rtrgiew. pt mv u ih�,- "'A ents to be made from top of hole. yern Form DD-97 C • ,A TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _ ... DEPTH . HQLE�NO.. _. HOLE N0. _ HDLDNQ...v - G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 4 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' L 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' .5 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered i-1 n Deep hole observations made by: }�fLrl�S .Px' S7er/3 /��c tU?Date r---7— —rte Design Professional Name: LZ Address: -?o Signature Design Professional's Seal NE %Z ilk ®�® sOSOy QAOR�sS1opP� �. T, s� 00 APR ! l PM G: 23 A i m L A \/C),La j" 1:�, M G M � rr xt�c. t.� asr„x# 100 Est e F 'jtc Ad 1• p i ,A Imo. t}� Ad Ea 46 Ad 1 lot-- (I �Q �