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is ` P TNAM C OU NTY D EPARTME NT OF - .IV-ISION -.OF EN.VIRO- NMENTA L - HEALTH SERV-- ICES...; r :..v....� . q CERT ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at D S C %ZZa�. Town or Village —FJ-1144M V4 Owner /Applicant Name JE> J Q� _0 t22- 0 Tax Map 57:Z Block 2' Lot Formerly Mailing Address 7 W14i Subdivision Name © SGgw' c .a A Subd. Lot # Z— Zip Date Construction Permit Issued by PCHD / Separate Sewerage System built by Lzaa 1�-iz- Address '7 W d4 iT/z tJ.11 ? c►,'sr, Consisting of Gallon Septic Tank and Other Requirements: Ili Water Supply: Public Supply From Address or: Lll� Private Supply Drilled by FFo v r-> Address e 52 C °Has erosion'iontroi been completed? `_ Number of Bedrooms Has garbage grinder been installed? 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 $sued PCHD Construction Permit and approved plans and the standards, rules and regulations of t,ut Fou ty Department of Health. Date: cv Certified by Address rF D Rz y 9'S-D P.E. `"'R.A. License # ��V 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 when, in' the .judgment of the Public Health Director, such revocation, modification or change is necessary. By Title: S �/ Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 WELL L;Vr'irLt -ltuv r%r:rumi Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services /� PUTNAM COUNTY DEPARTMENT OF HEALTH / �/_ — SiREET,AOURESS. 'NNr t TAx GRIo NumsEA: WELL LOCATION 94 b e q al PAom g . .6--'2 - ,2 -- y 2 WELL OWNER NAME: ADDRESS: rr zz.urr '� Whrfeha,LL �d iU /Q P61VATE O PUBLIC USE OF WELL 1 - primary 2 - secondary $ RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED —S—_/ EST. OF DAILY USAGE SIQ gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ®ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL Q- ft. DATE MEASURED -� DRILLING EQUIPMENT ❑ ROTARY COMPRESSED. AIR PERCUSSION ❑ DUG ❑ WELL POINT - O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH _ L— ft. MATERIALS: Ml STEEL O PLASTIC O OTHER LENGTH BELOW GRADE_ ft. JOINTS: ❑ WELDED 99 THREADED ❑ OTHER DIAMETER — in. SEAL: 97 CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 1- Ib. /ft. DRIVE SHOE.$] YES ❑ NO I LINER: DYES A NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST OYES . 0 NO HOURS SECOND..._ _......._ . q__ .. ... GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST ► If detailed pumping METHOD: ❑ PUMPED tests were done is it O COMPRESSED AIR , ` ormation attached? 0 BAILED O OTHER ❑ YES O NO �LL LOG If more detailed formation descriptions or Sieve analyses are available, please attach, pTN Faont uaFACe r Water Bear- Ino welt 0'a peter KRMATiON DESCRIPTION coat ft. WELL DEPTH ft. DURATION hr, min, DRAWOOWN ft. YIELD gpm. Land i .1 t rn S WATER O CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE CAPACITY GAT.. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME O A.rievi n U" co "'1"'-_ _ OAT(s ADDRESS IR D J5 0-4 �� SIGNATURE �G A) 3/89 u PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.. HEALTH_ SERVICES-___ � 1-,e i ..... .' 4 .�... .4 . v...R- _ ....+ n a ...x- c isev. � . e s. .v s. .. —, v. r w.: �.. -. -• s. >`a+.e GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or P rchaser of Building Tax Map Block Lot �} -L—Z e S 2c2—c V41(,0_:Z1 Building Constructed by TownNil age S C!a c c 7 �4 t—I � 7 s Iz�. S C4 W !q- —1 A 1�. �o c�R IS Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described prbperty, 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 riegli * dit'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 bu ding utilizing the system. . N Date Mont Day. Year l General . ntractor.( ner) - Signature Corporation Name (if corporation) Address: E Q J C e r'. State Qe.,,,i Zip 140 O Signature: -a Title: Corporation Name (if corporation) Address: State Zip Form GS -97 ' ^ . ` ^ YML ENVIRONMENTAL SERVICES ` 321 Kear Street _ Yorktown Heights, N-.�Y-~.1.0598 (914) 245-2800 Albert H. Padovani, Director '0 _�. ^_ 9' ;z LAB #: 32.801751 CLIENT #: 8704 NON STAT PROC PAGE 1 BUZZURRO, BARRY DATE/TIME TAKEN: 03/10/q801:3OP 7 WHITEHALL RD. DATE/TIME REC'D: 03/10/98 02:00P PICK-UP ' ' REPORT DATE: 03/13/98 PHONE: (914)-779-4990 , . . SAMPLING SITE: 94 OSCAWANA RD. ' SAMPLE TYPE..: POTABLE PUTNAM VALLEY, N.Y. 10579 PRESERVATIVES:. NONE CnL'D BY: BARRY BUZZURRO TEMPERATuRE..: < 4C NOTES...: BASE BATH - COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 03/10/98 MF T. COLIFORM 03/10/98 LEAD (IMS) 03/10/98 NITRATE NITROG '03/1O/98 NITRITE NITROG 03/10/98 IRON (Fe) 03/10/98 (Mn) 03/10/98 SODIUM (Na) 03/10/98 pH 03/10/98 HARDNESS,TOTAL 03/10/98 ALKALINITY (AS RESULT ABSENT /100 ML 2.5 ppb 0.79 MG/L <0.01 MG/L 0.136 MG/L <0.010 /L 14.5 MG/L 7.5 UNITS 78.0 MG/L 94.0 MG/L NTO'.'-�'� NORMAL - RANGE METHOD ABSENT 1008 0-15 ppb 12345 0_ 10 9139 N/A . 9146 0-0.3 mg/l :2037 0-0.3 mg/1 2037 N/A 6.5-8.5 9043 N/A N/A COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER NOT) �OF A ZDSATISFACTORY SANITARY QUALITY ACCORDIk�THE NEW YORK STATE, ' AND EPA FEDERAL DRINK NG WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public'Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. . . Fe/Mn If both iron and manganese area 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 ' moderat ely restricted diet, a maximum of 270 mg/L of Sodium is suggested. N YML ENVIRONMENTAL SERVICES _ 321 Kear Street �.' ` - .~Y_o` .r~ k^ to. w~n Hei h ~ N Y -� 1~0 ~ 5?/�-.�~ 245-Pbou Albert H. Padovani, Director _ LAB #: 32.801751 CLIENT #: 8704 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8UZZURRO, BARRY '-DATE/TIME TAKEN: 03/10/98 01:30P 7 WHITEHALL RD. DATE/TIME REC'D: 03/10/98 02:00P PICK-UP REPORT DATE: 03/13/98 PHONE: (914)-779-4990 , SAMPLING SITE: 94 bSCAWANA RD. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, N.Y. 10579 PRESERVATIVES: NONE COL'D BY: BARRY BUZZURRO TEMPERATURE..:,," 4C NOTES...: BASE BATH COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE -RESULT NORMAL - RANGE METHOD ' SUBMITTED BY: Director ` ' ELAP# 10323 DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -31 BOX 22 1 ru I I a 0 1 rM '. III We u 16r J . �.I L , r 4L Ir 02586 REBECCA wI1TENBERG, RN, BSN Public Health Diredor ROBERT MORRIS, PE Director of EnvirormientdfFledith . DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 April 20, 2012 Barry Buzurro 94 Oscawana Heights Road Putnam Valley, NY 10579 Re: Addition - A- 041 -12 No Increase in Number of Bedrooms 94 Oscawana Heights Road (T) Putnam Valley, T.M. 52. -2 -31 1-91MM&M 0.3 M-71M."I MARYE.r.r.E.N ODELL County Executive This Department has 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 April 20, 2012. 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 se,,vage 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 ... 4. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 5. This approval is valid for two (2) years and expires on April 20, 2014. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you. have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, Gene D. Reed Senior Engineering Aide GDR:cw cc: BI (T) Putnam Valley ' r , r' REBECCA WITTENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH = 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 January 5, 2012 Town Zoning Board 265 Oscawana Lake Road Putnam Valley, NY 10579 To whom it may concern: MARYELLEN ODELL County Executive Re: Addition Procedures and Policies Please be advised that this Department recently revised its procedures and policies for the review of house additions. At this time the Department will not require a septic system to be updated to current codes due to proposed construction over 50% of the dwelling's original square footage. A copy of the current Procedures and Policies is enclosed. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. _ - - Sincerely,..:..... Gene D. Reed Environmental Health Engineering Aide GDR:cw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROCEDURES & POLICIES . FOR HOUSE ADDITIONS ..:Bulletin HA -1 . .._...__....:. a_ cw /proceduremanuaVRA -1 May 2009 Revised November 2011 TABLE OF CONTENTS A: IO�i ::.:::....................`...: 2.0 ADDITION GUIDELINES .......................... ............................... 1 3.0 SUBMITTAL PROCEDURES ..................... ............................... 3 APPENDIX A. ADDITION APPLICATION FORM ............. ............................... 4 B. LEGAL BEDROOM COUNT FORM ........... ............................... 5 C. SAMPLE HOUSE PLAN SKETCH ............. ............................... 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1.0 INTRODUCTION The Putnam County Department of Health (the "Department"), Division of Environmental Health services has developed this detailed guide for. submission requirements, policies and procedures relative to approval of house additions. The Department must review and approve all proposed house additions prior to construction. The following is a description of the requirements of the Department for submission of an application for a house addition. The Department may require additional information or procedures as considered necessary, based upon engineering review of a project. Professional architectural house plans are not required for addition approvals by the PCDOH and it is strongly advised that architectural house plans not be obtained prior to approval by the PCDOH. A pre - submission conference with the PCDOH staff is also strongly advised. 2.0 ADDITION GUIDELINES & PARAMETERS 1. The Department must review all proposed additions, which will result in an increase in living area. 2. A complete tear down and rebuild of an existing residence will be reviewed on a case by case basis. 3. Adding any or a potential bedroom(s) to a house requires a Department construction permit for the expansion or complete replacement of the SSTS. The Department will determine the need for complete replacement of the SSTS based upon the age and condition of the existing septic system. 4. Houses destroyed by fire or other catastrophic event will be permitted to be hind, if they meet building department criteria for grandfathering: - 5. Houses which will not be rebuilt in the same footprint or do not meet building department criteria for grandfathering may require a permit for a new SSTS. If the subject lot is listed or determined to be vacant, than a new SSTS meeting current code requirements must be provided. 6. Any addition which is considered an increase in the potential bedroom count requires a formal approval of SSTS plans (Construction Permit) by the Department and plans are to be prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code, unless the SSTS is presently designed for the proposed number of bedrooms. The plans shall provide for the installation of additional and/or new SSTS area meeting rp event code requirements. (See PCHD Bulletin ST -19). 7. A proposed house addition shall not reduce the size of the existing SSTS reserve area. An addition which encroaches upon the existing SSTS or reduces the SSTS expansion area will require a formal Department approval (see # 6 above). 8. The Department does not object to reducing the number of bedrooms in a house since SSTS sizing is determined by the number of bedrooms. The addition of rooms such as dens, offices, libraries, exercise rooms, studies, bonus /unfinished rooms, etc. may be considered as potential bedrooms, and each will be reviewed on a case by case basis by the Department. 1. The determination of whether a proposed room addition to a house is potential bedroom will be made by Department staff based upon: location of the room in the house -- - size of the room considered a a. Accessory rooms such as dens, libraries, studies, computer rooms, offices, sewing rooms, etc. may be considered potential bedrooms. b. Large bedrooms, greater than 24 feet by 10 feet, which may easily be divided by a partition wall, may be considered. two potential bedrooms. C. Storage areas or unfinished portions of the addition may also be considered potential living area and/or bedrooms.. d. The partitioning of basements may result in the added rooms as being considered potential bedrooms. N e. The renaming of a bedroom may not necessarily negate its potential use as a bedroom and will be considered on a case by case basis by the Department. f. Rooms which will not be considered a potential bedroom must meet one of the following criteria. i. If the room has a floor area less than 70 square feet. ii. If the room has a horizontal dimension less than 7 feet. iii. If the room in question can only be accessed through another room with no other means of potential egress, one of the rooms will be considered a potential bedroom, if the dimension criteria for a potential bedroom is met or exceeded by one or both rooms. g. For houses with current code SSTS's, excluding repairs, which were approved without a waiver after December 31, 1989, the Department will allow the following rooms on the first floor of -the house: living room dinin room_ kitchen family room and home office /study. Any other rooms beyond " those listed above will be considered a potential bedroom except for rooms which meet the criteria in item 'T '. 9. Any addition which does not result in an increase in the number of bedrooms will require the submission of plans (to scale), prepared by the property owner, showing the entire existing and proposed house floor plan with each room labeled. Once the review has been completed, the plans will be stamped by the Department noting the number of bedrooms, including potential bedrooms. If the number of bedrooms remains the same as existing, no further expansion of the SSTS will be required, provided the existing SSTS is functioning properly. The Department will issue a letter indicating the total number of existing bedrooms and that no expansion of the SSTS area will be required and that any other permits or variances required are the jurisdiction of the local municipality. If however, it is determined that an increase in potential bedrooms is proposed, then refer to #6 on the previous age. Any previous repairs which have been done on the SSTS which do not meet current code requirements do not count towards the SSTS capacity when an addition increases the bedroom count. 10. The existing SSTS must be functioning satisfactorily for an addition approval to be granted by the Department. 2. 11. The SSTS design flow for additions that show multiple kitchens, existing or proposed, will be increased by 200 gpd for each additional kitchen over one. 12. The legal bedroom count form must be completed by the Town Building .w = Department; even in the case where =a, Certificate of Construction Compliance. has been issued by the Department. Any addition not covered in the general outline above will be handled on a case by case basis. 3.0 SUBMUTAL PROCEDURES Prior to the construction of a building addition, plans for the proposed work must be reviewed and approved by the Department. The submission requirements for an addition permit are as follows: a) Addition Application (Appendix A) b) Permit application fee of $100.00 (Certified Check or Money Order made payable to Putnam County Health Department). Note, if the addition application requires a new SSTS, the fee is $500.00 ($100.00 for the addition application plus $400.00 for the SSTS review). c) One (1) set of house plans, drawn to scale, showing only the existing conditions. All living areas, including basement, are to be shown on the plan(s). The use and dimensions of each room are also to be provided on the plan. The plan is to include the applicant's name, street address, town, and tax map number. Please refer to Appendix C for an example. The plan does not need to be prepared by a design professional. d) Two (2) sets of house floor plans, drawn to scale showing the proposed building addition. All living areas, including basement, are to be shown on.,the_ plans, The _use and dimensions of each room are also to be provided on the plan. The plan is to include the applicant's name, street address, Town and tax map number. Please refer to Appendix C for an example. The plans do not need to be prepared by a design professional. e) The "Town Legal Bedroom Count and Proposed Addition Status" form (Appendix B) is to be completed by the Town Building Department. fl A copy of the property survey showing the existing house, well and SSTS and proposed building addition, drawn to scale. 0 u r tw REBECCA WITTENBERG, RN, BSN Public Health Director MARYELLEN ODELL Cotuq Executive ROBERT MORRIS; PE'_:. -. - - ...... _ Director of Environmental Health TIP _'05 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 ADDITION APPLICATION RESIDENTIAL ONLY I °i ,�. STREET 2 �.o:(� TOWN f:b 1 Nom' TAX MAP # a ,Z • '.2 — 31 NAME c '2 V Z-P_—o PHONEq bq 6?/-1407 PCHD# f0�Sc fJ4:a`v cam"'' MAILING J1 ADDRESS �' I DESCRIPTION OF ADDITION G�IGC.a�L ���!llvGa �Z�1�/� !t•`t ��o *NUMBER OF EXISTING BEDROOMS NUMBER OF PROPOSED NEW 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, - Br7ter, NY '10509, Phone: (845.) 808 -1390. Jl . Certified check or money order for $100.00. ,. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE �q COMMENTS 4. v;A e WO-110' 4 b REBECCA WFITENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (W) 808 -1390 Fax # (845) 278 -7921 Town Legal Bedroom Count & Proposed Addition Status Re: gA:7Z,,e y 01/ Z Z !%r, 5bwner's Name) Tax Map # �oC — �-- •3 Address: Lf ©,s Lam% / 6'yn5 Town: !// L' 1, 'Ie- y i • Year Built: % Cf According to records maintained by the Town, the above noted dwelling, is I/ in compliance with Town Code. MARYELLEN ODELL County Executive The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Other: The plans for the proposed addition are considered: Addition to existing house only Teardown and/or re -build allowed under Town Regulations uildmg ctor 5. ,� /,2 le�� Z 2, Da APPENDIX C 48' --4 1 t cola ire aw 8'5 4'8 22'8 - LIVING AREA BUZZURRO RESIDENCE BASEMENT zo 04 If 48' --4 1 t cola ire aw 8'5 4'8 22'8 - LIVING AREA BUZZURRO RESIDENCE BASEMENT zo 04 zo N 4v 18,11 22-8 ------ IF raUT13Ati UNTY DEP AR7EN ; OF EAITL at/ P:HOUSE PLANS APPROVED FOR 13�DR0014 COW',lT ONLY; o BEDROOMS RECREATION ROOM HALL 1187 x 137 61 x 14'8 co ti'g.11ature Title . ......... (D 00 co cm co O. co cli GARAGE 5/10 _)C"4 22'x 264 r cm co GYM OFFICE 11'11 x 11'5 8'1 x 115 BOILER 4 . s In 9) is is 4'4x10'4 123 V5 4'8 22'8 LIVING AREA BUZZURRO RESIDENC BASEMENT to 71 N,j x W�f L, C,-: -Ig , 111;11,� A). 53, 0" 4j. M Fg, '4 'o 4 +s T, b'a"P, IV` "V" -51& X .14 Jl: Xz� -n, , 140; A,(.V v M! 15� �VO AV; , 4,,V" I V 'A 21 0 .1 NP, 0M, 6ov ter' ti -,Cq - I �iA 163 AV Ell, 7 V � kiR Doe,, .� \ \ \ � A. REBECCA WrITENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health March 15, 2012 DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Barry Buzzurro 94 Oscawana Heights Road Putnam Valley, NY 10579 Dear Ms. Buzzurro: Re: Addition- A- 041 -12 MARYELLEN ODELL County Executive _ No Increase in Number of Bedrooms 94 Oscawana Heights Road . . (T) Putnam Valley, T.M. 52. -2 -31 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 15, 2012. 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. -'-"'-T. All 'pl"irig- fixtures must lie updated with water -saving devices,- i:e:; n-ew low - lush- toi�lets� �= -= -- - restrictors for 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 other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 808 -1390, ext. 43261 Sincerely, Gene D. Reed Senior Engineering Aide GDR:cw cc: BI, (T) Putnam Valley ..,AWCCA WITTENBERG, RN, BSN ROBERT MORRIS, PE Director of Environmental Health 1 Geneva Road, Brewster, New York 10509 Phone # (W) 808-1390 Fax # (845) 278-7921 Town Legal Bedroom Count & Proposed Addition Status Re: Buzzuro (Owner's Name) TaxMap# 52.-2-31 Address: 94 Oscawana Heights Road Town: Putnam Valley Year Built: 1998 According to records maintained by the Town, the above noted dwelling, in compliance with Town Code. Is not in compliance with Town Code. MARYELLENODELL County Executive The Legal Bedroom Count is.: 3-bedrooms with office (lower level) (four bedroom septic system) This information has been obtained from: Certificate of Occupancy: CO#98-47 One Family w/deck and finished basement. Other: The plans for the proposed addition are considered: xx Addition to existing house only Teardown and/or re-build allowed under Town Regulations j 413112 B g Inspector Date 5. ... -. .mot- ...... - .. _ ...._._.. ._..- ._..,w :;. . ....- ..__....._- .__._.- .... -... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEUAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # G.- Located at 0 S C 7 �y Town or Village � I ] -( �" Owner /Applicant Name Tax Map SBlock Lot �•-� Formerly Mailing Address 7. W 91.L6 Subdivision Name O SCOW A aJ A LJ000 t Subd. Lot # Z.. Zip Date Construction Permit Issued by PCHD Separate Sewerage System built byL� s� Address W Consis. ng of % �. Gallon Se tic Tank and D FT Other Requirements: Water Supply: :Public Supply From Address or: Private Supply Drilled by �O % r—> Address -. _.Building, Type.. .... w l:.- " . __ -. -. -- _.Has erostort_control been.completed ?. _ �- Number of Bedrooms Has garbage grinder been installed? N�. • _ __ 1 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 ssued PCHD Construction Permit and approved; plans and the standards, rules and regulations of o ty Department of Health. Date: 3 2 r' Certified by P.E. `'�R.A. esi ofessional) "" Address O 2:) o S—P License # go '5V Any person occupying premises served by the above systems) 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 when, in the judgment of the Public Health Director, such, . revocation, modification or ch a is necessary. By. Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 _ - - - - - .. ___ ...._ n .. .�. .�. _......_ -- .__._.a.,_.._..__. _..._ ___.__...__� /,' � 0 UTILITY /X " 00 112 x Co -I�a u4 RAN M E; O s< r -T I IZ 0 F- P, 4-r 1-4 r- 9,4-.M 5 • 5tLF 4-L�E-j 0. GARAGE • e-- 444 0 er-e i L i �4c^ NO" . P9,61C Amy vV/ ov F-;z 4 R. 0, V ftL • k# VA*AFOK PbAk-&Q,1�0, --4 UNFINISHED BASEMIEMT —14 -T MAN UP -r '.. -,T \ " yc 2 (p c. P-A4-1 E wA LL ltv" e-cpl-jc,; Poo t, /+ Up L-cwtk I-AVEL wiHo�=W5 A/rrH FOUNDATION PLAN. 114- ., OSCKW-ANNA HE.lGHTS'PU,t.NAM. VALLEY .VICTORIA BROOKE 0 4- .�7 ,e�� - CA 014m -rH E F F- L- P T /,' � 0 UTILITY /X " 00 112 x Co -I�a u4 RAN M E; O s< r -T I IZ 0 F- P, 4-r 1-4 r- 9,4-.M 5 • 5tLF 4-L�E-j 0. GARAGE • e-- 444 0 er-e i L i �4c^ NO" . P9,61C Amy vV/ ov F-;z 4 R. 0, V ftL • k# VA*AFOK PbAk-&Q,1�0, --4 UNFINISHED BASEMIEMT —14 -T MAN UP -r '.. -,T \ " yc 2 (p c. P-A4-1 E wA LL ltv" e-cpl-jc,; Poo t, /+ Up L-cwtk I-AVEL wiHo�=W5 A/rrH FOUNDATION PLAN. 114- ., OSCKW-ANNA HE.lGHTS'PU,t.NAM. VALLEY .VICTORIA BROOKE 0 4- .�7 ,e�� - CA 014m v. .r '•1 irs' M32 21210 /2' i CONSTRUCTION BY CHELSEA MODULAR HOMES• INC. IT: KS- a Z ❑ CHELSEA NODULAR HOMES. INC. P.O. BOX 1188 ROUTE 9. 11/22/96 K$ MARLBDR4 NY. 12512 ', 914-236 -3331 N r MB. " MJM' MASTER BEDROOM 36XSF, lJ 101 /11 /9/. W M C M H W:v li?3 S'F •''7. >r --------- - - - - -- L J BEAM REQUIRED T— 1,Z R-6 I@ �' BEDROOM #Z BEDROOM #3 10' -0' X 9' -11, 10-0' X.9• -11' `• 99 SF 98 SF i; 'i. I J I 1� � I I frR�1 /1• — FFF------ ---��� Brij' -i] i� /�•— i �x i-sTlni� �l2ST fL o ©'iz G DE ROORRAW W 80AMM OF ALL O81EA MOR M HOW' ARE CW WOf M WE WLL EIFOW CHBSEA MDDIfM HOMES RESERVES THE RIGHT TO MAKE MOOR C14AHM 01 DBAE?I CLIENT`. BUILDER: odr3�cao; no64opaa araooaa ADDRESS: ADDRESS: 670 LEETOWN RD PUTNAM VALLEY, NY STORMVILLE, NY, 12582 s' — .e'-r P -1] 1/P 1' c •I u• -+� 1H• r =r Nd0 •; �2BR •� 1n u .ac• visa / 5111!C �) / 2016 / B -7FS \\ sLaPEU /// �Xis�In� R. K ITCHED - D.I4V LNG R qM; a �1) - }0'..Xy,12e��. ! -; =: y:.t j�:.i2.'.• Tr.. ......:... .;- l� ��. � \\.. '117 SF ,>..4 \ I / \ t " BEAR REQUIRED BEAN. REQUIRED \ / \ SLOPED g s \.,IV' G ROOM. d ! VZ 3• X le-3- Fp YER ' / �\ F . i \ z. \ zRSZ zR>z �- 6' -S Le• _ it -Y 6' -a V.. •r -r i H ALL COFMOS TO PROTECT OUR CONSDHUBIE NWITM9TT N DEVEMMfi VM RARE AND ELEVATVa IONS AS REOLOWD BY MODULAR CONSTRUCTION METHODS. . SITE LDC.: SHEET #'!A -3 DWN. BY+ -(MSM PRDJ• ID #: C800 APP. BY: + - - -- SERIAL M - --- DATE, 110/31/96 Q i R p1� piSTERED AA OP�ID �q9 c i O �e D20999� ryF ST T E & PLANS AND ARCHITECT'S STAMP VALID ONLY FOR MODULAF CONSTRUCTION BY CHELSEA MODULAR HOMES• INC. W 11/27/96 KS- MANUFACTUREiR WORMATON Z ❑ CHELSEA NODULAR HOMES. INC. P.O. BOX 1188 ROUTE 9. 11/22/96 K$ MARLBDR4 NY. 12512 ', 914-236 -3331 N r ©COPYRIGHT 1996 CHELSEA MODULAR HOMES -- ALL RIGHTS RES 11/11/96 MJM' %ECTEO UUER SECTION 6 "�W�K:�iTLUS*clAs9A� no lJ 101 /11 /9/. W M C M H T ,z w �s,��,1."�.•." -°3 s acwmA.¢] a ."r wr w u>fR r�.e,..,.... . r S Y f 1. 566° z7' sd "4 52 'Zlc�Zl�`;a rJ •9 47 .'U u Z A� i . N� LT- V PTI T6 Am T46 T-i Tq .41 P F- IT /1 14 ROY A rlr%��L j, CWSLALPoLJ(�r e>ox of. Aqlats Lith derviow ance witb- Lons of the 2.0 39 A G �.. Deptli t �+.�. Pm seab•o-.. volaoe Ntaiie �[ Beirtar>rJ Doolp flow G P b 'PCHD.Nod8=11 e 4 Ya11e� Wb= PM b mmpm d SalsuaM Sowuw S7� to ow d Jam.— aYw S�plle Tads esid E. Waiw S1119¢s IPIIW SINOW. irI Pehaa.Sa>D11Wdb7 c �1!1WIa I represenCthat 'l am wholly and compNtaly nspo"Ie for,the design and location of the proposed systom(�: 1) that the separate disposal system above dose ►itled will W eoeistruetedis.snown•on the approved smandment there to and in accordance with this standards; rules an rpu ns o �{ County Department of .Health, and that on:compkition thereof a "Certificate of Construction Compliance" satisfactory" to the Commissioner of Nealthwill be submitted to the Dpartmint. and a writtan.guarantes will be'furnishid the ownor,.hiaaucoaseors, heNSOr assignaby the builder; that sold builder will P" in paled operating condition. any piit'of mkt senrne .disposal system during'Wo period of two (2) years immediately folkowin4 thedate of the isms- once of the approval Of the Certifkato of .Corwruct"* Compliance of the original system or any repairs thweto; 2) that the drilled well descrilled above will be located as otiose on the ovpproi sd:pNn and that said weil'will . Installed in accordance ith the standards, rules and rpuW cis Sf the Putnam County ceigartrPWA of Health: / Sign ad P.E. Date , %�QRJ/►�. — c.Addrau —i License No �SCrT f� APPROVED FOR CONSTRUC'iION- Thit.approval expires two. f► m he datL iss4odunte%Amst,uctio. of the building has Oeen undertaken and Is rsrrocaple for coup or y be amendeet or modifi d.when cons ry by the, mission► of Health. Any Change or alteration of construction p requires a new relit owed for 'disposal of'doniestic I age, aid /or to water supply only. 'PV. 10/88 Do'* sr Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLI'CATION�'TO CONSTRUCT A;' WATER WELL PCHD PERMIT # WELL LOCATION Street Address o a Villa City Tax Grid Number. WELL OWNER Name Mail' g Ad ess I�' p�D Private O Public SE OF WELL ( - primary 2 - secondary ® RESIDENTIAL ® PUBLIC SUPPLY O BUSINESS O FARM ® INDUSTRIAL U INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify, O STAND -BY AMOUNT OF USE YIELD SOUGHT — ' gpm /# PEOPLE SERVED /EST. 0 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION NEW SUPPLY NEW DWELLING) Q j2EERXN I TING WELL OF DAILY USAGE al GIADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING ni&KA,41AT _11M --cmato eQ WELL TYPE DRILLED ODRIVEN ODUG []GRAVEL OOTHER IS WELL SITE SUBJECT;TO FLOODING? YES I WELL IS LOCA ED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _X_NO NAME OF PUBLIC WATER SUPPLY: Ty el,4- TOWN /VIL /CITY DISTANCE - -TO. PROPERTY- FROM --NEA_ St ..WATER MAIN' .: .e.. 1 .. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED `ON SEPARATE SHEET ( at (sign ture) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: a 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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 drills T19 operations be contained on this property and in such a manner as not to degrade or other is conta ate surface or groundwater. Date of Issue: a 8_ 19 f 6 Date of Expiration �� 19 t Issuing 0 f icial Permit is Non-Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Mark A. Day, PE Robert V. Oswald, LS ■ 10 -65 Route 82 Hopewell At., NY 12533 (914) 227 -6227 Fax 226 -1315 DAY & OSWALD neers & Land Surveyors 11996 Robert Morris, P.E. Public Health Engineer Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: Rosenbaum, Proposed SSDS Oscawana Lake Road, Town of Putnam Valley Dear Mr. Morris, The enclosed plan has been revised for the above referenced project based on your review letter dated December 9, 1996. • The well has been relocated as to eliminate any direct line drainage conflicts. • The existing NYS Wetland is located across Oscawana Road from the project site, this has been indicated on the plans. The wetland extends both east and west of the property but it's boundary does not cross to the north of Oscawana Lake Road. a There is no curtain drain proposed for the site, the detail -has - been removed from the plans. • A minimum of 1' of ROB fill has been indicated on the plans with the addition of regrade contours and a fill pad detail. • Deep hole data has been submitted with this letter. Thank you for faxing the review letter to our office, our client has been very patient with us and I would like to get Board of Health Approval for him as soon as I can. If you have any questions concerning the revised plans please contact me at our office. Happy Holidays! Sincerely, Tanya Reinhard �. r v • �• r r- �r • • : r var n, 011111:61MA v OCOQ1 DESIGN Soil Rate Used �P `7 Mi.n/1"- Drop: - _S.D. Usable Area Provided No. of Bedrooms. — .'Septic Tank Capacity _ IL_ gals. Type Absorption Area'Provided By L.P. x 24 ". width trench . Other - Name Signature Address SEAL ° mw #069M THIS SPACE FOR USE BY HEALTH DEMMEM ONLY: Soil Rate Approved sq.ft /gal.. Checked by Date DEP'T'H HOLE NO. ...HOLE NO. HOLE NO. 2' um A Tip 4' 1 I_ .►.1D2 �OaTT, I Lam i1C1,4 Ltam 5' !o• L . 6' r w�^,c@ �,s 6 .71 8' c) V 9' 10' 12' 13' 14' INDICATE LEVEL, AT WHICH GROUNU4ZATER IS ENCOUNTERED - .�•� _ . :.. INDICATE LEVEE, TO WHICH WATER LE_ VEL RISES AFTER BEING E'NMUNTFM N __..... DEEP HOLE OBSERVATIONS MADE BY: _. DATE: DESIGN Soil Rate Used �P `7 Mi.n/1"- Drop: - _S.D. Usable Area Provided No. of Bedrooms. — .'Septic Tank Capacity _ IL_ gals. Type Absorption Area'Provided By L.P. x 24 ". width trench . Other - Name Signature Address SEAL ° mw #069M THIS SPACE FOR USE BY HEALTH DEMMEM ONLY: Soil Rate Approved sq.ft /gal.. Checked by Date rim ., . u..._a -._..- a.... BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York &q?nber 3, 1996 Mark Dav (914) 278 -6130 Barger, Day and Oswald Route. 82 Hopewell Jct., NY 12533 Re: Proposed SSDS: Rosenbaum Oscawana Lake Road (T) Putnam Valley Dear Mr. Day: 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. The well location should be proposed the minimum of 200 feet from the proposed and existing SSDS locations on lot 3 and 1 respectively. The relocation would eliminate any direct line of drainage conflicts. 2. ..If.a wetland is on the property or within 100 feet, of the.prope>Gty line - the.boundary -is to,be on the ptan 3. The SSDS on the property N/F Fisher is to be labeled as existing cZr proposed. It cannot be labeled as both. 4. The stone/gravel used for any part of the SSDS is to be clearly labeled as washed. 5. If a curtain drain is not proposed the detail should be crossed out or removed. 6. Detail for a 1250 gallon septic tank is to be provided on the plan. 7. The minimum of 1 foot of ROB fill is to be shown on the primary and expansion area. 8. Deep hole data has not been submitted. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Ve truly yours, IN Robert Morris, P. E. Public Health Engineer RNVjP REGISTERED ?FAIL RETURN RECEIPT REQUESTED Date 0CMr3 pl 29, !99 Building Inspector 2lOS4� 6 W . 7 _1�s�9 Dear Re: Construction Permit for single family residence Applicant IPAOA4 _ Street Town Tilt - -- 2 _ - -Z JS 1------ - - - - -- . This Firm (I am) submitting an application to.construct a sewage disposal system serving a single family residence on the above captioned property, to the_Putnam County Department of Health. In order to process this application the Health Department. requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for any variances? Yes No -- - - - - -- --- - - - - -- B) Is any portion of the parcel located within a regulated vetland or its control area, and if so is a wetland permit required? Yes _____ No --------- C) Is any other local permit or approval necessary? Yes-- - -- No. If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Name Kb R9 _ Health Department Inspector JK /jp vetland bh Very truly yours, Engineer, Architect, Owner Richard C Barger, PE & LS Mark A. Day, PE Robert V. OswalA LS ■ 10.65 Route 82 Hopewell At, NY 12533 (914) 127 -6227 Fax 226 -1315 ..t : _ .Z.._.... BARGER, DAY & OSWALD Consulting Engineers & Land Surveyors November 3, 1996 Robert Morris, P.E. Public Health Engineer Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: Oscawana Woods, Lot #2 Dear Mr. Morris, I am submitting and Application for Approval of Plans for a Wastewater Disposal System on behalf of the owner of the above referenced property. The owner wishes to construct a four bedroom home on the property. The design of the SDS is based on a percolation rate of 6 -7 minutes per inch. Nine laterals at 50 feet are required for a four bedroom home. I have encluded with this letter plans, the appropriate paper work, . and the . application fee. F .... If there are any questions or comments please contact me at our office. Sincerely, Tanya Reinhard TR/tr enc. Q 1 1 �7 _7 H 111 Ind .PUr,NMM CC{7NTY DEMUMM= OF REAL= DIVI.SICN OF READ SmcmiCFS MINIMS - 4 5 I Z 3 4 5 NO=: 1. Tests to be repeated) at same depth until avprcxiunate? y equal soil rates are obtained at each percolaticn test hole. All data to' be subniued for review. 2_ Deptrh reasurQnents to be rrade f_--= top or hole_ ,c F2LE NO. Owner �G-�� _ f� ,,t j .UAA Address ma_ _ 16cate3 at (Street) Sec. Block Lot -31 (indicate nearest cross street) — M.:Inlc?r�lity "i'Ovi Water -shed SOIL P —T: SST IIM. RDQU= TO BE SUEM11= jviT-H AP-P I=MTS Date of Pre -Sca k ng —T Date of Percolat i cn Test 1 " 2-9 (1 HOLE NU-M'1 c=r TDE P-ZRC;,=ON PEtC OIATTION Run Elapse Depth to Water F-r m meter Level No. Ti.nle Ground Surface In Inches Soil Rate Start -Stop Min. start- Stop Drop In Min /In Droo Inches Incises InCZes 0 112L lLc -- 2 5 LZS - I D6 Ca „ ? -G)ry 1' MINIMS - 4 5 I Z 3 4 5 NO=: 1. Tests to be repeated) at same depth until avprcxiunate? y equal soil rates are obtained at each percolaticn test hole. All data to' be subniued for review. 2_ Deptrh reasurQnents to be rrade f_--= top or hole_ ,c PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF - ,ENVIRONMENTAL•` HEALTH• -SERVIC'ES _ __:� -_ • _. . Date Re: Property of Located at 0WAX&IWA, 1 6 2V (T)Tuj`Q,&M VA,t.Lb1% Section 2, Block ? Lot 3) Subdivision of -WawAJ-IA. .d Subdv. Lot # 2 Filed Map # Z7- 3 G Date Gentlemen: This letter is to authorize a duly licensed professional engineer X or registered architect_ (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in - - -- connec•t:ion °wi:t -h- -thi-s--ma-tte --•and �to- -supervis -e 'the constructibri'bf` said' - -- system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E. , R.A. , # 069Co4C0 to -05 ZWI� 82 Address )�sdcnbL4q _Z 27 -(o227 elephone r. 7� / / is r' Owner of Property �. FW & LECAD Mf , Aadress Y"� �IE� W 400 Teyephone 0 <3574. BA 'i`:_6!§WALb ' *-Z' GINEERi't SURVEYORS ..,--�,"' -10-65 RT.'82'_,PH.'914_-227-6227 HOPEWELL JUNCTION, NY. '125.33 50-584/219 TO THE .............. DOLLARS Bo M First JEiuclsori %alley lvrit satiors4l Bank of tbeffudsoii Valley bWN S TRHMT. F;SHKILI, inr 4524 ' r C . FOR 0 0 3 5,7 L, -III +1 0, 2 9 0 5 El Lo L o: A,2 -1 :2 -3 ? 15 Le, 2 111 11 . 1 pUTNAM COUNTY D E pARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 1.. ""lam TUNA 2. Name of Project: l v.na.t �i�i�S l� Z 3. Location(T�V /C: 4. Project Engineer: T.'&\i v4X--,�) 5. Address: JQ-(nom P2 License Number: C'Xc (OLHI:� Phone: S. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Paris Office Building Realty Subdivision Other (specify) '. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II._ Unlisted Is a Draft Environmental Impact Statement (DEIS) required? ............. �t) . Has DEIS been completed and found acceptable by Lead Agency? Q Name of Lead Agency • Is this project in an area under the control of local planning, zoning, or other officials, ordinances?.,.__._._ ........ ............................... • If so, have plans been submitted to such authorities? ..:.::.......:.... • Has preliminary approval been granted by such authorities? Date Granted. . Type of Sewage Disposal System Discharge..*.... Surface Water;�Ground Waters: . If surface water discharge, what is the stream class designation ?......... - Waters index .number (surface) ........... ............................... Is project located near a public water supply system? .................. _ If yes, name of water supply . 0 Distance to water supply _ Is project site near a public sewage collection or disposal system ?..... ''tt , Name of sewage system 1�.1 h\ Distance to sewage system , Date observed: 23. Name of Health Inspector:L�?" =�' �'Ib1�121 Project design flow (gallons per day) ...... ............................... 25. Is State Pollutant Discharge El'iminatlon System ( SPDES) Permit requirea?.. No 26. Has SPDES Application been submitted to local DEC Office? /! 27. Is any 'portion of this project located within a designated Town or State wetland ?...... .......... .. .... ............................... .... 28. Wetland ID Number ... .......................16....... .. ................ k 29. Is Wetland Permit required? .. .......... ............................... Has application been made to Town or Local, DEC' Off ice? �_ 30 -. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill; sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: NA/A- 33. Is there a local master plan or file with the Town or Village? ........... NO 34. Are community water, sewer facilities planned to be developed within 15 years? l`. 35. Are any sewage disposal areas in excess of 15% slope? I� D 36. Tax Map ID Number. ............... a... .... .................... 37. Approved Plans are to be returned to: Applicant Engineer. r .,__: -. if the application is signed-by ap e rson other than the applicant -shown- i'n "Ite "m 1 "the application must be accompanied by a Letter of Authorization. Failure to comply with this )rovision 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 be 1 ief. Fa Ise statements made herein are punishable as a Class A Ni emeanor. pursue to section 210.45 0 the Pena 1 Law. ;IGNATURES & OFFICIAL TITLES;