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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -44 BOX 22 I i, LY I IF rr J � Icy m Ji ' 10 1 'Is J I 02641 DbMa. d �mg(iwme.W Betatlti Saievloea. Causal. ICY.10612 Spmeer,to Pnvlds Fam* iv SSWAGE as CSS'LVWATS OF COMPLLANCB Paralt I g �� owr or Vilwas 1 Taax Map Eenewd ❑ Revbtoa ❑ Date d Prevlo.s Booftg Type Y/ � Lot Aeon S 2,16 Ace, Fm oob Depth _ . Volume Number of Hed<ooaae Deego Flow G P D 4OCK7 PCHD NoOkstioo 4 Beeialeed Whom Fm b comoieted Sepeeats Sewenw Sydm a mmm 011 Gauo. Septic Tank ••d _ J`J -� i" �DO 'IQ � To be Constructed by phi `wig - -• Rddroee wow Supply: Pah& Sep Frog Address a on ) PS, to Sfpply Ddled by � � � "` Rev. 14/88 I a C � a a. •C 6jr O DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 PCHD PERMIT # WELL LOCATION Street Address To Villag City Tax Grid Number WELL OWNER Name Mailing Address Private O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT �5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE`gal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY RrNEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION GIADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE MbRILLED 13DRIVEN ODUG OGRAVEL 0OTHER IS WELL SITE.SUBJECT TO FLOODING? YES No IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name "Cb ` At "t29LVi11i51')C) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _X'_NO NAME OF PUBLIC WATER SUPPLY: %_ TOWN /VIL /CITY DISTANCE TO PROPERT YROM-NEAREST WATER MAIN: LOCATION SKET H SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (dat ) L, /0' rs ignatpf e PERMIT TO CONSTRUCT A This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;* (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling ope 97--.cent ained on this property and in such a manner as not to degrade or otherwi conta at fac or roundwater. ro, Date of 19 Date of Expiration 1 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 " �. Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SgWAGE TREATMENT SYSTEMS REVIEW-SHE T STREET LOCATION 44YAME OF OWNERU ✓"�� E��7 (�' Gam/ �� REVIEWED BY - DATE 1 TAX MAP It Y N DOCUMENTS Y N P T APPLICATION E N CONTROL:HOUSE,WELL, SSDS P PERC & DEEP HOLES LOCATED WELL PERMIT _ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION gLETTEll OF AUTHORIZATION CATION MAP SIGN DATA SHEET (DDS) /J `AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE RPORATE RESOLUTI NN�!1/l;`" ED, PIT & D BOX SHOWN & DETAILED f' T EAF HOUSE - NO.OF BEDROOMS--,a CANS - THREE SETS bS & SSDS'S W/M 200' OF PROPOSED SYS. HOUSE PLANS - TWO SETS -4 �er PROPERTY METES & BOUNDS E REQUEST SE SETBACK NW� 'GRT LOT) S. MOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION. /4 NO BENDS; MAX.BENDS 450 W /CLEANOUT gFIL E AL SUBDIVISION FILL SYSTEMS U DIVISION APPROVAL CHECKED e LA BARRIER C RATE ��� 5 HORIZONTAL; SLOPE 3:1 TO GRADE EPTH L SPECS FILL NOTES CURTAIN DRAIN REQUIRED STANDPIPES FILL CERTIFICATION NOTE GENERAL ;�]T H GUAGES PEPAPPROVAL, IN NYC WATERSHED L PROFILE & DIMENSIONS MITTED TO DEP LUME TED TO PCHD FILL IN EXPANSION AREA IF REQ'D TRENCH DEEP HOLES OBSERVED .... ... .. ...... .. . . ... TRENCH PROVIDED 60 FT MAX. - - RCS WITNESSED, iF REQ'u LEL, TO CONTOURS EX- APPROVAL SSDS ADJ. LOTS - 100% EXPANSION PROVIDED WETLANDS (TOWN/DEC PERMIT REQ'D?) SEPARATION DISTANCES SPECIFIED ATA ON DDS PLANS & PERMIT SAME ON PLAN - FROM SSTS PRE 1969 NEIGHBOR T &TION � " 1 9! -TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL LETTER BI/ZBA -,x,11 O FOUNDATION WALLS _15'WELL TO PL 100 YR. FLOOD ELEVAAt- � JWTO WELL, 200' IN DLOD, 150' PITS OTHER REQ'D PERMITS) 1 TO STREAM WATERCOURSE LAKE (inc. expan) REQUIRED DETAILS ON PLANS 50' CATCH BASIN, 35' STORMDRAIN, PIPED WATER WAGE SYSTEM PLAN - (NORTH ARROW) ]0' TO WATER LINE (pits -20') SSDS HYDRAULIC PROFILE GRAVITY FLOW 0!4NTERMITTENT DRAINAGE COURSE NSTRUCTION NOTES 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS IGN DATA: PERC & DEEP RESULTSs/ IS'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% T CONTOURS EXISTING & PROPOSEPe- �� i to CD discharge /I00'with 182 cons day discharge DRIVEWAY & SLOPES, CUT-0,1-5; SEPTIC TANK FOOTING /GUTTER/CURTAIN DRAINS m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: /� f .'2/ -7° e -e_., FORM ST -2 �A PUTNAM COUNTY DEPARTMENT OF HEALTH YJ RONIb�E- TAL_:HEAL , -H . SERYIC CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV ^ 1'6— 61 1 Located at 91'mP, � � a t,A, AptWW 12b Town or Village �A(� Owner /Applicant Name WA ��-a,, tFtW �1 ( Tax Map 'L Block 3 Lot T Formerly 1J / - Subdivision Name 0 Subd. Lot # Mailing Address $% ' Ll.(.,, ] Vc� er_.'�' RT AkLRT Zip Date Construction Permit Issued by PCHD !111-511-1 Separate Sewerage System built by J , L IC,c q%)A M Address �"� MmAw�lc ST CPeM Consisting of Gallon Septic Tank and �j� �., — QE ��� VJ1 Tom' Other Requirements: Water Sunnly: Public Supply From. Address or: Private Supply Drilled by Address bA2:�7iL. 9' 'p Zt,, Builds. - ?..... .. ... _ ..._....... -�� Has erosion contibl been•completed. Number of Bedrooms Has garbage grinder been installed? 1\i I certify that the system(s), as listed, serv4gthelIN ,e were constructed essentially as shown on the as- built plans (copies of which are attached) 6k ued PC D Construction Permit and approved plans and the standards, rules and regula,* p ent of Health. Date:' °I Certified by - E. R.A. Address License # (5:10 Any person occupying premises served by;the ai promptly take such action as may n. ssary ... to secure the correction of any unsanitary conditions � from such usage. Approval of the selqate "age treatment system shall become null and void as soon as a public sanitary sewer becomes available andihe of the private water supply shall become null and void when a public water supply becomes avai'lall' c approvals are subject to modification or change when, in the judgment of the Public Health_-Birech revo tion, modification or change is necessary. :�. . r By: Title: Date: White copy- _Fi ; Yello copy -Building Inspector; Pink copy - Own O ange copy -Design Professional Form CC -97 . 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location . Street Address/s: Town/Village: Tax Grid # Map Block 3 Lot(s) ©� Well Owner: Name:: Add�rress: Use of Well: I- primary 2- secondary esidential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment L\L Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ? Open hole in bedrock Other Casing Details Total length I ft. Length below grade eft. Diameter / " in. Weight per foot lb /ft. Materials: < Steel _ Plastic _ Other Joints: _ Welded ->< Threaded _ Other Seal: 2L Cement grout _ Bentonite Other Drive shoe: ><-Yes No Liner: Yes ,�5No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed _Pumped ompressed Air Hours - Yield 5 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing er(in) F:;e ll Formation Description ft. ft. Land Surface " If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type�r„rr. i Capacity _ Depth !'l`- Model 7 -1-4' Voltage ; 3 0 HP . Tank Type ' �0 Volume WX Date Well Comp] ted Putnam UI ty Certification No. Date of Rep rt Well Driller (signature) nuxnr rxact location of well wim aistances to at least two permanenylanc�rttarks to be provided on a separate sheet/plan. Well Driller's N ( Address -/ Signature: �/T= ����a -, Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 7r % r YML ENVIRONMENTAL SERVICES � Albert H.. Padovani. Director "8�� PEEKS[ HOLLOW RD. DFITE/TIME RLC 06 1`29 10:'30A PUTNAM VALLEY, NY 10570 PRESERVAIVES,- NONE TEMPERA NOTES COL. I FORM METH.-. FLAG PROCEDURE RESULT NORMAL RANGE ME1 DATE 'PUT AM CNTY PROF-ILE - ALi'-- - ��— - ' ' ' '— - 'r' ".-T, -I A E irk )fWAS NOT OF A T COLLECTION. ` ' tPA bead E. Copper RUle fO',' Public Systems i' re of their distribUtion points h.ave a LEAD value of more ppb- ancl a COPPER' value of 1.3 mg/L, else wal-e-r ertaxen 41-o reouce tne wansrscorroszve |� and manganese are present, their total value l not exceed 0.5 mg/L. . for Sodium are proscribed. Suggested guidelines state people on a sodium restricted diet,the water should Ac"cl fl C. In o, more than 20 mg/L of Sodium. For those on a erately restricted diet, a maximum of 270 mg/L of Sodium s:ggeste�. .` ' �.` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH, SERVICES FINAL SITE INSPECTION Date: eet Locatiox Owner rrsetiq:° Town Permit - -- TM # Subdivision Lot # 1. Sewage Svstem Area a. STS area located as per approved plans ... .. ....................... b. Fill section - date of placement 3:1 barrier , Lgth._ Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... �I e. 100' from water course/w ds ...... ............................... II. Sewage System S _ � _ .........1, 250 ......... other ................ a. eptic t nk size 0 b. Septic tank ins level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly se ....... ............................... 1. ength required eh installed 2. Distance to wate ourse measured Ft.. %t5.f 3. Installed according to plan ........ ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5.. 10 ft. from properly line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed fore 100 % ......................... 8. Size of gravel 3/4 - clean .................... 9. Depth of gravel in trench 12" minimum ................... 1.0: Pipe'ends capped::.:..::.' CF. Pump or Dosed Svstems I Size opump T'am�er ............../. ��:: ........ ..... 2. Overflow tank ........................::.. .... ... ..."-:G..... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .............. ............................... .... 6. Cycle witnessed by H.D.estimated flow /cycle.31fr- III. House/Building a. House located per approved plans ... ............................... b. Number of bedrooms .............. ............................ .. IV. Well a. Well located as per approved plans ................... b. Distance from STS area measured ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 COMMENTS Form J . PU TNAM COUNi'Y DEPAR = OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 5�► STr&4I G°rQt2G- Building Constructed by ag?s T� "LL �o W P-0 t� f Location - Street Subdivision Name yyKPTNk f Municipality I Subdivision Lot # Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal system, or any repairs made by me to such system, except where the failure to operate properly is _.__.. .... ....... ..caub'ecd by- tk�e��il���3- er::�ra�gl- gent.acf ..of tt�e:. occupant :..o£..the.lauilding�.ut lining..` _.. -- the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 this 'O day of _ 19 Jj4t, I 4-,A� General & ntra to er) - Signature Corporation Name (if Corp.) rev. 9/85 mk r Signature Title �0 Arm wxc4owaot4 Corporation Name (if Corp ) Address Owner or Purchaser of Building Section Block Lot 5�► STr&4I G°rQt2G- Building Constructed by ag?s T� "LL �o W P-0 t� f Location - Street Subdivision Name yyKPTNk f Municipality I Subdivision Lot # Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 disposal system, or any repairs made by me to such system, except where the failure to operate properly is _.__.. .... ....... ..caub'ecd by- tk�e��il���3- er::�ra�gl- gent.acf ..of tt�e:. occupant :..o£..the.lauilding�.ut lining..` _.. -- the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 this 'O day of _ 19 Jj4t, I 4-,A� General & ntra to er) - Signature Corporation Name (if Corp.) rev. 9/85 mk r Signature Title �0 Arm wxc4owaot4 Corporation Name (if Corp ) Address PUTNAM COUNTY DEPARTMENT OF HEALTH hIVI9f 'OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at Sc--r , t0, 4aWoVJ 12b Town or Village SaLTt L,, � J -' Owner /Applicant Name 16 WA Tax Map _, 2 Block 3 Lot Formerly l� Subdivision Name V3 Subd. Lot # N� /�•� Mailing Address PCX's ' 1 AW—,W z) q Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by , j . 2. tai" -TJ CJG Address, N� ST. C �y2Al. Consisting of ®�-� Gallon Sep ltic Tank and �7 LEA pF ��� 1+V1f Other Requirements: Water Supply Public Supply From ME Address. Private Suppl_y.Drilled by Address BAdAkOL 'SC's 'pVT011 ...-� Building Type —V_i kg- Has erosion control been completed? Number of Bedrooms 13 Has garbage grinder been installed? 1l� I certify that the system(s), as listed, serving the built plans (copies of which are attached), in plans and the standards, rules and regulatio Date: al 9'O 611 Certified by Address were constructed essentially as shown on the as- fued PC Construction Permit and approved kLievaRtment of Health. 7,P.E. �—c R.A. License # D:10 t2tn Any person occupying premises served by the a 'iii promptly take such action as may n.. ssary .: to secure the correction of any unsanitary conditions Aga from such usage. Approval of the set W ate age treatment system shall become null and void as soon as a public sanitary sewer becomes available andahe of the private water supply shall become null and void when a public water supply becomes av�lah '. �ch approvals are subject to modification or change when, in the judgment of the Public Health ir , ch revo tion, modification or change is necessary. •. �� �, By: ti Title: Date: White copy - �Fi)e; Yello copy - Building Inspector; Pink copy - Own O ange copy - Design Professional Cl.- Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health V De"Vartment Of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 November 19, 2010 Fax (845) 808 -1937 Robert & Lea Baxter 25 Oakridge Drive Putnam Valley, NY 10579 Re: Addition- A- 141 -10 Robert J. Bondi County Executive No Increase in Number of Bedrooms 855 Peekskill Hollow Road (T) Putnam Valley, T.M. # 52. -3 -44 Dear Mr. & Mrs. Baxter: 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 October 20, 2010. 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 r- _A11- pluYnbinl; -fi fares must be updated -with water. - saving device' ,J.e:; new .low flush: - toilets, restrictors for shower heads and faucets etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals Please note, per our conversation the proposed finished basement is approved as shown. There is no Health Department expiration date so the basement can be finished now or any time in the future without resubmitting to the Health Department. If you finish the basement in the future a separate permit may be required by the Town of Putnam Valley 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. GDR:kly cc: BI, (T) Putnam Valley Sincerely, Gene D. Reed Senior Engineering Aide i �� v3 �� o� 47_1 Uer W n, - o v O F l C .�CApi�s NoT e,�.?►s±' D psi y_. T Fc e>o �A o to �_ /2310-7 l 10? $ -- _ l_3 -O 7_ i� -`T Cp�v to CZ�� 15 Kl� SM& TT LO --CA P—T _YC - 1� -V- 1- a e x./-1-1 �.A-nsA __ i-s— — w c��a -�- r� r�a � � ►�—.5 ,d.� Go N �i aw��� zue)�-� _ LOCAL LAW 4-2010 A LOCAL LAW to amend Chapter 165 (Zoning) of the Town Code of the Town of Putnam Valley so as to add a new subsection (5) to Section 165 -45 B of the Code, dealing with reconstruction of damaged and/or destroyed structures containing lawful nonconforming uses. BE IT ENACTED by the Town Board of the Town of Putnam Valley as follows: (1) A new subsection (5) is hereby added to Town Code Section 16545 B (Zoning), reading as follows: "(5) A structure devoted to a lawful nonconforming use, which structure is damaged or destroyed by any means, may be rebuilt without variances, or a site plan or development approval plan, and the nonconforming use resumed, provided: (a) a building permit is obtained, a certificate of occupancy issued, and the lawful nonconforming use is resumed within 2 years of the structure's damage or destruction; and (b) the new structure is .rebuilt on or within ...... _ . _ ...�..__,,._._._.z ......_._� _........__.. _.. -._ eOn$u3..::hu--.....g..00 nn co Mains no. ;...... more habitable area than the structure it is _. replacing, and will be no higher at any point than the structure it is replacing." (2) This Local Law shall take effect upon its filing with the New York State Secretary of State. Dated: 5 -19 -10 Putnam Valley, New York TITLE NO. CERTIFIED -TO: In accordance with the exlatiry code of practice for land surveystidopted by the Now, York Sate Association cf Professional Lend Surveyors,t �a �TACON /C . CattNbatins o Shall tun only, to those individuals individuals PARKWAY) and ' Institutions Mown hereon under the title policy number shown above Said ¢sftltieatFai+s are not transferable. pEOPL E �F TXE S AIM or /Viral YORK N 62'OB'OS'E 5. 3. SJ' Jos y w�/�Q / ✓ /.ff FRAM6 IY.C, a . rw. T(V't iry Mr e4rD r yA .�L /TBR •. tips ws°u , t F/L ED JEPr K, /!s3 MAP /Ma. Z tit, ' , .wiwow LOT ! V R� 2065.00 """ ' 3•a0 1(ntrrwatr MKS r) AREA s /. SW ACAW j ivory: OF.PIADPE''IPTY +% REFER 70 LAMER JdSj PA6Et SM SO/. J/7uArt /K THE ertitications hereon afe valld 41 the map and copies of surveyor said map or copies 4ear the harem. Impressed seal TOWN .OF Pall TNAM �ALLEY e surveyor whose signature a�pean hereon. PUMAM COUNTY NEW YORK r unauthorized alteration or addltiolr to a survey map f! CA E: r, a D_ ATE: AAA Y03t /!97 i bearinpalieaneed tandsurveyere exci tea viclatlon of I Section 7208, sub- dMston 2, of the New York state ? Education Law. The location or underground Improvements or encroachments, it any axtet, are not certltiad. Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE _.:. _..__- Director of Environmental•I1'ealth October 20, 2010 Department ®i 'Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Robert & Lea Baxter 25 Oakridge Drive Putnam Valley, NY 10579 Dear Mr. & Mrs. Baxter: Re: Addition -A- 141 -10 Robert J. Bondi Count, Executive No Increase in Number of Bedrooms 855 Peekskill Hollow Road (T) Putnam Valley, T.M. # 52. -3 -44 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 October 20, 2010. 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. "Tlie area of th&'existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrirtors for shower heads and faucets etc. 4. 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:kly cc: BI, (T) Putnam Valley Sherhta Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE. _ "' Uirecto'r'of fnvironmental Health' r Robert J. Bondi County Executive Department ®f Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Robert & Lea Baxter 25 Oakridge Drive Putnam Valley, NY 10579 Dear Mr. & Mrs. Baxter: October 7, 2010 Re: Addition — Application Incomplete 855 Peekskill Hollow Road (T) Putnam Valley, TM # 52. -3 -44 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. The following was not submitted with your application: • Sketches of existing floor plans (drawn to scale, showing all living areas including the basement). .. , ....-.__. _....._.. tZpon a..re,. ipt bf_.a submission, revised to reflect the-above comments, this application will-be considered further. Sincerely, EOVIEI��W 511 Gene D. Reed Sr. Environmental Engineering Aide GDR:kly PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project. (T)(V) /" C/ County c Site Location Building construction begun z Z' - e . . c, Extent Is property within NYC Watershed ? ::............... 0 Yes a No SECTION B. TO GiRAPHY (Please check all appropriate boxes) 1. x y 0 Rolling [7 Steep slope a Gentle slope Flat 2. F --- I Evidence of wetlands F7 Low area subject to flooding F—] Bodies of water aDrainage ditches F__] Rock outcrops 3. Property lines or corners evident ....................... ............................... es No 4.. Do water courses exist on or adjoin the property? ............................ E] Yes E4o 5. Will these affect the design of the sewage system facilities ?............ 0 Yes �Pdo 6. Do watershed regulations apply in this development ? ....................... F7 Yes L4�60 7 Will extensive grading be necessary? ... ............................... Yes gr g ary ? .............. 0 8. Will extensive fill be necessary for SSTS ........................... 7' 9. Do filled areas exist within the SSTS area? ........ ............................... 0 Yes o If yes, what is the condition of the fill? b . SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand Gravel oam a Clay � Hardpan a Mixture 11. Observed from: � Borings Bank cut ackhoe excavations 12. Soil borings /excavations observed by on / 13. Depth to groundwater on 14. Depth to mottling �� on 15. Are test holes representative of primary & reserve areas ...... ............................... es 0 No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 2 �7ECS -Ill1C:1Ji,..9JRL'i1Nl'Y�ITE' � _ •• ..v. - -.'• .- '" - r• .• _. .. �. s ._ +..�_ .r... es _... _ «_ = c 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes F�� 19. Will groundwater or surface drainage require special consideration? ..................... r Yes 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .:................:....... �' , Yes F----+Ne--- SECTION E. REMARK'S 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ...... F Yes c�e� Inspection data 22. Do adjacent wells and/or sewage systems exist ?..................................................... F] Yes 23. Additional comments A-:�, `Z - -�--� ,24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) I TEST PIT PROFILES Hole # _,Lot # Hole # 2---Lot # Hole # Lot # Depth to water '�Z!� Depth to water Depth to water !� Depth to mottling Depth to mottling Depth to mottling _...Deptlitio rock/imp: °-_._.._ w . -. Depth°io'rock/imp- rock7imp. G.L. G.L. G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 .o 10.0 0.5 0.5 1.0 1.0 2.0 2.0 3.0 3.0 4.0 4.0 5.0 5.0 6,0 6.0 7.0 7.0 8.0 8.0 M 10.0 9.0 10.0 PMM COUNTY DEPARTMENT OF . DIVISION OF 1' •' ' 1WY HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��t% y Address r Located at ( Street) S S ^� y1s /� ���C� Sec. �� Block 3 Lot (indicate nearest cross street) manicipa.Lity Watershed • a • �+�a• s_ �; wa a C114 v ;� -a- R i 9 - 1. I'V41 wgis jµw: : • • a M •,► Date of Pre- Soaking Date of Percolation Test HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Tine Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 ���° 52 3 4 5 1 x/34- 5-c;;, I b 21 3'72-1110?- 4 2 3 4 IN 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 1 „ TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DFP'I'E1 HOLE - NOa- 'l G.L. 3' 4' 5' 6' 7' 8' 9' 10` 11' 12` 13' 14'...... - . INDICATE LEVEL AT WHICH GROUNDMdM IS ENCOUNTERED '^ INDICATE LEVEL TO WHICH WATER LEVEL, RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERMCIONS MADE BY: BkBk&ALLD DATE: {'Z DESIGN Soil Rate Us -0 Min /1" Drop: S.D. Usable Area Provided No. of Bedroams Septic Tank Capacity t00CD gals. Type - Absorption Area Provided By L.F. x 24" width trench Other � �� � • / ! 49 4c--V., \ �n5- ."T.�J��� A,wn,. 4��. - -0. !Q .A Name C Signature yy r + Addresses SEAL d THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY :. Soil Rate Approved sq.ft /gal. Checked by Date ,PC_ 1 PUT NAM COUNTY D E PART M E NT OF H EA LT H APPi�- ICATLON- •.FOR - APPROVAL -OF -PLANS FOR A WASTEWATER DISPOSAL SYSTEM rA 1. Name and Address of Applicant: N 2. Name of Project: (� �1 -� ` 0 3. Location T /V /C: 4. Project Engineer: /�. -�-�.. 5. Address: St"� License Number: Phone: 6. T e of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision 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 4&., 10. Name of Lead Agency �k L ft 11. Is this.projpct.J,n an area under the control of local planning., zoning, or othet-.:off-icials-; • ordinances? ..... ........ . ".:'. " .:................ _ ... 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 Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?..... /... " .-- 16. Waters index number (surface) ........... ............................... I _t 17. Is project located near a public water supply system? .................. T AO 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal'system ?..... 20. Name of sewage system t_k l Distance to system 21. Date test holes observed: 22. Name jeage of Health Inspecto 23. Project design flow (gallons per day) ....... ............................... 6CFV� 11/93 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 25. Has SPDES Application.been submitted ato�^ local "DEC Of fice. .....`.. ..... .. " 26. Is any portion of this project located within a designated Town or State wetland ?.... .... ................... ............................... K%b 27. Wetland ID Number ..................... ............................... �1 28. Is Wetland Permit required? ............................................. 0 Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. 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: 32. Is there a local master plan or file with the Town or Village? ........... _YAFS 33. Are community water, sewer facilities planned to be developed within 15 years? 34.' Are any sewage disposal areas in excess of 15% slope? ........................ 35. Tax Map ID Number .......................... ............................. f:r..- _ .. 36. Approved Plans are to be returned to: ................ Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter-of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pur uant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: