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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -29 BOX 23 I IIL J 1 6` i _I . ,L _`, ml r XL .', '- ' 02763 - , TNAM COUNTY DEPARTMENT OF HEALTH D SION -D ENVIRONMENTAL HEALTH _SERVICES. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PY 4 "� Located at ©3 �'� �G.�� q ��`, e J7 °a Town or Village a T� �l U� G Owner /Applicant Name 1151,. / :Tax Map Block l Lot z 9 Formerly Subdivision Name I% e Subd: Lot # Mailing Address '� 9 �! �' �� °Q Zip Date Construction Permit Issued by PCHD /5 9 5 2 'C A Separate Sewerage System built by W64 L. lf'4 e�- Address J�� r��✓� .� n Consisting of J cl e Q Gallon Septic Tank and yz, �. �� Other Requirements: —' Water Supply: Public Supply From Address or: ✓ Private Supply Drilled by / � /1 �✓��! �r� /! �' r� Address l6s� r✓f l� °V� PP �-- _._..._:Buidirig Type- -ri Hai erosi ®n eontrol�beea completed? Number of Bedrooms Has garbage grinder been installed? IYV I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: �� !�� Certified by v� P.E. ►'' R.A. ional) Address 4� ° License # > L/ Any person occupying premises served A. 5 s) shall promptly take such action as may be necessary to secure the correction of any unsanitary a?,. g from such usage. Approval of the separate sewage treatment system shall become null and voi 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 revoca ' n, modification or change is necessary. ,2� n G I c i By: `" Title: &ve� 4L- . Date: 12 z Q White copy - HD Fi ; Yell opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 - PUTNAM COUNTY DEPARTMENT OF HEALTH V, DIVISION OF ENVIRONMENTAL HEALTH SERVICES W -WtELL COMPLETION REPORT fil- V-be� Well Location Street Address: Lake Oscawana Road Town/Village: Putnam Valley Tax Grid # Map Block Lot(s) Well Owner: Name: Address: (Kobalka) Webber Construction, 2 Chapel Hill Rd., Sherman, CT 06784 Use of Well: I- primary 2- secondary xxx Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby 1Drilling Equipment Rotary Cable percussion xxx Compressed air percussion Other (specify) Well Type Screened Open end casing xxx Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 40 ft. Diameter 6 in. Weight per foot _19 lb /ft. Materials: xx Steel _ Plastic _ Other Joints: _ Welded xx 'Threaded _ Other Seal: xx Cement grout _ Bentonite Other Drive shoe: . X cc Yes _ No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped x Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface-static '505 71) 110 During yield test(ft) 750 Depth of completed well in feet 900 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 5 To soil , sandy loam .w /cobbles 5 15 Ledge - = - - Soft brown sa ri i ke 20 900 Hard black & white granite If yield was tested at different depths during drilling, g ng� list: . Feet Gallons Per Minute Pump /Storage Tank Information 765 1/2 Pump Types mers pacity Depth 600 - Model 5ST55 -76 P Voltage 230 HP 12 V ank Type piaphragfi✓olume 62 gal. 900. 5 Date We11 Comp eted 7/.3/98 Putnam County Certification No. jDate 2 of Report 7/3/98 Well Driller (signature) NUT E: Exact loc on ot- well with distances to at least two permanent landmarKS to be provided on a separate sneettptan. 75 Putnam: Ave.,. Brewster, NY Well Driller 's L L ,, INC. Address: Signature: o t Date: 7/:7/98 obert M. Min 1, resident White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 1- i4. NORTHEAST LABORATORY OF DANBURY 39-3 MILL P PLAW ROAD DANBURY,CT 06811 _.... _._ _- CT Cert: _ PH -0.4o. ~ � " NYCert: � 11471 (203) 748 -7903 - FAX (203) 748 -0652 'LABORATORY REPORT - -. WATER SUPPLY TEST_ ING REPORT TO: MILL DRILLING, INC. DATE SAMPLE COLLECTED: 11 /10/98 &11/18/98 75 PUTNAM AVENUE TIME COLLECTED: 12:40 P.M. BRESTER, N.Y. 10509 COLLECTED BY: BOB MILL DATE RECEIVED @ LAB: 11 /10/98 &11/18/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 11/20/98 SAMPLE SITE: KOBALKA, OSCAWANA LAKE RD., PUTNAM VALLEY, N.Y. SAMPLING POINT: BOTTOM OF TANK SOURCE: WELL TREATMENT: NONE TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) E Coli (Bacteria) PHYSICALS: PH Turbidity CHEMISTRY: Nitrite N 11301 - Nitrate N Alkalinity Iron -�— - Manganese RESULT: 0 per 100 ml NEGATIVE 7.48 2.4 NTUs <0.01 mg/L as N <0.01 mg/L as N 64.0 mg/L 116.0-- �. Mg /L .1. .. .- 0.123 mg/L 0.019 mg/L Sodium 4.5 mg/L Lead <0.005 mg/L MAXIMUM CONTAMINANT LEVEL 0 per 100 ml NEGATIVE no designated limit 5 -NTUs 1 mg/L as N 10 mg/L as N, no designated limits no designated limits .._ 0.30 mg%L, ._..... __ __. _ _.__ . , ...._.. ......_ r ..... _. _... �. . 0.30 mg/L. [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 20 mg/L ** 0.015 * ** ml = milliliter mg/L = milligrams per Liter 1`;D = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 11/10/98&11/18/98 SAMPLE, AS TESTED ABOVE: M or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) m. Laboratory Director' (W *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105. OUTSIDE CT: 800 - 654 -1230 DEC. 4.1998 6:42AN JPK ENTERPRISES N0.983 P.2 P UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by n Location - Street /j G � / ,/,lG"e, Building Type -6/Z / . z g Tax Map ll Bloch Lot TownNillage 2 Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage ofthe 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 ofthe Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to placeqh 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 wiJIM or negligent act of the occupant ofthe building utilizing the system. The undersigned .further agrees to accept as conclusive the determination of the Public Health �.....w ...� ., ::: Director ot'the:Paftnaw" Coaanty..iDepazehient of Health -as to whether or not the failure -of the�system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated., Month Day J/ Year �1 General' Contractor (Over a Signature M[2hae Ull b%✓ I(X 7 • to Corporation Name (if corporation) A Signature; Title: "�?AAIPJ Corporation Name (if corporation) Address: dh Address: State Q✓Yb,(. , Zip -7 State Zip Fora 0, a' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL, SITE INSPEC'T'ION - Street'Location ' 'y Town ` t -r. "&f.&V TM # 2 s 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tEFsii - 1,00 ........ 1, 250 .......... other ................ b. Septic tank ins evel ................ ............................... c. 10' minimum from foundation :......... ............................... d. Distribtuion Box All -out et) s at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set. ..........:.......... ............................... engtFi required Length installed r 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends ckpped. _ ............ t. g. Pump or Dosed Systems Size o pump chamber .............. .... 2. Overflow tank .......................... ®.... ? .. 3. Alarm, visual / audio .................. ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin 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 Date: Inspected by Owner Permit # Subdivision Lot # .4 Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES fE- LDACTIVITY'REPOM' z Tel: C, (hJ A-m A Ly! AT)T)RESS, Street PERSON IN CHARGE. Name and Title TYPE OF FACILITY: I mr� FINDINGS: Town State Zip --J :49 nstp. d 012, C- 2 76 0 /a1 1 5-7 -ter t Kr ! *-,,,-,,&iC(tW% JM, �tir'LAgIr",L. - 0 ,� ::5 N(OT C,4jF0q L�ItrL L Av Ct-eflm - N k PAID JF I 0Q,77O&* INSE141"HIR' j,(r 11 rc_ TF],! I 1 1) Signature and Title J/ RFPnRT -RF-r.FTvFT) By: I acknowledge receipt of this report: SIGNATURE.' 02/96 Title: Rev. -,:. r. Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH r-, iw4x-xi-irA 1FXV A ir r1r cuiox), FIELD ACTIVITY REPORT NAM P., of. Tf-h AnDRESS. Street Town State Zip PERSON IN CHARGE C natt-, n'D TNTT-P'P'%1rPUMn-- _=1 %,� 1, L i Name and Title TYPE OF FACILITY: V, 0t- �r-, I FINDINGS: MI I r) , . K I * `C&Itperm T- 140-r 2� co�j I I f 4") / " —IAa T4.10p, Af, KL T1,42-0 L, 7n�-C,,o (M A iz.&C rN.qPF,rT0R, Signature and Title RF,PnRT -RFrFTv-Fn ny-, I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. 0 " -..,: �-^�°-',aY�- .. -,-- mss.....: s�°''" ^ -^.-�^-""""-'•- ----X. ;-r— 1 4:. PUTNAM w6w �I H OF REALTH r p T Is to Proivlde Posit /- - DbMw d Seedoea: �atssl •, 4 OF MPIJAN ._1 1 Pkikk FOR SRWAGN D'EM4 AL SYSTEM Posslt CO rY'a� c, Cl ., �i qtr. or vm.se - o:y::.e. "., :+vr� ar �^:v �l�T- ' -. r - _C�d_ e••^► +} .. -. /,.. r:• .•vas c v•:•r. .a,' r , .. S�dliltian Ndaee �! G Lot i~ Tax gyp 8 R tai t� Oww/Affftmd Ntioe %'.0 'G' /.�' - l 9s rj /1 Date od Prevloos Appiovol, ftA&gU/ �, lili./JV (/ - 4 Q� Town �C�i %�1` � �s �. patg Subdivision Annroved� Z� Fee Enclosed 0_ It Amniint CG Y/JJ G- Lot A.e... Pm Secum Ott pepfb ripeG�''i valame Dealp [low G P D O O PCHD NotfBCitloo 4 Requhert When FIII y Number d Bodrosre 5 � a Z LO— GA= O:O aryl Shcptk Tank end ct To be.a akepSod by `- .. Address Water SftP44 Pd& 11 � —Adler . � aed �� Stglp� Deed by — �1ddt'e� Oliar Regbhesseuta 1 rep►aerit'itnat 1 am wholly and completely refponsitlle fa;the design and location Of the proposed system(s); lj that tM se ►ate sew dl wl t stem . above described will be Constructed as shown on,tha approved amopdmeni. there to and in accordan the standard; rules a regulations o nom county Deputmant of :MMRh, and that,on eolnplilion thereof a;' Certificate ', of Conitructi ' satisfactory to the.Commissloner of MMlthwill 'aid a submitted t0 the Oepertms At, -and a written quarsintN wili be furnished tM owner,; assfgna by the bu{Wa►, that pu {kler will VW* in Hood operating' condition any pert of said .swage disposal witem dugns tn' . Immediately following thedete of the Isom- ante of the .4 of -the_ Certificate of Construction Compitardc4 ,of 'the oriiinal will M located aa"shoindi on the approved plan and,tnat sled well wt0 bi insial n. tacco , y n t o; 2) that the drilled well descrlbid above it n ules and regu aZilons of, the Putnam County Department of Health. �4RpA. Date Sgned -, P.E. / Address Zy7 /- ✓�i!l� . r�.:: License No �• y 1 APPROVED FOR CONSTRUCTION: Tnii aOp►owl•axpirai two t•he .dat6 f .tM building .MS been undertaken and is revocable /or Cause or meY ba amenda0 or modified when consiary by' Co W6'n Any cMnge or Jttwation of construction reouires a w it. A owe for disposal of domestic pe a ivate R eV. �f A n A(, . 1��88 dMte C. BY Title W 7 (12 Win" coulm 91 PIZ C- DEPOSAL SIRM '0�� Town or vehop. 0 • SW61vidlic 9:14 Omm/Affbmi Asm Daft ad pri;fomm Appoyd. bdMft IrYW I't FM &wdm 0* LI Dora —vahme- -pCHD MoMmIlm b RequindMon M Is complobd Iftsibm al Befisome— Dodos F101W, G D smm,iim, ft-WW Sy"m to 061dit Ole- - W; de - To be- 'by AAWbmm--- WmW sop* poft SW* WC46- l000,000.or an Sipply DAW odw the h 1) that. the Separate Systorn(S). of the i rePreammuthat i �am,w olly.,and, comp_ eiv, :a I "'!n,a!�- proposed standards; rules and regulations abo%je discribad will tie IlrUcted as %hoWn: con tiiiii to _4 of HaRk. and that :ej 0 the 51 sitisimori to the cornmissionir of meenhwill !Iata, oi�.. the bulklor. that said WNW will tie Iiikvm0t" tiiiho Dipait" a writion ,urnlshod, the, owni , I I A?,, to, assloi by. bd 606ratinip Am I IWI§o*Wq thedsto of the iseu- aaeee " tr a 1 40 the cokificite of Coiistruckibn—Corniilla' ino lfty'r"6irs thwoto;12) that the dril w*ll.dos&M" 06WO located at Pk and that wait 7,1 6�'l n"F`0% ru shown !hmapp-�— n will r Ix 4) wW be t In "d redusyMns of .,the Putnam COWk Y "0' it' Wd 09 Health. s. K. DOW Siined p.E.I P.A. Add f nB N APPROVED FOR CONSTRUCTIO YntB appoval expiroi two Y rom,the d e issuod uWl,"S" I struttlon 64 building has b. undertaken .601 W rovoca . ble for cause or "m I y 6 aiiw66iled.6r. 6iWified t CoMjinl' i SCI 0601keelth. Any chorw or alteration of Construction "Im!Y by millaires a ne4 per Appro"Viod for ViW"Osmml of age'. all/i iraio' IW5'ter supply only. .Rev. 0 r?—Il& M GOD Title Im a 'a DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 "PI;ICXr1d9' i0' _tbNSTRUCT °'A' WAT'W WELI;' PCHD PERMIT # -for WELL LOCATION Street Address JJ / Tow`n Vil a e City . / Tax Grid Number WELL OWNER �`�� Name Mailin Address rivate �a41-1,0Public E OF WELL 1 primary - secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT _or gpm /# O REPLACE EXISTING SUPPLY JdNEW SUPPLY NEW DWELLING)- PEOPLE SERVED /EST. OF DAILY USAGE &® Sal O TEST /OBSERVATION 13 ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name cod &1-�� e, Address: � IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES t/ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY _p.IS,TA��d: TO P,RUP,EIiTY „FROM NEAitEST WATER MAIN _. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED JgON SEPARATE SHEET (date) (signature) 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 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 any and all water or waste products from such well property and in suc oa manner as not,to degrade or f Date of Issue: / 19 ej Date of Expiration 19q shall take appropriate action to assure that drilli o erations be contained on this other onta in t surface or groundwater. f Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT 'P► WATER "WELD PCHD PERMIT WELL LOCATION Street Address Cz* �, s Town V llage C ty / Tax /£` Grid Number J s WELL OWNER Name d aili Address � // -?� / rivate blic (�_E OF WELL primary 2.- secondary RESIDENTIAL 0 PUBLIC SUPPLY 4BUSINESS O FARM 0 INDUSTRIAL 0 INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY 0 ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT_�' S' gpm /# ® REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGE k® gal ® TEST /OBSERVATION 12. ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE UDRILLED ®DRIVEN ®DUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES A--" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -e117 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A/'°NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE, TO PROPERTY FROM NEAREST WATER FAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (da e) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in suc a manner as not to degrade or othigrNise contaminate surface o I r groundwater. Date of Issue: 1 19—f I' ke&6v 14mi-o Date of Expiration �� _19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 January 17, 1997 Frank Sullivan, P. E. 2972 Ferncrest Drive Yorktown Hts, NY 10598 Dear Mr. Sullivan: Acting Public Health Director Re: Proposed SSDS: Kolboka Oscawana Lake Rd. (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." / 1. Current engineers authorization letter is to be submitted. /2. D -box detail is not correct. The first outlet is shown before the baffle. p-43. House sewer is to be noted as having a minimum slope of 1 /4 "A p0014. Trenches are to be shown as being straight on the plan. ROB fill is to be proposed if grading is required. ...._.._.. , .:5: ---Tirst"r v- =feevof -trench is-n;t-ca cuWe ► in the total footage,.- are-to - scale two feet longer than the effective length, i.e. a trench of 60 feet is to scale 62 feet. Upon receipt of a submission, revised to reflect the above, this application will be considered further. V yours, Robert Morris, P. E. Public Health Engineer RNVjp !�. V-40! BRUCE R. FOLEY, R.S. Acting Public LHealth Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 =6130 January 17, 1997, Frank Sullivan, P. E. 2972 Ferncrest Drive Yorktown Hts, NY 10598 Re: Proposed SSDS: Kolboka Oscawana Lake Rd. (T) Putnam Valley Dear Mr. Sullivan: 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. Current engineers authorization letter is to be submitted. 2. D -box detail is not correct. The first outlet is shown before the baffle. 3. House sewer is to be noted as having a minimum slope of 1 /4 " /ft. 4. Trenches are to be shown as being straight 'on the plan. ROB fill is to be proposed if grading is required.. ro 5. First two feet of trench is not calculated in the total footage. Therefore trenches are to scale two feet longer than the effective length, i.e. a trench of 60 feet is to scale 62 feet. Upon receipt of a submission, revised to reflect the above, this application will be considered further. ME V yours, Robert Morris, P. E. Public Health Engineer PC -1 , PUT NAM COUNTY D E PART M E NT OF H EA LT H `M' APf�LICATI6N ~FOR�APPROVAL bF `OCWA FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 'lfPol &z1&& /P �'/ Y- 2. Name of Project'. )52 04 3. Location T /V /C � 0.l�- 4. Project Engineer: ,!1���� 5. Address: License Number: 2, Phone: 6 . TvDeof Pro ect : 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? fl' 10. Name of Lead Agency ®V�� an, area. under. the : contr cST , f„ .l;oca3:; p . Ann lg zoning; or other officials, ordinances? .......... ............................... 12. If so, have plans been submitted to such authorities? .................. y4c:!!� 13. Has preliminary approval been granted by such authorities? Y � Date Granted:/"Of 14. Type of Sewage Disposal System Discharge...... Surface_ Water AOO' Ground Waters 15. If surface water discharge, what is the stream class designation ?........ —AIIA 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 disposal system ?..... A119 20. Name of sewage system eA --r Distance to sewage system 21. Date test holes observed: 22. Name of Health Inspector: 23. Project design flow (gallons per day)......6&0 .......................... 11/93 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.: /4, 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? .................................. ............................... A47 27. Wetland ID Number ........................ ............................... /7- 28. Is Wetland Permit required? .............. ............................... POO Has application been made to Town or Local DEC Office? 29. Does project require a DEC Stream Disturbance Permit? ................... ory 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? ........... S 33. Are community water, sewer facilities planned to be developed within 15 years? 7 34, Are -any sewage: - disposal . areas_.in- ..excess of 15%,slope? ........ ....... ........... w 35. Tax Map ID Number .............. 7-q............................ 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. % 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 Lau. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: DESIGN DATA SHEET= SUBSUFACE-- SISJAGE 1jI8P0SAt"ftS1b4` -FILE NO. Owner Address, 19,04 1,�e exel Located at (Street) Sec. Block lot (indicate nearest cross street) -municipa.Lity Watershed SOIL • E' 0• TEST DATA REQUIRED TO. BE SUBMI= WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE REBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches o2, 1 2 4 5 2 3 > 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtainedat each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS EkICOUN EKED IN TEST HOLES _..HOLE G.L. 1° 3' 4' 5° 6' 7' 8' a 10° 11' 12' 13' 4 INDICATE' LEVEL AT WHICH GROUNDWATER ISf ENCOUNTERED INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: c��i`�� DATE: % DESIGN Soil Rate Used _ Min /1" Drop: S.D. Usable Area Provided No. of Bedroams Septic Tank Capacity i 0-0 el' gals. Type Absorption Area Provided By ,3 e 0 L.F. x 24" width trench Other Name (7 �!�/ /i�Ff� Signature _ O'' =, Address Ve14&10,W11,-&04 THIS SRACE FOR USE BY HEALTH DEPARZMENr ONLY: ; `T Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH __.__..:. -. __ .........:.. . . _ .. R.ZVk _TQN OF . El�i_VIRQN�IE�T�AL :�.FcAL��Z$,��G��- _... _ .. +.' cv..pa•.,:o•rt::..w�..1:r.mr, ...r...,.a.�c..a�• __ _ . +` - Date r Re: Property of Located at �SCC� �� /��7G,i ✓�c/01G' (T )y L! 6 Section Z,5 Block j Lot 1 Subdivision of 'Eq Subdv. Lot # Filed Map # Date y Gentlemen: This letter is to authorize U �' �� / /✓� a duly licensed professional engineer 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 `connectio.yi -w th.,thi.S.�mat�ter� ��d �t�q.' ���. vas _�_�tY�e_:�cOn�t��,cti;pn, -.of 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. Counte ne� P.E., R.A., # %S Address Very truly yours, Signed Owner o Property elephone Address ?r'C�k�� \��a� Town Telephone APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES �1N DIVIDU'A1. WATER"' SUPPLY & SUBSURFACE =SE• WAG- E�4)I:SPOBAL::SYS PEMSS : ILEVjIEW S� for CONSTRUCTION P�EJ�7� J� STREET LOCATION OSGrt,�iG� -�. `/ "/J'c, `/ NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE -,:P—/ rTAX MAP # DOCUMENTS. S LETTER )DS) [ON ETS SUBDIVISION �I LEGAL SUBDIVISION SUBDIVISION APPROVAL- CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED MSTANDPIPES GENERAL El�EX- APPROVAL SSDS ADJ. LOTS F WETLAND ( TOWN/DEC PERMIT REQ? ) DATA ON DDS PLANS & PERMIT SAME NEIGHBOR LETTER BI/ZBA 100 YR. FLOOD ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) '�SDS HYDRAULIC PROFILE m GRAVITY FLOW UCTION NOTES (GRINDER NOTE) DATA: PERC AND OT CONTOURS E STIN R�P 'AY & SLOPES CUT 3 /GUTTER/CURTAIN DRAINS EROSION CONTROL; HOUSE,WELL, SSDS EROSION CONTROL NOTE PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION Y EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE /IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS LAYBARRIER 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA PROVIDED =60 FT MAX 9DCw SEPARATION DISTANCES SPECIFIED ON PLAN FIELDS 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 2O' TO FOUNDATION WALLS 15' WELL TO P.L R� 100 TO WELL, 200' IN D.L.O.D., 150' PITS M100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) "501 TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') C� 50' INTERMITTENT DRAINAGE COURSE C1D 200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. SEPTIC TANK =I O' FROM FOUNDATION; 50' TO WELL COMMENTS: APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY.& SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEEl� for C0NS'rRl C�`IUIV"PERMIT'. . � STREET LOCATION OScaQ.,n Lek e 1 ?o� aI NAME OF OWNER BY B. HEDGES R.MORRIS OTHER ✓ S.S, DATE -/j TAXMAP# DOCUMENTS. �g r ~ e- Y PERMIT APPLICATION LI EXP. AREA; SHOW Y FLOW, SUFF. SIZE m IF PUMPED PIT &(U2&WOWN & DETAILED ERMIT M P ER m OUSE - NO. OF BEDROOMS *DESIGN EERS AUTHORIZATI0 WELLS & SSDS'S.W/IN 200 FT. OF PROPOSED SYSTEM D S) ` /PROPERTY METES & BOUNDS M CORPORATE RESOLUTION En HOUSE SErBACK_NEGE&SAAjYj gIGHT LOT) m PLANS THREE SETS =HOUSE SEWS Cj-l/ 4"/FT. 4 "0; YPE PIPE ED HOUSE PLANS - TWO SETS m NO BEND`, W/CLEANOUT )AL SUBDIVISION m 01VISION APPROVAL CHECKED m ,C RATE L REQUIRED DEPTH ZTAIN DRAIN REQUIRED m STANDPIPES 'GENERAL m EX- APPROVAL SSDS ADJ. LOTS m WETLAND ( TOWN/DEC PERMIT REQ? ) m DATA ON DD`S'PLANS & PERMIT SAME . m PRE- 1969 - NEIGHBOR NOTIFIFICATION + 0210 YR. FLOOD .ELEVATION SEWAGE SYSTEM PLAN - (NORgi ARROW) SSDS HYDRAULIC PROFILE CONSTRUCTION NOTES RINDER NOTE) DESIGN DATA: PERC A LTS_ CONTOURS EXISTING & PROPOSED DRAINS ,PROSION CONTROL-; HOUSE,WELL, SSDS EROSION CONTROL NOTE FERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION LOCATION MAP FILL SYSTEMS C HORIZONTAL: SLOPE 3:1 TO GRADE SPECS m FILL NOTES CERTIFICATION NOTE 711 GAUGES PROFILE & DIMENSIONS m`FILL t�l EXPANSION AREA _, J H WRA NCH PROVI6 D $0 m 60 FT MAX n LL-� COKTOT 1RS 100 ^ /o.EXPF;NS�ONPR��`•r -� ��F.r� .. .. SEPARATION DISTANCES SPECIFIED -ON PLAN FIELDS m 110`�,,, I)Rf CAY, h4a4QF6ZREES 'T6P-of4iLL [�201''TO FOUNDATION WALLS 15' WELL TO P.I 0 0 TO WELL, 200' IN D.L.O.D., 150' PITS 0 TO STREAM WATERCOURSE LAKE (INC.EXPAN) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (PITS -201) INTERMITTENT DRAINAGE COURSE FT. RESERVOIR, ETCM 150 FT. GALLEY SYSTEMS 'MINTO C.D. S = >5%,20'- 4%,25'- 3%,30' - 2%,35'- 1%j100'• J% ' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. S TIC TANK ILI 10' FROM FOUNDATION; 50' TO WELL DEPARTMENT OF HEALTH Division Of Environmental. Health- Services 4 Geneva Road, Brewster, New York 10509 (914) -278 -6130 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: BRUCE R., FOLEY, R.S. ;Iing..Pilbiit "H&aitH'iTire�tBP •�. February 7, 1995 Re: Proposed SSDS: Kolboka Oscawana Lake Road (T) Putnam Valley Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as 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 standard environmental form PC -1 has been enclosed. Please provide answers for each question, yes, no or not applicable is required. 2. SSDS is proposed perpendicular to the existing contours. Current codes require that the SSDS be designed parallel to the contours. Furthermore, in fster:�s -arowsp_ d on: a. relatively.,f':at slope..an �gi:3l ;�,i.scr`ibuti�i►� system is required. 3. The following information is to be shown on the 1 " -20' SSDS plan, existing and proposed contours, deep test /percolation holes and footing /gutter drains. Upon Receipt of a submission, revised to.reflect the above comments, this application will be considered further. Ver truly yours, Robert Morris Assistant Public Health-Engineer RM/jp SHEftL17A AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Cardinale Carpentry Agent P.O. Box 269 Putnam Valley, NY 10579 To Whom It May Concern: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 27, 2007 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition Approval — A- 211 -07 Shahmohammed/Gustafsson 604 Oscawana Lake Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #62. -1 -29 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 27, 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 saving devices, i.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. 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. Sincerely, LCW: lm Lawrence C. Werper cc: BI (T)Putnam Valley Public Health Engineer 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health Cardinale Carpentry Agent P.O. Box 269 Putnam Valley, NY 10579 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Director of Environmental Health September 25, 2007 Re: Addition — Application Incomplete — Shahmohammed /Gustafsson 604 Oscawana Lake Rd (T) Putnam Valley, T.M. # 62. -1 -29 To Whom It May Concern: 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: 1:.. Sketch of existing second floor plan !draw n: to seale�)-and use of each room. _ -; 2, Copy of survey showing well and septic locations to the best of your knowledge. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. LCW:ens Sincerely, Z_ - '" Lawrence C. Werper . Public Health Engineer 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 i AM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE OR SEWAGE TREATMENT SYSTEM[ PCHD CONSTRUCTION PERMIT # Located at &-5 ga wo ." -V /.a 1,116 A00 Town or Village Owner /Applicant Name SO Tax Map Z Block Lot z- 37 Formerly Subdivision Name /*-4 er -�f Subd: Lot # Mailing Address `� � 9 �" J�fe Alze V V Zip Date Construction Permit Issued by PCHD 2 Z-4 del IA Al AU Separate - Sewerage System built by We J 4 C�rs�s� e::'0- Address .�/` C r'-W 04 e; o 17 - Consisting of O Gallon Septic Tank and Other Requirements: —' Water Supp4: Public Supply From Address ®re ✓ Private Supply Drilled by IV, -N we -11 .0r ,111110 Address 1,3,-e,P �f �� °v% Building Type 1�j; <�Itwe e Has erosion - control -been complete ? t TT Number of Bedrooms 3 Has garbage grinder der been installed? A& I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: �Z 71 Certified by P.E. R.A. Address 2,97 2 VZ u 4 * „„, License # 2- 11 Yk5 Any perso occupying premises served a s) shall promptly take such action as may be necessary to secure the correction of any unsanitary g from such usage. Approval of the separate sewage treatment system shall become null and voi ®�� 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 revoca ' n, modification or change is necessary. By: i Title:.�Je:��Es ����� � W , Date: I-J a, White copy - HD Fi ; Yell opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 09/26/2007 12:40 FAX 576 7087 JUSTIN MINIERI 16 001/004 CD LY QTY L 'A TtJp- �e>4 �ttD - 4V---kL7-44 NUE7tAT M I s-'5u45t> % /4117 7 -7 -r FLOCN-9- rp-21�ec-::> -94 09/26/2007 12:41 FAX 576 7087 JUSTIN MINIERI r 004/004 / \ r U\\ 54 V V D 0 ,. Co. v — _ II oil 4..... 5-4 I 0% � IN-0 W G ,na: �I.r'•.v...m -t. A. Z. L 09/26/2007 12:41 FAX 576 7087 JUSTIN MINIERI Ia003 /004 gal,•I.j Ak s. 13' y FIS11�WtlOkEY90�'IAMdIN: •, ,•I :ilq.• q 1 .; 1 ~' 44-4 Y a� „ Z/16.C1 ' I r y�91Dr' 01 XZ • r" 4 b IL ' ' � • � 1 n �H 1�''1 y - t r, •,viz 4 1 a� „ Z/16.C1 ' I r y�91Dr' 01 XZ • r" 4 09/26/2007 12:40 FAX 576 7087 JUSTIN MINIERI Ca 002 /004 MON MR $SWAGS DIPW" SMZM pa&eer to r.•'w Ptlatail B on CEWWWArgOF b� fAwsf!#d 9 - W Now �,f �p 9 C�1.,1 $eIt / fag � � � • lilach— . �- a � � i L J�a% o /� Q' 7K�— l�et'L'.tae O -- /► Rota a FWAU to Ammvid d A . r," "0c:' le �'/ z� - —�— --� Datg Subdivision ARpr ved Fee Enclosed ® Amntl„t• Mmft ✓�w 4 � i7 c W Am � FM Sachem 'tYPa 0* Li Dedrrb _vetnme Krat *W of Deem Abear 0 P 1) Q O PC= MoflfiftAm is leankild Whost FM L owl sswett 0 S� to t> a �g O & * Saps Task . O d d' -2 Z " W1 To W oMMUSLUd by � Addma WSW sgqppl9.. Pltwk Gay b� e�ak,a�, SWAY by ._.._Addmm a fQ I rearONnt that 1 AT Wholly Ind COM064161y responsible f0f tha daslgn ana IocatiOh of tfle prepoWd System(s). t) thal iha separate taw 0 dNpeul tytloi DboYO beaefibaa will bo Coflttfuclao 01 WOWA On the approved amandment lnara t0 and in a[cerdanC6 ith iha sI dards. rules an regu a ova .7 6 V rlal County Department of H=Rh, and that On completion thereof a "COnItKato 0f Cefletfsetts baliefacto►y to the Cemmlaaloflet Of hoafthw� j iio alfbfnRted to (he Osparenwnl, and a written quafaAtaa will be furnlshod the ewocr, feaS lh aselgns by (he bufldef, that MW builde w, puree in 96" opwatl" corldnion shit Dart of maid mwil" disposes aystern auelne thi Immediately follpwing thed6te of tfsa Ise dnso o► tho •ptaoval of the Caflirleaku of ConsttuCtfon Compilonco of tho orlglnaf ny r o: 8) Chet she d►Nlod Walt detnibad oho« i v141 be located as sflatrfa ow tho opproved plan and (hat mld wall will be snstaf n acct B,Ith A rules and raga a"T wi n�f iha Putns Coynly 0"Artmefrt of Health. I Dato 5igned ^+�^ P.E. t $RA. t ` % !- Addrasf / F ' '- •`l Y/ r"'I � License Ne � APPROVED FOR CONSTRUCTION! Thf1 approval alrbuet two years freers the a0 a u f the Dullping has Doan undertaken ova K 4.� rovombla for couse Of may be amanded or modified whom Considerpd�84fisary by CO Any ehanga Of �lt®atlon Of tOnat ►uCt I6 n� foaulras a per U. A�pfemad for disposal of defnactic sa�:ast/ebwogo, s / ivato only. �Y. I Rev. �� �r 1 4 , Data my 4 `F - Title t� - y �t IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: -- - - - -- - _ -- - YES �� NO �.r Nl� OF PUBLIC WATER SUPPLY: _ _�T�Ok�� f �� L• %C.�TY '•t �a DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED r r MON SEPARATE SHEET r`• �� 1, �/ / � �,��tr..� �' � •�1 �•;• �f r/ • (__,,.� . 1 (aate) (signature) i a�. >r1 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 f•a.nitary Code, and provided that within shirt;• (30) days of the completion of water weli,COnstructior, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with thp:-.requirements of the Putnam County Health I4artrr,L�rYt' attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Departm During all well drilling operations, the applicant shall take appropriate action to assure th any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherw�ae contaminate surface or groundwat Date of Issue: it,'_' 19 r 7 1.• M 1 Date of Expiration Permit Issuing Official f Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insn. Orange convt WA11 n,41' No 1 °G SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORE. MOLINARI, RN, MSN Assoiate Commissioner. of Health ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 !� 2 :l ADDITION APPLICATION RESIDENTIAL ONLY ..STREET 604.Oscawana Lake Rd TOWN Putnam. Vly. TAX MAP# 62:: -1 -29 ',:NAME.- Shahmohammed /GustafssonPHONE 845- 528 -1290 pCHD# ,,,A LING %�E�7' M J ' ADDRESS DESCRIPTION OF ADDITION Fnmi ly Room Extension NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS 3 (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�lept., ..1 Geneva,lZd, . _ s �_._:_.:. .�..._. 1. Certified check or money order for $100.00. 2. 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. 5. 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 SHE R-LITA �ANLER. !NEED, !t Commissioner of Health LORETTA MOLINARI, RN, MSN . Associate Commissioner of Health. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New fork 10509 Town Legal Bedroom ]Count Re: SHAHMOHAMMED /GUSTAFSSON (Owner's Name) Tax Map #: 62.-1-29 Address: 604 Oscawana Lake Road Town: Putnam Vallee Year Built: 1999 According to records maintained by the Town, the above noted dwelling, is XX in compliance with Town Code. County Executive is not in compliance wzth.Town CodP, _ The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Other: As s is t . Building Inspector 1/11/99 - CO #99 -1. 9/19/07 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 a f .6 ri >�.� (� .F ,. ��� __ J s �- r s t r .c - =-� � �' ��tip'r ar..�T•r{IS ��.�'>. i'77a rid x • �p _r:F 1X+d ,��fYL•',r t5�s� .t 1 " t 1�H(. ,..�. 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