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HomeMy WebLinkAbout2768DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -33.2 BOX 23 Ll we �6 N r- 02768 Public Health Director c . —, -.: - - •- �:iiu: Y" ;^ - l�fi=s%fr1F>::� °' :iii':;• dvi.:i:I\T:.......,. Associate Public ' Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 December 31, 2001 Pedersen c/o Lynfield, Architect 82 Oscawana Heights Rd. Putnam Valley, NY Re: Addition- Pedersen -580 Oscawana Lake Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 62. -1 -33.2 Dear Mr. & Mrs. Pedersen: 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 form this Department dated _December 31, 2001 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at ou without prior approval by this, department. - 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valle If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML-.kg Public Health Technician cc: BI(T) 1; m m N N U IN m N Z X Q L� cn H N Q A J w J w z_ J 1 0 ti 0 14 SECOND FLOOR PLAN- PLAYROOMI/BEDROOM P.' dDDITION BEDROOM 4 BECOMES LAUNDRY ROOM & HALL; PEDERSEN RESIDENCE ` 580 OSCAWANA LAKE ROAD P, C v, PUTNAM VALLEY, NEWYORK 10579 frL'EXA off -Gee i 0 � i .... IM d I In i d I I I NEW BEPROOK I � Eini E� -HALL �"'j a zvwo i;:s'4z& ROSET -„--= vza Odra' - ,�.r,..... - -_ 14�i�•1�9�n�M1��� - pSfi' ' p84 I W , ... ti,dE/IC�t%(1�Ar � EORQOM 3 a b RFDBQ NI2 OFFI ,.:.F.: j� may' s a + 0q- f • „r � a IN't.4 fN'NiY ti.J -A I jacquehne I,ynfaeld Architects 82 Oscawans Heights Road IFuutnaim Valley, N. Y. 10579-2304, X1845 52S -0068 fax 845 528-2010 f a .e * BRUCE R. FOLEY Public Health Director Fk, Yo Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278.6130 Fax (914) 278.7921 P rrJ ACH STREET S8 0 05MA trAha 4*- KJTOWN Vow TX MAP # 3 3. 2. NAME fh PHONE X26_, PCHD # LyA)Fly #IuHGreGT MAILING ADDRESS f2 PSCa t.Jt'LMt2'[��2�- --���� t�GuiCcj �/ y /D5 G�K.Ar�E Foie 3- cARs. M HOttooM EXPAr/tloni DESCR]PTION OF ADDITION roti ✓E)ZStoLd 6F 6EV ftoo" T9 /VEIN $Eb R.06M NUMBER OF EXISTING BEDROOMS 4 PROPOSED # OF BEDROOMS + (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278.6130. I. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non- professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Fab 98 82 Oscawana Heights Road Putnam Valley, New York 10579 - 2304 tel 845 528 0068 , fax 845 528 2010 e-mail jklra @bestweb.net 4 ®o Mike Luke, Health Official County of Putnam Dept. of Environmental Services, 4 Geneva Road Brewster, NY [Fax: From: Jacqueline Lynfield Pages: 3 [phone Date: 12/13/01 me. Pedersen Residence CC: Pedersen 580 Oscawana Lake Road Putnam Valley NY TNW2. -1-33.2 ^X Urgent X For Review X (Please (comment X Please Reply ^X (Please Recycle - o Comments. Please find attached: Survey of property do 2 copies of existing floor plans u,yF 2 copies of proposed floor plans I°�'6'�' ° Q'f 1 S (�K 4- b,,( . one application kk e �, U9 $100 Money Order % -, j v)/ 0 Bedroom Count from Town of Putnam Valley t— Let me know if you need further clarification. Thank you. 4- � BRUCE R. FOLEY Public Keolth Director nEPARTIVMrrr. of J Geneva Road Brewster, Now York LORETTA M0LMARI R.N., M.S.N. Y .4s be 4'1? ='itbll� Director of Potle„t Services HEALTH 10509 Enviroameat :l Stealth (945)279-6130 Fox(945)278-7921 Nursing Services (845) 278.6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (84$)279-6014 Preschool (845) 278 -6082 Fox (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re:y"D�. Residence Tax Map 2 �- Town llt N ^rA VAU, Gentlemen: According to records maintained by the Town, the above noted dwelling IS In IS NO'r in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: Y ASSESSORS RECORD: L6111:10141 BFhouseguidelines ��?.�� -��� -emu � � G���� --��1� �� � J ii iC 7 12 LTJ O 0 10 �A jw ;0,9. I 61B -TI ml lK, 00 C, ff7ft WN W/h X 14 V4 1-h L 12, 0 rT-1 ;0,9. I 61B -TI ml lK, 00 C, ff7ft WN W/h X 14 V4 1-h L 12, SECOND FLOOR PLAN- PLAYROOMNBEDROOM ADDITION P BEDROOM 4 BECOMES LAUNDRY ROOM & HALL � � L n PEDERSEN RESIDENCE 2 580 03CAWANA LAKE ROAD ACt/r(t.� W --------- �.�/.l Ol ,�wL - - - - -y ° POTN,�M VALLEY, NEW YORK 10578 /A/ 6L f/ r - - -- �. I r--- - - - - -� - ; - - - - -- I _ - -- _ O CV F� NEW BE F OOM A e M r JEW ' ' •� �� ! i� m .RFf1�OM - •"Wayrvans O uNDRYL:.1� • � I aye .,a�. y PAP HALL ! _ z -vli ` 3itL 3t ` c uil O l m' I i w s=o r t n..• a q RFDROQM 4 0 - - -— -- - - -- — OFFICE - - -- . r tQ�2 — - - 3 PUTNAM COUNTY DEPARTMENT OF HEALTH ! F HOUSE PLANS APPROVED FOR i Jacqueline I pnfield Aiefieas i BEDROOM COUNT ONLY,' 82 Oscawana Heights Rdad It /! I Putnam Valley N. Y. I0S79 -2304 t 7 BEDROOMS i td 845 528 -0068 fax 845 526 -2010 YOM ,. S.• Signature & Title Date t 4 fr i f -J t • i� i ,a F: i' Id �Y !Y i !a �l 'tt !ry . iy 1i i� 5: u:- ;a �t .F ii 55 �U !q } i �DF x PUTNAM COUNTY DEPARTMENT OF HEALTH i HOUSE PLANS APPROVED.FOR BEDROOM COUNT ONLY, P y BEDROOMS Ti. gnatum & Twe �1 ,t Sri I a� '4 i. 33.2 GARAGE FLOOR PLAN - MUDROOM ALTERATION PEDERSEN RESIDENCE 580 OSCAWANA LAKE ROAD PUTNAM VALLEY, NEW YORK 10579 cv Y i 24 '9294 44 31314 1 1 Nc�rB� M�9Y - /MVH �r�il -1. 'gE7� - +EEU GoLUyr•1S I 1 14oT- '►-o ej cs6- iF= b17'. Yd S9 4 4L 61-3 rd L r4 �- -- L- -J ..,__J VP PJ'✓TIUG ern' S'FSK-v { L-73•{ 6JP GE -iarR 7D BE / Sly ej? I 1 ;rvorrH Ca (w .,cf) I ' I I I 1 _ � Fo✓rtoerwu - - - I 1 I g'p 1 1 I I _ 24� crGLT t3z r� - !e NL'aotAr -t Nc'�lDt -lz Q 0 0 A s MASTFR RFDROOM - Pe a�uu� ra /veorr� 3�xga" BEDROOM 1/ SI/oWE¢ /s_e X /s �4 44 - C8 " -NUHSFRY ' .�OD¢E'61NCt b ...V34_..-- r,4".. VAO O ZIAOV 71 2 -PZ4 ` 1 v ° - 04Z;� " BEDROOM 3 �' , /./0 N BFDRO N 13=3 %z x I a ' OFFICE ; =G -. /� 3.t• / / 4 46 3046 V 4 /8 I _ 3dlb 3B�G �a r� 'i ,! �. i .� O �� , �6 ��' �-. �, I ( � I ism — — • - 1 MART ■ /8'� _ vz� _ swu ymm r�s .rcr e U /5 +9 SOGtZEwVG� 0 N _b-- -Td6/i vs YZ1 Oz, vl+ e BEDROOM 3 x IOL8 FF.ICE. " b 3Mb /8'30K-/B ;1. 1.•i �4 r,z/ O b'. -lvz u n 6-x ub�� Vi`y�� 110-i W O 1 2 0 } W �k Wp — ------------ ;-- - - - - -- —1 mZ - - - - -- --- - -�--t 0:5 i i--- - - - - -� = - - - -- I I i 006 WQ C° _ NEW BE P kROOM I � I EW LAUNDRY , I :.4 I ,t HALL — Nom!! PLAY -R`" a 09M `, DEMO I j I w wl� I �CLOSET A I I I 1 4 0 w fA a 0 g 0 O LL O i SECOND FLOOR PLAN - PLAYROOM/ /BEDROOM ADDITION BEDROOM 4 ;6ECOMES LAUNDRY ROOM & HALL PEDERSEN RIESIDENCE 580 OSCAWANA LAKE ROAD PUTNAM VALLEY, NEW YORK 10579 ,t I t 7 . t . t 4 _ ie�o• v r „ _• _. ¢O j � �• /inn � 4BSC® �� � •. � b FAMILY ROOM BREAKFAST KITCHENS q M FOYER , +• LIVING ROO-M _______ DINING F Oro A/ 0-,vz �i GARAGE FLOOR PLAN — MUDROOM ALTERATION PEDERSEN RESIDENCE 580 OSCAWANA LAKE ROAD PUTNAM VALLEY, NEW YORK 10579 s' a, r' i is i ` -Q 1 \` PUTNAM COUNTY DEPARTMENT OF HEALTH � . DIVISION OF ENVIRONMENTAL HEALTH,SERVICES CERTIFICATE OF CONSTRUCT O COMPL PCHD CONSTRUCTION PERMIT #Fy 67,0 Located at Owner /Applicant Names Formerly IANCE FOR SEM&- MENT SYSTEM Town or Villag e' Tax Map 6x Block % Lot - .4 Subdivision Name % *�•7�!or /%rt� C'�' %- Subd. Lot # 7, Mailing Address �'�e1 �'�e5 Ndo'/;lc+' Zip Date Construction Permit Issued by PCHD 111C'R7 Separate Sewerage System built by f' Address Consisting of 14-5, 5, Gallon Septic Tank and Other Requirements: 2 � �: C • Water Supply: Public Supply From Address. or: tl Private Supply Drilled by G '�` � ��� Address Suildina s ype ��f %d�! �ff�'_ Has erosion ::anttczl..been comniei Number of Bedrooms -41' Has garbage grinder been installed? lovt'% 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. w Date: % �iV Certified by ✓�Tr1 -�-'' P. E. R. A. Z- n � � (p igLn, ofessionaq Address ��7, �y License # 0.-1 Any person occupying premises served by the aboyesystem(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, mo ' cati n c ge is necessary. r By: , Title: Date: Z v White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Vaeii Ldcation `Street Address: - ' 580 Oscawana Lake Road Town/V�illage Putnam Valley Tax Grid # Map (j7- Block D Lot(s) 3 '• Well Owner: Name: Address: Westchester Modular Homes, 2910 Rte 22, Patterson, NY 12563 Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 33 ft. Length below grade 32 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic _ Other Joints: Welded X Threaded.. Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 40 gpm Depth Data Measure from land surface- static (specify ft) 4' During yield test(ft) 200' Depth of completed well in feet 265' Well Log If more detailed information descriptions or 111 . . are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 18 Drillinc in over urden clay and boulders 18 Hit roc at 18' ti ^- �3 , .�eanalIses � ¢.t; 33 265 Drillin in rock 'ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5,jDra Depth 220' Model 5GS05412 Voltage 230 HP Tank Type WX302 Vol e 86 cial. Date Well Completed 12/3/99 Putnam County Certification No. 002 Date of Report 12/30/99 D ' gna e 1 0 1 NUT E: Exact location. of well with distances to at least two permanent landmarks to be ptdvlded on'a separate sheeVplan. Well Driller's N . F al & 1/01' Inc. Signature: M4.ltol.rd T. al, Jr. Address: 4 Putnam Ave., Brewster, NY 10509 Date: 12/30/99 White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by 'g� 33.4 Tax Map Block Lot 411 Town/Village tYlal/4,- Ve, ve-1 [•O 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 .property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not th failu a of the system to operate was caused by the willful or negligent act of the occupant of th3ui it g utilizing the system. Dated: Month / Day /r Year d Signature General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Title: Corporation Name (if corporation) Address: P910 �-�. 2.Z, 2i4T7ee5o,0 Zip State /U Zip j2 S o If Form GS -97 0 :4 NORTHEAST LABORATORY (DF DANBURY 39 1V ML PLAM ROAD -. DAN_>$U12Y...CT_ °izG) i4tf= l3lS'i -FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 CC:PATRICK FAHEY DATE SAMPLE COLLECTED: TIME COLLECTED: . COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: REPORT DATE: 1/7/2000 & 1/20/2000 1:00 P.M. B. BERGH & P. F.4HEY 1/7/2000 & 1/20/2000 1/7/2000 & 1/20/2000 LAB# 11471 1/26/2000 SAMPLE SITE: WESTCHESTER MODULAR, 580 OSCAWANNA LK. RID., PUTNAM VALLEY, N.Y. SAMPLING POINT: BACTERIA -HOSE BIB @ TANK%CHEMICAL- UPSTAIRS BATHROOM TUB SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: BACTERIAL: 1/7/2000 Total Coliform (Bacteria) PHYSICALS: 1/20/2000 Color _ ... Odor Turbidity CHEMISTRY: 1/20/2000 Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead G MAXUVIUM. CONTAMINANT LEVEL 0 per 100 ml 0 per 100 ml 3 15 ND . - -- 6:87- 0.5 NTUs 5 NTUs <0.005 mg/L as N 1 mg/L as N 0.65 mg/L as N 10. mg/L as N 51.0 mg /L no designated limits 66.0 mg/L no designated limits 0.43 mg/L 0.30 mg/L <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50.mg/L] 6.0 mg/L 20 mg/L ** 0.012 mg/L 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 1/7/2000 & 1/20/2000 SAMPLE, AS TESTED ABOVE: X® OTABLE or aOT POTABLE (PER NEW YORK STATE'DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 4 Laboratory Director °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 NORTHEAST LABORATORY of DANBURY .39 MILL ,PLAIN- ROAD- - DANBURy,. PT 06.5.1 1. -0404 48--065 Y y Eiii:'-full 3) 8 90 X 208'� LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 DATE SAMPLE COLLECTED: 1n12000 TIME COLLECTED: 1:00 P.M. COLLECTED BY: B. BERGH DATE RECEIVED @ LAB: 1n12000 DATE(S) TESTED: 1/7/2000 1 TESTED BY: LAB# 11471 REPORT DATE: 1/10/2000 SAMPLE SITE: WESTCHESTER MODULAR, 580 OSCAWANNA LK. RD., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB @ TANK SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: RECOMMENDED LIMIT BACTERIAL: Total Coliforin (Bacteria) 0 per 100 ml 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L ----- ml = milliliter mg/L = milligrams per Liter ND = none detected RESULTS BASED ON SAMPLES SUBMITTED:1/7/2000 SAMPLE, AS TESTED ABOVE: XD OTABLE or AMNOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director •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 YML ENVIRONMENTAL SERVICES 321 Kear Street - - '--- --- ' '---�' SWIMS- Albert �.��� - LAB W 32.000100 CLIENT Q 11733 NON STAT PROC PAGE I PEDERSEN, MAUREEN DATE/TIME TAKEN: 02/01/00 09:00P 24 OLD POST RD. SO. DATE/TIME REC'D: 02/02/00 09:00A CROTON-ON-HUDSON, NY 10520 REPORT DATE: 02/07/00 PHONE: (914)-271-5650 SAMPLING SITE: 580 OSCAWANNA LAKE RD. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY, 10579 PRESERVATIVES: NONE COL'D BY: RAGNAR PEDERSEN TEMPERATURE..: NOTES ... : RESERVOIR TANK COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 02/02/00 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Director ELAP# 10323 BRUCE R. FOLEY . Date To: LORETTA MOLINARI R.N., M.S.N. ssai:�l Fuu;ic-- 1)eaUh 'Dirad- e - Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Faz (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 FAX COVER SHEET From: Adam B. Stiebeling Asst. Public Health Engineer "For your information For your review As discussed Notes/Messages Fax #: 6 fa "&goc No. Pages (Including cover sheet) fease respond Attached as requested Please call )tA t_ Uh-1l %> o \' In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2157. r BRUCE R. FOLEY DEPARTMENT OF B EALT H 1 Geneva Road Brewster, New York 10509 LORETTA..MOLINARI R.N., M.S,N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (0 14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 FAX COVER SHEET Date: al � 1 ©d To: i From: Adam B. Stiebeling Asst. ]Public Health Engineer loa your ih991irmanon ]Fo our review As discussed Notes[Messages sr_"' t_f Fax #: No. ]Pages (Including cover sheet) Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2157. r u l fNAINI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - FINAL SITE INSPECTION Street Locati 1 , it M M WE r C,t 0 Ed r ii rea ed as per appro ed lans............ - date of pla e Lath. A not Stripped ......... .........�.j � ........ . a, etc., are�ter than 15�Aondi STS -1,000 - ..1,250 ......other ................ stalled level ......................... I.................... from foundation .......... ............................... Noutrets at same elevation - grater tested ................. 2. roteeted below frost .................. ............................... 3. Minimum 2 ft.Origirral soil between box & trench-s unction Box - properly set...... ' ....... ...........:................... — +T.- LengtFi required ��• Length installed �� 2. Distance to watercourse measured Ft.......... 3. Installed according to plan .......... I ...... :....................... 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 ` /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ......................... ........................:...... .D u, M r poi =Dosed S)'Stem -,k ofpump�ber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visuallaudio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ................... ............................... 6. Cycle witnessed by H.D.estimated flovi /cycle .......... III. HouseBuildin a. ouse ocated per approved plans ............................. . b. Number of bedrooms ..................... ............................... Date: �L Inspected by: ermit rw bdivision Lot r 7 _ i7-Well located as per approved plans . ............................... b. Distance from STS area measured ft ........... c. Casing 18" above grade...' ­­­- d. Surface drainage around well acceptable ....................... Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially baekfilled .......................................... c. All pipes flush with inside of box .................................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1197 PUTNAI-I COUNTY DEPARTMENT OF HEALTH N- DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE ENSPECTION Date: A. s Permit --7% Subdivision Lot r uL.l.Or2. 1. Sei)-age S }'stem Area a. STS area located as per approved plans ........................... b. Fill section - date of placerient 3:1 barrier Loth. 125 Width VyAvg.Dpth z 1 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. SeptFcitanlk size - 1,000 ......... 1,250 ......... other ................ I . Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box F—All outlets at same elevation-water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Bo?c - properly set ............... ................ .......... eng required •Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1116 -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' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... J0 —Pipe. end; capped ...............:.....::::::... 4 a: Puff 6r Dosed Systems T Size ot pump c am er ................ ............................... 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. House/Building a. house loc ated 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i Erosion control rovided p................. ............................... Rev. 1/97 Public Health Director February 1, 2000 ' ar�J Vii: �: ��: `i.lLiiilV7'C1�1 `l�.l`I ..`: 1Vl.�rl�.l`I .,:G::• «. r. �s. n. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Pat Environmental Health (914)278-6130 Fax (9i4) 278-7921 ®�p� Nursing Services (914)279-6558 WIC (914)279-6678 Fax (914) 278-6085 fJ Early Intervention (914)278-601.4 Preschool (914) 278 -6082 Fax(914)278-6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Application of Construction Compliance Pederson, 580 Oscawana Lake Road (T) Putnam Valley, TM# 62 -1 -33.2 Dear Mr. Sullivan: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 31, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Submission of Water Quality Analysis, pursuant to PCHD Bulletin ST -19, Table 1, Water Quality Analysis. _ — -- a .:p V A„tah'I� P ra nl f.`r r� C, r -- -t � - _ -8 tS. . •1 JP.. - ,o. • �; v The review of your application will commence once the Department receives the requested information and. determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application.. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations: Should you have any questions or care to discuss this matter further, please contact me at (914)- 278 -6130 extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ° ABS:cj i�rnt"► �xu»� tml�zn�ir tIDtF �AQ.`�SI %p _ mot IM 9..i$c. Iro . C=ACzOCO by A a en ft" �G" ' 1 roprosont`.thot 1 am arholly and.- complotoly rosponsiblo for tho dosign . and location of tho proponxl Eystom(a). 1) that tho mporato o dispowl :s Eton abovo doscribod Grill too constructed as Shown on tho approved amendniont thero to and in accordance with the standards, rules and rcou a ons O . • nam [county Dopa tm alt OP C, c Rh,_ and that on complotior� thovoof a. " Cartif icoto of Construction Complianib" btiEPoctory to tho Commimlonc;r: of H861thtvill (a tobmma to too .DC�ft..Mo at, anal a tvritton goarangoo twill -bo furriishod tho OMncr, his tuceomwro holas_or a6lbns by tho builder, that Call WWCr WHO 0MCO ip cc" op-atloop condition; any sort of old, mWom disposal system during tho pariod of tevo (8) ycarE I ly folootaira toodoto of too imw or= of tfao Otlexrcoal of tho Cortitkato of Construction Complioneo of tho original system or any ropau. t drillod tvoll dosspmcd 06400 0100 Do Coeotcd oo chi-va on tfio approved pion and that said woll ciill'bo instnllyd eeorolo 0o e i tho ato Q� Of tho Putnam a OoIE County b6portWh, iot oP Ndbith. (data ,� rSitlnc® P.E.- OtA. Addrow APP, ROVED FOR CONSTRUCTIOW: This approval oupiros two roars- from the dato issuod uroMs coo oP i con undortakon and is rovoeoblo for eauso or may bo amonded or modified whop consider°d notespry b onor o4 Any C, oration of construction rcauros, a ar pov t. Ap ipal of domestic sanitary scag a 6 ar tB o Data o 10/00 o -- ` -f / •' • /' •' 1� Y 'I �• Ea' 'Y M v "r 7"• !!--• �!`T'f' -m -�r :wr %a. :-r= ..::.:.– .Y_r- s . _ .__.... _..:.: .: :.... .a. .. .. .rer...:^..' -. _ .. ,• • 'Di:7i'v�i� " i�' 11Fi ''iyili�i:-'.'�v13J•l���i�.L`' .1TlJt�a' i�1J '�J:J�iL' ".7�i$1LC1 F'�i�� ;': Owner Address Located at (Street) Sec. 2Z- Block / Lot -35 2' (indicate nearest cross street) municipa.Lity • • OV 24 'x• • •' 4� /• Y •� Watershed TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test �1$7 HOLE NUiSF..R CLOCK 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 2/1 Z /D 2 /a'�� /� 'v �y zz zs' 3 io 3f /��f� 41130' 5 7�Z 4 5 1 2 3 4 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 submittiod 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 ENCOUNTERED IN TEST HOLES _ r_ 4 HOLE NO.- HOLE NO - - - - - - - HOLE N0. _ G.L. d/ rev d� 40W 6 1 3° 4' 5' 6' 7' 8' 9' 10' 11' 12° 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED / DEEP HOLE OBSERVATIONS MADE BY: c�� G� �'G �% DATE: DESIGN Soil Rate Used ��_ Min /1" Drop: S.D. Usable Area Provided e;�oY/O No. of Bedroans Septic Tank Capacity gals. Type /la' 27 Absorption Area Provided By L.F. x 24" width trench e .rte Other '7 �� /� //� ✓�e� Name 'MI Address eG 7 / 11-01, - THIS SPACE F Z USE BY HEALTH DEPART Soil Rate Approved sq.ft /gal< Checked by Date 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 ;. n�I�•I�f''Trt f Ti !^f;'. ^C�'Vti `^32TTr!^ 71Z: -KET�.T'. � -/� PCHD rPERMIT #LJL � 7� WELL LOCATION Street Address Town Villa e Cites Tax Grid Number WELL OWNER Name ailing Address rivate r ri G/' J7 Z �► ell s Public USE OF WELL 1 - primary 2- secondary VO RESIDENTIAL 0PUBLIC SUPPLY' QAIR /COND /HEAT PUMP ❑ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE d`�Plj gal REASON FOR DRILLING O REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING O TEST /OBSERVATION 12. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN EIDUG OGRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ✓k✓• Lot No. Z WATER WELL CONTRACTOR: Name A4 4/J Address: y_17WP4"0 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES +✓ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY. FROM NEAREST WATER . MAIN, LOCATION SKETCH S SOURCES OF CONTAMINATION PROVIDED 1/9 17 2ON 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 thirt3• (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 such manner as nno't� to degrade or otherwise ontaminate rface or groundwater. Date of Issuer 19_ Date of Expir ion 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well pl,,*-q IN) 49 0") AL) W (A) ro 4�. (A LV) 14 00 to CIO 41 4, kD Ul --rill ai rip vl: A." 71 . . .... s; 1 ..... . Di t me _.epar —if 111-7. is on of .'ir O I UQ P. �.ance with f o�rj oaf or ap lidab] e les d Re.- i4ns-lo-f -tb 7 Cc iurl m,-, nt I j VC 4- ...... ....... • "to i ILIJ Pi -4 A IS It Irv, ae. i; M N r_t C i ..� . I U, nt Lt c• U• .. O, CC` t N IQ N !V N f..3 w N 4 Z m County j Departmani, of iie Ita.. I _ - I 0►nt► - + ,. 73 f of IEnvir4nmdntal l -a ce, j oved as o 'pd aoa °m _ _ of the ------ P- p _..- ..._. (.. �(f y ;._ a . i .r iea rt' ent. . J ' ' 1 : � � +-tom- , -. ...1�•- .�,� ��' � t -fii.•t<� -- , ! 394..• ........ 4 , vp �..... I_.. Ar�M :.�.J. [:_,.- ' .:._ -.•- i A� `; v' Yl+f� °- Or�?.. p,. r{ _, o . , J • -7 � I r I ! ' ►, . � -...�. __ . �._ : o°`'IC 5e-W , -� � f ,..•c, -. _� �- i -• fi _ _ - : �° is j 4. ;•, ... ..._.. ...... ..__..I ....... ......_�__._'._ __. -..j ...._ � 'mss._ _.. _ _. .- I __ _ _...f ._. i - £. If A. VI to 1 a= PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES __.... .. ,_ _... _ ._ . _ -. .,.. .. .. _. � ........._ Date Re: Property of A; 6d24-1 Located at (T) P, p^ Section Subdivision of M • . ^ t � D V � 6 � G- Block 1-4 Lot per' e A a�� Subdv. Lot # .* % ,Filed Map # 24,f� / Date,ov! Gentlemen: This letter is to authorize :E23 3in� 97 a duly licensed professional engineer or.register-ed architect (Indicate 5 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 connection with this matter and to supervise the construction of said ysiela-ur -systems -in-'conformity 'with'- the 'provisiorfs§7of Article 1'5- of 147,'Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned:..;, OF NEW Y P - Ee, R.A., ; Vez;y, truly ,yours, Siped . 0 er of Property Z_3 o,� S Address Town / � Lf / L/ Telephone Telephone O .r APPENDIX 3 PUTT��t :COUNTDI;Y`1K'f:tit'E:^i'� V:Et��'Li"N'= U:iV'iS'iGNC�i' L'r'Ls; IFr:liAC�r INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS' � REVIEW S IEET for CONSTRUCTION PERMIT Q STREET LCC.ATION 31'; 'a_z0M/A NAME OF 0 WN ER �G�9i11a.y / � ✓t°` BY B. HEDGES R.�IORRIS DATE Dili,' %?- TAX SLAP 3 3 DOCUMENTS., EPERMITAPPLICATICN- �'ELL PERMIT PNVS LETTER 1Vb ENGI.\EERS AUTHORIZATION DESIGN DATA SHEET(DDS) �� CORPORATE R.ESOLLTION LA.NS THREE SETS =' HOUSE PLANS = TW'O SETS RIANCE REQUEST SUBDIVISION -� L--GAL SUBDIVISION S BDI`:TSION .APPROVAL Ci -EE-KED PERG RATt FILL REQUIRED DE -P':? CURTAIN DRAIN REQUIRED —.. T.ANDPIPES GENERAL Y EXP. AREA: SHOWN; GRAVITY FLOW, SUFF. SIZE IZIAUNIPED PIT & D BOX SHOWN DETAILED_ E—ffHglhSE " =` \0. OF BEDROO S L L4 «-'E'LLS & SSDS'S WAN 300 FT. OF PROPOSED SYSTEM EEn4PRQpE-RT"Y),IETES & BOUNDS HOU`SE SETBACK NECESSARY (TIGHT LOT)_ _ HQJ.> -SE SEWER - l;'t "%FT. -t'0; TYPE PIPE NO BENDS: ', LAX. BENDS W/CLE.A \OUT FILL SYSTEMS ' ' ! CLAYB.ARRIER '0 F" 44 ONT.AL: SLOPE 3:1 TO GRADE _' FI P 'I' = FILL NOTES FIC.ATION NOTE DEPTH GAUGES =FILL FILL PROFILE .; DIMENSIONS VOLUME '—! FILL IN EXPANSION .ARE.A ' EX- .APPROVAL SSDS .ADJ.'LGTS- `--i NVE"TLA -ND ( TOWN/DEC.PER-MIT REQ ?) Z11, TRENCH �� . CDS PLANS ..pF_R�IIT SA.�1E . TRENCH PROVI X60 FT 1IAX – PRE- 1969 . \EIGHBOR�`OTIFi::C.�T _ -!` ^ ^- .. c_. _ ION �r. "P" ,iCaLLLL. O c:OLN!i i< –� LETTER BLZBA0 °b EX -P_ANSION PROVIDED L-=- -! 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON'PLANS FIE S ! SEW'AGE SYSTEM PLAY , (NCRTN ARROW) 0 P.L.. DRIVEWAY. LARGE TREES. TOP OF FILL SDS HYDRAULIC PROFILE GRAVITY FLOW E ? i30 FOL' \UATION WALLS m, IS' WELL TO P_L ' N'OTES.(GRI \ -DER NOTE) Z 00 TO WELL, 200' IN D. L.O.D., ISO' PITS ONSTRUCTION DESIGN DATA: PERG AND DES' RESULTS PTO STREA_�I WATERCOURSE LAKE (INC.EXPAN) IET TWO -FOOT CONTOURS E}CIS i iNG & PROPOSED TO CATCH BASIN, 35' STOR\tDRAIN, PIPED WATER DR] VEW`AY &SLOPES CliT : `:: TO W'►TER LINE (PITS -2p') - 617 SETTE \rI DRAINAGE COUR FOOTL \GIGUTTER/CL'RTAI\ "DkX]NS I „TER`iI ” E OSION CONTROL HOUSE ti1�LL ISSDS 00 RESERVOIR, ETC I�0 FT LEY SYSTEMS WF OSIONCO,NTROL \O�'E � � � -- !. 5- \tIN- TOCRC 8 DEEP HOLES LOCATED r - ?0'.\i1V-30 C.D. ARGE %1.00 W iTH 1S? CONS DAY D(S. � REPRESS \TATIVE OF,PRIi`fAC�' AND�E;CPAhS E1L