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Home My WebLink About2890DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.13 -2 -14 BOX 24 r r trREr rr r 7 � � r r t r` Lml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health March 17, 2014 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 80 81390 Fax # (845) 278 -7921 Charles Westfall 84 West Shore Drive Putnam Valley, NY 10579 Re: Addition — A- 024 -14 No Increase in Number of Bedrooms 84 West Shore Drive (T) Putnam Valley, T.M. 62.13 -2 -14 Dear Mr. Westfall: MARYELLEN ODELL County Executive This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated March 17, 2014. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. -2.- The area of the existing 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 modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 5. This approval is valid for two (2) years and expires on March 17, 2016. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, Gene D. Reed Principal Engineering Aide GDR:cw cc: BI (T) Putnam Valley ALLEN BEALS, M.D., J. D. MARYELLEN ODELL Commissioner of Health County Executive ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 00 Phone # (845) 808 -1390 ADDITION APPLICATION - RESIDENTIAL ONLY PCI1D# C Owner's Name: Name: Ciro i <S We 5 Owner's Phone #: T9 — 366-9639 Site Address: O I W 566 Town: ?V� Uqk� Tax Map # 62.13—Z— N Owner's Mailing Address: 89 V*2 Short Dt';V <_l pvtnWvi Valleu N.Y. 1 a5 7� Owner's Signature: Description of Proposed Addition: kp,v 01C(d44;0IV ON p�,e�5� W-ew bckONM5 mboV , 5t'c�- flak- oN , New (-1!!ar d.ecK *Number of existing bedrooms: Total number of bedrooms (existing + proposed): .. * (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPCTOR) * *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 Please submit this form and the following to Putnam County Department of Health, 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. 1. Certified check or money order for $ 100.00. 2. Two sets of sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS Rev. July 2013 5. Town Legal Bedroom Count & Proposed Addition Status Re: C hCA r �5 W ��ol H (Owner's Name) Tax Map # Z Address: Sq cV � t qrf– Drl y/- Town: Vk'+ 1C/1(I1 ywk 4 l 05 7 Year Built: Z D 0 According / to. records maintained by the Town, the above noted dwelling, is in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: —4 ,.i r , 1 i11 -111161illai1 Gii hay been "Uul'altied horn. Certificate of Occupancy: ( arii� Vt Other: The plans for the proposed addition are considered: V Addition to existing house only Teardown and /or re -build allowed under Town Regulations Building Inspector Date 6. ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva R64. Brewster, New York 10509 Phone #045) 808 -1390 Fax # (845) 278 -7921. Michael Piccirillo, A.I.A. 962 East Main Street Shrub Oak, NY 10588 Dear Mr. Piccirillo: 3 MARYELLEN ODELL County Fxecutive February 27, 2014 Re: Proposed Addition for Westfall 84 West Shore Drive (T) Putnam Valley, TM 62.13 -2 -14 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows. 1. Kindly revise the existing plan to show the basement. 2. Please also submit two revised plans for the proposed finished basement. Upon receipt of a submission, revised to reflect the above comment, this application will be considered further. Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR: cml zee M zip Ir os� Z.1,1-im xb la ,P—q51 L6 r(j Z) van.4 '.jar tre *4Ah. -J.1 .stare 0-alth A0.4 -Al ---- ------ View 4WIGIOU Vi, wrawed as noted.for oomformame with 4"40018 os sagautums at the Ar --9- A0 c Ct) 20 2 it g. 92 7J.- J/ ge 7X /x 16, 93 A-9 9.7 717 rd zee M zip Ir os� Z.1,1-im xb la ,P—q51 L6 r(j Z) van.4 '.jar tre *4Ah. -J.1 .stare 0-alth A0.4 -Al ---- ------ View 4WIGIOU Vi, wrawed as noted.for oomformame with 4"40018 os sagautums at the Ar --9- A0 c Ct) PUTNAM COUNTY DEPARTMENT OF HEALTH .. DIVISION .OE ENVIRONMENTAL HEALTH- SERVICES CERTIFICATE OF CONSTRUCTION PCHD CONSTRUCTION PERMIT # /'Ok" -"-/- ? V Located at f'�' �� V" - ;.re Owner /Applicant Name Formerly Mailing Address /9 7 TREATMENT SYSTEM Town or Village Tax Map 612-13 Block Lot Subdivision Name Subd. Lot # Date Construction Permit Issued by PCHD yi Separate Sewerage System built by 0 rr✓''f 7 e r Address ( a_ Consisting of 1;-7-5—e Gallon Septic Tank and Other Requirements: 7' Water Supply: Public Supply From Address Zip /C7s '�0/ or: /4 Private Supply Drilled by /11" %�� '�� Addressy" -''`1� f ��- ?�.�': Hai Pros;., a ..R�.�ild;,zo T_ypr. .%- �,r,...� �. n. ,onr:•ol been cc��r�nle��,..� ?. Number of Bedrooms Has garbage grinder been installed? A./e e �t I certify that the system(s), as listed, serving the above emises were constructed essentially as shown on the as- built plans (copies of which are attached), in acc N issued PCHD Construction Permit and approved plans and the standards, rules and regulations y s ty Department of Health. � G � Date: 7— elel Certified by a _� P.E. L/' R.A. z e 'gn essi . 895 Address X72- /1We�e> License # y9 Any person ccupying premises served by the TaWe sys em(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 revocatiop, moc ZiMcessary. By: Title: Date: altww White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT vVelt Location " Stre' f Addre - r wn/Village:'. Tax Grid # - Map 6a.,6 Block Z Lot(s) ^ /4 .. Well Owner: Name: Address: Use of Well: 1- primary 2- secondary _ esidenti Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment C Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole. in bedrock Other Casing Details Total length a y ft. Length below grade %, ft. Diameter " in. Weight per foot alb /ft. Materials: XSteel _ Plastic _ Other Joints: _ Welded _Threaded _ Other Seal: ?<.. Cement grout _ Bentonite Other Drive shoe: X. Yes _ No Liner _ Yes _ yNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped aL Compressed Air Hours Yields gpm Depth Data Measure from land surface - static (specify ft) Q During yield test(ft) Depth of completed well in feet a D Well Log If more detailed information descriptions or sievi:,ar a�l:vses_ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description . ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feat Gallons Per Minute Pump /Storage Tank Information Pump Type j ®ul dS Capacity sl - Depth a q 0 Model wX a 5 Q Voltage Ri 4 HP 3 /,y A 6 Tank Type fiPO Volume / y.10" Rot rb, T Date Well Completed Putnam County Certification No. Date of Report ell Driller signature) Nu i Ev rxact location of well with aistances to at least two permanenx lanamarxs to oe proviaea on a separate sneetipian. Well Driller's Name LS��c.�c_ X;04 QV Address:��Y Signature: ` o a r� Date: 00 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML EygjR2eaENSt�ejVRVICES Yorktown Heights., N:Y_.__10598- r ...s ._....,..._.___. _..�..... w... _ Albert H. Padovani, Director LAB #: 93.001149 CLIENT #: 12403 NON STAT PROC PAGE 1 N--- -- ---- -----M N N N N N N N N--- N" M --------- N N N MICELI9 ROBERT 25 SUMMIT RD. MAHOPAC, NY 10541 SAMPLING SITE: WEST SHORE DRIVE . : PUT VALLEY, NY COLD BY: LEE ANN DIRITO NOTE:S.. i�: WATER TANK NNNNNNN N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N DATE. FLAG PROCEDURE DATE /TIME TAKEN: 07/18/00 09:OOA DATE /TIME RECD: 07/18/00 12:45P REPORT DATE: 07/25/00 PHONE: (914) -628 -6688 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ----------------- NNNNNNNNNNN N N N N N N N N N N RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/18/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/18/00. LEAD (IMS) 7.5 ppb 0 -15 ppb 9101 07/18/00 NITRATE NITROG 15.3 MG /L 0 - 10 9139 07/18/00 NITRITE NITROG 0.498 MG /L N/A 9146 07/18/00 IRON (Fe) 1.73 MG /L 0 -0.3 mg /l 2037 07/18/00 MANGANESE (Mn) 0.042 MG /L 0 -0.3 mg /1 2037 07/18/00 SODIUM (Na) 133 MG /L N/A 07/18/40 pH 7.5 UNITS 6.5 -8.5 9043 07/18/00 HARDNESS,TOTAL 1B4 MG /L N/A 07/18/00 ALKALINITY (AS 144 MG /L N/A ._.__07./.1.S./40 ,.._ _. ..TURBIDITY (TUR 9.2_.NTU . ........ .....__,_::. - -., t7- �_.NTU.... ... _..... _.._.._. .COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS> (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb %Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No-limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a . moderately restricted diet, a maximum of 270 mg /L of Sodium is.suggested. s YML ENVIRONMENTAL SERVICES 321 Kear Street - -- - -- - - - -- -_ . _ . _ Yorktown N. Y . 4 0598. (914) 245- 2800 Albert'.H. Padovani, Director. LAB ##: 93.001149 CLIENT #: 12403 NON STAT PROC PAGE 2 NNNNN NNNNNNNNN N N N N N N N N N N N N N N N N N N N NNNNN N N N N N N N NNNNNNN N N N N N N N N N -- N N N N N N N N N N N N N N N MICELI, ROBERT DATE /TIME TAKEN: 07/18/00 09s00A 25 SUMMIT RD. DATE /TIME RECD: 07/18/00 i2:.45P MAHOPAC, NY 10541 REPORT DATE: 07/25/00 PHONE: (914) - 628 -6688 SAMPLING SITE: WEST SHORE DRIVE SAMPLE TYPE..: POTABLE s PUT VALLEY, NY PRESERVATIVESs NONE COLD BY: LEE ANN DIRITO TEMPERATURE..: < 4C NOTES...: WATER TANK COLIFORM METH: MF NNNNN NNNNN --------------- N N N N N N N N N N N N N N -------- N N N N N N N N N N N N N N N N N N N NN N N N N N NN N N N DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW.pH.MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED HARDNESS MAY RANGE FROM 0 TO SOURCE AND TREATMENT TO WHICH SOFT WATER: 0 -70 MG /L MODERATELY. - HARD - WATEP : 70 -140 HARD - WATER a .'-14Q -3170 I�G %L SUBMITTED BY: AS CALCIUM CARBONATE, IN MG /L. THE gUNDREDS OF MG /L, DEPENDS ON THE THE WATER HAS BEEN SUBJECTED. VERY HARD WATER: ABOVE 300.MG /L MG /L - - MG /L = M I L-L I 9RAM : � ER . LITER ( i grain %gallon = 17.2 `MG %L) ' _ - Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 - - • r vA%a, I 1.KU-IN MENTAL HEALTK SERVICES FINAL SITE INSPECTION Date: % Zb Inspected by: S•; eet Locati Owner ftt t_ Town Permit 'F' TM � � �? �. — pa..... -.:.. -. _. - �� -- b istonLoti...... .. ..__.� . ....... . 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement .3:1 barrier Lath. Width A�vg.Dptn C. Natural soil not stripped .................... ............................... d. Stone, brush,.etc., greater than 15' from STS area ......... e. 100' from water. coursehvetlands ...... ............................... II. Sewase System a. ':ptie tan size - 1,00.0 .: 1?50. ...other ................ b. Septic tank installed level .... ........ ............................... c. 10' ninimum from foundation .......... ......... ....................... d. Distribtuion Box .1. All outlets at same elevation - wader tested ................. 2. Protected below frost ................................................. 3. Minimum 2 R.Original soil between box & ttea-ches Junction Box - properly set........: ............. ............................... L Le_-ngu required Lent h installed 2. Diice to watercourse measured Ft.......... ® . -cording to plan ................. ::.................... ed a � of trench acceptable.1/16 -1/32" /foot ............. t ft lfrom P" P r`Y �o a line - 20 ft.- found?tions.......... Depth of trench X30 inches from surface .................. 4i. Room allowed for expansion, 100% ........................ 8: Size of gravel 3/1'r - 11/2" diameter clean .....:............. 9. Depth of gravel in trench 12" minimum .................. 10. Pipe ends capped ....................... ......................... :..... g. p ump or Dosed Systems 1. Size ot Dump c am err:.:..- .°. : : : : ................. :.. :.., ... _... 2: O��etTow taiik .......................................................... 3. Alarm, visual / audio ............ ............................... 4. Pump easily accessible, manhole to grade .............. 5. First box baffled ...................... : :............................. 6. Cycle witnessed by H.D.estimated flotiWcycle....... III. ouseBuildin 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 i2 fl....... c. Casino 18" above grade .............. ............................... d. Surface drainage around well acceptable .................. V. Overall Workmanship 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 p f. Curtain drain outfall protected & dirto exist water( g. Footing drains discharge away from STS area........ h. Surface water protection adequate ........................... L Erosion control provided .......... ............................... Rtv. l /97 rtn�. Fn - Public Health Director -1> e 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 (945) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 August 8, 2000 Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Punny West Shore Drive, Lot #3 (T)Putnam Valley, TM# 62.13-2-14 Dear Mr. Sullivan: The above regarded application is and cannot be processed. This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until the following has been received: 1 -).. M—Standard E911. Address Form. 2) ❑ Construction Permit Application. 3) ❑Certificate of Construction Compliance Application. 4) ❑A certified check or money order in the amount of: ❑ $300 for a Construction Permit. ❑ $300 for a renewal of a Construction Permit. ❑ $150 for a revision of an approved Construction Permit. ❑ $200 for a Certificate -of Compliance. ❑ $100 for a Well Permit. 1] Other If you have any question regarding this matter, please call me at (914) 278 -6130 ext. 2152. Very truly yours, Theresa Nemeth Senior Typist Rug 10 00 08:11a Planning Hoard (9141 526 -3307 p.2 BRUCE R. FOLEY Public Health Director LORETI'A MOLINARI - Ii-N, 'M.S:N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environments! Health (914) 278 - 6130 Fax(914)279-7921 NurAng Services (914) 278 - 6558 WIC(914)278-6678 Fax (914) 278 - 6085 Early intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax(914)278-608 OWf ERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: hoj '✓� 6 .0 (Signature) j DATE: 5 1 E The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VFRFRM) l Rug 10 00 08:10a Planning Board (914) 526 -3307 P.1 'gown Of Putnam Valley PLANNING DEPARTMENT T ]® NW.... THE FAX YOUV EEN !WAITING F001 l ti''•../ 7NTS: 265 ®scawana Lake Road. Putnam Valley, NY 10579 -2004 (914)526 -3740 - Fax: (914)526 -3307 Email: PLANNING011UTNAWALLGY.COM BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director a7iYLC: if' U% ' Alieiit '.Jervicas :< DEPARTMENT OF HEALTH 1 Geneva Road 9 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 July 27, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ®F Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Bell, Lake Shore Road Town of Putnam Valley, TM# 62.13 -2 -14 Dear Mr. Sullivan: This office has conducted a final inspection of the above referenced project on Wednesday, July 26, 2000, as requested. I offer the following comments for your review and consideration. 1. Distribution box is not large enough to accommodate required number of lateral exiting boxes after baffle * A baffle D -Box is required. 2. Effluent force main (2" PVC) required to be cut and elbowed down @ A 90° to inlet. 3. Effluent pump installed is not as stated on approved plan. * Please submit design calculations and specifications for "Zoeller" Pump installed. _ * Clove and specifications Yurs „ant to PCHD Bulletin ST -19. 4. Pump "W0ff' switch to be removed from exterior of house. * Pump wiring must be direct to circuit. 5. Provide a rise to within 12” of finished grade for pump chamber as required. 6. House built is not as shown on plans submitted for Health Department review. * Please submit a copy of house plans for review and bedroom count verification. This office will conduct an additional inspection upon completion of the above stated comments and at such time as application of Certification of Construction Compliance is received, to verify final grading and final compliance. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. e7 ABS:cj Very truly yours, da� Adam B. Stiebeling Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL EAL'TH.. SE VTC'E S ... -_ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM /,?e� -� Feq )"-w (-/ Owner or Purchaser of Buildin Building Constructed by Location - Street iz_1 5 2 14 Tax Map Block Lot l- tvr )1a /1-e- y TownNillage Subdivision Name 3 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 ._ _ .rys+4_ The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the ilding utilizing the system. 21 11 Dated: Month Day �Z Year General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip 2-0"'e' Signature: Title: � � /,:! ,r r' , 6: 70 "�k y 7;, Corporation Name (if c rporation) Address: State M -1 d,� c / v Lip / (A/ Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Buildin Building Constructed by Location - Street Building Type d 2__J -5 �Z 114- Tax Map Block Lot 1177a ry Y4 11,e- TownNillage Subdivision Name 3 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment'system, or any repairs made by me to such system, except where the failure to operate properly is `caused by the willful or negligent act of the occupant of the building utilizing the system: - - The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the ilding utilizing the system. 11 � Dated: Month dl Day Year 201'`' General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Signature: Title: A-1 ;14i {-o' Corporation Name (if c rporation) Address: `1 5TZ_r_1A4, -_/e - State 4*6;�W e /I,/, ip l e-i-y/ Form GS -97 PUT:NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL_ ,A. T SER. '_ ES.....:..:: GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Buildin Tax Map Block Lot !� /" G" 11,,7a I;77 )1a 11e- Building Constructed by Town/Village r 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 ofHealth, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said .system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing_the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the ilding utilizing the system. Dated: Month Day Year Signature: Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Al Corporation Name (if corporation) Address-. �`1 = /G' /�/� %!Z Zip State Form GS -97 BRUCE R. FOLEY . .LORETTA . MOL1.NAR1..R.I;1;- - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road t 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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 August 8, 2000 Frank Sullivan, P.E. 2972 Ferucrest Drive Yorktown Heights NY 10598 Re: Punny West Shore Drive, Lot #3 (T)Putnam Valley, TM# 62.13 -2 -14 Dear Mr. Sullivan: The above regarded application is and cannot be processed. This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until the following has been received: 1) ®Standard E911 Address Form. 2) ❑ Construction Permit Application. 3) ❑Certificate of Construction Compliance Application. 4) ❑A certified check or money order in the amount of ❑ $300 for a Construction Permit. ❑ $300 for a renewal of a Construction Permit. ❑ $150 for a revision of an approved Construction Permit. ❑ $200 for a Certificate. of Compliance. ❑ $100 for a Well Permit. ❑ Other If you have any question regarding this matter, please call me at (914) 278 -6130 ext. 2152. Very truly yours, Theresa Nemeth Senior Typist 07/25/Z0@0'_--U7: 49 9149624248 JOSEPH SULLIVAN rwtit rat REAMY TR - DIVISION OF ENVUt®NMENTAL HEALTH SERVICES ATTENTION OWADAM ❑ GENE zj amalffawlemmotlyelk All information must be fully completed prior to any Trenches inspections being made. 0 PCHD Construction P nit # �r 9 9 Located: -O rwv (T) (V) 0"7 Owner /Applicant Name: TM 42L.1-3 Block ,,.�_ Lot .lam Formerly: 0 e,11 Subdivision Name: E Subdivision Lot # a Is system fill completed? Date: Is system complete? Date: Is system constructed as per plans? V &=k _ Is well drilled? 'Date: Is well located as per plans? Are erosion control measures in place. 08 1 certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County 04artment of Health. .�� ® U Date: Certified by: YE R.A Address:` �.7%��i� �re i—� Lic. #��f COlnments: Fom FIR -99 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director. „ -`i irrector' of- Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 July 27, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Bell, Lake Shore Road Town of Putnam Valley, TM# 62.13 -2 -14 Dear Mr. Sullivan: This office has conducted a final inspection of the above referenced project on Wednesday, July 26, 2000, as requested. I offer the following comments for your review and consideration. 1. Distribution box is not large enough to accommodate required number of lateral exiting boxes after baffle * A baffle D -Box is required. 2. Effluent force main (2" PVC) required to be cut and elbowed down @ A 900 to inlet. 3. Effluent pump installed is not as stated on approved plan. * Please submit design calculations and specifications for "Zoeller" Pump installed. * Curve and specifications pursuant to PC TD Bulletin ST -.9, 4. -' Pump "WOff ' switch to be removed from exterior of house. * Pump wiring must be direct to circuit. 5. Provide a rise to within 12" of finished grade for pump chamber as required. 6. House built is not as shown on plans submitted for Health Department review. * Please submit a copy of house plans for review and bedroom count verification. This office will conduct an additional inspection upon completion of the above stated comments and at such time as application of Certification of Construction Compliance is received, to verify final grading and final compliance. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public.Health Engineer ABS:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .:.. �,.. CONSTRUCTION PERMIT FOR SEWAGE TREATMENTS .... _. . p b PERMIT # 1 ✓ °a -� (� �- j Located at �� f'1��/'f�-E' Town or Village Subdivision name Subd. Lot # Tax Map Block Z Lot Date Subdivision Approved � //� 7j� Owner /Applicant Name 4 ay e lYe,,I/ Mailing Address Zfi� ��, Ar �-p Amount of Fee Enclosed ;4'ev Building Type Renewal Revision Date of Previous Approval V /Y Y. Zip ll��iJC'� Lot Area'_ No. of Bedrooms Design Flow GPD O�41O Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by & f gallon septic tank and 4r du .4 /C-- Address Water Supply: Public Supply From Address `' Privaie'Suppiy*Drilied by__.. *,.. - J-14 . _ Address li3dt Oi': . I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. t Signed: P.E. Address R.A. Dated %� License # ;?- y "-4-1 APPROVED FOR CONSTRUCTI N. is approv expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe . Appro d for 's ar of omestic sanitary sewage only. By: if Title: Date: 3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profession 1 Form CP -97 ON PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location: Street Address: TownNiillage Tax Grid # �,�' ��°r: ✓� ��p�� Map z ,/,5 Block Lots) % Well Owner:_ Name: Address: Use of Well: A," Residential. Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage of al.' Reason for Replace Existing Supply Test/Observation Additional Supply Drilling k"New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes k--f No Name of subdivision .4 -fAt- 5J / rr -, i Lot No. --'S Water Well Contractor: A' A'h Address: O-rl Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: --• Town/Village Distance to property from nearest water main: 1� % ✓� Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 3 /IT Permit Issuin f�icial: � g Date of Expiration 1 1 el 301 at Title: l Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ENYIlaONMENTAL HEALTH SERVICES.. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Addres s Located at (Street) Agl;?e Tax Map Block Lot (indicate nearest c ss street) Municipality Po� Om Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test &Z,.g—cP'zg;V NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 15 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 .......... be h to Water Water ........... . ... ......... ........ .... Hale 'N .... ante Start. Ala se TjnlJ .�. 0m*: Vt . �:::��Surface ( ...... Level ..... . Percaiatton . .... . . .. . .. ...... . ..... .... atop Jim V X ... ...... . 2 3 4 5 I 2 '- 2' /'�— /-:!;� -3. 3 -3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 15 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. J HOLE NO. HOLE NO. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 14.01 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' j i Indicate level at which groundwater is encountered A �,o�E' Indicate level at which. mottling is observed Ai/7- Indicate level to which water level rises after being encountered Deep hole observations made by: c�1�,p / /i'`� Date &,0,(15' Design Professional Name: J ) J I era" e Address: >9 y', r��o C r Signature: Design Professional's Seal Of NE14. s. C: _ JYT Jt F SULLIVAN P. E. 962 4248 P.01 PUTNAM COUNTY DEPARTMENT OF HEAILTH DI'V'ISION% OF ENVIRONMENTAL REALTH SERV, I LETTER .OF AUTHORIZATION RE: Property of 4-4-.. . eVe,11 Located at f'f' ✓f ..: c.�/�'D /'�- n,-:i r. . TN / !'a► / ..Tax Map Block .- . �y - -:: _ ._ .:Lot .!/'04 : Subdivision of l a�e Subdivision Lot # Filed Map.# Date Filed , Gentlemen: This letter.is to authorize a� a duly licensed Professional Engineer : K 'or Registered Architect to apply for the required..' wastewater treatment and/or water supply_ permit(s)-to serve the above -noted pro porty, itf acco Nance. with the staiviards; rules or regulations. as. promulgated .by �tht . Public Health Diredtor of the ftsttatn.: County Health Department, and to sign all necessary papers on my behalf in co{�rtecti' .viAih. this.::' matter and to supervise the construction of said wastewater ttetinent ind,/or water supply systegis in conformity with the provisions of Article ' 145 and /or 147 of the k duration Law , tire. Public, ea1Eh Law, and the Putnam County SO: nitary Code. �---- Very. truly yours, ountersigaed: P.E.jR72 k.; # .-X o gQ' Property} . Mailing Address .'�- �' / rdr � bpi-,, Mailing Address: - :2J I State Zip ✓O States Telephone: ~ ,92 x Telephone: �. -. Form 'I:A -97 •; b 14-16:4 (2 07)—Text 12 PROJECT I.D. NUMBER 617.21 SEOR k Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM. _ For 6kIST6 ACTIONS Only PART I— PROJECT INFORMATION (To be completed by ADDlicant or Protect soonsorl 1. APPLICANT /SPO SOR 2. PROJECT NAME. .7� 3. PROJECT LOCATION: Municipality �t!/�J�� County 4. PRECISE LOCATION (Street address and road interseo a, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: ANew ❑ Expansion ❑ Modlficatlonialteratlon 6. DESCRIBE PROJECT BRIEFLY: ;1041 '11�iml 07 7. AMOUNT OF LAND AFFECTED: Initially &.9t__ acres Ultimately acres S. WILL PROPOSE ACTION COMPLY WITH EXISTING ZONIItG OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesllOpen apace ❑ Other De ribs: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? 19Yes ❑ No If yes, list agency(s) and permltlapprovais 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑ No If yes, list agency name and permit/approvol 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor . name: /' " / !n�'� Date: Signature: If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (ro be completed by Agency) A. 6ES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL.EAF. ❑ Yes ❑ No B. 16I1.1. ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, 110138 levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? _.❑ Yes C No If Yes,, explalp bP,(af1,y__ ��:: . _.:..:.... .�.. - - -- - --- ti _ .. _ .- _ . "- ..- . " "..:._ . "... <.I PART 111— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency i Date Title of Responsible Officer Signature of reparer (If different from responsible of icer Public Health Director July 22, 1999 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 To: Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan, M.SX . Associate Public Health Director Director of Patient Services Re: Bell, Lake Shore Drive TM# 62.13 -2 -14 Town: Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. 1. Slope in area of SSTS is 16 %, please review. 2 -_ . This Office has no record of Deep Test Hole observation Please schedule an. ' appolntment. 3. Specify length of Curtain Drain. 4. Specify type of Curtain Drain outlet structure. 5. Add note to plan stating minimum 10' separation from ends of trench/fill to stone wall. 6. Specify size of pump chamber. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:mcb a BRUCE R. FOLEY . " Public ' heaith Director' - - July 22, 1999 LORETTA .MOLIN_ARI R.N.. M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 To: Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, NY 10598 Re: Bell, Lake Shore Drive TM# 62.13 -2 -14 Town: Putnam Valley Dear Mr. Sullivan, This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. 1. Slope in area of SSTS is 16 %, please review, 2. This office has no record of Deep Test Hole observation. Please schedule an uppo.rtment. ...__... /3. Specify length of Curtain Drain. loom i/�4. Specify type of Curtain Drain outlet structure. Add note to plan stating minimum 10' separation from ends of trench/fill to stone wall. `/6. Specify size of pump chamber. r This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly your Adam B. Stiebeling Assistant Public Health Engineer ABS:mcb