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Home My WebLink About3040DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.18 -1 -73.1 BOX 25 03040 1 F � rNI Bill 03040 .1% I 4.. -NIT PUTNAM COUNTY DEPARTMENT OF HF�CLTH;''.; f:. l:. '. .. - DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT f3 T EI% 1,. ::,.�.?Ps.- .mr:Mx...xs Ptl.v. IBC Well Location Street Address: .� S (/ Town/Vill ge: P d a �`/o, f� Tax Map # GA 4� 1 7 Map Block Lot(s) rG,P�S bar % Well Owner: Name: via ,r r f� v� dress: k n - Q r /(a � 3S O Cc_ot AJ G.Aa, �q� . VfP y Use of Well: 1- Primary 2- Secondary estdential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment tary _Cable percussion Compressed air percussion_Other(specify) Well Type Screened _Open end casing _ Open hole in bedrock _Other Casing Details Total Length �3,_ft. Length below gradt� Diameter in. Weight per foot jjr lb/ft Materials: Steel Plastic Other Joints: Welded JZ Threaded Other Seal: ement grout Bentonite Other Drive shoe: Yes o Liner: _Yes Screen Details Diameter in Slot Size Length ft De t to Screen ft Develo ped? First I _Yes No Hours Second Well Yield Test _Bailed _Pumped _ Ompressed Air Hours '7.+- Yield gpm Depth Date Measure from land surface-static (specify ft During yield test De pt o complet;d well In ft. 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 _ .. :..... :.._w- - _ ............ (......._ .. :... f7 tiG' / t! . . � _. -. .. ........�- __ . w _ _. _ . � ._..... _.. .. If yield was tested at different depths during drilling list: Feet Gallons-Per-,Minute Pump /Storage Tank Information y`.,;' "'` '_`!;! Pump Type rti hterst c�-Capacity ' Depth, Modeler -(g Voltage HP ...... JZ J_ Tank Type Voluble 1'� PA _ __ -- --' � La lNell`Cleetl" Well Driller FCxCertificate =# ri®q -� �� "NYgState Purnp'InstallerPC #,� p�,� X s try Da�e`ofReporti` A r k s 1 �� , Y 'II Well Drtller Name 8'Add .ss #11uc�P tN t f • -...� A:WV'm yY,x, l., t"YSf: 'R}i:.: q'�Y 9V. ._. ....,,^�..eh :.;li:...''�4 Well Drilled, (stgna //rt,�,,,, -�.�% v i y'�i��' i:4 ^' Il,•I r 1F.kMY x F! xNA. xl. i` i.iYR�� f1, "�x.x�k�.MAr... - 1 t!SF�.'S'rAfl gar...... 'I.... yM. ,C� Pump l alter NamesAdtlress , s ' ^ 3 u� ', §tip' ,* ..: ]% .K F.:. ,S J A .i £ 1 . "; N . .. Sk YwR `F y S Y fe� '�'^ 55d t R,1 3 T xi ..: y:Y , ,', 3} rY Pumpinstaller (st natu "re , a J '^k .. �iP' ). iA �'. � ' �'•I wt' k Sf NF�N�'''*'�, MFe c "d '� "�'• yiM1iP A @ C NOTL � Exact Location of well with distances to at least two pern{anent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 I��'^� Albert H. Padovani, Director | LAB #: 1.703525 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 1 ANDERSON WELL DRILLING DATE/TIME TAKEN: 06/22/07 10:00 152 BARGER ST . DATE/TIME REC'D: 06/22/07 10:16 ATTN: NORMAN, SARAH ' REPORT DATE: 06/25/07 PUTNAM VALLEY, NY 10579 PHONE: (914)-528-1491 SAMPLING SITE: 435 OSCAWANA LAKE RD SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: BEVERLY _ TEMPERATURE,.: < 4C -- NOTES.".: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ QeTE - FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/22/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18-20 9222B COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIp��'THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: All 1 | Direc 'Elio H. Padovani, M.T.(ASCP) r ELAP# 10323 ..._�.., _....,,... ._....._.. ... r....v ..._. ....._ __,. ..,_.._...._.,. :- ...."".':'•...._. .`. .,...... .. ..: ;v e{.xs:+« c;a."Cti '�,c +.ag'�' e+'..�ysmo yt r PUTN'AM _ COUNTY HEALTH DEPARTMENT... PIN _..... _- _ .. DIVISION OF ENVIRONMEN!'AL HEALTH SERVICES "VI 225- 3838/225- 3833/225 -3641 PROPOSAL FOR SEWAGE DISPOSAL, SYSTEM REPAIR OWNER'S NAME Richn.rH & Virginia Mansfield PHONE 528 - 4585 SITE LOCATION Oseawana Lakes Road Putnam Valley N.Y. 1M# 42 -5 -5 MAILING ADDRESS P.O. Box 349 Putnam Valley N.Y. 10579 PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE October 1986 TYPE FACILITY Single Family PROPOSED INSTALLER A. Kastuk & Sons Putnam Valley N.Y. PHONE 528 -9523 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. .Different location may require submittal of proposal from licensed professional engineer or registered architect. System is to be located in the same place. Proposal Disapproved r000sal at)Droved with the followinq conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). I tall 's name and number do �t Q1 (e.g.,house corners). three precast 6' diam. x 6' deep e. ns er - . �. System repair to be performed in accordance with the above proposal and conditions. Y'- owner, or reported agent of owner agree to the above conditions. IG U TURE TITLE OWNER. .'DATE 10/18/86 BI); Pink FS: White (PQHD); eLLc�v ( ) , Naw Ah Ali w e. v Y14, vj 57C ot A N� jr tiJ Y14, vj 57C ot A N� a' PUTNAM COUNTY HEALTH DEPARTMENT Y DIVISION: OF ENVIRONMENTAL. -SSE VICES- 225 - 3838/225- 3833/225 -3641 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME RIchA -rM & Virginia Mansfield PHONE 528 - 4585 SITE LOCATION bscawana Lake Road Putnam Valley N.Y. TM# 42 -5 -5 MAILING ADDRESS P.O. Boa 349 Putnam Valley N.Y. 10579, PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE October 1986 TYPE FACILITY Single Family PROPOSED INSTALLER A. Kastuk & Sons Putnam Valley N.Y. PHONE 528-9523. Proposal (include-.sketch locating all adjacent wells): NO'T'E: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. System is to be located in the same place. Proposal Disapproved iature &_T CO L7 Ql Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. r "A. System repair to be performed in accordance with the above proposal and conditions. r .S owner, or reported agent of owner agree to the above conditions. SIGNATURE TITLE' OWNER. DATE 10/18/86 ?RS: WAte (PC D); elbow (Tam HI); Pink ) Gyp /� I- i►�t;�c�' c �t w � c w � t Y: t r c t Y: t r ,fir' @ley q f ^1 5OWNJ "A,J M SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L'ORETTA'MOLINARI, RWMSf N Associate Commissioner of Health Nemerj Design Group 215 Hilltop Street Mahopac, NY 10541 To Whom It May Concern:: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 4, 2007 IA- Addition — Approval.—A-180-07 No Increase in Number of Bedrooms 435 Oscawana Lake Road (T) Putnam Valley, T.M. # 62.18 -1 -73.1 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 August 31, 2007. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at two without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. I. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. _ _. _ . 4,• -This Department recommends youm contact-yourlocal Building- Department'to ensure' setbacks and other current codes can be met. 5. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of _Putnam Vallev If you have any questions, please contact me at (845) 278 -6130, ext. 2261 Sincerely, Gene D. Reed Senior Environmental Engineering Aide GDR: ens cc: BI (T) Putnam Valley 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 ) e ,1 SHERLITA AMLdER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. R®NDI -County Executive R®IBER' Director ADDITION APPLICATION RESIDENTRAL ON STREET �� SCd W AN 1N L Me- TOWN � T . V l ��,,C, k Tex #G l f PHONE PCHD# MAILING St, M l c 1. 'T® Ave-L -% n t ectdi ADDRESS W&AerAt I' 6lragy 215 41c Sk. MaLL4 -0 p� toy I (DESCRIPTION OF ADDETION �Mte NUMBER OF EXIS'T'ING BEIDI1®OMS 2 ' 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 D;ept., 1 Geneva Rd, :Brewster - NY 10509, Phone: (845) 278=6130. 1. Certified check or money order for $106.00. 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 a o SIHERLITA AMLER,.MD,.MS,. FAAP ._ Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. ....ROBERT J: BONDI _ _ ,... _. .r..TM�;.•.....:< County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count Re: MARKOVSKY (Owner's Name) Tax Map #: ( 1R- 1-73.1 Address:�43 -5 0, -scawa Take Rsad Town: o f 1?13� V l e — Year Built:;, According to records maintained by the Town, the above noted dwelling, is xx in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Building 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 ALL BE R£d/OWD AND IH£ AREA PROPERLY STAB/UZ£D BY BE PDWORMW IN ACCORDANCE NES FOR URBAN DM90N AND !/ALL BE INSTALLED IN . FORK "CLINES FOR URBAN rA.OR % { \ y�� SN X00+ m`O• aft 1 W 1 N ... G .♦ .. <xC rn _..0. .!/.. >.a...> .. -.•. ..wr_ Ft, '�..�- .v.'4'J .._;... .. r.t�S: .. s. -- . OR FpRN'E�� OMPK \NS M �26p, NpW W It c v �� 46 Op E 222.08 ^ F I 14 oo. I 0 y1 `N 6.1 2 1.�o •1 ON 5� Y, W O Z 97LED U7E eA w7H R.aa a mu oF T or 7H /S EARTH ' PT AS MaL. /S ti !AL DESIGN i E GROUND i LED FoR LOT 1. *. THE SMEA/r ILLED y,11 / i) N \ \• �a 110 �(r t . ' • w .... t:3' rn ...,.:C: . r.. J � •�, \ \J.�. A. r �.V..rw•iU •!� >.w • .t Wf: r w h the swat the sJmwsloa onn'Ls nsedd A£, the slothsy ro'/ to be ohondo,•fd wd o -4• no. Nee da9d e?o`'e slom N, W J°°,. m .�f w -W Jy ® Jrvkv d* ef'N� ..! \pC \ I ' J�1 1 u.�. vAyy r / I13— I 1 1 // 11 sain yA WTI It \ FAr / u7 / / e�M1M1r � � y0C 40Tfl,- i, r �� , 1 g \ \ 56 Acres /' o\ \ \ o+ / \ 0l S. F. / _ "S A Atrof, yp \ Q \ \ \ / / / / / / dN/r aW� // fM,mt �/� / / C � � T #2 . 3 Ar 2 5524 Acre. \ \ O \ a 00 ma ' EL 117.3 YJ % b U :30; 8 �*SS'TS ,ESCHEDULE 1' i; «.ItTAN DRAW fu REMARPa /..>' aw. f / sou. vide sl/t Ifo9ce barrierWown o#' / slope o/ wfd and ser�c% line / lNGL£ FAMILY / \/._ .. ' : -•.. _....- - /. ' ..' . ' ... abog p/0 A I / \ I relocate dirt drive onto property / I 100' m to wetldnd��ond ..� \\ I / � � —' )rowde silt fen 9 edge of -- POND �. I 1 Apr erty line. / 1 /I \ �>/ UTILITY 1 / 100imin _ •I POLE L 147.3 — I OtjuTa I I �u►J� of 41 I apyEeAY i / /L0� 96�G0 3 sank SINGLE FAMILY Q STORY tsFFAx RES1D£NC£ —THREE BEDRbOM 1M Dm , 3 I ' �/ p}eg� � , / i• d 11 LIKE �• I \ m FOUND p4 9L I M ,Cluz.99 S Ry unuFY valL SUBDIVISION PL T \ 1 1 / i) N \ \• �a 110 �(r t . ' • w .... t:3' rn ...,.:C: . r.. J � •�, \ \J.�. A. r �.V..rw•iU •!� >.w • .t Wf: r w h the swat the sJmwsloa onn'Ls nsedd A£, the slothsy ro'/ to be ohondo,•fd wd o -4• no. Nee da9d e?o`'e slom N, W J°°,. m .�f w -W Jy ® Jrvkv d* ef'N� ..! \pC \ I ' J�1 1 u.�. vAyy r / I13— I 1 1 // 11 sain yA WTI It \ FAr / u7 / / e�M1M1r � � y0C 40Tfl,- i, r �� , 1 g \ \ 56 Acres /' o\ \ \ o+ / \ 0l S. F. / _ "S A Atrof, yp \ Q \ \ \ / / / / / / dN/r aW� // fM,mt �/� / / C � � T #2 . 3 Ar 2 5524 Acre. \ \ O \ a 00 ma ' EL 117.3 YJ % b U :30; 8 �*SS'TS ,ESCHEDULE 1' i; «.ItTAN DRAW fu REMARPa /..>' aw. f / sou. vide sl/t Ifo9ce barrierWown o#' / slope o/ wfd and ser�c% line / lNGL£ FAMILY / \/._ .. ' : -•.. _....- - /. ' ..' . ' ... abog p/0 A I / \ I relocate dirt drive onto property / I 100' m to wetldnd��ond ..� \\ I / � � —' )rowde silt fen 9 edge of -- POND �. I 1 Apr erty line. / 1 /I \ �>/ UTILITY 1 / 100imin _ •I POLE L 147.3 — I OtjuTa I I �u►J� of 41 I apyEeAY i / /L0� 96�G0 3 sank SINGLE FAMILY Q STORY tsFFAx RES1D£NC£ —THREE BEDRbOM 1M Dm , 3 I ' �/ p}eg� � , / i• d 11 LIKE �• I \ m FOUND p4 9L I M ,Cluz.99 S Ry unuFY valL SUBDIVISION PL T