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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -17.2 BOX 26 , I�, � . R, ., r , 1 NJ . �vml i r I r 16 '� �.� � 1, 1 �; J � . r - , 03161 r' e SHERLITA AMLER, MD, MS, FAAP Commissioner f Hea/tti LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI .Cou mrv;F�eR_ ROBERT MORRIS, PE Director of Envi o ental Health ADDITION APPLICATION RESIDENTIAL ONLY RN STREET ;92 ), J)D) A o L.A lzC 42 d TOWN F'u4 TAX MAP# 7Z i h NAME_ _ Z �Z c PHONE °I j q- 33 ©_ 4 9 �j q PCHD# O �� MAILING ADDRESS Pjy, tom DESCRIPTION OF ADDITION F i J t-AY -4 F_ 1= 9(1 titmJ 4 IFAZ A 5;A0 '13 1 NUMBER OF EXISTING BEDROOMS 4 PROPOSED # OF BEDROOMS 4 (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., 1. Geneva R,d, : �• - • -- - ter; wct r, 'r! - X060 -� �p 1� 3: °4�) '2��i -v 3v.. - _ _ _ _ _ ...._...... J. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERL_ITA.A.M.L EFMMD. M5., FAAP C:ommtsstaner olealfh LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 County Executive Town Le2al.Bedroom Count, Re: Z.Z) (C— (Owner's Name) Tax Map #: Address: Town: p N T-0 A M VA-L LE Year Built: Q�OO According to records maintained by the Town, the above noted dwelling, is V/ in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This inforniation has been obtained from: Certificate of Occupancy: ✓ , Other: Building Inspector Dat Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -65581 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 SHERLITA AMLER, 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. BONDI County Executive ROBERT MORRIS, PE Director of Environmental. Health January 20, 2009 M.. Zreik 52 Indian Lake Road Putnam Valley, NY 10579 R6:-- Addition- A- 005 -09 No Increase in Number of Bedrooms 52 Indian Lake Road (T) Putnam Valley, T.M. # 72.4-17.2 Dear Mr. Zreik: I have received and reviewed the plans f r 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 January 20, 2009. 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. u:tr5 '.' "7'i'[iJ apYll�`Ili u�GSliGt'Vai7uae "alYy' construction shown as existing that has. not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ t' _APPLICATION APPLICATION TO CONSTRUCT A WATER WELL, - -- -- •- - - - �ltriit please print or type4- aiiJ Well Location: Street Address: Town/Village Tax Grid # Map Block 0 / Lot(s)174 Well Owner: Name: Address: �rr-c W ova e /6 c /�f�9/�a n �vsi �d �iser� Al Use of Well: 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 __4 Est. of Daily Usage ,7-0,e gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type b'` Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No >- Is well located in a realty subdivision? ...................................... ............................... Yes d' No Name of subdivision / 0 ti C -/u / 0 ®'st Lot No. A- Water Well Contractor: Al - 17" 4 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village --9 Distance to property from nearest water main: Ali z� Proposed well location & sources of contamination to be provided on separate sheet/plan. _h_ff 6�� "r.� -,---' Dais:- �''��� ._ AaNlira:7t Si,n��tare:...�- 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 ),qui r es a new permit. Well to be constructed by a water well driller c ifi by Putnam County. Date of Issue � Permit Issuing Official: Date of Expiration I/)- O Title: Permit is Non - Transferrals e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES tiV Y 1ii1 l:',� Iiii� i`lE;iuV i i+ ulT Sig: v'vE i:�i Y IV PERMIT # =-----iown Located at ., o1 , `G' � � t/ i�� /3o dG� illage Subdivision name /P 9 4,�Subd. Lot # Tax Map %7— Block o Lot 17• Z Date Subdivision Approved ��� ell Renewal Revision Owner /Applicant Name �yole (,, e' Date of Previous Approval Mailing Address /0 a 6 Amount of Fee Enclosed OC/ uc Building Type ; e Lot Area ;�* No. of Bedrooms 4 Design Flow GPD XCW Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S sy tem to consist of Other Requirementsvl To be constructed by Water Supply Public Supply From / 2 Sd gallon septic tank and Address Address or: _ P :'ate Sut�ly jJtiiled b__ = ?, t:t�,� 109 .._.; Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem 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. __ _ .� OF NEW , ' Signed: d 694g& Address 2- 9 7Z )05�r,o�, R.A. Date / License # y X93 APPROVED FOR CONSTRUCTION: This approval �i' om the date issued unless construction of the sewage treatment system has been completed and inspected d is revocable for cause or may be amended or modified when consi ered n essary by the Public Health Directo . y revision or alteration of the approved plan requires anew pe Appr d for c ge domestic sanitary sewa a only. By, _._.._.. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT �i'ca -- :..Z iin° - -' 'v 4I- -Gi; i=►cIU CSS: - - ._ - _. I `ll .� /. e I ax �irid o �l7' Map�)i' Block/ Lot(s) Well Owner: N me: �.. Addre eV Use of Well: 1- primary 2- secondary _ Residential Public Supply Air cond/heat pump rrigatiol Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _ Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _2!�_ Open hole in bedrock Other Casing Details Total length ft. Length below grade /9 �7'ft. Diameter 61'? in. Weight per foot Ljl,�q _lb /ft. Materials: Steel Plastic _ Other Joints: _ Welded Threaded Other Seal: Cement grout _ Bentonite Other Drive shoe: _)g� Yes No Liner: Yes ->e'No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes_No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield / gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or siege analyses. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface L �� q, TT) If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Lob&,r. Capacity 7 C-11W Depth �a Model -Awp6m. Voltage Da 0 HP � 4 lip Tank Type Volume J'rl aa//d� p yv' 2_1r/ Date Well Completed i�`G� Putnam County Certification No. Date of Report l �3 Well Driller (signature) lvlJl'LTact location of well with distances to at least two permanent ianparKs to oe proviaea on a separate sneeupian. Well Driller's Name Address: !a� Signature: Date: D �9 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 :.r -axa ... x' . Y e:_... s n .... t r. '..a .Drn. V u • ... . ' ..� '� �:.v n. e_ � u +. -. ..- .Kex -_. -tee.. M.t .. my ...a ♦ 19.. y .:Y r.t •.. .. ...D. a.r .. .. a . . r ..� .. .y�. u .. _. . eaa.. r. APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �r�gsylar�G 141, 2. Name of project: .5�'�% 95 3. Location TN:1'PC'14' , 4. Design Professional: 1°�'�� / /i'��.� 5. Address: lwr-,? �►���%�, 6. Tye of ro•ect: Private/Residential Apartments Office Building Food Service Institutional Realty Subidvision Commercial Mobile Home Park Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? A:o Type Status (check one) ....................... ............................... Type I Exempt .� Type II Unlisted — 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... All� 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10, Name ofLead.Agency 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 12. If so, have plans been submitted to such authorities? ........ ............................... 13. Has preliminary approval been granted by such authorities ? Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water ✓' groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... 17. Is project located near a public water supply system? ....... ............................... Ale 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ Ala 20. Name of sewage system Distance to sewage system /%% 21. Date test holes observed _ i� � 22. Name of Health Inspector PG A}-F-1- Form PC -97 2 23. P ^r.o. yj, a� e. c� .i: t vd.eissa i.g. n z . f - lorr•w ++ " .(.g.`ar� l:lo o .n...n s vpI K - o d-. airy. - �' GA � iv. .: .. j •. -. r.r� r.. z ^'9:.y..r � r.. w�'µ. !s t °A - —, L � _ �. ✓.. v:.:.nN . •. ... ...'n 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... �d 25. Ilas SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? • le 27. Wetlands ID Number ........................................................... ............................... 28. Is Wetlands Permit required? ................................. t............ ............................... o4%a Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? .. ............................... 111d 30. Is or was project site used for agricultural activity involving applic,�tion,of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No y 31, Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/NO Ala DESCRIBE: 32. Is there a local master plan on. file with the Town or Village? ......................... Ny 33. Are community water and/or sewer facilities planned to be developed within a 15 years in or adjacent to project site? ................................ ............................... any,.szwage�treatment areas in excess of 15% slope? ...p..........,.,..............V 35. Tax Map ID Number .......................... ............................... Map 7a Blockol Lot) 7- a, . 36. Approved plans are to be returned to ..... Applicant k"' Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: vlailing Address: ............................. PUTNAM COUNTY DEP-ARTMEN'T OE HEALTH � � % r Apr 4 ON OF ENVIRONMENTAL HEALTH ERA - C-.C5�.. .. RE: Property of LETTER OF AUTIIORILATION J,- cl dry Located at Q ax Map 4 Subdivision of ?2- ]31ock 67,1 SLrbdivision Lot # l,iled Map # �l � � Date Filed Gentlemen: This letter iS to authorize a <ltlly IICCi1SEd Professional Lnineer _ or Registcred to apply for the required waStew�rter trealbllellt andlor water Supply pellllit(s) to SeLlie the Above- noted property in accordance ��rllh tl�e• standards, rules or regulations as promulgated by the Public Mea)th Director of the P17tIMM Counly l- 1ealtll I)cpartnient, and to sign al( necessary papers on aly beLzalf in connection with this matter CQ17d to SupGZV1.Se the Co115,11- ucljon vl'said WtIstt: water tretincizt andlor Wrl(er SLIPI)t / Syscerns in Conformity with the provisions of.Article 145 Auld /or 147 of the Education Layv, the Public Health _ L, t i4 , an rl. . _ Cou.ra el�sl ne yes Mai eSs Pr 6NC s CA t Very truly yotu-s, Sigrlud: 47L_�� (l�wn�r of Property) Mailing A.ddress: State PUTNAM COUNTY H�L` H DEPT'. 019112 -- - - - -•- 4 Geneva Road (9178 - 6130 Brewster, NY 19 Date C 19' u., 1. elel- ,laune� _ Received of _ The Sum Of_ U ❑ Cash ❑ Check 14-16 -4 (2fd7)— T'ueur P2' rPROJECT I.D. NUMSEA - �r w _ .. 017.21 .. L_..�.�_.._. --.- 44_44_.- 4444. r..- �...�.�.+.+,.�..- ..�.,.�,� ...,� - •...z.. �.. n.: - r ..�Y>I�i1 Q;r� :.: ,.. i _,a w. ,;,�. � ti ,ice• . State Enr trtwnentaei Quality RovWw SNORT ENVIRONMENTAL ASSESSMENT FORM For UNLWID ACTIONS Only PART I— PRIDJECT INFORMATION (o be corT plated by�Appp0cant or Project sponsor) I 1. APPLICANT JI,PONSOR .. -- - «W ~�•� { PROJECT NAME ✓i� yyld n �' J PROJECT LOCATION: / f �./J Munlclpallly ✓ G1 �cC lfj% Q //✓� Ccrar��ty �(�� %_a_� o 4 PRECISE LOCATION (Slratpt addrasS and naY, promina+lt landmarha. 61C.. or provide maps 6T) 10�:�177alzl �/o ` / -y S. 15 PRO OSED ACTION - ___ Now r] Expanslor, �� h4oditicationlalters0on 6. DESCRIBE PROJECT BRIEFLY' 7. AMOUNT OF (-AND A .� 8. WILL PROaOBEO ACl IL Yas [J No :I%.0LGacree — r..... ._.- 4444._ _�_.._ ._._. ._«....._..._._— ......_..�.. —.. ON COMPLY WITH EXITIING ZONINU OR OTHER EXISTING LAND USE RESTi41CTION67 11 No, daracrlbe bri -mby �G%' 9. WHAT IS PFIE.SENT LAND U43E IN 'VICINt'rr OF PROJECT? ~- ��- -� - -�_ — �-- - -_._� ___.___ . __--•1� usicenlfmi ❑ Intusfral L Commercial 13 Aprlculiuro Park /FwastJO e n Space Other .. L,•.u.- ..- .•....,�_ . ., ... .-� .. «_. 4444 _ -_r- v ... «"_.._. «.�,..� �_ - ...,,.._e.. _. 4444. ..4. <.....•... > :_ ... ..,. -. -... _.. ._._. ._._..o - ^""- �'-. ..'. _ .. ....,.- ..__._._......_.._._...__-...__...._..._ �.-..._....,.-_ � ............. �.....__._..--._.._.. _.__-- ......_....._— �..- .._.__� .__— . «...�_...�_.�- . -._.. _..- ...___ - - -_. 4444.._ -_._._ 10. DOES ACTION INVOLVE A PI RMIT APPROVAL, OR FUNLWNG, NOW OR t1LTIR xx T(ELY FROK ANY OYHEH GOVERNMENTAL AGENCY (FEDERAL. STAi���[ --��IOR LOCJ<L)Trr--1I � �C � ��� Yea l__I No It yen, II81 avwa cy(a) And ParrnlUUp6xovtta y 11. DOES ANY ASPECT F THE ACTION HAVE VA CUR14ENTLY VALID PEPWIT OR APPRL7VA' Yea No It yas, dal ag"oy name and prrmIVxpprOVal 12 AS A RESL10' OF PROPOSED AMON WILL EXISTING PERMIT)APpROVAL REQUIRE 7r ODWICKTION') -" t� Yes NO r CERTIFY THAT THIS INFORMATION PROVIDED ABOVE IS 'RUE TO THE H51 OF M`f ANOWLEDQE Signature. -- �- •-^ - ---- _4444. —� - ... ¢� ..�._,.,....... �i�,��....,..._........ tf the action Is In the Coastal IArew., ;god you gy$ % otete 69ancg, complete the Coa.Rtsl AssessY>'r ong Form Wore proceeding will this 89"SIMOnt L.___.___._ «4_4_4______4 .�...�...._.........�..._.�._ _...�...,._.._ .._..., _.«..�,_.....,.r_......r._.._«. �..««..�.�.� IVER IV IWO- DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTIN FILE NZ). owner Addr �2 ess Located at (Street) T-7 %v,71 oh(4 ,t d Sec. '7 z Block Lot 17 (indicate nearest cross street) Municipality R-f '47 Lla" Watershed Omni Z�6[9) V.V 9 tell za N 2;zo a I—YV-Vv • - -- 1109 - AVURKWAVIR" • Date of Pre-Soaking 6 &pAqz Date of Percolation Test HOLE (Z o 7-.--9 ) 2 NU1BER CI= PERMLUION 3 PERCOLATION Run Elapse Depth to Water From Water Level 3ZZ ZZ No. Time Ground Surface In Inches Soil Rate ? Start-Stop Min. start stop Drop In Min/In Drop Inches Inches Inches 2 3// 4 5 2 3 C- 3ZZ ZZ J0 5 4 5 NO1M-:-, 1. Tests to be repeated at same depth until approximately equal soil rates are obtained,at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole." rev. 9/85 2 3 4 5 NO1M-:-, 1. Tests to be repeated at same depth until approximately equal soil rates are obtained,at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole." rev. 9/85 TEST PIT DATA MQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 31 41 51 61 71 81 91 10' ill 121 13' -14' ... .... . INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE J"M To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ✓a DATE: ZV,-, DESIGN Soil Rate Used V Min/1" Drop: . S.D. Usable Area Provided Jrdo No. of Bedrocr"%-, Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other 3 3 4 OF NE$. Name it Signature Address S //V /Sp-/w THIS SPACE FOR USE BY HEALTH DEPARTMENT OPMY: Soil Rate Approved sq.ft/gal. Checked by Date Al, JZ1/ G.L. 2' 31 41 51 61 71 81 91 10' ill 121 13' -14' ... .... . INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE J"M To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ✓a DATE: ZV,-, DESIGN Soil Rate Used V Min/1" Drop: . S.D. Usable Area Provided Jrdo No. of Bedrocr"%-, Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other 3 3 4 OF NE$. Name it Signature Address S //V /Sp-/w THIS SPACE FOR USE BY HEALTH DEPARTMENT OPMY: Soil Rate Approved sq.ft/gal. Checked by Date PUIt M COUNN DEPARIMENr OF HEALTH • DIVISION OF HEALTH SE WICES DESIGN DATA SHEET - SUBSUFACE S5gAGE DISPOSAL SYSTEM FILE NO. Owner Address 4�'Ih g Located at (Street) �G> /'�%/�!1 Sec. Block f,,Il Lot, i (indicate nearest cross street) ! Municipality /4�c/ Watershed TO HE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking /U 6 Date of Percolation Test i HOLE c Z NL�ER CLOCK TIME 3!% PERCOLATION �S 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 In z- Jv 3,/,/ 1-5 �1s 3 ZZ Zs 3 11C2 4 5 3a 4 5 11 2 3 4 5 NOTES: I. Tests to be repeated at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to' be suhnittd for review. ` 2_ Depth measurements to be made fran top of hole. rev. 9/85 3//� �� 3!% ZZ �S 4 5 11 2 3 4 5 NOTES: I. Tests to be repeated at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to' be suhnittd for review. ` 2_ Depth measurements to be made fran top of hole. rev. 9/85 r ` P�11'NAI'v1MUM DEPARTMENT f1flll A1.TH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADS GENE All information must be fully completed prior to any inspections being made. For: Fill Trenches !� PCHD Construction Permit # — ©` Located: A-,v° Owner /Applicant Name: AWe Zee— TM -71 Block Lot /7- Form_erly: Q4h e �d r�o e- Subdivision Name: Subdivision Lot # Is system fill completed? Ale, Date: Is system complete? Date: Is system constructed as per plans? 7Y'r!�� Is well drilled? Date: -4 Is well located as per plans? V e S Are erosion control measures -in place? � I 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 Department of Date: -321.7— Certified by: PE 0`_ RA_ Design Professional Address: �9% i ►�Ci�'� %��-' �'� Lic. Comments: ;� 0ep!'�_- A Cpl' /l �-ri �--•- � /�- Li � � � Form FIR-99 08/12/2003 06:59 9149624248 JOSEPH SULLIVAN PAGE 01 PUTNAM COUNTY DEPARTMENT OF HEALTIEK DMSION OF ENVIRONMENTAL HEALTH SERVICES PCHD Construction Permit # . /dPe 9- d I For: Fill y" Trenches Located. Zz"ifV`err7 24"lle— /iFgoylrs (T) (V) Owner/Applicant Name: ��� / r�r'/� TM 72 Block _ j Lot l7 Formerly: i// "t �d1'rUrry-O &� Subdivision Name: �d Gl►� Subdivision Lot # -- Is system fill completed? —_ Y�� Date: z Is system complete? Date: Is system coostmaed as per plan Is well drilled? j Date: Is well located as per plans? a� Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in aceord4nce with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Certified by:* .. - PE RA Design Professional Address: �o //� Lie. # Comments: FOR: MADAM ❑ GENE ❑ (NAME) Form FIR -99 AIIG -12 -2003 TUE 07:26 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION T.,1c. a,ir Town 1°" TM# a— i -7- a- 1. SewaLye Svstem Area Date: VI'Ir6 Inspected by: --rIs n Permit # PV -f-0 i ''a•� Subdivision Lot # Gcx et,,& r",s4 (� 2 a. STS area located as per approved plans.......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands ............. II. Sewaze System a. Septic tank size - 1,000 .......... 1, 250 .......... other ................ . b. ' Septic tank installed level ................ ............................... c. 10' minimum from foundation ...................................... Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6, renc es 1. Length required Length installedd 2. Distance to watercourse measured Ft......, / /�� 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capppc4 ...... ...........:....:. ... ........................... . g: Fump or hosed Systems - ` 1. Size of pump chamber........1.0)'L(O .X �' -0 ................ 2. Overflow tank .........................:... .....................I......... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House/Building a. house located per approved plans ... ....................:.......... b. Number of bedrooms ...................... ...........................'... IV.. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured **�'l 00 - 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.. J f. Curtain drain outfall protected & dinto exist watercou / g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ....:................. .......... i. Erosion control provided ................. ............................... Rev, ?2/02 r MR Mr- { 'k. r .,,rr .'•• -:., •• L�L -,.i' aa'� a:avi.aa`t'�.0 1\i :, '1Vt. v.aV. -. •. ,... i' - •• -, . Acting Public Health Director Director of Patient Services May 16, 2003 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 /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, NY 10598 Dear Mr. Sullivan: c� Re: Field Inspection — Zreik Indian Lake Road, (T) Putnam Valley TM# 72 -1 -17.2, Permit # PV -4 -01 itUr3 it'l' T" -' BONIJI County Executive A site inspection was made for the above referenced project on May 15, 2003. The following comments must be corrected in the field. ✓ I Cast iron pipe needs to be inspected when installed. 2: The jurcti ,r_ bc-_cs should be i e iiuved..ar d pipes - fi�or_n the distriv:at on b,-% slt Dula rah directly to each trench (one pipe to one trench). 3. A few sections of pipe between the junction box and distribution box are less than 1/8" per foot. /4. Force main needs to be installed. ✓5. The well casing needs to be raised a minimum of 18" above grade and surface drainage around the well needs to drain away from the well. 6. A pump test needs to be witnessed by this Department. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, j fh.� -n✓.a Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Z-Z� e- - / Owner or Purchaser of Building AL Building Constructed by Location - Street _ Building Type 92- 0/ 17 Tax Map // Block Lot 1?-"o',74jV ez�- TownN lage Subdivision Name 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 0VAtalX'h, 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 01'&t building ut�liz�ng 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 oithe bulldingutlliz�ng�he system. Dated: Month d� Day /1 Year e3 Signature: c _ , o Title:. General Contractor (Owner) - Signature Corporation Name (if corporation) Corporationl�ame �lf corporatiion� Address: loo C,,,-ony, lee %1,y Address: State �5s�,✓� /l/ Zip ® State Zip F onn GSA1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL- HEALTH :DER .w_C ? "R•' , _A - .`Y}.<: .T ;.•. .W.�r..r ._. S r.�♦ <. ...K..^ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ,Z Owner or Purchaser of Building a,t Building Constructed by Location - Street Building Type 92- 9 1 /7 Tax Map Block Lot TownNillage Subdivision Name .a 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 ottrel'utnatri County Ioepa -tment ana hereby guarantee to the owner, his successors, heirs or aisigns, 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 thebuildinutll�z�ngthe: 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 buildin�vtil�ti�ngbhe system. Dated: Month F Day /1 Year 43 Signat Title; u 7 r General Contractor (Owner) - Signature '�' i��-� Y G • /'e 0 es- a ra 4 . Corporation Name (if corporation) CorporataonL�tame (if corporation) Address: /o o -orn,� %�r u,� flo, Address: State �S�j,,� f,�G �(1 Yr Zip o State Zlp F M GS -91 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL --SE',L�:� v- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Cxk Z z, e- Owner or Purchaser of Building At Building Constructed by Location - Street Building Type 92 ® 1 /7 Tax Map Block Lot TownNillage Subdivision Name .2 Subdivision Lot # . I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage ofthe sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations 0f'the4Utnam County Department oii�ea�th, ant 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 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 buildinqutvli2:=%the system. Dated: Month F Day 1! . Year 03 ti if r General Contractor (Owner) - Signature Corporation Name (if corporation) Address: (o e CiL -o�,,� ��,�,, /Lp, State Y� Zip o Signa Title: Corporat�.onl�[ame �i� corporation) Address: State Zip F onn U -91 7 .. 7 BY THIS CERTIFICATE OF COMPLIANCE THE a NEW YORK BOARD OF FIRE -UNDERWRITERS.,_. ' BUREAU OF, ELECTRICITY^ ,J 7 40 FULTON STREET "' NEW .YO RK; NY .10038 13 CERTIFIES THAT, Upon the application of upon premises owned by ALL STATE ELEC.(BARTOLOMEO, *MICHAEL ZREIK P.O. BOX 11 INDIAN LAKE ROAD 7 MAHOPAC, NY 10541, PUTNAM VALLEY, TN, NY 10579 j Located at INDIAN LAKE ROAD PUTNAM VALLEY, TN, NY 10579 Application Number: 1108943 Certificate Number: 1108943 Section: 79 Block: Lot: /7. � Building Permit: BDC: W106 7 . Described as a Residential occupancy, wherein the premises electrical system consisting of j electrical devices and wiring, described below, located in /on the premises at: J1 Basement, First Floor, Second Floor, Attached Garage, Outside, Attic, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 1 found to be in compliance therewith on the 10th Day of April, 2003. Lj ,1 . •T 1 re QTR Rate 2atine Circuit Type- - — . II Alarm and Emergency Equipment hI jl Sensor 7 0 110 Appliances and Accessories Clothes Dryer 1 0 4.5 Dish Washer 1 0 1.5 I Furnace 0 0 Water Heater 1 0 4.5 Air Conditioner 2 0 36000 Bell Transformer 1 0 Hydro Massage Tub, Residential 1 D Micro -wave 1 0 20 Range 1 0 8 Panels 1 100 24 Smoke KW KW Gas KW BTU Amps KW Wiring and Devices Outlet 199 0 Fixture 56 0 110 Incandescent seal Receptacle 59 0 110 General Purpose Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. a �.r�nE non E 121 nil : J 012 ���� EPLJ' j-E3 fa-� n��r��n�n�.r��nr��n�n� n�r����n�n�0 MMQIMM-5, 5 CERTIFICATE 5 BY THIS O,F COMPLIANCE THE. OF 5.. = '��•RS.; NEW .-YORK: BOARD FIRE UNDERWRITER!5 �? .1, :.�a.w.- .Yw�.1:�M: _. _v . , _ . .:; • :... / ....r �_.: ter-, .ta-aR. .. 1 _. Ca -. M� .v ,R na•J_ � o...• �::.... . .. lr. ..._ .. � «... ,.w ..a w, BUREAU OF ELECTRICITY �i S 5 5 40 FULTON STREET — NEW YORK, NY 10038 SCERTIFIES C5 5 THAT 5 Upon the application of upon premises owned by 5 5 SS 5 SP.O. ALL STATE ELEC•.(BARTOLOMEO, * MICHAEL ZREIK BOX 11 INDIAN LAKE ROAD 5 5 5 MAHOPAC, NY 10541, PUTNAM:VALLEY, TN, NY 10579 C5 S :• :1 Located VALLEY, TN, NY 0579, 5 at INDIAN LAKE ROAD PUTNAM 5 Application Number: 1108943 Certificate Number: 1108943 5 5 Section: Block: Lot: Building Permit: 5 5 BDC: W106 5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement, First Floor, Second Floor, Attached Garage, Outside; Attic, 5 5 5 5 5 was inspected in accordance with the National. Electrical Code and the detail of the installation, as forth below, was found to be in compliance therewith on the Toth Day of April, 2003. 5 1 M; 5 Receptacle 6 0 110 GFCI Receptacle 1 01. 1110 - Laundry: 5 . 5 1j Outlet 10 0 CATV 10.0 Telephone 5 5 Outlet Receptacle 1 0 Appliance 5 0 110 General Purpose 5 Switch 54 Service _- 5 5 5 1 Phase 3W Service Raring 200 Amperes C5, � Service Disconnect: 1 200 CB Cj Meters:l CT: 40 5 5 j 5 5 5 j 5 - Sea, 5 5 j 5 5 � 2 of 2 . 5 T This cert ificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 rJ�� Pr�cPc l�r�r PcPrJ�rJ�rJ�rJ�rJ�rJ�rJ�� Jar Pr�cPcPrJ�rJ�r�r�r�r�rJ�rJ�cPrJ�rJ�rJ�rJ�cPrJ�rJrJ�rJ0 r]r] L-11 E�rJE PETRr !rJ�rJ�rJ�rJ@P�rP�rJ�r�rJLr PrrL3Pr� I O � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 32.306836 CLIENT #: 56853 NON STAT PROC PAGE 1 ZREIK, MICHAEL DATE/TIME TAKEN: 08/21/03 01:0OP 10 LAWRENCE AVENUE DATE/TIME REC'D: 08/21/03 01:20P SLEEPY HOLLOW, NY 10591 REPORT DATE: 08/29/03 PHONE: (914)-672-7212 SAMPLING SITE: 52 INDIAN HILL ROAD - ~ ` ^^���� SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY ` PRESERVATIVES: NONE COL'D BY: M. ZREIK TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD BASIC PROFILE 08/21/03 08/21/O3 08/21/03 08/21/03 08/E!1/03 08/21/03 08/21/03 08/21/O3 08/21/03 NMS MF T. COLIFORM COPPER (Cu) IRON (Fe) TDS CONDUCTIVITY HARDNESS,TOTAL PH LEAD (NMS) CORROSIVITY (L ABSENT /100 ML 0.068 MG/L <0.060 MG/L 108 MG/L 169 70.0 MG/L 6.8 UNITS 2.5 ppb -1.5 ABSENT 1008 0-1.0 mg/1 2037 0-0.3 mg/1 2037 N/A 9064 N/A N/A 6.5-8.5 9043 O-15 ppb N . COMMENTS,' - .' - '-'-� '``r' `-' -BACT- THESE R��UL�S -N�I T � TW / � �� ' / |E W 6 N-'') O' / ' ' � ` SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. TDS TDS IS A DIRECT MEASUREMENT OF CHEMICALS DISSOLVED IN WATER. WATER WITH HIGH DISSOLVED SOLIDS GENERALLY ARE OF INTERIOR PALATABILITY AND INDUCE AN UNFAVORABLE PHYSIOLOGICAL REACTION IN THE TRANSIENT CONSUMER. FOR THESE REASONS, A LIMIT OF 500 MG/L IS DESIRABLE FOR DRINKING WATER. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L> 11 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights N.Y. 1O598 _ � - z a�n W =all TO "In "I~���'���=����&��������'*�8�B����' Albert H. Padovani, Director LAB #: 32.306836 CLIENT #: 56853 NON STAT PROC PAGE 2 ZREIKp MICHAEL DATE/TIME TAKEN: 08/21/03 01:00P 10 LAWRENCE AVENUE DATE/TIME REC'D: 08/21/03 01:20P SLEEPY HOLLOW, NY 10591 REPORT DATE: 08/29/03 PHONE: (914)-672-7212 SAMPLING SITE: 52 INDIAN HILL ROAD : PUTNAM VALLEY, NY COL'D BY: M. ZREIK NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 e.5. 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. .7���,�����-������������������������^��������=-.~�����~������'��� SUBMITTED BY: Director ELAP# 10323 ._,_ Unless' a tcrnperature r2nae has. begn -provided Lo test', mgji-ig LSI index ropoi ed 11 ,.rpibm prior Iz Js fo. ...temperature . (70.JoP.,&_22_6C). At lower temperatures, scale tends to dissolve more than at higher temperatur.es.when all other factors remain equal. Contrariwise, at higher temperatures, scale tends to deposit morejhan-at lower temperatures when ail other factors remain equal. The following 'chart gives a general comparison of LSI, tendency to form scale, and an approximate qualfficatio,n . of the. water's corrosive capability: LS.1 Index Description Corrosive Potential 2.0: 1.0 0.5: 0;2 .0. -2.0, -3.0 Extreme scale formed Very severe scale formed Severe scale formed Moderate scale formed Slight scale formed Stable water No scale formed; slightly tendency to dissolve scale No scale formed; tendency to dissolve scale No scale formed; moderate tendency to dissolve' scale No scale formed; strong tendency to dissolve scale. No scale formed very strong tendency to*dissolve scale Minimally Corrosive Minimally Corr6slivii Minimally Corrosive Non-corrosive Non - corrosive Non-corrosive Non-corrosive Non-corrosive Non-corrosive. Corrosive Corrosive YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-P900 C:. Albert H. Padovani, Director B #: 32.306836 CLIENT #: 56853 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ EIK, MICHAEL LAWRENCE AVENUE EEPY HOLLOW, NY 10591 1PLING SITE: 52 INDIAN HILL ROAD : PUTNAM VALLEY , NY -'D BY: M. ZREIK [ES'..: KIT TAP `-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE BASIC PROFILE 08/21/03 08/21/03 08/21/03 08/21/03 08/21/03 08/21/03 08/21/03 08/21/03 08/21/03 DATE/TIME TAKEN: 08/21/03 01:00P DATE/TIME REC'D: 08/21/03 01:20P REPORT DATE: 08/29/03 PHONE: (914)-672-7212 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFOAM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD NMS � MF T. COLIFORM ABSENT /100 ML ABSENT 1008 COPPER (Cu) 0.068 MG/L 0-1.0 mg/l 2037 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 TDS ' 108 MG/L N/A 9064 CONDUCTIVITY 169 N/A HARDNESS,TOTAL 70.0 MG/L N/A pH 6.8 UNITS 6.5-8.5 9043 LEAD (NMS) 2.5 ppb 0-15 ppb CORROSIVITY (L -1.5 0 T -THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI��`��~�'HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. TDS IS A DIRECT MEASUREMENT OF CHEMICALS DISSOLVED IN WATER. WATER WITH HIGH DISSOLVED SOLIDS GENERALLY ARE OF INTERIOR PALATABILITY AND INDUCE AN UNFAVORABLE PHYSIOLOGICAL REACTION IN THE TRANSIENT CONSUMER. FOR THESE REASONS, A LIMIT OF 500 MG/L IS DESIRABLE FOR DRINKING WATER. TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) t YML Environmental Services (Division of Yorktown Medical Lab, Inc.) 321 Kear Street. Yorktown Heights, NY 10598 Tel. (914) 245 -2800 CORROSIVITY AND THE LANGELIER'S SCALING INDEX The Langelier's Scaling Index (LSI) is used to determine whether .or not water has the capability to either depositor dissolve scale. "Scale" is defined as a hard, granular layer deposited on a surface by impurities found in water, or other medium. Scale from water is usually composed of Calcium and Magnesium salts, though other inorganic salts may also contribute to the scale formed. �. A thin layer of scale deposited on a surface can form a protective la' er that resists the corrosive effects of water flowing over it.- However, some studies suggest that a layer of scale that is too thick can actually promote corrosion through electrochemical reaction, and in the case of pipes, can deposit to such a thickness as to block the passage of water. On the other hand, water which tends to'dissolve scale will inhibit the protective benefits of a thin scale layer, and may also leads to direct corrosion of surfaces, pipes and fixtures. The LSI is not a direct measurement of the water's corrosion capability. Instead, it is a measure of the water's tendency to form a protective scale layer, or to dissolve a scale layer. It is therefore an indirect assessment of "Corrosivity ". s- n:,rr LSI i� "f': nrjrh UnlQSS a temp,erat�.lrp range h�J Uce,..r c:.�led "prior ^��� `estir:g, "tile in��e<:recvrfn�l._'.". ` ' -temperature "(70 6F'6( 22 oC)." At lower temperatures, scale tends to dissolve more than at higher temperatures when all other factors remain equal. Contrariwise, at higher temperatures, scale tends to deposit more than at lower temperatures when all other factors remain equal. The following chart gives a general comparison of LSI, tendency to form scale, and an approximate qualification of the water's corrosive capability: LSI Index Description 3.0 Extreme scale formed 2.0 Very severe scale formed 1.0 Severe scale formed 0,5 Moderate scale formed 0.2 Slight scale formed 0 Stable water -0.2 No scale formed; slightly tendency to dissolve scale 4:5 No scale formed; tendency to dissolve scale -1.0 No scale formed; moderate tendency to dissolve` scale -2.0 No scale formed; strong tendency to dissolve scale -3.0 No scale formed very strong tendency to'dissolve scale Corrosive Potential Minimally Corrosive Minimally Corrosive Minimally Corrosive Non - corrosive Non- corrosive Non - corrosive Non - corrosive Non - corrosive Non - corrosive Corrosive Corrosive - t�.14 �14-'J41-J ;,17 ,'3/01:'TAO3 ll: 0 '314$S2424e ALF INC 3r" -ZPH SLUIVAN PUTN AM COUNTY DEPARTMENT OF IMALTH- NZA GUARANTEE OF SUBSURFACE UWAGE TREATMENT SYSTEM PAGE 01 PAGE 03 .___. 'el -44. 1-e.,' /f - -- X1. t /; a Owner or Purchaser of Building Tax Map �yv J' 21005., Lot BuildingConstmoted b.v TOwTl�li��$ �� .,.m.+doGCd_+�rr! �G�� /�►dL� � 1 lJ�,r G '�'••� �d�6� /`IJ�+ / �� Locatien - Street Subdivision Name F3ui ldiiyg Type Subdivision L M to represent that I An: wholly and completely respansi* for the location, workfim ship, mater w, cunstrvez,ion and drainage of the sewage treatment system serving the A*vv- desccibed property, sad that is has been constr cted w shown on tho spproved p)an or Approved Aattendmeiat thareto, and in � �c.�rdrayce with the standards, xules &:�d rtpltttiow ot'the Pwtnm Cep DtFlAn.1tu rjl 'x ahh, a nt harcr�y gwarsntee to the owner, his successors, heirs yr aissigne, to,plaws in good oporating coed tioa any part of said system constructed by me which Ws to oprr W tar a period of two YOM inunedWely tbilowi lg the date of approval of the "Certificate of Cons b%wdon Complisac o" for the SeW.Age Treatment systarta, or any repairs made by we to sucb ry910M OXC401 wbere !be failure ro operate properly is caused by the wtliSvl or aegligetst act of the occuptsnft vttt�aeb ilQirg,uti�i�in�'t e systrr�, ' S'; a undersigned &rther zigmes to a04ept as conclusive the dotermimtorr of the Pubic Heals* Dircctcr of the Putnam County Department of Health as to whether or not the failure t�: apere4e.wyas c�_1Saeci:Ey th! Wilk-WI -m �,, ;�►1g ^.,f �;: 4 GG�tiey►dLtit acttut ii4in�vtiriz»ag� Dateo: Montt•, C:2�1 . -. Day / Year General CoMxaotor (Owner, - Signature `'orpomt ;an Neal- (if CC C2clii�ti} Anthony L. Fiorito Inc. Ossining NY 102 Star tip - Signature; �,vss n C�po��i� tala�at. (i� Gvcporc�asawal Address it Yucm G9.9'i Qbg 4w4 d W. .k YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown H s ]�.Y. 1(>5q8 ` -'-�-'-0i41-05-2000 Albert H. Padovani, Director LAB #: 32.308622 CLIENT #: 56853 STAT PROC PAGE j ZREIK, MICHAEL DATE/TIME TAKEN: 10/23/03 01:00 10 LAWRENCE AVENUE DATE/TIME REC'D: 10/23/03 02:00 SLEEPY HOLLOW, NY 10591 REPORT DATE: 10/28/03 PHONE: (914)-672-7212 SAMPLING SITE: KITCHEN TAP SAMPLE TYPE..: POTABLE : 52 INDIAN HILL RD, PUTNAM VALLEY, NY PRESERVATIVES: NONE COL`D BY: MICHAEL ZREIK- TEMFERATURE..: < 4C NOTES...: COLIFORM METH: MF - - - - - - � � �- - - - - - - - - - - - - - - - - - - - - - - - -������������������������������������. DATE , FLAG PROCEDURE RESULT NORMAL RANGE METHOD PUTNAM CNTY PROFILE 10/23/03 MF T. COLIFORM ABSENT /100 ML ABSENT 10/23/03 LEAD (IMS) <1 ppb 0-15 ppb 10/23/03 NITRATE NITROG 0.23 MG/L O - 10 10/23/03 NITRITE NITROG <0.01 MG/L N/A 10/23/03 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 10/23/03 MANGANESE (Mn) 0.016 MG/L 0-0.3 mg/1 10/23/03 SODIUM (Na) 12.6 MG/L N/A 10/23/03 pH 6"6 UNITS 6.5-8"5 10/23/03 HARDNESS,TOTAL 90.0 MG/L N/A 10/23/03 ALKALINITY (AS 66.0 MG/L N/A (TUR COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD 'HE NEW YORK STATE AND.EPA FEDERAL_DRINKING-WATERSTANDARDS,. 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 1008 9101 9139 9146 2037 2037 9043 -_-_ --__.- | YML ENVIRONMENTAL SERVICES 321 Kear Street g -~ (914) 245-2800 Albert H. Padovani, Director ZREIK, MICHAEL DATE/TIME TAKEN: 10/23/03 01:00 10 LAWRENCE AVENUE DATE/TIME RE'C'D: 10/23/03 02:00 SLEEPY HOLLOW, NY 10591 REPORT DATE: 10/28/O3 PHONE: (9l4)-672-7212 SAMPLING SITE: KITCHEN TAP SAMPLE TYPE..: POTABLE : 52 INDIAN HILL RD, PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: MICHAEL ZREIK TEMPERATURE..: < 4C NOTES...: COL. 11: METH: 111F ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ =~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASURB,ENT 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 AS CALCIUM CARBONATE. IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. . , -`- _ .' � ��NlD l�G21���_��--�� --' _ .�� `~-,-. -' -'-_-~_.__--_----~-_' ~ '-MODER7�'E[Y`����T-����F������40-MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L-) SUBMITTED BY: ' Director � � ELAP# 10323 BRUCE R. FOLEY Public Health Director DEPARTMENT' OF HEAL "I HH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Servrl�es LuvironmentaI Ilea Itl] () 14) 278 - 6130 Fax (9 14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Enrly Intervention (91,1)278-6014 Preschoul (914) 278 -6082 Fax (914) 278 - 6648 E91�ADURESS V RIF1CATION FORM OWNERS NAME: TAX NIA N'tJitilBE R': E911 ADDRESS: AUTI=101. -17'r(,.D '1.'(.)NVN O. (Sid nature.) DAIT".: 72 , ! f Z 2 1,11 C P011, M] County Department of Uealth will not issue a Certificate of ('011S.h-etctlull t_'ompllance fulness the=. above form Is completed, i.e., a legal ,E911 "(1dreSs is assigned by an authorize(l towaz offici��l. 1'hi.s form is to be subrluittei! With tilt application for a Certificate of Constnictloll Compliance. 171134 Full on 21,1014MAR N lop] � J �� J,A'7 Y . .ii_@..0.P -E TA 19.;11ZA.�,,,,� �L=H 5gRV-10ES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # R - 9-el Located � -7"n GIlee` �� /� � q �/ Town or Villa g e Y %� Owner /Applicant Name — Tax Tax Map 7x Block Lot 7 �- Formerly Cl" Y C, R i r eep e Subdivision Name Mailing Address Subd. Lot # 21 Date Construction Permit Issued by PCHD 5 a -12— —01 Separate Sewerage System built by A-, Zip / y-3'W rti G� / e •-: � Address la y 6-o 03 Si n i'r f `�• Consisting of / a ®y Gallon Septic Tank and -V e;( Other Requirements: 0' JQ'�? Water Supply: Public Supply From Address 'e or: j-1 Private Supply Drilled by e eoo Address ,r- o �l$ :n• .s � P_._.i 4�'�` ��:d'..^.' s' 1 -... !. �.�' .`S - - .� . .................. _._...< �8 Number of Bedrooms IV Has garbage grinder been installed? Ala 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 Coun ,.(�- F i � 0• \� Date: A9 i o% Certified by d ?address (. Design � ( Any person occupying premises served by the above system(s) of Health. P.E. i-" R.A. action as may be necessary to secure the correction of any unsanitary conditions resulting from"hiWO @W. 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, modification or change is necessary. By: , /'—� Title: Date: `0 3 o �J 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 WFULL COMPLETION REPORT- Well Location Street Address: ill ? Tax Grid # 1 _�1. Z Map�y' Block Lot(s) Well Owner: Name: Addre Use of Well: 1- primary 2- secondary _ Residential Public Supply Air cond/heat pump rrigatio Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _2L Open hole in bedrock Other Casing Details Total length ft. Length below grade 19 'vft. Diameter in. Weight per foot f�_lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: � Yes No Liner _ Yes _>,,'No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped 4 Compressed Air Hours Yield % 6 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) ---- Depth of completed well in feet 34) 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 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typ Capacity % C�lf Depth &k5O7 Model Lam' Voltage0 HP k Tank Type Volume 5'1 0 © 1•►^ �3 Date Well Completed Putnam County Certification No. Date of Report Well Driller )(signature) N71'E, Xact location or well whit distances to at leasi two perm 7nt ian�mams to uc pruviuGU uu a brpatmr, attccvytati. Well Driller's Name Address: Signature: Date: b ?'q White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97