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HomeMy WebLinkAbout3171DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -23.5 BOX 26 03171 'r� }61 rid ., �Qr dr . ' 1��- . .,y ` r s iL ' r `� 03171 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 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 August 9, 2004 Gross P.O. Box 247 Tuckahoe, NY 10707 Re: Addition — Gross, 9 Horton Hollow Rd. No Increase in Number of Bedrooms (T) Putnam Valley, TM #72 -1 -23.5 - a )ear lvlr. IE�:rs. CV ©s`s: 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 this Department dated August 6, 2004.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. Any permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Sincerely, c GrG� Michael Luke MI-:hn Public Health Sanitarian cc: BI (T) Putnam Valley METTA MOLINARI Wrtc Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, Now 'York 10509 Environmental ileAlth (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6679 Fax (845) 279 Early Intervention/Preschool (845) 278.6014 Fax (845) 278.6641 PRO OSED A.1J=Q, AERLIC =S XDWAL VZJ--6U ROBERT 7. BONDI County ExecWtve STREET TOWN TX MAP # '7oA- ( -a 3.5 NAME ho 62QLS PHONL"gl yl CHD # MA-tLINaADDREssj —o _c 44 �kc(ca,hw nT�i DESCRIPTION OF ADDI'T'ION 3 (h l ��" -.� .�._,. -1t' ,�E►;�' �: s��r %fU11'1 P�OPSF #'afi,'T;DTt�30MS_ - (I'(LOM T. OF OCCUPANCY OR CERTIFICA'T'ION FROM IIURDINO INSPECTOR) ' r *Any addition which is considered a bedroom requires formal approval of pl ns (Construction Permit) prepared by a Professional Ln&cer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY •10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan' (drawn to' scale, all living area Including basement) * Non-professional sketches are acceptable 3. Two seta of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date .of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions, 5, Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. QFFrc ME Comments • Feb 9a1 _ -_ _ - - •:�.._..- ._ .^ . - .. ""� __....:.-.... - . -. _ - -- _ .,_.K;.... PERMIT NO: 2003 -507 DATE: 12/9/2003 TAX MAP #: 00/72. -1 -23.5 LOCATION: 9 HORTON HOLLOW RD ISSUED TO: GROSS BRUNO & WAI AMY PO BOX 247 TUCKAHOE, NY 10707 An Application having been properly filed for new construction, addition(s), alteration(s), repairs as per the attached specifications and plans, I hereby grant such applications upon the following terms and conditions: All work must be done in accordance with plans and specifications annexed to the application and shall be located precisely as indicated on plan(s) and/or survey. All work shall be in accordance with Uniform Building and Fire Code of the State of New York and all pertaining County or Town regulations. All electrical and plumbing work must be done by contractors duly licensed by the County of Putnam. Where applicable, Home Improvement Contractors' license will be required. This permit is issued for the following: RENEWAL /2002 -564 ONE FAM. RES. W/3 CAR GARAGE; REAR DECK (8'X 16); FOUR BEDROOMS; UNFIN. BASEMENT; UNFIN. STORAGE OVER GARAGE; UNFIN. ATTIC - STORAGE ONLY. RENEWAL EXPIRES 11/3/04 NOTE: THIS PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE TOWN OF PUTNAM VALLEY, _NY CODE ENFORCEMENT OFFICER LORETTA MOLINARI Public ffeaGA Dirrctor DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, Ncw York 10509 Environmental Health (945) 278 - 6I30 Fax (845) 278 � 7921 Nursing Servlce9 (845) 278.6558 WIC (845) 278 - 6679 Fax (845) 278.6085 Early Interventlon/Presebool (845) 278 - 6014 Fax (845) 278 -6649 Putnam County Dept. of Health. 1 Geneva Road Brewster, NY 10509 Re: Residence To Whom It May Concelxt.: According to records maintained by the Town, the abovo noted dwelling, IS IS NOT In compliance with Town code and the total number of bedrooms on. record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER: Building Inspector bouseguideiines ROBERT 3, BONDI County &ecutive EXISTING 10' POURED �—CONCRETE FOUNDATION WALL PROPOSED 2X3 *1" Sl!MEM SHEET ROCK M /) VSUL A 70 V PROPOSED 2)(3 WVD STUDDED —160" 5/8' SHEET R" WMf 1AMIA1101V PROPOSED RECRE4 WN AREA EXISTING COLUMN PROPOSED PROPOSED 2X4 *WD MUDDED WALL, 518" SHEET—,,,, ROCK WN IMULA770Af PROPOSED 2X3 NOW STUDDED 5/8' SHEET ROCK WH AGULA77W f/ EXISTING 10* POURED CONCRETE FOUNDATION WALL NOTES 1. 5/8- SHEET ROCK SHALL BE INSTALLED ON CEILING IN PROPOSED RECREATION AREA i I.T I HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; -*,_EXISTING 4- PVC VERTICAL SANITARY LINE PROPOSED 2X4 WOO STUDDED 10,14,14 518wW2!FT ROCK W17H INSULATION EXISTING COLUMN I ": i PROPOSED \—EXISTING WOOD. BUILT STAIR WE WORK SHOP AREA s. BEDROOMS UP EXISTING GARAGE v C4 z Ne C-4 'O L) O -J b c� O r� =� m cg o to ilr 1= 4d O LA_ __j tA' 41d La "S M UJ LJ tn En C> 4 t N/F BRUNO & AMA' GROSS 6.282 acres 72 -1 -23.5 SUBDIVISION LOT #5 FILED MAP # 2824 d pAR �e f � FkiSn�c EXISTING DRIVEWAY SUBBASE Z d d d EXISTING DISTRIBUTION BOX EXPANSION AREA EXISTING CONCRETE VAULT (HOUSE TRAP) EXISTING SEP11C TANK EXISTING SEPTIC FILED EXISTING (8 LATERALS) DWELLING WEXISTING EXISTING WELL 100' d DRIVEWAY SUBBASE EXISTING WOODED AREA Do, OF �/2 L £k�SnNc �I� rj�,ljr p�Rl e ! RpAO fx�SnHc STp� oc� pF F NOTES f wq4 x�SnHc c I. APPROXIMATE DATE OF WELL & SEPTIC p�RT Rpq p SYSTEM INSTALLATION - FEBRUARY 2003 o EXISTING DRIVEWAY SUBBASE EXISTING SITE LAYOUT WELL & SEPTIC LOCATION HORTON HOLLOW RD PUTNAM VALLEY, NEW YORK 10579 7/20/04 SCALE: 1" = 40' EXISTING BRUSH AREA i / MONUMENT FOUND PARCEL TAX MAP SECTION: 72 BLOCK: 1 LOT: 23.5 f d �� � �C_)i ,r, PUTNAM COUNTY DEPARTMENT OF HEALTH y' DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Sej111ress: wnNilla : A-041 ITax - Grid # Map '7_�2 Block % Lot(s),�23. Well Owner: NaTg Add re % Z 41 79 �4" A" 1/ X° . Use of Well: 1- primary 2- secondary 74 Residential Public Supply Air cond/heat pump, I igati n 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 Open hole in bedrock _ Other Casing Details Total length __JLO�ft. Length below grade S- AA Diameter _�� N in. Weight per foot _ lb /ft. Materials: _X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: Cement grout r Bentonite _ Other Drive shoe: Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Second Hours_ Well Yield Test_ _. �.._ .. Bailed c�tr;�ressed'. _? it = . - ° Hodrs field g pm Depth Data Measure from land surface - static (specify ft) .3 ,0 During yield test(ft) - --- Depth of completed well in feet ro .) o t 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 Type Capacity __S:- Depth 5 8V Model ,S' &,2, , Voltages HP _ !" Tank Type Volume OD Date W 11 Com leted 7 °3 Putnam County Certification No. Date of Report v Well Driller (signature) NTE: Fluact location of well with distances to at least two permanent lt(ndmarks to be provided 'on a separate sheet/plan. Well Driller's Name =yam � =r S,gnaiu Date: 26 L White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; f it G Form WC -97 r • i �r iJ k ;a • ;y a 47 -6 1/2* .a` 15 -10 1/2' 15'-9 1/2' 15 -10 i /!r •` A B I C ,y - 2'-6• 10•-9 1/2' Y-6• •3 -3056 r N (V BREAKFAST ,4' -9 1/Y z 12 —Y r o in O 9 BREAKFAST WINDOWS ARE INSTALLED O 7 -11 3/P MDR 'NT ; . 5 18- 3056 -18 3056 3056 I. eo' ■ TRAY CQILRIC _ RO ONLY [l."covelpm•� ' DINING ROOM ��, ^a 5' -5 3/4• 4' -0• s -5 3/4• < 15• -0 1/2' x 14• -2' s - FAMILY ROOM ' 1/2:'H 187 -9' o f I I '• � I `� Pi0 '� ` 1 - e ��-- ----- - -- -�' R Di0 ,._,. *DELETE SOFFITS* m KITCHEN :o A,1D qIO' I� '• DECORAIIYE CMMUNS® 15• -1 1/2' x 13•- 10''.y0 n SHIP LOOSE I o �' 'D '{tea■ xus �lige � axw r rues PEDISTAc4 DD26 - O r 71 LIVING ROOM n "1 15' -0 1/2* x 16• -0' a I RO T -10 1 - x 5 -10 3 4' .I, INSTALLED nD2 CC279 CC79 ®u CM20T , STU U`' -- .14'-11 1/2' x 10• -6' OEM BV B e PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS Signature & Title Dale a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - APPLLICA'T FOR. "PROy A ; _0 1 P-1-JA TS A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant:. Kathleen Kuczma 320 Fox Run Lane Carmel, NY 10512 2. Name of project: Kuczma 3. LocationTN: Putnam Valley 4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson, P.C. 6. Drainage Basin: Hudson River Rt. 9 Cold Spring, NY 10516 7. TyM of Proiect: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? TypeStatus( checkone ) ------- - ---------- ------ - - - - -- Type Type H 9. Is a Draft Environmental Impact Statement (DEIS) required? - - - - - - - - - - - - - - - 10. Has DEIS been completed and found acceptable by Lead Agency? - - _ _ - - - - - - 11. Name of Lead .Agency Putnam County Department of Health Exempt Unlisted X No N/A 12. Is this project in an area under the control of local planning, zoning, or other. ' officials. : - ------------- ---- - - - " - -- ==------------ -- - - 13. If so, have plans been submitted to such authorities? - - - - - - - - - - - - - - - - - - - - - - No 14. Has preliminary approval been granted by such authorities? N/A Date granted: N/A 15. Type of Sewage Treatment System Discharge - - - _ - - - - - _ surface water X groundwater 16. If surface water discharge, what is the stream class designation? -------- _ - - - _ N/A 17. Waters index number (surface) _ _ - ----------------------------------------- NSA 18. Is project located near a public water supply system? - - - - - - - - - - - - - - - - - - - - - NSA 19. If yes, name of water supply N/A Distance to water supply N /A' 20. Is project site near a public sewage collection or treatment system? - - - - - - - - - No 21. Name of sewage system N /A' Distance to sewage system N /A' 22. Date test holes observed 23. Name of Health Inspector 06/10/99 A. Stiebeling 24. Project design flow lops ------ - - - - -- goo J � (� per Y ------=-------------=---- 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? --------------- NSA Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? Yes 28. Wetlands ID Number _ N /A' ------------------ ---------------------- 29. Is Wetlands Permit required? -------- -- - - -- 4 - - - - -- --------- r----- _- - - - - -- No Has application been made to Town or Local DEC office? - - - - -- - - - - - - - - - - - - - N/A' 30. Does project require a DEC Stream Disturbance Permit? - - - - - - - - - - - - - - - - - - - No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? - --- ------------- Yes/No.. No 32. Is project located d within 1,000 feet 'of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? - - - - - - - - - - - - - - - - --- Yes/No No 111 W61.114 I NW' 33. Is there a local master plan on file with the Town or Village? - - - - - - - - - - - - - - - - Yes A Are community water and/or sewer facilities planned to be developed within, 15 years in or adjacent to project site? ------------------------------------- No 35. Are any sewage treatment areas in excess of 15% slope? --------------------- . No ' 36. Tax Map ID Number Map 72 Block I Lot -23.5 -7 -------- --------------------- 3 Approved plans 7. are to be returned to Applicant X Design Professional NOTEA applications for review and a pproval'of a new SSTS to be located within the NYC Watershed shall up I ude'to ­­--lbe'senno eliep wd need 1i0tDe'SeM1nU lic A -th&DEP­aidb ihe-project- -fequn MP agh approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require quire DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I.,the application must be accompanied by a Utter of Authorization (Form LA-97). Failure to corr4)IY with this Provision maybe grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form isRue to the best of my knowledge and belief. False statements made herein are punish.a as­-!.­-., a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Bade y & Watson, P.C. co c. Mailing Address: - - - - - - - - - - - - - - ------ 3063 Route 9 Cold Spring, NY 10516 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - _� c'�Tri►r re R -!w, . .._.� r,` ��, � -a*;sr �i�. -- r �f' ;��w .r {,.M, -. - _ -yj _ .lam 1 r.V ^ Owner Westchester Holding Co. Inc., Parcel H Address Cortlandt Manor, NY 10567 Located at (Street) Horton Hollow Rd. Tax Map 72 Block 1 Lot 23.5 (indicate nearest cross street) Municipality Putnam valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 01/07/99 Date of Percolation Test 01/08/99 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch A 1 2:28 2:34 6 19 — 22 3 2 2 2:35 — 2:41 6 19 — 22 3 2 3 2:42 — 2:48 6 19 - 22 3 2 4 5 — — B 1 2:30 — 2:38 8 19 — 22 3 3 -_ A2. 3 !_._.-38 2:47 2:55 19 - 8 19 22 3 3' 4 — — 5 - — 1 — — 2 3 — — 4 — — 5 NOTES.` io`b&repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _ c 1 min for 1 -30 min/inch, _ 2 min for 31-60 min/inch) All data to be submitted fofteview. < 1;2. 'Depth measurements to be made from top of hole. Form DD -97 G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES TO�..`_1 Topsoil \I/ SAND & SILT SAND & GRAVEL ffoT V Vr% 2 -rnT P YO. Topsoil SAND & SILT SAND & GRAVEL 2. Indicate level at which groundwater is encountered NOT ENCOUNTERED Indicate level at which mottling is observed NOT OBSERVED Indicate level to which water level rises after being encountered NW. Deep hole observations made by: John P. Delano P.E./ A. Stiebeling Date 06/10/99 Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: Design Professional's Seal 01; c 14-164 (11&� —Tea 12 PROJECT 1. D. NUMBER 617.20 SEAR Appendix C State Environmental Quality Review - S, -•c' � `r,1.:.�:: "�so� :.•:�: =�.� ::t:'�'..- s`--": c;. _..��. _. �:;. x;.; . ".= :4•:::;:;,�..'r:T,v �' v" Rail L:'�1� For UNLISTED ACTIONS Only PART 11—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT /SPONSOR 2. PROJECT NAME Kathleen Kuczma Kathleen Kuczma 3. PROJECT LOCATION: Municipality PUTNAM VALLEY County Putnam County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) ( See Map Provided ) 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of new single family residence, septic system & well. 7. AMOUNT OF LAND AFFECTED: Initially <2 acres Ultimately <2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑No If No, describe briefly Construction of new single family residence, septic system & well g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial Commercial ❑ Agriculture Park/Forest/Open space Other Describe: �j11�.9�'r� -L`� �G'Wt� Cb !v �'�- -'/•1CC '- �-C� jr—1 ) OES. ACTIONINVOLveA -PERFAiTArm}(Au O 1=.1iyJlNv,N ;LLTIKi;a F YazR01� "4NY�?'r�E�.trJL'E�� ?ii iE��T:�;'cihCS�tvi. 1T�GEtWU " STATE OR LOCAL)? ®Yes • ❑ No If yes, list agency(s) and permit/approvals Putnam.Valley - Driveway and Building Permits. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ®No If yes, list agency name and permit/approval 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 Applicant/sponsor name: John P. Delano P.E. Engineer f/appticant Date: November 27, 2001 Signature: v 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 nAnT 11 _ CA11110AMUCUTAI ACCCCCIUCkIT /Tn ha - mmnlafarl hu Onanrtul A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑Yes _ -- ]No _• _ _ B. WILL ACTION RECEIVE COORDINATED hi5A'_ CIS PROVIDED FOR UNLISTED ACTIONS iN.' NYCR12, PART 817.6 11 No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No 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, noise 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. N' 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. Co D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? � __ ❑Yes. - E-1 No -•--if Yee:ex{Y3irbrier�z�:.:. _ _. «-.-• y. ..... - �. .d....- ......_____. _ :4. t- . PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, detemUne 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. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ 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 ea Agency 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer) i. r•, PUTNAM COUNTY'DEPARTMENT OF HEALTH - DIVISIO_N OF ENVIRONMENTAL HEALTH SERVICES___ _.r....,....r.� -,,._ .,.. r &'°z�';:;o' off"- ,.o-..._„- ...,m . ��.. , -.;.s� ...�...- .� � �..,T.•. ..� ..o...z......_rr ., . i- G'�= �.�,c:- :a� -::� �:..e ....,_,. _. :w� -, ..�.. +.. .: r ...�.. CERTIFICATE OF CONSTRUCTION COMPLIANCEQGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ? V G -_ 0 Z- ��. a o3 U Located kop -ratt OLCOW RaA'C�. Town or Village Cr) PQ- vt�lktA Vt,'+z1C Owner /Applicant Name B 20 tko Formerly K P,T'N Lee v,i )K o c-2 �-A A� Mailing Address �>O ' ?�0>1 Date Construction Permit Issued by PCHD Separate Sewerage System built by OW Tax Map *12— Block t Subdivision Name kksrc ar. 'PA i2G4d- =: Subd. Lot # 15 [� r_k�t.Vko Q Ki w i a im 29 ('Jz_ [-4 a 9:k AddressTo—c-t-&t _Lot Z3.5 Cc, Zic , _Zip la Ti o u Consisting of Gallon Septic Tank and 430 L, c U F t? &I u�v. �'ticrE Other Requirements: Water Supply: Public Supply From. Address or: Private Supply Drilled by �[ot_ at �"Oe' ?3"q )'rJ4,C - Address P0T"#vJ'kVile- =Q:`JJA y� .`mot �� �- .. Has. Prosicar. ,co*�tr 1 beer- r znplct d ?r - B�a.:.ldme oe . � n b e co e Number of Bedrooms Has garbage grinder been installed? q 0 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,gounty Department of Health. Date: 1 (i 0 s Certified by Address -3 u(,3 (Design Professional) COLD 5Prarrvrr ,W P.E. Z R.A. Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: Title: Date: Whiw'copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT • rvei;'i�;u�rtu>ta " " �4►" ei aiires j� "� y� wrf %Viii Xt'r ` `ax trill Map -7_Q Block Lot(s)d3, Well Owner: Na Addre Use of Well: 1- primary 2- secondary 7°' Residential Public Supply Air cond/heat pump I tgati n Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X' Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing 5�4 Open hole in bedrock _ Other Casing Details Total length ft. Length below grade d'''ot. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: -,,0— Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped L Compressed Air Hours 2 Yield gpm Depth Data Measure from land surface- static (specify ft) 3.0 During yield test(ft) ------- Depth of completed well in feet C.�_ o 1 Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ,' " O ' C' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _S�' Depth .5V Model ,S' 10-2-1 Voltage 9,3 0 HP Tank Type Volume / Date W �IlCom leted ' d Putnam County Certification No. 7af rt Well Driller (signature) NOTE: aact location of well with distances to at least two permanntnt lkidmarks to be provided on a separate sheet/plan. Well Driller's Name Address: 4 Y Signature: �� %� �_ Date: 26 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; ��i 71 Form WC -97 ��AM Cp a �.a BRUCE R. FOLEY * LORETTA MOLINARI R.N., M_S.N. r + - �...,... .� ... .. �.— :.:.._. .. .. •. y , �� ;. •.._;.,,er .. • —...:. ... ." '.:.... ,.,. —� .�f' -. � " Director J.:�.. O .iLPl:v ut of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN 0 DATE: Bruno Gross 72.-1-23.5 Horton Hollow Road (Signature) November 06. 2003 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. (E911verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _... GUARAN'�TFF.OF STJBQTiRFAPE �Fv��,&r =E �'�? ;AT1v_rEla�T,cYST Bruno Gross Owner or Purchaser of Building Building Constructed by Horton Hollow Road Location- Street Residential .72. 1 23.5 Tax Map Block Lot (T) Putnam Valley TownNillage Westchester Holding Co., Inc. Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except. where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. - Th ; iiildc":T,iigiizd ui41- - i`ccs I — acctpi as cunciusive the determination or the Public Heaith 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 building utilizing the system. Dated :lVl th . Nov. Day 06 Year 2003 Gener o ct r (Owner) - Signature N/A Corporation Name (if corporation) Address: P.O. Box 247 Tuckahoe, Signature: Title: Corporation Name (if corporation) Address: State New York Zip 10707 State Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street zz,70 loop �1010,'` :'�- _� �~����=���� Y'�'1(%�9E>' ` (W4> 245-2800 Albert H. Padovani, Director LAB #: 32.308140 CLIENT #: 55075 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ —mm ~~~~~~~~~~~~~~~~~ GROSS,BRUNO & AMY PO BOX 247 TUCKAHOE, NY 10707 DATE/TIME TAKEN: 10/06/03 04:301-:' DATE/TIME REC'D: 10/06/03 04:50P REPORT DATE: 10/14/03 PHONE: (914)-271-8715 SAMPLING SITE: 9 HORTON HOLLOW RD. PUTNAM VALLEY SAMPLE TYPE..: POTABLE : BASEMENT TAP PRESERVATIVES: NONE COL'D BY: BRUNO GROSS TEMPERATURE..: < 4C NOTES...: COLlFORM METH: Ml---' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 10/06/03 MF T. COLIFORM ABSENT /100 ML ABSENT. 1008 10/06/03 LEAD (INS) 1.0 ppb 0-15 ppb 9101 10/06/03 NITRATE NITROG 1.40 MG/L O - 1O 9139 10/06/03 NITRITE NITROG <0.01 MG/L N/A 9146 10/06/03 IRON (Fe) 0.149 MG/L 0-0.3 mg/l 2037 10/06/03 MANGANESE (Mn) 0.015 MG/L 0-0.3 mg/1 2037 10/06/03 SODIUM (Na) 4.18 MG/L N/A 10/06/03 pH 7"3 UNITS 6.5-8.5 9043 10/06/03 HARDNESS,TOTAL 150 MG/L N/A 10/06/03 ALKALINITY (AS 132 MG/L N/A 10/06/03,,, rj ITY.1ZUB',, - 1.9`NTU.O-N� � �l�~^�����������������_�'_� COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD l HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Ph/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive 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 that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 , Albert H. Padovani, Director LAB #: 32.308140 CLIENT #: 55075 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ GROSS,BRUNO & AMY PO BOX 247 TUCKAHOE, NY 10707 DATE/TIME TAKEN: 10/06/03 04:30P DATE/TIME REC'D: 10/06/03 0%501-` REPORT DATE: 10/14/03 PHONE: (914)-271-8715 SAMPLING SITE: 9 HORTON HOLLOW RD. PUTNAM VALLEY SAMPLE TYPE..: POTABLE : BASEMENT TAP PRESERVATIVES: NONE COL'D BY: 8RUNO GROSS TEMPERATURE..: < 4C NOTES... COLIFORM METH: Ml--'' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 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 �MQ LfA .HARD W� rmxu F i (1 grain/gallon = 17.2 MG/L) ' SUBMITTED BY: Director ELAP# 10323 BRUNO.GROSS PO BOX 247 TUCKAHOE, NY 10707 November 6, 2003 Joseph S. Paravati Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Dear Mr. Paravati: It has been brought to my attention that my well completion report is incomplete. The report is missing the storage tank information which was not completed by the well driller. I am the plumber of record as per the building permit. I also installed the storage tank. The storage tank is a V -250 Goulds w/bladder, and the capacity is 20 -22 gallons. I hope that this letter will be sufficient enough to complete the well completion report. If you have any questions please feel free to contact me- at (914) 224 -4783 Th you, 0 os 1 BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 19 Dec 2003 TO: Mr. Joseph S. Paravati, Jr. jPuteam County Department of Health 11 Geneva Road lBrewster, NY 10509 We are sending: File No. 98-105 W. O. # 16150 RE: Certificate of Construction Compliance Gross Horton Hollow Road Westchester Holding Co., Inc Tax Map 72.4-23.5 Permit(ritle/PO # Sent via: US MAIL MESSENGER PICK-UP FAX copies date description of document F-11 119-Dec-03 I [Certificate of Construction Compliance for Sewer Treatment System F-11 106-Nov-03 JE911 Address Verification Form 51 130-Oct-03 7 Well Completion Report F�l 114-Oct-03 —1 Well Water Test Results F-11 106-Nov-03 1 ILetter From Bruno Gross (RE: Pump Tank) F-31 106-Nov-03 I [Guarantee of Subsurface Sewage Treatment System F�A "'OTS,"Iks- 51 106-Nov-03 1 jApplication Fee F-1 17 ❑ 1 —1 0 1 1 REMARKS: Copies to: File Yours truly: Subd. Lot No. 5 PV-6-02 ❑ UPS-NIGHT 1:1 RJ UPS-2 DAY El ❑ UPS-3 DAY ❑ UPS-GRND ❑ UPS-COD ❑ John P. Delano, PE Tel: (845) 265-9217 ext 12 Fax: (845) 265-4428 Email: jdelano@badey-watson.com 40 40-05 498850 624500 23106 t �i,Kr ac TM 7771 Tr-15� '3 fii �� nS -ems 5�-. � 'Ip � ✓`V. 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J ' r P `}F�ga.:. f r'r��q "^ef_ amid � h ROM Mu " �o s. .wYaz' PUTNAM COUNTY DEPARTMENT OF HEALTH - _DIVISION -,OF ENVIRONMENTAL-HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV-4P -01 n 011(103 n� - Located at 1-40ZTON koliaW Roa >,-> Town or Village W�st'ru� ��� I�tio;ay Subdivision name co. xi�r, , * A,, {6i_ jr Subd. Lot # 5 Tax Map *12-. Block i Lot 2, 3 . 5 Date Subdivision Approved 0 3J 1 ©j do Renewal Revision X Owner /Applicant Name BRuA0 qua 5f, Date of Previous Approval d 2c d Mailing Address t-?O. Zok 29-1 7-ycK, R0V-- Zip 10101 Amount of Fee Enclosed 1-`5 0 Building Type Rms1©L-tJFiA— Lot Arealo.Z84CNo. of Bedrooms 4 Design Flow GPD 00 Fill Section Only Depth Volume Separate Sewerage System to consist of S z S0 gallon septic tank and Other Requirements: To be constructed by 'B Zu jq o 42,051 Address 'j>0 5!X 7-41 ill .Y, jorl e Water Supply: Public Supply From. Address or: X, Private Supply Drilled by gic -Ks64 Se-as. Address 4�— Ae.kisoq ` I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sv tem 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. Signed: Address P.E. R.A. Date 01-04,03 051(p License # Q (6 Z 5 0 -S APPROVED FOR CONSTRUCTION: This approval 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 it. Approved for discharge of domestic sanitary sewage only. 1901A S By: Title: Date: 2 wi�/Copy - HD File; Yellow copy - wilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 - —: LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive 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 OFFICIAL NOTICE OF PERMIT SUSPENSION CERTIFIED RETURN RECEIPT REQUESTED September 19, 2003 Bruno Gross P.O. Box 247 68 Main Street, 2nd Floor Tuckahoe, NY 10707 Re: Suspension of Permit: PV -6 -02 Horton Hollow Road, Lot #5 (T) Putnam Valley, TM# 72 -1 -23.5 Dear Mr. Gross: Please be advised that the permit for the above regarded project has been suspended by this Department for the reasons noted below: 1. Proposed system has not been constructed according to the approved plans. 2. 100% expansion area no longer exists. 3. Silt fence not installed according to the approved plan. The suspension of the permit will remain in effect until these issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit all work shall cease upon written notice.served upon any person connected with or working in said system. Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. JSP:tn cc: BI (T) Putnam Valley John Delano, P.E. (Badey & Watson) M. Budzinski, P.E. truly yours &� ?Fseph S. Paravati, Jr. Assistant Public Health Engineer qV s jcw� 3 ?�i^sy�r�jr�j"sx/ iY t4 vaP 1� - '' � ' y, ,�. i "```M �3✓ �"�''x1+'rv'' R"'.G Laec!-+U �s � �`—�— t. � � ,� t MR � d •sh. ^? x"' a , r '� `�-= -� �'s s= "M. ,� -v, � "� �. .s�'� -'. �, 5, � � � � �° ?FT��., � "+� 'Y ��� �;tF'"k f -M1 ".F�1' �,°� - - - - - a=,' e�.- -��'�..a -max -- ��- �`•'"�' � �.��s`-'� ���` �, ,R,.'."�'z".'�fi -�� .€ x�X"�..7�'�'� �-�� -';,� �z�- ....... 101-0 .., Z #.s}ar'KM'� '> "ri... � N xt�a..r �t sCI��',�� �� P°~ +� r��� rt� � 4� •�J�'�` Sz Et �- �tv. ;'b .� � � ,,. _ - ��' � r. 47 � r. � x _ x �� ��' spy / Y°; . ��- ,�+:�t;✓ r:w's'� xY '*mot �#rtt`«' fi'�r�3���s�nr �' "�-'�� - - �`*�" -�i �'- .�C� � ✓a?�` .� ""y' - � ,�4 `' - t Yn �. S • r -�a" wA v �f *> • '�' �%°s� =� f.'`.,� xmb- Ir. ,,, x� '? '`�. '�€ ' `�i. -s p � =I j� �L o - 1 ( PUTNAM COUNTY DEPARTMENT OF HEALTH � DIVISION, OF- ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # _ P V `G - 0 Located at 41p S - pa M0�,�,p Ro , Town or Village T _ Wes- rcM637bQ 1�W.piaSb Subdivision name ca. zie. r Asacf,, &Z Subd. Lot # 5, - Tax Map Block �_ Lot Date Subdivision Approved 03110/00 Renewal Revision Owner /Applicant Name kATRaR.r,<n1 &u_e_%mA Date of.Previous Approval Mailing Address 3W& R" LAb)C-� —A,Am8L Zip 1 ofi 1� Amount of Fee Enclosed 21m, 'Co Building Type K6511064,TIAL Lot Area . Ae No of Bedrooms _Y_ Design Flow GPD_a00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage Ustem to consist of )Z60 gallon septic" and Q00 ,Lr OF 2q " W)09 A628IMom I&ACti &S SPAa6d C✓ 6' 0- c: Other Requirements: To be constructed by AAROLD LNO&O, smS Address P-r,9 1 QLQ PAIJlrc , M1 1 b51b WatYr.Saip.�� _ Public Supply From Address or: Private Supply Drilled by rtiQ1exrw RQeS , Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the §eparate 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. Signed: Address R.A. Date jt Zjjoj License # 61.525 APPROVED FOR CONSTRUCTION: This approval 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 rmit. Approved for discharge of domestic sanitary se age only. fir` /—Zy-CD 2 By: '� Title: Date: White copy - HD F le; Y to copy - Building Inspector; Pink copy - er; Orange copy -Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -APPLICATION TO CONSTRUCT A_ WATER WELL ae. a•w9<.rt A�14_ .P =�. .a�: <.I. .W -...a d.3 a.. .r= r'a.'ZLa._ i.rN..: wC�a.r ..a sE-� 'ti_r� _fit ---�,; Ir....��•_- -Kf. - lease print or a ' � .a m.= •.;.v. �-x. it �-�i i� ;�- � • "�:a...= :.�•:« ::: -�:>; Well Location: Street Address: To Tax Grid # Aoono 4 Map -71 Block ( Lot(s)23. Well Owner: Name: Address: KATE 3 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 Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason PRoftr Pti-RaLd T for Drilling Well Type _(� Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision W , z Lot No. Water Well Contractor: ale -KSom Bus. Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: A" Town/Village N/A Distance to property from nearest water main: &A Proposed well location & sources of contamination to be provided separate sheet/plan. e- A) i�.s -,._ ._4p ^l,a?.n* Signature: M 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 —Z Z Permit Date of Expiration — Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTME \T OF HEALTH DMSION OF ENVIRO \1IENTAL HEALTH LN- Dn'IDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS R$VTEW SHEET Felt CQ \ST.RTJCTIONPERMTI - ' - - NAME OF 0 %NI ER: uC -R� S ET LOCATION: 4-13Z�� REVIER'ED BY: R`L OR, AS, &ATE: °� TAX MAP ": (CONFIRMED) 52 g l' N DOCL- iE \TS 'Y Ni (REQUIRED DETAILS ON PLANSCONT'D) ( LJ- PEPUNUT APPLICATION �UHOUSE SEWER -'VV FT. 4 "0'; TYPE PIPE CAST IRON L-)NVELL PERINUT OR PWS LETTER ( NZ O BENDS; hLAX BENDS 45° WICLEANOUT (6( )PC -97 J RT5 EWALS ZJ(,--)LETTER OF AUTHORIZATION (___)USTIE NOTE (NO C NG ) (Zj(—)DESIGN DATA SHEET (DDS) SYSTEMS (j(—/)CORPORATE RESOLILTION U(_J10' HORIZ I AL; T TRENCH SLOPES 3:1 TO GRADE ( ZUSHORT E_4F U(_)FILL SPE F NO ES 1 -5 UUPLAN- -THREE SETS (__)(_JFILL PROFI NSIONS C4L-)HOUSE PLANS - TWO SETS (JUFILL Di E ANSION AREA U(ZVARLANCEREQUEST �Y /�U GRE 9�'2 FEE suBDrvlsio�i A ( �jULEG.AL SUBDIVISION (UU CLAY B R VJlLJPERC USUBDIVISION APPROVAL CHECKED UFILL CE YIF ION OTE RATE .. UUDEPTH U( f�FILL REQUIRE DEPTH LJLJVOL. ON RO.B., UNCLASSIFIED & IMPERVIOUS UUSEPARAANCE FROM TOE OF SLOPE (��CURTAL`� DRAWi REQUDtEI) GENERAL U OCATED Lti NYC WATERSHED LJPLA\ UDEL TO PC �-j P APPROVAL, I J,=:::JUDEEP TEST HOLES OBSERVED (,dUPERCS TO BE WITNESSED (-!J�,EX-APPROVAL SSDS ADJ, LOTS (4( ,JWETLANDS (TOWN/DEC PERMIT REQ'D ?) O(`JDATA ON DDS PLANS & PERMIT SAME (- __)(PRE 1969 NBIGHBORNOTIFICATION )[_)LE TTER BI/ZBA...:. .,i_.. iUi i00 i FLOOD ELEVA ION Wri200' - U(,,ISOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS L/J(JSEWAGE SYSTEM PLAN - (NORTH ARROW) SZJL.JSSDS HYDRAULIC PROFILE ( J(- _)GRAVITY FLOW (__)CONSTRUCTION NOTES 1 -15 _._ UDESIGN DATA: PERC & DEEP RESULTS (-j2' CON TOURS_ EXISTING & PROPOSED ( Z(­JDRIYEWAY & SLOPES, CUT (,!!!n( ,FOOm- G /GUTTER/CURTAIN DRAINS (,,J-(-JUSDA SOIL TYPE BOUNDARIES (Zj( _JTTTLE BLOCK; OWNERS NAME ADDRESS � TM", PE/RA; NAME, ADDRESS, PHONE" (/__)(- -_)DATE OF DRAWINGMEVLSION (Zj( JDATUbi REFERENCE (/U(_JLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ej(-JPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (U( __)WELLS & SSDS'S W/IN 200' OF SSTS �(-JPROPERTY METES & BOUNDS grpSrc�v.. a,..lrt •- . COINIMENTS: (REVSHEEI) �)ULF TRENCH PROVIDED� 60FT MAX. ()(__)PARALLEL TO CONTOURS (__)100 % EXPANSION PROVIDED. UDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL j UGEOTEXTME COVER SEPARATION DISTANCES ON PLAN - FROM SSTS e�(__)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__)20' TO FOUNDATION WALLS (__)100' TO WELL, 200' LN DLOD,150' TO PITS )100' TO STREAM, WATERCOURSE, LAKE (mc. espan) L_)50' TO CATCH BASIN, 35' STOP=RAIN, PIPED WATER )(10' TO RATER LL" G..(Fits - 20') . - _- --. ..... .. . ..:... . lU50' ►TERINUrTENT DRAINAGE COURSE, UIV200'1500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (__)(__)10' N111.4 TO LEDGE OUTCROP SEPTIC TANK (16CJ10' FROM FOUNDATION; 50' TO WELL WELL ( �.�DI�MENSIONS TO PROPERTY LINES -- ( ell -L . )LOCATION OF SERVICE CONNECTION (�LJMIN 15' TO PROPERTY LINE _ � �SLOPE U(�SLOPE IN SSTS AREA --(S20 %) (_)(!-REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS UUPUiYIP NO ES ( _JUDO!; 75% F PIPE L /DOSE VOLUME NOTED (J(JDETAIL FO 0 E IN, (PIPE TYPE, ETC.) UUPIT AND D-B H N & DETAILED (_JU1 DAY STO GE ABOVE ALARM CURTAIN DRAIN UUSTANDP , 5' B TH SIDES, DETAIL (_)(__)15' [IN to - %, 20'4%,25'-3%,35'-l%, 100 % -<l% (_)U20' b1IN CD DLSCHARGV100' with 182 cons day discharge U(___)l0' b to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of. Located at Kathleen Kuczma Horton Hollow Rd. T/V Putnam Valley Tax Map # 72 Subdivision of Westchester I Subdivision Lot # 5 Filed Map # Gentlemen: Block 1, Lot 23.5 Co. Inc., Parcel II 2824 Date Filed 03/10/00 This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer X or Registered Architect _ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersi ed: Si ed: P.E., , # 0 fc ZSaS (Owner of Property) Mailing Address Badey & Watson, P.C. 3063 Route 9, Cold Spring, State N.Y. Zip 10516 Telephone: 845- 265 -9217 Mailing Address: State 320 Fox Run Lane NY Zip Telephone: 845- 225 -4074 Carmel 10512 Form LA -97 a i BADEY & WATSON LETTER of TRANSMITTAL Sur- veyin, & - E_ ineering, P.C. Y 3063 Route 9, Cold Spring° 14 w fwlr fUJf - ` " - _ Date: w14 Dec 2001 � (845) 265 - 9217'. (914) 628 -1800 (914) 739 73577 File No. 9 8-105 (845) 225 73312 FAX (845) 265 74428 W. 0. # 14417 RE: Kuczma TO: Horton Hollow Road Adam Stiebeling Westchester Holding Co., Inc Subd. Lot No. Putnam County Department of Health T Map 72: 1 -23.5 Permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑UPS -NIGHT MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GROUN ❑ UPS -COD ❑ . We are sending: copies date description of document • 171. 13- Dec -01 A lication Fee -.0 27-Nov-01 lConstruction Permit for Sewage Treatment System 1 F ter bf Authorization -- ❑1 10- Jun -99. —� Application for Approval of Plans for a Wastewater Treatment System _ Fl 27- N6v -01 ' 'I Short Etivironniental Assessment Form — 10- Jun -99 _j De Data Sheet 27- Nov1Q1 .. ; .. _ Separate,Sewa a Treatment 5ystem"Sheet_1 of 1 4-A-_12 - -- - . O2 I Floor Plans 7 27- Nov -01 [Application to Construct a Water Well -- - � REMARKS: Signed John P. Delano, P.E. Copies: File BADEY & WATSON LETTER of TRANSMITTAL vey 3063 Route 9, Cold Spring, New York 10516 Date: 04 Dec 2003 File No. 98 405 W. O. # 16150 RE: Grading of Expansion Area Gross TO: Horton Hollow Road Mr. Joseph S. Paravati, Jr. Westchester Holding Co., Inc Subd. Lot No. 5 Putnam County Department of Health Tax Map 72.4-23.5 1 Geneva Road PermitlTitle/PO # PV -6 -02 Brewster, NY 10509 Sent via: US MAIL El LIPS -NIGHT F-1 MESSENGER El UPS -2 DAY El PICK -UP El UPS -3 DAY El FAX UPS -GRND We are sending: UPS -COD El copies date description of document 1 19- Nov -03 -7] ICopy of Comment Letter ❑ ® 04- Dec -03 Revised Plan to Show Regrading and Profile ._a ❑ L ❑ r REMARKS: Dear Mr. Paravati, Persuant to your letter of November 19, 2003 Please find a set of revised plans to show the regrading of the expansion area and a profile to illustrate that it can be reached by gravity. Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey- watson.com 40 40-05 498950 624500 22946 a LORETTA MOLINARI Public Health Director 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 November 19, 2003 John Delano, PE Badey & Watson Engineering 3063 Route 9 Cold Spring, New York 10516 Re Dear Mr. Delano: ROBERT J. BONDI County Executive Proposed SSTS Revision — Gross Horton hollow Road, (T) Putnam Valley TM# 72. -1 -23.5 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 review and consideration. 1. Based on our site meeting on October 1, 2003, the new expansion area was to be lowered 2 feet in..order,.to matcb..tbe.grade _ o£.the..prim:ar -y system. ?t.app Pars that.no-re a iiiiti; is J�ir� _:.. -. r. .. --- _ . .. _._ _ hYopo -ea on iiie p an'toi "the expansion area. 2. It appears the expansion area cannot be reached by gravity. Please provide a profile of the entire system from house through expansion area to show whether a gravity system will work. 3. Please show any regarding that is being proposed near the septic area (i.e. between the house and SSTS). 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, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY, DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION �,,._..,�.:. �,.. .-;..:.. = .;�-r.- �:... _:.,,. - _.... . _. 9_ = ..........., . �:. a .. ... ,,,..,- .....,.:.- ...... :•;,at.-'; ...,:.,_..: -,. - -- ...... - .� �. ...,. .. a .- • . , ., .. RE: Property of Bruno Gross Located at Horton Hollow Road T/V (T) Putnam Valley Tax _Map # 72. Block 1 — Lot 23.5 Subdivision of Westchester Holding Co., Inc. Subdivision Lot # 5 Filed Map # 2824 Date Filed Gentlemen: 3./10/2000 This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer N or Registered Architect _ to apply for the required . wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations. as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E.) XW ## 062505 Mailing Address Badey & Watson, P.C. 3063 Route 9 Cold Spring State New York Telephone: Zip 10516 845- 265 -9217 �'e; -Y.ti rl Signed: Mailing Address: P.O. Box 247, Tuckahoe State New York Zip 10707 Telephone: (914) 980 -8778 Form LA -97 BADEY & WATSON LETTER of TRANSMITTAL IJ ?'7�:7ir A F�;vras�._n4p`jny PC_ r 3063 Route 9, Cold Spring, New York 10516 Date: 28 Oct 2003 File No. 98 -105 W. O. # 16150 RE: Permit Renewal Gross TO: Horton Hollow Road Mr. Joseph S. Paravati, Jr. Westchester Holding Co., Inc Subd. Lot No. 5 Putnam County Department of Health Tax Map 72.4-23.5 1 Geneva Road Pennitrriddl`O # PV -6 -02 Brewster, NY 10509 Sent via: US MAIL El UPS -NIGHT EJ MESSENGER © UPS -2 DAY El PICK -UP El UPS -3 DAY El FAX D UPS -GRND 11 We are sending: UPS -COD El copies date description of document F. 1 20- Oct -03 I Construction Permit for Sewage Treatment System F-11 ILetter of Authorization 24- Oct -03 I FApplication Fee 150.00 Dollars ® 28- Oct -03 � lRevised Separate Sewage Treatment System Sheet 1 of 1 ❑ -7 El I El I REMARKS: Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey- watson.com 40 40 -05 498850 624500 22672 -, - .. - - - �, Ttle, - � �; ; ` M�SM IA'TN1(YEINA�tI "R.N., M.S.N. f Public Health Director 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 OFFICIAL REQUEST FOR STOP -WORK ORDER Iry Sevelowitz Building, Zoning & Sanitary Inspector Putnam Valley Town Hall Putnam Valley, NY 10579 Re: Stop -Work Order Request: Gross Horton Hollow Road, Lot #5 (T) Putnam Valley, TM# 72 -1 -23.5 Dear: Mr. Sevelowitz: ROBERT J. BONDI County Executive September 19, 2003 - _ Thy . eruct :TPV -G -32 for -iiic-aeove' regarded "`project been suspended�by'this Department for the reasons noted below: 1. Proposed system has not been constructed according to approved plans. 2. 100% expansion area no longer exists. 3. Silt fence not installed according to approved plan. It is respectfully requested that a Stop -Work Order be issued until these items have been satisfactorily resolved. Thank you, in advance, for your cooperation in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. JSP:ta cc: John Delano, P.E, (Badey & Watson) Bruno Gross A oseptruly yours, h S. Paravati, Jr. Assistant Public Health Engineer IN 'Fill i i .4. � '� ;i � t ""*'a:,.r� _,tom+ _. � �• :. _. � .� _. -. , r Ly "fir•. 4 t '-�?�. � t � ivk,. - > , �. ' , f�' T k; �fx i� S�tg i h .yd,J v n � E n ��9 rya, � f a' wG � Sy t A S f "�yGmy.4 T q G"p�C 4"".' f'` �?'rRbfi+^YPZGvn'n•a°lt'm9`;.k' _ F " 1 f u t HER + a�Ce Y Ya MANI�+ 1 w� .try s r all 9_:. t• t� l OAR iA 1Q'• y: � +�.t�r � tr 5� t x