The URL can be used to link to this page

Home My WebLink About3225DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -9.2 BOX 26 �, ' 91% I �Ue �`, E 03225 PUTNAM COUNTY DEPARTMENT OF HEALTH LI Y 1►J� li ' J - l'1 �Vl \T111� 1 r" i� Lc"AiliTH - .xE,t.1%71E'S " CERTIFICATE OF CONSTRUCTION COMPLIANCE F REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV - 5 - 9 9 / 3� Located at 469 PEEKSKILL HOLLOW ROAD Town or Village PUTNAM VALLEY Owner /Applicant Name RICHARD BROWN Tax Map 7 3. Formerly BROWN Subdivision Name Subd. Lot # Block 1 Lot 9.2 BROWN Mailing Address 469 PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, N.Y. Zip 10579 Date Construction Permit Issued by PCHD 3 / 8 / 9 9 Separate Sewerage System built by RICHARD BROWN Consisting of 12 5 0 Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From Address 469 PEEKSKILL HOLLOW RD. PUTNAM VALLEY, N.Y. 10579 460 LF OF 2 FT. WIDE LEACHING TRENCHES Address or: x Private Supply Drilled by NORMAN ANDERSON Address BARGER STREET PUTNAM �'ALL%Y N Y'.'1-0_.7`79, Building Type FRAME RES . Has erosion control been completed`? ' yvFs Number of Bedrooms 4 Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premi built plans (copies of which are attached), in ce with plans and the standards, rules and regulatio of the utnam Date: 11/22/99 Certified by Address 2 MUSCOOT RD. NORTH, MAH9CPAC,/ N.Y,./;1'0541 NO G essentially as shown on the as- instruction Permit and approved of Health. P.E. RA. x 11056 Any person occupying premises served by the systdn(s) shall promptly take sdch 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 revocatiox modifica ion c angi is essary. By: Title: 14 Date: Z' 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 it l 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL - C'OMPF.t^TIM. RE -PORT. Well Location S eet Address: �Tp�pillage- Tax Grid # Ma Block Lot(s) �f 2 Well Owner: N e: Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _74— Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below grade 3 aft. Diameter - in. Weight per foot e�Eib /ft. Materials: Steel Plastic _ Other Joints: _ Welded �C Threaded _ Other Seal: 7-K 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 Compressed Air Hours Yield /X" gpm Depth Data Measure from land surface-static ( specify ft) During yield test(ft) Depth of completed well D feet oo 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 ,3Unj,2� Capacity _/ 0 Depth Model ze kw_ 9 Voltage _L3 0 HP Tank Type - 7? o ;Z- Volume / Yv Date Well Completed 2/1 P9 Putnam County Certification No. Date 7716 ort Well Driller (signature) . 1VV l E: txact location or well wttn atstances to at least rwo permanent ianumagKs to oe pruviueu un a 5cparaLU sucUupiaii. Well Drillees Name 0'0 a4w.,n Address: �5�y 44 ` Signature: `'�J Date: &/ S� White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ^ . ~� YML ENVIRONMENTAL SERVICES 321 Kear Street Albert H. Padovani, Director LAB #: 32.906943 CLIENT #: 10261 NON STAT PROC PAGE 1 BROWN, RICHARD C. DATE/TIME TAKEN: 10/26/99 08:00 P.O. BOX 226 DATE/TIME REC'D: 10/26/99 11:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 10/27/99 PHONE:* SAMPLING SITE: 469 PEEKSKILL HOLLOW RD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: SAME TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 10/26/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS),(WA944QZ1.OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 ^ " . _. YML ENVIRONMENTAL SERVICES 321 Kear Street to\^& 11TS9MAn'.��`��..�.`,�.`.'��.��^'^___ (914) 245-2800 Albert H Padovani Directo H. , r~ LAB #: 32.904872 CLIENT Q 10261 NON STAT PROC PAGE 1 BROWN, RICHARD C. DATE/TIME TAKEN: 08/10/99 10:00 P.O. BOX 226 DATE/TIME REC"D: 08/10/99 10:45 PUTNAM VALLEY, NY 10579 REPORT DATE: 08/23/99 PHONE: SAMPLING SITE: 469 PEEKSKILL HOLLOW ROAD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY NY PRESERVATIVES: NONE COL'D BY: RICHARD BROWN TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/10/99 MF T. COLIFORM PRE5NT /100 ML ABSENT 1008 08/10/99 LEAD (IMS) 1.0 ppb 0-15 ppb 9101 08/10/99 NITRATE NITROG <0.2 MG/L O - 1O 9139 08/10/99 NITRITE NITROG <0.01 MG/L N/A 9146 08/10/99 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 08/10/99 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 08/10/99 SODIUM (Na) 12.7 MG/L N/A 08/10/99 pH 7.8 UNITS 6.5-8.5 9043 08/10/99 HARDNESS,TOTAL 210 MG/L N/A (AS 138 MG/L. N/A '-l`URI�IDITY� (TOR At :17 <1n@TL!~__��042FNIAT: 12 �� -Ivy 08/10/99 08/10/99 E. COLI (CONFI ABSENT 100/ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE-l��RRK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS ` TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. Ablic 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 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 tho5e on a moderately restricted diet, a maximum of 270 mg/L of Sodium " ~ » � YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 , Albert H. Padovani, Director LAB #: 32.904872 CLIENT #: 10261 NON STAT PROC PAGE 2 BROWN, RICHARD C. DATE/TIME TAKEN: 08/10/99 10:00 P.O. BOX 226 DATE/TIME REC'D: 08/10/99 10:45 PUTNAM VALLEY, NY 10579 REPORT DATE: 08/23/99 PHONE:_ SAMPLING SITE: 469 PEEKSKILL HOLLOW ROAD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY NY PRESERVATIVES: NONE COL'D BY: RICHARD BROWN TEMPERATURE..: < 4C NOTES...: KIT TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. ' 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 TREAT O WHICH THE WATER HAS BEEN SUBJECTED. - -'—' A`+SF�x`8 - '-- ��'`'��-`�`��'��ART! AB��,F� 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) SUBMITTED ^ .2- Director - ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH .DJV.TSION.:O1�7TR1i T w,• -_ ..� .t i. �t� ^w�.- w- +•+'rs —..�� .r.. ►. + ;_ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM RICHARD.BROWN Owner or Purchaser of Building OWNER Building Constructed by 469 PEEKSKILL HOLLOW ROAD Location - Street ONE FAMILY RESIDENCE 73. Tax Map 1 9.2 Block Lot TOWN OF PUTNAM VALLEY Town/Village BROWN Subdivision Name #2 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.will.fibl..0 negligent a.ct.nfrh.e occupant of the building utilizing 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 building utilizing the system. r ---- Day 2? Year 99 Signature Corporation Name (if corporation) Address: 469 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY State NEW YORK Zip 10579 Title: OWNER Corporation NamLI(if corporation) Address: 469 PEEKSKILL HOLLOW ROAD . PUTNAM VALLEY State NEW YORK Zip 10579 Form GS -97 11./29/99 PUT. COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 AL)AM STIEBLEING RICHARD BROWN V UH 2 91 PRINTS El SPECIFICATIONS C6 SHOP DWGS SAMPLES Cl OTHER DI YOUR USE 0 REVIEW Q COMMENTS COMMENTS: ENCLOSED PLEASE FIND AS -BUILT SSDS REGARDING THE ABOVE MENTIONED. FROM JOE_ BERG. rj• COPIES TO: 0 - - A. Town TM&I rr . PUTNAM COUNTY DEPARTiNIENT OF HEALTH DIVISION OF ENVIRONTIVIENITAL HEALTIJ SERVICES FINAL SITE INSPECTION 3 —r— V. Z Owner t>bt., Permit Subdivision Lot 1. Seii•aae System Area a. STS area located as per approved plans ...... .. .................... b. Fill section - date of placement 3:1 barrier Lgth. Width Ava.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands ..................................... II. Sewage System a. Septic tank size - 1,000 ..... <� 250 .... other ................ b. Septic tank installed level ............................................... c. 10' minimum from foundation ......................................... d. Distribtuion Box T—A I outlets at same elevation-water tested ................. 2. Protected below frost ........... 3. Minimum 2 ft.Origin'al soil between box & trenches Junction Box -p roperlyse t ... f ..................... 1. Lena gthrequirea 'jA�j Length installe�- 2. Distance to watercourse measured 3 �to Installed according to plan ....................... 0 ................. 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations .......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1' /z" .diameter clean .................... 9. Depth ..q. .... ............................................. g. Dosed Systems P ump or Dos I . Size o t pump c_Ta_m5e_r ............................................... 2. Overflow tank ............................................................ 3. Alarm, visual/audio ................................................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................................................... 6. Cycle witnessed by H.D.estimated flow/cycle ........... 111. House/B n u' ildi 2 a. House locat&d per approved plans .................................. * b. Number of bedrooms ...................................................... IV. Well a --Well located as per approved plans ............... b. Distance from STS area measured ft........... c. Casing 18" above grade .................................................. d. Surface drainage around well acceptable ... .. ................... V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box .................................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .................................. i. Erosion control provided ................................................ Pav 1107 CONNIMIENTS reNO a rJ I■ • low =53NNEW, 70 = (400 ?-O'd 111101 PUTNAM COUNTY DEPARTMENT OF IWALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FORFINAL INSPECTION Fort Fill PCHD Construction Permit 0 PV -5 -99 Trenchft—x . . im Located PEEKSKILL HOLLOW ROAD (T) MPE PUTNAM VALLEY- Owncr/Applicant Name RICHARD BROWN: TM 73 •111cck 1 9.2 Lot Formerly .—Subdivision Name BROWN Subdivision Lot# 2 Is system fill completed? N/A Date Is system complete? IF -S Date 7 / 6T9 9 Is System constructed as per plans? YES Is well drilled) ) YES 7/6/99 Date, Is well IwAted as per plans? YES Are erosion control measures in place?YES I certify that the system(s). as listed, at the ab6ve premises has been constructed and I have inspected and verified their completion inaccardwe-with the issued PCHO Constriction. Pe Putnam County Ing 6 of Health. Date: 7/13/99 .Certified by:JOEL GREENBERG - PE Design Profc3sional Addrcss2 MUSCOOT RD. NORTH 11056 KA"HOPK-C-jN.)F.71 0541- - Comments: PLEASE INSPECT AS SOON AS POSSIBLE 001, RAX FOR- MADAm EIGENE Form FIR-99 UU yO L MtGo, ArchQlect 7UwMmwotRosvdNdrlh htaho air N New York 10541 42641"asJost off-611-1667 Os ` r; n 10'd LO8Z 8Z9 bi6 b1:b1 6661- £1 -inf PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION.OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # I �_. �� Located at PEEKSKILL HOLLOW ROAD Subdivision nameBROWN Subd. Lot # 2 Date Subdivision Approved . 12 / 7 / 9 8 Town & OF PUTNAM VALLEY Tax Map 7 3. Block 1 Lot ) n -n-, Renewal Revision R C). -2-- Owner /Applicant Name RICHARD BROWN Date of Previous Approval P.O. BOX 226,-469 PEEKSKILL HOLLOW ROAD Mailing Address pUTNAM VALLEY, NEW YORK Zip Amount of Fee Enclosed $300.00 016167"o Building Type (1 ) FAM . RE S - Lot Area 3.0 ACIVo. of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 5 0 gallon septic tank and �p OF 2 FT. WIDE LEACHING TRENCHES Other Requirements: To be constructed by NOT SELECTED Address Plarlic.Sunply From Address or: X Private Supply Drilled by NOT SELECTED Address 444 LF I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewaa 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 daaAof the issuance of the approval of the Certificate of Construction Compliance of the original system orany� airs theret j License # 11056 APPR VED OR eONSTRUCTION: 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 p it. Ap roved for disc arge of domestic sanitary sewage only. By: Title: Date: 3 $ White copy - HD File; Yellow copy - uilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES T(Q CONS6_ U T A WATER WELL _ $ PLe�I��. - please print or type - PCHD Permit # r` {f� Well Location: Street Address: Town/Village Tax Grid # P �0 PEEKSKILL HOLLOW Map 7 3, Block 1 Lots) go Well Owner: Name: Address: P.O. BOX 2 2 6 , 469 PEEKSKILL HOLLOW RICHARD BROWN PUTNAM VALLEY, N.Y. 10579 Use of Well: x 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 5 gpm # People Served 4 Est. of Daily Usage 33 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason ,W HOuSr for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision BROWN Lot No. 2 Water Well Contractor: NOT SELECTED Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: N/A Town/Village N/A Distance to property from nearest water main: N/A Proposed well location & sources of contarnii atio to be provid d on separate sh et/plan. ZY PERMIT TO O TRIJ T A WATER WELL This permit to construct one water well as set orth 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 Permit Issu' g Official: Date of Expiration o cn Title: 07V �K" Permit is Non- Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 RD. 1.t ...... ..fig, 14- 16- 4(9 /9i) -Tex1 12 617.20 rifto ir:T I.D. NUMRiiR I !.Ir_rt !" - "' �. JIIItO bltVtrOIIIUWtl11 Qualily Review 1 SHORT ENVIRONMENTAL ASSESSMENT FORM Sor UNLISTED ACTIONS Only ;. PART 1. - PROJECT INFORMATION (To be conmle(ed by Almlicant or proiec:t Sponsor) 1. APPLICANT /SPONSOR -. 2. PROJECT NAME RICHARD BROWN RICHARD BROWN I PROJECT LOCATION: Municipality TOWN OF PUTNAM VALLEY County PUTNAM 4. PRECISE LOCATION (Street address and road intersection, prominent landmarks, etc., or provide map) PEEKSKILL HOLLOW ROAD 3. IS PROPOSED ACTION: M3 New. El Expansion ❑ Modification /Altcrnliolt 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 1. AMOUNT OF LAND AFFECTED: . Wdally_ 3 .0 0 !acres Ultimately 3 .0 0 acres . S. WILL PROPOSED ACTION COMPLY WITH EXISTINO ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes O No R No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? IN Residential 13 Industrial O Commercial O Agriculture ❑ Parlgf;Drest /Open Space O Other Describe: to. DOES ACTION INVOLVE A PERMIT-APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY QTHER GOVERNMENTAL AGEN( FEDERAL, STATE OR LOCAL)? ..< M Yes O No If yes, list agency(s) and penniyapprovals PUTNAM COUNTY HIGHWAY DEPT. & PUTNAM VALLEY BUILDING DEPT. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? O Yes Y6] No If yes„ list agency nalne mid penniyapprovat -� 12 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 0 Yes I No ION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE CERTIFY T THE INFOR:OWN Applicant/ nsor N e:_ I CHARD Date: 2/22/99 Sign :. PROJECT ARCHITECT Z IV if 'the action is in the Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment .. w r PART 11- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DO1?S ACTION fiX('PRI) ANY TYI'Ii 1 T1IRFSI101.1) IN 6 NYC'RIt, PAlt'f 617.4? If yeti, svwndinntr. tlir. revi w In,w� tiv and iiu :Ih�+ I t.li,l. IdAI . 0 Yes O No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTION IN 6 NYCk PART 617.61 If No, a negative declaration tray be superseded by another involved agency. O Yes .O No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWINO: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waster 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 wildlire species, s9gnifrcant habiEats, 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: CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short tenn, cumulative, or other effects not identified In Cl -05? Explain briefly: ' C7. Other hnpacts (fncltid'utg changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? 0 Yes O No E IS THERE, OR IS THERE LIKELY TO EE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes O No if Yes, explain briefly: PART III hr;l'ItI MINATION ()1! sl(INII1(.'ANCI( (To Ix'. clin►pleled by Agency) IN,S "I'ItI1C'1'IONti: Vol. 4u101 1111veltir.I:l1'ect iden►ifilvl Axwe, (1rlelIIIhot whi:lht•i it is xuDaanlinl, I:nli, inyMal:u11 in 41111riwiue Agnil'icanl. I uh efflxi should be t►ssc�sed in clinnellon with its (a) sUlfn (b.e. urban or nund): (b) In,)ll:ibili� or occniring; (c) duration; (tl) irn vaubility; +�� r:'i r1 r+ ir! 9r�•. (s- Oh:•, +f:• --. i c n .. 1 „ . 9 : . .. ;'. . _ < -_ .,.._. ¢ .. fa. .y a,.., «.t..� _�3y1�latlt< -.- •rs_ ai:..�, GV.i. ?.ul iiii►Cnt;, d. it C.Isa,t; fm[ Gt1) liiiliitlellliUlltilltl 'titIfI1CICIlIy dclall to show thal all relevant adverse impacts have been identified and adequately ntldrezed. it question D of Part It was checked yes, the defennbtation and significance must evaluate the potential unpact. Check this box if you have identified one or more potentially large of signifcant adverse impacts which MAY occur. ?hen proceed dfredly to the FULL EAP and/or prepare n positive decl arati oil. O . Check this box if you have detennined, based on the information mid analysis above and arty supporting docunientatio», that the proposed acldon WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting Vds. determination: ,.. Name of Lead Agency Print or Type Name of Responsible Office in Lead Agency Title or Rtwponsilibe Officer Signature or Responsible Officer In Lead Agency signature or Preparer (ir (different rroni responsible (Iffieer) PUTNAM COUNTY .DEPARTMENT OF HEALTH JS-10 -T. O r evI MENTAL F� dTA � E , LETTER OF AUTHORIZATION RE: Property of RICHARD BROWN- - Located at PEEKSKILL HOLLOW ROAD T/V PUTNAM VALLEY Subdivision of Subdivision Lot # _ Gentlemen: 2 Tax Map # 73 Block.:. 1 Lot P/O 90 BROWN Filed Map # 2778 Date Filed 2/24/99 This letter is to authorize JOEL GREENBERG a duly licensed Professional Engineer"", or Registered Architect .. x to apply for the required wastewater treatment and/or water supply permits) 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 tretment and/or water supply systems in 661hf6 fiW with the pf 6 v—i s-i 6--h-s—bf 1aticie`i 5 and/or 14 of t 1✓- cu dtioa -La w-,:triZ, - -- Law, and the Putnam CouAty, Sanitary Code. Very truly yo �. one 0 Signed: P.E. , # (Owner of Property) ail' g A dress TH Mailing Address: P.O. BOX 226, 469 PEEKSKILL Op NF-%q HOLLOW ROAD MAHOPA PUTNAM VALLEY State N.Y. Telephone Zip 10541 628 -6613 State N.Y. Zip 10579 Telephone: 528 -2940 Form LA -97 , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH .._ _:-..._ INDiVIDUAL�VATIyR .SI1PPJaY�,:SsL'.BC ?JIi.F.aCF- SEA• YA, �''. E_ ,- ��,- .c^�r..TSk�,�Ta-�,,a�1S:. ��.,�:...s:�.:_.•::;.:s �- �::•.;::::: -�, ... _.. - -__. ...... Y:_.1y. ;,,.. y.,: .r. V:- sc: ..c- •ax.- .,..a.:.•o,:- .o•,.a•.: ., ,.a,y �..at.,y c. -.: -.. - "`' ' •"°- "`'� "'` o. " - REV(I(EW SHEET FOR CONSTRUCTION PERYIIT STREET LOCATION 1`l��C�G��` ►+^�� NAME OF W ER��`� ? 3 �9 REVIEWED BY /��/ DATE 9 TAX MAP, # Y DOCUMENTS / PERMIT APPLICATION WELL PERMIT Wife PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS 1PUSE PLANS - TWO SETS VARIANCE REQUEST SUDIVISION tLEGAL SUBDIVISION DIVISION APPROVAL CHECKEDC RATE L REQUIRED - DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED LANS SUBMITTED TO DEP LEGATED TO PCHD DEP APPROVAL, IF'_REQ'D, _ P CS WITNESSED, IF REQ'D X- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEWATION OTHER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE�GRAVITY FLOW 160-NSTRUCTION, NOTES SIGN DATA: PERC & DEEP RESULTS pod ONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: Y �. ROSION CONTROL:HOUSE,WELL; SSDS PERC & DEEP HOLES LOCATED PRESENTATIVE OF PRIMARY & EXPANSION loo CATION MAP P. AREA; SHOWN; GRAVITY F OW, SUFF.SIZE IF PUMPED, PIT & D BOX SHO & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF POSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) 12 50 HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONT ,SOPE L 3:1 TO GRADE ILL SPECS FILL NOTES TION NOTE VOLUME PILL IN EXPANSION AREA 6F TR__ENCH RO PVIDED �� 1 60 FT MAX. P1 6 ALLEL TO CONTOURS` ' 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS IYWELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS f� 'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35'- 1%,100' - <I% �Ornin to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL FORM ST -2 PUTNAM COUNTY DEPARTMENT OF HEALTH Lot #2 DIVISION OF ENVIRONMENTAL HEALTH SERVICES . - -yr.Y ... r . • u. - --..ti n...- x .. � �e .. e.- > - r _ r .. �.... .-r .. .. , ... _ �...r r.. ..y! -�n..a .a.. ._ _ _.+v <u .ter -'•��- - r � . -♦ -. . DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Ddnald & Richard Brown Located at (Street) Address 617 Peekskill Hollow Rd. Peekskill Hollow Road Putnam Valley, N.Y 10579 Tax Map 7 3 Block 1 Lot 9 0& 91 (indicate nearest cross street) Municipality Town of Putnam Valley Watershed Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 4 /14 / 9 8 Date of Percolation Test 4/15/98 Depth to Water Vater r G ou d e tt E om r , n L vel Percola on e EIa Time . Surface (Ynches) nro Jn Rate Hole No Run No Start Sto �Nhn) Stan Stap Inches Min/Inch: ..::..;:::.. 1 l 3:05 -3:33 28 22.5 " - 25.5" 3 28/3= 9.3 2 3:34 -4:02 28 22.5 " - 25.5" 3 28/3 = 9.3 3 4:04 -4:32 28 22.5 " - 25.5" 3 28/3= 9.3 4 5 22. 3:08 -3:35 27 2" -25" 1 3 27/3 =9 2 3:36— 4:03 275 2" -25" 3 27/3= 9 3 4:06 -4:33 27 2" -25" 3 27/3= 9 4 5 1 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at K each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES - r,� �..n __. __, n" ---•'C ,. � - .r `ir_.. - „_`LcC:.,.: :.w; ,. �aat.... ;- o-;, {r'r•.xr al.- ..r. 1 �w :a•:r . ..a,� .. ... =lc--� :- i'•_; :�,-o .. DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. Top Soil -(4 ") Top Soil -(g") 0.5' Medium Brown Medium Brown Sandy Loam Sandy Logm 1.5' 2.0' Sandy Logm Sandy Logm 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' ..6.0 6.5' 7.0' �! 7.5' 8.0' 8.5' 9.01. 9.5' 10.0' Indicate level at which groundwater is encountered None Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered N/A Deep hole observations made by: Joel Greenberg Date 4/15/98 Design Professional Name: Joel Greenberg Address: 2 Muscoot Rd. North .,4g.hopac,N.Yn10541 A Signature: Design Msional's Seal /BRED 4R� ftEN:E GR� m0 Q o 0 -4 it 0• o11og6�0 OF NF- r U 1 tr A1V1 1, V U 1� l Y Ll'�t'A.K 11Vll.lr 1 V1' t1LAL l ri • DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: RICHARD BROWN P.O. BOX 226, 469 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY, NEW YORK 10579 2. Name of project: RICHARD BROWN 3. Location TIV: TOWN OF PUTNAM' VALLEY 4. Design Professional: JOEL GREENBERG, R.A.S. Address: 2 MUSCOOT ROAD NORTH 6. Drainage Basin: _ HUDSON RIVER MAHOPAC, NEW-YORK 10541 7. Type of Project: 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 (SEAR)?, Type Status (check one) ...................... ............................... Type I Exempt Type II Unlisted x . 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been. completed and found acceptable by Lead Agency? ............... N/A 11. of Lead Agency N/A 12. Js this project in an area under the control of local planning, zoning, or other ... .- . offi iah �r lYi t-iv g`� YES 13. If so, have plans been submitted to such authorities? .. No ..... .. .:.........................:... 14: Has preliminary approval been granted by such authorities? Date grtanted: N/AI 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) ..............................:............ ............................... N/A 18. Is project located near a public.water supply system? ..:.... ............................... . No 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 4/15/98 23. Name of Health Inspector ADAM. STIEBELING 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? N/A Form PC -97 27. Is any portion of this project located within a designated Town or State. wetland? . NO > ' 28. Wetlands ID Number .......:.....:............................................ ............................... N/A 29. Is Wetlands Permit required? ...................................... : ....................................... . NO %Ias appi cation 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 32. Is project located 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 DESCRIBE: NO NO 33. Is there a local master plan on file with the Town or Village? ......................... YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... _ 140 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number .......................... ............................... Map 7 3. Block 1 Lot P /0 .90 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and reed not be wnt iii dUpp',c c to the DEF; i l0hour, 4r� nrni�rt.moa.FWr• +�y, � L'�� _ approval of the SSTS~prior to final approval by the Department. Projects within the watershed may also require 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 1.,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 Secdo445 of the Peltvqv. SIGMA -TURFS A OFFICIAL TITLES. OWNER Mailing Address: ......... P.O. BOX 226, 4.69 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY, N.Y. 10579 C, 4S. I' Deck 45.2' 2 Story Frame -F Dwelling •Z79 'f—eq �>O>- -3 > :z to a W >-M ro to rC zr> 0z ywD Monument no 2 overhead UgaQ r-�41LL 0* Pavement overh 13 W _.===::o Ires H oLLow r_> 0 pole 0 0 :< A -:E;> � L-i I L- -T 9, V. z JOEL L. GREENBERG ARCHITECT 0'r N S 4 IL Rj Cob O lc� 01 4t 4G6LF OF Mt C , WIDE so'Jf Te. 6p -6,01 c Wr t� 4S. I' Deck 45.2' 2 Story Frame -F Dwelling •Z79 'f—eq �>O>- -3 > :z to a W >-M ro to rC zr> 0z ywD Monument no 2 overhead UgaQ r-�41LL 0* Pavement overh 13 W _.===::o Ires H oLLow r_> 0 pole 0 0 :< A -:E;> � L-i I L- -T 9, N V. z JOEL L. GREENBERG ARCHITECT 0'r N S 2 HWWT ROAD MOM KAMMAC. NEK YORK 0541 ("emus FAX M4) 621-207 N V. z IL O lc� 01 4t C , J! Wr t� 10 0 V. z IL O 01 4t 7.1 .,P. DRAMS 1= AS jx>UIL7 AS MaTem I