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HomeMy WebLinkAbout3274DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -90.1 BOX 26 y is NIN IN LIN I IN IN r .r; . �r� aF - �'9 =�'� L No .T 03274 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM Mk OFFICIAL USE ONLY ;? 2 e-1 — t--;, 2--- SITE LOCATION TM# OWNER'S NAME -w- t-f ere 62-le e ��ve PHONE MAILING ADDRESS -e "t ' , �v PERSON INTERVIEWED e5P�e�/� PCHD Complaint # Name & Relationship (i.e., owner, tenant, etc.) DATE— PROPOSED INSTALLER_ %~/3 ADDRESS /Z ` � -' TYPE FACILITY PHONE REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system Different location may require submittal of proposal from licensed professional engineer or registered architect. AIGNATUR TITLE DATE_ Proposal approved with the following_ conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6'diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapprove Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC-RP 99ML 15'ATE ��,�c v.9Oor16� Jp� w 4L F 3. LA oa°.• °� NJA4� o e• o � 0 (� a� o -4 e. D c � a 'b Lp o July • ° ltp J -i yO d- T 0 V . cn � i ° s J v u ` 60, it ✓" c L T !ice 41� y o Q Z 0 f9 � �C=JrA rA CA P�O�d 7d j _ abb�pp (1 CA C4 V ►, $ N R �. L w >K peck map7r) ,619 {, >05M21 :Oz - Frvme r�n��z 5pwellin9 �— ,9.66 q log) b � . Pnrch �< i 0 ' 66�/� V mow. .--. wc• � �. �sma a - -� �v�C2fHyb �O O►��y0py 'p 0 o_ i o � 0 Stone all I 4 ' RerTI O r i 'C P ,�. ----- --- c 1 o PaVe►nent UVE goo W,. 01- / 0 ;uide Rai1N Ow Wires --. o�� le i uYll>LI 1,OUt1 Ly LC�I01- YWOIIw u+ 400 +�� ..vision of Environmental Health 3env10e. ,aproved ae noted for oonformanae with .pplioable Hulse and 8egulatione of the Will o� �• w BRUCE R. FOLEY Public Health. DEPARTMENT OF HEALTH I Geneva. Road Brewster, New York 10509 X LQRF-T-,rA-MGL W4RL Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (945)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Preschool (845) 278-6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: 0 45 ��W&ur" Re: Residence Tax 1 Town ,re3 According to records maintained by the Town, the above noted dwelling i Pz 1".) J. -JS:N(- in compliance with Town code and the total number of bedrooms on record is L� This information has been obtained from- CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: L/ OTHER wilding Inspector V- BFhouseguidelines _ _ . _. i ._ __ _ _ - , r"e.Q.K s k. LL W t Ti9,tC t4 73."t'9'O -I t 10L`eW �, w V'41'�R'y P"QOpoaed �•.� :s`ec� tv�Nk.S •n 0 -1 I 6' -5' 6'-5• i 5• -10• 7, -7. 6 _cl i B' i ( IN L (2].2'X12' - DECK 8._4. — .- T4`2• -- 5._ ®. O r N / OW.P. CFI \ 3446 446 f 9 . HEADER 26'_0• I _ :n v .1• 1 4• / YYY 1d11S POST WOOD (FORMS oo*R.Q.) B FAMILY ROOM .` ' g PO� ALIGN WITH .POST FROM ABOVE"- o 4' =' 4' °- � STORAGEI ;•'� 0 f_ _ -'- "- fA450A18Y FIRE PLACE FOUNDATION - r- -, _ `6' -�. - ----- 10 "- '.� COLUMN �----� I B'-3�' (2) 2'X12' W/ 1/2'X11' STEEL FLITCH 6'-9�� IMSS. PLATE (:ENTER BEAM 11'-2• �- w -� 14' -3�' I. 3. . , � VY p .S! �- -' O n .i y ' �""♦ 2 2 "x12' W 1 /2'X11' STEEL FFUUTCH 7� S.0 3' -7- I - - - -� 16' -7j' 3'_10' "o `- - --- �-- -- -- 21' 6�. 2 =4 - -- -CLOSET 1 o ' FARING W-0, S ALONG F.P. 5 ON F.P. F001 N N c , LAB o! o o \ \ HOUSE PLANS l.FFI`jl D FvR f -_ _7 I - ip \ St DT CY)llla C1YL =j I ' ® PROVIDE SUPPLY UTSIDE AIR 1I � MEGH. ROuAL • - - —. 1 •�� S,.,BEPROOvS.: ME H- RM. Ida ass c storeTi}e 4 BATH R t r 40 1 40 S I - UP (13) RISERS 7 71 11' -1 ' CL. 7' -2' -= -< 30 AT 7.96' EA. Ail -0— ~ 1; I I . . . . . . . . . . . . to 4A �. ;. pt a & a r..a t: to 4A �. ;. pt a & a r..a a' F 1 5' -8' 14' -2" - n pJ_ HEADER — -�- — -T TF - 4 26'-0" -� 1` 2 I y'-1�" I 1' -q' . 10'-0' tl _ =~ 41S POST WOOD (FORMS DOOR'f6Q.) ; ' ® ^_� `_- I — LINE i "F STEP IN SLAB ABOVE, SEE F ^ I FAMILY ROOM 3 I \ LOCA4-)N. PROVIDE 12' WIDE CONC. I HIGH ;SLAB. PROVIDE #4 BENT RE -Bt INTO ;HIGH SLAB AND CONC. WALL. Pf POST ALIGN WITH POST FROM ABOVE'- ^ o - I AT WERFACE OF LOW SLAB AND HICI SHAL' !BEAR ON TYPICAL CONCRETE F _ iJ OR C,'?NPACTED FILL. STEP DOWN TO REOU'r EO AT FOUNDATION WALL. OS.D. r _ l fTASORRY flRE PLACE FOUNDATION _ STORAGE I — I TYPZI SLAB ON GRADE, SEE PLAN I, _ (2) 2'X12' W/ 1/2'X11" STEEL FLITCH PLATE CENTER BFAM lJJ WN - - - -� ! B• -3 6• -9k" uASS. „' -2 }• ; �_ _� ,4' -. j_1 UN EXCAVATE[ _ OL _ _ 2 2 "X12" W 1 /2'X 11' STEEL F TYPIG.BEARING POCKET, SEE PLAN 3' -7" r. - - - -� DOLIKE, HEADERS AND TRIMMERS AT f I ^ I -4 10' -0' , 18 y] `BEARING I `• L � ^�" t�� . o ' LAB BEA VALL ALONG F.P. SON F.P. F001 10 .� _ r'�� 1 NAK COUN9 - jf EPARTNENf QF HEALTH 4 ", ® PROVIDE SUPPLY OUTSIDE AIR ��"" MECH. ROVat * \ ® 0 r •Y CL(�j*N GRADE ABOVE, SEE 7•- .s ME H. RM. 'vaool4 c urr 1' T 0 1.- i I "' Cais0 14 Title is z D9% 7 M 4° 4° 13 j "I 't 11' -, ' CL. t }1' "' _ _ < 30 Al 7.96" EA. ' I •r a .° 9:. m W' 7'-2 I ,' I ,' - -- zil =H -- Inj 3. 1 ;! TYPICA;,LEDGER, SEE PLAN NOTE N.J 60 _p' 1; 9• -0' I gn' a' F 1 SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT �/ T DIVISION OF ENVIRONMENTAL HEALTH SERVICES (� V PROPOSAL FOR SEWAGE DISPOSAL SYSTIVII �y OFFICIAL USE ONLY w i_ PERSON INTERVIEWED 4 4C-1 PCHD Complaint # ame & Ketationsup i.e., owner, tenant, etc. DATE Z— PROPOSED INSTALLER /3. ADDRESS /?, '0-` w TYPE FACILITY 64, PHONE REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. :i';,%c.;nw'n clr. �re�^.r_.rt- agerif: n hWr'�G:. i? °we. t3_iite. conditions- St�ate4_on _this_forrn._.... _... _.:� _ �.__..- n..__ . _.- - - -• ___ ...._._.. _ _ _. _� / TITLE DATE Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML ATE Tea.. ��(. .. .« •�:�:.:. :y. c�i,a= .tom.:}.. _ , at . •�•�: v-w .BRUCE R FOLEY Public Health Director :�..- ..<.'` ...-. ...�.rs. n =p ,tw, = -._ uz.w» i- ,•�.- ..'it` . -1.:1m x _ � e 9:� v _ w+ �LORETTA MOLINARI'R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 July 5, 2002 Louis & Irene Orofine 465 Peekskill Hollow Rd. Putnam Valley, NY 10579 Re: Addition - Orofine, 465 Peekskill Hollow No Increases in Number of Bedrooms (T)Putnam Valley, TM #73.1 -1 -90 Dear Mr. & Mrs. Orofine: 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 form this Department dated July 5, 2002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at five without prior approval by„ this department. the exlgi tig° aWage - aigposal`Ty'§tem,`auci li§ expans'ion rea,must`be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The septic system must be expanded as shown on R224 -02 Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley . If you have any questions, please contact me at your convenience. Very , William Hedges WH:Im Senior Public Health Sanitarian CC:BI • 6 BRUCE R. FOLEY DEPARTN MNT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY STREET yCpS Pe-d 6K,l t_. 1id1 Icu, TOWN %A*NA~n 4 4,_TX MAPi# 73. % - 20 "f NAME oeop;,vo PHONE b =SAS 3 ?S3 PCHD# AoJ v MI AILI\TG ADDRESS q C 6- loee.AS /r. L(_ H-, c, (C,,i 6i.� u e /V Y L ©J 7 � DESCRIPTION OF ADDITION ;iv.a' 6. - U v � v -149 - ( 60Nk6 tecx -- cvv,- NUNIMER OF EXISTING BEDROOMS `/ PROPOSED # OF BEDROOMS! (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. �- -feast stion'ut tIu"s °ro'im'and`trie following to Putnam County Health Dept., 4 Geneva Road, 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 sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) *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. OFFICE USE Comments Feb98 BFhouseguidelines n PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE F ATMENT SYSTEM PCIIIi CONSTRUCTION PERMIT # PV -4 -99 rc p . Located at 465 PEEKSKILL HOLLOW ROAD Owner /Applicant Name Formerly N/A DONALD BROWN Town O911IX PUTNAM VALLEY qo a j Tax Map 73. Block 1 Lot Subdivision Name BROWN Subd. Lot # 1 Mailing Address 465 PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, NEW YORK Zip 10579 Date Construction Permit Issued by PCHD 3 / 8 / 9 9 Separate Sewerage System built by DONALD BROWN Address 465 PEEKSKILL HOLLOW RD. Consisting of 1250 Gallon Septic Tank and 4 c f) LF OF 2 FT. PUTNAM VALLEY, N.Y. 10579 WIDE LEACHING TRENCHES Other Requirements: Water Supply: Public Supply From Address 152-BARGER STREET or: X Private Supply Drilled by NORMAN ANDERSON Address PUTNAM' VALLEY, N. Y. 1 0 5 7 9 " as erosion conuoi nee o mXert_1 , a 1, .1-1 'vJ.4CE e • - _ _� _ .� _w _ _ ��_�. Number of Bedrooms 4 Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above nre ses wer e o structed essentially as shown on the as- built plans (copies of which are attached), in accordanthe issu d P HD Construction Permit and approved plans and the standards, rules and regulaji x f the P Coup ment of Health. Date: 1/ 1 9/ 0 0 Certified by Address P.E. R.A. _X # 11056 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, mo ificat "on r an e . necessary. By: Title: 40 Date: c�o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Location SAM Address: S T Nilla : -) , Tax Grid # - Map j'6 , Block Lot(s) C1,1 Well Owner: Name: Ad ess: Use of Well: 1- primary 2- secondary _>e- Residential Business Industrial Public Supply Air cond/heat pump Irriga n Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment X Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length / q o ft. Length below grade 13F lift Diameter G" in. Weight per foot /6 lb /ft. Materials: Steel _ Plastic _ Other Joints: _Welded >4 Threaded _Other Seal:. e- Cement grout _ Bentonite Other Drive shoe: LC 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 _24 Compressed Air Hours Yield /61*' gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or� are available, please attach. -De th.From Surface. Water Bearing - Well Diamefer(ia) 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 3,taae-, Capacity /0 Depth 360 ' ModeVu�,�-/os°o7 Voltage Zge) t/ HP Tank Type hh(30 )- Volume / L o Date Well Completed A>—f A I Putnam County Certification No. Date of Report / I � %� Well Driller (signature) ./y WYE: Eltact location otwell with distances to at least two perm t J�imarxs .to be provtaea on a separate sneeuptan. 1, �„ 1 r�, Well Driller's Name c' Address: %I Signature: / /oS Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH .. ...:.q.o -.'4: .s �.,..Y..-. <wP•�nr GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM DONALD BROWN Owner or Purchaser of Building DONALD BROWN Building Constructed by 465 PEEKSKILL HOLLOW.RBAD; Location - Street RESIDENCE 73. - 1 , 9.1 Tax Map Block Lot PUTNAM VALLEY Tower #K6Kx BROWN Subdivision Name 1 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 nro erly is ca►_asPd by -. the willfiit Qr negligent act_ of the occupant of_ the building utili,zinR the ...... ...... ........._ _...T L...p - ...�. -. Y.._....- ..- ... -....r W-n �. -- .0+'...-- ...- r-�a. f.. ...r v. ..� ._.__1 v.�.- .._r.. -... __- .�.�..- ...r - .... -..._ �.+... 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. Dated: Month JANUARY Day 18 Year 2000 Signature: If Title: CONTRACTOR (SSDS ) General Contractor (Owner) - Signature Corporation Name (if corporation) Address: .465 .PEEKSKILL HOLLOW ROAD StatePUTNAM VALLEY, N.Y. Zip 10579 Corporation Name (if corporation) Address: 465 PEEKSKILL HOLLOW ROAD State PUTNAM VALLEY, N.Y Z-lp 10579 Form GS -97 GREENBERG Architect TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 JANUARY 21,2000 PUT. COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 0ADAM STIEBLEING DONALD BROWN- AS -BUILT 1-99-04 ILJ�`JJI IIJ�`�IJ�IJI (l�L -1 \� COMMENTS: ENCLOSED PLEASE FIND r FROM J0 ,/j I COPIES TO: r, 91 PRINTS ® SPECIFICATIONS ® SHOP DWGS El SAMPLES 0 OTHER COMMENTS: ENCLOSED PLEASE FIND r FROM J0 ,/j I COPIES TO: r, ® YOUR USE Q REVIEW COMMENTS COMMENTS: ENCLOSED PLEASE FIND r FROM J0 ,/j I COPIES TO: r, Public Health Director February 1, 2000 _..... LORETTA ..MOLLNARI R.N., M.S.N. Associate �'Fub ac ' tieiiiin "iii ictor Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509Q j 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 Joel Greenberg, RA Two Muscoot North, RFD2 Mahopac, New York 10541 Re: Application of Construction Compliance Don Brown, 465 Peekskill Hollow -Road (T) Putnam Valley Dear Mr. Greenberg: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on January 31, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review.- • Submission of Water Quality Analysis, pursuant to PCHD Bulletin ST -19, Table 1, Wat °r Quality Analysis.. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your. application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please contact me at (914)= 278 -6130 extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj YML ENVIRONMENTAL SERVICES ~ 321 Kear Street (914) 245-2800 Albert H. Padovani, Director LAB #: 32.000082 CLIENT #: 4087 NON STAT PROC PAGE 1 BROWN, DONALD DATE/TIME TAKEN: 02/01/00 10:15A 465 PEEKSKILL HOLLOW RD. DATE/TIME REC^D: 02101100 10:50A PUTNAM VALLEY, NY 10579 REPORT DATE: 02/07/00 PHONE: (04)-526-2448 SAMPLING SITE: 465 PEEKSKILL HOLLOW RD. : PUTNAM VALLEY, NY, 10579 COL'D BY: DONALD BROWN NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: C8LIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 02/01/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 02/01/00 LEAD (IMS) 1.2 ppb 0-15 ppb 9101 02/01/00 NITRATE NITROG <0.2 MG/L 0 - 10 9139 02/01/00 NITRITE NITROG <001 MG/L N/A 9146 02/01/00 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 ' 02/01/00 MANGANESE (Mn) <0.010 MG/L 0-0,3 mg/l 2037 'EXJDIUM-(Na)- 7.92 MG/L N/A _ 02/01/00 pH 6.6 UNITS 6.5-8.5 9043 02/01/00 HARDNESS,TOTAL 152 MG/L N/A 02/01/00 ALKALINITY (AS 128 MG/L N/A 0�� -~ �'}��@� L COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) 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. 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 2() mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street 14 ��9���_�' (914) 245-2800 Albert H. Padovani, Director LAB #: 32.000082 CLIENT #: 4087 NON STAT PROC PAGE 2 BROWN, DONALD DATE/TIME TAKEN: 02/01/00 10:15A 465 PEEKSKILL HOLLOW RD. DATE/TIME REC'D: 02101100 10:50A PUTNAM VALLEY, NY 16579 REPORT DATE: 02/07/00 PHONE: (914)-526-2448 SAMPLING SITE: 465 PEEKSKILL HOLLOW RD. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY, 10579 PRESERVATIVES: NONE C0-'D BY: DONALD BROWN TEMPERATURE..: NOTES...: KIT TAP COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB 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, INMG/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 : 0770 � �_ VERY HARD WATER: ABOVE 300 MG/L ---'^'-'NDSAT%WMAXRl> LJATS� �^NE! �L��GRAM- PER 1LITEN- HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) ' SUBMITTED BY: Albert HT A ;Ani,_R&.(ASdFT Director ELAP# 10323 S, NORTHEAST LABORATORY OF DANBURY (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P:F. BEAL & SONS DATE SAMPLE COLLECTED: 1/7/2000 4 PUTNAM AVENUE TIME COLLECTED: 10:00 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: OWNER DATE RECEIVED ,@ LAB: 1/7/2000 DATE(S) TESTED: 1/712000 TESTED BY: LAB #11471 REPORT DATE: 1/10/2000 SAMPLE SITE: D. BROWN, 465 PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, N.Y. SAMPLING POINT: FAUCET _ SOURCE: WELL TREATMENT: NEUTRALIZER TEST.PERFORMED.: RESULT; _ v , _ RECOMMENDED LIMIT BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - -- ml = milliliter mg/L = milligrams per Liter ND = none detected RESULTS BASED ON SAMPLES SUBMITTED: 1/7/2000 SAMPLE, AS TESTED ABOVE: ❑ or AMNOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES \.) FINAL SITE INSPECTION Street Loc � C°, ✓,5 / \� liis ec iGcL�. (�4Gc� Owner Town Permit r `t- Ti\-1 T I ; P ­10. Subdivision 1. SSewage System Area a. STS area located as per approved plans ........................... b:. Fill section - date of placement ):1 barrier Lgth, Width Avg.Dpth c. Natural soil not stripped .................. ............7.................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. optic tan. size - 1,000 ....... 1,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 1. Minimum 2 ft.Original. soil between box & trenches Junction Box - properly set ................... ............................... 1. ength required Length installed c� 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 -1 %2" diameter clean .................... ath- of-g -31K � -12 1m- - _ it t��rih..- �� rr 10. Pipe ends capped .................... ................................ - g. PumD or Dosed Systems Size of pump chamber ................ ............................... 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........... III. HouseBu..,ild�iU a. House of cated per approved plans ............... ............... ... I b. /number of bedrooms ...................... ..............................I IV. Well a. Nell located as per approved plans ............. ..F................ b. Distance from STS area measured X00 ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall `Vorkmanshin 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 ................. ............................... L' r. . � wt rrd" �. SEEN i ISOi� -j ImME Im/1�/���`� IINEWMA ism ', I VIA Ism . � wt AUG-25-1999 11:34 914 628 2807 P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL INSPECTION For: Fill Trenches PCHD Cons ction Permit 9 Located A (MT) (V) Ev w= : OwnedApplicant Name V1h 4 allbxh- TM 7 Block 7 Formerly Subdivision Name Subdivision Lot # Is system fill completed? Date Is system complete? Date r' Is system construcLed as Ver- plans.? Is well drilled? Ket Date Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. PE� RA= FOR. VIADAM 13 GENE Form FIR-99 TOTAL P.02 AUG-25-1999 11:33 914 628 2807 P.01 Mo, IRIT-3099IM: 1WINOogoot Road ivol-Ift Na,'Ivlpd4 Now lrork 10541 f S7 r UNI IUD Rik FAY. mumusam FROM... bfl 'b v. votl uVNT It EcEl VG A LL . PAGES UFTHANSA11851UH, PLEASH CALLUS ,A.V SOON AS PUASIBLO. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE T TEM ,p n PERMIT # Located at PEEKSKILL HOLLOW ROAD Town or 7 KIRK PUTNAM VALLEY Subdivision name BROWN Subd. Lot # Date Subdivision Approved . 12/7/98 Tax Map 7 3. Block 1 LotPp/ O 90 Renewal Revision + ' Owner /Applicant Name . DONALD BROWN . Date of Previous Approval Mailing Address 617 PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, N.Y. Zip 10579 Amount of Fee Enclosed $300.00 Building Type (1 ) FAM . RE S . Lot Area 3.2 8 No. 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 OF 2 FT. WIDE LEACHING TRENCHES Other Requirements: To be constructed by NOT SELECTED Address _ Water.Stinlv�---7_ Public Supply From Address or: X Private Supply Drilled by NOT SELECTED 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 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. Address i MUbCOOf ROAD NORTH, MA40PAC , N . Y . 1 0 5 41 License # 1 1 5 6 APPRO ED OR 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 permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: 3f ab I White copy - HD File; Yellow copy - Bu ding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES W3•'� � tt. �i.i r .. .. .. ... W �:. ~ -sYW.' , yaLr.., ...5ai'il sir.•.: L: TST- 2 � y . 1�R pL ;01C a / w a please print or type PCHD Permit # 17 4V d `t ° Cl / s Well Location: Street Address: TownNillage Tax Grid # PEEKSKILL HOLLOW RD. PUTNAM VALLEY Map73. Block 1 Lot(s)P /090 Well Owner: Name: Address: DONALD BROWN 1 617 PEEKSKILL HOLLOW RD., PUTNAM VALLEY, 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 Lo 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling —X_ New Supply (new dwelling) Deepen Existing Well Detailed Reason NEW HOUSE 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. 1 Water Well Contractor: NOT SELECTED Address: Is Public Water Supply available to site? .................................. ............................... Yes No- X 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 contamina 'o to be provid n separate she `t/plan. Date. - � ��i�,i iLC4lii� uigaatare: - PERMIT TO STRU 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 4g I q1 I Permit Issui Official: V:�' Date of Expiration '3 O Title: i Permit is Non- Trannsferr bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1Y r u i i i Agin %, V U i*l I Y 1)hrAK'1'1V11 M'1' OF 1-1L+'AL''H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR ...A WASTEWATER TRF,ATMFNT- SYSTEM 1. Name and address of applicant: DONALD BROWN 617 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY, N.Y.- 10579 2. Name of project: DONALD BROWN 3. Location T/V: TOWN OF PUTNAM VALLEY 4. Design Professional: JOEL GREENBERG, R.A. 5. Address: 2 MUSCOOT ROAD NORTH MAHOPAC, N.Y. 10541 . 6. Drainage Basin: HUDSON 'RIVER 7. Do 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 (SEQR)? 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. Name of Lead Agency N / A 12. Is this project in an area under the control of local planning, zoning, or other o °aicial� ordina!?�eS? YES- �,.. .. ... _.... ?_ -_. ._ `. -.- ...... _... .___ •- ...�. ems. -. -_- 13. If so, have.plans been submitted to such authorities?......... .. .. ............................ No Jill.. . 14: Has preliminary approval been granted by such authorities? Date gr6ted: 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) ........................................... ............................... 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 oy 21. Name of sewage system N/A Distance to sewage system N fA 22. Date test holes observed 4/15/98 23. Name of Health Inspector ADAM. STIEBELING 24. Project design flow (gallons per day) ................................. ............................... 800 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.............:..... y 29. Is Wetlands Permit required? .....................................:. .:. :.- .�..:�::,:.:.:.;:..:,.... . _ ... _ 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 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 DESCRIBE: 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 ;. No 15.years in or adjacent to project site?.::::.:....: .................. ......:...:.................... 35. Are any sewage treatment areas in excess of 15% slope? ............................ NO 36. Tax Map ID Number ............................................................... ...... .. : ..:....:...:....:. :..:.:..:. :.................. Ma p 7 3 . Block 1 Lot P / 0 10 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and approval of anew SSTS to be lo_ catd.d w_ ithin the NYC Watershed shall .•� _ .tutu 1.1 %1U�111CiQt� tV Lll� Dl r; a�il�uugh iheprujeci may require i�EY 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 l .,the application must be accompanied by a .Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICUL TITLES: OWNER Mailing Address :.... ...........:................... 617 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY, NEW YORK 10579 r tl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at T/V PUTNAM VALLEY Subdivision of Subdivision Lot # Gentlemen: DONALD BROWN PEEKSKILL HOLLOW ROAD Tax Map # 73 BROWN 1 Filed Map # 2778 Block 1 Lot P/O 90 Date Filed 2./24/99 This letter is to authorize JOEL BERG, R.A. a duly licensed Professional Engineer or Registered Architect x 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 tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health • rYy Very truly yours, Counters' Signed: E, - P.E., A., Y (Owner of Property) 0. CIA m Mail g ddress 2 Mailing Address: 617 PEEKSKILL HOLLOW ROAD MAHOPAC PUTNAM.'VALLEY State N.Y. Zip 10541 State N.Y. Zip 10541 Telephone: 628 -6613 Telephone: 528 -2940 Form LA -97 1, !b- 4(9 /95) -Tex1 Iz 617.20 Pk.ojnGT I.D. NUMRRft Aj+Tx,nrlix r'. SJ;tj._ _ nt:�F=fi�ity?�futiv:t.: SHORT ENVIRONMEN'T'AL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Spomgbr) . 1. APPLICANT /SPONSOR 2. PROJECT NAME DONALD `BROWN DONALD BROWN 3. PROJECT LOCATION: Municlpallty TOWN. OF . PUTNAM VALLEY COwr'Y PUTNAM . 4. PRECISE LOCATION (Street address and road Intersection, prominent Imidmarks, etc., or provide map) PEEKSKILL HOLLOW ROAD S. IS PROPOSED ACTION: . X3 New 0 Expansion O Modifi6tion /Alteration 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE ?. AMOUNT OF LAND AFFECTED: . Enitlany 3`.28 acres Ultimately 3.28 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? lXYes 0 No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? dXResidentiat 0 Industrial 0 Commercial O Agriculture .. O Park/Forest /Open Space 0 Other Describe: a _ -� . _ _ _ - �...- - v...- ...�z- ..z•w...+.w.. -ve..• sr•o�a"•. e. w�w.s•.ar -.. . r -..:.0 .. •_ - ..s.... +m.- , .orr to. DOES ACTION INVOLVE A PERMIT-APPROVA4 OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ADEN( FEDERAL, STATE OR LOCAL)? .. EYYes 0 No U yes, list agency(s) and pennit/appmvals PUTNAM'COUNTY' HIGHWAY:nEPT. & PUTNAM VALLEY BUILDING DEPT. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? O Yes 0 No If yes, tilt agency name and pennit/approval 11 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? 0 Yes 0 No I CERT THAT THE INFORMATION PROVIDED .ABOVE IS TRUE TO THE, BEST OF MY KNOWLEDGE Appll : 3po Name: DONALD BROWN Date: __,I 2 A 9 Signatures PROJECT ARCHITECT u If the action is in the Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment R LNtYll2fiN[�iEN liYf: 7t ySiSSMENT (7 u'!ic'ciiinpleiu] by Ag iicyj' s A. 1)t7MS AMON 17,Xr r-F-d) ANY TYI111 1'1• IRRSIK)I.0 IN 6 NYC IM. 1'Awr 617.4? Ir yrv, ccxirdhmly 1hr. wvir.w ljime- w mid uw: Iht+ 1 1.11.1. 13A1 . U Yes 13 No B. WILL ACTION RECEIVE.COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTION IN 6 NYCk PART 617.67 If No, a negative' declaration may be superseded by another involved agency. O Yes O No C. COULD ACTION RESULT W ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWINO: (Answers may be handwritten, it legible) CI. Existing nlr quality, wiface or groundwater qunlity or quantity, nolse levels, existing trdfic 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 wildlife species, significant habitats, or threatened or endmngered species? Explahn•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. c -tclb ltduce -by t ie iruposed-acdon? lk C6. Long term, short term, cumulative, or other effects not identified In CI -05? Explain briefly: C7. Other hnpacts (includhtg changes hi use of either quantity or type or energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CPA? O Yes O No E IS THERE, OR IS THERE LIKELY TO 1313, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 13 Yes 0 No If Yes, explain briefly: I'A1t 1 111 1)I I'IiItMINA'I'IUN (')1+ SIONl!'ICANC1: ('110 Ixt completed by Agency) INSI'1 {I1C. "I'IONti: Per ijrc•h ndvrtxr. ale'a idcnlifirvl :dhow., delcrminr, whcil;ri• it i+ tinl�sl;udi.�l, I:nl , inilxnl;u�l ui �Ahr�wi�u signific ;mt, Inc ..olfuii should he trssmud in connection with its (a) selling (i.e. urban ar..nu;�l). (h) t,roh;ihilil or ort:urring; .( c) .durnli;m;.(d)'irRti�;txl >!fily; ( ; .s _ .gcogrn!►hwc ctJx; tuic(_��_trta�nilucle � nc s�;v,:rui!� slit iieaie► fs ifF-i u- R,lc�c siippini g lti ft riiiiti " rt`sor� th,d "cxplt►ni►iions con(nin sufficic:; nin . � 'tldti 'lo''s7row iiiarflil relevmrt adverse impacts have been identified and adequately addressed. If gtwzlion D of fart if was chuck_ ccl yes th detenninatioir and_ significance must evaluate the l0ential unpact.. Chock this box If you have identified one or more potentially large or signii'icmrt adverse inipicts which MAY occur. Then proceed dlroctl y. to the FULL EAF and/or prepare a positive dccl arali on. O . Check this box if you have delennined, basal on the Information mid analysis above mid any supporting docun►entntion, that the proposed action WILL NOT resuli in any significant adverse environmental impacts AND provide on attachments as necessm*, the reasons supporting .this determination: i., Nmne of Lead Agency punt, or Type Name of Responsible Office in Lead Agency Title of Rtwponsible Officer Signature of Responsible Officer fit Lcad Agency Signmure. of Preliaror (if (liffertad form responAble officer) 0 PUTNAM- COUNTY DEPARTMENT OF HEALTH Lot #1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES x DESIGN DATA SHEET - SUBSURFACE. SIE�?t'A,E „TREA'ME1T SYSTEMrt - Owner Donald & Richard Brown Address 617 Peekskill Hollow Road Located at Street Peekskill Hollow Road Putnam Valley RI.Y. 1 0578 (Street) Tax Map 7 3 Bloc� I_ Lot 9 n R g a (indicate nearest cross street) Municipality Town of Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre- soaking 4114/98 Date of Percolation Test 4/15/98 Hole No. Run No. Time Start - Stop Elapse Time tMin.) Depth to Water . From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 1 3:01 -3:26 26 22” -25" 3 26/3- 8.66 2 3:27 -3:53 26 22 " -25" 3 26/3= 8.6, 3 •54 -4:22 26 22" -25" 3 26/3 =n8.6 4 5 2 1 3:03 -3:30 27 21' -'24" 3 27/3 =.9 3:31-3:58 Y 27 wr -` 21"-24 3 27/3= 9 3 3--59-4:26 27 21 " -24" 3 27/3= 9 4 . y .5 2 wtt 3 4 5 MUTES: 1..• Tests to be repeated at same depth until approximately equal percolation rates are obtained at 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 F: submitted for review. ` 2. Depth measurements to be made from top of hole. -97 Form DD TEST, PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -i;D�PTHTw.n k" ... .. -. r et••:: ee �: eK., .. ... .. ,r HOLE NO. i HOLE NO. 2 HOLE NO. G.L. T62PSoil Top Soil 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5', 5.01 1 5.5' 6.0' 6.5' 7.0' 7.5' - Red,Brown Red, Brown, Sandy Sandy Low Loctm Medium Brown Medium Brown SandyLOOM Sandy Loam t 2' r 8.51 9.5' 10.0' Indicate level at which groundwater is encountered none Indicate level at which mottling is observed N/A 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 M11cf -cf-A Rd N4rt r MahoDac. N_'Y.^1n541 n Signature 11 EaED 4RQ �, "'J4 0-0110 0 0,j a' BRUCE R. FOLEY Health•'1?zrector LORETTA MOLINARI RN., M.S.N. - Assocrate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 TO: Design Professionals submitting plans to CHD FROM: Bruce R. Foley, Public Health Director SUBJECT: New Requirements for Construction Comp nce Permits - E911 Address DATE: April 13, 1999 Effective June 1, 1999 all submitted Construction Compliance Permits are to contain the assigned E911 address at the "Located at " section on the form. The following names are the contact persons in each town to obtain the E911 address: Carmel: Michael Carnazza, B.I. Carmel Town Hall 60 McAlpin Ave. Mahopac, NY 10541 628 -1500 Philipstown: Thomas Monroe, B.I. Philipstown Town Hall 238 Main Street Cold Spring, NY 10516 Kent: Julie Butler, B.I. Putn Valle ittoria.Colle5anti,(T - P1annia, _ n : _- - • :_ r -.. -- K- en.= ToW;n.1-lall ...:: 531 Route 52 265 Oscawana Lake Rd. Carmel, NY 10512 Putnam Valley, NY 10579 225 -3900 526 -3740 Patterson: Richard Williams, (T) Planner Southeast: eather, Deputy B.I. Patterson Town Hall Southeast Town Hall 2 Route 164 1 Main Street Patterson, NY 12563 Brewster, NY 10509 878 -6319 279 -5698 Be advised, no Compliance will be issued without the current E911 address. Thank you for your cooperation. BRF:cj cc: Mario Rampolla Donald Smith George Michaud