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Home My WebLink About3534DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -9.18 BOX 28 03534 .. ..L ',� ~� ` i I I , ' I� 21 i , ;rhim 11 it I I JL .T ., 03534 11hi**0 COUNTY DIMATtTl�N ', OF HEALTH ^' N.Y Eo>�eer Moot Ptle" 11 A 6 -JA 4. N CA OF CONSTRUMON 6iMPLL4NCE-FOR,SEWAGZMISPOSAL SYSTEM Fy _PIYMAM VATJ 18 . '71 "r" Ilb ��l 7, 0 7 ORTHtMEADOW: ER, Name MP MaM Ad&ki t,.:. zip subdn of �� ——` A -96: Fee; Enclosed Permit. t i s . PADEN -CONSTRUCTION -CONSTRUCTION N Y- lQ544 GaHon'Sev c "k-Mdl57? T !OF TM=G- 1 250- d'T' d wain 1 PabUte Supply From -Addreig- -S AAdriis Ik,.JTNM VA=, N.Y M" UPP iidbyMR imn Rppil- rnmp 1 tl:P(I vp Bau Tyw, (I FAM.'�- RES., Lot i 10579 9 m A 4 llm�Wof Bedroo ag Omer R �G,sh� 'piiits of the completed w6AA copies ye, premises "Y�� 'ti Y, "t. 6�4' sy-iieo(q) ;ap filed. e of which attached), -and 'in'acF"n!Fe-.yA" the.'standaids,: n 'I ce"ih v thwj;e�rmit issued by the '' Pil 6" County Department ' — ' -Cortif PAE., RA,Y, A 1 /15/96. "nom No. t o the co rr to., :,wtig n= ectibri of my unsanitary Ariy,p &'pub d P!S'n! co6ditions' resulting from such* US04L ow it tz: mnRWy nwa beconm Pr ilabl& ' Such opprovals We ble�41 8PRF I Of the Ivati, I a- b" nm ova ivalli d' 6' ilwtl the L hi. Is T it L Date 77 7 7 3/89 7 21 co- wzijL %jV1.1rLj1;11V" Lxj;..LWLXJI office Use Only DEPARTMENT OF HEALTH � 4. b'1V1*9io6'Of -Enviionmental 6t -h 'Serv, PUTNAM COUNTY DEPARTMENT OF HEALTH STREET DURESS /6'r-779 TAX 010 NUMBER: WELL LOCATION —ko WELL OWNER NAME: ADDRESS: (3 PBIVATE 1 0 PUBLIC USE'OF WELL 1 - primary 2 - secondary 13 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED 0 BUSINESS ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE _.� �00 gal. REASON FOR DRILLING L[]REPLACE EXISTING SUPPLY []TEST/OBSERVATION []ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) [3DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH &/" -0 " —ft. I STATIC WATER LEVEL — ft. DATE MEASURED I-,Z2 LM DRILLING EQUIPMENT 9 ROTARY ❑ COMPRESSED AIR PERCUSSION 0 DUG 0 WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING 2 OPEN HOLE IN BEDROCK 0 OTHER CASING TOTAL LENGTH tL MATERIALS: 0 STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE —A _/L ft. JOINTS: 0 WELDED 0 THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: &CEMENT GROUT OBENTONITE OOTHER WEIGHT PER FOOT 17 Ib./ft. DRIVE SHOE. EIYES 0 NO I LINER: 0 YES SNO SCREEN DETAILS-.- DIAMETER (in) 'S LOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST . OJES 1 0 NO Rip. GRAVEL PACK 0 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH —ft. BOTTOM DEPTH — WELL YIELD TEST -'If detailed pumping I METHOD: ❑ PUMPED i tests were done COMPRESSED AIR !ormation attached? 0 BAILED ❑ OTHER :,0 YES 0 NO It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH Faam suswe ""' Bear- ing Well oia- meter In FORMATION DESCRIPTION mot It tt WELL DEPTH ft. DURATION hr. min. ORAWOOWN It. YIELD 9PITI. Land Sur(ace 27� 6/ WATER )a CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED. 0 YES ONO STORAGE TANK: T Y P E Pal'- C CAPACITY PUMP INFORMATION TYPE CAPACITY 11 MAKER DEPTH MODEL VOLTAGE 2-70 HP I WELL DRILLER NAME DATE ADDRESS GUATURE leu 97 .7y j �JV'13 (J : -*I V) "1 "W `TUeACipErj °H 4•JEgIV ' NO 1103 -1 '10 -D AO 3W 113HJ_ 1V `ii31:331 S8313WVJVJ 3H1 803 `Z'.GHVQNUlS 831VM EINI.*IJi3 VJ3 aNa 31ViS .18►: A M3N 3HI All-IM-10 AJVI,I NV's. A8i_il _lV dS I 1V:= V J0 (10N SVM) n 831VM 3H1 1VH1 31V;:i I SIN I Sill -IS38 3:33HI lo vG- : S1N31 ,JWI_I:_I . . 1N3S8V -1W ()()I/ 1.N3_GV WJoJI70o "I JW 961LOII T GOH13W 3EINV8 - r1VW4; --;N 381iI: A3OJJ OVIJ 31Va J : H13W W-10J I -103 3SOH : " ' S310N Ot "I . 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DATE/TIME TAKEN: 11/07/96 10:55 152 BARGER ST DATE/TIME REOD: 11/07/96 11:30 'PROJECT 50 #2 | REPORT DATE: 1 1-/11/96 PUTNAM VALLEY, NY 105179 PHONE: (90)-W-1491 ^ SAMPLING SITE: NO. MEADOW LANE SAMPLE TYPE..: POTABLE : PUTNAMVALLEY . PRESERVATIVES: NONE COL'D BY; SARAH ANDERSON TEMPERATURE..: { 4C NOTES...: HOSE COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 11/07/96 MF T. CQLIFORM ABSENT /100 ML ABSENT* COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A |j H|�5FHC|URY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. ^ � SUBMITTED ' Albert H. Padovani, M.T.(ASCP) ` Director ' ELAP# 10323 PU NAM COUNTY DEPARnMU OF HEAVIR DMSION OF ENVIROIZ=AL HEALTH SERVICES MICHELE ANDROBERT GREENBERG Owner or Purchaser -df Building DON PADEN Building Constructed byi 10 NORTH MEADOW LANE Location — Street TOWN OF PUTNAM VALLEY Municipality ONE FAMILY RESIDENCE Building Type . - _ � .. - - .. 'sue.- .,.�;.�.. � • . 74. 1 9.18 Section Block Lot JUNIPER Subdivision Name 8. Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of'the sewage disposal system serving the above described property, and that it 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 disposal. system, -oz repairs•..made b- me- to sach:: system; .P .ept .wt ere�the fa luie~to~=upe2'ate ` properrTy is 6 caysia by the willful or negligent act of the occupant of the building utilizing the. system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the pil County Department of Health as to whether or not the failure of the.syst ' ate was caused by the willful or negligent act of the occupant of the b i utilizing the system. �"\ - Dated this 15 day of NOV. 1996 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. .9/85 mk Signature Title PRESIDENT PADEN CONSTRUCTION CORPORATION Corporation Name (if Corp.). KENNARD ROAD PUTNAM VALLEY Address NEW YORK 10579 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO1WMAL HEALTH SERVICES R MICHEELE ANDROBERT GREENBERG 74. 1 9.18 Owner or Purchaser.df Building Section Block Lot DON PADEN Building Constructed byi 10 NORTH MEADOW LANE Location - Street ' TOWN OF PUTNAM VALLEY Municipality ONE FAMILY RESIDENCE Building Type - JUNIPER Subdivision Name 8 Subdivision Lot- #-- -_.. GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of'the sewage disposal system serving the above described property, and that it 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 "Certifidate of (tonstruction Compliance" .for the sewage disposal s�,-sten' or- any xe - 'a rG .m� de ?��> i� t ., .ct.:,t s � « �� e° i. whzre "-tile" failure to operate Pa 1. r P P Properly is caused by the willful or negligent act of the occupant of the. building utilizing the system.. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the t County Department of Health as to whether or not the failure of the cyst to �1 ate was caused by the willful or negligent act of the occupant of the b i utilizing the system. Dated this 15 day of NOV. 1996 Signature General Contractor (Owner) - Signature Corporation Name (if Corp.) .Address rev. 9/85 mk Title PRESIDENT PADEN CONSTRUCTION CORPORATION Corporation Name (if Corp.) KENNARD ROAD PUTNAM VALLEY Kd&ess NEW YORK 10579 YML_ ENVIRONMENTAL SERVICE 321 Kear Street Yorkt'oWn He i.Ahts, N.Y. 1059-3 . (914) 245- •2800 Albert H. Pa davani, Director LAS #k: :32.418442 C(IENT 0: 2173 NON 'STAT PROC PALE 1 -r✓---- .. ✓ -/ YN/✓I✓ -r✓ Mr✓ -. v-N--r✓-P✓P✓--I✓-N-- -- -- ---- I✓ Nr✓I✓ I✓I✓I. I--IJ--I✓ r✓ I✓. vLP✓r✓I✓I✓r✓---- r✓-rJY✓-- --1✓ NORMAN ANDERSON-INC. DATE /TIME TAKEN: 11/07/96 10:85 . 152 BA(,GER ' ,r DATE /TIME REC'D: 11/07/:76 11:30 F'f=t+mi,_1ECT 50 #2- REPORT DATE: ti / 11/96 PUTNAM VALLEY, NY 10`579 PHONE: 0914) -b28- 1471. SAMPL I NQ SITE: NO, MEADOW LANE SAMPLE TYPE" .. % POTABLE PUTNAM VALLEY PRESERVATIVES NONE i::OL' D BY: SARAH ANDERSON TEMPERATURE..: 040 NOTES. HOSf.::: � OLIFORM METH: MF DATE FLA► PROCEDURE RL::suL_T NURMAL RANGE METHOD 11/07/96 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: : BACT THESE RESULTS INDICATE THAT THE WAT N3 WAO ) H WAS NOT) OF A SAT I SFACTORY SANITARY QUALITY ACC ORD E NEW YORK STATE AND EPA ' FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETER; TES=TED, .AT THE TIME OF COLLECTION. SUBMITTED BY!- Albert H. P dovani, M.T.(ASC:P) Director ELAP# 10323 V - FD'l1ilAM COQN'1'Y DSPAff�WN1' OF �LTH Dbtdee d lMybemeaital 8=66 Saevloew-. taairi . N.Y. lim inghweir eo Provide Peaoik if a CS41fFICATZJJIF DD DO MON.,1RUd FOR.SZ*A=.DBlOSAi ST91M . `- TOM OF' un-o"d NORTH ME AD_C.�W :: LANES _ owe im digs '~ SebdlvlaM. Name - JUMPER ~PROPERTIES : c.� Let N -8 ` ~ — ' • ^Ts: Map 174. ` - > :9..8 MIMELE & . -ROBERT GREENBERG RmewW— ❑ RbvWM p . Omm/AWAmet Nnlils - Date of P-16- ApProvsl '` s A�.M 44 PENELOPE .COURT Tows MAHOPAC 'N.Y. 10541 . FILED 5�:6�96 Amrnlrit- ZIP Date Subdivision A_pnroved Fee Enclosed- ® 300.,00 JBWMbg THx, ONE FAM. RES. lst Am 3.0005 ACRES Pp secnon ow Depth vas Nwmbeir 01 Bedrosale 4 Design now G P D 800 PC® Notl mtkn )e Betjaltmd Wbee FM )e mgieted Sepeetite SswenV SYptes to 000" 011250 Gallo. Sepdc Took Mod To be ema4■t4ed by PADEN CONSTRUCTION A.—KENQARD ROAD, MAHOPAC, N.Y. 10541 WMW SoP*: - Pd ft Stapp Firm Addm= an . XX & SW, DMW by N. ANDERSON srtd..=BARGER ST., PUTNAM VALLEY, N.Y. 10579 Od. b (1) FT. TO . (1 .5) FT ... BANK ' RUN FILL TO REGRADE TO 15% 1 represent that'l am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew di HI i stem above described will be constructed as shown on the approved amendment thereto and in accordan with the standards, rules a repu ns o e u nam County - 6ipirtmept of health, and that on completion thireof a, "Certificate of. Construction pliance•' satisfactory to the Commissioner of H"Nhwlll be suOmHtad to: the Department, and a written guaratntee.wih b� the owner, his su i, hairs or aligns by the builder, that said builder will plate M good opeiatblg condition any pert of save swraga 4i500'? sydelll., urirq the per O two (2) yeas Im lately following thedete of the I=- sows of the bliroval of the Certificate of Construction Compliance thwo . final system epairs thereto; ) that the drilled well.described above will tea IoeataA as shoargon the approved plan and that said. wall will ba Instal i` is ce wl t itandardi, r s d r u ations of the Putnam County Department Of Health, We 5/31/96 Sign. P.e.— a.A.X TWO MUSCOOT ROAD C, 11056 Address tense No APPROVED FOR CONSTRUCTION: This approval expires two years, ram t date issu unless construction of the local ing Ms been undertaken and is revocable for cause or may DO amended or modifie0 when considered n ►y Oy the mmissionsr of hfeenn Any c e or alteration of construction ►eouira$ a new mit. Approved ford sal of domestic sanitary and /or priva ter supply only. Rev. 10/88 oate � ey =�� — Title In e� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New-York 10509 (914) 278 -6130 APPLICATION `TO. CONSTRUCT -`A WATER WELL PCHD PERMIT -� WELL LOCATION Street Address Town/Village/City Tax Grid Number NORTH MEADOW LANE TOWN OF PUTNAM VALLEY 74. -1 -9.8 WELL OWNER ROBERT Mailing Address ROBERT GREENBERG, 44 PENELOPE BBPrivate CT., MAHOPAC N.Y.10540 Public USE OF WELL 0 - primary 2 - secondary PRESIDENTIAL 0PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL O INSTITUTIONAL OAIR /COND /HEAT PUMP ®ABANDONED O TEST /OBSERVATION ® OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 300 Sal ® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 13 ADDITIONAL SUPPLY ® NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING NEW HOUSE WELL TYPE ®DRILLED OD RIVEN ®DUG ®GRAVEL. OOTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: JUMPER PROPERTIES Lot No. 8 STATER WELL CONTRACTOR: Name NORMAN ANDERSON Address : BARGER ST., P . V' 8 N . Y IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY -DISTe ICE' TQ. _PR,AP9,47jX_ ];RQM_NgW$T -WATER MAIN: -. N /.A, LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET 5/31/96 (date) ftsignap6re PERMIT TO CONSTRUCT A WATER This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise co n rface or groundwater. Date of Issue : c��-.P 1 f 19� Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller „ I)mSKV OF ENVIRUCAiL�TAL IIEAUI'H SMVICES SL;C'T'IUN_II��LUT__ h JMSIGN DATA SIIIKC.'- SUEQSU,rACS Sr!WAGE DISF'OS11L SYS'T'EM FILE a). ROBERT GREENBERG 44 PENELOPE COURT, MAHOPAC, N Y. 10.541 Owner hdclress - , Located at (Sb.eet) 1311RGLIt S'T'IZEE :'T' _ Sec. 14 • Blcxxlc 1 I_'ot 9,8 (i.nd.i-c -ate. nearest. cross str.ec�t) - - - - HirAcipality TOWN OF PU`T'NAM VALLEY Watershed HUDSON RIVSR W L PE WLATION TEST LAIW RR QUMED 'T0 BE SUDII'T'T'EU_WIliI APPLiC;Nrl( -NS Data bE Pre - Soaking 1 / 1 / 9 3 - -� Date of Percolation Test 1 / 1 / 9 3 HOLE -- - -- - -. NUS M- MX Y, 'T'TME PL_1ZCQT.,l1'I'IUN PERWLA.Tlw RUIi -_ El,ipse Depth to Wabz -r.Fan Mater Level - - -- Rdi '1'i.rrn Ground Surface In Indies- Soil Rate btaA -Stop Min. Start Stop, Drop In Min/In prop - __ -- inches _ Inches Indies : 1 0 -1 : 40 30 24 .5 26..25 1 .75 30/1 .75 =1 7. 1 II -1 2 1441 -2:11 30 24.5 26.25 1.75 30/1.75 =17.1 3 2:12 -2:42 30 24.5 26.16 1.66 30/1.66 =18.1 4..2:43-3:13 241:5 26.16 .1.66 30/1.66 =18.1 2 11 :12. -1 _92 30 24.5_ 26'.25 -, 1 .75 30/1 .75 =1.7.1 1 14 :_ .._.. ... �:�....3_ .. 2 _ _ r _.� . _. 3 . 0w .. y .... 2.4:, S .. ... . _ _ ____: _- ...,.::.� -. -7 5- " =;:� C� %.1..,.z5 T•1-• : 1:'.. � , ... _.. 5 1 I .2 3 2:14 -2:44 30 24.5 26.16 1..66 30/1.66 =18.1 2:45 -3:15 30 24:5 26.16 1.66 30/1.66 =18.1 NOTES: 1: 'I sis to .bn zepetntrd at saurr, depth until. approxirnr�ately equal soil rates are bbEai.ne�i ,at each percolation test hole. All data to be submitted for revir:�111. 2. Depth rrr_-asu.rrim nt:s to he merle f.ron top of hole. tov, 9/85 TEST PIT DATA- DESCRIF.V] JAM4 1101ri, wi. DTH 1 SM111TE0 WITH AP 110T.,r3 W). DTH 2 7- S, ji 41 SANDYLOAM & SANDY LOAM & MEDIUM 21 MEDIUM STONES 31 41 6 71 12 STONES If m HOLE W.). Ngf,7y, LA;l Al Y AIU N1 W-Cl I LER I,, Et I • MR GrICUINDWN." 0 )Cb0N1"k_ 1WtWt ttvm TO WILICH WATER LEVEL RISES AFTER BEING F t,=UN,.rERED NONE. U 'HOLU 013SERWrIONS MADE BY: JOEL GRE . ENBERG, R.A.- DATE: 2/8/93 W` DESIGN 8dd tAEd Used 1 6 =20 Min/P Drop: S. D. Usable Area Provided 500 S.. F. Ndi bt 8edroctlls 4 Septic Tank Capaciljy 1250 coals . Type CONCRETE Ab§bfbLlorij rea Provided By 572 L.F. x 24" wid ft. -1 .5 ft. taper6d bank run fill sectirl x br to ing grade... -to Q, .,Kwtd.JOEL GREENBERG, R.A. Signature 0 Add,ft§d TWO MUSCOOT ROAD-NORTff SPAL MAHOPACi NE WYORK 10541 0 THIS M EyJR USE BY 11CALT11 DEPARIMERP ONLY - .9011'MtO Approved ....... Sq - f L/qmal Checked by _._..__._.__ t e PUTNAM COUNTY'.DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - Date 5/31/96 Re = Property of_- MICHELE &'RROBERT . GREENBERG Located at NORTH MEADOW LANE (T) PUTNAM VALLEY Subdivision of Subdv. Lot # Gentlemen: I Section .74. JUMPER PROPERTIES Block 1 Lot 9.8 2617B 5/6/96 Filed Map # Date, —_____ This letter is to authorize JOEL GREENBERG a duly licensed professional engineer --or registered architect X' (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in "c'onne'tiori wtn "tns matter' anct to supervise' the "`construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law; the Public Health Law, and the Putnam County Sani- tary Code.. �gE0 -4R FtENc C / 26 n Counte i 0� A - � o P.E. _TW_0_MU _ ROAD NORTH Address MAHOPAC, NEW YORK 10541 628 -6613 Telephone -------------------------- Very t Signed 44 PENELOPE COURT -- --------------- - - - - -- Address . MAHOPAC, NEW YORK 10541 - -Town 628 -4726 Telephone - - -- r�,—i P1tJ'TNAM COUNTY D)CL��,..IL�'MJCNT O.F' I3EALT)FI APPLICATION,.FOR APPROVAL,.-OF PLANS .FOR „A .WASTEWATER DISPOSAL SYSTEM 1.. Name and Address of Applicant: MICHELE & ROBERT GREENBERG 44 PENELOPE COURT MAHOPAC, NEW YORK10541 2. Name of Project: NEW RESIDENCE 3. Location T /V /C':TOWN OF PUTNAM VALLEY ARCHITECT 4. Project : JOEL%:R BERG, R.A. 5. Address: TWO MUSCOOT ROAD NORTH MAHOPAC,.NEW YORK 10541 License Number: 11056 Phone: 628 -6613 6. Type of Project: X. Private /Residential Food Service T Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project. subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I... Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? NO 9. Has DEIS been completed and found acceptable by Lead Agency? ......:.... N/A 10. Name of Lead Agency N/A 1i. Is ah.is pro3e.ct -. .n. an.area under :the control of local-.,p.lannin9, .zonin,� ”' or "otherToficial's,�ordinances? ........ ...... ............... 12. If to,.have plans been submitted to such authorities? NO i3. Has preliminary approval been granted by such authorities? N/A Date Granted: 4. Type of Sewage Disposal System Discharge...... _ Surface Water * *. Ground Waters 5. If surface water discharge,'what is the stream class designation! .......•. N/A 6. Waters index number (surface) ....... .. ... ........................ NI-A 7. Is project located near a public water supply system? .................. NO 8. If yes, name of water.supply N/A Distance to water supply 9. Is project site near a-public sewage collection or.disposal system ?..... NO 0. Name of Sewage system N /A. Distance to sewage system. 1: Date observed: � 2/8/96 � 23. MICHAEL BUDZINSKI Name of Health Inspector: 4. Project design flow (gallons per day)... ............................... 800. 2. 25, Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. N0, 26. Has SPDES Application been submitted. to local DEC Office? ............... n/a 27. Is any portion of this project located within a.designated Town or State wetland ?...... .. .... ................. ............................... NO 28'. Wetland ID Number ...................... .................................... N/A 29. Is Wetland 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 or NO NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source.of contamination? ...........:..YES or NO NO DESCRIBE: 33: Is there.a local master plan or file with the Town or Village? . YES 34. Are community water, sewer facilities planned to be developed within 15 years? NO. 36. Tax Map ID Number ............ ............................... 740 -1 -9.8 ARCHITECr' 37. Approved Plans.are to be returned to: Applicant X Dwbow If the application is signed by'a person other than the applicant shown in Item 1, the appli•catioh must be accompanied.by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjuqan at informb f orm is true to the best of my knowledgbelief. heroin are punishable a a A Misd r pursue t the Penal Law. SIGNATURES & OFFICIAL TITLES: I BAILING ADDRESS: \1_1101M - OPAL, NEW YORK 1051 ion provided on this Ise statements made to Section 210:45 of PRO= ARCHITECT r �. PUTTAM COUNTY DEPARTMENT OF F?EAL'f .: HOUSE PLANS APPR(j %FD FOR BEDROOM COUNT 01'rL'1; ZZEDROOMS " 4 iigaat=o$TItls�. Dad t E P� 617 em G w T GA9- AC,1_ Ia 1 u 141>.'L51 -1142" (3)2yI2\V 17 6, &,ou 4' S1 G" yG "lo'D° X2;0 `3" 14'-0" Chu 24210 G "xGgSt_1oe� . _ .IN up Noo r- AMI L QtA 1h4 o \VS ai C-Li. P, C- - 12' � "x13'0° 8' -i "x13" 14'x13' uNiE!, -S tIOTEp m 4'y rn REF. + 1 G „ r a wbia DeY DN pµ 11AL_L cl... .. t 7��T- N f s DIN. e-M _•' - o2oDM P�W_ o M 611e'- �o2'ko13o'M ' " IIx13 y2xA.n "1' 1,3 1.0.1 . . 11'x I-7, -2" aei �,2x1o3o' •o " N � I 1 - L _ 4 • 4" 3'0" 3, 2, �,2:, 13 4 3'•0" Q •O Q 1 I '. — - v c) e-'- w .T —` --= e 0 1N T:) L o o -r-?L,6 Q - IL c. oil r �. PUTTAM COUNTY DEPARTMENT OF F?EAL'f .: HOUSE PLANS APPR(j %FD FOR BEDROOM COUNT 01'rL'1; ZZEDROOMS " 4 iigaat=o$TItls�. 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