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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.14 -1 -25 BOX 29 ■ . „ Is ills ILI III Im Is r J ., A �r ,, i, ' r I,� ti ii , 9 , 'r !� :� MEN I 03661 9 T � PUTNAM COUNTY DEPARTMENT OF HEALTH_r 6 Division of Environmental' Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM �i ��� ����' Town or Village w� ,� (�j.„ 6- eaD Lot Subdivision Owner Building Type G3 �w i i i �-- Lot Area l : Cd -4- Number of Bedrooms 3 _ Design Flow 2- i2r2 151 �s` l� fl$t9`y1 Total Habitable Space ���i -� i lr� Square Feet Separate Sewerage Systemrr'to consist of Gal. Septic Tank and h J (mil `2,f'es To be constructed by V- V, Address �7L�f lei (-1ei6 i C�nf i'11 A 4�,1 Water Supply: Public Supply From i Private Supply to be drilled by r 1, Address Other Requirements I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o the u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health 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 disposal system during the period, of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or .any repairs ereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed ; n actor nee th the " /d/:Sles and regulat�'ons of the Putnam County DeparNNtm nt of !Health. \Date (_ 1 l a Signs . 16-- ° / 4� P.E. R.A. Address License No. -- „PPROVED FOR CONSTRUCTION: This approval expires a yea fropthte nless construction of the building has been undertaken and is a !ocable for cause or may be amended or modified when onside necesioner of Health. Any change or alteration of construction `uires a new permit.. Approved for disposal of dom itary se ater supply ly. �e ADS �' /��% B Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Em- dro,amental Health Services,. Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION CO �'�'tJ Village CERT COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Town or village 1 O ��j �� �4� 1� Tax Mal'G- �� Block Located at i'! . ���� M />, Tax Map Lot # _ Suba. # Owner V.p (4!E -- Address �✓. -�O'-a_x) c Separate Sewerage System built by t r� �� , Consisting of t 000Gai. Septic Tank and Other requirements Water Supply: Public Supply From Private Supply Drilled By,� !� Address Q t-J” i� r Building Type No. of Bedrooms Date Permit Issued Has Erosion Control Been Completed? i certify that the system(s) as listed serving the above premises were constructed essentially as shown on the sans or cpe ccmpie - , --- of which are attached), and in accordance with the standards, rules and regulations, in accordance with the f e plan, and the permit issued by the Putnam County Department++ of Health.. �. Certified by °°" P.E. R.A. Date ' A-, g ,4468 Address �" G License No. 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 sewerage 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 YAW when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Commis oner o Health, such revocati ,modification or change is necessary. �--- I `'9 Title .�'(G YORKTOWN MEDICAL LABORATORY INC. PA Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 245 -3203 DATE COLLECTED RESULTS OF EXAMINATION OF WATER DWNER DATE RECEIVED CITY, VILLAGE, TOWN &/OR NAME OF SUPPLY / DATE REPORTED C SAMPLING 'POINT. ceg BACTERIA PER ML .(Agar plate count at 35o C). CTOLIFORM. GROUP (Most probable No. /100m1.) HARDNESS, TOTAL -ppm DETERGENTS= D1 c NITRATES (as N) - Mg /L IRON, TOTAL - mg /L AMMONIA, -F EE as N M— L These results indicate that the water was /O(,., of a satisfactory sanitary quality when the sample was collected. A. H. PADOVAN 1, M. T. (ASCP) I JT PUTNAM COUNTY DEPARTMENT OF I.TEALT DIVISION OP FNI"IRMENTAL HEALTH SERVICES Date 1.4- -77 Re: Property of Z' -/ 4a 22t _J _Ct el' .512 Located at WT Section Block Lot Gentlemen: This letter is to authorize. T. MIMAEL DALY P.E. 'a duly licensed professional er x -engine or -registered architect- (Indicate.) (Indicate.) to apply for a..Coristruction 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 connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 14S or 247, Education Law, the Public Health Law, and the Putnam County San.1- tary. Code.... Very truly yours, Countersi );coo 2^ 3 She-.oz odk U.y. Address 914 243 7494 Telephone 1(7' Telephone i`.I' AL' Y `I'l�. 1 :T1,�PECTSfstI Yes No Cotnntent,s Property line- or corners found • ,. . ; 0 0 o Can cstima.te house location . • • ... . . Will driveway need cut e • , • .. . . i . Must trees be: removed -note these Is deep hole reprosentative of entire SD area -Additional deep" holes. needed.. Sufficient SDS area available considering driveway cut, house location, separation distances, etc. DEE,P HOLE DATA Water elevation: Rock elevation: 1� Soils descr_i. �pt-i on : Date: FINAL SITE, I ISPECTIG�1: Insp., by : House located where shown on approved plan : SDS located iah °re approved . .ten 'th of. trench measur d Width of. trench average Slope of tile line.. and trench acceptable ; . Room allowed for exDa.nsion trenches e • . , .. _ Over 50 'ft. from swamp, watercourse .NaturalsC soil not.-stripped rr:. SDS_are �'— uT'u lli c \i.iliJC'il':L��� "railed `� -. �[•• e • • e s •.. •o .' • 10 Ft. maintained from prop line and 20 ft. from house : e Separation of trench from: house, .well etc. follows plan . . .. . ` . number of bedroom ns checks o • . Stones,, brush, stur.:ps, igibble; etc-. greater than. 15 ft. .from nearest trench 15 Pb-- of. peripheral. soil horizontally from trench , y • Junction botes.properly set : : . Could surface_ run off from. driveway;. roads, ground 'surface, etc. char nnel near SDS , area. • • • • • • e e • •. • 'o • e o • • • • • Does lot dra -inage appear O.K. :in area of SDS. . _ FINAL GRADING OF SITE ACCEPTABIX �Mects St o. ' Rema r. ks • es No DOOM ITNTS r - sry.pJ_ans. O,K;,:: ' - ~Design data sheet P�res presoaked? Kdll. 30" pert test depth - Const. results for 3. runs D. Hole log O.K. Corporate Affidavit for oth --.o than individual ; if .Authorization for engineer ° IFtter from Water Supply if' applicable rah I if variance requested -such noted.on plans & apps. 1) ... DETAILS if .change is proposed, } 1. Existing contours shown ,kshow new contours} i Slopes for driveway cuts, etc. shown Rater service line location Footing drain, etc. location . To'O slope, bottom slope of fill iU Percolation tests and deep test pit location Septic . tank size and conformance t o 3 �.R. house minimum pr %ous° setback shown Distribution box ftg. below frost / All -water within 50 ft. of PL shown I Plan and profile SDS , All other wells and SDS closer 200' shown or reference Trade �_ �.o -r -ty boundar°c .nees "arid" bounds -= clearly shoes SEPARATION DISTANCES SPECIFIED ON PLAN !0 to -P.L. 10"* to .-Eoundati.on walls ! ii !0' to Nearest well 10' to stream,' march, lake, etc. incl . expansion).f .5' to Curtain drain ! f0 0' to water line.(Pits -20' ) 5' to storm drain I 0''to, large trees i I 0' from foundation to, septic tank / 5' to pipe from leader drain & .foo -ing Orain 3 C, r. -'1. i, f c'li;: :•: it (y � I -r ( + ` 10C �;t'] C)T, j.r0 , ?r ?Il: i0C1 rc �. ,> y�C 1_ Sri ,lli�il 17;�C1'i.c.lJ CC, 11 .�"i:.C: !0:1 �''tr :, _ .L� 'i�`.ZG :L O-' 1 s, stem sC.11Vi t,?� f'Jb I tI se: :•; �= C: O1? 1:1 i1L^.'t:C:� '�7'S �hUl J 1 ri; =✓,Y' C; v r ., n 021 1? t, l a• t! 1: ! L , L11 h> J F y :;2'.. t'. Jl,c::7(.t:Jl'(r' t. ,� I. 4. t' . c LIi }cpc. 1,4iri:!jt Oi LT c`L]_.i;ll J .. l'. c ^ 1 L6 :i? dLJ.C):. z a• ,n ) ai( J `Il-2 Il::x'C by ^t,��T r 4-c, Oi t tli ll.. .. 'Or �•r. cJ �_ 11S ) - 1•Q Cl 3. a: c. f' :.L Il ("Jn(: Crl .: ?•'? `.: `"v 4aiv G:�"!`: i�r. }.I,. :` :. :a. C:�•�'. �'�. . ••�� #. J1 L.0 v d 11 `; t�-r;� ••r' i C.^ J v 1. t• -Ci2 �� n _• �• �•� Cam' i J.. > -' '� ` _1 , .. J.'Cl �.. �' lr l7 l e?""1 ?��, . sy til'll (;:rl� �ar c2'1 �, 1T1 •.. V.._L• (1_C. .. �i O., .,.�1I .a.�_ :4J �•.,O.y 1_ ` �• ," - i:o ' y �, irs :r.,:cic ' 1�, `'� �et:a :., d- --- C,T)�('J'iti lV f, ;�1, •, .,�,.•' . .. Jam:. - _ �' }a')1 .Ci ' •� L_ - �• v u .'.. J. J_ it.J. 1� '-. - +� • uv - .. tiU�.�C11I'1�' L1�;2I � ':1 �.,. ^. v; 1oCI-'4' v Of f i 1T f' ` .. {+ T .� �1 G tt l!. i::.'• i' C �,CJ j `C ---� ` . .= .... C.-il (`i1 � �.4 .J! i'C�C%.Ll %., •� ••ir Div � � ,1 `_.! : t. C[• :(` � :iZ i�C.'. �.�: _ t•} LlT // + �.' l•i .. L O .C)1 _••�L . E. Clay Oi 'Tr. tic l , C 1. ♦J \- U._.Iy 1:� .!.; .a r ' T'� � (7 � CO i :GJ1•:P� -r�'� IOI l�i` 1..�- _i1J Lfr1 i4a� J Cry IS UIRFD C' ,T., ;_, of 1'Oiti�'•Ilt:ti1 ,,. �y •JC1 vdC-C•'., z LIt' L: ?u e,a iG21.1; Of' ' i i COUNTY L }Wi: a iii 14E.: "•1r Ti M Town of Putnam Valley Planning Board 265 Oscawana Lake Road Putnam Valley, New York 10579 (845)526 -3740 Fax (845)526 -3307 www.putnamvagey.com March 9, 2009 MASOTTI, JOHN SITE DEVELOPMENT PLAN APPROVAL SPECIAL USE PERMIT GROUND AND SURFACE WATER PROTECTION DISTRICT PERMIT AND NEGATIVE OF DECLARATION OF SIGNIFICANCE 20 SHOPIS DRIVE TM: 74.14 -1 -25 FILE: 2008 -0014 WHEREAS, the applicant is proposing a two (2) story addition to an existing single - family residence located on Shopis Drive on approximately 1.09 acres of land in the R -1 Zoning District; and WHEREAS, the 25' x 18' addition is proposed on the westerly side of the residence and the first floor will be utilized as an accessory apartment; and the accessory apartment will be limited to a living room, dining area, bedroom, kitchen and bathroom; and WHEREAS, after careful review of the application by the Planning Board and, as a result of testimony provided by the applicant, the Planning Board has concluded that: 1. There is adequate off - street parking for the proposed use; and 2. The proposed action will not cause or result in traffic problems that will imperil public safety; and 3. The proposed action will not adversely affect the quantity or quality of the water supply in the neighborhood; and 4. The proposed action will not cause a degradation in air quality or of ground or surface water quality; and Page 1 of 6 5 The proposed action will not , create, erosion or cause sedimentation 0Y siltation; and 6. Adequate screening and landscaping is provided; and 7. The proposed action will not create unreasonable noise, glare or other nuisance in the neighborhood; and 8. The subject site is accessible to emergency services; and 9. The proposed action will not create any hazardous condition; and 10. The site will be properly maintained after the granting of this Special Use Permit; and 11. The Fire Inspector will certify that the subject structure is in compliance with fire safety requirements; and 12. The applicant has submitted detailed architectural drawings which were approved by the ABACA on September 30, 2008; and 13. The applicant has obtained all necessary permits and approvals; and 14. The applicant will provide the Fire Inspector with a list of all chemicals and hazardous materials (if any) kept on the premises. WHEREAS, after careful review of the application by the Planning Board and,.. as a_ ._. _ "Ve'v�ded -by the applicant; she 1'lnrr�iiii� 3oard'nas cu�lcludeu iriac the application is in compliance with § 165 -36A of the Zoning Code; and WHEREAS, on February 12, 2009, the Zoning Board of Appeals granted an area T variance under Section 165- 36A(2)(c) of the Zoning Code to allow the footprint of the dwelling to be increased by more than 10 %; and WHEREAS, the subject site is located within the Ground and Surface Water Protection (WP) Overlay District; and , WHEREAS, in accordance with Section 165 -26D of the Zoning Code, a Ground and Surface Water Protection District Permit (GSWPDP) is required; and WHEREAS, in accordance with plans approved by the Putnam County Department of Health• on January 24, 2008, the on -site sanitary sewage treatment system will be expanded upon and upgraded to accommodate the proposed accessory apartment and new addition; and Page 2 of 6 WHEREAS, the applicant has satisf ed the Planning Bpard's criteria fnr ± e:i GSWPl P ('gee" l fanning B ar'd'Resoliztion dated October 29, 2007); and WHEREAS, the proposed two (2) story addition is being sited approximately 66.4 feet from the southerly property line, 133 feet from the northerly property line, and 74.7 feet from the westerly property line; and WHEREAS, approximately .65 acres of site disturbance is proposed; and WHEREAS, according to the Wetland Inspector, no disturbance is proposed within 100' from a wetland or watercourse; and WHEREAS, Sketch Plan Approval was-granted on February 9, 2009; and WHEREAS, the project plans and application materials were referred to and approved by the Putnam County Department of Planning and Development under Section 239 -m of General Municipal Law; and WHEREAS, the Code Enforcement Officer has determined that a Major Grading Permit is not required; and WHEREAS, the NYS Office of Parks, Recreation, and Historic Preservation has reviewed the project and according to a letter dated August 2, 2008 from said agency, the project will have no impact upon cultural resources in or eligible for inclusion in the State and National Register of Historic Places; and WHEREAS, the Planning Board has determined that the security required under §165- 16C(3) is not necessary; and ° v" WJ1!EREAS, given the fact that a Special Use Permit and Ground and Surface Water Protection District Permit are required and the subject site is located substantially contiguous to the Taconic State Parkway, the proposed action has been determined to be a Type 1 Action pursuant to the New York State Environmental Quality Review Act (SEQRA) 6 NYCRR Part 617.4; and WHEREAS, the Putnam Valley Planning Board declared itself Lead Agency on September 22,2008; and WHEREAS, the applicant has submitted Parts 1 and 2 of the Full Environmental Assessment Form (EAF), dated August 4, 2008; and WHEREAS, the Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c) and determined that the proposed action will not have a significant adverse impact on the environment; and Page 3 of 6 al aobl relat l ort- WHEREAS, t e nz Fkx pard has..cpnsideedr - - term direct, indirect and cumulative environmental effects associated with the proposed action including other simultaneous or subsequent actions. NOW THEREFORE BE IT RESOLVED THAT, the public hearing for the Site Development Plan and Special Use Permit is hereby closed; and BE IT FURTHER RESOLVED THAT, the attached Negative Declaration of Significance is hereby issued; and BE IT FURTHER RESOLVED THAT, the Planning Board hereby approves the following drawings, subject to the below conditions: 1. "Plot Plan" (Sheet 1 of 1), prepared by Charles A. Manganaro Consulting Engineers, P.C., dated (last revised) February, 2009. 2. Architectural elevations and floor plans (Sheets 1 of 11 through 11 of 11), prepared by Charles A. Manganaro Consulting Engineers, P.C., dated (last revised) January, 2008. BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid for a period of 18 months after the Site Development Plan has been signed by the Chairman and may be extended once, at the request of the applicant, by the Planning Board for a period not to exceed six (6) months; and BE IT FURTHER RESOLVED THAT, the Special Use Permit is hereby granted, subject to the below conditions, for a period of three (3) years and may be renewed every three (3y,ye rs thereafter:n accor deltic- with.�165--16A(4) ;o tls�, 01fing= dde -,z- BE IT FURTHER RESOLVED THAT, this Special Use Permit and any renewal of this permit shall terminate upon the transfer of title to the premises or upon the failure of the permittee to continue to occupy the premises as a, principal residence; and BE IT FURTHER RESOLVED THAT, a Ground and Surface Water Protection District Permit is hereby issued; and BE IT FURTHER RESOLVED THAT, the below - listed conditions must be completed within six (6) months of the date of this resolution. Should the below listed conditions not be completed within the allotted time frame, this resolution shall become null and void unless an extension is requested by the applicant (in writing) within said six (6) month period and granted by the Planning Board. Conditions to be Satisfied Prior to the Signing of the Site Development Plan 1. Submission of all applicable fees and escrows. Page 4 of 6 2. e_Plammng Board Chairman shall_sign.theEAFa ...,:_.ter. -, .. -. - .�...... _ 3. A construction monitoring escrow in the amount of $2,500 shall be submitted to the Planning Board Clerk. 4. The applicant shall satisfy any outstanding comments provided by the Town Engineer and Town Planner. 5. Final reports from the Town Engineer and Town Planner addressing resolution compliance shall be submitted to the Planning Board. 6. Eight (8) original copies of the Site Development Plan (Plot Plan Drawing 1 of 1), signed and sealed by a NYS Professional Engineer and signed by the owner of the property, shall be submitted for the Chairman's signature. Additional Requirements .to be Satisfied Subsequent to the Signing of the Site Development Plan 7. Prior to the issuance. of a Building Permit, a site inspection shall be conducted with the applicant, contractor, Building Department, Town Engineer and Town Planner. Prior to this inspection, all required silt and construction fencing shall be installed and all trees,to be removed shall be marked in the field with a surveyor's ribbon. 8. Prior to the issuance of a Building Permit, the foundation location shall be survey located (by use of off -sets) by a NYS Licensed Land Surveyor . and shall correspond to the approved Site Development Plan; correspondence from the - _.. -_.... surveyor shall. be pr-ovided-to. the Town certifying the---same. _ . 9. Prior to framing, an as -built survey of the foundation, conforming to the approved Site Development Plan,. shall be submitted (with elevations) to the Building Department. The survey shall be prepared by a NYS Licensed Land Surveyor and to the satisfaction of the Town Engineer. 10. During construction, the Building Department, Town Engineer and/or Town Planner may require site inspections as necessary to determine compliance with the Site Development Plan. 11. Prior to the issuance of a Certificate of Occupancy, a final site inspection shall be conducted with the applicant, contractor, Building Department, Town Engineer and Town Planner. 12. Prior to the issuance of a Certificate of Occupancy, the Building Department shall confirm with the Planning Board Clerk that all consultant fees have been paid in full. Page 5 of 6 - 13. The continued validity of a Certificate- pf;D�c�al;anc; .qh� 1.be.subjec to c6hfirU0& . rconformance with the approved Site Development Plan and Conditions of Approval. 14. The continued validity of this Special Use Permit shall be subject to continued conformance with the approved Site Development Plans and this Resolution. Motion: Thomas Patterson Second: Tom Carano Yea Nay Abstention Absent Michael Raimondi, Jr. X Tom Carano X Annette Lindbergh X Thomas Patterson X John Landi X op oe BY: ?� lichael. Raimondi, Jr. The Planning Board Clerk hereby confirms that conditions 1 -6, identified above, have been satisfied. Confirmed BY: Date: Filed at the Office of the Town Clerk, Putnam Valley, New York, On the Date 0 1 "BAR 13 2009 Page 6 of 6 y..:.StateXnviron :rental Quality Review ° - NEGATIVE DECLARATION Notice of Determination of Non - Significance Date: March 9, 2009 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Conservation Law. The Town of Putnam Valley Planning Board has determined that the proposed action described below will not have a significant environmental impact and a Draft Environmental Impact Statement will not be prepared. Name of Action: Addition and Accessory Apartment for Masotti SEQRA Status: X Type 1 Unlisted Conditioned Negative Declaration: Yes X No Description of Action: The applicant is proposing a two (2) story addition to an existing single - family residence located on Shopis Drive on approximately 1.09 acres of land in the R -1 Zoning District. The 25' x 18' addition is proposed, on -the; .westerly...side. -.of the . residencle- and the. f rst -floor will be utilized`as an - accessory' apartment: Given the fact that a Special Use Permit and Ground and Surface Water Protection District Permit are required and the subject site is located substantially contiguous to the Taconic State Parkway, the proposed action has been determined to be a Type 1 Action pursuant to the New York State Environmental Quality Review Act ( SEQRA) 6 NYCRR Part 617.4. Location: Shopis Drive, Putnam Valley, Putnam County, New York Reasons Supporting 'This Determination: The Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c), specifically: 1. The proposed action will not result in a substantial adverse change in the existing air quality, ground or surface water quality or quantity, traffic or noise levels; a substantial increase in solid waste production. According to the Town's Wetland Inspector, the subject property does not contain wetlands or watercourses and no disturbance is taking place within the Town's wetland buffer area. Stormwater runoff is being captured and directed to on -site stormwater infiltration systems. The limit of disturbance has been reduced to .65 .acres and the single - family Page 1 of 4 residence' and accessory apartment will 'generate approximately .32 tons of solid waste per month. The proposed action will result in one (1) vehicle trip per PM peak hour, a negligible increase. 2. The proposed action will not result in the removal or destruction of large quantities of vegetation or fauna; substantial interference with the movement of any resident or migratory fish or wildlife species; impact a significant habitat area; result in substantial adverse impacts on a threatened or endangered species of animal or plant, or the habitat of such species; and will not result in other significant adverse impacts to natural resources. The limit of disturbance has been reduced to .65 acres. The site is currently developed with a single - family residence and the site is not known to contain significant habitat or, endangered or threatened species. 3. The proposed action will not result in the impairment of the environmental characteristics of a Critical Environmental Area as designated pursuant to 6 NYCRR Part 617.14(8). The subject site is not located within a Critical Environmental Area. 4. The proposed action will not result in a material conflict with the Town's officially approved or adopted plans or goals. The Town's Comprehensive Plan encourages the use of accessory apartments. 5. The proposed action will not result in the impairment of the character or quality of important historical, archaeological., architectural, aesthetic resources or the existing character of the community or neighborhood.. The NYS Office of Parks, __._.._ .�.. p tion^_and_Historic Preservation has reviewed the rrnect.an accordin to 'a - letter dated August 2, 2008 from said agency, the project will have no impact upon cultural resources in or eligible for inclusion in the State and National Register of Historic Places. Further, the project has been reviewed by the Town's Architectural Advisory Board. 6. The proposed action will not result in a major change in the use of either the quantity or type of energy. The accessory apartment will result in a negligible increase in energy. 7. The proposed action will not create a hazard to human health. 8. The proposed action will not create a substantial change in the use, or intensity of use, of land including agricultural, open space or recreational resources, or in its capacity to support existing uses. 9. The proposed action will not encourage or attract a large number of people to a place or place for more than a few days, compared to the number of people who would come to such place absent the action. Page 2 of 4 ll e`-pToposed- a'ct on' will -not 'create 'a materi 't e i �l� or' oih r` actions "thaf would result in one of the above consequences. 11. The proposed action will not result in changes in two (2) or more elements of the environment, no one of which has a significant impact on the environment, but when considered together, result . in a substantial adverse impact on the environment. 12. When analyzed with two (2) or more related actions, the proposed action will not have a significant impact on the environment and when considered cumulatively, will not meet one or more of the criteria under 6 NYCRR 617.7(c). 13. The Planning Board has considered reasonably related long -term, short-term, direct, indirect and cumulative impacts, including other simultaneous or subsequent actions. For further information contact: Laura Lussier, Planning Board Clerk 265 Oscawana Lake Road Putnam Valley, New York 10579 This Notice is being filed with: 1. Supervisor Robert Tendy Putnam Valley Town Hall ...... A.v , -. _ 2165 Oscawana Lake Road Putnam Valley, NY 10579 2. John Masotti (Applicant) 20 Shopis Drive Putnam Valley, NY P0579 INVOLVED AGENCIES: 3. Putnam Valley Planning Board Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, NY 10579 4. Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 Page 3 of 4 -EN1ERES ED AGENUES . x 5. Putnam Valley Zoning Board of Appeals Putnam Valley Town Hall .265 Oscawana Lake Road Putnam Valley, NY 10579 6. Putnam Valley Code Enforcement Officer Putnam Valley Town. Hall 265 Oscawana Lake Road Putnam Valley, NY 10579 7. Advisory Board on Architectural and Community Appearance Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, NY 10579 8. New York State Office of Parks, Recreation, and Historic Preservation (OPRHP) Peebles Island, PO Box 1.89, Waterford, New York 12188 -0189 J Page 4 of 4 G {. t d v a� -. �• i �� PUTNAM COUNTY DEPARTMENT OF HEALTH �-- Division of Environments/ Health Services, Carmel, N. Y. 10512` CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM 1 V t N kK Town or Village &d'.a• -'1 etiiock ......,c �. �.... .. Locat E 1 ' Y Owner— I Tax Map Lot #- subd. # Separate Sewerage System built by \�' N� Z'� t�C+� Address "SA—a- �C�z Consisting of I QDC Gal. Septic Tank and 3 �� \V Other ►equi►ements Water Supply: Public Supply From ' Private Supply Drilled By"l n t O Z Address R- N� ► Building Type ��S ► ` No. of Bedrooms 3 Date Permit Issued Has Erosion Control Been Completed? 2 certify that the system(s) as listed serving the above premises were constructed essentially as shown on the lans of the completed work ( copies of which are attached) , and in accordance with the standards, rules and regulations, in accordance with the f' a plan, and the permit issued by the Putnam County Department Of Health. Date Certified by i P.E. R.A. A-,g 4168 Address �e� License No. Any person occupying premises served by the above systems) 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 sewerage 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 pq when a public water supply becomes available. Such approvals are subject to modification or change when, in the Judgment of the Commis oner % Health, such revocat W. I modification or change Is necessary. Date 7'� ^yam `� T lL,J.l1IIZ ?� .�r;T ., By ""'c"r UE Title � i,•?a'.i.;.. u.= �_i'"C.4.L1:' `: _. 1• �)�. ;`�. ?. J:: Ut �"� S ' C, _. he i i'•.i�I) -i �:'G1 +41 +• - - _ _�" ,_ i_ ;i J_' __ i.: ._ G_ v ^ 'ham _ _.�� or -0th G'�- v� 3 _ CCCi ili: '' ' n :rte LC:_ l Z4- day o,�� ].� Si���: iJ. t, c a n'd a.-' —E::-, C.., .., ..;7J. .-,• '.':.:. t) ��_ _ :� t)�' ._.L' PLf_:S t��:r }Jtl1.i' l0l` u (i T� 1.� ' r :f) ;� � � "At 7'� ^yam `� T lL,J.l1IIZ ?� .�r;T ., ---'' _ ^'�l1'�C Oi :11�tri4 ..Lmliltal 1�:: ^.1.� �1 :,C1'V iCGC� of Z PUTNAM COUNTY DEPART ;INT OF HIyALTH DIVISION. OF RNVIRO1\TT4F,0PITAL HI? INIi SERVICES T 1 I1 T '� TT ,..,�0 >?Nfjr . -1 - .FT -C-E, R�J.�.LJIAI�;, DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM / FILE NO. Owner 'RF- a:,11 h44!7= i : Address 'N Located at (Street �Ao , S (�;� DoE Sec. t b Block q Lot ¢ Indicate -" nearest cross street) Municipality PUT111aW �/��� ' Watershed �Alcz�P► t"a AJ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Ruh Elapse Depth, to Water Water Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches t 1 tl t1 I F3 19 1 1 2 147 l A 2_d 1 n 10 10 o Z l 1 i `7 7-0 14- 14 zl 2z: I 5, 2 0 _2, ,J T 5 . -k' = 4 ! ©r'' "_rd(t Notes: 1) Tests to be repeated at same depth "until aP.Proximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Dc;pth measurements to be made from top of hole. TEST PIT DATA UQbIRED TO 11.1,; SUf MITTED WITIi APPLICATION DESCRII;'7'IOId OF SOIL" '?T,, 0U'11�'.I.'E -,F,D IN "TEST IfOLES DEPTH HOLE . NO.�_(___ _ HOLE NO. G.L. �? .�E►� 6" 12": 18" . �• 24'! .� 301t �► 36 42tt 126ari rrowN �i��D � VE L r HOLE NO. v, THIS SPACE FOR USE BY HEALTH DEPARTMENT 'ONLY: Soil Raise Approved Sq . Ft /Cal . Checked / i SHERLITA AMLER, MD, MS, FAAP Commissioner of Health °" ^" Lt�hT"I Al MOLINARI, RN, MSN ,4ssociate Commissioner of Health DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 iROBERT J. BONDI !;!? t .EYecutive ADDITION APPLICATION RESIDENTIAL ONLY STREET do ��o r � _2)4Z TOWN PcaTr�� if u.-�1 TAX MAP# 7A ' 14 NAME OtFN 1MdFSoTT'i PRONE $45 =Sod 8 —%4 PCIID#-4 MAIELING ADDRESS 01.0 S !!o S 1'2' Mme' f A-r- `Ivy 10,-5-4 k DESCRIPTION OF ADDITION _� o NUMBER 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. Please submit this form and the following t9 Putnam.County Health Dept., 1. reneva:Rd, _. . `.Brewster,. ?Y 105v Phone: (845) 2-78- s - 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non- professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 4, . y SHERLITA AMLER, MD, MS, FAAP Commissioner of.Health: LORETTA MOLINARI, RN, MSN Associate Commissioner of Health _ ROBERT.J.. BCINDI - County Executive DEPARTMENT OF HEALTH C f 1 Geneva Road, Brewster, New York 10509 IV , Town Leal Bedroom Count Re:__ AA I t) T T I 1 (Owner's Name) Tax Map #: 94,14 Address: Z.O SHo P IS tb 41 v Town: PULTNP,&\ VALL66- Year Built: According to records maintained by the Town the above l G ove noted dwelling, r is V1 in compliance with Town Code. e ev- 0/ F I LC r is not in compliance with Town Code. This information has been obtained from: Certificate of Occupancy: Other: ELJG . DEP . a,.. Ass F Cr6,t's Building Inspector (D z �� Date /.611.710 1 a 4.v Environmental Health (845 278 -613 Nursing Services (845) 278.6558 ) 0 Fax (845) 278 -7921 �> J Fax (845) 278 -6026 WIC (845) 278 -6678 L4/) Early Intery Nursing ention Pr 5 /Preschool (845) 278 014 7F Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health + LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 31, 2007 John Masotti 20 Shopis Dr Mahopac, NY 10541 Dear Mr. Masotti: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI _CountyExecuAive - - �_ ROBERT MORRIS, PE Director of Environmental Health Re: Addition - Masoti -A- 114 -07 20 Shopis Drive (T) Putnam Valley, TM # 74- 14 -1 -25 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is seven. 2. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please.revise the proposed floor plan to reflect. no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for seven bedrooms. If you have any questions, please contact me at your convenience. . LCW:ens Sincerely, Lawrence C. Werper Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845)225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORE,TTA MOLINAIIy,nN; Associate Commissioner of Health 'DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health REQUEST FOR FIELD TESTING All information below must be fully completed prior to any scheduling. DATE: I t E411 1 0th MP-. 5k6L !itsly R ,Qli4 i 0e- ENGINEER OR FIRM: Chm& -s 4 Net, j `AA PHONE. #: Gbt j) PERSON TO CONTACT: ❑ NEW CONSTRUCTION ❑ REPAIR PROGRAM ADDITION PROGRAM REASON: DEEPS: CK PERCS: ❑ PUMP TEST: ❑ ROAD /STREET:_10 _J tIS,�(' S Dwz,� 00T) :N Sl TOWN: Ti", TAX MAP #: '74e i4 ._ I -,52S— SUBDIVISION: LOT #: 4 OWNER: -7-DAZ11J ZV&SO 7 n' NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ V Proposed SSTS within the drainage basin of West Branch. or Boyds Corner & ::Croton_�'alls Re-oir s -- a. SSTS within 500 feet, of a reservoir, reservoir stem or control lake. ❑ �I Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ X Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. Cl A Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: COMMENTS: REQ. FOR FIELD TESTMG:KLY Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 I ,SHERLITA AMLER, MD, MS, FAAP Commissioner of Health _;ORETTA-ii9i3UINARI, RNI ,`M9N " �.... Associate Commissioner of Health John Masotti 20 Shopis Drive Mahopac, NY 10541 Dear Mr. Masotti: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509. ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health October 3, 2007 Re: Addition — Masotti, A- 114 -07 20 Shopis Drive (T) Putnam Valley, T.M. # 74.14 -1 -25 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Permit application was not provided. 2. Application for approval of plans for a wastewater treatment system was not provided. 3. Letter of authorization was not provided. 4. Design date sheet was not rovid-ad: Soil .testin .is,ieqdiairt d�for.lots reatcr,bran ten 10 ... yeas-6W. ... .. _.. .. . 5. Short Environmental Assessment Form was not provided. 6. Three sets of SSTS were not provided. 7. North arrow was not shown on plans. 8. SSTS hydraulic profile was not shown on plans. 9. Construction notes 1 -15 were not shown on plans. 10. Design data: Perc and deep results were not shown on plans. 11. Two foot contour were not shown on plans. 12. Footing/gutter drains were not shown on plans. 13. USDA soil type boundaries were not shown on plans. 14. Title block with tax map number, professional engineer's name, address, phone number were not shown on plan. 15. Datum reference was not shown in plans. 16. Location of watercourses, ponds, lakes and wetlands within 200 feet of property line were not shown on plans. 17. Property metes and bounds were not shown on plans. s Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 =6648 r t i 18. Erosion control for SSTS was not shown O eet of�;STS_were not shown on plans. 20. Engineer's scale must be used. 21. Trench, junction box and septic tank details were not shown on plans. 22. Two foot solid pipe from junction box to perforated pipe was not shown on plans. 23. Only 464 LF of trench is shown in the expansion area. 24. Dosing or alterriate design is required for 625 LF of trench. 25. An application fee for $400.00 was not submitted. Enclosed for your use are the necessary forms, Appendix 75 -A and Bulletin ST -19. This office will continue its review upon consideration of the above - mentioned comments Please feel free to contact me at est. 2163 if any questions arise. LCW:ens Very truly yours, Lawrence C. Werper Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY SUBSURFACE, SEWAGE TREATAIENT.,3YSTEM,5 :,:;���..-,;,-:.-. AREVREW SHEE'rr NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRD IF-:, AX I AAP-m: (CONFIRMED) Y N. DOCUIfENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) Us N '0 BEN ��XNCLEANOUT L-)(--JWE L PERMIT OR PWS LETTER IN BENDS; MAX BENDS 45 C - W LS UUI ETTE}t OF AUTHORIZATION JJSITE NOT C HA NG E) (_)C_)RESGN-DAT SHEET-(DDS) FILL SYSTEMS ((_)CORPORATE RESOLUTION _(_)10' HORIZONTAL; PAST TRENCH SLOPES 3:IiTO GRADE UUSHORTrEAF C -J(-_)FILL SPECS/ FILL NOTES 1-5 UUPLANS THREE SETS C-)(-)FILL PROFILE & DIMENSIONS (_)(___)HOUSE PLANS -TWO SETS ((__)FILL IN EXPANSION AREA (_)(_)VARIANCE REQUEST FILL GREATER THA gV 2 FEE SUBDIVISION (_J( _j CLAY BARRIER )LJLEGAL SUBDIVISION, C C_JC__)SUBDIVISION APPROVAL CHECKED _JC_)nlL CERTIFICATION NOTE 7-- (_J(_JPERC RATE _J(_�JDEPTH GAUGES "' -- --- - -- -77=7-.-,--.-- 7-7-77-.7----.'' C C-J(_JVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS C _)(_JFILL REQUIRED — DEPTH C_)C_JSEPARATION DISTANCE FROM TOE OF SLOPE (,_)(_)CURTAIN DRAIN REQUIRED TRENCH GENERAL (_)(ELF TRENCH PROVIDED 60FT MAX. (•)(LOCATED IN NYC WATERSHED ( _)(_)PARALLEL TO CONTOURS (__)LJPLANS SUBTNIITTED TO DEP (__)0100% EXPANSION PROVIDED (_)(_JDELEGATED TO PCHD (_J(_JDETAnJDUST FREE CRUSHED STONE OR WASHED GRAVEL (_L)(_JDEP APPROVAL, IF REQ'D C-_)(_JGEOTE XT . ILE - COVER (__)C_)DE'El�,T,rS,T-iHOL-ES,,OBSER-V,ED SEPARATION DISTANCES ON PLAN - FROM SSTS DUPE RCS,TO--�EE,�NV,rrN-ESS TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL _(_)EX 9 - - . J-�L�10 i _)EX-APPROVAL SSDS ADJ, LOTS (_J(_)20'TO FOUNDATION WALLS C _-)(-_)WETLANDS (TOWN/DEC PERMIT REQ'D?) C_-)L_)DATA ON DDS PLANS & PERMIT -SAME (--)C -)(-.JlOO'TO WELL, 200'.jNDLOD, 150 .TO S -------- (-)(--)PRE 1969 NEIGHBOR NOTIFICATION -)l 00' TO STREAM, WATERCOURSE, LAKE (inc. expan) (___)(-_)50' j5O' TO CATCH BASIN, 35'STORN -RAINPIPE W A TER UULETTERBUZBA _ V-9 -FLOOD ELr--",r-AT'LON*W[12001--"'-'* _JC_J50'INTERMrrTENT DRAINAGE COURSE T -jSOI `OLD U( REQUIRED DETAILS ON _J200' /500' ETC. 150' GALLEY SYSTEMS. PLANS (_JC_JlO'MLNTO LEDGE OUTCROP "ORTH ARROW) GE,'�'S-YS,T,E-,M,,,P,I,-A"N�-(N C-J(-JS-E-WA'-`l"4r`- DS, Q ' SEPTIC TANK (JJHAD CjCIOFROM FOUNDATION; 50' TO WELL. WELL C-JC-J"C NSTRUC-TION A CUL-- )DIMENSIONS DIMENSIONS TO PROPERTY LINES -JDESIGN,0ATA:� ,RESUL S __) C_)LJLOCATION OF SERVICE CONNECTION-- C-)C SfD -)!!�CONT,OURS,rE)aST--ING"&—PICO - C-)Lj?VIIN 15' TO PROPERTY LINE' (--)C--)DRIV-,EWAY,-&-:SL-'OPES4CU,.T., ------- (-)()FUOT,K,G/GUIT-T,ER/C-UR.T-AIN'DRAINS 77-------.--------- _JIC_JSLOPE IN SSTS AREA 520 /o) UUUSDA -.SOIL TYPE BOUNDARIES _ (_JLJREGRADED TO 15%, IF REQUIRED ------ _)TITLE BEOCK OWNERS NAME ADDRESS IDL)SE/PWR SYU&MS-- TWIP1 C_)L_)PUMPNOTES (__)(DATE OF DRAWING/REVISION WX'V0'0'LUMElbOSE VOLUME NOTED DOSE 75% OF P C-)C-J, ATUKREFERENGE _J(_J C-JC C_JC_JDETAIL F0,*f6RCE MAIN, (PIPE TYPE, ETC.) _),LO CATION60Y.NXTERC (_}(__)PTT 9 -BOX SHOWN& DETAILED C--)C -IS (__)L_jjKY STORAGE ABOVE ALARM -)PROPOSED AN -HiFLOOWANR CURTAIN DRAIN 109INJER-i-ii 0E.VZT;4;0MS C _)C_)STANDPPES, 5' BOTH SIDES, DETAIL C-JC-i P -->5%,20'4%,25'-3%,35'-l%, 100%-<I% _JC_jl5'MIN to CDS (-JC-j PRO .ERTX'METE§'kl6U9U§ (-J(_)20'MIN- to CD DISCHARGE/100' with 182* cons day discharge Lj(-J���WL FOR HOUSE, WELL & C_)(_JIO' MIN to NON - PERFORATED PIPE C4T-(- 'OMMENTS: Alzk�---lv; V -- IEVSHEET)09/01/00, y u f W Lam. � �4.-a � sc , h-�,� pX�� J �.e„�,e �,� - a,,�`a w...�� 'rte` JSHERLITA ANILER, MD, NIS, FAAP Commissioner of Health f Associate Commissioner of Health June '29, 2007 John Masotti 20 Shopis Drive Mahopac, NY 10541 Dear Mr. Masotti: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Director of Environmental Health Re: Addition — Masotti, A- 114 -07 20 Shopis Drive (T) Putnam Valley, TM # 74.14 -1 -25 Receipt of your letter dated June 27, 2007, regarding the above referenced addition is hereby acknowledged. Your question will be answered in the order given. 1. See attached floor plans. The second kitchen adds a one bedroom flow. _ 2. 'Itiwenty feet for fields, ten feet -for septic tan -k. °.Y 1--Less than 50% increase in square footage of living space. 4. The additions are also off a playroom. If you have any questions, please contact me at 845- 278 -6130, ext. 2163. LCW:kly Enc. Sincerely, Lawrence C. Werper Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 76026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 a Mr. John Masotti..., .. _ .. 10 Shopis Drive Mahopac, N. Y. 10541 Tel (845) 518 -6456 Department Of Public Health 1 Geneva Road Brewster, N.Y. 10509 Re: Addition - Masotti -A- 114 -07 20 Shopis Drive (T) Putnam Valley, TM * 74 —14 -1— 25 Dear Mr. Werper, June 27, 2007 Regarding the denial of my addition, I have a few questions I would appreciate you answering in writing for me if you would please. 1. Could you possibly list which rooms are being considered "potential" bedrooms? 2. How far must the footings be from the existing septic? 3. The size of the addition seems to be too big for the Department of Health-.: What size :�:.�_' ::« -_:�.= :wo a be acceptable ?" n. 4. The Department's Website states that an addition off the kitchen or living room at opposite end of bedrooms may not be considered a bedroom, but mine is. Is there any particular reason for this? I would appreciate an answer as soon as possible. Thank you in advance for your cooperation in this request. Sincerely, John Masotti IMAM SHERL:ITA AMLER, MD, MS, FAAP Commissioner of Health LORE'etA-Pvf& N i 1SN° Associate Commissioner of Health Mr. John Masoti 20 Shopis Drive Mahopac, NY 10541 Dear Mr. Masoti: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT I BONDI County Executive "1tQBctT,1V1ORMS,.PE «:.. ,. . Director of Environmental Health June 11, 2007 Re: Addition — Masoti-A- 114 =07 20 Shopis Drive (T) Putnam Valley, T.M. #74- 14 -1 -25 An engineering meeting has received and reviewed the plans for the proposed addition to the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is seven. 2. The addition of a potential bedroom requires this Department's approval of a revised septic system plan fxom a professional engineer. :. 3. The new footprint of the house is too close to the existing septic system. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for seven bedrooms. If you have any questions, please contact me at your convenience. LCW:ens Sincerely, h Lawrence C. Werper Public Health Engineer Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085. Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a ca•. i.l•' ... M' ia... .err• � � .� w . w • • - . _ �. .. .w �. � LETTER OF AUTHORIZATION RE: Property of ��r, � ;%1�) "c� T-�-j Located at 20 sHr"'O; S DDwaa -, T/V Tax Map # ) .2S- Block + Lot 1 Subdivision of N Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize A0, <�&ilk jt. Jt%A4,1, AeP a duly licensed Professional Engineer *_ or Registered Architect " to apply for the required wastewater treatment and/or water supply permits) to serye.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 Law; and the Fuina-n County Sanitary Cade. Countersigned 7/ P.E., R.A., # ul leo� /#A �. u - Mailing Address -4, & Z+c -C State w Zip Z9 x &/ Telephone: :L%1 349, Very truly yours, Signed: (O,�Or of Property) Mailing Address: �,-2Q3 S' ;..s 216)-Lec- _J4 � -� State Z q y Telephone: 34r 0 Form LA -97 FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE .� ..:..: .x;01' §Y IONTEIMIT FOR E.WkGE..Til A MEN ft Ttm . PERMIT # 0 Located at D 1z" Town or Village U0, _ i nu- Subdivision name Subd. Lot # Tax Map4 Block f _ Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name ,_JO,46,0 1)2AS 0 T- ` - Date of Previous Approval Mailing Address --AO S;fvFl�S Zip 10 t % Amount of Fee Enclosed 400. 0z) Building Type �� Lot Area `d D No. of Bedrooms Design Flow GPD_ Fill Section Only Depth Volume PCIIID NOTIFICATION IS RE UIREID WHEN FILL IS COMPLETED Separate Sewerage _System to consist of gallon septic tank and Other Requirements: To be constructed by Water Supply: P le. Public Supply From Address ¢I'Sr Address or a P_rav- a Supply Dulled b� t _ - Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage 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. r c Signed: 'Al' P.E. r/ R.A. Date O j -i to —2-1311 Address /3S % � �. Su., y o �,T 07& License # 0 - % q7 -� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewagge� only. By: Title: f/" j�C:""' Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 SHERLITAAMLER, MD, MS, FAAP Commissioner of Health "° LORETTA MOUNARI, liiN,r ISN Associate Commissioner of Health October 22, 2009 Charles A. Manganaro Consulting Engineers, PC 65 East Route 4 River Edge, NY 07661 . Dear Mr. Manganaro: ROBERT J. BONDI County Executive ... -t..�- _- .. - -.- ._ :, .. ...o-.4.........._.. ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Re: Field Inspection — Masotti Residence 20 Shopis Drive (T) Putnam Valley, TM # 74.14 -1 -25 The above referenced separate sewage treatment system can be backfilled. The following comment needs to be addressed. • A bedroom count inspection needs to be performed by this Department upon completion of construction. If you have any further questions, please contact me at (845) 278 -6130 ext. 43261. GDR:kly Sincerely, Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH PlYISION OF ENV ARO ?-VMEN—TTAI-, IIEATLII�-S1"RVICE3 FIELD ACTIVITY REPORT ADDRESS: Street Town State Zip PERSON IN CHARGE OR ENTERVIEVJFT). 0 lr-,) PUMP TEST DOSE TEST REQUIRED GALLONS 36.7 49 e? EL. START 0 STOP 4- Signature and Title RFPORT'RFCFTVF.n RV: acknowledge receipt of this report? SIGNATURE: )2/96 Title: D o17 o� 03 REQUIRED GALLONS 36.7 49 e? EL. START 0 STOP 4- Signature and Title RFPORT'RFCFTVF.n RV: acknowledge receipt of this report? SIGNATURE: )2/96 Title: D o17 - - -, 9 ,.w, rt%1' r Commissioner of Health Robert Morris, PE Director of Environmental Health August 26, 2011 Consulting Engineers PC. Charles A. Manganaro 65 East Route 4 River Edge, NY 07661 Dear Mr. Manganaro: epartmei t of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Re: Field Inspection — Masotti Residence 20 Shopis Drive (T) Putnam Valley, T.M. 74.14 -1 -25 Paul Eldridge County Executive A re- inspection at the above referenced property has been completed. There are no further comments to be addressed at this time in reference to this Department's open work inspection. A submission for final compliance needs to be submitted to this Department prior to seeking a C of O from the local, building department. -` If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Very truly yours, Gene D. Reed Sr. Environmental Engineering Aide GDR:cw DIVISION OFF ENVIRONMENTAL REALTH SERVICES _ ....._... GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �o /► 00 777 n 74.14 ols° Owner or Purchaser of Building Tax Map Block Lot 6.1-1 k. /A e- l/a flees Building Constructed by TownNillage Location - Street Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and 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 said7 system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the 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 A-% ©f/ Day Year O `L 7 101- ener ontractor (Owner) - Signature ,TO Ado_1 u Corporation Name (if corporation) Signature: Title: CyA,- Corporation Name (if corporation) Address: %y6 6d'1411�( CI Address: State !L Zip State Zip Form GS -97 1 -1!, -0 John & Donna Masotti 20 Sfiopis Drive ..�.. Mahopac, N.Y. 10541 845- 528 -6456 Department of Health 1 Geneva Road Brewster, N.Y. 10509 Att: Mr. Gene D. Reed CC: Mr. Joseph S. Paravati P.E. Re: Revised Septic As -Built Plans for 20 Shopis Drive Dear Mr. Reed, October 17, 2011 Please find enclosed the revised Septic As -Built Plans as requested. Also, please note Engineer's new address: Charles A. Manganaro 7 West Cross St. Hawthorne, N.Y. 10532 Attn: Shailesh- R. "Naik, P.E. President Tel: 914 - 769 -3400 Lisc #: 072797 -1 Please notify us when the papers are approved so that we may pick them up as per prior authorization given by Mr. Naik to Mr. Paravati authorizing us to pick up the signed papers when ready. Please notify us if any other information is needed. The phone numbers we can be reached at are; John's cell 914 -552 -3217 and Donna's cell 914 -552 -6419 or home 845 -528 -6456. Thank you for all your help. Sincerely, John & Donna Masotti John. John.& Donna Masotti 1 20 Shopis Drive Mahopac, N.Y. 10541 845 -528 -6456 Department of Health October 17, 2011 1 Geneva Road Brewster, N.Y. 10509 Att: Mr. Gene D. Reed CC: Mr. Joseph S. Paravati P.E. Re: Revised Septic As -Built Plans for 20 Shopis Drive Dear Mr. Reed, Please find enclosed the revised Septic As -Built Plans as requested. Also, please note Engineer's new address: Charles A. Manganaro 7 West Cross St. Hawthorne, N.Y. 10532 Attn: Shailesh R. Naik, P.E. President Tel: 914 - 769 -3400 Lisc #: 072797 -1 Please notify us when the papers are approved so that we may pick them up as per prior authorization given by Mr. Naik to Mr. Paravatl authorizing us to pick up the signed papers when ready. Please notify us if any other information is needed. The phone numbers we can be reached at are; John's cell 914 -552 -3217 and Donna's cell 914 -552 -6419 or home 845 -528 -6456. Thank you for all your help. Sincerely, John & Donna Masotti Sherlita Amler, AM, MS, FAAP Commissioner of Health Robert Morris, PE Director ofEnvironmental Health October 5, 2011 Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Consulting Engineers PC Charles A. Manganaro 65 East Route 4 River Edge, NY 07661 Re: Field Inspection — Masotti Residence 20 Shopis Drive (T) Putnam Valley, T.M. 74.14 -1 -25 Paul Eldridge County Executive Dear Mr. Manganaro: This Department is in receipt of your submission for Certificate of Construction Compliance for Sewage Treatment System. The following correction needs to be made. • The plans titled Septic System As -Built plan do not show the As -Built information as - -- -does tic survey Upropeity. Either the Survey of Property needs to be titled As -Built or the As -Built needs to show the As -Built information. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Very truly yours, a Gene D. Reed Sr. Environmental Engineering Aide GDR:cw YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 LAB #: 1.801421 CLIENT #: 11719 NON STAT PROC PAGE: 1 of 1 MASOTTI, JOHN & DONNA DATE /TIME TAKEN: 03/23/08 07:45 20 SHOPIS DRIVE DATE /TIME RECD: 03/24/08 09:25 MAHOPAC, NY 10541 REPORT DATE: 07/14/08 PHONE: (845)- 528 -6456 SAMPLING SITE: 20 SHOPIS DRIVE, MAHOPAC, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES:...NONE COLD BY: JOHN MASOTTI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE I RESULT NORMAL - RANGE METHOD 03/24/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER WAS);:)WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING - HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: L1LCUl.Vl _ ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Aibert'H`Pad ©varii; Director LAB #: 1.801421 CLIENT #: 11719 NON STAT PROC PAGE: 1 of 1 MASOTTI, JOHN & DONNA DATE /TIME TAKEN: 03/23/08 07:45 20 SHOPIS DRIVE DATE /TIME RECD: 03/24/08 09:25 MAHOPAC, NY 10541 REPORT DATE: 07/14/08 PHONE: (845)- 528 -6456 SAMPLING SITE: 20 SHOPIS DRIVE, MAHOPAC, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: JOHN MASOTTI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/24/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS),' AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING - -- THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY,:: !. Albert _H---- Pad0vdni , M . T.. (ASCP )- Director ELAP# 10323 DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SE WAGE TREATMENT SYSTEM a ©7n° Owner or Purchaser of Building �. fl). )< - to:�E- Building Constructed by ©70 .5764 0iS Location - Street 5j q je_ Tax Map Block Lot P(,-Z7-1V4-rq TownNillage Subdivision Name Building Type v Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property,. and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system.... 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 AJOC-1 Day Year D 9 Signature: (Owner) - Signature Corporation Name (if corporation) . Address: % qA Cord l4l f't 11 State /�%� f ! _ 1 Zip Title: ®cv.-_C''/ Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ' Owner or Purchaser of Building Building Constructed by do S Location - Stree -7-f,, 1.4 - / Tax Map Block . Lot 60c oT t TownNillage Subdivision Name 53,;9 k fame_`' V !! jy 4 e>C'- Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or'approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the 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 N OV Day .L Year ® y 46eneral Clntractor (Owner) - Signature T wo/moo -Z'-pc , Corporation Name (if corporation) Address: State A � y • Zip Signature: ,i Title: ©'G�. ✓iQ r Corporation Name (if corporation) Address: State Zip Form GS -97 :¢ ,�� J P T NAM COUNTY DEPARTMENT OF MEA -0 Dff V ffSffr► N OF,ENVIRONMENTAL HEALTH B R �7. gr+..s31 S CERTIFICATE OF CONSTRUCTION COMPLIANCE LIIANCIE lFOR SEWAGE TREATMENT SYSTEM )FC'IFIIIID CONSTRUCTION P EIfl MIIT # 14 -a � � � z Located at oleg i s Town or Village qcryu^,ff J/,a, Owner /Applicant Name 2,/V- MAS077-1- ` Tax Map 7f-44 Block 1 Lot CZS- Formerly Subdivision Name Subd. Lot # Mailing Address 03 Zip /® Date Construction Permit Issued by PCHD loe Separate Sewerage- System built by �� --7-- Ab®t� ddress / %a l AOX Consisting of Gallon Septic Tank and �v,� � sa Other Requirements: Water SuDDIv:'� Public Supply From Address ®r: Private Supply Drilled by e (� Address ,..... n T yPe Eluildi .. - a erosj.o.n -conol_heencdi IP +0.d ?__ - ... _ ._ ..._ _ .:.._... Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnamy Department of Health. Date: q -LT 2.& 11 Certified by Address G fG o (OA r5z k P. E. t% R. A. (Design Profession 4) Wit.( -1449 License # b 72 7J 1 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 Director /Commissioner, such revocation, modification or change is necessary.' By: c Title: P Date: Z d W it opy - HD File; Yellow copy - Buildin Inspector; Pink copy - Owner; Orange copy- Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: -, o /fry /-/A0 r-T'/. 2. Name of Project: IV#Sor77 A-54:4 e-QAW#a -3, Location: TN: 4. Design Professional: SWmArc�N R AWK )4 g C,%sp,�s A.lygr�j«,t 5. Address: 6,54r,7 .�rf�z, 61, �u�t�"� 6. Drainage Basin: Ce"i �L c :;-L xed A;:,;e,- dye-, A),J -. 7. Type of Project: 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) ? .............. Yes/No J Type Status (check one) ...................................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No /UO 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No /61k- 11. Name of Lead Agency /Jh4 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? Yes/No )/z5 _._... -- 1, . _ ...If scz;.ha_ve_pla,.ns peen submitted to such authorities? . :.......t... .. YP :/No 14. Has preliminary approval been granted by such authorities? A? Date granted: i 15. Type of sewage treatment system discharge ........................ surface water 16. If surface water discharge, what is the stream class designation? .......................... 17. Waters index number (surface) ............................................. ............................... 18. Is project located near a public water supply system? . ............................... Yes/No 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .......... Yes/No 21. Name of sewage system Distance to sewage syst( 22. Date test holes observed 23. Name of Health Inspector _ groundwater /U //+ /Jo /)o 24. Project design flow (gallons per day) !`T 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No' AlA 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No Rev. 11/02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within 'a designated Town or State wetland ?... Yes/No N3 28. Wetlands ID number .............................................................:.... ............................... 29. Is Wetlands Permit required? ...................................... ............................... Yes/No Has application been made to Town or Local DEC ......................... Yes/No 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No A 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 /U DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No . 1\1A 34. Are community water and/or sewer facilities planned to be developed within 15 years. in or adjacent to project site? .................................. .........................Yes/No 35. Are any sewage treatment areas in excess of 15 % slope? .............. :............... Yes/No 36. Tax Map ID Number ..... ... ^. ........ Map Block �_ Lot 37. Approved plans are to be returned to ................ _ Applicant 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 need not be sent in duplicate to the DEP, although the project may require DEP 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 Section 210.45 of the Penal Law. SIGNATURES& 0.FFICL4L TITLES: Mailing Address .... —y�,� Q%jt JJ /f11 j��� Form PC -97 'J Wasbehus er County Department of Health Division of Environmental Sanitatiou WMI C091 TION REPORT This report is to be completed by well driller and submitted to Health Department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality, before certificate of construction compliance is issued. Well construction to be in accordance with Bulletin SD-62 "RULES & REGULATICNS RELATING TO INDIVIDUAL WATER SUPPLIES" IMATION: MUNICIPALITY SECTION BLOCK wlY `1 -3 LOT lifF.Id. CMfOEis s TELL DRILLER: V1 6 P, /ij �4 J�e5 ,,,Iel %else.✓ .- Al. r Bailed '(measure from land surface) Length= Feet' or ' ' t /Pumped Hours 'Static: J Feet' Makes / -naavaa aiwasva Diameters 49 Inches'Yield: 4f -G.P.K.'or Pumped % -5'4 Feet t Length . Ft. *Size KiyAt Vie.% c _ s t Diameter , -In.' TOTAL DEPTH OF WELL P?0 d FEET tc _. _.. �.. ve escr on o... f orms • ona p_en� Ground Surfaoe _�.c, hardpan,, shale, sandstone, granite, eta. Include size of gravel (diameter, ' and sand (fine, medium, coarse), color of material, structure (Loose, packed, t cemented, soft, hard). For example: 0 ft. to 27 ft. fine, packed, yellow sand; x.27 ft. to 13/6 ft. gray granite. Ft.to n. t �Ji�i€'O %��•/�✓ Gcr�O� 'S t Ft.to Ft. t tom._ +.,, w _ t 1 Ft.to .not D t PUTNAN'l. COUNTY n.to Ft.' �cCO �� WrAl TLI - - ��• t Ft.to n.' Date Well Was Completed %may .7�' Date of Rep( Well Driller B wELS. PIT AND PUMN EQUIPMENT 6h-TAILS '" Ffii she'd Well. ' Cheek ''it with 4 -inch Gravity Draid to Grade Pit with 4 -inch Gravity Drain to Basement Pitless Adapter Casing Min, 12 inches above grade Other: Describe Pumps Hake % Type vLs f',J'XXIe- Capacity - � G. P..M® Storage Tanks Type e� Capacity P2- Gal. (1e2 Gal, Min.) DIAGRAM SHOWING LOCATION OF WEII ON PUMSES Indicate location of house, well and. sewage disposal system with distances. A1so indicate direction of slopes, and direction with distances to all wells and sewage disposal systems within 250 feet. I I i i f I certify that the individual water supply indicated above was installed as per the j rulee and regulations of Bulletin SD.62 of the Westchester County Department of Health. PU`I'NAM COUNTY DEPART sI T OF IIEALTH DIVISION. OIL. ENVIRONMEDITAI, I-T1-JItTII SERVICES - QEFZF PlITLF?T:rtG.;: Y. DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO.' Owner.. �4 i c� hAA- Address�f4- .i-- ,:.i;: 1. �i �lt►t� .� 1.1 a �C; Located at (Street" ��"� �o Sec. 1'� Block Lot - �Indlcate nearest cross street) Municipality V&�.. _ c r �Watershed AM4 rl , s SOIL PERCOLATION TEST DATA RFQ,UIRED TO BE SUBi1ITTED WITH APPLICATIONS hole Number CLOCK TIME PERCOLATION PERCOLATION` + apse p t h . Uo 7 a er water Level No. Time From Ground Surface in Inches. '.Soil Rate Start -Stop Mina Start Stop Drop in Min. /in drop Inches Inches Inches' 2 2�} l C) 3 6 7a S i 5 • Notes: 1) Tests to be repeated at "same depth•until a roximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth moa,surements to be made from top of hole. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN:Rktk SKEET - "Si1B9 SEWAGE TR EATMENT SYSTEM Owner X�A-50--f-7-7' Address 610 5 18 74 - lei -1 `as- Located at (Street) Kiopj) S-'P ,-e_-r Tax Map Block I Lot (indicate nearest cross street) Municipality afte-11L_ Watershed —)J J,4 SOIL PERCOLATION TEST DATA Date of Pre-soaking 7� X 07 Date of Percolation Test /Uodgw% 08 2 -33 7 - 13 1 3 C4.3 -3 1099 4 5 3(,, 2,411. 67711 5-4 AVI x7l' aA _oo 917 3 1jA5- 6- 3,-j A7 4 5 2 cis, - R4 9 40 k o be4,60,6ated at same depth until approximately equal percolation rates are obtained at each I N V gercq atpi5p- test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be pq _prreview. 60t. measurements to be made.from top of hole. --wr: .-:, -;.- I . Form DD-97 : I�FPTH.. -:: G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' TEST FIT DATA t" 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed Iq oIr k' Indicate level to which water level rises after being encountered Deep hole observations made by: SW A, L-C Ski '9 • N A iv, Daterl�ytav►g�� Oq,1c °% Design Professional Name: SHAT t- &!;H ti • �J NY w Address: CHA'(-- LE A. W1A,+OC+AM fit) &- jASuLj idQ 6AG Ift ��F NE��° 65 EAST 9-y�:sE4- 5::TE 6 �(Z%gM C-10 c4e) (-a 0766 � Signature: `' 1 Design Pro&ssional s Seal , C7,�if6�'j VL PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address,1,o,Si*,o;S.,/1- Located at (Street) 00o�r�) Tax Map Block 1 Lot (indicate nearest cross street) Municipality ej±v, Ire— Watershed. /V/,r SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test NOTES:':; I.- 'T6s'fs:to be repeated at same depth until approximately equal percolation rates are obtained at each ercolatioh'tist hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submittlid ,for review. 2.. Depth measurements to be made: from top of hole. Form DD-97 2 -1 3 2 -7 3 4 4. 5. -J - NOTES:':; I.- 'T6s'fs:to be repeated at same depth until approximately equal percolation rates are obtained at each ercolatioh'tist hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submittlid ,for review. 2.. Depth measurements to be made: from top of hole. Form DD-97 2 3 4 5 2 3 77 NOTES:':; I.- 'T6s'fs:to be repeated at same depth until approximately equal percolation rates are obtained at each ercolatioh'tist hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submittlid ,for review. 2.. Depth measurements to be made: from top of hole. Form DD-97 TEST PIT DATA Z& DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -:7.110LE.N.O.. p Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: SHAILGC.-H IZ, NA---Ik, Address: CHAzLe& A.- MAt,'(4AMKg-o 6pA.%vLr',4Q E06►tic-EASS-c LS eA -C, r P-o L, -,r, 4, S I c F- Ifee- Fz (4 F-, �j T 0 7 (06 1 80 K,A( Signature: A 072701 Design Prof6ssional's Seal 116, 41 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r- MAL SITE INSPECTION Date: lasp , ected Street Location 9_0 sRep(s Permit# TM # 7Y, f Subdivision Lot # 1. -Sewage System Area a. STS area located as per approved plans ........... * .............. b., Fill section - date of placement 3:1 barrier Lgth.- Width -Avg.Dpth c. Natural soil not stripped... d. Stone, brush, etc., greater than 15' from -STS area...,...... e. 100' from water course/wetlands ............. ......... ............. IL Sewage System. a. Septic tank size - 1,000 ........... 1,250 ......... other ................. b. 'S.eptic'tank installed level ................................................. c. 10' minimum ftom foundation ......................................... d. Distribution Box 1. All outlets at same dlevation-water tested .................. 2. Pr otected below frost .............. .................. I .................... 3... Nfinimurn 2 ft.0riginal soil between box-& trenches e., Junction Box properly set ......... o ............................... 6. Trenches 1. Length required Lengthmistalled 2. Distance to watercourse measured + iaoFt .......... 3. Installed according to plan ........................... I ............... ...4.. Slope of trench acceptable 1116 -1/32" /foot ............. 5. 1-0 ft. from prope.r.ty line - 20 ft.- foundations .......... 6.. Depth of trench <30 inches from surface ........... I ....... 7. Room allowed for expansion, 100%.... 8. Size of.gravel 3/4 - 11/2" diameteT clean ............ 9. Depth of gravel in trench 12" minimum ............ 10. M stuns.. .. .......... .............. S - . g se 1. Size of Vti6p chamber ................................................. 2. Overflow tank..... ........................ ............................... 3. Alarm, visual/audio .... ................ ....................... 4.. PUMP easily accessible, manhole to grade ........... ...... 5. First box baffled .......................................... I ................ 6. Cycle witnessed by H.P.estimated flow/cycle ........... IM House/Buildixig a. House located per approved plans . ...................... ' b. Number of bedrooms ...... IV. Well Well located as per approved plans... ....:..... ................... b: Distance from STS area measured o© ft........... C. Casing. 18" above grade .............. I .............. .................. d. Surface drainage around well . acceptable ...................... V. Overall Worlananship a.. L Boxes properly grouted ............................. .......... ......... b. All pipes partially back filled ........ ........... 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 outfaE protected & dir.to exist -watercourse g. Footing drains discharge away from STS Area ................ h. Surface water protection adequate ........ : ................. ......... i. Erosion control provided ................................................ Rev. 12/02 617.20 Appendix C State Environmental Quality Review ... - - .SHORT EN1-- i- RONMENTAfc=ASSESSM-ENTf FORM —......u._..__ For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME isl © /�j 3. PROJECT LOCATION: tqo Sy OPT s P` Municipality County' 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) S i — , 1 - C�� W i 5. PROPOSED ACTION IS: 11 New V Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAN�.AFFECTED: Initially fQ B acres Ultimately Y oC)�i acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND" USE RESTRICTIONS? XYes n No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? © Residential F-1 Industrial Commercial Agriculture Park/Forest/Open Space Other Describe: 3 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? E] Yes F;_11 No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes %No If Yes, list agency(s) name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REPUIRE MODIFICATION? Yes No - - - --- - --- ----- -1 CERTIFYTHAT THE-INFORMATION PROVIDED ABOVE-IS TRUE-TO-THE BEST OF MY-KNOWLEDGE- - Applicant/sponsor name: o Date: Signature: ri If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXC EED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR - -DA o _ B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be eiperseded by another involved agency. 0 Yes 70 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: �6 C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: U C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: A ti C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth`, /subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: N CJ C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly'. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? Yes o If Yes, explain briefly: FEi2� LIKELY TO BE, CONTROVERSYRELA- TEL•? T C POTENTI ;Vr-Ag tr- RISE•E!4V= RONMBMTAL!!VFACTS? - Yes If Yes, explain briefly: PART 111 - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or'otherwise significant. Each effect should be assessed in connection withits (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULI EAF nd /or prepare a positive declaration. heck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILI NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination r�C Name of Lead Agency ate /f -- - -.... - - -- - - - -- Vy' Print or Type Name of Responsible Officer in Lead Agency Title of Responsible 0 cer Signature of Responsible fficer iQl -ead A,ggncy„ z., -,..� Signature reparer (If different from responsible officer) AdNno N.:.; Id �Y /4i COUNTY BOARD OF HEALTH JOSEPH P. CORIZZO President DANIEL SELDIN D.D.S. Vice President PAUL ROLAND Secretary. GERALDINE A. ZAMOYSKI M.D. ALFREDO F. GARCIA Jr. M.D. PAUL CHANG M.D. JOYCE MILLER M.D. WILLIAM ZURHELLEN M.D. HON. THOMAS BERGIN Putnam iii: County DEPARTMENT Of HEALTH County Office Building . Came], New York 10512 9141225 -3641 JOHN SIMMONS M.D. Deputy Commissioner J. ROBERT FOLCHETTI P. Director Of Environmental Health Services ELAINE KRUEGER R.N. M. Director Of Patient Service Dat'A' 7 f 2 ell, f Crx �f Re: 90h / /Cf4.. iC/ Fes, 11 Dear A. review o he submitted application to construct a sanitary sewage disposa: system for the proposed premises has been concluded by this department. — - The plans are being returned to you for the following reasons. REQUIRED INFORMATION MISSING ('1) Completed application (2) Design data sheet _(a ___14ouse:..plans - -(-2 sets) (4) Authorization for engineer (5) Layout plans (SDS) (a) House location (b) Plan and profile 'of .SDS. (c) .Location of driveway (.d) Location of well or public water. main? ?, (e) Contours of property (f) Location of any water courses, ponds or lakes on property. or.within 100 feet of property (g) Location of deep test holes and percolation test holes (h) Location of all wells and sewage disposal systems within 200 feet of property lines _. (i) House setback (j) Footing.and leader drain location . (k) 10 feet to property line (1) 20 feet to foundation walls (m) 100 feet to nearest well (n) 15 feet to curtain drain (o)' 10 feet to water line (pits 20 feet) (p) 15 feet to storm'drain (q) 10 feet to large trees (r) 10 feet from foundation to septic tank (s) 15 feet to pi f,om leader dr in and footing drain ,! (M Other: Lf -G If you have any questions concerning this matter, please feel free to contact me at this office. my yours, m KUy 2 8 1977 HE '7 S; :t4 r� i� f� 'r.. f GEOGRAPHIC INDEX 497309, 645858 SEPTIC 77f-,CHART POINT ✓Afl SS7S PLAN NO. A B„ ELEMGM 29 DA7UM•- 7 113 B 109 s7 72221 739. 1 8 160.1 51.01 11 717.44 734.94 17 4L29 42.71 720.30 737.8 18 46 56 34W2.. B i4 721.22 1 _738.72 1 19 146.891 39. 4 1 721. 18 1 27 1 7814 1 3,3[,14 1 724.82 1 742. J2 28 77.87 34 e5 1 724.85 1 742.35 29 95.84 45,.K7 728.68 746.1@ 30 106.20 55.32 1 728.59 746 09 31 1100.271 50.511 728.57 1 74607 Sae Note 7 •• See Note 10 ' yf A CoP --et TACON /C P 765120E ,4RKw,q Y i MeN- Filed Map No 843 N055320 -C 5 ---c 17.99' End of Fence !:57. 0.7' Out 08' Ptn CoP Set y W6/ . p -e 2 E� c gPlne T No. CE7e O .7.x95 (5575) ' 9A�_ NO// In Tree Post A' Wire ! Frome Lateral End (Typ /co /)6 -- fence Angle 64 `wed ^ 0.2' In O O Z3 71 1J � 70 h eoaem t so __ -__ I� a Lateral End (Tjplca/ Stale Powers Retahing; i4v/ E7eK7 OY (NOW 2!) .. Z E?..- 7 .57 (SS75t O le 77 ...__ h ,J in Set -t Roar S01 Ebk 74726' (NCW 0 B It IB- :-yV` --79 7 ,p 20--------2 r Junction E7ev. -74676 (5575 )) Box i Box (Typical) -2 0 FAst fbar SA/ 741.10' (NGW 29) z2 2J •_ V Q` O-7tB70 (5475) i 2} - .• 25 _ •7 Frame Steps Guide Guide s9- ?Tank .O -4 ' 4 77 2l�=- 28(Co66. w) 5 4 Or t o f r lj /y �.. 70 Concrete 4 ` - '6 ~ • ._. -7 Q 4't \C \Oh �1 is Post & We Fence \� ost 't Wire A. M"'w.4 Fence `lJ Out a°"- `�'' Y kris S Plan ter q s Q Lot»P f ostl..s ^ ii 60.5' ti & Q a sts' �iBox��' Wd /OrM �� ti Brick P /Doter Met �� �y She i` wrhbng v 5 R 20 O V es L 7 45 a ti t �k,; a m . fM L 1748 ,.�i, °f i '; utth Q S MbvdFenay y7 rap P!n A a Asphalt a Or/w % Pin Copt Recotisred et r,,,. > . )0.9 3 N8 }4, s f10 yr ', . d ia%0 W 4 ng /e O is Monument Recovered ^�i 0.2:£ O3E' Pin Found End of fence �pin' found �� 8 °� 5'0476 b0 W. / 0.6',!n 0.7' /n Post & Wire Fence A Pin Found i N 1. I' /n r �c h QN Cu Ph `'� �P Recovered O6' In � 0 Post � y Fence Comer 1{� Fence 1 0.6' In From Comer .`�``.,•, -,;,� i' 237.63'