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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -47 BOX 29 03709 ALLEN BEALS, M.D., J.D. Commissioner of Health :. `ROBERT `7"7R�tiS `P:E:; Ii9IPR ,. Director of Environmental Health MARYELLEN ODELL County Executive DEPARTMENT OF HEALTH 1 Geneva Road,. Brewster, New York .10509 . Phone # (845) 808 -1390 Fax. # (845) 278 -7921 January 30, 2014 Hisashi Kobayashi 170 Barger Street Putnam Valley, NY 10579 Re: Addition — A- 009 -14 No Increase in Number of Bedrooms 170 Barger Street (T) Putnam Valley, T.M. 74.17 -1 -47 & 48 Dear Mr. Kobayashi: This Department has received and reviewed the plans for the proposed 'addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated January. 30, 2014. The addition is approved with the following conditions: 1. The total number of bedrooms. must remain at four. without prior approval by this Department. 2. The area of the existing sewage disposal system its expansioa.area.must.be- maintained: - ,3. All plumbing fixtures must be updated with water saving devices,, i.e:; new low flush toilets, restrictors for shower heads and faucets, etc .. . 4. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 5. This approval is valid for two (2) years and expires on January 30, 2016. Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43 26 1. Respectfully, Gene D. Reed Principal Engineering Aide GDR:cw cc: BI (T) Putnam Valley ALLEN BEALS, ALD., J D. _ ROBERT MORRIS, P.E. Director ofEnviromnentalHealth County Ewcuave DEPARTARNT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 =1390 ' Fax # ,(845) 278 -7921 ADDITION- APPLICATION' RESIDENTIAL ONLY STREET Barger St. TOWN Putnam .Va11$yAX MAP # 74 :17 -1 -47& 48 NAME Hisashi Kobayashi FHONk528 -6470 PcHD #- _OO q MAILING 170 Barger St., Putnam Valley, \.NY 10579 ADDRESS DESCRIPTION OF ADDITION Second ' F1 nor arid; ri nn $ al rarar; nnq *NUMBER OF EXISTING BEDROOMS 4 NUMBER OF PROPOSED NEW BEDROOMS 4 * (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 -applicablesectiobs o € the. Putnam CoUntyv Sanitary Code: - Please submit this form and the following to Putnam County Health Dept., l Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. 1. Certified check or money order for $100.00, ' 2. Sketches of existing floor plan (drawn to scale, all IMng area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -.1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office!with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the building Department with legal bedroom count of dwelling. OFFICE USE . COMMENTS 4. 11/15/2013 13:40 8456282807 JUN -V 200C, 1 i :t 41. �ROif.-�NVf RONUcNiA: I�k:iR SlI L111,ITA ANT L R. hID. MS, FAA COtriiiirssi�'1141: oj'riaLrl dl; .... LOR£T TA. MOLINARI. PNI IvtSN .4ss h=urt t:onanissionur of Health JOEL GREENBERG 5401(olaLl DEPAR I MENT OF HEALTH I Geneva Road. Brew;tet, Now York 10509 PAGE 01 FOGERT J. BONDI � � f.oeeRTYMORTUS, PE .� (}ri'r: tor• o" nvil'orortenrol Health ✓/ Town .Ledal Bedroom Cnunt & Proposed addition Status Re: lg/sft�Al LO $ A VAS l,< (Owner's ?dame) � U Tax Map #_..? `T• c i 1– 41 40 w - Address: /90 5AP—C/-c. air &—r- Town: IjTN AaW LS7Gl Year Suilt: ( 2 <7 3 According to records maintained by the Town, the above noted dwelling Js Y in compliance with Town Code, Is riot in compliance with Towa Code. Thy: Len-al Bcdroom Count is: This information has been obtained from: Certificate of Occupancy: Other: Thy: plans [0T the proposed addition are considered: New Construction Addition to existing house only - - I eardown. and /arse -build allowed under Town Regulations Building insp -2ctor Dote c. EnvironrnenUll Health tLM27 &.61:0 F.% lkarurSupph- Section (84W23 —iM Fes: (8.15)225 -5418 Nursiltn5:rvice5 ��i�:lj -ivy av i�ti:. ;,,_;27'v 7: e r;iirs;n.- Rnme Tarr Fay (FW3: 2 ?6 -605* WIC trsrl� tnlervCMiGn i prrscnvvl.io:�►?sS i5�% Fax ..Nov ALLEY I i i —=t I i I --t r-- n � n rri ---�� a► r. Breakfast PUT-11M CC UNTr D3PARTNW 0? Room : ! y` bath. a. HOUSE PLANS APPROVED FOR BENOOM COUNT ONLY; ;� r Bed Room #1 - _ LDROOMS Kitchen Family Room r22 +h i i i• i i j gna Lure - .s. — I _ closet _ closet Bed Room #2 { �n Media Room — Dining ,Room t . u Q i Library i i- 5-,rs ri �0 n .4 o` ! 1. ,toe@ �reent�erg, RA, NCARB 'Architect- Planner i I 2� Muscoot Road tdorth Whopac, W 10541 —� i��+pa Area 32661 i us � �_4 i �„ i i —=t I i I --t LOWER FL-,. PHASE 1. RENOVATION it 0 MAN COUNTY D .,OF HOUSE PLANS APPRO FOR 0 BEDR M COUNT ONLY; 3 DROOMS Jib C3 Outdoor Wooden 81=ature & Title Deck 5910 iz 13*7 r5 147 272 ao 92 32-32 1 -6 —13 — - I i T. 31IT 33 42 71 71 6 bathroom exercise area Bedroom Family Room Fit 3'1 - ------------ ----- --- ---- L ---------------------- T 5111 so closet STORAGE- laundry rm utility .room n �'jl tank L-M ",closet J S- W 724 il,10 —.13!11— r4—' V4 — INI 32 LIVING AREA .l500 Joel Greenberg, RA, NCARB . u I 137 3 11"0- : ` 1'4 4.10 41 � BS� B1 -7711 n Master suite Closet' 134 1 LIVING AREA 24'1 Living Area 1172 ft2 .Y T•ry rr a EDRCOM COU 4 i )2NDFLR. - ECOND• FLOOR RASE 2 EXPANSION biyyuatu" & Title Joel Greenberg, RA, NCARB Architect. - Planner s: KDJAYASi�) 1oinil T . ............... Fath, 22- ISATO El closet F, 0-set fp�-Mi ,Iq 7 '1 IP 0 N ED I! qL-- LIV. Rpk- 7771 0 � = A � wilm 9 WIJVI A IIIUVA� Will --4 PUTNAM COMMIPEPARIMM"'? Air HOUSE PLANS BEDROT11 COUINT C BEDROOMS Joel Greenberg,:RA, NCAM , .94 Living Area. 1810 Architect - Planner -2M- E FOR .33 N a*A a a ti,9' X% I BRUa TL, 'FOLE Y_ P11hUr RpnIth nirprtnr LORETTA, MOLINARI R.N., M.S.N. Associate Public Health Director Director' of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 JUN 13 2000. Environmental Health (914) 278 61'30 Fax (014) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 , Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6& 1 66f May 26, 2000 Hisashi Kobayashi 17 Barger Street Putnam -Valley NY - 10579 10 Re: Addition - Kobayashi, 0 Barger Street Increase in Number of Bedrooms (T) Putnam Valley, TM# 74.17-1-47 W Dear Mr. Kobayashi:. I have received and reviewed the plans for the- P "-ro - osed -addition to the above-meniioned residence. P . . . : . The proposal for the addition has been approved As per,plans bearing the latest revision date of May 26, 2000 and this Department's approval stamp.' Based onthe.information -submitted, the above-mentioned-additionis in. 4pp wing riovedwith the foffQ. conditions: 1. The total number of bedrooms must remain aurivithout prior approval by this Departmen.t..' 2. The area of the. existing- sewage disposal system, and its expansion area, must be maintained. I All plumbing fixtures must be -updated with water saving devices, i.e., new low flush toilets, restructures for shower heads and faucets, etc. Any other permits or variances requir6d are the -responsibility 'of the applicant and the jurisdiction of the. Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly William Hedges Sr. Public Health Sanitarian WH:tn cc: BI (T) 4V X Public Health Director ;..,„A,0R1_P-TT;A_.M0L1NARI R.N., M;S;X.. -Associate Public, Health' Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 October 2, 2001 Joel Greenberg, R. A. 2 Muscoot Road Mahopac, NY 10541 Re: Addition - Koboyashi 170 Barger Street Bedroom count (T) Putnam V I alley TM#74.17-1 47 48 Dear Mr. Greenberg: I have received and reviewed the plans for the proposed addition to the above-mentioned residence. The. proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated October 2, 2001. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this department. '2. Th& area th&'exis ting sdVdg6&§posilsystem; and'its exoansion'afea, must 66' maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or -variances required are the responsibility of the applicanant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges Sr. Public Health Sanitarian WIMP cc: B1 (T) Putnam Valley R (r' J BRUCE - R. , r ULM, I- Public Health Director _ e O1tETTA. -M0 1NAR1_,KN.,..: R!:._S.N. Associate'. Public Health ,Director �y Director . of Patient r Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Pax (914) 278 - 7921 Nursing Services (914J278.- 6558 WIC (914) 278 - 6678 Fax (914) 278-6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 May 26, 2000 Hisashi Kobayashi 17 Barger Street Putnam Valley NY 10579 Re: Addition - Kobayashi, 17 Barger Street Increase in Number of Bedrooms (T) Putnam Valley, TM# 74.17 -1 -47 & 48 Dear Mr. Kobayashi: I have received and reviewed the plans.for the proposed addition to the above- mentioned residence. The proposal for the addition has been approved as per plans bearing the latest revision date of May. 26, 2000 and this Department's approval stamp. Based on the information submitted, the above - mentioned addition is approved with the following conditions:...... 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. AU:-Plumbing fixtures must be updated with water saving devices, i.e.,' new low flush toilets, restructures for shower heads and faucets, etc. Any other permits or variances required'are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very trulyrs _r William Hedges Sr. Public Health Sanitarian WH:tn cc: BI (T) DEPARTMENT OF HEALTH Division of EnvtronmWd Ifealth 'se"Iccs 4 Geaeva Itoad Public Health Alreelor Brewster; New Yotk 10509 Tel. (914) 278 - 6130 For (914) ?78.7921 p,&O10SED AD1?ITIOV APPMC0QN. Rte 1� dA]I,Y1' STREET 17 Barger Street TOWIN Put. ValleTX MP # 74.1.7 -1 -47 & 48 NAB Hisa ii Kobayashi PIj��TE 345 -6470 PCHD # MAILING ADDRESS 17 Barger Street, Putnam Valley, N.Y. 10579 . DESCRIPTION OF ADDITION . FINISH BASEMENT AND ADDITION TO SOUTH SIDE OF HOUSE (TWO STORY) NUMER OF EMSTIlIG BEDROOM 3 PROPOSED # OF 13EDROOLMS 4 (FROM CERT. OF OCCUPANCY OR ' CERTIFIcATmo` FROr18UIWWO INSPECTOR) *Any addition which is considered a bedroom requires formal approval of pleas.(Consu=tion Pernait).prtparcd. 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 to Putnam County Health Dopt., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130, • . 1. Certified check or money order for 5100.00 2, Sketches of existing floorplan (drawn to scale, all living area including basement) . Non professional sketches ate acceptable , 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 location, to the best of your knowledge. include date of Installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling, , fE. Comments i * - OR= R FOLEY. RS. ' '• �� .�: • Acticy P�bre'.He�tth D'vaee.e w • DEPARTMENT Of . HEALYH • Division, Oi Environmental Health Services 4 Geneva" Road, Brewster, New York 10509 (914' 278 -M30 - Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re. HISASHI_KORAYASHI Residence T&xMap,74.17-1-47--L.48 To1Nn PUTNAM VALLEY Gentlemen: According to records maintained by the ToNNA the above noted dwelling is IS NOT in compliance with Town code and the total number of bedrooms on record is \ This information has been obtained from: . CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER JOEL GREENBERG, RA, w. A w ARCHFrECrAANNOt Z1v1LoqowFtw loom., MAHOPAC, PEW YORK 10541 914 62SM3FAX91462892OrT r ENUUL- May I G, 2000 hsa5hi Kobaya5ki 7 Barger Street Putnam Valley, NY 10579 TM# 74.17 -1 -4748 Re: 5D5 REPORT 4 BEDROOMS — 200 GPD X 4= 800GPD PERC RATE 0 -5 APPL. I .2 OLD, 1.0 NEW 800/ 1 .2 =GGG, 800/ 1.0=500 3 PIT5 WITH 1.5 FT. GRAVEL- PERIMETER AND BOTTOM 2 PIT5- 10' DIAMETER = 3. 14 X 8.5' DEEP =282.6 x 2 565,120 I PIT- 9' DIAMETER= 28.26 X 8.5' DEEP = 254.34 TOTAL AREA PROV. 819.54 TOTAL AREA REG' D 800.00 THEREFORE 5Y5TEM 15 ADEQUATE FOR 4 BEDROOMS - :APPROVAL CI YOUR USE REVIEW ❑ COMMENTS ®i COMMENTS: FROM JO L Gf��ENBEI�G, R.A. COPIES TO: �� JOEL GREENBERG, RA, Nc,ARs ARCHrFECRU RIP/�Bt KORTH MAHOPAC, PEW YORK 10541 914 62SM3FAX914628207 SMAM.- FI } May I G, 2000 HlSa5hi Kobaya5ki 17 Barger Street Putnam Valley, NY 10579 TM# 74.17- 1 -47*-48 Re: 5D5 REPORT 4 BEDROOMS — 200 GPD X 4= 800GPD PERC RATE 0 -5 APPL. I .2 OLD, 1.0 NEW 800/ 1 .2 =GGG, 800/ 1.0=800 3 PITS WITH 1.5 I=f. GRAVEL- PERIMETER AND BOTTOM 2 PITS- 10' DIAMETER = 3.14 X,5.5' DEEP =282.6 X!2 r 565.20. I PIT- 9' DIAMETER= 28.26 X 8.5' DEEP= 254.34 TOTAL AREA PROV. 819.54 TOTAL AREA REG' D 800.00 THEREFORE 5Y5TEM 15 ADEQUATE FOR 4 BEDROOM5 berg, R.A. S �_ r•, � /: r 1' t+ �: ,''� �: 1 � t ! �i�" j .' 3 7-7 El closet closet � 15'B i n 4 zz I FL A N 4. v x At;. 9 G 1 A , r l7 rl AO _2"MuscddfRd.;N _ Mahopao,rNY °1,0541 =3256 A rr• . I �I zzd � ill X11 Ml I c L r i y 121 274 7-7 El closet closet � 15'B i n 4 zz I FL A N 4. v x At;. 9 G 1 A , r l7 rl AO _2"MuscddfRd.;N _ Mahopao,rNY °1,0541 =3256 A rr• . I �I zzd � ill X11 Ml I c L 173 PLAN b�.� YAs� + 3 � Mr. Joel L. Greenberg 2,Muscoot.Rd N. Mahopac, NY 10541-3256 rt P,AA L in 2� E PLar11, APPRUVW tuti T ONLY', �S[DROOMS LJV .-I- 0 . ............. 15eD9-0 C3) A- 22*8 -T B-A a p 6 DEN I. I � 172 7 3'4 59'10 t 13*7 1 I'l 1 "5 23'9 3'2- r t 14'8 -Z4- closet closet closet STOR utility room iDVA 8'4"5 ------ 767 3'10 7 4'2 --T- "'�"UTNAM UNTY(r��EPAF%Tf LENTO HEALTH bath tD HOUSE PLANS APPROVED FOR 0, BEDROOM COUNT GNLY; EXEC E -Df iOONIS Ll at 14 e Signature& Title powder rm OffPYINC, FAMILY 4'4 a4t —tip closet Laundry C7 iI oil tank l closet[A L74 r8 11,10- '4 131"S 3-2 --65--- 4 LIVING ARIa 1745 qi LOWER F, Xj S-r. PL A tJ 6Al2 /4 A Y A S A I I. MrJoel L. Greenberg 2 M us.. Rd. N M. Mahopac, NY 10�41-3256 AREA WA ,pp-,OP6sF-9 RAN i 66AYAS91 Vat Mr. Joel L. Greenberg Puscoot Rd. N. ...., -� --- ---- 1� -C -/-Lv,*, PAlk. 01 1 vFN/ --A )/ AQ Nav%j UP, TO A m w%T* In A A 1 A LOWER - FL': PUTNAM CO DEPABTlM.OF: PHASE, ! OUSE PLANS APPROVED FOR ... R E NOVAT I O N BEDROOM COUNT ON;E.Yj ,BEDROONS Outdoor o Wooden Signature & Title Deck - 5710 � 1r� m 11 •' 137 T5 147 202 32 t± 34 32 32 31 3'342. 71 76 53 92 85 —� I CD- bathroom ,L exercise area o 00 Lr- Bedroom #4 Family Room �I r4r, -- - - - - -- - - - - - -- ------- - - - - -- - - -- 47 -__ =_ 31 p - - = -- ---- -- ---- ----- -p - = =_ == O -- ------ - - - - - -0= - :::_-- ------------- - - - - -� ---------------------- -- -. - -- - ,i � --Up. 1 3 J b closest STORAGE laundry rm j. utility room HM Ol nk 0 closet 2'4 718 11'10 13'f t 4 -4 4.4 14'1 32 - -_ LIVING AREA Joel. Greenberg, fiA, NCARB 622 Architect - Planner i r l J i1 V f1 L 1_ I 2 Muscoot Road North I°t f7 R c� PUTNAM COUNTY DEPARTNl1T O:I3LAL HOUSE PLANS APPROVED FOR 643 BEDROOM 28'10 137 S ? 24'8 47 43 4'4 4'.10 45 8'5 711 % e - o Open below. (Entrance Hall) Closet a K Master suite ' bEfl�.obNt -3 is Closet 1T2 18 LIVING AREA z7 -Ifiving Area 1172 ft2 273 � 643 s 2NDFLR ..SECOND-FLOOR PHASE 2 EXPANSION Joel GreenWg, RA, NCARB Architect- Planner 140 E A Y A s "l 2 Mu-mot Road North Mahopac, NY 10541 , 4' 0 n bola) '0I as �--ao m an 9 Im -742=n M 02 42-T42-72"] , �,ro ® Breakfast #' fi Roo* oom V M COUNTY DEPARTMENT OF 3Tl K, bath.: i' NS APPROVED FOR Bed Room #1 >r BEDROOM OUNT ONLY; Kitchen Family Room rr OMS Ll &Title cl�5et closet j i I Bed Room #2 { Media Room Dining Roam --� rt - -f •t —r- Library t iT I i i T1 C I :9 „ JL p r 1• _ Jae". �reentterg, RA, NCARB I ., - — -- 2n - — ' Architect - Planner II.- -- 2`Mus000tRoad North �� �+t n • ss n iMahopw, W 10541 Liuma Area 3266 ff2 °f Garage 760 ft2 aNumber of Bedrooms : Design Fowtc /P %D r p, S.eparaLe !SeweLage- System' to consist +of; 1`000 Gal Sepf3c Tank, and _j To be o$nstructed by _�E -�*S Ca±�1�iObcaS.SO Address Water SuPP {Y x.. Pub{�c, `Sapp {Y :From - _ - r p Aridersion Well dw iI � � ;�— Private 5'uppi� to �be 1dnlled by ' a Y � Barga Street Putnam aV Other Requueme "ts DOill�St1C US'e _DYl1V� ={ 'IS represent that..P am wholly and completely iresporpsibte for thie'design,and locption of F,the, propo& - - above ;described Will me be tonstructed'asshow,n . on Lhe approved angmept thererto and , n.i oac�,A,` County rDepartment of -tl ea @h;,.:and thae 9n completion thereof a 'd'drtiu ate ° of,Gpnstru" be submitted to the iDepartment, 'and a.Wriitph guarantee,will be furnished the owhei, ii« place in good operating conddlori any part of said sewage disposal; system; during thGo, j0 , tM ance of the app ►Oval of ,L_he Ceftificate of Constiuctwn Compliance of tfie;oripinal slRtel�, r- n Will De.locsted as, shown on °the appRovediplafi and.athat said well will'beiinstalied (In aceor4 ith= Y � 'County Department +of Health � � � mate June 2 0 S g i nea a u a Peeksk� - gPP4ROVEDiFOR'GOM5T- RUGTIfON This approval !.expires,onetryearfromthe' date 4edi tj c, yl ►;evbeabheLfoT ea -use of may be ameride&or•,mpdifiedainrhen c0'Clsidered neea3sarya by ..t e;`; ommis i ill requires ar new ermit Approved for d�sposall rof +dome ryf. age ,,and/ lusts wafer a r �- d 017" -� #l� :" Z-%-t' hat tine sepal t' W, to sewage disposal system qumtt' Ops:of ` thq, Putnam; pmmisSloner.of:.Wealtfiwill, fib` 111-41'04 -"A Jit said builder will! y ►paling thedate-of tt.e lnd �•vv�ll described above ' )PUTNAM COUNTY DEP-PA�RTMENT OF HEALTH ° ±Perfmit C Df�Won +oS/^ FnWFPPmentaU Health Services Cannel �N1 �Y x1'05.12' RE�IIED CONS 'iI y1€ON PERMIT .FOR SEWAGE MPOSAL SYSTEM; Town of ; Putnam 'Valley ',(T f 4. ., ow.n ' t lax Map 'lags - �Located .at iNrQne r - a _- Subdivision` - - _i�5utd LLot Na Renewal ® _ +iTaviarion IiC a Y t ,�, ""�',_ �,+ a x--' -'z x , ae Q;._ 1 z.saslh ab�i� 4 21, �-�-' Date�°O '}Preiio�1`s'C;A,ppsoval ��1g8`2 -__ - !Qw.r[ep/A`dtitesa - - - _ y ` Contezpory ' }w �-�3 5 Ascres Buildings Type _ �- Lot 900'rea _ - - Pill Se'cton Only . a Y ; _ aNumber of Bedrooms : Design Fowtc /P %D r p, S.eparaLe !SeweLage- System' to consist +of; 1`000 Gal Sepf3c Tank, and _j To be o$nstructed by _�E -�*S Ca±�1�iObcaS.SO Address Water SuPP {Y x.. Pub{�c, `Sapp {Y :From - _ - r p Aridersion Well dw iI � � ;�— Private 5'uppi� to �be 1dnlled by ' a Y � Barga Street Putnam aV Other Requueme "ts DOill�St1C US'e _DYl1V� ={ 'IS represent that..P am wholly and completely iresporpsibte for thie'design,and locption of F,the, propo& - - above ;described Will me be tonstructed'asshow,n . on Lhe approved angmept thererto and , n.i oac�,A,` County rDepartment of -tl ea @h;,.:and thae 9n completion thereof a 'd'drtiu ate ° of,Gpnstru" be submitted to the iDepartment, 'and a.Wriitph guarantee,will be furnished the owhei, ii« place in good operating conddlori any part of said sewage disposal; system; during thGo, j0 , tM ance of the app ►Oval of ,L_he Ceftificate of Constiuctwn Compliance of tfie;oripinal slRtel�, r- n Will De.locsted as, shown on °the appRovediplafi and.athat said well will'beiinstalied (In aceor4 ith= Y � 'County Department +of Health � � � mate June 2 0 S g i nea a u a Peeksk� - gPP4ROVEDiFOR'GOM5T- RUGTIfON This approval !.expires,onetryearfromthe' date 4edi tj c, yl ►;evbeabheLfoT ea -use of may be ameride&or•,mpdifiedainrhen c0'Clsidered neea3sarya by ..t e;`; ommis i ill requires ar new ermit Approved for d�sposall rof +dome ryf. age ,,and/ lusts wafer a r �- d 017" -� #l� :" Z-%-t' hat tine sepal t' W, to sewage disposal system qumtt' Ops:of ` thq, Putnam; pmmisSloner.of:.Wealtfiwill, fib` 111-41'04 -"A Jit said builder will! y ►paling thedate-of tt.e lnd �•vv�ll described above ' C..�. 2. PUTNAM COUNTY DEPARTMENT OF HEALTH REVISED,' Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION IPERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley,, (T) Town or Located at village East side. : of Barger Street Tax.Map .- ya. -.�.. >,r., . .. ..: >_.N.o � ..„ _.,..a,..:e...•.»_ __: y _....., ..- ,.:•,.: T,- .,,P�e,�,:. 68I � ..ter+- :.c.^. -' -._ i..� :.- Subdivision 1�OYle Lot 2 Job Owner - Mr & Mrs Hisashi Kopbayashi Address 416 Benedict Avenue 6F Building Type Frame Lot Area 1.361 Acres Tarryt Wn- ...RNY 1'05191. Number of Bedrooms 3 Design Flow 600 gall day Total HabitaLp I Space Square Feet Separate Sewerage System to consist of to Gal. Septic Tank and V4 IF of 4x4 galleries To be constructed by James Campobasso Address arger ree Water Supply: Public Supply From Putnam Valey, NY 10579 X Private Supply to be drilled by Anderson Well drillers Address 'Barger S reet Putnam Valey, N.Y. 10579 Other Requirements 100 min from drainage..dAtch �eereee ee� ��►l tr'Yli /�f -tee• I represent that I am wholly and completely responsible for the design and location of the proposed system(s);� a disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the sts Sul ns o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance "e � �idh er of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heir, inn y' ilde tosaid builder will place in good operating condition any part of said sewage disposal system during the period of two (2) y m wi e9date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairset ; 2k rill 611 0 described above will be located as shown on the approved plan and that said well will be installed in accordance with the stanjaTdS, ul a 1 pf the Putnam County Department l nt of Y l lth.1,982 _ 6 • To Date Signed Pal. X R.A. Address r' d e Road ee.kskill, NY 10 Z�� ®� 9027846 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unles nstruction of the building has been undertaken and is revocable; for cause or may be amended or modified when considered necessary by the Commiss' r of Health. Any change or alteration of construction requires a new permit. �~ Approved for disposal of domestic a s age, Nat 7- 8 - — /o Date y e►..cy�p - ewyw -- Title PUTNAM COUNTY DEPARTMENT OF HEALTH I �f%: JJ c), (REV, REVISED ) Division of Environmental Health Services, Carmel, N. Y. 10512 Putnam Valley (T) CONS - (RUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Town or Village .. .. Located =cep _- _.; .��! v+ l�vsi"� � *�:..,,,..,.� :.,::: _,= _ '.� Tax::p•�� - ;�da.i Subdivision None Lot 22 Job Owner Mr. .& Mrs Hi.--a,-.hi Kobayashi Address.416. Benedict Ave 6F Tarrytown N5 .1 Story frame Lot Area 1,.365 Ac. 10Kg1 Building Type � 3 600 gal /day 1680 Number of Bedrooms Design Flow Total Habitable Space Square Feet Separate Sewerage System to consist of .1000 Gal. Septic Tank and 64 LF 4x4 galleries To be constructed by. James Campobasso Address ' Banger I Street Water Supply: Public Supply From s �n - AJ20, NY 10579 Private Supply to be drilled by Anderson well drillers Address Barg r St Putnam Vall _y, N. Y. 10579 Other Requirements Pump pit - with pump to higher elev + I represent that I am wholly and completely responsible for the design and location of the proposed above described will be constructed as shown on the approved amendment there to and in accordance County Department of Health, and;that on completion thereof a "Certificate of Construction Col be submitted to the Department, and a written guarantee will be furnished the owner, his succe4 place in good operating condition any part of said sewage disposal system during the period,? ance of the approval of the Certificate of Construction Compliance of the original system orgdn will be located as shown on the approved plan and that said well will be installed in accordance withC County Department of Health. a ay Date May 6, 1982 Signed )w seeta -ge pit d �7lq the Commissioner of Health will PAh builder, that said builder will l §:following thedate of the issu- he drilled well described above g,rqpulations of the Putnam � a �Q -e • P.E. R R.A. ® 84 0276 Address -I- u J- d Lid @nse No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issue tl unless cOn �/JQ �j �bu•IAing has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Com r 9Mt E�AtIy S&nge or alteration of construction requires a new permit. {Approved for disposal of domest' ry se ge, or t r supISIVOW •ee10 / Date -7 9 By �� Title * N� CONST,Twcp0i\I }.PERMIT `FOR. zW 11 I L'ncatR�+ at — re�e, 1�.. Subdivision � � � � i\Tnn BuildingiTSype1 �Storys3r`GL. Y Number of Bedrooms 3 Des b z, s� �^�`�SeparatelSewerag e'i,System Ito cohsist'< 7 To - be constructed Iby J F C � Water Supply , Public Supp tie Other lRequ ementsx Y 'Pump 1,,epr.esen that 1 am wholly_ and comp b.oys described.will'be constructed_ ass 66 ; {County +Departmeht^�of�lHealth; and' +1 4� ,be submittedxto theaDepartmerit, ani n , k� 4place, m good operating jqqQc dion;an } ance of the approval of the +Cer�tif,ica will be ilocafed as shown on',tne approve t County Department. of Health p � Date - ��A�pril 13�,:. 1982. ,r Address APPROViED�FOR CONSTRU @eTION' P revocable fo�p#cause�Oramay be meriii�ei Zreguves a Me pr w permit ' gpovedrfo t r = ? t 2= } 3 q s AMA COUCNTY �D PA'RTIVIENT3 qOF l '�' � '� x ` f�Enwronmental" Health Services ,iCarme% N �Y- ,•r.f05,`12�> >?. �'� '�- ` DtSPOSALrSXSTEMPtTTNA1VI a¢ a" Town+ or �V�Ilage =k Kobavas3�i« x4i s ��1J6,�Benedleat �Avnue6�F x Address: � �1.x 6fi����cre ;sue TarrytownE, rvN,. Y.; 41 {6�0 0 gal /day � � - � � _ ��� � �168 0 •� � � - � - � a.obassYo y �Bargeril _Street Putnam' �V ey, Y Address - } " �U'led �tiy � A`nders�on We "11 ,Dr�i�llers - - Barger qtr gfi PintR?_Taa1TP 5'9� t 6y eftd`a x �±. 0 ceepmergericy verilow ,leacah P-, IV. It A T >1 r i - sidle for the tlesign and location of7 the proposed isystemr -' 11 that -tti� f age disposal system approved amendment,therefto and °ink accordance with'the standard °"n. nam -- le`f-ion thereof a C:ertificaYe° xof Contruction?Compliaiice satisfa� dyer ofil,HealtA,�Nill )La�rantee wiiillgoe fu►nished.;the owner,ihis successors lle�r; orga�)4ldunng heoperiotl of two 2 ( ) oarsemi a e,of the,:issu- uciwn Compl�ahce of theor�gmalsystem,or any ►epairs theret w_ 1 e ribetl above. , iat aI we �i filPbe installed -An accordance W:dh ,the slander s;b nS, e; (Putnam '- 9i9ned 7 7 Q a :. I t ;exp�res;.one yea► fiom the date. iqs ed swnle s' c str cu ton oft �! _ g � jwodertaken land" is r: I -sue � ' X85' a Rt o��of construct toh (',when considered inecessary ,by the. �COmmissioner of. Health; Any � �p► _ domestic //�nd ry jsewage and /or pr vat water Supply only « T�u .. ✓e��._. ..�C..r.� s ?Tl i� ±s/iz PUTNAM COUNTY DEPARTMENT OF HEALTH '�"bivn!6N OF ENVIRONMENTAL HEALTH SERVICES Date Fobtuad 16, 1982 Re: Property of Mr. & Mrs. HiWobi Kobayashi Located at Bai,g,or strest Putnam Valloy Section 68 I Block 3 Lot 22 Gentlemen: This letter is to authorize /1, a duly licensed professional engineer 41 or registered architect (.Indicate) to aply for a Construction Permit fora separate.sewerage syst6m; to P serve the above noted property-in accordance with the standards, rules re'g'` ulations' as promulgated by the Commissioner of the Putnam Count' y Department of Health, and to sign all necessary.papers on my behalf in' connect ion -with this matter. -.and..,t.o super-vi-s:e ;the constructibn of se ld, system or systems in conformity with the provisions of Article.145 or 147 Education Law, the Public Health Law, and ihe,Putnam County Sani- tary Code. Cduntersiened: -0 7 P E 2 I Noit., g® ,Road 1. Add.r'10;3 10566 737 - 1656 elephone Very truly yours, Signed Owner of Property 6 Address-' Tblepifone lea t S. R q 2780 FEB 24 1982 DhI4. OF"MEAL H PUTNAM;COUNTY.'DEPARTMENT.OF HEALTH. DIVISION OF ENVIRONMENTAL- _HEALTH'SERVICES` ;- COUNTY OFFICE•' BUILDING, CARMEL ° .N: 'zY. 10512 DESIGN DATA-SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FIhE "NO." Owner *4 &- bits. 8isashi KobayashiAddress 416 %uodiet lvelaum 6F Tarr*towm, . Ny 105 1 Located -at (Street. ar' er Str®®t - Sec .- 68,=I Block 3 Lot 22 nearest cross street) Putnam Vell Pa ®kaMuni ci pa lit y (T) Watershed kill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS. oe_.. _ Number CLOCK TIME PERCOLATION PERCOLATION'. apse P . o Water Water'Level, No. Time From Ground Surface in Inches Soil Rate- - Start- -Stop Min. - Start. --------- . Stop Drop-in. .Min: /in drop Inches Inches Inches 1 1202 1.2x35 3 42,00 43.00 1 3..06 2 1TaA 12241 3 42.00 43.00 1 3000 3 5 1.12s37 1209 2.., 38,50. 39..50_ - 1243 L'ts46 38.50 39.50 _ - 1 . 3 3 .:0! 5 - -. 6vpf Notes: 1) Te \sts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. , t Address I A ©rtTiridg• Road _.Peekskill, :: -278A6 70 YL.p1.w.. -.0 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �s�s••ss Soil Rate Approved Sq. Ft /Cal. Checked by Date �1 TEST PIT DATA REQUIRED. TO BE SUBMITTED,WITH APPLICATION DESCRIPTION OF:: SO- ILS._E iCOUNTERED. -:IN TESm- :HOLES • - DEPTH HOLE .. _N0 . 1_ . +. :. _ ' ::..HOLE _NO.._ .::... _-HOLE HOLE NO . 3 .. 4 G.L. Topsoil Topsoil :opt oil... ::.... Topsoil 6" 1211 Tops ©il Topsoil -Topsoil_ Topsoil All fide, r` laT' loaiat finis sit T loam ii1 silty lo$n ' fits silt?. loam G`F Sandy. $01..; - g O� .. ..! v ffi , y gi'$$iiT renri e�nv►r '`r soak largo, 3011 st ©yes..... . r,r.. .: ,..... ..' ls8gs stouss......., sons 18rgs s otiss. 3 .42, .:.. -.... .... __.. .__ .. __.._ 6611. ` r 7811 8�+'!' INDICATE...LEVELA.T, WHICIi_GROUND WATER..IS ENCOUNTERED zNDICATE LEVEL TO WHICH-WAT ER- RISES AFTER BEING ENCOUNTERED 6075 feet.? TESTS MADE. BY Date 982 Soil Rate, Used Min/? "Drop: . S.D. ° Usable. Area Provided .. �dar, Noin of Bedrooms 3 Septic Tank Capacity 1400 �• r� Type Absorption:- Area, Prow de :.:'By. ^:.., ......L.F.x2?+ _� th trench.:. _. 64 LF of 4a1+ galleries e *F �Tther ems. o Address I A ©rtTiridg• Road _.Peekskill, :: -278A6 70 YL.p1.w.. -.0 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �s�s••ss Soil Rate Approved Sq. Ft /Cal. Checked by Date June 119 1982 '-� . ``a l To; PV Planning Board VED- From: Sara E o � McGlinchy, :CXiairman Environmental Como J 7984? Re:.Kobayashi, Barger St. F ®� C U Ty A site inspection was made`on the afternoon of June 9, 19820 My first concern (since I couldn't believe I was at the right site based on the ma )'is how can -a surveyor (in this case John Salvatore Romeo) submit .a.map with no indication of one of the main feeder-streams of Barger Pond. I would hope that the Planning Board insists on submissions being accurate and as complete as necessary to make an informed decision. I was requested by your Board to do a site inspection to consider the piping of a drainage ditch. I found instead: a fast, flowing stream with wetlands vegetation; evidence of flood plains; a stone wall that had been.-pushed into the stream near the construction;. a foundation being built about 15 feet from the' stream; and a foundation drain leading directly into the stream which flows into Barger Pond. The day I did the.eite inspection, cement leachate was flowing into the,stream I feel that the proximity of the house under construction to the stream should have required a long.form EIS and suggest that such a request be made in future applications for construction near a running or standing body of.water. Regarding the revised question of piping a stream,instead of a drainage-ditch., I feel that permission should not be'granted on the following grounds: __....... _..::_ One- .6f the quality _of -liie :i.x_ "PV° is-�our, beautiful, lakes axid shams with their biota.. This resource should not be diminished by the unnecessary filling or piping of our waterways.. According to Robert Tutoni of the Putnam County Dept of Health (in a phone conversation on 6/11/82) no diversion or piping of the stream is necessary to meetthe Departments specifications.regarding placement,of the septic fields in this case. Any filling or curtailing of streams increases the chance of flooding above that/restriction. Because of our steep terrain in this town., this consideration should be of paramount importance.in dealing with bodies of water. Meandering streams cleanse runoff water before entering lakes and ponds. Piped or culverted streams have no such opportunity and increase the rate at which lakes and ponds fill in and also increases the nutrient load. These nutrients lead to algae blooms which are beginning to plague our standing bodies of water in this town. This condition should not be exacerbated. In conclusion, I recommend that no permission be given to pipe the stream on the applicant's property and that an accurate map showing the streams course and an EIS for the,construction of the house near the stream should be on file. Mr. Robert Tutoni P.C. Board of Health Carmel, N. Y. 10541 TOWN HALL PUTNAM VALLEY, N. Y. Tel. (915) $26 -2377 CIVED TOWN OF PUTNAM VALLEY F UN, 2 2 1982, pij i .NAM . coutqTy BUILDING, ZONING AND SANITARY INSPECTOR OF HEALTH June 18, 1982 Dear Mr. Tutoni: The application of'Hisashi Kobayashi was reviewed by the Planning Board at their meeting of June 12, 1982 with relation to the stream which runs through the S.W. corner of the property. A site inspection report submitted by the Putnam Valley Environmental Commission indicates that the existing stream was not properly shown on the survey. Furthermore, if appears that the foundation which has been constructed might be ,,encroaching upon the Southern property line. I have requested that the. work be stopped and that.an "as built" survey be submit- ted showing all existing conditions. A survey, dated June 15, 1982, submitted June 16, 1982, shows the location of the stream and the location of the foundation to be quite different:'from the sewage disposal system plan approved by you on May 17, 1982. The house is located within the proposed septic area and the proposed galleries are only 85' from the existing stream. -1 'mould appreciate' it if you could reviera this situation'immediately'and report your findings to me. The Stop Work Order'I have issued will remain in effect until the matter has.been - resolved. For your perusal, I am enclosing a copy of the plan you approved with the "as huiW' foundation and existing stream super - imposed on it. Hoping to hear from you very soon, I remain, MOD:vc Copy: Hisashi Kobayashi James Campobasso Yours truly, �01 4ER MARVIN O'DELL Building, Zoning & Sanitary Inspector . Sr �� . �a ..E-r.:c'_!_,+ /S _ _y 'v iwRa G F ... 3 - 2_ _ AG i O Fs A�,p S, y o sTAtE '3 7wx L_ NA /L IN LOG Al 4 �. 6.3 °35 - F O R M '9%` /oy,be. _.�_ `- - STp�E / .rA%� ss•>. S� �� , \ \ L4� Qe Tax 1-07 ,22 <<\`, 10. - -• � f +P �.� -- �4� t AREA :? /.365 ACRL''"S ��4 � � �`9.3,F�y�.. M� /y r47 ° ✓,'�. `!r •, /Y• \�— SOAK /J - O,v L /N! - v.l �10.��' v`\` ,vo RECEIVED rAx � oT g 1 AN 22 iaw SURVEY OF PROPERTY Certifications hereon are valid for PUTMA14 C7i,t >!TY FOR Bank, '{ D.:rl. fUf FE,aijM /� Title Co. 8 Owners for this fransection a l only, Certifications are not transferable fo_+ subsequent Bank, Title Co. or Owners 111 5A S/7 �J / / Sy/ ('O�AYA ._..- _.._...,_.._,_ All certifications hereon are valid for; thls JOHN S AL VAT RE ROMEO, SITUATE IN IT HE map and copies Thereof only if said map 'or .: TOWN . O P P UT NA° tO VA L L E ) . .3 t .'..n ;rtltnrq f)nt;nirt• 1 -.dnd SH+rl')•nr copies bear the impressed seal of the sur• veyor whose signature appears hereon: - i NORTHRIDGE ROAD PUTNA M CQU i PEEKSKILL. N. Y. NEW YORK "It is hereby certified that this surveyt was / is ;JUN MVEYED. JC BLUARY /3/_/982 prepared in accordance with the eustinq Code of Practice for Lend Surveys adopted (OUGHT TO DATE'4"L. /d•1_ 198 =(Fo , o..l.: u1T+sn) Y P i i E. tic L. S. NYS l_tC. NO. 0299Afi SCALE: 1 40' - by the New York State Association of. Pro- - f � "OUGHT TO OATS.._...._. fessional Land Surveyors." Ef;CROACHMENTS BELOW GRADE IF ANY NOT SHOWN SURVEYED AS IN POSSESSION u / A' Hisashi Kobayashi Putnam Valley (T) 68 I Owner 0or, grc a'ser of Building Section` Aud. Lo Constructors Info Building Constructed by Block . Barger street (East . °Sidi) 2 ...Location " - Street Lot Puth m Vh]. li (T) None Municipality-,.i. Subdivision Name Contemporary.... Building Type Subdv. Lot # r GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I: iom wholly" and completely responsible:' for. t, 2'. location, workmanship -,, material,.construction and drainage of the sewage disposal systerri.serving the above described property; and,that it has:been . constructed as shown on the approved plan or approved amendment , thereio - - -..and in. accordance with the standards, rules and regulations of the Putnam'. t..,_, - . County Department of Health, and hereby guarantee to the owner,. hi`s success- ors,.heirs or assigns, to place in good operating condition any part.'.o.f. said system constructed by me which fails to operate for a period of..two years immediately.following the date of initial use of the sewage, disposal 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 occu- >_ pant of the building.uiilizing.ihe system. The undersigned further agrees to.accept as conclusive the determin- at;ioxr °o'f the pi_ector, of th-e Division' o_ Einy „rorXmental.�Health;;Services- =.:::: :; of the Putnam'County Department of Health as to whether or not the fail - ure of the system to operate.was'caused . by the willful or negligent act of the occupant of the building utilizing the system. Dated this J day of tober 19 82 Signatu=16,� -- Q Title d ess THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TQ.FILE. NOTICE OF DATE,,.OF FIRST USE.OF SYSTEM. >e yP, ` V, z Division of Environmental ;',Health�,S,ervices, Putnam County Department of Health YORKTOWN MEDICAL LABORATORY INC. P.O. Box 99 321 Kear Street. LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 Yorktown Heights, N.Y. 10598_201 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 245-3203 L Q 4951MAIN ST., MT. KISCO, N.Y. 10549 666.3335 T - STON. AVE. (N.EAR HOSP- iTAL).CARME L,�N ..Y.1.0. 512 27B 933. 0 ELEIGH ., r.— -, -o �:a... ,,. , a -..__ ->-r. L•.�.:...' ..,..- w: -. ..�• -. .- -n .. -w - � - - moo.,. G LAB # DATE TAKEN: - -� DATE RECEIVED:. DATE REPORTED: SAMPLE SOURCE% YC LABORATORY REPORT mg /L REFERRED BY: ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY .................... O''BACTERIA, TOTAL /mL ........:. ❑ ANTIMONY ................................ ............................... ❑ ARSENIC ..................................... ............................... ❑ BOO, 5 DAY ................... ............................... ❑ BARIUM .... ............................... .... ................... COLLECTED BY: ❑ BERYLLIUM ....................... ............................... ❑ CARBON, DIOXIDE, FREE .............................. ` �� /moo S ❑ CHLORINE ................... ............................... ❑ CADMIUM ..................................... ............................... ❑ ACIDITY .................. ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY .................... O''BACTERIA, TOTAL /mL ........:. ❑ ANTIMONY ................................ ............................... ❑ ARSENIC ..................................... ............................... ❑ BOO, 5 DAY ................... ............................... ❑ BARIUM .... ............................... .... ................... ❑ 8ROMIOE. ......................... .. .......... ❑ BERYLLIUM ....................... ............................... ❑ CARBON, DIOXIDE, FREE .............................. ` ❑ BISMUTH ......................... ............................... ....... ❑ CHLORIDE ................... ............................... ❑ BORON .....::................................. ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM ..................................... ............................... ❑ COO ........................... ............................... ' ❑ CALCIUM ..................................... ............................... .... ........ ❑ COLOR ......... ❑ CHROMIUM (tot.) ................. ❑ CYANIDE ................... ............................... ❑ CHROMIUM (hexavalent) .................... ..........................:.... ❑ DETERGENT, ANIONIC .............................. ❑ COBALT .................................... ............................... ❑ FLUORIDE ................... ............................... ❑ COPPER .................................... ............................... ❑ HARDNESS ................... ..............:................ . ❑ COLD .................... ................................................... ❑ MPN COLIFORM COUNT/ 100 ml .... ,.%�................ ❑ IRON .................................................... M-WT COUNT/ 100 ml i.l ............... ❑ LEAD ..................... ............... ............................... ❑ CONFIRMATORY TEST ... ............................... ❑ LITHIUM .......................... ............................... ❑ NITROGEN, AMMONIA ... ............................... ❑ MAGNESIUM ............................... `❑ NITROGEN, KJELDAHL .......... ❑ MANGANESE .....:.... ❑ NITROGEN. NITRATE ... ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ......................... ❑NICKEL .................................... ............................... ❑ ODOR ....................... ............................... ❑ PALLADIUM ................................. ............................... ❑ OIL & GREASE ............... ............................... ❑ POTASSIUM ...........................:.... ............................... ❑ PH ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM .........................:.......... ............................... ❑ PHOSPHATE (ortho) ....... ............................... ❑ SILICON .......................... .......... ............................... ❑ PHOSPHATE (condensed) ........... : ........... ........... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ....... ............................... ❑ SODIUM ........................................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .......................... ❑ TIN ............................................ ............................... ❑ SOLIDS. SUSPENDED ... ............................... ❑ ZINC ............................ ................................................. ❑ SOLIDS. DISSOLVED .................................. ❑ .......... ........................ ............ ...................... SOLIDS, TOTAL .......................................... ❑ .................................................... ............................... ❑ SOLIDS. VOLATILE ....... ............................... ❑ REMARKS:..................................... ............................... ClSPECIFIC CONDUCTANCE .............................. ❑ .................................................... ............................... ❑ SULFATE ................................................... ❑ ..................... . .................... .................... ........ ❑ SULFIDE .................... ............................... ❑ .................................................... ............................... ❑ SULFITE .................................................... ❑ 1..........I....... .................... ❑ SURFACTANTS ............ ............................... ❑ .................................................... ............................... ❑ TURBIDITY ........................ ................ ............ ................................................. . THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE 5ATIS7ACTORY CHEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGULAT S, DRI ING WATE ANDARDS (PART FOR THE PARAMETERS TESTED. ALBERT H. PADOVANI M..T (ASCP), DIRECTOR: TOWN OF PUTNAM VALLEY • WELL DRILLERSLOG AND REPORT - l--`-*r' This JS ui completed by wefierlller and Bldg, Department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Tak Map Street Sec. Bl!. Lot Well Ownerr. UZ q � Malind Addreift 'City or Town Tel.: * Viell Drille WELL LOG Depth from Give description of formations penetr6ted, such Ground Surface as: Peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diameter) ' ameter) and sand (fine, mediumt coarse), color. -of- material, -:structure, - (.I-,00se,, packed--,.-:,. cement, soft, hard). For example: 0 rt. * to 27 ft. fine, packed, yellow sand; 27 ft, to BZS 1-77 Well Driller A Signature CASING DETAILS YIELD TEST WATER-LEVEL SCFEEN DETAILS Length Ft. �4- Bailed or Pu mped Hrs. (Measure from Static. Ft land 'surface , Make: ii Diameter:� Inches Yield:P-GPM When Bailed or Pumped Ft. Slot Length Ft. Size Kind: Diameter In. WELL LOG Depth from Give description of formations penetr6ted, such Ground Surface as: Peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of gravel (diameter) ' ameter) and sand (fine, mediumt coarse), color. -of- material, -:structure, - (.I-,00se,, packed--,.-:,. cement, soft, hard). For example: 0 rt. * to 27 ft. fine, packed, yellow sand; 27 ft, to BZS 1-77 Well Driller A Signature