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HomeMy WebLinkAbout4215DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.81 -1 -34 BOX 32 04215 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Mr. George Apergis 296 Lafayette Avenue Cliffside Park, NJ 07010 RE: Apergis Variance Request 49 Laurel Road (T) Putnam Valley TM #83.81 -1 -34 Dear Mr. Apergis: JOHN KARELL Jr., RE, M.S. Ruhiic Health, Director October 6, 1993 Pursuant to discussions at the Board of Health meeting held on September 29, 1993, the following additional information is required by the Board. 1: Topography - on site and with in -200 feet of the site: ` 2. Location map 3. Verification of the locations of surrounding subsurface sewage disposal systems. 4. Locations of adjacent wetlands and watercourses. This information must be provided by a Professional Engineer or Registered Architect. This proposal will not be placed on a future agenda until this above- mentioned information'is provided. If you have any questions, please contact the writer at ext. 151. Very tr ly ours, Joh Karell, Jr., P.E. Public Health Director JK:mk 14.16.4 (2187) —Text 12 t. PROJECT I.D. NUMBER 1);i 617.21 SEOR Appendix C . Eneironme64al Quality R &&eta° SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR _T 6� ks 2. PROJECT NAME 3. PROJECT Municipality LOCATION:, ! L tq /�-e_� t / //%�f� ounty �t� �✓ j f'Y] 4. PRECISE LOCATION (Street address and road intersections, rom!nent Ian , ejc., or re map) %Ltd rte 4rcJ !J l� c �EC- ke— (r' T!! 5. IS PROPOSED ACTION: RO �! New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: "a �' e LJ "z e— 1 0 � r? x 1 5`r1 it /� f 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ® No If No,. descrlbe briefly - LLI f_- j 1 V e C J- s -1--D �J e /. SZ t f3 r• i ��lts(i n74 eCC4, �Jr� -S� ��s r 0,0 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other _._. Describe:. _.._. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes 2N o If yes, list agency(s) .:d permiVapprovals 11. DOES ANY ASPECT OF THE ACT, 2N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0-Yes ❑ N,, If yes, !Ist arency name and permitlapproval V A--fl el)L' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yes ❑ No I CERTIFY THAT TYPE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: r- , & IT e-!:4 Date: i Signature: C P_ v i✓ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment J. OVER 4 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A., DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART. 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. r Yes ❑ No 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 patterns. solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural. archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in 01-05 ?_Explain briefly. C7. Other impacts (including changes in use of either, quantity or type of energy)? Explain briefly. I D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — 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 with its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental imps. ...ts AND provide on attachments as necessary, the reasons supporting this determination: F ° 141" (2(871 —Text 12 PROJECT I.D. NUMBER 617-21 SEOR 4ppeqdix C E tiat Qua ty Re. i- Wiiii�'� 6in I V ew._t SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION Jo be completed by Applicant or Project sponsor) 1. APPLICANT SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: Municipality ounty 721 4. PRECISE LOCATION (Street address and road intersections rominent Ian rkl, e c., or pro e map) Jr ie�cJ_ Lr4-k::r .7— 5. IS PROPOSED ACTION: 2�•_New El Expansion ❑ Modificationtalteration 6. DESCRIBE PROJECT BRIEFLY: L 0 ti) E—� 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? E.'Yes El No If No,. describe briefly -- L.L� C 1 TO 6J C tox- 9. WHAT JS PRESENT LAND USE IN VICINITY OF PROJECT? R'Residential L 1 Industrial IM Commercial ❑ Agriculture ❑ ParxiForest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL,) ?? ❑ Yes 2-No If yes. list agency(s) A permitiapprovals 11. DOES ANY ASPECT OF THE ACT. `N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 2'Yes ❑ No It yes. !Ist aSency name and permitlapproval --T 0 W 'J o eu -rtj "n V 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING.PERMITIAPPROVAL REQUIRE MODIFICATION? Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor name: e &—cJr-7 — Date: Signature:' L/ If the action is In the Coastal Area, and you are a state agency, complete the .Coastal Assessment Form before proceeding with this assessment /1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE, I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑'Yes ❑ No -• - ... " . B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? It No, a negative declaration may be superseded by another involved agency. r _: Yes :No C. COULD ACTION RESULT N ANY >OVERSE EFF= -CTS ASSOC:ATED WITH THE FOLLOWING. Answers may be nandwntten. f :egiblei CL Existing air quality, surace :r groundwater cuaiity or quantity. noise ;eveis. existing ;rarfic --atterns. sciic Naste -tocuc ;Ion or disposal. potential for erosion..rainage or `loosing :rcolems? Exclain briefly: C2. Aesthetic. agricultural. archaeological, historic. or other natural or cultural resources: or community or neignporncod character? Explain oriefly: C3. Vegetation or fauna, .fish. snellfisn or wilaiife species, significant habitats, or threatened or endangered sbec:es? Explain oriefly: C4. A community's existing Mans or goals as officiaily 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 oriefly. 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. I D. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — 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 with Its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impsnt5 AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency . 1 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officert Signature of Responsible Officer in Lead Agency _ . -.Signature of Preparer (if different responsi e o icer) - r Date _ x•- 1416.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR'. Appendix C .. . State Environmental) "If4yy 6ie'vieW SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ;SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: _ Municipality j? r? �' l �� / j,Cil �ounty ! ✓ / /L ±� 4. PRECISE LOCATION (Street address and road intersections ,.prominent Ian�r� k , etc.. or prov a map) �.�I,u �. c-- -r>r;` �� ., a ry j�ci •�- r�� C. �G v � % ,�cc -: / 5. IS PROPOSED ACTION: C4 New ❑ Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: '� i I �, G Lv (.( C �1 �x I Srl i� c %l �rf ILTY, 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? `i Yes ® No If NN –o-,. describe briefly Ai e? A a T -0 4J < �^/ SZ• i 'Yr 41 i� 1 i_ 7 C �' i 9. WHAT PRESENT LAND USE IN VICINITY OF PROJECT? rr--ff nn Residential L✓ Industrial ❑ Commercial U Agriculture ParklForesUOpen space ❑Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU ?? ❑ Yes L, No It yes, iist agency(s) A oermidapprovals 11. DOES ANY ASPECT OF THE ACT, :111 HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 0-Yes ❑ No it yes. 9st acency name and permlVapproval —rO WAJ a PuTNrn V A-tfel 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? N Yes ❑ No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AppBeantlsponsor name: L.� -.�i ��' L �Q'`��/ � Date: 1 L/ °-_ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment ?C+s �� ��.-,� ?. . 3:. ixi,?�'.� �5•.,. '�`. '� A� ".' �^._.,,.r3e..a.:... «- t ,. �� .._.��`:'�'�, , � �:... iu..:: h. � ..: -� .. ! �v _.�... _. _ .. _- ..�.- .�.,�•• —•';'' t .�. ,,.? ..�'.+w - 1"�....- .. _.. a PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. -DOES ACTION EXCEED ANY-TYPE I THRESHOLD IN 6 NYCRR, PART 617.121 , If yes, coordinate the review process-and use the FULL.EAF. 'Cl Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No, a negative declaration may be superseded by another involved agency. I_ Yes n No C. COULD ACTION RESULT ;N ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be nanawritten. !f egibie) C1. Existing air quality, surface or groundwater quality or quantity, noise levels. existing traffic patterns. solid vaste production or aistiosal, potential for erosion. Jrainage or flooding proclems? Explain briefly: C2. Aesthetic, agricultural, archaeological. historic. or other natural or cultural resources: or community or neighborhood cnaracter? Exotain oriefly: C3. Vegetation or fauna, fish, shetifish or wildlife species. significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing :fans 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 aevemoment. or related activities likely to be induced by the proposed action? Explain briefly. 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. I D. IS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART ill— 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 with its (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 ttlat explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental imps: is AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ire of Responsible Officer in Lead Agency .. , ignature of mgww (if different from responsible officer) k _ t tj Oate a x r ,r 14-11114 (2187)—Text 12 r PROJECT I.D. NUMBER 617.21 SEOR r _... ;. App®ndi_x,C State Environmental Quality R®vieta SHORT ENVIRONMENTAL ASSESSMENT FORMA For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT, SPONSOR _ 2. PROJECT NAME 6 3. PROJECT LOCATION: _ } Municipality `� `/ L A'�! i' : , f u. jl;; �ounty �✓ /L�:�"/✓1 d. PRECISE LOCATION (Street address and road intersections, rominent Ian�}�rk a rov c., or p a map) L.,- }-rime '� S K► "� �L' �TLt; 't.Grl.;f rT v• L l� J�ci �- 5. IS PROPOSED ACTION: Y� New L..: Expansion ❑ Mod ificatianialteration 6. DESCRIBE PROJECT BRIEFLY: T 4 I �, rte. L` 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ®No If No,, describe briefly - L�_! C A.) 1Z c d- s _Fd 1LI c t L i �--'f I S I ( IV4 � r 1-i 1 lam-' H•<l. �) I�� 7' C R.� 1 V !t t-} Y 9. WHATJS PRESENT LAND USE IN VICINITY OF PROJECT? Residential �. Industrial [I Commercial C1 Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL) ?? ❑ Yes R No If yes. i13t agency(s) .d oermiVapprovals 11. 0-yes ANY ASPECT OF THE ACT, 2M HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 0Yes ❑ No If yes. !Ist acency name and permittapproval Ti-J.AJ o -� P✓T—N 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 12 Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE i Applicant/sponsor name: r L ��' f� y Date: y � Slgnatuie: �— v . L/ ( If the action is in the Coastal Area, and you are a state agency, complete the - Coastal Assessment Form before proceeding with this assessment 3 fa - ® ,.r ,w .a• .. •ca 'Kr i q .94 t� - w.«-�1 - -sv fir.,....•- ,.�..•r ,, N- ai..s+an PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) :A,,•DOES ACTION.JED�CEED ANY TYPEa-THRESHOI:D IN'64NYCRR, PART 617.12?-,., If yos, coordihate the review process and use the FULL EAF. ❑ Yes Q No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No, a negative declaration may be superseded by another involved agency. r Yes r No C. COULD ACTION RESULT ;N ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: ;Answers may be handwritten, .f legible) C.. Existing air quality. surface or groundwater quality or quantity, noise levels. existing traffic patterns, solid vaste production or disposal. ootential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural. archdeoiogical. nistorlc. or other natural or cultural resources: or community or neignborn000 character? Explain briefly: 63. Vegetation or fauna, fish, snellflsn or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing Mans 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 oeveicoment. or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-057 Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro 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 with its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: . Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency lid e of Responsible Officer SrRnaturc R e icer in Lea Agency Y ao rc o sparer (1 different rcsponsi e o rced j418.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 Appendix- C . State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEAR 1 . APPLICANT 'SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: J ��L _ Municipality 7 '� rei 41.• f�,_ _j�i �ounty LT ✓ / /L'� � 4. PRECISE LOCATION (Street address and road intersections,` rominent Ian rk$, a c.• or prov a map) •T- 5. IS PROPOSED ACTION: New []Expansion n Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: '� ! I �, r L:_.. L, C. ( d i` r X 1 SI i� J. �!— a�f'tLT� 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ® No If No,. describe briefly - C I I A,; t. d � TV 1:1 C / 5Z � '�- t r— ( 1 , � ` l S , t Cl(1F�h'.l�i i T tic x k l-4 v C. 9. WHAT PRESENT LAND USE IN VICINITY OF PROJECT? Residential t✓ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ! i Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes R"No If yes, iist agency(s) A Dermit/approvals 11. DOES ANY ASPECT OF THE ACT, 241 HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 0-Yes ❑ N� If yes, !Ist arency name and permlVapproval -T o W AJ iav otin V A-1 (el 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? 12 Yes ❑ No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanVsponsor name: / e Date: • J Signature: C r— v It the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment J. y' V1 ip.•q�� -P .y, ,� -2•_- ,JP�'.,r•'•4Y,,h t,•,^uhTj • dY�- h'�yT.'.�.d.N'�,l,iMww+`•sa* t Sl ",�V'm7 r.iM ^4Jy +fF�.�M.p •A ?j tlM1.Pf "C'��O r t rr— _ ..- ... �: '` � � � ".ii. c ? , r: _.d �c•-.�._ �» Via. � , �•.;a,�,� .�c�. o PART II— ENVIRONMENTAL ASSESSMENT (ro be completed by Agency) .:.A:-:DOES ACTION.- EXCEED-ANY TYPET'THRESHOLD IN fi- NYCRR; PART 617.12 ? - i. If -yes, coordinate the review process,and: use the_ FULL EAF.. , ❑ Yes I1 No _ _. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No, a negative declaration may be superseded by another involved agency. - Yes ` NO C. COULD ACTON RESULT iN ANY ADVERSE AFFECTS ASSOCIATED WITH THE FOLLOWING: ;Answers may be handwritten, .f iegibiei Ct. Existing air „uality, surface or groundwater quality or quantity, noise levels. existing traffic patterns. solid 'Haste production or disoosal. potential for erosion. drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural. archaeological. historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, snellfisn or wildlife species. significant habitats, or threatened or endangered species? Explain briefly: Cd. A community's existing clans or goals as officially adopted. or a change in use or intensity of use cf land or other natural resources? Explain briefly. CS. Growth, subsequent - eveicoment. or related activities likely to be induced by the proposed action? Explain briefly. 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. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — 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 with Its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Imps.: is AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Tide of Responsible Officer Sianature of Responsible Officer in Lead Agency -_ >,. ignature of Preparer (if differe t from nesponsi e o icer) r r te ��? fl 14-16-4 (2187)—Text 12 1 PROJECT I.D. NUMBER 617.21 SEOR -7 Appendix C 77-- State Environmental Quality ROViOw' SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS only PART I—PROJECT INFORMATION Jo be completed by Applicant or Project sponsor) 1. APPLICANT 2. PROJECT NAME 3. PROJECT LOCATION: . � )�� i -1 - County ✓ r" l, iq-171 Municipality 4. PRECISE LOCATION (Street address and road intersections, rominent Ian rLkI. ec.. or prov)de map) du /y J 5. IS PROPOSED ACTION: 2 r New ❑ Expansion ❑ Modificat ionialterat ion 6. DESCRIBE PROJECT BRIEFLY: T 4 F_ L�_,' L C Pj k;- I- a 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes El No If No,. describe briefly U_! C 1 A-C C t A- A? or-' 9. WHAT PRESENT LAND USE IN VICINITY OF PROJECT? Residential L Industrial ❑ Commercial I Agriculture ❑ Park/Forest/Open space Other Describe:. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, - OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERA• STATE OR LOCAL)? ❑ Yes 4o If yes, iist agency(s) A oermiUapprovals 11. DOES ANY ASPECT OF THE ACT. :!M HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0-yes ❑ N,, It yes, !1st aCency name and permittapproval eurt-jeA VA-I(P-1 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE .Applicantisponsor name: Date: Signature.- If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessme nt OVER 13' 4.1 - 4z ';J lMi 0 t I d PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) -Ac -DOES ANION EXCEED ANY TYPE I,THRESHOLD'IN:6 (JYCRR,;PART;617,:12?- ,» If yes, coordinate the, review. process_ and use the FULL.EAF. . ❑ Yes ❑ No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? If No, a negative declaration may be superseded by another involved agency. r Yes (_I No C. COULD ACTION RESULT iN ANY ADVERSE 217FECTS ASSOCIATED WITH THE = OLLOWING: ,Answers may be handwritten. it legible) Cl. Existing air quality. surface or groundwater quality or quantity, noise ievels. existing tratfic Datterns, solid .vaste production or aisoosal. potential for erosion, irainage or flooding problems? Explain briefly: I C2. Aesthetic, agricultural. archaeological, historic, or other natural or cultural resources: or community or neighborhood character? Explain briefly: I C3. Vegetation or fauna, fish, shellfish or wildlife species. significant habitats, or threatened or endangered species? Explain briefly: Ca. A community's existing Mans 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. C6. Long term, short term. cumulative, or other effects not identified in C1-05? Explain briefly. I C7. Other impacts (Including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise s(gnifi=nt Each effect should be assessed in connection with its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impants AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency i Print or Type Name olf Responsible Officer in Lead Agency Title- of Responsible Off icer Signature of Responsible Officer in Lead Agency ::! - of reparer (if different msponsi a icer) , } x ; 14-16.4 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 P pandix C. State Environmental GUSlity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS only PART I—PROJECT INFORMATION (To be comoleted by ADDlicant or Proiect sponsor) 1. APPLICANT 'SPONSOR 2. PROJECT NAME J. PROJECT LOCATION: Municipality L/ Ltq-&"rel �ounty 7 A. PRECISE LOCATION (Street address and road intersectionspromi ent an q C.. orprqvde map) y &r4-L 5. IS PROPOSED ACTION: 2 r New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Del I 4e- I -S 1-i IV 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? r [j Yes No If No.. describe briefly IL� C C s c I's r7fob k y- it 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? aResidential L Industrial ❑ Commercial ❑ Agriculture ❑ ParkiForesVOpen space Other Describe: - 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes R"No It yes, iist agency(s) A Dermitlapprovals 11. DOES ANY ASPECT OF THE ACT, 2M HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 2-Yes ❑ No It yes, 9st acency name and permittapproval WAj orJAVA-ffel- 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yes ONo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: `ir� Date: Signature: C71— It the action Is In the Coastal Area, and you are a state agency, complete the -Coastal Assessment Form before proceeding with this assessment OVER 0 It the action Is In the Coastal Area, and you are a state agency, complete the -Coastal Assessment Form before proceeding with this assessment OVER DAUT u_FNVIRnNMFNTAL ASSESSMENT fTo be completed by Aaencv) Ay Dq 0ANY TYPE HRESHC? IN 6.YCRR; PART 81712 ?rlfy ew-process and use the FULL EAF: _, ❑ Yes ❑ No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. r Yes r'Na C. COULD ACTION RESULT ;N ANY ADVERSE EFFECTS ASSOCIATED WITH THE = OLLOWING: (Answers may be handwritten. tf iegtbie) Cl. Existing air quality. surface or groundwater duality or quantity, noise ieveis. existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural. arcnaeological, historic. or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish. shellfish or wildlife species. significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing Plans or goals as officially adopted. or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent deveiopment. or related activities likely to be induced by the proposed action? Explain briefly. 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. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No if Yes, explain briefly PART III— 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 with its (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 tllat explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. • Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. • Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental imparts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible O icer ._..: ianature of repave* . ,n A ,. 'June 8, 1993 George Apergis 296 Lafayette Ave. Cliffside Park, N.J. 07010 "r. Ray Jones Board President Putnam County Department of Health L10 01d Route 6 Carmel, New York 10512 Re: TM 83.81 -1 -34 Dear Mr. Jones: This letter is to formally request a variance in order to Dlace a well on my property at 49 Laurel Road, Lake Peekskill, Vew York. I purchased this property on June 16, 1983, with the listinct understanding that I would be able to install a well on Same. A permit was granted and was renewed every year except this rear when we.wanted to renew.it and were turned down. I have been informed that the well has to be 150' from he drainage pits on my property. The distance is not 150' as per. - - opy -of enclosed- site'plan previously submitted to Mr. Robert Morris. I would like a variance of separation between septic system ind well. I have worked hard for many years and planned to retire to ay Lake Peekskill home. I have been improving the house on the aroperty to retire to; paying taxes in good faith and renewing the aermit every year in the belief that I could install a well. There is presently "summer water ", which is yellowish and disgusting Booking and has ruined my home appliances, is only on from April ;o November and I need water year round in order to live in the louse. My wife and I would sincerely appreciate your consideration n granting a variance for a well to the property. Thanking you in advance, I am, Very truly yours, George Apergis i ,9 eor . T96--LbFF&y-6tt6 AV. Cliffside Park N.J. 07010 February 09, 1993 Mr.Robert Morris w Assistant Public Health Engineer Re: Well permit w Dear Mr. Morris: Since the distance between the proposed well and one of the drainage pit is 95 feet I have to move the existing drainage pit - to a new position that will be 10 feet away from neighbor's property and 106 feet away from the proposed well as you see the enclosed site sketch. Do I need a permit for this? If so, do I get it from the Dep- artment of Health or from another department? Please notify me as soon as possible. Very truly yours, George Apergis CSC_ ✓'J ... — =l , s DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 March 16, 1993 George Apergis 196 LaFayette Avenue Cliffside Park, NJ 07010 Dear Mr. Apergis: JOHN KAFiELL Jr., P.E., M.S. Public Health Director In response to your February 9, 1993 letter in which you request information on a septic system relocation. 1. If you propose to abandon the existing septic system, a new septic system would have to be designed by a professional engineer meeting current health department codes for the existing house. This does not appear feasible. 2. A repair permit would be required from this Department for a repair of the septic system in the same location as the existing septic system. 3. The current minimum separation distance between af�ll and seepage pit is 150 feet. f:: there: ar: e .'.any , questions., I may .be, reached,, at -ext.. ,1,66: _ Very-truly yours, Robert Morris Assistant Public Health Engineer RM /iP P. Ell a a7•�y..IJEID 10 59 � MARVIN O DELL Blaq. l spector JOHN MAHONEY Deputy Zaning rnspactor TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT June 2, 1993 To Whom It May Concern: Re: Property Status - 49 Laurel Road TM #83.81 -1 -34 The above noted property is a pre - existing non - conforming lot containing a seasonal one family structure. TOWN HALL PUTNAM VALLEY, N.Y. (914) 526 2377 BETTE STOCKINGER 91cfg. Dept. Clerk MARV1tJ —bl DELL Building & Zooigg Inspector MO'D:es ` THIS IS YOUR OFFICAL TAX RECIEPT o ` ^ RECEIPT FOR TOWNAND COUNTY REAL ESTATE TAXES COLLECTED BY THE TOWN OF PUTNAM VALLEY FOR THE TAX YEAR Jan 1, 1993 Thru Dec 31,1993 ' Re��i1�t �/"����` OWNER : APER8IS GEORGE M & ANNA ^ PAYMENT TYPE : Full Payt LOCATION : 49 LAUREL ROAD TAX AMOUNT : 700.05 SEC/BLK/LOT 083-081-0001-034-000-0060 PENALTY AMT : 0.00 MAIL CHARGES : 0.00 NSF CHECK CHG : 0.00 TOTAL PAID : 700.05 APER8IS GEORGE M & ANNA . DATE PAID : 01/11/93 296 LAFAYETTE AVE RECEIPT NON : 03651 CLIFFSIDE PARK NJ 07010 BILL NO. : 000146 ` THIS IS YOUR OFFICAL TAX RECIEPT o -4 3E.- ;,c I HL'CuNllN6 BOAHU OF APPEALS. TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK Name of Applicant or Appellant: John Cassimatis Address: 508 W. 180th St. , New York, N.Y. 10033 Date of Request for Hearing Form: 9/15/76 Date of Advertisement: 10/20/76 In PUTNAM COUNTY COURI Location of Property: Laurel Rd. , Lake Peekskill Zone: R- Nature of Request: Variance to drill well in accordance with Local Law #2 -1975 as amended. Date of Public Hearing: 10/28/76 Place of Hearing: Town Hall, Qscawana Lake Road, Putnam Valley, N. MEMBERS PRESENT: HOWARD .D... ARONOW ................. Chairman of the Board MORRIS .AXELROD .................... Vice Chairman JAMES GRIFFIN .. , , , , ......... Secretary .HI*REF RT . I.EV. ENSON ............... N. KEVIN, ,CARO$E41t.A.. , , ....... . .... ......... ............................... The matter having duly come on to be heard before a duly convened meeting of the Board on the 28thday of October, 19 76 ; and all the facts, matters and evidence produced by the applicant, the Zoning Inspector and interested parties having been duly heard,, received and considered, and due deliberation having been had, the following decision is hereby made: ORDERED, that the application or appeal be and the same hereby is Granted. :Qo3iw:k WO&kdx Therefore, it is ORDERED, that a permit as applied for be issued provided that application for the permit as applied for is made to the Zoning Inspector within one (1) year from the date hereof. Application may be made within thirty (30) days after the expiration of said one (1) year period, to the Zoning Board of Appeals to extend the provisions of this order for a further period of one (1) year upon payment of a fee of : $10.00. VaribrYd .gran -ted'. with 'ahe provision.; tY�at ..it Gan _on.ly be renewed one _:time, with the following condition: That a laboratory sample report­be -filed with the Inspector between Sept. 1st and Sept. 30th in each and every year �oilowing date of granting variance; said test shall be made no earlier than 60 days prior to Sent..lst. TOWN OF PUTNAM VALLEY The property described in the within variance is known and designated as and by lot number 128 & 129 in Block 52 only, on a certain map entitled, 'Lake Peekskill, Sec. E," and filed in the office of the Clerk Of the County of Putnam, State of New York, on May 28, 1929, under File No. 185F. TM 94 -3 -11 JOHN KARELL Jr., P.E., M.S. _. ...:.:..!Public -,Health- :Diregtor...,,. ,.. .... _ DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 0: All Board of Health Membsrs FROM: John Karel!, Jr., P. E. Public Health Director i RE: Board of Health Meeting September 20, 1993 Variance Requests , Since these requests were only discussed briefly in workshop session: last month, I am forwarding copies to you early in order that you may review them a: your leisure. if you have any questions please contact me at ex`. 151. b DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 August 23, 1993 George Aper.gis 296 LaFayette Avenue Cliffside Park, New Jersey 07010 Re: Variance Request Name: Apergis Street: 49 Laurel Road Town: Putnam Valley (T) Tax Map: 83,81 -1 -34 J I�- JOHN KARELL . Jr.. PE, M.S. Public Health' Ouector' Please be advised that the matter of your request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on 9/30/93 at 7:30 P.M. in our Health Department Conference Room, 4 Geneva Road, Brewster, New ".York.. You...gr - your..._ representative-must attend the. meeting to present your case. You are referred to the attached "Neighbor Notification" and "Variance Request" procedures which must be satisfied. The materials required in the "Procedure for Variance Request" document must be received in this office by 9/13/93. Ver •trul your , John Karell, Jr., P.E. Public Health Director For the Board of Health JK: pt cc:JK File Dear Sir: DEPARTNiEINT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 August 23, 1993 Re: Variance.Request Name: Apergis Street: 49 Laurel Road Town: Putnam Valley (T) Tar. Map:83,81 -1 -34 -- �...•'JOHN,..KAflElL !rte- P-E,::-M S. �. . Public Health Director Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a sewage system and well proposed for the captioned property which is contiguous to your property will be -heard by ttie Putnam Coui`ty,_._Boar,d of Health on September 20- 1993 at 7:30 P.M. in our Health Department Conference Room, Geneva Road, Brewster, New York. If you have any questions, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext.151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. Very truly yours, J/ohn5 Karel , Jr., .E. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 BOARD OF HEALTH Procedure for Variance Request -ZJOHN.KARECC Jr. -P`_. M.S. .. Puolic Health Director Pursuant to the provisions of Article III Section 2, (b) an application for the installation of an individual sewage disposal system that has been denied by the Director may be reviewed by the Putnam County Board of Health who may reverse the decision based upon proof of hardship and with concurrence of the Director that the proposed sewage disposal system will not create a health hazard by its use. Individuals wishing to make application to the Board of Health for a variance must submit a letter, to the Board President, Michael Schoolman, Putnam County Department of Health, 4 Geneva Road, Brewster, New York which application must include: 1. _. Ln .a- letter (14 copies). a) Formally request a variance b) Fully describe the variance requested and the properties affected by the Variance, i.e., a reduction in the required 100 foot separation distance to the Smith well is requested. The proposed separation is 80 ft. c) Discuss the hardship that will be experienced should the variance not be granted r''- 2. Provide 14 sets of plans 3. Submit a letter from the local Town Building Department that the property in questions is a legal building lot. The Board of Health will not consider variance requests for property that is not a legal building; lot from a Town Zoning standpoint. short: }y..or`m grell, Jr., P.9. Public Health Director JK:pt 6/93 14.184 (2187) —Test 12 ^1 [PROJECT I.D. NUMBER 617.21 SEOR State Environmental Quality Review, SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT :SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: Municipality County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks. etc.. or provide map) 5. IS PROPOSED ACTION: 0 New G Expansion n Modification /alteration O. UtSGMIt= YHUJW,1 UHICYLT: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 0 Yes 0 No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? rI 0 Residential 0 Industrial 0 Commercial 0 Agriculture ❑ Park/Forest/Open space 0 Other Describe;.. 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU ?? 0 Yes C No if yes, iist agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACT, 2N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes ❑ Nc It yes. !Ist arency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 0 Yes ❑ No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: Signature: 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 _. s s PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A.. DOES ACTlCN.-EXCEED. ANY,TYPE I THRESHOLD IN 6 NYCRR. PART 617.121 If yes. coordinate the review process and use the FULL EAF. ❑ Yes S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaratior may be superseded by another involved agency. r Yes (_i No C. COULD ACTION RESULT ;N ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING; :Answers may be handwritten. f legiblel Ct. Existing air quality. surface or groundwater quality or quantity, noise ievels. existing traffic patterns. solid '.Paste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic. agricultural. afcnaeological. historic. or other natural or cultural resources: or community or neighborhood character'! Explain briefly: C3. Vegetation or fauna. !ish, shellfish or wildlife species. significant habitats. or threatened or endangered species? Explain briefly: C4. A community's existing -lans or goals as officially adopted. or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in Ci-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. I D. IS THERE, OR IS THERE LIKELY TO 8E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— 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 with its (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. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Imps its AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency �1 Print or Type Name of Responsible Officer in lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency -gnature of reparer (if different from responsible officer) Date � o DEP,ARTNIENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, Ne%v York 10512 (914) 225-0310 BOARD OF HEALTH VARIANCE REQUESTS NEIGHBOR NOTIFICATION JOHN KARELL Jr., PE.. M.S. Public Health Qtrec:or Beginning January 1, 1989 appeals (petitions) requests to the Board of Health for a variance from provisions of the Putnam County Sanitary Code will not be heard by the Board until such time as the Director of Environmental Health Services of the Department of Health is provided with proof that notification of the date of the variance hearing was made to all property owners contiguous to the property in question. A location map with contiguous properries shown along with the property owners name and Tax Map # must also be provided to the Department. Notification shall mean receipt by each contiguous property owner and the local mun c ;b al Buil-4in Insp.ector.. gf,.a copy..of .the: attacied notification form along with a copy of the latest site plan and letter requesting'variance-: (see item n- (a) (b) (c) in "Procedure for Variance Request ". Proof of receipt of notice by contiguous property o tiers and the Town official can include either of the following: 1. Copies of registered mail receipts 2. Copies of the notification form signed by the contiguous property owners Notice shall be made at least 7 days prior to the date of the meeting and no earlier than 21 days prior to the meeting. Failure to provide the Board with adequate documentation of the performance of the notice may result in the Board delaying action on the request until proper notice is executed. The proof of notice shall be submitted to the Director of the Division of Environmental Health Services on or before 2 PM, on the day of the hearing. JR:pt ,nlol DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION` fi0 ' CONS7�RUC'I+ "A"�n1A'rER WELL - _ r. -'IL -t -,- I - - PCHD PERMIT Street Address Town/Village/City Tax Grid Number WELL LOCAT IO rIEA LPO WELL OWNER Name Mailing Address Private :5• 4 ?E( -C-T)S 'L V- r2:- TTF7_Av. C.Lipf-S'D &P4(Liv 13 Public WELL RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED 9BUSINESS - primary O FARM O TEST /OBSERVATION 0 OTHER (specify 2- secon ary O INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE__gal REASON FOR O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 12-ADDITIONAL SUPPLY DRILLING NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED 'C P_Z_:T i 2. (z) � /fit N I> 71 i S l�� 0 0 S G f S �(.i q S I �_1.� +-.Er Rd REASON FOR WO _'� W U- S W S( U DRILLING t �j L V P -CO -U L - . WELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name O e-jp— Address: A-S A. (z,Q V 1z_ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �NO 00 71 "re- NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM AR NEEST WATER - MAIN :• LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED i O ON SEPARATE SHEET (date) Vgnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue• 19 Date of Expiration Permit is Non - Transferrable 3/89 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller DAVID D. 'BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services George & Anna Apergis December 22, 1986 296 Layette Avenue Clifton Park, New Jersey 07010 Dear Mr. and Mrs. Apergis: JOHN SIMMONS, M.D. Deputy Commissioner RE: Proposed Well Construction Laurel Road (T) Putnam Valley Application # 71 -86 Review of an application to construct a well for potable water.supply.purposes.- to serve the above captioned property has been completed. Review indicates as follows:. 1. The lot is presently supplied by the Lake Peekskill Water Works.with summer water. 2:. The lot.,area is'approximately 5000 square feet. 3:= Tie proposed we-11 is located` approximately "80 "feet 'from the existing sewage disposal system on your lot, which according to the plan by Eastern States Septic Compan y. consists of leaching pits. Recognizing the above, and that a minimum separation distance of 150 feet is required between a sewage disposal system consisting of leaching pits and a well, your application.for a permit to construct a well on this property.is hereby DENIED. Ver tr ly yours, /.John arell, . Jr., P. E. Director, Environmental Health Services JK:pt cc:JK File Mr. Odell ( T ) Bldg. Insp. P. V. Mr. Sullivan . Lake Drive ,-6U2.- I + Lake Peekskill, N. Y. "ni►w swialut of E N STATES SEPTIC CO. TRENCHING DIGESTERS ' '' ""` ` " i '.T TOWiN' OR STATE y _ Y DRAINAGE - • IMHfF TANKS } SEPTIC TANKS SEPTIC TANKS CATCH BASINS _ K. R. LIETZ & SONS . CESS POOLS INSTALLED BOOSTER PITS ` : . Raymond K. Lietz & Kenneth J. Liets CITY DIS. PLANTS OIL PITS Owner & Operator' OIL STORAGE TANKS INDUSTRIAL SLUDGES �. 8 c DAVID D. 'BRIJEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services November 17, 1986 George & Anna Apergis Laurel Road Lake Peekskill, Putnam. Valley, NY 10579 RE: Proposed Well Construction Application # 71 -86 (T) Putnam Valley . Dear Sir: Review of'the above captioned application has been canpleted> Additional information or clarification is required as checked below: JOHN SIMMONS, M.D. Deputy, Commissioner fl. A detailed reason for drilling the well is required. A short narrative is required. For what. purpose will the well be used, i.e., drinking, lawn watering, etc. /2.. Is the site presently served by a well?. Explain �3. Is the site .presently served by a sewage disposal system? /4:.. 'Is the present structure to be reconstructed? . Expanded? Explain, How ?.. V5. A sketch showing the location of: - the proposed.well - the.existing sewage system on this parcel - the existing house on this parcel existing'sewage systems and wells on adjacent parcels within 200 feet of the proposed well. - all of the above is not provided. Upon receipt of the above information this application will be considered further. e yours, o ell, Jr., P.E. JK:mk Director Environmental Health Services cc: Bldg. Insp. C Johnson TWO COUNTY. CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 ll// 3�b DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION --TO- CONSTRUCT-""A..-AWAT8R:.:WELL.:... ��--jj � /cAwa pP QnnA Lake�'�e �Ki�� ''� 0"1VCHD�PERMIT # WELL LOCATION Street Address Town/Village/`City Tax Grid Number WELL OWNER Name /-. Address / l� 2v(LC' r aN►�€1 e� iS o�q� �Q�1� R42 �U� .9 • rivate O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, p AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE ? gal REASON FOR DRILLING ONEW SUPPLY O REPLACE EXISTING &PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING u 6: (V "vet e wou � gA WELL TYPE ' DRILLED ODRIVEN E]DUG GRAVEL E] OTHER IS WELL SITE SUBJECT TO.FLOODING? YES _ /'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ,y,2K_� U4` P_ tk( Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: V YES NO NAME OF PUBLIC WATER SUPPLY: [�j TOWN /VIL /CITY bISTANCE TO`'PROPERTY -FROM- NEAREST "WATER MAIN­;:- LOCAT ON SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ON SEPARATE SHEET r (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: Date of Expiration: Permit is Non - Transferrable A I^,- 19 19 Permit Issuing Official @CeIpt TM #94 -3 -11 - State . of. Now 4 .YoPIC down ®f Putnam Valley Building Dept. October 25 ...............:........., 19...8.5 .............................. Received from George & Anna Apergis 15.00 ............................................................................................. ............................... $..........'..........:. Fifteen and /no ................................. :............................. ................. DOLLARS .........................................:................. ............................... . ....... .Re.ne.w.a.l .... of ... >'e.�m . t... �� $4.- 2.3.6....iWell�....Perm.i.> ... 05.-. 7.. 7. .6 ............................. ... 'Town of Putnam Valle RENEWAL BUILDING PERMIT 85- 0776 Location of. Premises Laurel Road.— TM94 -3 -11 George & Anna Apergis _ having heretofore filed an application for a renewalpermit pursuant to the Zoning Ordinance, Sanitary Code, Building Code and the Laws in effect in the Town of Putnam Valley, Putnam County, New York, and having paid the required fee in the sum of $15 .00 it appearing from the said application that the j proposed improvement is intended to and will comply with the requirements of the law,as aforementiory . a_ Well permit is hereby granted this 25 day of October 19 tS577 fedditional 'information Variance -,Well NOTE: This permit expires one ,year from date of Issue. TOWN PF UTNAM r By T VALLEY I q DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPL'ICATION' TO­CONSTRUCT A WATER_•WELL- I PCHD PERMIT #`'V WELL LOCATION Street Ad/dre s f To Village ity Tax Grid Number �a Jr r e, Jj a cr C Ae t ex ri = 9 -- r -3.j WELL OWNER Name I Mailing Address rivate G.ed „ A . a Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP `_O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION 0 OTHER (specify 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED :?,/EST. OF DAILY USAGE j&0 Sal ❑ REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED 13 DRIVEN ODUG GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES � NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Al 17,7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES P”' NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE _TO. PROPERTY. FROM NEAREST WATER MAIN:: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ,BON SEPARATE SHEET (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade o Date of Issue: I 19 Date of Expiration % ��qf 19 Permit is Non - Transferrable 3/89 shall take appropriate action to assure that drilling operations be contained on this r othe a M contaminate surface or groundwater. : Permit Issuing Official White copy: Yellow copy: AP® -o Oj 3, or al HD File Pink copy: Owner Bldg. Insp. Orange copy: Well Driller /fzilgV DEPARTMENT OF HEALTH ^1C Environmental U 1 11 C Division "v: ionnienLa Health Services %-CD 4 Geneva Road, Brewster, New . York 10509 (914) 278-6130 JOHN KARELL A, P.E. PAS. Public Health Director March 16, 1993 ,George Apergis 196*LaFayette Avenue ltllffside Park, NJ 07010 Dear:.'Mr. Apergis: In response.to your February 9, 1993 letter in which you request information on a 'septic system relocation. 1. If you propose to abandon the existing septicsystem, a new septic system _would have to be designed by a professional .,engineer meeting current health* department codes for the existing house. This.does not appear feasible. 2..-.-A repair permit would be required from this Department for a repair of the septic system in the same location as the existing septic system. 3.- The current minimum separation distance between a(.01 and seepage pit is 150 eet If there are any questions I may be reached at ext. 166. Ver truly yours, Robert Morris Assistant Public Health Engineer RM/jp I C, 0 P JOHN KARELL Jr., RE, M.S. y• :'t: o . .:. �. -v Health- DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Mr. George Apergis 196 La Fayette Avenue Cliffside Park, NJ 07010 Re: Well permit Dear Mr. Apergis: January 15, 1993 A application to construct a water well has been enclosed. This application must be completed in full, including a site sketch locating all existing septic systems within 100 feet of the proposed well location, prior to review by this Department. If there are any questions I may be contact at ext. 166. Very ruly yours, Robert Morris Assistant Public Health Engineer RM/jp Enc. . -.: ,�Y a ... � , _ a .. : _ . a � .. �. _._ ...... .. -:�� - �.:�,.�_..� ._.... . -_ - .fro.: - .... . __ . , .., � .. 3A, t 4VL -k sty Ax a rli4�- IT 4 9. ^A hVI P® 't DEPARTMENT OF HEALTH Division, Of . Environmental Health Services 4 Geneva Road, Brewster, New York 10509 . (914) 278 -6130 George M. Apergis 196 Lafayette Avenue Cliffside Park NY 07010 Dear Mr. Apergis: JOHN KARELL Jr., P.E. °Public Health•Dircctar. -- - November 17, 1992 RE: Application to Construct a Water Well Enclosed please find an application to construct a water well. The enclosed application must be completed and submitted with a site plan, - a copy of "the "survey is adequate showing' all 'septic- systems.-within 200 feet of the proposed well location. After the above is completed you will receive comment from this Department. If there are any questions, I may be reached at ext. 166. Ver ,,Z yours, yours, vAou.:;' Robert Morris Assistant Public Health Engineer RM:mk enc. X66 LAkeland 8 -68A2 Lake Drive Lake Peekskill, N. Y. E°le�niri j - 5peciirlist of ° p' ="� C TRENCHING 4r. mrR .r;: -.. 4• -,�. t.:,•�... .O �- .�':p':.�. -v �. _ ��;.....R .. ,.. ..-.•. ._ 1 .,, .S.r;c DIGESTERS h ANY TOWN OR STATE DRAINAGE BEDS IMHOFF TANKS SEPTIC TANKS SEPTIC TANKS CATCH BASINS K. R. LIETZ & SONS CESS POOLS INSTALLED BOOSTER PITS � Raymond K. Lietz & Kenneth J. Lietz CITY DIS. PLANTS OIL PITS Owner & Operator OIL STORAGE TANKS , INDUSTRIAL SLUDGES n, a V) r n b A z� r. _41 196 La Fayette Av. Cliffside Park N.J. 07010 February 09, 1993 Mr.Robert Morris Assistant Public Health Engineer Re: Well permit Dear Mr. Morris: Since the distance between the proposed well and one of the drainage pit is 95 feet I have to move the existing drainage pit to a new position that will be 10 feet away from neighbor's property and 106 feet away from the proposed well as you see the enclosed site sketch. Do I need a permit for this? If so, do I get it from the Dep- artment of Health or from another department? Please notify me as soon as possible. Very truly yours, George Apergis x". 1 z. 1 -g6 -3 (12/78) ,APPOIDIY B MORT SM O SSES.4N�P1'f PRAY .:L -_" .. Gat° : -.c � :�. _. ., _.. ..� l c �. w s. u . j.: _ • —x: M.i� :- ::• -':v +-.� ... :i. •�—gf ... - � . e nr• .c, c n 2MUCTIOHS1 _... (a) In order to assurer the questions in this short ZAF is is assumed that the ppreparer will use currently available Information concerning the project and the likely impacts of the actiono It is not expected that additional studi ®e, research or other investigations will be underte►keno . o (b) If-any question has been answered Yes the project way be significant and a completed Environmental Assessment Foams is necessary® (c) If all questions have been answered No it is likely that this project is & ot significant,, ,� / ,i (d;i v o enta Assessment ��veG 4�j At - '�l/��i'r/% UrG� /wed :19 Will project result in a large physical change �, f°7dty to the project site or physically alter more than 10 acres of land? e o o o e a e e e e o o ate® Yes No 20 Will there be a major change to any unique or unusual land form, found on the site ? 'e o a o o ® Yes No 3e Will project alter or have a large affect on an existing body of boater? o o a o o o o o o o ® Yes NO 4o Will project have a potentially large impscb on �✓' groundwater quality? a 0 0 o a e 0 0 0 0 0 0 ® No Se Will project significantly offect drainage flora / on. adjacent aites?, a o 0 o e o 0 0 0 0 0 0 ® Yes ® Y10 6 ®' Will project affect any threatened or endangered ,plant or animal species? o o o 0 o a a e o e o �® Yea NO 7a Will Pro �ect result in a major adverse effect on air quality? 0 0 0 0 o e o 0 a o 0 0 ® Yee No 6. Will.project have a major effect on visual char - - meter of.the .community or scenic views or.vistas known to be' important to the community? o a e Yes No 90 Will project adversely impact any site or struct- ure of h storic, pre- historiev or paleontological importance or any site designated as a critical. onvironmental.area by a local agency? a 0 0 Yes No 10e Will project have a major effect on existing or future recreational opportunities? o•0 0 ® rtes , No llo Will project result in major traffic problems or cause a major effect to existing transportation ,� systems? 0 0 o a a o a o 0 0 0 0 ® Yes ® No 12a Will project regularly cause objectionable cdorsp noised glare, vibrationo or electrical disturb ance as a result of the project's operation? e — Yes No 13o Will project have any impact on public health or -� safety? e e o 0 0 o e o a o 0 e o� Yes NO lbo Will project affect the existing community by . directly causing a growth in permanent popula- tion of more than 5 percent over a one-year period or have a major negative effect on the character of the community cr neighborhood ?o o ® Yes ® so 15o Is there public contrrovGejrsy concerning the project ?? .Yes ✓ No PREPARER ®S SIGNATURES i/�'J P�� TYTLEa , (i✓ ��'%4� REPRESENTINGa "'��°�'��''���i�gJ:S DATES ��- e�a��e JOSEPH F. SULLIVAN, P.E. 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N.Y. 10598 (91 4) 962-4248 /:7, C.'IV. /7 �G�f � l//t°�l 1 7/ Dear DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York. 1050.9 (914) 278 -6130 Re: .Variance Request Well Name Apergis Address: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 i:' JOHN' KARELL: Jr..:_P.F_-. jAS_ Public Health Director Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a well proposed for the captioned property which is contiguous to your property will be.heard by the r, Putnam.- County_,Board of- of.- December 13,;: 1993 at 7.:30- :P..M. ` -in our_ Health xDepartment Conference Room, Geneva. Road , Brewster;drew -Yo rk. If you have any questions, concerns or information which may bear.on our deliberations, you may appear at this meeting or contact the writer at Ext. 151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still-on the agenda. ry trul y u , 6 ohn Kare 1, Jr., .E. Public Health Director 'For the Board of Health JK:pt cc:JK File Frank Sullivan, P.E. 4Z 7 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 "JOHN KARECC Jr., P.E.1 -M.S,; Public Health Director October 6, 1993 Mr. George Apergis 296 Lafayette Avenue Cliffside Park, NJ 07010 CIO C-4 RE: Apergis Variance Request U: 49 Laurel Road Z- _ (T) Putnam Valley r- TM #83.81 -1 -34 LU wear Mme;: Apergis: c1 rte, PL sum to discussions at the Board of Health meeting held on September 29, 1993, the following additional information is required by the Board. 1. Topography - on site and within 200 feet of the site. 2. Location map 3. Verification of the locations of surrounding subsurface sewage disposal systems. 4. Locations of adjacent wetlands and watercourses. This information must be provided by a Professional Engineer or Registered Architect. This proposal will not be placed on a future agenda until this above - mentioned information is provided. If you have'any questions, please contact the writer at ext. 151. Very trrdly ours, Joh� Karel l ,1 r. ' P. E. Public Health Director JK:mk `r r January 13, 1994 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 George Apergis 296 Lafayette Avenue Clifford Park, New Jersey 07010 I JOHN KARELL Jr., P.E., M.S. • :,.,P,ublicsJllealth:4Direcsur. ,. Re: Variance Request well Name: Apergis Street: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 Dear Mr. Apergis: Please be advised that the matter of your request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on January 24, 1994 at 7:30 P.M. in our Health Department Conference Room, 4 Geneva Road, Brewster, New York. ,Your.or your representative must attend the meeting to present your case. You are referred to the attached "Neighbor Notification" and "Variance Request" procedures which must be satisfied. The materials required in the "Procedure for Variance Request" document must be received in this office by January 19, 1994. Wry fruly � ours, J'; Karel l,"� .E. PNIblic Health Director For the Board of Health JK:pt cc:JK File Frank Sullivan r A Dear DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Re: Variance Request Well Name Apergis Address: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 JOHN KARELL Jr., P.E., M.S. Nbli Healttii Director' Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a sewage system and well proposed for the captioned property which is contiguous to your property will be heard by the Putnam County Board of Health on January 24, 1994 at 7:30 P.M. in cur--Health- Department Co.nfer.ence Room„- Geneva, Road, - .Brewster, New York... . If you have any questions, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext. 151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. ;Very trul yours, oLL' Karel , Jr. , . B. blic Health Director For the Board of Health JK:pt cc:JK File '+rsf January 13, 1994 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 George Apergis 296 Lafayette Avenue Clifford Park, New Jersey 07010 Dear Mr. Apergis: /L JOHN KARELL Jr., P.E., M.S. {•; -'_. Public Health Directcr__ _ Re: Variance Request well Name: Apergis Street: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 Please be advised that the matter of your request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on January 24, 1994 at 7:30 P.M. in our Health Department Conference Room, 4 Geneva Road, Brewster, New York. Your or your representative must attend the meeting to present your case. You are referred to the at "Neighbor Notification" and "Variance Request" procedures which must be satisfied. The materials required in the "Procedure for Variance Request" document must be received in this office by January 19, 1994. Vety truly► ours,f t j X J� ` Karel, , ,�� E. Pblic Health Director For the Board of Health JK:pt cc:JK File Frank Sullivan Dear DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Re: Variance Request Well JOHN KARELL_ Jr.,.,P.E., M.S. Public Health Director Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a sewage system and well proposed for the captioned property which is contiguous to your property will be heard by the Putnam County Board of Health on January 24, 1994 at 7:30 P.M. in 'our•::Health Department .Conference Room, :Geneva- Road;- -Brewster; New York::c---- -:•: If you have any questions,, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext. 151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. Very trul yours, r� n , 6 hi �rarei Jr P,Jblic Health Director For the Board of Health JK:pt cc:JK File Apergis _Name Address: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 JOHN KARELL_ Jr.,.,P.E., M.S. Public Health Director Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a sewage system and well proposed for the captioned property which is contiguous to your property will be heard by the Putnam County Board of Health on January 24, 1994 at 7:30 P.M. in 'our•::Health Department .Conference Room, :Geneva- Road;- -Brewster; New York::c---- -:•: If you have any questions,, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext. 151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. Very trul yours, r� n , 6 hi �rarei Jr P,Jblic Health Director For the Board of Health JK:pt cc:JK File November 29, 1993 6 K", LL —Jr., P.E. M.S.... .. F Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 George Apergis 296 Lafayette Avenue Clifford Park, New Jersey 07010 Re: Variance Request -well Name: Apergis Street: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 Dear Mr. Apergis: Please be advised that the matter of your request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on December 13, 1993 at 7:30 P.M. in our Health Department Conference Room, 4 Geneva Road, Brewster, New York. Your or your representative must attend the meeting to present your case. You are referred to the attached "Neighbor Notification" and "Variance Requests' procedures which must be satisfied. The materials required in the "Procedure for Variance Request" document must be received in this office by December 7, 1993. er tru ou ' bEi Kar 1 , r, .E. 4, ublic Health Director For the Board of Health JK:pt cc:JK File Frank Sullivan, P.E. Dear l �"s -:7•; ..> �< -, - ..r.; ,o.,: �,: JOHN.KARELL' JJ.: 'P..E,.. M:S'•.;:: .. . Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Re: Variance Request Well Name Apergis Address: Laurel Road Town: Putnam Valley Tax Map: 83.81 -1 -34 Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a well proposed for the captioned property which is contiguous to your property will be heard by the '"Putnam Courity'Board' of -Heal rh ` on-- Dec' ember -l3 -; -1993 at- -7�r30 P.-M. -- in- :our::He,alth Department Conference Room, Geneva Road, Brewster, New York. If you have any questions, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext. 151. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. pry trul y ,u , ohn Kare 1, Jr., E. Public Health Director For the Board of Health JK:pt cc:JK File Frank Sullivan, P.E. i i 1 i 1 i - - yy�f�• �2. �� 3 . a i f �'• i. ,.a f'• �N f t. j± r: