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HomeMy WebLinkAbout4311DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -16.3 BOX 33 1 1 loom k, a Me r IS i Fr I . wj or I W; , . A 4 . 16 f T m I 000 to 04311 J A \l/� r z e PUTNAM COUNTY DEPARTMENT OF. HEALTH . DIVISION OF. ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # N-14_cifo 3o-19 Located at 8 apA9 Town or Village PUT 4h i VAI -LEAA pyp�tcF�cts' Owner /Applicant Name VeA"MaKt- 60 Z'- Tax Map _ Block �_ Lot 1 •3 Formerly 4.i�'A Subdivision Name F%1 WLLL F.siWrV$ AM- Subd. Lot # 3 Mailing Address X30 Wes; Ac5 -J � S K" y Zip Y Q03�1 Date Construction Permit Issued by PCHD I I C q Separate Sewerage System built by 5`jTo -vim kK--KU 1C- Address PUT -JAM %!MA-97 Consisting of 506 Gallon Septic Tank and W,5 l.F - ?A t#IC.t{- W 1t*— Apsoe•PRGtJ . Wka* JCAtSiS KKK) AT— Co 4'f: 0. C-. Other Requirements: Water Sup uly: Public Supply From Address. or. Private Supply Drilled by tub2MAiJ 50 3 . i W.Address Rk-OJ �I VA�u,1 _� =��E :_ _ __ Has erosion control been com�leteci? _- 6�0 Number of Bedrooms Has garbage grinder been installed? tic) I certify that the system(s), as listed, serving the above premises were. constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: O L Certified by Address P.E. X R.A. License # 6�2� Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in .the judgment of the Public Health Director, such revoca ' n odifi ol e ' necessary. By: Title: HNC . Date: 2 9 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 * _ PUTNAM COUNTY DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well �a#a��n . - Street :.difres "s:. :� _ �; - -: -.. _ ►�wS Tovvn/Village' ` ___::.- d.�e� Lla lle ,Tax Grid.# Map Block Lot(s) 16.3 Well Owner: Name: Address: 3 3v 4i IfVM SY- /r!�. C L, Use of Well: I- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) I dustrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length ft. Length below grade f3. 4; -ft. Diameter P in. Weight per foot lb /ft. Materials: O.�Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: ieement grout _ Bentonite Other Drive shoe: &,Yes _ No Liner _ Yes &/ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test. Bailed _Pumped ompressed Air Hours W1 Yield /0 gpm Depth Data Measure from land surface - static (specify ft) 010' During yield test(ft) Depth of completed well in feet �00 Well Log If more detailed information descriptions or sieve. °analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation (Description ft. ft. Land Surface 33.,.5—o 6 o v p✓ b L v cp ,V 3 3. J'_ 3 oo, e d _ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type C.Lw ,gA, Capacity Depth 190 Model Voltage 230 HP Tank Type Ive 1r7,,)/ Volume a4_16 Date Well Completed `71 aLf /q9 Putnam County Certification No. Date of Re ort l L) g 9 Well Driller (signature nu ii m: rxact location of well witn aistances to at least two permanent landmarks to be provided on a separate sneettplan. r Well Driller's Name if t% t i 'Ed in Address: IS-2- 44,e +�/ V a Signature: Date:i e.�9 S All/ 7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 � YML ENVIRONMENTAL SERVICES 321 Kear Street _ Yorktown Hqiohts^_]N,y,,10598_, . _� ' ZA'-:`��0i914y2��5�2E�/U''- -� ` AlbeA H. Padovani, Director LAB #:.32.904986 CLIENT #: 9139 STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~*~~~~~~~~~ BROOKFALLS DEV CORP 330'W 45TH ST. ATTN: DAVID SCHW'RTZ ,NEW YORK, NY 10036 � PLING SITE KFALLS RD. � - NY COL'D BY: DAVID� k WARTZ'-----' NOTES...: OUTSI6E HOSE BIB ~~~~~~~~~~~~~M~~~~y~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 08/13/99 DATE/TIME:REC'D: 08/13/99 01:25 REPORT DATE: 08/18/99 PHONE: (212)-265-8189 SAMPLE TYPE.�: POTABLE PRESERVATIVES: NONE TEMPERATURE,,: <4C COLIFORM MET& MF °~"~~~~~~=—~~~~~~~~°~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY / PROFILE 08/13/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 08/13/99 LEAD (IMS) 3.3 ppb 0-15 pp6 9101 08113/99 NITRATE NITROG 4.11 MG/L 0 - 10 9139 08/13/99 NITRITE NITROG N/A 9146 08/13/99 IRON (Fe) 0-0.3 mg/l 2037 08/13/99 MANGANESE (Mn «`CE 0-0.3 mg/l 2037 08/13/99 SODIUM (Na) 70.1 MG/L N/A 08/13/99 pH 8.2 _ —n .__ UNITS 6.5-8.5 9043 08/13/99 HARDNESG,TOTAL 112 MG/L N/A 08/13/99 ALKALINITY (AS 146 MG/L N/A 08/13/99 TURBIDITY (TUR NTU,,e,._ U°` .`_<1 =~ �0 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI-THE N� �� NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD valne of More than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive ~- potential. _ � Fe/Mn If both iron and manganese are present, their total value � �'7 combined shall not exceed 0.5 mg/L. -' � Na No limits for Sodium are proscribed. .Suggested guidelines state ., . that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For th0ie on a 'u moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. ` IP i° - -. f.', .i•,i -._. -.. -is tea. .n.`.&, -..*: .: l= JM I : 7 - DVS %T -1Et +lr'T°t�"S7!..�1".�:�l.0 t;o.,.?. e'...• . ... •�•e t. C..:,:, w:'. .-:. ...:.. , 321 Kear Street Yorktown Heights, N.Y. 10598 ( 914) 245 -2800 Albert H. Padovani, Director LAB #: 32.905416 CLIENT #: 9139 STAT PROC PAGE 1 - -- - -- -------- ------------ ---- - - -- -M BROOKFALLS DEV CORP 330 W 45TH ST. ATTN: DAVID SCHWARTZ NEW YORK, NY 10036 DATE /TIME TAKEN: 08/31/99 O1-'OOP DATE /TIME RECD: 08/31/99 02-OOP REPORT DATE: 09/01/99 PHONE: (212)- 265 -8189 SAMPLING SITE: 8 BROOKFALLS ROAD SAMPLE TYPE,.: POTABLE PUTNAM VALLEY LOT #13 PRESERVATIVES: NONE COLD BY: DAVID SCHWARTZ TEMPERATURE..: f 4C NOTES...: OUTSIDE HOSE COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL -- RANGE METHOD 08/31/99 IRON (Fe) 0.103 MG /L 0-0.3 mg /l 2037 COMMENTS: Fe /Mn If both iron and manganese are Present, their total value combined shall not exceed 0.5 mg /L. >UBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director FLAP# 10323 � | YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktowp Heights, N_y,, - `'7l . `245=2BDD'�'-­��''�-;�;�`���=��������` | Albert H. Padovani, Director LAB #: 32.904986 CLIENT #: 9139 ~~~ ~~~~~~ ~~~~~~ ~ ~~~~~~~~~~~~~~~~~~~~~~~ � BROOKFALLS DEV CORP 330 W 45TH ST. ATTN: DAVID SCHWARTZ NEWARK, NY 10036 SAMPLING SITE: 8BROOKFALLS RD. : PUTNAM VALLEY NY COL'D BY: DAVID SCHWARTZ ' NOTES..": OUTSIDE HOSE BIB �~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE STAT PROC PAGE 2 ~~~^~~~~-~~~~~~~~~~~~~~~~~~~~°~~~~~~~~~ DATE/TIME TAKEN: 08/13/99 DATE/TIME REC'D: 08/13/99 01:25 REPORT DATE: 08/18/99 PHONE: (212)-265-8189 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. 'MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED-AS THE SUM-OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGEFROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED- SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L 7 MD-LI 'PER.LITER^ ^ �1'~~ ` 'n/oall � ='|�7��'^ MUMS IL) � - - ~ SUBMITTED BY: Director / ` � �� ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM B mk� ppkx al a. JF Coop � . I � - ► � , 3 Owner or Purchaser of Building Tax Map Block Lot 5q-F,V�- BTU K P k- AM V� t5fEMDbftNg Constructed by TowniVillage Location - Street Subdivision Name i2X-_5(D EIJil Building Type Subdivision Lot # I represent, that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown _on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said. system constructed by me which fails to operate fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful .or negligent act of the occupant of the building. utilizing the system. _ The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system: Dated: Month Day Year Signature: � - -- Title: � General Contractor (Owner) - Sigifature m1oyj i" S Ll61keLO PMX�NIF caZP• �5�2✓ �— Corporation Name (if corporation) Corporation Name (if corporation) Address: �0 W . As +o ST; Address: r /J 4 n ✓ State 'Zip I WING State W y Zip G � Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH MENTAL HEALTH SERVICES DIVISION OF ENVIRON r FINAL SITE INSPECTION Date: Inspected.by StreetL5*on er Permit # TM, Subdivision Lob , 1. Sewage System Area a. STS area located as per aliproved plans ............................ b. Fill section'- date of placement .):I barrier , Lg'th. Width Avg.Dpt.h c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands ......... ........................... Ii. Sewage System a. Septic tank size =1,000 ......... 1,250 ......... other ..... UDD ........... b. Septic tank installed level ................................................ c. 10' minimum from foundation ......................................... d. Pistribtuion Box 1. All outlets at ame elevation-water tested ................. 2. Protected below frost ................................................. 3. Minimum 2 ft.Original soil between box & trenches Junction Box - 'erly se ......................... ,prop 1 . Ldngtniequire( YT-5 Length instalieTC TS__ 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1116 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface... ..:............ 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1%" ' diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ....2, ................ I..,,..................,.....,......;:.,;;.. _g-�Yuxu D o r- 0 i*d-Sistcms - 1. Size o t pump chamber ............................................... 2. Overflow tank ............................................................ 3. Alarm, visual / audio ................................................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................................................... 6. Cycle witnessed by H.D.estimated flow /cycle...._ III. Houseffluildi a. House located per approved plans ........................ . b. Number of bedrooms ...................................................... IV. Well a. Well located as per approved plans ................................ b. Distance from STS area measured ft........... c. Casing 18" above grade ................................................. d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All, pipes flush with inside of box .......................... * .......... d: Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to f. Curtain drain outfall protected & dir.to ' exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .................................. i. Erosion control provided ................................................ Rev. 1/97 JuL— lb-1777 13 ;4f F_Kull bHUtY 6. WH151JNs Y.L. TU 2787921 P.01 d"71 J-,IJ nay 1L•.0 rm runRa err W HEWN FAX NO. 19142787921 P, 2 PUTNAM COUNTY DEPARIMIgT OF HEALTH WENMONMENTAL 9-=T- EOR. F21" %2=10N For, Filler Tmrhes _ PCHD Construction Penn it # - A -I& Owner /Applicant Name Fonaedy____, —Subdi-eisionNme OW50 Subdivision Lot # A= erosion control weasura in place? I certify that the system(s), as listed, at the above premises has been coustructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Certified VDesign Professional s Comments- FOR: ® ADAM ® Old FAdm FIR-99 TOTAL P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH ✓ DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f 14 -(-1(a Located at or Village PUl'TIJAtA w Subdivision name s 0-A15T Subd. Lot # 3 Tax Map Block Lot �(o• j Date Subdivision Approved _ /'Zy 61 C) Renewal Revision Owner /Applicant Name �2,r�ICF= A,tSy D - I.aP�►'ll Date of Previous Approval 2-q Mailing Address W al;-V -45+ij t,1 Zip Amount of Fee Enclosed A 3,W. UO Building Type � t Lot Area � , 5 No. of Bedrooms 5 Design Flow GPD 110019 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l .1500 gallon septic tank and C2S Lf-- -- 1� `� vwt ,� P_Pil Uri iR- B�•DC.N � SP A A'� G� (o . C-. Other Requirements:. O `- Z) ao e> v-- 1 LL boa- CyzA-y,,jG m l S n> "A>C To be constructed by WASTLAy, Address P%-lTt J-At e( VA &4-9,� - NJ- Water Suonly: Public Supply From Address :...yPnvate- Si pply-Orilled by i�E3 0e� Address - Prs � W>lsal'.:..: �t c.: I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date L") 2Co a8 License # e7_975 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p rmit. Approved for ischarge of domestic sanitary sewage only. Q t By: l Title: `� Date: White copy - HD Fi ; Ye ow co - Building Inspector; Pink copy - er; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APIPI.ICATI ®N 'T ®. CONSTRUCT WATER WELL please print or type PCI-ID Permit# P\J f4 WeH Location: Street Address: Town/Village Tax Grid # PQ00 -S lDA RkT AN Map JDA Block I Lot(s) Well Owner: Name: a Address: DRrn� 33d Use of WeH: _ Residential Public Supply Air /Cond/Heat Pump Irrigation I- priimuary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage (fib gal. Reason ffor Replace Existing Supply Test/Observation Additional Supply Drillflng New Supply (new dwelling) Deepen Existing Well Ibetailed Reason : q,3 . f?U&Abr -_ � for Drilling Well 'Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ><' No Name of subdivision F1•E-HU - l�S�` M5 - Lot No. S Water Well Contractor: Kb2 t A3 DeVSZsJ Address: �� ',�c(,l l'r�✓ Is Public Water Supply available to site. ................ Yes No Name of Public Water Supply: W16 Town/Village Distance to property from nearest water main: 7 1 nit Lj Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 'Zfo. A licant,Si nature:: • U�.G�L(7 �- • _.:...._:.__ .. �.._ .. pP g PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. A - - /1 Date of Issue q Permi Date of Expiration Title: Permit is Non-Tiransfeiriable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PU"I'NAM 3; C C UN T Y JOEPAR"rMENT OF HEALTI APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM Name and Address of Applicant: - $rookfails.Development..Corp 330 West 45th St New York NY 10036 2. Name of Project: Individual SSDS 4. Project.Engineer.: Badey & Watson, P.C. License Number: 6505 Phone: 265 -9217 3. Location T /V /C: Putnam Valley 5. Address: US Route 9 Cold Spring,NY 6. Type of Project: X Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality"Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. �— Unlisted 8. Is a Draft Environmental, Impact Statement (DEIS) required? ............. N/A Has DEIS been completed and found acceptable by Lead.Agency.? ........... m./Al lo. Name of Lead Agency Putnam rnunty Dppartmenfi of 14P;41 fih 11. Is this project in an area under the -cgntrol of local planning, zoning, or other oficials,,•ordinances? ................ ...............•.Yes -- ....a _ .. _..... ... -.. .a . .... ...- r.- .... . -... ..�. r .- �..., is .. ..� _ .. ... ..... ._ _,. Y• a < -. - -F^ .... .. ...... .. e. .. ..^e .._....._... .. _.., _�. ..+ _ .. �. • � .... ... 12. If so, have plans been submitted.to such.author.ities? No 13. Has preliminary approval been granted by such authorities? N/A Date Granted: 14. Type of Sewage Disposal...System Discharge.._......., surface }rater X Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N/- 16. Waters index number (surface) ........... ............................... N/A 17. Is project located near a public water supply system? .................. No: 13. If yes, name of water supply.. N/ A Distance to water supply N/A_ 19. Is project site near a public sewage collection or disposal system ?..... No 20. Name of sewage system N/A Distance to sewage system N/A )ate observed: May 1987 23. Name of Health Inspector: Michael J Budzinski loject design flow (gallons per day) ....... ....................•.......... 800 A 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. No 26. Has SPDES Application been submitted to local DEC Office? »N /A' 27. Is any portion of this project located within a designated Town or State wetland? ..................... :........................................... No 28. Wetland ID Number ... ................... ............................... N/A 29. Is Wetland Permit required? ............. ............................... No . Has application been made to Town o,r Local DEC Office? No'..'., 30. Does project require a DEC Stream Disturbance Permit? ................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO No 32. Is project located within 1,000 feet'of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO No DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... Yes 34. Are community water, sewer facilities planned to be developed within 15 years? No .. -3.5..--- A.r...e -;an:y sewage - :di- sp_osal..areas,,-,in excess of 15ro slope ?,._..,:. :.. _._ _ Yes 36. Tax Map ID Number ......................... ............................... 84 -1 -16.3 37. Approved Plans are to be returned to: ................ Applicant X Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to coimpl .r'ith this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is t_r-ue. to the best of my know.7edge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the- Pena 7 Law. SIGNATURES & OFFICIAL TITLES: & Watson, P.C. 9 ' MAILING ADDRESS: U'.-S: Route 9 Cold: ,-Spring NY 10516 PUTNAM COUNTY DEPARTMENT 'OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT.- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health birector In the matter of application for: SEPTy— 5q 5T-e v lEe,tr e0Q Fb� I.-M h - sc,�+v�ci�czrz :represent that I am an officer,or employeeof the corporation and am authorized to act for: Name of Corporation: bew VFFlaS7 pFJ•/ /�ersT C - Having offices at: ' �j%p Y f�T -AS *e2y -, ��-f� 100--), Whose Officers Are: President - Name: N', le- 's R f Z Address: .� _ o �,Jes7`' C/ S'i-It- ,Sf,-ee: 1N1r /1/ =y Vice President - Name: Address: Secretary -Name: -- - - - �� address: . � . ..�.: ;• � - -.� "..:�.. _.:. .._ _ ...�., - �..- � , .... - -�. ,_ ��.:. -. _.. _ _..::. ,.._ Treasurer Name: Address: and.that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day. of (font i) —.(year) tary..Pu lic NORMAN 6' SCbNdAF 2 NOTgVf PUBLIC, VMS OW YA' No. 02 C35S6170 Cealiflod In Dronx,Counl�.Qu.�+ Commisslon Exptros Jae, 31 Form CA -97 Signed: Art ( 17 Corporate Seal PUT1oT.AM COUNTY DEPARTMENT OF HEALTH DIVISI ®N OF EN VIRONIVIENTAL HEALTH SERVICES : LETTER OF AUTHORIZATION RE: Property. of BQS 1V_4 W > pPyeLC)P T ec�12P , Located at P>0400VF�t.15� l T/V Rrtt J" Tax Map # Block �_ Lot Subdivision of F�)OTM LL, eS SAS 1 Subdivision Lot # Filed Map # . ?�!Date Filed o Za bo. Gentlemen: This letter is to. authorize �--t -� a duly, licensed Professional Engineer_ or Registered Architect to apply for the required wastewater treatment and/or water :supply perinit(s) to serve the above -noted property in accordance with the" standards, rules or regulations .as promulgated by the Public Health Director of the Putnam County, Health Department, an,d to sign all necessary papers on my behalf in connection with this matter and'to supervise the construction of said wastewater treatment and/or water supply systems in conformity withthc provisio_nst -of Article.145 and/or 14.7.01 the:Edueat!on_1awy :the, Public Health LAW, and: the Putnam County Sanitary Code.. Very truly yours, Countersigned: Signed: i i P E, I - 250cj.. (Owner of Property) Mailing AddressorS Mailing Address: 530\4 45+in `5(—: 4 rr) Ll 'Ot?, _V_ CDR Form LA -97 COUNT)," OF 111;;A' DIVISION 01F ENVIRONMENTAL HEALTH SEIRVICL t. .1996 RC: Pr 0jr) c.rt Brookfalls Deve.,jopment Lo c: a l o d Pb_,k8ki11 Hollow Road (,:r P U C n a r",-.-.v a 110 Y ..5cc-tion-8-1 ilock ------ ...... [-'oothi.11 EState&.- subdv. Lot: —riled Map 2477: - Dzi t e--­_6 2 0/9 0 G-c r, t I C m C11 Phis 1c-ttc, 7..,5 -to a.,utliorizriz John P. D a n n , P - E_-_ a duly liCCI-15CCI '..1.'70fCSSiOnZll mgin'ecr X or registered liidicate) tc scwagc o to a., .)ply -f 0�- for a 5Cp3ra Serve the nbovc proper-ty j.-L accordmce iN•it'.I t1ir, ui 1. 3 the Commi.,5s, -iex- oE -LM; %j U.; I j,o,� C).1" r C C, U:".,..l L 0 1 _'i .71 pr k a. gra L c d b 7.11 C o au-i L C., t io 11 w:; ; i, V.! . . I . 'r u s ilia C MW Lo crvi..i C Mv., c; C)...-., C. 'J. on. zm; 151 Co"I .'i.l f -- - n L CI 1, 11 C P L It II i:l I-, i I 1' 7 , F, d LI C; tl *.he I'lablic Lary C 0 cl C 0 ull t cr 3:;, gn 0. ('14 6/ BADEY & WATSON, P.C. Act cl.v (�' fj S US Route 9 Cold Sprinq Tel cphol-le •ary truly , Y 0 kx.r 5 1 d ---------- vr, 330 West 45L_h_S New York, NY 10036 (212) 247-3450 m PUTN,si COUNTY DEPARTMENT OF IIEALTII Division of Environmental Health Services APPEUDIX L . ,. AFFIDAVIT - CORPORATE - OWNER' APPLICATION FOR PL•'RPIIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for.: Cons te!.:�:_ i o:i Pocmit for Sewage Disposal .System & Water Well I, • u,.�'� i.. P' ;ciiwartz . represent that I am an officer or employee -of the corporation and am authorized to act for m_. )o'rl-falls Development, Corporation (Name of Corporation) having offices at 330 West 45th Street, New York, New York 10036 Whose officers are: President: ,ail es Schwartz, 330 West 45th St. , NY, NY 10036 .- (.Name and Address) Vice — President: li 1 (Name and Address) Se r_ztary . .. _ - _ _ (,tame °and Add'i i" s) _ Treasurer: - (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 29 day of... D:,ce+nhe c 19.9.5 . ! •' (� 1 fir.. Notary Public REBECCA W. LINDA ' NOTARY PUBLIC, State of New York No. 5004353 Qualified in Dutchess County �}/j /� Cnmmissinn Fznirrc Nnvrmhrr IA %`i17& 8/84 Signed: ,✓ Title: Corporate Seal PUTNAM COUNTY DEPAR'111NT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN'DATA'SHEET'= SUBSURFACE SEWAGE -DI SPOSA.L SI'STU',1 '' 'FILE NO. Owner David M. Schwartz Address 24 Edgerton St., Dari.an, CT 06920 Located at (Street) Peekskill Hollow Road Sec. 118 Block 03/05 Lot 03/01 (indicate nearest cross street) SUBDIVISION LOT # 3 Municipality T/0 Putnam Valley _ Watershed Peekskill. Hollow Brook SOIL PERCOLATION TEST DATA REQ U� IRED J`O BE SUBM'I'TTED W17-1 APPI;I'CATIONS Date of Pre - Soaking 12/13/87 Date of Percolation Test 12/14/87 HOLE 11.:32 -11:57 25 a7.0 30.0 3.0 NUi`IBER CLOCK TIRE PERCOLATION PERCOIATION Run _ Elapse Depth to Water I front Water Level 30.0 No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches B 4 1:06- 1:45 39 A 1 11 :19 -11:49 30 26.5 32.5 6.0 5 A 2 11:55 -12:15 20 25.5 29.0 3.5 6 A 3 12:16 -12:39 21 25.0 28.25 3.25 6 4 5 B 1 11.:32 -11:57 25 a7.0 30.0 3.0 8 B 2 .11:59 -12:32 33 26.0 30.0 4.0 8 3 1.2. _3 �1' 05 3.0. B 4 1:06- 1:45 39 29.0 32.0 3.0 13 5 1 2 4 5 NOTES: 1. 2. rev. 9/85 Tests to be repeated at same depth until approximately equal soil rates are obtained at each perco.lation test: hole. All data to be submitted for review. Depth measurements to be made from top of hole. Name John P. Del.,aLq, P.E. Signature % BADEY &, WATSON = 0 tA.4 Address Surveying & Engineering, P.C. SEAL C: Route ­9 Cold S2ri 2Eg, No; 1"ork L 6, 0516 1 THIS SPACE POR USE BY HEALTH DEPARTMENT ONLY: ' ; D'JL,lt1i Soil Rate Approved sq.ft/gal. Checked by . n 11 Uj Date TEST PIT DATA REQ(JTRED rM BE SURNMED WTTH APPLICATION DFSMTPTTON OF SOTLS FNMUNTERED TN TEST 1j01,F1,S DEPTH I IOLE NO A HOLE NO. B HOLE' Nb. G. L. Topsoil Torsoil. 21 —Silt Loam Silt Loam 4) 51 6) .71 V 8) 9 10, 12' 13' 14' INMICATE, LEVEL AT MlICH CROUNDMkTER IS ENCOUNTERED 7' -0" T.J. Freeman DEEP HOLE, OBSERW\TIONS K BY: of BADM,,, &,. WATSON, -DATE: 5/27/87 Surveying &, Engineering, P.C. Dr,,STGN Soil. Rate Used 13 Mir: /1" Drop: S.D. Usable Area Provided 6,000 3F No. of Bedrooms 4 Septic Tar& Capacity 1250 gals. Type concrete Absorption Area Provided By 500 L.F. x 24'' width trench Other Name John P. Del.,aLq, P.E. Signature % BADEY &, WATSON = 0 tA.4 Address Surveying & Engineering, P.C. SEAL C: Route ­9 Cold S2ri 2Eg, No; 1"ork L 6, 0516 1 THIS SPACE POR USE BY HEALTH DEPARTMENT ONLY: ' ; D'JL,lt1i Soil Rate Approved sq.ft/gal. Checked by . n 11 Uj Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS Co REVIEd6�S BEET FOR CONSTRUCTION PERIN11 — • C 'T" STREET LOCATION �fZp G 5 NAME OF OWNER �" Ge !�vm T)�/ REVIEWED BY DATE 6 TAX MAP # ^I "'�6• Y DOCUMENTS Y ERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS PC -I / - PERC & DEEP HOLES LOCATED WELL PERMIT `' PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION LETTER OF AUTHORJZATION LOCATION MAP DESIGN DATA SHEET (DDS) KE.AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE � CORPORATE RESOLUTION MPED, PIT & D BOX SHOTAILED 71SHORT EAF HOUSE - NO.OF+r BEDROOMS Z PLANS - WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. SE PLANS -TV*O'SETS PROPERTY METES & BOUNDS . NIARLA4,Nl OUSE SETBACK NECESSARY (TIGHT LOT) FEE HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE xf1l gPE NO BENDS; MAX.BENDS 45° W /CLEANOUT GAL SUBDIVISION FILL SYSTEMS BDIVISIO OVAL CHECKED LAY BARRIER RC RAT :.`: 0- FT: HORIZONTAL;SLOPE 3:1 TO GRADE L,REQUI © DEPTH F PECS FILL NOTES ol- RTAIN DRAIN REQUIRED STANDPIPES F ERTIFICATION NOTE GENERAL UAGES CATED IN NYC WATERSHED PROFILE'. &DIMENSIONS NS SUBMITTED TO DEP OLUME D EGATED TO PCHD FILL IN EXPANSION AREA DEP APPROVAL, IF REQ'D TRENCH ZQtP. TEST,HOLES OBSERVED' LF TRENCH PROVIDED (�2 j 60TT MAX. •-= RCS WITNESSED, IF REQ'D PARALLEL TO CONTOURS APPROVAL SSDS ADJ. LOTS 100% EXPANSION PROVIDED WETLANDS (TOWN/DEC PERMIT REQ'D ?) SEPARATION DISTANCES SPECIFIED DATA ON DDS PLANS & PERMIT SAME ON PLAN - FROM SSTS PRE 1969 NEIGHBOR NOTIFICATION 10' TO P.L.; DRIVEWAY, LARGE TREES, TOP OF FILL LETTER BUZBA TO FOUNDATION WALLS _1 YWELL; TO PL 100 YR FLOOD ELEVATION 00' TO WELL, 200' IN DLOD, 150' PITS OTHER REQ'D PERMIT(S) 00' TO STREAM WATERCOURSE LAKE (inc. expan) REQUIRED DETAILS ON PLANS 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER SEWAGE SYSTEM PLAN - (NORTH ARROW) 0' TO WATER LINE (pits -20') SSDS HYDRAULIC PROFILE_ GRAVITY FLOW 0' INTERMITTENT DRAINAGE COURSE CONSTRUCTION NOTES 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS DESIGN DATA: PERC & DEEP RESULTS 15'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 °/q35' -1 %,100' - <1% T CONTOURS EXISTING & PROPOSED 20'min to CD discharge /I00'with 182 cons day discharge DRIVEWAY & SLOPES, CUT SEPTIC•TANK FOOTrlNG /GUTTER/CURTAIN DRAINS 10' FROM FOUNDATION; 50' TO WELL COMMENTS: FORM ST-2 i,k �m r, t , - Toan Brookfal l a Raac� If ...5 Ht • ` ' G 'K . A .:Z :' 6 ` d ; G +L e liz "..t°n 66 11 Foothll�l' Esa East a `3 840 ' ¢ m.103 r t i Brolikfalls Develox mmt J �aFIC949I1Q � ! � � 3 NOW �iii uina9• a��-i, ,84• a®ppO, Dati Sadie sion Annr:oyea "6/20'', FM #2477 Fee" Enclosed,-V' r Residential 3e5;. Ac �r dame lot Pt rc r , RIP P �ZQQ asp ci w 500 . LE' of abso ton ch .;. .... 3 oB t PI^nvi Ap �RnR' f i 1 -1' for adi ncr; -1 n t (k� _ i- rari�h qj� r< . a Red. Hw-k Odw I:t®pra�nQ thatzl'am'who11Y and ComPbt ®ly id: 4o�,tho d ®t�gn arW location o4tho propo�d QY ®m(51 1� tha4..tho $apoiata •[oar dispofol stem aOoV® dafcribod will't7e tonstrueted as shown on 1RO approved amendment Cher® to antl in accwdenco witPl the standards, rules a ragu s o nam . R:o„ntY DepartmenQ 00 69as18h, +en8 that on eo,npb4imoa,thareo9 a Corti9iceto 09 Construction Complia„co• 9t4is4actogy to tho Commfssionsr o9 MoaltB,will bo stibmitte� to ¢he Depevtme„t and "a ararritten�®uevant®o will tie `9uvnisitiod Yho ow rrr his - Paaeoee�rq hake oc i' ns ®Y tho buila8or that; Laid tiYfldsv i%III place in �®d o�otirlg4coro®ition�onYypert o /,Fsaid sfaara�m�dispossl sya4em durirea tho pariodio4 two'(2 olmn,a8ieto 4olCOwi the- �ateo9•t1,o isw- Yeav IY of 04 tia' apprara0 09 ¢h0 Coi¢i9icaQo 09 Co'nstvue4iOn Compli� nee o9 the oridinfil ¢Y>tom t,r rmpobs Qhcgato• 2) tht,¢ tho'drfllO® uwoll deswilm, o13o+ro CIrIN b located esOwrw on tlxp approved pbn }and that said well erin ba instal Uin r dn j h hey ar,davds, nabs on® ragu�i0 E 04 tho Putnam t:eelntY ®c,rtmaw¢' 09 10ea1¢h. : Q to ;7tt)1e :13e,19,96 sign . P MA Riddre ^l_ieonn NO 6250 APPROVE[) FOIQ COPISY91l2CT10P1 Yhfa approval ettpive�s twp' Y _ s B a data issu CohstPUCtioll 09 tiW., ®uildnlg twa_t>een u,lde►tak®n ,ark Is ral%OCable YM CA {OV Irla b3 amen6G'� Or mOOiried C/lgrl- can4id0r - rY by tlic C i O11o►'Of t4t*AIQh.� .sing' Cherege O► nation. 04 eonstvue4bn r Ylrfl4 a :n` tln i► � 4 OV(:d `QeI dispOSt l 04 dOmasit ¢an 8 �, an9 /p- e" sii9lptY Only: + Rev. 1088 i7oQ0 eY, Yi410 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION:. TO,- C. QNSTRUCT- :A•,= WiAT- Bi�-,'WELEr -'- PCHD PERMIT # ) v WELL LOCATION Street Address Brookfalls Road Town/Village/City Tax Grid Number Town of Putnam Valle 84 -1 -16.3 WELL OWNER Name Mailing Address VPrivate Brookfalls Develoment Co M. 330 West 45th St NY NY O Public USE OF WELL 1 - primary 2 - secondary )G RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP 0ABANDONED 0 FARM 0 TEST /OBSERVATION O OTHER (specify, 0 INSTITUTIONAL ❑ STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 6 /EST. OF DAILY USAGE 600 gal ❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY IM NEW SUPPLY NEW DWELLINGI ❑ DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING To supply new dwelling WELL TYPE ®DRILLED DRIVEN []DUG C]GRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: es Foot Hill Estate East Lot No. - WATER WELL CONTRACTOR: Name Norman Anderson Address: Shrub Oak NY PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY _. .:.:....- . DISTANCE TO PROPERTY FROM NEARES T WATER MAIN: N/A .. -. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED QON SEPARATE SHEET �. June 13, 1996 ��.. (date) V (signature) ` i 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 dril operations be contained on this property and in such fa manner as not to degrade or oth r cont ate surface or groundwater. Ue of Issue: 19 ��b Af Date of Expiration a 19� Pe it ssuing Official Permit is Non- Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller BADEY & WATSON Surveying and Engineering, P.0 Route 9 (914) 265 -9217 739 -3577 628 -1800 FAX (914) 265 -4428 F1 William Hedges Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Copies Date No. Description LET'T'ER OF TRANSMITTAL Date: June 13, 1996 ,., Job No: 86- 192.13 Re:. Brookfalls Development Corp. SSDS Permit Application Brookfalls Road Town of Putnam Valley TM # 84 -1 -16.3 7 Se t �y: US Mail ❑ UPS ❑ UPS Overnight ❑ Fed Ex ® Messenger ❑ Pick -Up 1 6/13/96 SSDS Construction Permit Application 1 6/13/96 Well Construction Permit Application 1 6/13/96 Letter of Authorization 1 Corporate Resolution 1 Design Data Sheet 1 Application PC -1 3 6/13/96 SSDS Plan - 1 M6ney_0rddf6r $ 360.00 No. 6432489 Remarks: Signed: Kurt Schollmeyer, P.E. Copy to: A L t G f I' I 'i. 570-16'( ,Q Cl 0 M t0 W 0 rn rn 00 It z x w 0 z U_ n. a 0 0 w 0, wrr; "4- Yy'°^`�' <. •`..<i,_ s .a. `.ice ::sy��i�i -. it— - .: �+s.... � -.::%. :....ia4 r::�'_.i.,_' +r AS-BUILT. RELOCATION - DIMENSIONS IA 22.1' SEPTIC TANK 18 39.6' SEPTIC TANK 2A 32.3' SEPTIC TANK 28 42.4' SEPTIC TANK 3A 53.6' DROP BOX 3B 55.2' DROP BOX 4A 86.5' END LATERAL 4B 103.6' END LATERAL 5A 105.7' END LATERAL 5B 112.7' END LATERAL 6A 84.8' END LATERAL 6B 60.4' END LATERAL 7A 82.9' END LATERAL 76 46.8' END LATERAL 8.g:'` : -5::'- y END LATERAL: 8B 1-7.9' END LATERAL 1 C 73.2' WELL 1 D 52.9' WELL SHERLITA AMLER, MD, MS, FAAP Commissioner of Health i.A)RETTA MOJLINA b-.M 1 .�•.::; :. ;....y ..__ :: Associate Commissioner of Health Henry Lopez 8 Brookfalls Road Putnam Valley, NY 10579 Dear Mr. Lopez: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 7, 2008 Re: Addition- A- 251 -07 No Increase in Number of Bedrooms 8 Brookfalls Road (T) Putnam Valley, T.M. # 84.4-16.3 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 January 7, 2008. 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 and its expansion area must be maintained. _ 3...All pjum ingfixtuxes 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 proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals 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 (845) 278 -6130, ext. 2261. Sincerely, le n D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 SHERLITA AMLER, MD,-MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health ROBERT J. BONDI County Executive 'I OBER'iF'aVIOR IS;•PE = :. Y °-=w•:: Director of 4mental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET.6R°aCFAUS lZin' TOWN RM-"" '-'ALLt'f TAX MAP# NAME - - A E MRS/ LOKZ PHONE &4" '2107 9 S 16. PCHD# MAILING ADDRESS f7° goX Lo2S , PuTrlor►i V01L6t1 1•Ct{ 1 O S7Sj DESCRIPTION OF ADDITION 'NUMBER OF EXISTING BEDROOMS d' ' . PROPOSED # OF BEDROOMS `} (FROM CERT. - OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) addition which is considered a bedroom requires formal approval of plans (Construction permit) �,.;prepaf d .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 ept., 1 Geneva Rd, Brewster;'NY `10509, Phgne: (845):218-6130. �. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale; all living area in cludirig.basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non- professional sketches are acceptable . 4. Copy of survey showing well and septic locations to the best of your knowledge.. Include date of installation if known. Label all .wells and septic systems within 200 feet. of the property. line. Contact this office with any questions. .5 Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845.) 278 -6014 Fax (845) 278 -6648 SHER-LITA AMLER R��NdS, FAAP LORETTA MOILINARI, RN, NISN Associate Commissioner of Health. ROBERT L BONDI . - :...... r - :C, .tyaCe cut ires; DEPARTMENT OF HEALTH 1 Geneva Road; Brewster, New York 10509 Town Legal Bedroom (Count Re: `- 0� `Z_ (Owner's Name) Tax Map #: Address: 1-t_� Town: i' N V ' Year Built- According to records maintained by the Town, the above noted dwelling, is in compliance with Town Code. is not in compliance with Town Code. .. - The Legal Bedroom Connt This information has been obtained from: Certificate of Occupancy. oa Other: L:p C, -P. L,6 0� 8 Building Inspector Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 xexr �x. �st�rs yx Vii.. r. 1 r��.. 2MMS" MV, r Am 4.; g r7ouRED CC JC- F17A FrU- n }by x ,%j I I .� y Li+ L :A I •� I �r. ` �Xla.FilN1 SC7l�,T ri 3._23/4 ru ar s' r r [ l Y. Z C3LL 9 F 1 P,EAM w FrU t tr • °ir�31,1C FTta T TYP :VZo , .... 19 _ 1 I I , �`� - ILA�TEP.i —'-�- ..,$nlLo__LS.�►..IL.:F°rU _ _OQ � r- ,'t ZCWL ..t,�.:'�ii .:dot aa�'r.ae .J `rV..., : - , . _. J ' -- • (L> FPO-jr FTC A', —`� LINE OF LN ITIL-VEREn RME_ To NVaIlJTAIIJ FLpOP, ,7015T5 Ai3dVE I.a Bu P,Y it r • 'l 4: t el