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Home My WebLink About4331DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -42 BOX 33 Sam r JSol 1,01 y ;. : . , ' Sir I. 6 ' � j,,1, 1 ■II �' P r '' 0 I 1 r' MI 04331 PUTNAM COUNTY DEPARTMENT OF HEALTH 1� _T CERTIFICATE OF CONSTRUCTION COMPLIANCE E: TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV 3i _q3 Located at 6 SLL tr PII BV_00� LANJE Town or Village P0T0A -M VALLC-� r;p RL, 4, LO24zi INC Owner /Applicant Name LU is &A-eyi 16— Tax Map ��i Block Lot ` Z _ Formerly DAV 6 ") CC.46APTZ_ Subdivision Name F00-Th}I LLE-S F}TC_S 'WeS*T Subd. Lot #} Mailing Address e) S 1. GE N BRICK) �4_ LANE Py1 N w V A(LO Zip �S Date Construction Permit Issued by PCHD EE e. 399 7 Separate Sewerage System built by S-'�f e Address Pi) -T u apl VAL 'e Consisting of I I Q0D Gallon Septic Tank and 315 LE 24 " Vi 1 h _ PAS O R ETI p ) 7 O EN, C41S S*C b A-T U) - F-f & L, Other Requirements: Water Suooly: Public Supply From Address or: Private Supply Drilled by NO �_MA4 -AtJl6. P�SQN Address V H LC-1 ? .B-u-ilding..TYPe ... 2 rs ID'r��!� l � L _ :...: ;t"rlas erosion �oritioi bden completed Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam ounty Department of Health. Date: 4 —1 �— C I ?j Certified by %� P.E. )( R.A. Address License # G U L (5 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 hange when, in the judgment of the Public Health Director, such revocatio odifi=ionmrgelis n cess By: Title: Date: 3 f� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. - - WELL COMPLETION RT IsiLl.- _-L. —el➢ Locatnon Streef Address: sie g � L �„� PT tN il lage: �.l Tax Grid # Map Block Lot(s) We➢➢ Oeyn;¢: Name: Address: Use of WeI➢: I- p>rimairy 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Detae ➢s Total length ft. Length below grade l—ft. Diameter iin. Weight per foot / lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Z< Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: Yes _ No Liner:— Yes X, No Screen Detaks Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second . Well lYieRd Test Bailed _ Pumped Compressed Air Hours Z Yield gpm Depth Data Measure from land surface- static specify ft) During yield test(ft) Depth of completed well in feet r We➢➢ 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 / u If yield was tested at different depths during drillin list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3,- Capacity Depth 5-,FO Model 53' i U - Voltage zap HP / Tank Type 121X z 9'o Volume ! zo Date Well Comp eted Putnam County Certification No. Date of Report Well Driller (signature) riu jim; zxaci iocation or wets with atsrances to at least two permanent tanamarxs to be providea on a separate sheevplan. Well Driller's Na a �� Address: /f / /.�� ' `C,46& 1 Signature: l Date: P p 0/ r /GSA` White copy: VD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller 1° r Form WC -97 j. i. i L It PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT W 1C. L L 4- '7 'hell Locati�d �trzet .�dc�ress: g S 2e /Soo L v- - 'ill�'ge �i'�x Ci'il#` ' - Map Block Lot(s) y Well Owner: Name: Use of Well: 1- primary 2'- secondary w Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial 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 Diameter �" in. Weight per foot /� lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: 'X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes xNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed Pumped Compressed Air Hoursal Yield /a-gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Sao 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 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type _3,12LhA Capacity / D Depth Model /O S Voltage X 3 o HP. ZAP Tank Type '2.v 'V Volume i �6 Date Well Completed / /-2,0 te (/ Putnam County Certification No. Date of Report Well Driller (signature) 1vU�rE: Exapt location of well wim alstances io at wasi two permanepL idn rrlarres w uc prvvLucu uu a zic1,aLaw aLLCCU1,LauL. Well Drillees Name O Adt �c �L� Ga Address* i� ' Signature: - Date:' os'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 Heightq, N�,;q � y 105 --��-�-.,�~��s��r.,.^��--,��-,_�--' Albert H. Padovani, Director LAB #: 32.901343 CLIENT #: 10470 NON STAT PROC PAGE 1 BOEHMIG, CARL & LORI DATE/TIME TAKEN: 04/21/99 11:30 330 W 45 ST. DATE/TIME REC'D: 04/21/99 12:00P NEWYORK, NY 10036 REPORT DATE: 02/14/01 PHONE: (212)-265-8189 SAMPLING SITE: LOT #80LEEPY BROOK LN : PUTNAM VALLEY, NY COL'D BY: DAVID SCHWARTZ NOTES...: OUTSIDE HOSEBIB ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/21/99 MF T. COLIFORM PRESNT /100 ML ABSENT 1008 04/21/99 LEAD (IMS) <1 ppb 0-15 ppb 9101 04/21/99 NITRATE NITROG <0.2 MG/L 0 - 10 9139 04/21/99 NITRITE NITROG <0.01 MG/L N/A 9146 04/21/99 IRON (Fe) 0.064 MG/L 0-0.3 mg/l 2037 04/21/99 MANGANESE (Mn) <0"00 MG/L 0-0.3 mg/l 2037 04/21/99 SODIUM (Na) 5.47 MG/L N/A 04/21/99 pH 8.0 UNITS 6.5-8.5 9043 04/21/99 HARDNESS,TOTAL 140 MG/L N/A 04/21/99 ALKALINITY (AS 126 MG/L N/A _ 04/a1/99 TURBIDITY.(TUR . 1.5.NTU ' ' 075 NTU ' ' t^4/21199+ ^^Er~COLI ACONFI ABSENT '100/ML- ABSEN^-`_~ COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS OF A ' SATISFACTORY SANITARY QUALITY ACCORDING TO RK 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 aLEAD value 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 bbth iron and manganese are present, their total value 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 those on a moderately restricted diet, a maximum of 270 mg/L of Sodium / YML ENVIRONMENTAL SERVICES 321 Kear Street Yofktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 32.901343 CLIENT #: 10470 NON STAT PROC PAGE 2 BOEHMIG, CARL & LORI DATE/TIME TAKEN: 04/21/99 11:30 330 W 45 ST. . DATE/TIME REC'D: 04/21/99 12:00P NEW YORK, NY 10036 REPORT DATE: 02/14/01 0 SAMPLING SITE: LOT #8 SLEEPY BROOK LN : PUTNAM VALLEY, NY COL'D BY: DAVID SCHWARTZ NOTES...: OUTSIDE HOSE BIB ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is suggested. 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. THEVORMAL 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 RANGE FROM 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 MODERAJEEVARKWATE0 170S140, L NOW UIg'ER'v. � HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: ELAP# 10323 YML ENVIRONMENTAL SERVICES 32z Kear Street Yorktown Heights, N.Y. 10598 ' | Albert H. Padovani, Director LAB #: 32.902290 CLIENT #: 9139 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BROOKFALLS DEV CORP 330 W45TH ST. ATTN: DAVID SCHWARTZ NEW YORK, NY 10036 SAMPLING SITE: 8SLEEPY BROOK : PUTNAM VALLEY, COL'D BY: LORRAINEBOEHMIG NOTES...: LORRAINE BOEHMIG ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE 05/19/99 MF T. COL DATE/TIME TAKEN: 05/19/99 03:25P DATE/TIME REC'D: 05/19/99 04:20P REPORT DATE: 02/14/01 PHONE: (212)-265-8189 LANE SAMPLE TYPE..: POTABLE NY PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD [FORM ABSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINE�i;~THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Director ELAP# 10323 .^ 1!. ` , YML ENVIRONMENTAL SERVICES 321 Kear Street _ Yorktgwn '' N.Y, � � � T9 2'{�� | Albert H. Padovani, Director LAB #: 32.902290 CLIENT #: 9139 NON STAT PROC PAGE 1 BROOKFALLS DEV CORP DATE/TIME TAKEN: 05/19/99 03:25P 330 W 45TH ST� DATE/TIME REC'D: 05/19/99 04:20P NEW YORK, NY 10036 REPORT DATE: 05/26/99 PHONE: (212)-265-8189 SAMPLING SITE: 8 SLEEPY BROOK LANE SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: LORRAINE BOEHMIG TEMPERATURE..: < 4C NOTES...: LORRAINE BOEHMIG COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 05/19/99 MF T. COLIFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN�=��~THE NEW YORK STATE AND EPA FEDERAL DRINKING WATERSTANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H. Ka it vani, M.T.(ISCP) Director 1008 ELAP# 10323 04/30/1999 35:57 • 9142453170 YORKTOWN MEDICAL LAB PAGE 01 YML ENVIRONMENTAL SERVICES 321 K.ear Street ZN -T. 1.1Y5t7' Zx -' c" :s. .oz'.`c'�»"i�w`'rco .:.::�•', ?i;': �.•C! - T'.. .. 4.:Si.r 1+'�'uyl :,. y. `. .n.. .4J n' -_ ( 914) 245 -2807 Albert H. Padovani, Director LAB #: 32.901343 CLIENT #s 10070 NON STAT PROC PAGE 1 NNNn/NNNNryNNNNNN NNNNNA/iU :IJNNNNMr VNNNJI /N NNNV•.+ NN N+nr •+ MMn1'+'NNN.'1/NNNN NNN N.V NNN Nn. nr ' +NNNn/ w /NN BOEHMIG. CARL & LORI DATE /TIME TAKEN: 04/21/99 11:30 330 W 45 ST. DATE /TIME REC'D; 04/21/99.12:00P NEW YORK. NY 10036 REPORT DATE: 04/30/99 (212)-265-8189 SAMPLING SITE: LOT #8 SLEEPY BROOK LN a PUTNAM VALLEY, NY COLD BY; DAVID SCHWARTZ NOTES...: OUTSIDE HOSE BIB N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N carry N ry N N DATE; FLACK PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: 4C COLIFORM METH: MF --------------------------------------- RESULT NORMAL - RANGE: METHOD PUTNAM CNTY PROFILE (14/21/99 MF T. COLIFORM PRESNT /100 ML ABSENT 1008 04/21/99 LEAD (IMS) <1 ppb 0 -15 ppb 9101 04/21 /99 NITRATE NITROG -<0.2 MG /L 0 - 10 9139 04/21/99 NITRITE NITROG <0.01 MG /L N/A 9146 04/21/99 IRON (Fe) 0.064 MG /L 0 -0.3 mg /1 2037 04/21/99. MANGANESE (Mn) =:0.010 MG /L 0 -0.3 mg/1 2037 04/21 /99 SODIUM (Na) 5.47 MG /L N/A 04/21/99 pH 8.0 UNITS 6.5 -8.5 9043 04/21 /99 HARDNESS.TOTAL 140 MG /L, N/A 04/21 /99 ALKALINITY (AS 126 MG /L N/A 04/21 /99 TURBIDI'T'Y (TUR 1.5 NTU 0 -5 NTU 04/21/99 E. _COL I (CONF I ABSENT., _ 100 /ML ABSENT- COMMENTS.- BAC:`T' THESE: RESULTS INDICATE THAT THE WATER (WAS .(WAS NOT b- A SATISFACTORY SANITARY QUALITY ACCORDING TO STATE AND EF'A FEDERAL DRINKING WATER STANDARDS. FOR THE PARAMETERS TESTED. AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for pi EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. .tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaker, to reduce the waters eorr o si ve Fe /Mn If both iron and manganese are present, their value . combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guideline> state that for people on a sodium restricted diet.the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium 04/30/1999 15:57 ' 9142453170 YORKTOWN MEDICAL LAB YML ENVIRONMENTAL SERVICES ear Street :.:i. YoC' kl';;J'r"He"a .gi1'ts'i .'N'. (914) 245 -2800 Albert H. Padovani, Director PAGE 02 LAB #e 32.901343 CLIENT #: 10470 -- N-. VI -------------------- "I----- NI,I ^• - - -- NON STAT PROC PAGE 2 ------ I,-,yNw/!V------------------AN---NNwI-- BOEHMIG. CARL & LORI DATE /TIME TAKEN: 04/21/99 11:30 330 W 45 ST. DATE/TIME REC ' D : 04/21/99 12:00P NEW YORK, NY 10036 REPORT DATE: 04/30/99 PHONE: (212) - 265 -SIS9 SAMPLING SITE: LOT #8 SLEEPY BROOK LN SAMPLE TYPE..t POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE COLD BY: DAVID SCHWARTZ TEMPERATURE..,. <: 4C NOTES...: OUTSIDE HOtil: BIB -------------------- - - ------------ - - - - - COLIFORM METH: MF - - - - - - - - - - - - - - - - - - - N - - - - - - - - - - - - - - - - - - - DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH 1 < 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 HARDNEL' s, '.: UEFINED AS -rHE SUM OF' THE CALCIUM & MAGNESIUM CONCENTRATION. BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE 'I'zON 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 = MILLI GRIM FER L I.TER' HARDI- WATER: 1.401'3i�0 MG /L _. ii -�rainigal'T��ri _ 17.2 MG /L) r. . SUBMITTED BY: 40 Albert. H. adovani, M.T. (ASCP) Director ELAP# 10323 CpG BRUCE R. FOLEY LORETTA MOLINARI RN., M.S.N. -;.;�.7 ��? s fate Pi�bl c uealth.Direpto_ z:.r _ . Director of Patient Services DEPARTMENT OF HEALTH[ 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: W & LarrAns EcduTdg TAX MAP NUMBER: E911 ADDRESS: 8 Seepy eraac Lam TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: to lee? The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) J �4 N, MAY -28 -1998 08! 58 FROM HADEY & WATSON, P.C. TO 12125814334 P.02 ]PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF EN- IRONMEIT -A- � -RE- A.LTH- -_SERVICES-._ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser-of Building Tax Map Block Lot co,ra? Y��a/c3r,n Ua��4 Buildinng Constructed by Town/Village S�e�°Oc,Br'oef �- 4_,� -e �oo� 1'��S �•Sf4fP.t ��_ S%- Location - Street '�? Subdivision Name S��s /eM Ic Lof # Building Type �— Subdivision Lot 9 I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system. constructed by me which fails to operate for a'period of two years immediately following the date ofapproval 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 furthg- ,�gree_s..to aecep as:corclusive the determination of the- 1?ublic: altkt D•irecfoz of the Putnani•County Depart ment 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 _ Fe-& I Day , 7 Y ar 01 , � , /-, -,7-., , �;, �, eneral Contract or (Owner) - Signature Corporation Name (if corporation) Address; State Zip Si gnature: r Corporation Name (if corporation) Address: �`,�► s L State Vv_�` Zip 1Q �7Z Form GS -97 TOTAL P.02 IDADIElY & WATSON LETTER of TRANSMITTAL Ac 3063 Route 9, Cold Spring, New York 10516 N ` Date: ' 19 Jan 2001 f V (845) 265 -9217 (845) 628 -1800 (914) 739 -3577 File No. 86- 192.08 FAX (845) 265 -4428 W. 0. # 13772 RE: Certificate of Construction Compliance SCHWARTZ TO: SLEEPY BROOK LANE Adam Stiebeling Foothill Estates west Subd. Lot No. 8 Putnam County Department of Health Tax Map 84.00 -01 -42 Permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT MESSENGER ❑ UPS -2 DAY PICK -UP ❑ UPS -3 DAY FAX ❑ UPS -GROUN o UPS -COD We are sending: ZZ copies date description of document ❑ ❑ ❑ R ❑ F-3] 23 -Jan-98 SSTS "As- Built" El I REMARKS: Plans included are in response to your letter dated January 9, 2001. A certified copy of the survey of property will be forthcoming. The balance of the application has been forwarded to the client to be completed and submitted to your office. Signed: John P. Delano, P.F. Copies to: File 4599 n • + BRUCE R. FOLEY Public Health Director DEPARTNErNT - OF HEAtTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director, of_ Patient.. Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 January 24, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: Application of Certificate of Construction Compliance, Boehmig, 8 Sleepy Brook Lane TM# 84 -1 -42, Town of Putnam Valley Dear Mr. Delano: OF �®RI 1 This office continues to determine that the above referenced Certificate of Construction Compliance application (revisions received by the Department on January 22, 200 1) remains incomplete. Please be advised that the following inform tion is required before the Department may commence its review, as requested January 2001. Well Completion Report for Well # 1 "well out of service" requires the following information to be completed: a. Street address. b. Tax Grid number. /c. Correct well owner. d. Well drillers signature. e. Date of Well Completion Report. 2.; Completed Well Completion Report for Well # 2: -,a: = Street ;address - .,... .. b. Tax Grid number.. ... _ .- . . c. Date of Well Completion Report. O3Z Original copy of water quality analysis for Well # 2. A copy is unacceptable. Submission of a certified copy of survey of property. Submission of three copies of the SSTS Guarantee form.: a. Tax map number completed. .b. Guarantee form dated. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY Public Health Director YDEPART WENT 1 Geneva Brewster, New OF Road York LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director, of - Patictit rs;cc s . HEATH 10509 Environmental Health (845)278 - 6130 Fax (845) 278 - 7921. Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 January 9, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: Application of Certificate of Construction Compliance, Boehmig, 8 Sleepy Brook Lane TM# 84 -1 -42, Town of Putnam Valley Dear Mr. Delano: COPY This office has determined that the above referenced Certificate of Construction Compliance application, received by the Department on January 5, 2001 is incomplete. Please be advised that the following information is required before ;the /,Dje rt ment may commence its review. Well completion report for Well # 1 "well out of service" requires the following information to be completed: a. Street address. b. Tax Grid #. c. Correct well owner. d. Well drillers signature. e. Date of well completion report. Completed well completion report for Well # 2: _ S eta, b. Tax Grid #. c. Date of well completion report. 3. Original copy of water quality analysis for Well # 2. A copy is unacceptable. Submission of a certified copy of survey of property. 5. Submission of three copies of the SSTS guarantee form.: a. Tax map number completed. b. Dated. 6. As -built measurements for Well #1 (out of service) to be stated on as -built plan. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj encl. Well # 1 & 2 - WC -97 GS -97 BADEY & WATSON LETTERofTRANSMITTAL Surveying& Engineering, P.C. "7&i�: 23 Fe�iroi (845) 265-9217 (845) 628-1800 (914) 739-3577 File No. 86-192.08 FAX (845) 265-4428 W. 0. # 13887 RE: Certificate of Construction Compliance SCHWARTZ TO: SLEEPY BROOK LANE Adam Stiebeling Foothill Estates West Subd. Lot No. 8 Putnam County De'partment of Health Tax Map 84.00-01-42 Permit 4 PV-31-93 I Geneva Road Sent via: US MAIL UPS-NIGHT Brewster, NY 10509 MESSENGER F] UPS-2 DAY L PICK-UP El UPS-3 DAY FAX El UPS-GROUN UPS-COD El We are sending: copies date description of document 71 122-Feb-01 1"Survey of Property prepared for Lot No. 8 of Foothill Estates West F-1 1 -71 _7- F-1 1 -71 REMARKS: Certified copy of survey as promised in our transmittal of 19 Jan 2001, and required under item 4 in your letter of January 24, 2001 Signed: John P. Delano, P.E. Copies to: File David Schwartz IMMI rmuri WHL)r_ T & WH I SUN P F. t;. TO 12125814334 P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.-OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE 01-F SUBSURFACE SEWAG)E TREATNIENT SYSTEM.- Lwriwe_ 9� ej Owner or PurchaCierof 13 ui Iding Tax Map Block Lot AJA/QM Vq-//e4. Building Constructed by Town/Village Location - Street" Subdivision Name Type 7 represent that I -am wholly and completel y responsible p-0--h-s-lble for the locat ion, workmanship, material construction and drainage of the sewage Lreatme at system servLng the property, and st in that is has b approveamendment- thereto, -and proyod- in accordance with the standards, rules and regulations of the Putnam County Department ofHeafth, and iaereby guarantee to -the owner, his successors ,-heirs -or assigns,. to place-in good operating condition _,__any__part -of said -.system. constructed -by -me --which --fails to - operate- for -a Apeniod -of,- two.---years approval oval the "Certificate of Construction Co I gxcept,wb6m.-tho failure. sewage treatment system, or any repairs made by rn-e-to such. system,: —6�rj --is caused -thc-willful or negligent t . act ct of the occupant of the building utilizing th y en %,?_s_rconc u r,,- Dlretor of the Putnam Q -the failure of-the-..s tem* -------------'-- of Health to whether or 'not to operate -was caused by the willful or negligent act of the occupant he ant of the building utilizing system.; Dated:__ Mon th -C r S1 atuze: Y. . . ......... . . Title: -deneWContract6r (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) -- . Address: Address- _3L LA loco_ -State IP Fonn GS-97 TOTAL P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NUM. MactIocation ot well witn distances to at !east two permanent lanamarKS to be proviaea on -a separate. sneevpian Address: 7' Well Drillees Natpe-.>,�2i2� _Date.:... Signatprq!... oS ..,W4itq'Copy:..'HD'File; Yellow copy - Building Inspector; Pink copy.- Owner; Orange:COPY Well-driller''. F WC-97. Form I :4.k Map------ Block - - .--Lot(s) Well Owner: Name- Address: Use of Well.; 1-primary 2-secondary &* V Residential Public* Supply Air cond/heat pump .�Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary . Cable percussion _ Compressed air percussion Other (specify) Well Type Screened Open end casing _S,— *Open hole in bedrock, Other Casing Details Total length. _ O ft. Length below grade 70--ft. - Diameter ----------- Weight per foot e ------ lb/ft.. Materials: X Steel Plastic Other Joints: Welded � Threaded - -----Other Seal.---;K Cefti&ntgfuiit'----'Bentoiiite-'--"O.ther' Drive shoe: ----No Liner: - —Yes -XNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Well Yield Test Bailed Pumped Compressed, Air. Hours Z Yield_ 3 gpm Depth Data. Measure from land surface-static (specify ft) During.y_kejd test (ft De th Of comi)leted well in feet Well Log 7 If more detailed' Depth From Surface Water Bearing Well .. ... ........... Diameter(in) Formation -Description - information descriptions.or sieve analyses - 7 are -available, - - please attach. . ............. Land Surface ------------ - - ...... - - ----- ---- --------------- If yield was tested at different depths during drillin 7 list Feet Gallons Per Minute Pump/Storage Tank Information Pump Type -Capacity -1-15 Depth 5 F-0 Model 5- Voltage HP Tank Type Alf 2 Volume Date Well Com leted 31Y PubminCounty Certification No. 7 . '17 Date of Report g- Well Driller (signature) NUM. MactIocation ot well witn distances to at !east two permanent lanamarKS to be proviaea on -a separate. sneevpian Address: 7' Well Drillees Natpe-.>,�2i2� _Date.:... Signatprq!... oS ..,W4itq'Copy:..'HD'File; Yellow copy - Building Inspector; Pink copy.- Owner; Orange:COPY Well-driller''. F WC-97. Form I :4.k PUTNAM COUNTY DEPARTMENT OF HEALTH[ DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT U/ ALL - 44- Z ilag 'fax 'Grld' Map.- -------Block __ Lot(s).._._ . Well Owner: Name: Address: Use of.Well:. _ .. 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farrri Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type °' - - Screened Open end casing Open hole in bedrock — Other Casing llDetails, - - - - -- - - - -- Total length ft. Length below -grade -- -- - %��'ft: -- Diameter - - - -- - - G" - - in. -- Weight per foot ____.___..A— lb /ft. -- Materials: T Steel Plastic Other Joints: -� Welded Threaded —Other Seal: - Cement grout Bentonite — Other, Drive shoe: - - -Yes -_ No - - -- - Liner:_ Yes _xNo Screen Details - - - -- - -- Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours - - - - Second - -- - - - - - - -- - - - - -- - -- - -_ - - -- -.. _ ._ - - -- -- -- - - - - -- - -- Well VieIld Test _Bailed _Pumped ?Compressed Air Hours Yield /�Lgpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet .300 - We.11 L .og ._ If more detailed information descriptions or sieve analyses please attach. Depth From S urface Water Bearing. Well Diameter(n) _ )Formation ]Description __.....:fft..:. _ fft.::. - Land Surface 1 66 - If yield was tested at different depths during drilling, list:,-- . ......:.... _ ,:Feet Gallons Per Minute Pump /Storage Tank. Information . Pump Type 1Ta Capacity 1 q Depth a Model /O S /0-2, 7'� Voltage- - -1 -30 Tank Type Volume /6 _ .._.-- - -- - - - ..... -_._ .. -- Date Well Completed - - Putnam-County-Certification No. - - : — - Date of Report - - ° - Well-Driller (signature)----- --=- - -- DEC -18 -2000 '1a:05 BADEY & WATSON, PC 4 t BRUCE R. FOLBY Publie .. Health, Director _ P.01/01 Post -it" F-ax Note 7671 -t%G lualPS' S l' waxl' e From^f coiDept.• t'� , Co. F Vcwri v Phone # Phone DEPARTMENT GL' 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278.6130 Pax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 preschool (845) 278-6082 Fax (845) 278.6648 December 14, 2000 John P. Delano, P.E, Badey & Watson, P,C. 3063 Route 9 Cold Spring NY 10516 Re: Schwartz 8 Sleep Brook Lane, Lot #8 (T) Putnam Valley, TM# 84 -1.42 Dear Mr, Delano: The above regarded application is and cannot be processed, This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until the following has been received: 1) ❑ Standard F-911 Address Form. C1Constplction permit Application. 3) ❑Certificate of Construction Compliance Application. e 4) A certified check or money order in the am uno oP] 13 $300 for a Construction Pennit. ❑ $300 for a renewal of a Construction Permit. $150 for a revision of an approved Construction Permit_ (�, ® $200 for a Certificate of Compliance, ❑ $100 for a Well Permit. Other if you have any question regarding this smatter, please call meat (845) 278 -6130 ext. 2152. M,r . Sd,)wc A--z , W e (Ceev'e.J r-J -der 0-r\ C" IV-4t- �. Ve � truly yours, , ;V Theresa Nemeth Senior Typist Tr)lrni 0 1:14 BRUCE R. FOLEY _ X.�ubl is __Health- .I1irP.ctor. LORETTA MOLWARI R.N.,, M .S.N. r M :.a:;:.,_.__r_ N,- �,:...;Assxist��P,ubti� ; l�2irtth:,"�c7rszcY�•"� -:�.:� ��..�.- Director of Patient Services DEPARTMENT OF B EALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558. WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 December 1. 4, 2000 John P. Delano, P.E. Badey & Watson, P.C. 3063 Route 9 Cold Spring NY 10516 Re: Schwartz 8 Sleep Brook Lane, Lot #8 (T) Putnam Valley, TM# 84 -1 -42 Dear Mr. Delano: The above regarded application is and cannot be processed. This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until the following has been received: 1) Stan dard E911 Address Form. '� zn 2) ` -__ Construction Pe`rmlt C�pplication. 3) El Certificate of Construction Compliance Application. 4) ❑ A certified check or money order in the amount of: El $300 for a Construction Permit:--_.- - $300 for a renewal of a Construction Permit. $150 for a revision of an approved Construction Permit. ® $200 for a Certificate of Compliance. E $100 for a Well Permit. ❑ Other E If you have any question regarding this matter, please call me at (845) 278 -6130 ext. 2152. 0 V!g truly yours, , Theresa Nemeth Senior Typist I, BRUCE - EOLEY- Public `bfealth Directo 'r.: - "y May 18, 1999 DEPARTMENT OF 1 Geneva Road - LORETTA_ MOLINARI R.N., _M S.N. - ` Associale� Public Health.."birector' . Director of Patient Services HEALTH Brewster, New York 10509 Environmental Health (914)278-6130' Fax (914) 279-7921 Nursing Services (914)278-6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Mr. & Mrs. Carl Boehmig 8 Sleepy Brook Lane Putnam Valley, New York 10579 Re: Sleepy Brook Lane, Lot 8 TM# 84 -1 -42, (T) Putnam Valley Dear Mr. & Mrs. Boehmig: E PILiE ClFY As discussed in our conversation of May 12, 1999, this office has reviewed and discussed your letter of April 20, 1999 regarding the concerns of the two wells on your property. The Putnam County Health Department will allow the two well(s) drilled to remain. Well #2 is to be connected to the house to serve as a source of potable water. Well #1 will remain "out of service" until such time as determined necessary and at which time must meet current compliance standards for proposed use. At this time this office is awaiting the Well Completion Report for Well #2, Water Quality Analysis and "revised" As -built Drawings, in order to issue a Certificate of Construction Compliance. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions' arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R Public �1'ealfh Directo `'�_ e - ..,� z „- . -..�3 '. ;,” '• L0FE,,T UA . W0UN R[ Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 April 22, 1999 Mr. Carl Boehmig 8 Sleepy Brook Lane Putnam Valley, New York 10579 Re: Sleepy Brook Lane, Lot #8 TM# 84 -1 -42, Town of Putnam Valley Dear Mr. Boemig: I received your letter of request to revoke the issued Well Abandonment Permit for your property. This letter is to advise you that I will bring this issue up at the next regularly scheduled Health Department waiver meeting on your behalf. The next scheduled meeting is May 4th, _ 1999. Please feel free to contact this Department if you have any questions. 1-�.truly:y� 1's, =f • _ aw." �. �k Adam B. Stiebeling Assistant Public Health Engineer ABS:cj cc: John Delano David Schwartz Carl Boehmig 8:Seep �xook�L .�:. Putnam Valley, NY 10579 April 20, 1999 Mr. Adam Stiebling Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Re: 8 Sleepy Brook Lane Dear Mr. Stiebling: My wife and I have reconsidered our request for a permit to abandon the original well on our property. The well represents a considerable investment and, although low yielding, can be used in the future for irrigation purposes, or for potable water should a problem develop with the new well. We are proposing to leave the well casing at its existing dimension above grade to meet existing code requirements. In view of the above, we are requesting that our request for a permit to abandon be terminated, and that you consider our request to keep the original well in its present condition for future use. Please advise us of your decision at your earliest convenience. Very truly yours, Carl.Boehmig CB/bt cc: David Schwartz 45 t'd �? -ye NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and appendix 75 -A, IONYCRR _ for Indlyldual SYst®mS_ 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well to Property line Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. jOther (explain) ... We.Tl ..... (.Exi.s.t.i.n.g.).... Poor ... . q. u. a. 1. i. ty. ... a. n. d ... . 1. ow... y.. aa. 1. d ..................................... ............................... ......... ..... esi re....to...aba.n.don... and.... re- dri.. 1.. 1....@... d. l- te. rnate....l.. o. c. ati. on: a ................................... ............................... Selected by Well Driller /Developer. ...................................................................................................................................................................................... .......................... . . . .. .................... 2. Proposed design or conditions of waiver: ............ *... .Aba- ndonmen-t. ... o f... ex- i. s. t. i. ng... wel. 1 ........................................................................................................ .......................I....... * Well to be staked by NYS Licensed Land Surveyor ............. ............................... '•. ................................................. ............................... ....... * Removal Q.f "installed'.' SSTS trenches to maintain . .100. ..... ' seation: .................................................................................................................................................................. ....................... per - -- - - .. we to septic... . -: ............................................................................................................................................................................................................................................................ ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Due to close proximity to road Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) . .............................................. ............................. ....................................................................................................... ........ .. ... ........ ..._....... ...................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by t • suing official for a change in conditions for which this waiver was granted. ORIGINAL - Local Health Agency fiEPFiESENTATIVE COMMIS §IONEA OF HEALTH ... . .. .... COPY - Applicant /Design Professional DATE DOH -1326 (7/92) (GEN -152) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPtL)fCA O NDON W ER "'IOhi 'li' ABA A AT WE .M. . please print or type Location: Street Address PCHD PERMIT # //U./ - '5 1=--LAf 'V(ASP" v -'� • Map t3� Block 1 Lot(s) 47- Well Owner: Name: Address: Well Type: Drilled Driven Dug Gravel Other 1Depth Data: Well Depth 600 ft I Static Water Level 5 ft jDate Measure % Use of Well: Residential Public Supply . Air /Cond/Heat Pump Abandoned 1-primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well . Name: Address: Contractor: NnP. ,N" Ir"L MZ-04Z 5wpa —, P_�` t QAM vA For lescription'of Work To Be Performed: Ei5mu p_ DROP Pi.PG ; P�,kM P, W x(>_j )(m t Z 1 �ia.E. �SriE -�-1_. V4. `Tv1_ C00 T1F be- PcaDXAM e� -MAWl OP- Pe-w J9- CA-&%t-J6, -To p� Fink C�a'. 01 24 1 it Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this Fermit has been completed. Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER BRUCE R.f FOLEY, R.S. Acting Public Health Director NAME: Brookfalls Dev. Corp: ADDRESS: .330 West 45th St. New York, NY 10036 SITE LOCATION: Foothill Est. West Lot #8 Sleepy Brook Lane Put -n�dm= Valley DATE: Aug. 6, 1998 STAFF PRESENT: BF, MB, RM, AS, BH, GR SPECIFIC WAIVER 1. Well to PL 15' REQUEST: * Drill Second Well @ New Location DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL ..CONTAMINATION PROBLEM? - YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? +X - -+ + - -+ YES Low Yield Well NO DISCUSSION Poor qualuty H2O - Abandon existing well -- Well to be staked by NYS Licensed surveyor - Well yield report & H2O quality analysis to be submitted to PCHD upon completion. REQUEST APPROVED OR DENIED APPROVED DENIED REASON FOR-DENIAL DIRECTOR OF PUBLIC HEALTH DATE: Off+ a BRUCE R. FOLEY - I .....: ,:�,�..;.,:._� _ �m , „ P111tlic:..,Hea h-.Dircc�or.•_�•. a:.:�'•_. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 MEMO TO: MR. WILLIAM J. CARL FROM: MR. BRUCE R. FOLEY DATE: AUGUST 21,1998 RE: REFUND Please send a refund of $50.00 to Brookfalls Dev. Corp. 330 West 45th St. Apt. Lobby E New York, N. Y. 10036 _. Tb s.was an overpayu -et_tt for a well permal :��48 -98. _ _ _ check was already endorsed when we discovered the incorrect fee. Thank you. PS Please send us a copy of the check for our records. BF: EP ENC. oj Yb PUTNAM COUNTY DIVISION OF ENVIRO please print or type TMENT OF HEALTH f ;NTAL HEALTH SERVICES PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # �- SLEEPL{ PAWL- i,i4tJ—,- 1R,91JAt4 1Map 04 Block ( Lot(s) 42 Well Owner: Name: � 5. Address: ,p�c,oPfi�� Cc�...P• � v�l�""d5� S i 12P�' N� 1�cX' �1`� Use of Well: Residential Public Supply Air /Cond/Heat Pump > Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _-5— gpm # People Served __z_ Est. of Daily Usage 400 gal. Reason for )C Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed'Reason RePacf- -6�&Smwcq LOW qkF,� We,l, for Drilling Well Type _� Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ....................................... ............................... Yes No Name of subdivision fbo—ttAct-L 5_5TAmalc yJE Lot No. 8 Water Well Contractor: NO tJ OrtJDe(LS0(J iNX, Address: DP�lIL-E4� Sr_ RAI-tJW \JAtkKAf1 Is Public Water Supply available to site? .................................. ............................... V es No X Name of Public Water Supply: W2! Town/Village P` Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. -A licant riature: A PP g U 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.ygars_from.thi_e_datP_ _. wue"ss �y -�� r�nli ana-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. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller 11M A-r IFIIJ7I'1VA1\t C®ILTN'1rY DIEIFAII8TMIEN'11' CIF HEALTH IlDMKO `lit ®IF IENWRQDNM ENTAIL IHIIEAIL'I<'IHI SIERVIICIE , 73 APPLICATION TO CONSTRUCT A WATER WELL , .•: •* •ple8e print otryw- A "' , , , r,. rc i `PCHD Permit # Wen Location: Street Address: Town/Village Tax Grid # 51.EZIF'_� ftwi4_ I PL,� N-4' V ('Mlap 04 Block ( Lot(s) 47- Wen Owner: Name: Address: ri " (,Of e. vAfF5-t_,A54q Si i2 `' Use of Wen: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secoadmiry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _� Est. of Daily Usage gal. Reason Tor Replace Existing Supply Test/Observation Additional Supply IIDriffing New Supply (new dwelling) Deepen Existing Well IIDetafledl Reason as —)L�� F,�&smwrq L-Ouj qlF� v46-t,t, for D>rAfling Wen Type 1�e Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 3< Is well located in a realty subdivision? ...................................... ............................... Yes i No Name of subdivision fb0-% N LA_ 5-:5T \NE13K " Lot No. Water Well Contractor: N 0eVW iNX, Address: -;T7 ' iv-JA4A VAt l.94i/ Is Public Water Supply available to site? .................................. ............................... Ves No X Name of Public Water Supply: t�%A Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. t3 A licant.Si nature:: - � ....�...�...._ 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 ater well driller certified by Putnam County. Date of Issue g �Z �� Permit Issuin Offic' Date of Expiration Of Ll 0 0 Title: Permit is Non - Trans >r>ra Ile White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 'Insp ted by °.' . . Street Locatio,,,� _L QPi�' �- 4�'�'� Owner `J elw f Town. 7/ (/- Permit TM 9 Subdivision Lot #. 1. Sewage System Area a. STS area located as per approved plans .......................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................. ............................... d. Stone, brush, etc., greater than 15' from STS area......... e. 100' from water course / wetlands ..... .................I............., II. Sewage System a. Septic tank size - LOOD2 ..... 1, 250 ......... other .............. b. Septic tank installed level .............. ............................... c. 10' minimum from foundation ........ ........... .I................... d. Distribution Box 1. All out ets at same elevation -water tested ............... 2. Protected below frost ................ ............................... 3. Minimum 2 ft.Original soil between box & trenche e. Junction Box properly set ........... ............................... f, — T- e�ngth required _� Length insta led' 2. Distance to watercourse measured. `P Ft.ID.. . �. Installed according to plan ....... ............................... 4. Slope of trench acceptable 1/16 - 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' /2" diameter clean .................. 9 - Deptltof gra' vel iii trench 12 "' miriiirium ................. 10. Pipe ends capped .................................................... ... g. Pump or Dosed Systems Size ot 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. House/Buildin a. house located per approved plans.................... . _. b. Number of bedrooms ................... ........... 3 .................... 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 pla f. Curtain drain outfall protected & dir.to exist waterco, g. Footing drains discharge away from STS area..........., h. Surface water protection adequate .............................. i Pm6n., Ybl' NORMAN ANDERSON, INC. WELL DRILLING PUTNAM VALLEY, NEW YORK 10579 (914) 529-8698 (914) 528-1491 17 fr le 41 e7 yo 7c1 v 1( 9V ids 2,3S z 9v S/o IL/ 1( YML ENVIRONMENTAL SERVICES 321. Kea •Street Yorktown'Heights,.N.Y. 10598 _ -- -• - t- 914•)' .24� °2CtF ?;:.s•< = . ; . . . � . - - .. , , . Albert H. Padovani, Director LAB #: 32. E306566 CLIENT # e 56:8 AVON ST A-r F,F'oc N----NN NNMNNNNNNNNNNNNNNNMNNNMNNNNNNNN NNNN NNNMNNIVNNNN--- ------- y NNNNNN— -- --NMNM FOOTH I LL.G HOME BUILDER DATE /TIME TAKEN: s 06 /24 /98 02:00 330 WEST 45TH ST MATE /TIME REC'D: 06/24/98 02:45 NEW.YORKa NY 10036. REPORT DATE: 06/26/98 PHONE: (212) -265 -8189 SAMPLING SITE: 8 SLEEPY. BROOK LANEq.PUTNAM VALLEY SAMPLE TYPE. POTABLE KITCHEN TAP PRESERVATIVES- NONE COLD BY: DAVID SCHWARTZ TEMPERATURE..a NOTES... N/A 4 NNNNNNNNNNNIVIV.NN— IYNNNN- ---evN NMIV N.VMNNNMNN MNNNMI4NNNNNNNNNNivNNN NNNMNNNn ,NNNivNNNMMNN DATE FLAG PR0C:E3:)UFN'E RE:;ULT NORMAL - RANGE METHOD 06./24/98 I RON (Fe) 0.969 MG /L 0 -0.3 mg / 1 2037 0.61/24/98 MANGANESE (Mn) • 0 . 010 MG /L 0--0.3 mg / 1 2037, 06/24/98 TURBIDITY (TUR 1 NTU 0 -5 NTU COMME N ;` Fe /Mn If both .iron and manganese 'are present.., their total value combined shall not exceed 0.5 mg /L. SUBMITTED BY: Alb -t H. Padovani., M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321` Kear Street . Yqrkt Heigh (914) 245-2800 ` Albert �;i H. adovani, Director | LAB #: 32.804eO5 CLIENT 9139 NON STAT PROC PAGE 1 BROOKFIELD DEVELOP COR DATE/TIME TAKEN: 06/02/98 08:00A 330 W 45TH ST. , DATE/TIME REC'D: 06/02/98 09:20A REPORT DATE NEW YORK, NY 10036 : 06/08/98 PHONE: (212)-265-8189 SAMPLING SITE: LOT #8 SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: DAVID SCHWARTZ TEMPERATURE—: < 4C NOTES...: KITCHEN TAP ' COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL- RANGE METHOD 06/02/98 IRON (IMS) 2,04 MG/L 06/02/98 pH 8.6 UNITS 6.5-8.5 9043 06/02/98 TURBIDITY (TUR 13 NTU 0-5 NTU' COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ' ' ` ~~- SUBMITTED BY: Hlberi H. raoovanz, n./.(ASCr) Director ' ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 K&tr Street (914) 245-2800 Albert H. Padovani, Director #: 32.80476e, CLIENT #: 4�139 NON-STAT PROC PAGE 1 ---------- ------ ------- IPKFIELD.DEVELOP COR DATE/TIME TAKEN: 06/01/98 02:00P )"•W 45TH ST. 'DATE/TIME REC'D: 06/01/98 02:30P V., 4."YORK9 NY 10036 REPORT DATE: 06/03/98 PHONE: (21.2)-265-8189 IPLING SITE: LOT #8 SLEEPYBROOK LN. SAMPLE,TYPE..: POTABLE PRESERVATIVES: NONE ,:J,D..BY: DAVID SCHWARTZ TEMPERATURE:. : .< 4C rES.'a'.,i KITCHEN TAP COLIFORM.METH: MF DATE FLAG PROCEDURE RESULT NORMAL RANGE METHOD .06/01/ge MF T.. COL IFORM ABSENT ../100'ML ABSENT 1008 COMME-INI-S: _T, .,THESE. RESULTS INDICATE THAT THE WATEW"(�WASAS NOT) OF A --':'SATISFACTORY SANITARY QUALITY ACCORDIW --IQIE NEW YORK STATE -1;AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. 1I�TTED. BY LA Albe�t. H Director ovani. M..T..(ASCP) ELAP# 10323 6:1, . .» YML ENVIRONMENTAL SERVICES 321 Kear Street ~/o-rkt�o�y. t N.Y. � (P-1� 5 2�'' | Albert H P�dovani ^Director ' H. ' � LAB #: 32.8044571 CLIENT #: 9136 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STAT PROC ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PAGE 1 �CHWARTZ /BOEHMIG ~ / DATE/TIME TAKEN: O5/22/98 11:`0A - BROOKFALLS DEV. CORP. DATE/TIME REC'D: 05/22/9812:45P ppb 330W. 45TH STREET REPORT DATE:' 06/02/98 MG/L NEW YORK, NY 10036 ` PHONE: (212)-247-3450 SAMPLING SITE: 8 SLEEPY BR8OK*LANE : PUTNAtf VALLEY NY COL`D BY: DAVID SCHWARTZ NOTES!".: OUTSIDE HOSE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ � DATE FLAG PROCEDURE ' SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFOWMETH: MF ~~~�=~~~~~~~~~~~~~~~~~~~~=~~~~-~~~~=~~~ RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 05/22/98 MF T. COLIFORM` PRESNT /100 ML ABSENT 05/22/98 LEAD (IMS) 3.9 ppb 0-15 ppb 05122198 NITRATE NITROG <0.2 MG/L O - 10 05/22/98 NITRITE NITROG MG/L N/A 05/22/98 IRON (Fe) MG/L 0-0.3 mg/1 05/22/98 'ANGANESE (Mn) 0.077MG/L 0-0.3 mg/1 05/22/98 SODIUM (Na) N/A 05/22/98 pH 6.5-8,5 05/22/98 HARDNESS,TOTAL -1Tj2'MG/L N/A ' ' 05122/98 ` ALKALINITY (AS 104 MG/L N/A 05/2208.-,-_Z ITy_(TUR12 �� '�5T�/98` -' 'l1F-FECAL COL�F ^� ��SE�JT J�''IT70`7��-~'`-'-' ABSlENi 05/22/98 E. COLI (CONFI ABSENT 100/ML ABSENT COMMENTS: � BACT THESE INDICATE THAT THE WATER (WAS) OF A 1;i;;;;;ijRK �RESULTS SATISFACTORY-SANITARY QUALITY ACCORDINS TO 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 distri6ution points have a LEADjvalue 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 ~ c6mbined sh,all not exceed 0.5 mg/L. Na No limits for Sodiun/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 those on a METHOD 1008 12345 9139 9146 2037 2037 9043 YML ENVIRONMENTALSERVICES � 321 Kear Street . Yo-rktown Heights, N.Y, 10598 ' ;�!j 4�.��^��.��r. | ' | Albert H Padovani 'Director | H. ' | . � ` LAB #: 32.804457 CLIENT #: 9136 ` STAT�PROC MHbE 2 SCHWARTZ / BOEHMIG DATE/TIME TAKEN: 0512Q/98 11:30A BROOKFALLS DEV, CORP. DATE/TIME REC'D: 05/22/98 12:45P 330W 45TH STREET ` REPORT DATE: O6/02/98 NEW YORK, NY 10036 ' PHONE: (212)-247-3450 ` SAMPLING SITE: 8 SLEEPY BROOK LANE SAMPLE TYPE—: POTABLE : PUTNAM VALLEY NY PRESERVATIVES: NONE � COL'D BY: DAVID SCHWARTZ ' TEMPERA .": < 4C NOTES...: OUTSIDE HOSE ' ' COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ^ ` . moderately restricted, diet, a maximum of 270 mg/L*of Sodium is suggested. ` / SUBMITTED.BY: . �_ ' Alb H. Padovani, M.T.(ASCP) ' Director ELAP#10323 PUTNAM COUNTY DEPARTMENT OF HEALTH -DI'V l-SX aGF- V-XRO IME— NTAL.,Xi[EAL T.-H SE- RV-HCES LETTER OF AUTHORIZATION RE: Property of Bt2C)01'FAL_(..S Goy't=LdPMn'4-T" carp Located at 5LF_€ -)K L. *45= T/V V,Ti,j,6,m yAw-r , Tax Map # Block l Lot 42- Subdivision of FCC - (U__ .ESTA-TES Wl�--=T_ Subdivision Lot # Gentlemen: Filed Map # 24-11 A- Date Filed a c) This letter is to authorize PTO 4+i P. Dr__`A-i _kD , P_. a duly licensed Professional Engineer >;:�- or Registered Architect to apply for the required wastewater treatment and/or water supply permit(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, and to sign all necessary papers on my behalf in connection with this _ :.matter and _to_supervis�_the construct said- wastewater treatment and/or water.supply.systems . inconformity withthc provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: Signed: '11111464. _Isl (� P. E., �, # � (Owner of Property) � Mailing Address vMA4SC PC_ Mailing Address: 3- 1hi 4ri -,H� ST. State N Zip Telephone: q (4- - ?O5 -0(2,(-7 State fly Zip Telephone: 212 -2_O r-81�39 Form LA -97 PUTNAM COUNTY DEPARTMENT 'OF HEALTH . � �DIYI�IQN= Q�'�IY.V;IRQNMENTA:L HEA7LTH:SERVIC'ES_;.. -: -, AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: , A�_s W EU represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: ve-yr MFNtT_ 92-2. Having offices at: Whose Officers Are: J0 W05_ _ -A5 - President - Name: Address: 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 day of iii month) (year) v NO;,; AN a C!N � R10;; iti;' �'!`3! tC, Stato of dam YoKc. 0- �.r.;,tYd la E3rontc 0 u� con�nits�lon Farptres den, 3t Form CA -97 Signed: Title:�,.y�1 , Corporate Seal a John Delano, P. E. Badey & Watson Route 9 Cold Spring, NY 10516 Dear Mr. Delano: r BRUCE R. FOLEY ` •'i �'.�T:'�, .MS_;;,v:- ,^•.., V:s: :..s-= •,:�I:f'�C'. ��Rjk2' :..�ii.�!.'inrj��;. -, DEPARTMENT OF HEALTH Division of Environmental Health. Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 30, 1998 Re: Construction Compliance Application for Lot #8 Foothill. Estates West Realty Subdivision Sleepy Brook Lane (T) Putnam Valley This Department has received and reviewed the application for the above referenced project and the following comments are offered for your consideration. 1. 01 3. The data submitted for the 24 hour pump testing does not comply with the procedure outlined in Appendix F of Bulletin ST -19. An appropriately sized storage tank is to be provided as outlined in Appendix G of Bulletin ST -19. The storage tank is to be sized upon Department verification of the 24 hour pinup test welt yii 6ld. u - The as built plan is to specify the make, model and type of water supply treatment unit installed. Manufacturer's literature on the treatment unit installed is also to be provided. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Very truly yours, IIIIJIA Michael J. Director of MJB /jp cc: David Schwartz , PUTNAM COUNTY DEPARTMENT OF HEALTH filc DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELLXO'II�IP.LE110IN 1 �'�DR,T �= . - _ .. _ _ _ -_ . _ _.. ,. Well Location Street Address: T n/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Supply' Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial 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 �^fft. Diameter & " in. Weight per foot / G lb /ft. Materials: X Steel _Plastic _Other Joints: _ Welded Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: ,?c 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 ,.Compressed Air Hours 21 Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completted well in feet Well Log If more detailed information sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drillin list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 34->4� Capacity -1-5- Depth S-90 Model 6T Voltage 2-36 HP Tank Type ltiX -2 �o Volume y/ �0 Date Well Co m leted 31 Putnam County Certification No. Date of Report aZ Well Driller (signature) NOTE: Ekact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan., Address: /f Y 7'1, Well Drillees Name �r�rn .�w �.�-,� _ E r/ Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller r .NORMAN ANDERSON, INC. WELL DRILLING -, _... , ,; � <. . r ,. ; � :.�~'. —_ , -. _ . ,F.•- - 152 BARGER STREET . ,. � . -,.... �:-�;� s�s � ,_ . - - - - -.z >-. . _ .. • x: w.:_ •v .. PUTNAM VALLEY, NEW YORK 10579 (914) 529.8698 (914) 528.1491 vo 7, i9y� U •f 70 yo S'o ` Ca � 4/d 7." ioS,*' Y' g; �c Z3S z 9" /y av �'Nv 3 yo S y o 3 F3 ' rya � 4S�oi y ' y o •f 70 yo ego 4/d YML ENVIRONMENTAL SERVICES 321 Kear Street .t � �F�. 4•..L .Y�n �,.!, �.,, E�:i.�. �,".:�• G.� �i.�c;!.�'' _�.y:: 1•�r� . "+ems. w� ate-' .°d. » �a ..:.�,T.w.-i.'e'• - ;y.. (?14) 245 -2200 Albert H, Pajovani . Director LAD 4: 32.804457 CLIENT #: 9136 _; :HWARTC / _ b Hm i s t;EW Y 0 R K , NY 1'(--) 0 36 STAT.FROC PAGE , DA T EXIME TAKEN: 0502/98 11:30A DATE - T ` RE!C ' D : 05/22/98 12:457- REPORT DATE: 06 / )F PHONE : (2 12 ) - 247 - 3450 SAN 'LING SITE: S SLEEPY BROOK LANE SAMPLE TY=•':= POTABLE • 'D PUTNAM VAL LEY NY PRESERVATIVES: NONE EO BY: DAVID SCHWARTZ E,` RJT_U RE 4t4 ' 17.': !f TSIDENHOSE . . . COL;FOntPET- M---- i= DA T E FLAG PROCEDURE .,- M RESULT ^0 =! AL - RANGE �K., 4jETH2 `U T NAB t C vTY PROFILE 0502/96 i 1F T. COL I FORM PRE ENT /100 ML ABSENT NT 05 /2E/9S LEAD ( MS ) 3.9 p0b 0-15 ppb JI !RATE NITRGG <ti,c i'G /L a) — 10 05/22/98 NITRITE NIT ROD 0 MS /` N/A 05/22/92 IRON (Fe) '1077 L /L !-1 . 3 ma / l 05 /22/72 MANGANESE (n 1 0.0 74 MG /L 0-0.3 mg /' 05/22/92 SODIUM (Na) R NiA 05/E2/9c7: 6.7 UNITS 6.5-8.5 05/22/,5 r,. P, �'—' r — T�.Tf L 2 :h1G /L 03/22/98 ALKALINITY (Ac .. .. •_•=•icy c T�,Rc, T._; .. --..: : _.:. _ ._.. 1 MF FECAL COLIF ABSENT 100 ML ABSENT 05/22/98 E. COL I (CONF I ABSENT 100/ML ABSENT COMMENTS: 3QT 7HEfE RES =ULTS INDICATE THAT THE WATER . (WAS) ('WAS. NOT OF A SATISFACTORY SANITARY DUALITY ACCORD I N3 TO - •!= RK 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 & Copoer Rule for Public Systems requires that no more than 10% of their distribution! points have a LEAD value 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 poten t ia" . FE /Mm If bath iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted cie:.,the water should contain no more than 20 mg /L of Sodium. For those on a • OCE 1234 - 13 c, 9146 C_);_ +7 2037 9043 ..-.. YI L ENVIRONMENTAL SERVICES 321 Kear Street `5.14) 245-2-230C, Albert H. Pa£iovani Direztor _AB #: 32.804457 CLIENT # : 9136 .TAT PROC . 'ABE SCHWARTZ / BOEHMIG BROOKFALLS DEV . CORD' 230W. 45TH STREET NEW YORK, NY 0036 036 SAMPLING SITE: E SLEEPY BROOK LANE PUTNAM VALLEY 1`dY COLD BY: DAVID SCHWARTZ NOTES .... OUTSIDE HOSE DATE FLAG, PROCEDURE DATE/TIME TAKEN: 05 /cc r. L 11:30A DATE/TIME REC ` D : 05/22/98 1 E : 45P REPORT PHONE: (212)-247-3450 SAMPLE TYPE—: POTABLE PRESERVATIVES: NONE T=MPE ATU iE... < 4C RESULT NORMAL - RA aSE METti^L moderately restricted diet, a maxitTturn of 270 mg /L UT St=diUj -P- is suggested. e e SUBMITTED BY Alb : Direct YML ENVIRONMENTAL SERVICES 321 Kear Street .Yorktown He�:�ht�,: _ (914 ) 245 -2800 Albert H.. Padovani, Director LAB #: 32.804768 CLIENT #: 9139. NON STAT PROC .PAGE 1 ----------------- -------------- NNN-------- VNNNNNNNNNNNNN BROOKFIELD DEVELOP COR DATE /TIME TAKEN': 06/01/98 02:00P 330 W 45TH ST. DATE /TIME REC'D: 06/01/98 02:30P NEW YORK, NY 10036 REPORT DATE: 06/03/98 PHONE: (212)- 265 -8189 SAMPLING SITE: LOT #8 SLEEPYBROOK LN. SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COLD BY: DAVID SCHWARTZ TEMPERATURE..: < 4C NOTES...: KITCHEN TAP COLIFORM METH: MF MNNNI -------- IVNNIVNNN/VNNNNNNNNNNNN ---- -- ----NN IVN NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/01/98 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 COMMCNI—S: BACT_ THESE RESULTS INDICATE THAT THE WATE (WaE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H P dovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES .,321 ["ear Street .- _ -° s_<Yia� F.r.;�vii.Heigh -ts °N'oV`o ( 914) 245-2800 Albert H. Padovani q Director LAB #: 32.804805 CLIENT #: 9139 NON STAT PROC PAGE 1 NNNNNN--------- V--- ---- -- ------ - --NNNN , v-/ v.---------------- --- ,v---- --- ----- .v.v.v- BROOEFIELD DEVELOP COR 330 W 45TH ST. NEW YORK, NY 1.0036 DATE /TIME TAi "EN : 06/02/98 DATE /TIME REC'D: 06/()22/98 09:20A REPORT DATE: 06/08/98 PHONE: (2212)- 265 -8189 SAMPLING SITE: LOT #8 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE COLD BY: DAVID SCHWARTZ TEMPERATURE..: 4C NOTES ... : KITCHEN TAP COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/02/92 IRON (I MS) 2.04 MG /L 06/02/98 pH 8.6 UNITS 6.5 -8.5 9043 06/02/98 TURBIDITY (TUR .13 NTU 0-5 NTU COMMENTS: Fe /Mn If both iron and manganese are present, their total valUe combined shall not exceed 0.5 mg /L. a SUBMITTED BY: Alber . Padovani9 M.T.(ASCP) Director ELAP# 10323 X323 YML ENVIRONMENTAL SERVICES 321 K'ear Street Yqli-L town -! H igh.t;s a:_N (91 14) 24- 5- 280,:, Albert H; Padovani, Director LAB #: 32.8 X5066 CLIENT #: 5698 NON STrT 'ROC F'ri 1 FOOTHILLS HOME BUILDER DATE /TIME TAKEN: 06/24/98 02:00 330 WEST 45TH ST DATE /TIME REC'D: 06/24/98 02:45 NEW YORK, NY 1,0036 REPORT DATE: 06/26/98 PHONE: (212)- 265 -8189 SAMPLING SITE: 8 SLEEPY BROOK LANE, PUTNAM VALLEY SAMPLE TYPE..: POTABLE :.fITCHEN TAP PRESERVATIVES: NONE COL'D BY: DAVID SCHWARTZ TEMPERATURE..: NOTES...: COLIFORM METFI: N/A DATE FLAG PROCEDURE REtiULT NORMAL - RANGE METHOD 06/24/98 IRON (Fe) 0.069 MG /L 0 -0.3 mg/1 2037 06/24/98 MANGANESE (Mn) 0.010 MG %L 0 -0.3 mg / l 2037 06/24/98 TURBIDITY (TUR <1 NTU 0 -5 NTU COMME�•:.i._ Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. SUBMITTED BY: Alb -t H. Padovani, M.T. (AS CP) Director ELAP# 10323 '.Y:• 1 +::'.^� R�:.:i 6 ECOI%D -OF: F;ILI th' HON - ---C -- 91'i'i7�L'fRSXT -IO -,:.:i._:;. ]FNTNAM C®1(JNT •IlDEPART 1hIENT OF HEALTH Division of Eanvnr®n meBnaR ]Wealth Services N Facility:_ C Town: � Time: Date: 7114 Telephone # Caller's Name: DffSCUSSffON: 0 �: z XCSrWi IL��S) All -r(G��S.�� I�ti�ui4L.. Z •I �iY(� I •� ✓i�• "��QNiA�: I � t W/ of"�, 1��-O - 7[2 Signed: Date: —71, Rev. 6/97 yV 414 ,4," awr —Tut 1E SEQR _.... An"dla C . - _ - . :�:._ - - - - , ... _ < { w ._ . �arstea 11!rs7si;cnn�ma',tBet,LZ1lat�► i4pglsw _ SHORT ENARONMEWAL ASSESSMENT FORM For UNLIETED ACMNS Only PART famPROJECT INFORMATION fro be comolotoo by AppllCanl or Pr(hct toed 1. APRUCAUT rsPomsoft C t. ECT kAME fsr. t` �� • k'fwarn borNril • Costaq '•►iTi I .. ratclaa LOGtTfO>+I tS��e.t .,�e �oae are►.aer,w►r. �gn+nnt lane�nAlrllt, Ka.. a OratN +»•PI St,dE�9Y �rLCO,,t `Bret$. >/ f., ra M V.INc� s. 19 t "ID A0Vft om. DE.wnsro. �+�� n+e.tlOtYaf�teq+�an r1�o►T•KML �Lt. a. at""PMWr $ftq LY! aj \mfi ry uu.�c�.� r 7. AM of Lmo 4 o- �y �: �e� ce•q>Rr 4rty. of .1 ,> , a. WILL PROPOSED YWR COMPLY Yam Exignmo mmrnG OR CngA musTwo LAND USE RQ51'ANCtIoor ❑ ru of ft it »o, d..-o+ wary 11* tD1r►. �syr. OV- ' ► vIeFp ! t. WHAIRIA02W LAND US& IN VICWTY OF PAWSM. kowto flal ©, .+ Cl N.N C!AttiWtlYtO , Q�.rWRO�+voval�p dl► Do>n+,I '�,Et�o•�r S.� 3 ri�ty „►�� IZ N�!, N C,� 1KT►+�i,►■ 10: *at$ AMON InvMVE R Pm” OR "094. NOW OR ULTIMATELY FKM ANY OTHER GOYEANMWAL AGENCY If SAL. STATE OR tOCMLell D Yoe it,M.'Nl� .tea Iw omwucra.+u 11, M AaPM Of TNt ACT.'N HAYt A CURRft y YAUO MtRMIT OR APP140VALl *t q QN•, h y.. ust e4•1!af NgfMta�M PermRh/N C `.� _v- ' !"10e t) {fit t'iGi '�J� E t ✓Art J esK 1'r". irj. � A Oi PLO Mutt fJQSTINO.IH�tmA ►F�OY RRCUfflE flOM! S Qdid. Gros Ow >v I Colm TRIAT Tm o"Pt ►Tiom >MQYIOEO R TWt to self eLtiT MY 1+<MON�vtt00f r —.. ApAtt011�1tlsgan.or is to sctW is In H>m Co"tsl Anal, and you am a ON Ems, Ir,mpWo Ins Coattel AesessmeM ft m helm Proc"nq with thls Asaesemord ova I l .d lt6LBLt6461 ON X� LURE Alg AJ.) MyNn'a AV PART II— ENVIRONMENTAL ASSESSMENT (fo be completed by Agency) A. DOES ACTION EXC ANY TYPE I THRESHOLD IN 6 NYCRR, PART 611.12? It yes, coordinate the review process and use the FULL EAF. NO B. WILL ACTION RECEIVE q9,0RDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded nother involved agency. !� Yes 11,2N o 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: 0�0 C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: �C) 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 usa 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. kAo C7. Other impacts (Including changes in use of either quantity or type of energy)? Explain briefly. QO D. IS THERE, OR IS TH ,V161NELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE, ENVIRONMENTAL IMPACTS? ❑ Yes 1214o 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..lf.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. ❑ Che this box if you have identified one or more potentially large or significant adverse impacts which MAY o ur. 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: tti AND provide on attachments as necessary, the teasonesupporting!his determination: -r-7A C, ti / ro a. Name of Lead Agency r_ I ciarh -n-i to afZ Print r T Na a of Responsible O it r in Lead Agency Title o Responsible Officer k - 9 Signature o sponsi a Of icer in Led0 Agency Signature of Preparer(I different esp onsi ie o iced 4uv'05i i2 l qqR Date L 6 BRUCE R. FOLEY,�R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10309 . (914) 278-6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: Brookfalls Dev. Corp. ADDRESS: 330 West 45th St. New York, NY 10036 SITE LOCATION: Foothill Est. West Lot #8 Sleepy Brook Lane Putnam Valley DATE: Aug. 6, 1998 STAFF PRESENT: BF, MB, RM, AS, BH, GR SPECIFIC WAIVER 1. Well to PL 15' REQUEST: * Drill Second Well @ New Location DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DIS,- kPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES Low Yield Well NO DISCUSSION Poor qualuty H2O - Abandon.existing well - Well to be staked by NYS Licensed surveyor - Well yield report & H2O quality analysis to be submitted to PCHD upon completion. REQUEST APPROVED OR DENIED APPROVED DENIED REASON FChq. DENIAL DIRECTOR OF PUBLIC HEALTH DATE: a 45 t "; — / e NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,1ONYCRR _. , r ....: _ - —... ; .��_; ... - _ _ or•1r� .lYtdu�,l•9;o4gghold S ,v ,g9-- TeeaimGnt Sgstams- 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well to Property line Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ... Wel ..1 ..... (.Exi.s.t.i.n.g.) .... Poor .... q.ual.i.ty. ... and ... 1.ow ... y4 . 1. d ........................ ............................... ........ ....Des.i.re....0 ..aban, don... and.... re- dri. 1.. 1.....@... a1te. rnate....l.. o. c. atin n. 9 ...................... ............................... Selected by Well Driller /Developer. 3. The proposed design may have the following limitations (check appropriate box(es)): ^J Increased risk of well or spring contamination. Due to close proximity to road Increased risk of surface water contamination. Expected design life of the system will be diminished. . Operation of sewage system is subject to mechanical problems. Other(explain) ............................. .................................................................................................................... ............................... ................................................................ ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by t ' suing official for a change in conditions for which this waiver was. granted. .... ............................................... ............................... FIEPfiESENTATIVE COMMISSIONER OF HEALTH ORIGINAL - Local Health Agency COPY - Applicant/Design Professional ................. . .......................... ............................... DATE DOH -1326 (7/92) (GEN -152) b ■ 0n -TAIL 117 eww"T Lot Nwo stmt SEAR APWdls C . $tat# RAwram Fdol Quaiky Wow .Y.1: c� a�:'oe', v'1. �r�.:.:..`.'.,.. - ..o..'.:�: 'o$e:. tea:.: .',i- i•ei.r<a ..'7 �y�� ,�� v��iipp��ecgqgg��++��t��eA per, �.e�� T1Vf��' Glr:If9VnR1G1t 1'iii'•�W �_q Y•wai}9 a4 .t4o '/ ; g I NT. FOf Yeef iH F" UNLISTED ACTIONS Only PART Im-PROJECT INFORMATION (to be comolalted by Appileanl or Protect 106AW {. APPLICANT WONSOR t. t 0JWT tI"I 1. PROJECTiO�nON' k"f�4rr{ !/offs ♦, PRlCtU LOG MN i met +vie erd row I6WT J9nk XMInoM WdatM eto.. a OWO IruW St.IttC�Y �t?,00,t LMUdL . i !04np, " V� 114 ONa.r []Espanua ilkatlonfellc+a�Ia� Y�� A-Op►T0Kln J41'L. d. 104NIS PRO to SAWN! IpS,7M4t0IL. Jut, 01,r 1?t0%4�sary -Ib 14t W6 EE OJT-i u(_ T. AMOUNT OF Lnwo Aff o- ►rmay? J . f 4 uru rJ,n�nuoq ti . t 9i� , G h >T' Oliv . Of 17mu. PROPOSED APOR COMPLY MT14 EXIVINO ZONrNC OR UTkP EXISTING LAND USE RIiSTRICYlOtdl O.. ``TU f!0 if Mp, d..-%,o V1.01 4t1141Vj#.. .srR/P r•>A�'1 S �.�� K�Sj�71i.T�`i�i F��SiT• j�lr�� F��'�S 1r 6, WHAT t,%3E1.'T LAND t1S5 IN VICINITY OR PRAJECT4 rWgId rllaI . © IeewrW C7 C..mmlil G AIIriesttYra ❑PorlrlPOravOPOnpaser ❑Doer Dowd", % I DBE ►� c { 'i.- 10. WCS ACTION UCMVE A PUNIT APPROVAL, OR "OtHG. NOW OR LILTIMATELY fWM ANY OTHER GOVERNMENTAL ,=1 1 {fiSERa1L ID Tp„ p- -CA, It. W A3pW OP THE ACT.:H MAVt A CURB MY VALJC "AMT OR APPP.OVALI TA ❑ w,- 11 y1:. Ott motor far* end Penaltllly Dom � G0 t 1 �xA1L iyoY � Ss,�,stifl, �t N1? �JSrj EAu 1'E •� '� U. AS A BPW OP PROPQ "11 fAITINO POWITIAPPlgv p[OtilflE MAT1ONt e. Otto S vi.01AA. x, tiEc.l• 1 CgtM THAT Tki 0010WATICN AT4C mm A to lax TO THE sw ir MY KMOwum CAW. dic i ff tho action h In the Coastal Arse, and you are • state agency, compists tho Coutel Asommertt Form before procesdi119 with this aaessawrd OVER • t Z .a 1ZoL8�t61fii ON Y.Yd LIM ANI a19 �VVNlid Y ON Y�1 PART 11— ENVIRONMENT ASSESSMENT (To be completed by Agency) A. DOES ACTION EXC ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes .l No_ r : Nttlt 7CC7t0`t RECEIVE C DINATED•REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded nother involved agency. f—I Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ct. 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: �Q C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I�Q C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: V 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 cevelopment. or related.activities likely to be induced by the proposed action? Explain briefly. �O C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. k4o C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. Q(7 D. IS THERE, OR IS TH 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. ❑ Che this box if you have identified one or more potentially large or significant adverse Impacts which MAY ur. 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 Impst,-,, AND provide on attachments as necessary, the teasons'support Ing 4his determination: J NA - C, Print r T Na a of Responsible O tic r in Lead Agency Title o Responsible Officer C&,.,, �, - - Signature of sponsi e Officer in Lead Agency Signature of Pireparer (it different from responsi6le of iced 12 199g Date 2 ;d11etj57d1 139; Aug-7-98 372=PM, Page 2/2 as - 4om—Irmis SEOR App"dx C P: SHORT ENVIRONMENTAL ASSESSMENT FORM For ismigrav Amme onir PMJ J..pM8C'r 101POWAVOIN fro be comostgo by Apoicant at "cl SpOftec" 1. AP UrAUT f3pon" kwe Let I E. - � Lc E. a., I E. "am"" —Rommurrimove,oftlef4 I to. Swvg�v Raook. . / �1 ---, -Y... 6" Avzlyvlcok� Jew 00*1,44 -v 1, .4-C&D , hh*Qaw 1. AIAWMT OF LA"D AtnMM GO%, -rook I I A vb-- - um ulv"my I. IVG 8" WILL PROPOSM A LAND LIN RUTNOT041 Vup COMPLY Vv" Exis"No on aTkp to 0 Yes ef" it 00% deft.N V40, -0.,vr. 7-1 9my-964vY Var.. f;, PG40, L*4, 0. AMOWINW JAND uss of vicim" 00 PAWW" alwmact 0"Gru, QCJS AM" fkyQL-ffA f"A qP"AL..QR.jpLN01k4 NOW OR Uk""t15LYfACM ANY ON" GOVER"60AL AuwCv MML Ova ditto n 1". Not aw"O am WRO"An"Is mm, ?W 04 opt" AMC Op Maw- mm I CWtM MATM ftq*WATM ?RD NO 'N APPPAVAU WOURM O? MAT CA I =- ti to ?on to "a up IAY Imc" oaux . tt ft action to In IN Coasts' Attu, and you an a out$ GPM, mupwo Otte Coastal Aesessmod form Wom pv*D"fq with this sssessinval OVER, F-1 14.18.4 (2187)—Text 12 PROJECT I.D. NUMBER IS9Y39 SEW Appendix C r ,..... = r6taie- �Envttoramai�tal 4cje11f"y ° =� ®irieai;.. • • -r s" :��: �- ...� -<-. _..�...��.� ..••,'• - ,e••- ..r��nw A'r-v a�:r.� •..__ � .a s*..•..: '. •.:- .. +a-:. «::rte ='= -_ .�..._ SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 (SPONSOR 2. PROJECT NAME t OtG tic 1sS emu. �Dr..� , Foar O(L t. FST- "; t,o r V 3. PROJECT LOCATION: Municipality �ii t t,1 County ?1-1' N 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: A ❑New ❑Expansion odification /alteration,2taL "I�O�Tb�(ikL �>ti(.lr 6. DESCRIBE PROJECT BRIEFLY: 12 Do�t w�L �tG o>ZtT� � vlcre ctw W Lc- It.t, m +p 7. AMOUNT OF LAND AFFECTED: L 65 s. Initially 1 • 1 ,1 acres Ultimately 'I • I IG acres �" 5' 1f V 8. WILL PROPOSED Ag4ON COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes No If No, describe briefly nroa,,, PG+ F^� S, f`i L1��liL t�rsr• JOCL- t,JAIv&. 1 ' �/nao C.i�t� 9. WHAT RESENT LAND USE IN VICINITY OF PROJECT? 00 Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: C ;r �w , r r-,+ - r �- �:i•I7:vC'�LF -.- _._7�7 i�,d._ �V /�i� • 1��.5i �1G i'•C`P'',�L,,. r .. o ..__ ._— _• -'._ - �.. �...._ _ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL►? ❑ Yes o II yes, iist agency(s) and permit/approvals 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 1 11. 00 ANY ASPECT OF THE ACT.�N HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Yes ❑ No . if yes, !Ist a_ency name and permitlapproval 1 / co rriacGt�L 1 ..r l �G 14D eJS`rj E U)Au l 1�i2vaa �-T�. 12. AS A §09VVOF PROPOSED ACTION WILL EXISTING PERMITIAPPROVA rPe REQUIRE MODIFICATION? c es C1 No p o ,4 a�at r P %�G *- .1 CERTIFY THAT THE INFORMATION PROVIDED AB VE IS TRUE TO THE BEST dF MY KNOWLEDGE Applicantisponsor name: Date: Signature: 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 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road' Brewster, New York. 10509 Tel. (914) 278-6130 Fax (914) 278-7921 FAX COVER SHEET Date: TO: Sc 14"1,qVz-T T, T From: Aa Adam B. Stiebeling Asst. Public Health Engineer p.;jr,information _For your review discussed Notes/Mess ages C- Fax#: No. Pages (Including cover sheet) tv,Lftj t 4f 11" 4 if aptn, Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (914) 278-6130 ext. 157. BRUCE R. FOLEY tor,•�- LWY• 'UNVII nVWQr- FAAtVAUr-fWtl4J; 2122658189; Aug-7-98 3:33PM; Page 2/2 Q&*4 00?t—TOM i olm For UPSUVED Aunow @f9v PAN I—Mum sopowavlow (ro bo complowd lw Applicom of projoat ODWMO 19 PROMED AMP$: op4m ovilpawm &STY -'Tb Rrezro- Eoxrj&U JN 7. AWWRT 09 tAfQ AM (."I> -r w.-,AA �. Ostm. Or 0. MU NWMW MZP0 WMMT WIM MM4,20"INO OW W14GA =nM tAW M MW&C"ONal o". Pte ro P. a=.Q. wtolly 0. IN iw— IAMO un IN vicim OF mism ktaftl a 0 o6doolow Oomx 12 06I.AACIM NOW QQ ATIMAMVIRM 40Y V?HM ICMDOVE IAL ARGNGV (FRpms, 0 yoo. RM CIPWO ON DSMWWVWM L-1 QVTW AV.!tl HAVE A GUROMY IMUD PMI? 90 AMMALT -ML =97me P rYEFaPPr bA =woe mmon"m to ?AM 70 we ow & w WV-^%QM v @ fti(n 310; 1z6L8LzHsl 'ON XVA HIME A13 AD wymu NY os:s 181 86-L -env QVIIL oy: iUVVN NVUbt MANAGEMENT; 2122 Aug -7 -98 3:27PM; Page 2/2 ra.t� p�lii --taut �0 . PrtaaleT Lp, awesew ht." $EaR R C _ _.._ .......... _ _ _.._ . .... ..q.� ^•TV aA :YS �..e� �: er. �.. .L;~ r:':- p'' ��{ 1i1��Ri�YIYYIIYYfi4Y�1� `aMdW(��ii�iLi�t`n -- _ .. � e al r.. �.. SHORT EWWRONMENTAL ASSESSMENT FORM For UNLISTED AC770M 4 Oft PART I —trRCt ECT INFORMATION (To be completed by Appliesnt or lProlsat sponsor) Ha. eeatcr t.CCATtOli: �� .„o,;,t 19 . l�at •�n,tdtt 4. PAECtsE Ltjd►710>wt.tStraat f tW0 �ttl lnte+mtlom. ptghtiwiq 10tldMafAH�. 014.. Or AtOe� poi l P��e«► v�/hS . Oe PROJINT 6011[PLr: �- Imo- �p�,Y►aralt- �areR,, . !� t''+e�r+ta4'i� ""'gym' 1�40�..tc�E ��+�r- W�,c. T. AMOUNT (W LAW AP "cTEa: sans �q:�"r �. ►�6 ,� ��r Or�v. o/� �� a. w" PPIOmm Amm W&M-f "?m FX"me $ONTO on OTq /p ow n@ vw Wall Aa;e Tone"? Min aft, It "0. ttamdes l ta�l�tvtise..� �vtaH4os �%,Hpa/ �ss�Ht:r�td• ��n W��e. 71 o. %VAT tAao Usll IN vc trf oP mQJW +. ft'sia "Of O tnaoobw O apm. tat a wman • ❑ ftw1 avow ame seaetasa, Vokow S--pdj �t1• v�rtie�i �a!y�lt�isTt+�'L. Dorm it aht�„ s ?..tcrt0a.ttiwotrltA FMote1111._WW on.ubrMAMX fPO t ANY 9MIA aov p eNr��,taaner t petue., Q rsa duo Kra. ��t ap•cel ao wanatvaa +t. AtiRSC'T on IN$ ACT.:N HAVE A OLWJWMY VAUD 1 W4* O m Ir iNS. �btl aceany nniM arts 9prao► Q. AS A Oa+ At;TM WILL 006"10 PlMfMPPIM Ono .,fig„ . IT OR APPROVAL7 �co�b ►t�� 6�er � xw�,. NMI M TaOaof t 4 ?m TO T" BEAT IAY IqKpWLQtM It the acttos to In the Coastal Ara, and you we a state, agency, emplate the C"etel Assessatant Reim motors proceeding with this assassm"i OVER t Z *d IZUBLU161 'ON RYd. R11VI ANS LD finAd AV 05:6 Idd 86 -L -JAY r? `` NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of part 75 and Appendix 75- A,10HYCRR for Individual Household Sewag®Treatmartt Systems - '-.a . :� rr,.xo --•'• .� Name of Applicant �D, - ~ 'a1 � ®atc r � ��1. vtz � i yr � t* l�rr`, rsT �.� No. Street Address 330 1 s-s- 4.5 r4 S-n -xtti-r City /Town yf 1 k y State Zip 10034. No. Street City/Town state Zip Site Location Gri � f0 Y �aOv W- (-� I �, Ky 1. Reason why site oes not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. fj��t, o ��to�ai�2Ty L tw►� Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. !� f .... Other (explain) ............... �G`1. C COGr� Q.� ►...,r...........t.....��... I �rE /.l r ........ ............................... Y ,./.. ..................k.11......... I ........................... . ......... ��2, �c.. .....j.......iC- t>!i��N1�c..... �.�y....... 04GV.......�..... ..... 1..... �1.? i! i. Cl �... f... �si ,�r[,c��ft�.�r..............._ ....................................................................................................................................................................................................................................................... ............................... 2. Proposed design or conditions of waiver: ............................................................................................................................................................................................................... ............................... : *!��ot c �cK.- .........D. ........... '. .! !? .4r...........l; .R. . .................................. ............................... ............ ............................... ,,.yy........... '�iL.......R.o..�� ........�J't'�! +�a ��......... ....... .5.......Z- .!.G.! . .-t'" ......L.4 a...S szvk.Y.� ....................'1' ................................................................................................................................................................................... ....:........l.�.Q..........�?T t +ri.fZ+ 'RVi ....:....................... 3. The proposed de ign may have the following limitations (check appropriate box(es)): 04d� ->ti �S,�P I teased risk of well or spring contamination. t��+� J v' Cwsrc �,rv,t ,� �, 7v Q,v,� Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) ..................................................... ........... .............................................................................. ................ . ............. ... ............._.......... .............................................................................................................. ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. DOH -1326 (7/92) REPRESENTATIVEOFCOMMISSIONEfi OF HEALTH D...ATE ........ ORIGINAL - Local Health Agency COPY - Applicant /Design Professional (GEN -152) r. i^ �. iu:'. =1•• 'T�.�I'r •. i'l +'�." rl'�9. I.+ - . -v ... -..V •f' I"i" n,.+, 0 .. ..J 1'.: �'L.1.� i .r�� - ?' IVi . ^V'.j.� •I T" °I""'• .�•YOa O�a`'J."� BRUCE R. FOLEY,p R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 9 SPECIFIC WAIVER C1 i REQUEST: .4 -5 �r i �... SK Inc✓, c� �t c.�tc...! i-oc we`r �,ti �c DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? v .. w........ :.. + - - -+ PUTNAM COUNTY DEPARTMENT OF HEALTH + _ SPECIFIC WAIVER ?nZoo r NO NAME: RESULT IN A SI IFICANT HARDSHIP? w5 ADDRESS:. 33© 0,F !',r ` s; u 5 i . �Ec,J Idu -c �% 1 �• c�'3 f� SITE LOCATION: ' I��'N�ic, X51- ��SP L OT- � S �r�r:% Y DATE: �c. q98 14 11- - vu,A4 STAFF PRE SENT: ?Ur. lMt, r2,vN, A.S- i� IY�Z 9 SPECIFIC WAIVER C1 i REQUEST: .4 -5 �r i �... SK Inc✓, c� �t c.�tc...! i-oc we`r �,ti �c DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? v .. w........ :.. REQUEST APPROVED OR DENIED APPROVED REASON FOR-DENIAL DIRECTOR OF PUBLIC HEALTH DATE: DENIED A n + - - -+ + _ YES NO WILL DISAPPROVAL RESULT IN A SI IFICANT HARDSHIP? Lot % YES NO DISCUSSION av�1 Q,�,��,t -Y 4z 0 c N YS L i c i t N uo Y � i 1L l•[zc� QJl�{.tZ'^'' ��h S -YSr) � �•L �s3s.. 1- ,•,too 7�' �L l.t- l IGLU ��v71 7?Cq_p Afol ' NiT1oAi. REQUEST APPROVED OR DENIED APPROVED REASON FOR-DENIAL DIRECTOR OF PUBLIC HEALTH DATE: DENIED A n p U al Comm Tl' N F' ?➢ a ItTi a11FaYT ro F Z=70 e. DNotrttr d MWbC==jb9 R{Z36 ♦,.UUCM 1►arw■4 PI .T. If: I : k'iyi4r -er urn P,v�:4�e Porna6c 7 � � •,. IMF9fY L1IFl I � T1: al F lem h11F I J �'� IMF F aaaaM f►Ip M'T??'IIflal'r Pam? gon =A(a1F. mama S'f STIiA!.A )rovb d7 M1430, L.cr =n usd a•1 ._ `w!.�1.5r6ra ti b m 1, 7 ti.;t>,d I .rl I I■, ,1.f, Dab ad NQvftM Agpovd W nnx.. ■I Ii li.r : 1rLwm ■ It /waver 1.�7dL -can 'ae.re �� • m m _ ' � � � Datg Subdivision .. • -. • o Enclosed[] 'AmPlint Hxd$aY�,y l.pc '� _ Iu.I �n:a • h'!IIC -•am O,m IP. t IUm.ynth • Clllu A ,G{ : I, '+wMkar d Fl�ra.oao.■ Il.,:.ur,m I "..��. {' IP • kom V hfM mi6rr4 wt= Y1191 l■ ,.� a ► •. r s i,+S,.�rum �e.arajr. s. ■a go ,=2:t d �.aill�.r u4x1 I■o�a •n.i -- _ - - I • Lx ..etirers,- te..1 F , � v � ! ... � � ,4Ln: 1 L w Va :a 1 u1 Fwndb \ aWd r.me V'rfto i r, Ind'114 2.d h.,, _ _ AIM I roprownt °that I am wholly and complotely rosponsiblo for tho dosign and location -of tho• proposod systom(s). 1) that tho 02porato,s2wrogo disposal system abovo doscribod will bo constructed as shown on the approved omendmont there to and in accordance with tho standards, rules a regu ans of nom County Dopartmcnt of Mmith, and that on_complotion thoroof a .-Cort'ificato of Construction Complianco".otisfactory to tho Commiooloni 41 kealth "dill D 99nittod to thin Doportnicat, and a %mittan guarantoo will bo furnisllod tho ovma, his euccoaers, hoirs or amlona by tho WNW. that waist bditimr' will 010co in go" opaotiab condition any part of 'Mid cawogo disposal system.during tho porlod of two (2) y6or4Immediatoly following the0&to of"tho'6m' oc= of tho apWavol of tho Cortificato of Construction Compli once of the original system or any ropaivo thacto; 2) that tho drlftg ivoll dosxrl 04 ab®vo tuflD bo locotod do drawn on,th o appaovo® pion and -that slid well will bo Installed in cor nco wyi t hdards, ruloo and rcguB ons of- . tho Putnam County pDoportm ont of KWIth: D040 Slanod midd►oos�CADC�R wAT Co 1 l..icenso Wo 92ZS6 S APPROVED FOR CONSTRUCTION: This approval ouphos two ears . fr m the date issuod unless construction of the building has boon undortaaon and is rarocablo for rA 80 or. may be omondcd or modified when eonald _ry by Commissionor of Mcalth. Any change or altaation of construction rc�ui►os o no t. Approv0d for disposal of domostic so age, a private actor supply only. R2V. 10/88 Dato By Title '�5 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 T''hYZ L. r- '- �ONS�RUCT�'A WAW EL PCHD PERMIT # WELL LOCATION Street Address SLGG fLCv K. _ Town/Village/City Tax 'PJTiv4N VALjZle 2A-1_4-Z_ Grid Numbers WELL OWNER Name Mailing -�1, CQ . Address 3 'Private O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL b BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION []INSTITUTIONAL .O STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE (ObDgal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY tkNEW SUPPLY NEW DWELLING 0 TEST /OBSERVATION GI ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING TO c, ce moo WELL TYPE DRILLED DRIVEN DDUG O GRAVEL. Q OTHER IS WELL SITE SUBJECT.TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Foo-r yktL. Lot No. , P WATER WELL CONTRACTOR: Name ' -V A6 p;= ��„��n Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�L- -NO NAME OF PUBLIC WATER SUPPLY: f Am TOWN /VIL /CITY i..-DISTANCE -TO PROPERTY .FROML ..NEAREST WATER MAIN:..- _,.... . �.. , ..._.... ....: u: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED IRON 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 third, (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 any and all water or waste products from such well drill property and in suc -a manner as not to degrade or other Date of Issue:V 1 19 417- Date of Expiration 9- - 19 4� Perm t Permit is Non- Transfe rable White copy: 3/89 Yellow copy take appropriate action to assure that g erations be contained on this e ontami a surface or groundwater. Issuing 6f ficia HD File Pink copy: Owner Bldg. Insp. Orange copy: Well Driller r- .:AN -14 -1997 14:23 FROM BADEY & WATSON, P.C. TO 12125814334 P.02 PUTNAk COUNTY DEPARTMENT OF BEALTti Division of Environmental Health Services AFPZt1D :EX L �..,,.. ... ...r•. v• �1 .....,�:_....... ,�'. -� ♦... 'r. ,.:_.. i.. .,...��,y..r, "•,l�k v v'... __.. �{• �.' �. ... ¢. - ♦:��d•:�r +.. ..,::I`.ai•s, r • --^°^t -. •+¢ "1� •__ . . � �-D��V'x j.a .�♦ �,,�, C��eAx� �•6FtNER• ai;�i%Cn�cz0ir . FOR PE&%iLT ApnicAvoN SUBmIrreD TO PUTNAM COUNTY HEALTH DOARTMENT TO: Commissioner of Health In the matter of application fvr: Cop,�sCrtucTtoN P �Ir+a�T �otL vo-At"g:` 2 L-->!~ LL-- represent that I am an officer or employee of the corporation and am authorized to act for —!;fZcppl� FALL LCDPtom•/y'i tol`j (Name of Corporation) having offices at 33C> ST �1S T XJ IV Y 10a 2 �2 Whose officers are: President: Uit,. ��G►- ltn�A.CL, -33a rl �_ t, TsT' K)Y .loc»� ° (•Name and Address) Vice-- Prasident: _ - (Name acid Address) Secretary: (Name and Address) Name and Address avid that z am and will be individually responsible for any and all acts of the cor,porataon with respcct to the approval requested and all su,nt a is relating thereto. r / 11�• Sworn to before me this /12 oE.,.� � ijLi.`c ��`�• day Signed: 19-L Title: Natary Public ,8/8'4 „1. • :Coroora•te Seal .« ' JAN -14 -1997 14:24 FROM BADEY &WATSON, P.C. TO 12125614334 P.04 PU'1`IMM . COUNT'Y' D1iPARTMLN'x OF 111':,AV.V11 DIVISION OF ENVXR0NM,ENTA1, 1JZALTH SERVICES FFiNllI}i X �'.� .. ..rae T'�'f.. %+m = :5�`T•ieYa^4f'+�.I�.. « » -V r°: :L...'y51. ^T -.. Y. a. 'ra 1. d -� . -•..' ^°..— `�:':.�•_ Re : Property of j r"ZC701L F.b.1 � V�?y,.c� M .NT co Located a t� i lr l= RS 1C L.�y {�i r✓ Section '34 131oc1c J'ot Subd> visinn of FOC;;V K1LL eSTAS VV i Subdv. Lo t ;! ^' _ _ MFiled Map Z417A —Date Cdzo/20' Gentlemen: -•-� ' This letter is to' autlzorize a duly.licensed professional engine er—klor.. (Indicate) to apply for a Cons truction.,Permit' for a separate sewage system, to serve the above not( >d property in accoxda ,nce with the standards, rulas or regulations os promulasated'by the Contmis'sioner of the PtiAtriam Cov.zxty Department of llcal.th , :Alld to sign all .necessary popers on my behalf in - connection, with this matter and to supervise the eonstructi'on of stii.d. :system or systems in conformity with the provisions v:E .Article 1115 or 111 1 d•..,the, Putna.m County Sar►i - i taary Code. r ,Co-anters:ivn'cd: :Address —fit Q .�. ; Telepl� one Very truly yours, S i g.nc d owner of Property -�-` 3=5b t-� ,A 5, , Addre as Y Town 'Z_! I.- 2 (-� Telephone TOTAL. P.04 ?U,a. 4,i +,►;n Jf "':-7 ;iJ'!�F ,1 ��Al;�, �.:°T !1�F' f311'A! T?i 1''t:-4u. i"_;u + °!��e� +:��m..arrzmJ "ir�a �k� `boa- .'•lima 1•arwwal. k Y 1 `��3 1 7 }= ��$rt++sva� tvr i nr-- ':«�ia� F'sr:�. 00 TOWN. Qf.. Putnam Vallew - - - 6A� d�Y4.dm.�nlW N.,Foothill Estates - �.i..! I a,t r 7b, bi av 84 i:3'le2k - I N 4 Niles Schwartz J w:m�3 &62I� 330 Nest 45th St., Apt, Lobby E irevo . May York, MY pp_jQQ36 Date Subdivision ARRro�, Fee En'closedtj A,,,,t $300.00 Residential Ica : as 1.196 f' llt�l sue=" . �1' Il�o-h � mAmsc.* °�'•ua±: d t3aahr-ae++cca �i0a�.,y��n b G: I" III a W� S:II!n tioa•E29Mkxa La lir V dv e.Vd MGM i'lAl la :=39�ntrF.J 1d4 Y�5i -o � iYYMFIGEA c• _ , I.R..{aC➢Q 4{"i.%'i' -a-400- wide- b- = _ .t. .t. trench 1'i Fi2"I - 7M,F •m: t: Prie •:• `•M7 Pir Lad h I • - ' ,M. 1 - ! = .'3:Pvee� I repromt that 1 am txholly and eompbtoly roe" nsiblo for too design and location of thO pvopOWd syst0m(5) ; 1) that the WOMto tax di sal sydonl abovo 0OW0e9 trill b° constructed as Mown on tho approved amondment there to and in aeeordoneo with tho standards, rulos o ►cau ne O nam County DOWUmnt of Hm ■k and that on tomptotio01.thoroof 0 "Cortificato of Construction Complionee" Musfaetory to tho CommicmiOnC7 of Hea■hvill L a Movact¢ed to too DepMmmi. aaW o exritton puaraintee trill bo fumWmd tho owaw. his tuccomars, holro or awlans by tho buifdsa. that saki bulWm exalt onto la 0=0 00=02000 ONW12600 any =4 of mtdl c3wovo dipoMI system during tho period of tyro (a) yews Immediately foltvmIng thodato of the Imu- Of M Op rat of 2019 CCrtiBltot° Of Construction COmpllanca of 2010 OF16inol system or PQV ropabs 0=o2o; a) that the drifted exalt dos aft3s 06"e wIM 00 txeote€1 oa cM= on 2ho apwrov 1 pbn ones that m troll exill faro Instal in rdan h , ho t�andovds, rube and rqu s of too tautnom COURRV ®C=11ma i of 9�^� ft. ®ato July 30, 1993' Sand a.A. — Ad�rori.piDEY & WATSOI�T License /do- 62505, AGPWOVED ROW'COMTWt MCM: Toil axsroaol onpiroc two yams from the data Imuoe unem construction of tho building .hoe boon undortakan and i2 rWOSt 053 for cauho 67 may Do on or modifboM arh3n conMW ry by tho C Issionor of Health. Any chortoo or afteration of construction fqugoa o 01�exy��u�'iB..% asmov1 for alai of doMcilt can or o exoto7 ardpoy only. l tev. oi$8 0 lY/ 1el Oy TIM zQ DEPARTMENT OF HEALTH a Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPL- ICATIVN-TO CONSTRUCT--A: WELL PCHD PERMIT~ # WELL LOCATION Street Address Sleeby Brook Lane Town/Village/City Putnam Valley 84-01-42, Tax Grid Number ' Suba. 1 8 WELL OWNER s Name Mailing Addres Lo AA Niles Schwartz, 330 West 45th Stpit. New -Y6r r , XIPrivate NY 10033Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP (3 ABANDONED O FARM 0 TEST /OBSERVATION 0 OTHER (specify, M INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD .SOUGHT 5 gpm /# PEOPLE SERVED 6 /EST. El REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION CtNEW SUPPLY NEW DWELLING C1 DEEPEN EXISTING WELL OF DAILY USAGE 600 gal CI ADDITIONAL SUPPLY .REASON FOR DRILLING DETAILED REASON FOR DRILLING Proyide pota ble water a pply . WELL TYPE DRILLED DRIVEN []DUG GRAVEL. Q OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Foothiii 'Estates s Filed Map No. 2477A Dated 6/20/90 Lot No 8 ,,WATER WELL CONTRACTOR: Name To be determined Address: ''a PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: NSA TOWN /VIL /CITY -: °DISTANCE TO� PROPERTY: FROM NEAREST: - .WATER. MAIN : - � ,. •_ __..: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ ON SEPARATE SHEET July 30, 1993 4 PC (? ee . (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 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 otherw&pe contaminate surface or groundwater. ate of Issue: h 19 Date of Expiration G� 19_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller u i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.. -^- .7.�, :. � .. C!.. n� ..... .. -.. __ ..-- aJ'-.t .- �.,'s�"�:.'k, ,ate =-.r . c -'=_za _:��.c- y.^-•, ;a,, "•'�:. �s.=+ i :. i'�. s' .-. �r .. - .�..r .. -�. "sat :-� - �w.,r:sr�+' >.:.,'1.1 .. .. Dates August 6, 1993 RE: Property of.- Niles Schwartz Located at: Sleepy. Brook Lane T /Os Putnam Valley Section 84 Block 01 Lot 42 Subdivision Of: Foothill Estates West Subdo Lot No. 8 Filed Map Noe 2477A Date 6 -20 -90 Gentlemen: This letter is to authorize John P o Delano, P e E o , a duly licensed Professional Engineer, to apply for a Construction Permit.for a Sewage Disposal System and /or a Private Water Supply, to serve the above noted property in accordance with the standards, rules, or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems.,_ in con Qrmity...w..ith the, pravisri.ons. of - - - - Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. BADEY & WATSON, Surveying & Engineeing, P.C. ga&"" 66e'4� P'0- John Po Delano, P.E. NYS Lico No. 62505 U.S. Route 9 Cold Spring, N.Y. 10516 (914) 265 -9217 Very truly yours, Signed Owner of Property 330 West 45th Street Apt. Lobby E New York, New York 10036 Address (212) 265 -8189 Telephone J � r C.� �a PUTNAM COUNTX .DEPARTMENT OF HEAL.TI� APPLICATION FOR APPROVAL OF PLANS FOR WASTEWATER DISPOSAL SYSTEM n: °Nul V find` AC�G I ASS of Appl'i cariir — J 330 Vest 45th St., ' Abt. Lobby E New York; NY 10036 Niles Schwartz. Putnam Valley. 2. Name of Project _3. Location T/ John P. Delano BADEY & WATSON, 4. Project .Engineer: 5. S�A udrve sin C License Number: Y g .. ... U.S. Route 9, Cold Spring, NY 62505 Phone: (914). 265 -9 6. Type of Project: 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 (SEQR)? Type Status (Check'One) Type I.. Exempt Type II. X Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? No Has DEIS been completed and found acceptable by Lead Agency? ........... N/A_ 10. Name of Lead Agency N/A 11. Is. this project in an area under the control of local planning, zoning, or other -officials, ordinances? Yes 12. T —'so, 0. p 1 ans •he6n- su ra at`tetl t' � e#i }i uth �riiies? ......,' .. . ; :.... New. 13. Has preliminary' approval been granted by such authorities? N/A Date Granted: N/A 14. Type of Sewage D 'isposal System Discharge:.::.. _ Surface Water' X ' Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N/A 16. Waters index number (surface) ........... ............................... N/A 17. Is project located near a public water supply system? .................. No 18. If yes, name of water supply N/A Distance to water supply- - jC 19, Is project site near a,public sewage collection or disposal system ?..... No 10. Name of sewage system N/A Distance to sewage system N/A )ate observed: 23. Name of Health Inspector: Michael J. Budzinski L, roject design flow (gallons per day) ...... ............................... 800 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. No OFS,AApI icati.on__- been - submitted t9.:- �.,c�1._n�C ..2 -, V,%r fr 'f v SEe � , .,C;.'i. .ter 'z`7+'- �sF •�. /i / °. f.' .. �e .: 1,£ -1 -. !:'f 27. Is any portion of this project located within a designated Town or State i3 wetland? ...:.............................. ............................... No 28. Wetland ID Number ....... ............... ............................... N/A 29. Is Wetland Permit required? .... ........ ............................... No Has application been made to Town or Local DEC Office? .N /A 30. Does project require -a DEC Stream Disturbance Permit? ............... I... 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 Ian ,dfill, hazardous waste site, salt stockpile, landfill, sludge.disposal site or any other potential known source of contamination? ...............YES or N0 No DESCRIBE: 33. Is there q'Jocal master plan or file with the Tow.?i,or Vi:l "lage? Yes 34. Are community water, sewer facilities planned to be developed within 15 years? No 35. Are any sewage disposal areas in excess of 15ro slope? ............:..........: No Ma;cj hD . Number. - - - -:... - 37. Approved Plans are to be returned to: Applicant X Engineer If the application is .signed by a person other than the° applicant shown.. i.n Item..1, the__.._..__. application must be accompanied by a Letter of ";uthorizatio.. Failure to comply with this rrovision may be.g.rounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is .true to the best of my knowledge and belief. False statements made herein are punishab7e as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 7 Law. I SIGNATURES & OFFZ�I�LO TITLES: -1AILING ADDRESS: -p n---JL- i, & f' �.F Eng-ineer" for Applicant ' ADEY & WATSON, Surveying & Engineering, P.C. U.S. Aoute 9, Cold Spring, NY 10516 • .. < . ' DIVISION '.OF - EN, _ ' HEALTH SEFniICES . DESIGN DATA SHEET- SUBSUFACE SSQGE DISPOSAL SXS'ITM rim- NO. � caner. Niles Schwartz Address 330 West, 45th St ../ Apt• • Lob E� �. Located at (Street) Sleepy Brook Lane Sec. 84 Block . 01 Lot 42 . (indicate nearest cross street) Subd. Lot #8 Muni.cipaiity Town of Putnam Valley Watershed Peekskill Hollow Brook SOIL PERCOLATION TEST DATA REQUIl ED TO BE SUBMI=ITH ..W APPLICATIONS Date of Pre - Soaking .1/22%86 Date of Percolation Test :1/22/86 . HOVE NUMBER CLOCK TIME PERCOLATION PERCDLATION Run Elapse Depth to Water -F-rcm Water Level No. Tim Ground. Surface In Inches Soil Rate Start -Stop, Min.. Start Stop Drop In, Min /In Drop Inches _ inches Inches .A 1 9: 3 7 - 9.:45 $ 24 27 3 3 2 9:50 - 9:55 5 24 27 .3 2 3 9:57 - 10:02 5 24 27 3. 2 4 5 B 1 10:05 - 10:10 5 d 24 27 3 F 2 10:11 - 10:16 5 24 27 3 2 ..... - 'rr.,. - ....: -j_ ... ., ,..,. .....z , i�...n• r.: . ... . - _._. «..... .... ... ... .. ..... - T`r- .,. -..... . -.-... .. �-.. ...,.� •.� . .. .. cry .. .� -..... _. ... .�..:. -.r... 2�t7I�S: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be suhraitte!d for review. 2_ Depth measurements to be made from top of hole. rev. 9/85 DESCRIF`PION .OF SQT S. ENQOUN Ri'D:. �IN :TESTjEQLES )DEPTH HOLE NO A HOLE NO. B• HOLE NO. .G.L. Topsoil Topsoil. . a �9� _� .. f.'.. .. r: �l MT • -A eC _ .1.0`��-`. F _ 1f •f 9 P.10" v _ v fG . T�'�1 Zvi. _ � i l ._.. . .... - . ;ti'j::A .,`f .� ��. Silt Loam Silt- Loam - 3' 5' 6' 71 8' 9' 11' 12' 13' 14' Sandy Loam I Sandy Loam INDICATE LEVEL AT WHICH GROUNUATER IS ENCOUNTERED Not .-encountered :1NI7'ICl�TE LL C; Wf IC?;� < T rET� Rl r i� AFTE.° BE,L )aNQX TTERED,:- DEEP HOLE OBSERVATIONS MADE BY: BADEY & WATSON P.C. DATE: 5/28/87 DESIGN _. Soil :Rate Used 3 Min/1" Drop: S.D. Usable•.Area Provided 5, OOOSF No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type Conc Absorption Area Provided By. 400., L.F. x 24" width trench Other Name BADEY & WATS.ON Signature e in Engine o /) Surveying & g g� P -C Address Route 9 SEAL $A,AIP Nt NEW yo, % W. DF Cold SSng, MAw York 10516 ° 0 o , 'PHIS SPACE VQR USE BY HEALTH DEPARRAEW ONLY:. 'Soil Rate Approved sq - f t /gal . Checked by �i `c�pA .0 ? erl)l Man delb cum A/oz Z 0 8/?Oov(S 00 ull CO. we 0 Al, eat) V Poe 566 .00 '00 ROo�\. 5L AS -BUILT RELOCATION - DIMENSIONS 1A 56' SEPTIC TANK 16 12.5' SEPTIC TANK 2A 69' DISTRIBUTION BOX 28 25' DISTRIBUTION BOX 36 36' END LATERAL 3C 36' END LATERAL 46 53' END LATERAL 4C 59' END LATERAL 5A 87' END LATERAL 58 56' END LATERAL 6k 69' - ` " "- END. ,, '•` =' 6B 46' END LATERAL I