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Home My WebLink About4590DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.06 -1 -28 BOX 34 rm AT ' J6 �' J. J6 ' � L - r 4 04590 0 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOL•INARI 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 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 . Majed F. Annabi 19 Meadow Crest Dr. Mahopac, NY 10541 Dear: Mr. & Mrs. Annabi: November 26, 2001 Re: Addition - Annabi- 19 Meadow Crest Dr.. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 85.6 -1 -28 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated November 26 2,001 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Four without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must.be.. _ :.maintained. _ 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly y , William Hedges WH:kg Senior Public Health Sanitarian cc: BI O jy Public Health. Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 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 ADDITION APPLICATION (RESIDENTIAL ONLY STREET 1WeQC)0Cv 4'6eS4 Do TOWN 4 `95,& NAME '1`)a ej C. -a PHONE ?kly ,s,2j - ",117 PCHD# ' i) MAILING ADDRESS Zf Aeg,%, :j e,Fr.Sf DESCRIPTION OF ADDITION /- I /) i NUMBER OF EXISTING BEDROOMS �PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept.; 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00.. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Khouseguidelines 10 F BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public Health Director Associate Public Healtl:.Director. =: -, :, k Wlv - j 6 ector o7 Patient Services . . DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(945)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 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 ReJ Residence Tax Map Town Gentlemen: According to re ords maintained by the Town, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER BFhouseguidelines I uildingAs ector , 0 U TNAM COUNTY DEPARTMENT OF HEALTH 1�IVISION OF ENVIRONMENTAL HEALTH SERVICES CE TWICATE OF CONSTRUCTION COMPLIANCE; FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # r Located at �} t'/ Apo CfeS T F)-1y� Town or Village R,47ki '0'1 Owner /Applicant Name D (� > i �2►9�� ' Tax Maps . Block 1 Lot 2_C2 Formerly Mailing Address e Date Construction Permit Issued by PCHD Subdivision Name T�e�_ a43o�',- Subd. Lot # _� Zip C2 S Separate Sewerage.System built by C C)/I iftt- t jvll Address 2)9S Consisting of 2S'U Gallon Septic Tank and �; OCR " J . -' Other Requirements: :7f74l- Water Supply: Public Supply From, or: t,./ Private Supply Drilled by A1ress Address Building Type ( ra Has erosion control been 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 regulation i� the Putnam j Co ty Department Of,Health. ,.. . ,.;� ` DateI i i ��V { u-. P.I✓. R: v •'so (Osiguz /f Address }�� . }lam 2 Y _ / a.-d i License # j/ -- .a . Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, codification or 'cbanjze is `necessary. By: j(- .._f,,,v�� . ... Title: ;` i {{ - Date: � l 1 White copy - HD.File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CF-97 air fee, - -� to -71 _ 1. -_1 �_ Vii( �� < • I - -- - - � -_- I __�__ .I JI A-1 71 77- 17 --� -1 i__,_ �- -- - - -t - ; -- - M-C, -- - EPART �e" OF iiFALA'8 J 11 H S, �EDI'MICS )NLY-;b DR— ign OOAq Ores - J -R, - -� U ; - - - - - -- O -- MOUSE rUTNAt- PLANS COUAITX AP ROVED F 0 (I ; -1 ! i ! -�I_ • I 1 -; EDRCO MS A a J� ?5� GAL. 5c,•r'G Ta.,. J \ `1 j�► V' Fl 11 0 L iALS Valve 7 J e _ 17 ---�- ----- ,., �4 I Ztv ' 60 6 Ito, it i-� 54� Ad Zo , 5d So I-A' Pr L '`` FiJ'1"NAM COUNTY DEPARTMENT OF HEALTH � = - '-DIVISION� OF ENViRON•MENTAL_�EALTH SERUICES .,.. CERTIFICATE OF CONSTRUCTION COMPLIANCE j� REATMENT SYSTEM PCHD QCONSTRUCTION PERMIT # .Q Located at 9 C(-e- 91Z Owner /Applicant Name D /1 GECj 2�4CS('7,� Formerly Mailing Address Z Date Construction Permit Issued by PCHD Town or Village lf► L)AA Tax Map • t!o Block I Lot 29 Subdivision Name cS Subd. Lot # Zip / Ck ¢ Separate Sewerage System built by C Qd (4>vn � Address 396- 9e-- 6t--f, q&ll & Consisting of J 26D_ Gallon Septic Tank and 6 00 4 w.�,:t P rill Other Requirements: %fir a-y A'-', po�n . 1p ;Ize a F, . Y� VVaterSupply: Public Supply From Address � ®r: Private Supply Drilled by y� Addresses 62 C!�/�a bI Biu)YdvgType �� Has erosion �oritroIbeen`completed? Numl�r of Bedrooms Has garbage grinder been installed? I certiy that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built flans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plansirnd the standards, rules and regulati=541the Putprmn Coy}nty Department of Health. Date: Adclass Certified by P.E. f--1 R.A. License # I_ ICS q Any erson occupying premises served by the above system(s) shall promptly take such action as may be necessary to seine the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatrent system shall become null and void as soon as a public sanitary sewer becomes available and the approval of t}; private water supply shall become null and void when a public water supply becomes available. Such appeals are subject to modificati or change when, in the judgment of the Public Health Director, such revoition, odifi ion o e is cessary. By-- ri Title: Date. Z % /0/ Wr copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION .. •, ....- F� -.r•OF ENVIRONMENTAL HEALTH SERVICES L.CQMPJLHIO REPO - 7 1 •l /�. -:�.. .` �.`��°.. - ,.- , . Well Location Street Address: � � �fpW Cj / /fit;( Town/Village: /�aho C. Tax Grid # Map --- Block Lot(s) -- Well Owner: Name: Address: CD eonfi��in_ J9s k� 6.'N/ ha a� �y Ilse of Well: I- 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 Y\ Open hole in bedrock _ Other Casing Details Total length 16 7 ft. Length below grade ft. Diameter in. Weight per foot �9 lb /ft. Materials: _ Steel _ Plastic _ Other Joints: _ Welded __� Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner:— No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield 'Test _ Bailed _ Pumped X Compressed Air Hours Yield /0 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet 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 Ad - g ,9 _u � _S6� ir If yield was tested at different depths during drilling, last: Feet Gallons Per Minute Pump /Storage Tank. Information p Pump Type Cray mD. Capacity GVyt. Depth Z,50' 3 Model G YCiVA4 PV. Voltage Z&O ! HP 3 Tank Type fit,. Volume 7 YP l� Gf M Daic Bell Completed l Z/ Putnam C Gty Certification No. 4 Date of Report c412 Well Dril er (signature) Ir v4u' h: hxact location oI weii wttn aistance5 tO itt least two E7cflniutGUL tauwiiai&b w uc fnurl u val a aVFY uw o.'v..1,. —.. Well Driller's N4m.e ,i% e5/o./1 � � )• Address: SZ- Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 IN CDA. CONTTR-AC- TIN CORP; 395 RT. 6N MAHOPAC, NY 10541 845-621-1408 ro. Co ago -3/4 H P Q 3 Ul L 4-s 3 F-4"vl, aol-,,W� ful-L 0 5 C) C6 (00 3 3A, 14 3 /u-� v� z U$ bIl- R a t Q-11 0-�Vctlz-.7. Al 3/q 14-C '7.-�JPrq (6� ` ^~ .� ° V^'C'. YML ENVIRONMENTAL SERVICES 321 Kear Street Yol-�ktow�! iohts�`�� ``�'`�-�.��.��- �'�.^��.��`�,, ' (914) 24 280- - ' Albert H. Padovani, Director ' .AB #: 32.106275 CLIENT #: 8471 NON STAT PROC PAGE 1 CDA CONTRACTING CORP DATE/TIME TAKEN: 01/16/01 o2.-OOP STEPHENR.J. ROACH DATE/TIME REC'D: 01/17/0.1 12:00P 395 RT. 6N REPORT DATE: 01/26/01 MAHOPAC, NY 10541 PHONE: (914)-621-1408 SAMPLING SITE: MEADOW CREST DRIVE SAMPLE TYPE..: POTABLE : MAHOPAC, NY PRESERVATIVES: NONE COL'D BY: STEPHEN R.J. ROACH 3 TEMPERATURE..: COLIFORM METH N/A DATE FLAG PROCEDURE RESULT . NORMAL - RANGE METHOD COMMENTS� - .Fe/Mn if both--iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Director ELAP# 10323 %6' N' YML ENVIRONMENTAL SERVICES 321 Kear Street York 'p - Height 0 Albert H. Padovani, Director LAB #: 32.007960 CLIENT #: 896 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ROACH, STEPHEN 395 RT 6N MAHOPAC, NY 10541 DATE/TIME TAKEN: 12/07/00 10:00A DATE/TIME REC'D: 12/07/00 01:00P REPORT DATE: 12/15/00 PHONE: (914)-831-9274 SAMPLING SITE: 19 MEADOW CREST DR. SAMPLE TYPE..: POTABLE. : PUTNAM VALLEY, NY PRESERVATIVES: NONE COL'D BY: STEVE ROACH TEMPERATURE..: < 4C NOTES...: BOILER DRAIN AT STORAGE TANK COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL -RANGE METHOD PUTNAM CNTY PROFILE 12/07/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 12/07/00 LEAD (IMS) 1.0 pab 0-15 ppb 9101 12/07/00 NITRATE NITROG <0.2 MG/L 0 - 10 9139 12/07/00 NITRITE NITROG <0.01 MG/L N/A 9146 12/07/00 IRON (Fe) 0.884 MG/L 0-0.3 mg/l 2037 12/07/00 MANGANESE (Mn) 0.041 MG/L 0-0.3 mg/l 2037 12/07/00 SODIUM (Na) 22.1 MG/L N/A 12/07/00 pH 7.6 UNITS 6.5-8.5 9043 12/07/00 HARDNESS,TOTAL 190 MG/L N/A 12/07/00 ALKALINITY (AS 204 MG/L N/A 12/07/00 TURBIDITY (TUR 10 NTU . `- 045NTU � COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE AS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI��f�F~THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution poipts have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both 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 is suggested. � YML ENVIRONMENTAL SERVICES 321 Kear Street '��=-��''��.��(u7 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.007960 CLIENT #: 896 NON STAT PROC PAGE 2 ROACH, STEPHEN DATE/TIME TAKEN: 12/07/00 10:00A 395 RT 6N - DATE/TIME REC'D: 12/07/00 01:00P MAHOPAC, NY 10541 REPORT DATE: 12/15/00 PHONE: (914)-831-9274 SAMPLING SITE: 19 MEADOW CREST DR. : PUTNAM VALLEY, NY COL'D BY: STEVE ROACH NOTES ... : BOILER DRAIN AT STORAGE TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY 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 .`'�.. �� AR} A 70�140.MG/L, =--,MILLI ITER MARD WATER: � l40-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director .T.(ASCP) ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES._ . - U.m --i ... �. "�. .y -- es.- a_':... s.. ....,> e-. ... '. •Y:. ..•G,. .. -1 -.e .• ..•�;;.:ro s... -. .. .. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM GV r !n Cam'% i 23 Owner or Purchaser of Auildig Tax Map Block Lot CD A Gn__ A9,icinew e i, Building Constructed by Tow. rvj _illage n� Location - Street Subdivision ame CJL&� 1.4 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and 'in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month l Z Day / j Year 00 'signature: l�h - Title: General Contr for (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: 3 & u A.44004e- State Zip nV Address: 3Y�_ (4-&-&1710 ✓ iAwnc State Zip /OT4/ Form GS -97 Li r �cc t i�lt t\ 1 Ur HEALTH DIVISION OF ENVIRONNNIENTAL HEALTR SERVICES FINAL SITE I\SPECTION i4('2z�' � Dat e: Street LocationtQdv4J 'C{L& nspected by: �� Owner .?J�'1 Torn _ . TIM.- Subdivision Lot 'r- I. Sewaae System Area a. STS area located as per approved plans ....................... b. Fill section - date of placement 3:1 barrier . Loth. Width Ava.Dptn c. \awxal soil not stripped ........... ............................... d. Stone, brush,.etc., Greater than 15' from STS zea ...., e. 100' from rvater course/wetlands . ............................... II. Se'wace Svstem a. septic tart stze -1,000 ...other.......... b. Septic tank installed level .......... ............................... c. 10' minima -m from' lour* idation .... ............................... d. Distri tuion Box . A-11 outlets at same elevation-water tested........... 2. Protected below frost ............ ............................... J. ivlinimurn 2 ft.Original soil between box & teni Junction Box - properly set......'. ............. ..................Q IaL regLtre jLength installed 0 2 . -`_ f rra:elcourse m �. Installed according to plan. 1 ". Slope oftren ' c- ptabl_ 5. 10 ft. frA L lie. D . tre <30 inches 7 allo I d expansio Size of vel 3/; -1' /z" dia 9. Depth o 1. E 10. Pipe ends PP ......... , �7- c 2. 3. 'All i� 6. III. Hou-, Row tank d Ft... ............................... (16 -1/32 "/foot...... 0 ft.- foundations... om su.- face........... 100% .................. 'ter clean............. m, visual / audio ............ ............................... p easily accessible, manhole to grade........ boxbaffled ................ ............................... !e v,itn'ss'd by H.D.estimated flovilcycle. ouse- cated per approved plans ........................ bAdNumber of bedrooms ............. ............................... ell � /elf. located as per approved plans.... . Distance from STS area measured ��ft. . Castna 18" above grade ......... ............................... . Surface drainage around well acceptable ..:.......... verall Workmanship . Boxes properly grouted ........ ............................... . All pipes partially backfilled ............................... All pipes flush with-inside of box ....................... d. Backfill material contains stones <4" diameter.., e. Curtain drain & standpipes installed according t f. Curtain drain outfall protected & dir.to exist wa g. Footing drains discharge away from STS area... h. Surface water protection adequate ...................... i. Erosion control provided ................................................ Rtv.1(97 FROM : Panasonic FAX SYSTEM PHONE NO: : 107 Nov. 28 2000 04:39AM Pi PUTNAM COUNI-Y DEPA RTIMENT OF HEALTH DIVISION OF ]ENVIRONMENTAL BtAITH SERVICES ATTENTION � �ADAM GENE REOUE FINAL INSPECTI For. Fill Alt nformation must be fully completed prior to any Trenches inspections being made. PCHD Constructiotj Pen* Located: Pi Pal ALAA) IT) (V) OwiieA plicant Name: tlk3! midr!,;t- lock —TM Lot we_Z4�-O& Formerly: 3'Y Subdivision Name: ViS, Subdivision Lot -9 Is system 611 completed? Date: is system complete? Date: Is system constructed as per plaits? e2s . Is well drilled? Date. Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. byi lAp Professional Address: Lic. Comments: Form FIR -99 Public Health Director < April 11, 2000 �l DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services 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 CERTIFIED RETURN RECEIPT REQUESTED CDA Contracting Corp. 395 Route 6N Mahopac, New York 10541 Dear Angelica Simone: r Meadows Realty Subdivision Lot #7 Meadow Crest Lane TM# 85.07 -2 -23 It has been brought to my attention that construction on the above referenced lot has begun. NO This notice is to advise �you that the regiiired.,erosion.r:.ont,:o? measures have not been installed or. - are installed incorrectly, as shown on a'n approved plan dated December 6, 1999. Effective immediately, a notice of non - compliance will be issued for a violation of the Putnam County Sanitary Code, Article III, Section 2, Paragraph C, and a stop -work order shall be requested from the Town Building Department as required by Article III, Section 2, Paragraph D. This matter is to be corrected by Monday, April 17, 2000. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj cc: (T) PV Building Inspector Roy Fredriksen, PE ff PUTNAM COUNTY DEPARTMENT OF HEALTH .:DIVIS_ION_ OF ENVIRONMENTAL. HEALTH .SERVI( CONSTRUCTION PERMIT F�RAENA" TREATMENT SYSTEM PERMIT # eV-3V-2 Q Located at MrA 7�0►- �CR�zS► �4rI� Subdivision name 9 ,9A S • Subd. Lot # Date Subdivision Approved 1 y m or V' r ,t Map Block 2 Lot Renewal Revision Owner /Applicant Name 4:f Q 4 ��'G� irl E� Cv r,1 o Date of Previous Approval �T - Mailing Address 65 ?5 91 ! 614 , Af klh�>a62" 14. Amount of Fee Enclosed `P" ` ,90 . /4./ Zip / os4 / Building Type tAL Lot Area No. of Bedrooms _,�— Design Flow GPD 4o O Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to'consist of gallon septic tank and 600F4'of 2�'tA)i0r T2.&rjcrf &s, Other Requirements: (fnc•y.� , (oFZ,2La,,;, Dr4,� aAc To be constructed by 7-[3 ,P, Address Water Suunly: Public Fz _ • _ .. .. _ $app Address or: Private Supply Drilled by o�� _ Address �- I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 7 2 F License # 6-D APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health.Director. Any revision or alteration of the approved plan requires a new it. Appro d f di char of mestic sanitary se age only. By Title: Date: 12" V White copy- HD File; Yellow copy - Building Inspector; Pink c py - Owner; Orange copy - Design Professio al Form CP -97 Pj1J'1CNAM COUNTY DEPARTMENT ENT OF HEALTH H DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ - ..�._ � . > .•.< 4:,^ mPPLK',A '_QN._T�?.��1�'. please print or type PCHD Permit # Well Location: Street Address: Town/Village r�}d�� #� / 2- ` > Yape"I � . ��.i. �JA !lam /`P , ' Block Lot(s) & Well Owner: Name: Address: %0.sd Use of Well: L,-IFesidential Public Supply Air /Cond/Heat Pump Irrigation &- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage Q gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling t -'&w Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling P Well 'Type ZDrilled c><Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ........................:...... Yeses, / No Name of subdivision -Ttl� Oc��.S Lot No. _ Water Well Contractor: 3r-p JD Address: Is Public Water Supply available to site? .................................. ............................... Yes No t/' Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to e provide n separate sheet/plan. ' %'-SigratZ.:i:: D 1e: -'�- ' �' ♦ .'z- JjplL- t PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate well drill r cert' ed by u County. Date of Issue 12,J&Jqf, Permit Issuin Official: Date of Expiration I I I I Title: �..� Permit is Non- Transferra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 dLOIR:ff�71X: R-1 NMI Associate Public Health Director Director of Patient Services 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 November 22, 199 7>4,q Roy Fredrikse, PE PO Bbx 95b MalTo"poac, New York 10541 Dear Mr. Fredriksen: 0. Re: CDA Construction, The Meadows, Lot # 7 TM# 85.06 -1 -28, Town of Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. Plan �' Provide 1250 gallon septic tank detail. (Sec 'Dimon SeAs rf�J p4re�1,1,4eo --s ), ' Provide monitoring stand pipe detail. �5c2° f'c�,f A,rJ -PAgt -1 a-'f Provide baffled distribution box detail. v�lcal:;trencn dietall to'rea "� .ean s'iU1�� -cr was bed ed gravel." - - - h .... _ ...._. - Note Complete fill note #3. - Depth of fill. - Approximate quantity of fill. Appliedtion Tax Map # Documentation Please correct Tax Map Number on all documentation. * Correct TM# for Lot #7 is 85.06 -1 -28. This office will continue its review upon consideration of the above mentioned comments. ple dSG feel e. - to Co tact mac at ext. .2157 •a 1an- ,estionsµriSA . . y Kµ Very truly yours, aL k;b.v-. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj �a- 1 Public Health Director DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services 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 November 22, 1999 Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Dear Mr. Fredriksen: �T Re: CDA Construction, The Meadows, Lot # 7. TM# 85.06 -1 -28, Town of Putnam Valley This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. Plan 1. Provide 1250 gallon septic tank detail. 2. Provide monitoring stand pipe detail. 3. Provide baffled distribution box detail. ..•X• 4. Tv�ical t each detail to read-"Clean.-stone or. washes - d .,v- ...- ....tea, . - ..........- ...a. .... Notes 1. Complete fill note #3. - Depth of fill. - Approximate quantity of fill. Application Tax Map # Documentation 1. Please correct Tax Map Number on all documentation. * Correct TM# for Lot #7 is 85.06 -1 -28. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj s . FUTNAM COUNTY DEPARTMENT OF- HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES. RE: Property of , LETTER OF AUTHORIZATION Located at ` 111L- 23 TN PJ-44vmVAZLfV Tax Map # 65-7 Block Z Lot 6 Subdivision of ! �E_ Subdivision Lot # 7 Filed Map Date Filed Gentlemen: This letter is to authorize P . a duly licensed Professional Engineer nor 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 supervise the construction of said wastewater treatment and /or water supply systems . l2YCrOFY t }1- the:pr�� iar4:of rrticl..la5. ndi'Or.f. fr *�� n a� R' Law, and the Putnam County Sanitary. _ Code. Very truly yours, c- ounttrsigned: Signed: .P.F,., R.A., # �C�S�D S (Own fPrope Mailing Address PO Boo < q,5-C) Mailing Address: g�- A) State J Zip /Z) \�_4 ( Telephone: (eo7& 0 3 Ik State 22 V , Zip Telephone: (fq/y) Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL EAL' R' _F VAC': {5- ,tea- -r .. AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: I - Lo represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: 04M " ,meha, , - 2 ��I� �f Whose Officers Are: President -Name: Address: Vice President Name: Address: %'7 6� /lJ / h Secretary - Name:. / r' , e-i Treasurer - Name: Address:... fjq1,?2e Ile 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. Signed: Title: (ESTER FOREST JR. Nova °r !?t -sc, State of New YOrk - ^- 186070 V %Jvsxchester County Corr�rn+si: jn Expires December 31P 19C Form CA -97 Corporate Sea-11 c 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617s1 8EQR_ - - - State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only . PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) . 1. APPLICANT /SPONSOR Gv 2. PROJECT, N JME �, r�ai e,� v -- 3. PROJECT LOCATION: r�CI�- Municipality County h 4. PRECISE LOCATION (Stye =t address ind road intersections, prom ent landmarks, etc., or provide map) 5. IS PROPOSED ' CTION: ea D Ex;,ansicn 0 Mcdificationialteration 6. DESCR!B_ PROTECT BRIEFL�Y:q �tJ �JG 4at4kSe- Jeo / l S/ f l 7. AMOUNT OF LAND AFF; ED: 3 Initially acres Ultimately _ acres 8. WILL PROPD ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? es 0 No It No, describe briefly 9. WHAT IS SENT LAND USE IN VICINITY OF PROJECT? :.,.,... -.. -. : esidentiz! • G industrial. i J Co" r^ rclal .. , . O A ^ricultuta D Other r+ „ - O ;Pa klForest]C7pen space 0 -- ?scribe: -' `- -• -. • .h; 4 iC. DOES ACTION' INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOC :SJ s 0 No If yes, list agency(s) and permltlapprova!s C14 => 60,5 D4V F 11. DOES ANY ASPECT 0= •HE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes. Qlro If yes, list agency name and permit/approval 12. AS A RESULT OF PRO? ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantlsponscr name: Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by t gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.121 If yes, coordinate the .revlew, process and use.the•FULL EAF — ❑Yes - (Nn - - - » d?e'• "¢: „' :r ;ri `r. ;:..r> B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ' [IN 0 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production. or disposal, potential for erosion, drainage or flooding problems? Explain briefly C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: y 04. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. cCs . t.r] O C-3 Co. Long term, short term, cumulative, or other effects not Identified in Cl-05? Explain briefly. V rsz C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. •- D. IS THERE, OR IS THERE LIKELY. TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 11 Yes El No If Yes, explain brieflyl PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its.(a) setting (i.e. urban or.rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons. supporting this determination: Name of Lead Agency. Print or Type Name of Responsible Officer in Lead Agency Title of Responsi e O icer Signature of Responsible Officer in. Lead Agency Signature of Preparer (It different from responsib e o (icer) r"t r r� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: e— 3S fL 6l- 2. Name of project: d6d 00WS -- Z,---> 4. ,Design Professional: 6. Type of Project: Private/Residential Apartments Office Building f 3. Location T/V: M*m V41te 5. Address: PC) x qS-0 v✓I,� �an�ae, 14-� Jr Food Service Institutional Realty Subidvision Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... . 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. . dame of Lead : Agency _ v .. ":.• ; -: _ ..._. . _. .� 1 1. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 12. If so, have plans been submitted to such authorities? s 13. Has preliminary approval been granted by such authorities /es. Date granted: y ' 14. Type of Sewage Treatment System Discharge .................. surface water _S,�-6oundwater . 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ...................... ............................... ..................... 17. Is project located near a public water supply system? ....... ............................... 18. If yes, name of water supply Distance to water supply r--- 19. Is project site near a public sewage collection or treatment system? ................ _ . b-4 Q . 20. Name of sewage system '"' Distance to sewage system 21. Date test holes observed j 2 22. Name of Health Inspector 9�J3,C Form PC -97 2 2 Pr sect design - fl.o-,y g( lons p -r day) l _ .... C� 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... , 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? f10 27. Wetlands ID Number .....:..........................:.......................... ..:............................ 28. Is Wetlands Permit required? ......................................:....... ............................... . Has application been made to Town of Local DEC office? 29. Does project require a DEC Stream Disturbance Permit? .. ............................... LLO 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ... ............................... Yes/No _o, DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... s 33. Are community water and/or sewer facilities planned to be developed within 1S ears -in or..ad'acent.to_ rpject: site ?...:............. ...... .... ..:...,.....,:.....,,...._.......... .. --ve J P J� _. 34. Are any sewage treatment areas in excess of 150/(0 slope? .......... . ................ . 35. Tax Map ID Number ................ ............................... .... Map Block .� Lot 36. Approved plans are to be returned to ..... Applicant L,--"&esign Professional If the application is signed by a person other than the applicant shown in Item 1.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNVATOW 140kWtfiS TITLES. Mailing Address -- '= f ....................... tlFA00VS- COT 7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES bESIGN -DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Z-YAj [ter L Col2p _ Address 4310 aoM 6 5 66.1 Located at (Street) WOO 0 S � IZ��' Tax Map 6!�j Block 2 Lot (indicate nearest s syeet) Municipality J tJA cro mil Drainage Basin _ J psp N• SOIL PERCOLATION TEST DATA Date of Pre - soaking 4�/�� Jcg Date of Percolation Test 4/l iN V I Lb: 1. T ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2.'- . Depth measurements to be made from top of hole. ` Form DD -97 Depth to Water Water From Ground Level Percolation - Hole No. Run No. Time Start Stop Ela se Time Surface (Inches) Dro In Rate - Min.) Start Stop Inc�es MinAnch 3: oo o % z I Yz 2 iS 2 3: o S 3:35 15�0 /45%2 24 3 3:3y 4-0 130 Y4- 24 4 5 t J10 y 3 V. I 'jam 1 •ii]:�r�. �r �.. I 4, � 1 2 3 4 5 iN V I Lb: 1. T ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2.'- . Depth measurements to be made from top of hole. ` Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLEST. • .... , :-n:r' - , ' °� . - . ..._ .. - -� " �-.-�;. � ....... � t�'. , ., tee, ri - . _.. .: -. . °4•; ' d _ :.,. . DEPTH HOLE NO. HOLE NO. Z HOLE NO.' G.L. T _ '%/ 5. 0.5' 1.0' 1.5' 2.01 2.5' 3.0' 3.5' 4.0' 4.5' J 5.0' J V 5.5' 6.0' 6.5' 7.5' (loc,lG 8.0' 8.5' 9.5' P FRE 10.0' F o � Indicate level at which groundwater is encountered rTMS o 50 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 12. Date Wslu Design Professional Name: fro )/ Address: po lax 9�'0 .. S 30 U6 Signature: r ft Professional's Seal �'�FSS9O,`� NMI INN =MEN ELM — dl':9� 21 > 5 "17 t [Sp 6AL. 5 T'C- 4':—Lld'd .U.Ly uepar Lnnu L Vk A" pion of F-livironmental Health 38rVI0b, I-S I . wed as noted for conformance with Lcab Rules and Regulations of I Department. PIE i0c-4 2, S 7' IS- r-,i Ct -r,TH c- 07, M�r A v- Tb, F- rz-, L.S. -TOO— tAE"-, 6 1 Sc I ',; 12 -11- ov "L ;. 0& 40 -1 9 09 -- - -------- 9G f --TL - ------- - L7 Lo "ig C Y-F '-A VIVI