Loading...
HomeMy WebLinkAbout2135DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -15 BOX 19 M r J j r 1'L, . I r I J2 02135 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A� WASTEWATER TREATMEhT`I'..SYS' - EM::- - -- -: 1. Name. and address of applicant: 1 Dsg -mh-2H SPAkiz) & Y� Ss.G Fb ScM�NEV�s NY ) �Isr 2. Name of project: W,aTER-FA u, ift aE 3. Location TN: Pu- -TN.4m U4LLr y 4. Design Professional: LA t ZA U. 5. Address: e j2o s S /?-D . 6. Drainage Basin: 7. Type of RMiect. Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt ✓ Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... p a 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency ,v %4 12. Is this project in an area under the control of local planning, zoning, or other K of cials; ordinances? :........................ . ....... .........._..........._..._- .. -... • . .. w._ _ S �......__ ... _. _ 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ........ ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .....:.......... Al D 21. Name of sewage system �/`/'A Distance to sewage system _i 4 T 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) .............. ._ ................ .., ,.............................. (opo GPI 25. Is. State Pollutant Discharge Elimination System (SPDES) Permit required ?... eo 26:"'-, Has SPDES Application been submitted to local DEC office? _A] Form PC -97 2. 2" Is any portion of this project located within a designated Town or State wetland? ND 28. Wetlands ID Number.. , .............. ..... ......... :........... . N; 29. Is Wetlands Permit required? ............................ .......... ...................... A/ o Has application been made to Town or Local DEC office? ............................... A 1 0 30. Does project require a DEC Stream Disturbance Permit? .. ............................... �)a 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/No /V o 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No ND DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... Wa .35. Are any sewage treatment areas in excess of 15% slope? . .............................:. NO 36. Tax Map ID Number ...... Map Block Z Lot /S- '37. Approved plans are to be returned to ..... Applicant � Design Professional NOTE: All applications for review and approval of a newSSTS to-be-located witlun-the N- YC- Wdtershed shall - be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,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. Il hereby afrm, under penalty of perjury, that information provided on this form is, to the best of my knowledge and belief. False statements made herein are unishab a Class A misdemeanor pursuant to Sectio4,210 45 of 4ARenal Law. SIGNATURES & OFFICIAL TITLES. w" : J Mailing Address :.... ............................... 5 s s t -O 4QoA N tLA" V,. P}'1 10,5 : Ti 14 -16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C . _.__...._ ,•,�5tate Envira�i'�tebi;e��'ai�ll ' ReWsw., :...,- :::....._......,...�,...� ...... _ .. r. .�..vv- ua.�..+rL ".n n-.i....v..iwn_.r -. .. .. .. ..r..�•.. _. ..r. .- _ s.o ..i •.v .-.. — ry" SHORT ENVIRONMENTAL, ASSESSMENT FORM .For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (TO be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR DoI.I SPA,,,)(, 2. PROJECT NAME tvttc- S `ei r6,-'l t.J2't -L 3. PROJECT LOCATION: Municipality 9_00Am .A-ULY County P�/✓,�,.+.� 4. PRECISE LOCATION (Street address and road Intersections, � prominent landmarks, et . or provide map) 5. IS PRO ED ACTION: New ❑ Expansion ❑ Modiflcationfalteratlon 6. DESCRIBE PROJECT BRIEFLY: C oY`!r/t `rcrt` Stir C- 7. AMOUNT OF LAND AFFECTED: D LG �� 2� Initially {2 % acres Ultimately acres 8. WlLL IPROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHA PRESENT LAND USE IN VICINITY OF PROJECT? Residentlal ❑ Industrial ❑Commercial ❑Agriculture ❑ Park/Forest/Open space ❑Other —Describe:: W-)C Td h e- V DtN �l.s•%? v ej- 1.6o C* et-_,s. l o P -rt 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE • 0 OCAL)? & Yes ❑ No If yes, list agency(s) and permlUapprovals NBC_ iD r�. 11. DqKANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑ No If yes, list agency name and permitlapproval h� P IT P\1 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMR /APPROVAL REQUIRE MODIFICATION? ❑Yes No . I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE � �`r Date: Applicant./sponsor name: Signature: Awa If the action Is In the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 N ,.. , PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes; coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration ayc uperseced.byanother ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, .potential for erosion; drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other affects not identified in C1-05? Explain briefly. C7. Other impacts (including as In use of either quantity or type of energy)? Explain briefly. —D.• IS -THMEE 61`11S1HERE -1:11KE-L-Y-T-O °6f, CONTRbVERSY'RELATED TO POTENTIAL ADVERSE -ENVfRONW1ENTAL- 1MPACTS? — ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE'(ro.be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If `necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or,more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive, declaration. ❑ Check this box if you have determined, based on'the information and analysis above and any supporting. documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary,_ the reasons. supporting this determination: Name of. Lead Agency Print or Type Name of Responsible Officer in Lead Agency Tit. e of Responsible Officer Signature of Responsible Officer in Lead Agency Signature-of Pfeparer (if different from responsible officer) Date 2 G Et OD VA log -o X14LD._ G 1. r D. N►h1L- ►4 K-6aM t �* �iA'Ck l 11�•b y IV -1 i -CAI£ 0 li Lld ►dG Zoonn 0-f'2k 6 3 A�7E)m rl PL A'j RANDALL ENGINEERING 1551 Cross Road Mohegan Lake, N.Y. 10547 914 -528 -1640 flOA,NLb A, JEOS,,c-)n Acy S P47jj> 1 wkTL- (L(:'4 -u., LA, PdT'u" vAu.dY, OY . Ho �SI� Pt A�i� 0 3�tcGi q G a€t Lob VA pp I L..td ��G RD,) An tz B�Ro�M Itckt�►i r 7cAlc SCE; A '- I'- ° 1 66bkkT 7:s% t�IA4U j P' El RAN ®ALL ENGINEERING 1551 Cross Road Mohegan Lake, M.Y. 10547 914- 528 -1640 wX-rk-(LeA -u_ LA, 70fivitt vAu.rry. OAP . Hbvs�' PLC �� p T THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 -;A.MIELE�SR.,'P.�E..-Ciiiii�.-- EL misriblf& Phone (914) 742 - 2001 Fax (914) 742 - 2027 December 10, 1999 Mr. Adam Sttebeling, ApHE Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Donald and Rosemary Spano - Lot # 8 Water Fall Lane (T) Putnam Valley (D Putnam West Branch Reservoir Basin DEP Project # 9879 ( Joint Review) William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection Dear M r. Sftebeling: The New York City Department of Environmental Protection (NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) project is incomplete. Please instruct the applicant to provide the following information before NYCDEP can start its review: —r.-"The 'USDA: 6if tyoes'dhd 66un'6fies - must 2. The test pit data shows sandy clay loam soil is encountered in both test holes. The percolation rate of 13 min/in shown in the percolation test data does not seem very probable for this type of soil. Please, provide us with a more recent test data witnessed by the county. 3. A clearer septic tank detail,plan. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773-4461. Smce ly, _2 Lucie ucie Lops Associate Project Manager Eng-meenn'-Design Review Xc: James Covey, P.E., NYSDH 465 Columbus Avenue, Valhalla, New York 10595 -1336 � T �,T y� � COUNTY �T r . �J �1� �1��!J 1�1 1 ��S ����1� �L OF HEALTH \� DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES .,.,.� . t.. . , fi -�,.; :max: >= :��.- ..;.:::.:::�:�:�<.�� r_. �,...,F �:. -:,. -- .:..- :,...,:. _:..._ _. ... � .,• : .�. ;.. �r :�T �,. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT S PERMIT # CV- � 1 Z A046%ieV * Pv�-►3 -92 �- Located at k9ATV2 F4LL.. Town or Village Q UTNA -" W(_ct y Subdivision name r°/ZEST PA-AK Subd. Lot # 13 Date Subdivision Approved '9/517 Owner /Applicant Name D04 5 04.0 o Tax Map "3 Block Z Lot I Sr Renewal !f Revision Date of Previous Approval 16/2-1(1-7 Mailing Address -(2 K ( 9 a)c S"1 G, L—D 1201 SckEnd 5,�lYLip -ml Amount of Fee Enclosed f -S 6-6 Building Type `6 Fi e'pt..,,, Lot Area 6- t U&No. of Bedrooms 3 Design Flow GPD G o 0 vious' Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 11-57) gallon septic tank and 3 9 Z L f' x Z fi 'ea), c( Other Requirements: To be constructed by Water Su)2111y: Public Supply From ®rt Private Su pply Drilled by........ Address ., ..:r- .._...., v. . t ..... Address 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 /10, Signed T�� i�ll*s�P.E. R.A. Date (0 25- Address t 5� C-455 A , 01 614 a� Lam; OT I b��cense # o 5 2 '7 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 permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ::.............a�ea�o �APPLICATION r_... _ Permit TO CONSTRUCT A WATER WELL �y .N PCItD �.. . Well Location: Street Address: TownNillage Tax Grid # Wk -re-k A-LL 1,.,)iF P -pi AA W Map Block 2i Lot(s) Well Owner: Name: Doq 510'x'° Address: (L41 JS aye 5t C, ht� k&,, Scot 0\1 IP,� L6 N `( (21S5 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 _57-- gpm # People Served Est. of Daily Usage C e--agal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling V--'N'ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ...........:................... Yes ' No Name of subdivision (--yve r)-r PAR-t< Lot No. 6 Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: gdj_ .Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 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 Form WP -97 ,w . v , +JAL: pt5 k f -D �. oN of• NDATtot4 \° loo OsO ' 11 � � ( To�o��t.i - � � �" � Skuuw�jZ% o . �1 _ , _nor ► - "` k� l_ i• F� t. n �� I BRUCE R FOLEY y � LORETTA MOLINARI RN., M.S.N. Public Health Director F OQ� Associate Public Health Director Director. o�'. Patient : Services - DEPARTN NT 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 (914) 278 (914) 278 -. 6648 WIC FAX COVER S�EET -6o8s Date: f 13 O C7 To: L Lop C� From: Adam B. Stiebeling Asst. Public Health Engineer For Y our information Fax #: 7 3- 0313 No. Pages l (Including cover sheet) Please respond _ For.gour- review _ ...__.. _. _ , : Aftached. as requested As discussed t 1 00 Please call Notes/iVlessages A+ao ' tiLr-`. S? �` ►9�.t c �t,t.tr� I In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. �- 4119^64� L4. N► �r RECORD, OF PHONE CONVERSATION Time: Date: Of 1041 C� 0 Person calling: _��CLI U _ Ph /one #: Reason O Inspection- O Deep and /or Peres: tZ ©� Scheduled Field Meeting Time: 10: co Date: t 13 � �t` P, C, S Y N Tentative /to be confirmed () ( ) Town: )y Road /Street: L- 4 Tax Map. #.; -.:., Comments: i oi� (L c `� f14 i 3 /c C, e lO cz WE a. # BRUCE R. FOLEY �� LORETTA MOLINARI R.N., M.S.N. Public Health Director �4+w� -YO Associate Public Health Director D AR (� p T !�+ Director of Patient Services .v -. _..c.. _.. ` 1 Geneva Road Brewster, New York 10509 Enviroumtntal Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services. (914) 278 - 6558 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 (914) 279 (914) 278 - 6648 wIC W. COVER Fax -boss Date: OO — T7 To: L OC I '. [00 �C'D, From: 'Adam t. Stiebeling Asst. Public Health Engineer For your information Fax #: 7 7— No. Pages (Including cover sheet) Please respond Fo your review _ . Attached as requested ; As discussed Pleas all S /l=am tti C Notes/Messages� In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. . r, 9- BRUCE R. FOLEY Public Health Directcr x • _ .._ ..... DEPARTMENT 1 Geneva Brewster, New OF BEAI,TH Road York 10509 LORETTA MOLINARI R.N., M.S.N. Aisociate'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 December 14, 1999 Mr. Sandy Randall, PE Randall Engineering 1551 'Cross Road Mohegan Lake, New York 10547 Re: Application to Construct a Subsurface Sewage Treatment System at Waterfall Lane, Spano (T) Putnam Valley, DEP# 9879 Dear Mr. Randall: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department is incomplete. Please be advised that the following information is required before the Department may commence its review. . USDA soil types and boundaries to be shown on plan. A legible septic tank detail on trench plan. U Dimension(s).of fill pad. area.. " Pefcolation t"est(s) to be witnessed-by fhis office: Please call to'schedule an -app oiniment. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you withing 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further, please.contact me at extension 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj .7 r . __JJ aJ •YV 1 VG THE CITY OF NEW YORK DEPARTMENT OF ENVIROYMENTAL PROTECTION � P JOEL A. MIELE, SR, P.E. Commissioner N::SWin] P =E:;Pb Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Adam Sttebeling, ApHE Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Donald and Rosemary Spano - Lot # 8 Water Fall ane (T) Putnam Valley ® Putnam West Branch Reservoir Basin DEP Project # 9879 ( Joint Review) Dear Mr. Sttebeling: Deputy Commissioner, Bureau of Water Supply, Quality and Protection. December 10, 1.999 The New York City Department of Environmental Protection ( NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) project is incomplete. Please instruct the applicant to provide the following information before NYCDEP can start its review: 1. The USDA soil types and boundaries must be shown on the plan. The •testpit date-shows sandy clay -loam soil is,encounteied in both test holes. The percolation rate of 13 min/in shown in the percolation test data does not seem very probable for this type of soil. Please, provide us with a more recent test data witnessed by the county. 3. A clearer septic tank detail plan. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Sin" ary, Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDH 465 Columbus Avenue, Valhalla, New York 10595 -1336 Transmit to � r s Number of pages: Date: (Including Cover Sheet) leper Tb: n p From: � � �. �� Phone.- 7 7-3 —T-V6� sut(ject: 5PA/vo (s S TS IF THERE ARE ANY PROBLEMS REGARDING THIS FAX PLEASE CALF. 914 - BRUCE R. FOLEY Public ..Health Director LORETTA MOLINARI RN., M.S.N. Associate .Public Health,:, Fiectar Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 105091 Environmental Health (914) 278 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6.085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM 'D PROJECT: a 1u TOWN: JOINT REVIEW J -r � c�1 V ✓1-r, t, ri NOTICE OF COMPLETE APPLICATION: L1,4 DATE: ° g Within the drainage basin of West Branch or Boyds Corner Reservoirs. Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. Design flow greater than 1000 gallons /day. (J'REV) v BRUCE R. FOLEY Public fHealthN Director On for LORETTA MOLINARI R.N., M.S.N. Associcte - Public Health 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 . Request for Status of Joint Review Project Date 12/®l/ 0 0 an Individual SSTS Construction v k-f-,c LJ Al-iFt?— ret--L, 7 J was deemed to be complete. Plank were forwarded to the New York City ]Department of Environmental Protection for review /comments /approval as required for joint review projects. Under the Watershed Agreement a determination must be made within 20 days after an applicants submission is deemed complete. At this time the 20 day period is; K 1) Almost over 2) Has past A determination has not been received by this Department. It is important that you notify this Department as to the status of this project. Please respond by fax (914) 278 -7921, or ca ., (914) 278 -6130 ext,-V9,6-,et your earliest convenie ce. Thank you, in advance, for your ass stance in this matter. �.77ti gj5L �� L dep fax# 773 -0343 " . PLTrtr M - CC(.TNT' D?A_'M'lF-NT OF F-" a-Lrd DILZSIC. OF r�1 - rR0'lD= HEALTH SE WIC=S DF&S�CV,_.G ?T`i. S: T- CiGS,��c�C:.. I<?Q_AL 5'�cIST��1 r slr �Tr�G -_ D r Owner "Dw1Rj) » W_. cW T2 P ��L I Loc? tea a � (S tr e°_t) y & (.LIAdZ�D 111. lr S Block 2 Lot I s . Undiorte' nerrzst cross street) it ko& Watershed w rsr ` Izh xcVA SO= ?=- cCOi -STC?V 5?' DAMP, ��-� ZO � ssh'� w '.' APDLI/C� - 4 1 /� /slci�S CL ti�SCcJCLT1G 1 o 2. Date Of Perc�laticn T s -y I Z., Z.: • r HO -r7 NL--'— (Z-=% T--L,%'--- P C .TIC�V P CrJL =.TTCN Rxi awe Deot: :,i to Stia -er Fraa W-- -te; lzvell N.C. Ttme Ground Surface L*: Lives Soil Rate Start -Stoo Min. Stax- - St6u Drco Li M -in/Di Dr-co inches Lndies Lnezes 1 ►2,2,t —12;42 19 24„ 27u Mau, 2 12'.4,0 —12' S Z 1-7 ,. U iZ u 3 ►2'51 24" t 5 2.. __.- ..__,..,....12r .....1;I(,... -- -Z ,2.7_ 3 1.0,f - _ _ > _. 3 t, - 2:17 Z-7 4 5 2 1',�� - Z:I�f �7 r�li,, . Z4 al 27 p 3 3 2:t5 - -2; - 10 Zak Z cl 4 5 NOT•_S: 1. Tests to be reoeated3 are obtained at - each for review. 2. Depth ve zz rents to at swe dev h un..il amradmatel.y euval soil rats pe_colation test hole. Ali data to' be szih itte3 be grade from too of hole. p TEST PIT DATA REQUIRED TO BE S"UaMl= WTI$ APPLICATION DESCRT10N OF SOILS ENCUNI'MUD IN MST R=- G.L. if 2' 3' 4' 5' 6' 71 8' 9' 10' 11' . 12' 13' . — T'oPSoiL Zile Soi L . LL 1, .Zack 2 dc -G Dew E= NO. NDICAM LaM AT WHICi CZCLNL E -,AMR IS E NCOUNIr�" RED f (liU NDICATE LEVM TO WaC3 i -A1ER LE'vr.l, RISES P BEING DEEP HOLE OBSERVATIONS M_nDF. BY: DP=- I DESI&N 4�14°I S• Soil Rate Used Min/1" Droo: S.D. Usable Pr =..a Provided 4.yz ° No. of Bed:oans �' Septic Tank Caracity 12 Sh —gals. Ty� C o ,U C , Absorption Area Provides By L.F. x 24" width trencm Other THIS SPACE FOR USE BY BEAM DE,PART'+E..W ONLY: MEMO ON ]-99 RANDALL"-ENGINEER -NG:: -� -.4.- y .. , DESIGN - ANALYSIS - INSPECTION 13 ROBERT J. RANDALL, P.E. 1551 CROSS ROAD #052752 NJ #32741 MOBEGAN LAKE 10 2xdx'CT #10089 Wl #1.25587 NEW YORK 10547 PROBLEMS SOLVED - 914 -528 -1640 Adam B. Stiebeling, Asst. Engineer Putnam County Department of Health 4 Geneva Road Brewster, NY 10508 re: Don Spano renewal, Waterfall Lane, formerly approved as # PV -13 -92 Dear Adam, 10/25/99 5:02 PM Enclosed are application forms for septic and well permit renewal, with letter of authorization, certified check ($300) , environmental short form, application for approval of plans, floor plans, and design data sheets. Drawings have been revised for compliance with current PCDH guidelines. Please advise if there is anything more required to process this application. i m PUTNAM COUNTY DEPARTMENT OF HEALTH I-VISION OF ENVIRONMENTAL.. HEALTH SERVICES, a._. LETTER OF AUTHORIZATION RE: Property of DojALt 4.. k 5A"t^A ,f S PA �)a Located at wA--rL —, yL j::�A -\,u LA--i--) E' T/V N.h ri► V4tL & Tax Map # 3 Block 2— Lot (S' Subdivision of 4:�VZYS ( ,PA4.R'K Subdivision Lot # 9 Filed Map # (546, Date Filed (< 1 174 Gentlemen: This letter is to authorize 75. tZNfl -1.- a duly licensed Professional Engineer t-f 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 supervise the construction of said wastewater tretment and/or water supply systems in conformity "will the-pro-visions-of Article 145 - -and/or -1.47 of the - Education. Law,, the public Healf Law, and the Putnam County Sanitary Code. Very truly y rs, Pu,ntersigned: Signed: # �ow`� Owner of ro rty) Mailing Address , I 5 1 Ciw S tkl Mailing Address: JQV3 W Q-A State Zip Telephone: State 0 . �A. . Zip iQ'N5s Telephone: 60-i\ k65'% - Sq,-1�j Form LA -97 X���_ PUTNAM COUNTY DEPARTMENT OF HEALTH �� �t� DMSION OF ENVIRONMENTAL HEALTH SERA SERVICES 1� U CTIOriT P NJ I'I r uH S�EWAOE I Mao IviENT S x PERMIT # Located at w AT rk 1FA u_ L A-.,l 1_r Town or Village 1J OTrY4+ti S(AL .tY Subdivision name rOkES -' PA,�K Subd. Lot # S Tax Map "3 Block Z' Lot S Date Subdivision Approved 9 /31? (6 Renewal ✓ Revision Owner /Applicant Name '� 04 5 P4,0 1) Date of Previous Approval o /2-7 (9-7 Mailing Address j 9 dX. SI G �'� k62k,+,.j 12p, S'ckEt,l 05, i2ip 'I?-( Amount of Fee Enclosed '3 Did Building Type '�> qi e-0koo t, ' Lot Area G. t,?4 1o. of Bedrooms 3 Design Flow GPD 00 W,ov5tF- Fill Section Only Depth Volume 6Sc) Cv, le l PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i 2 M gallon septic tank and S,? Z. 4f X Z7Izov Cb Other Requirements: To be constructed by Water Supply: Public Supply From or: - :'fi�atc Supply Drilled by Address Address - _ ..... _ .. ___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 treatments,, stem 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: "P.E. V R.A. Date l 0 zS-Am Address C S S ( Ab j IM 6 VA Era A-,-J 1 A:9C &A I d5Ucense # o S 2 1� 2_ 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 permit. Approved for discharge of domestic sanitary sewage only. : By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL PCPID- Permit# .L.� Well Location: Street Address: Town/Village Tax Grid # uJiXekFA .L Lq.JC' PJ(rJ 1 by Map Block Z Lot(s) Well Owner: Name: poll SAA✓° Address: (Zttt dS a�p 5 t G E.-b FReiZw ] (� sckON e,46 N r (ZIS5- Use of Well: v1 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 ___57� gpm # People Served Est. of Daily Usage BOO al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........... ............................... Yes No !/ Is well located in a realty subdivision? ...................................... ............................... Yes W, No Name of subdivision FvkFjT t'AkK Lot No. E5 Water Well Contractor: ' Address: Is Public Water Supply available to site? .................................. ............................... • Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provi d on separate sheet/plan. Date: k) ( 2X-/V5 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be. contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 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 AfortM Z56 C�(.I'�'1'Y DBPA'T Or �' ^ -.�M Ti DILVISICN. OF �Wr�QVR?ML ALTS S R. C S DES:GV Owner �on1 Prl_I� �z%m aM - W P t A1 L Locayd at (Street) RILW45 J IU-T Rb Sec. _ 31oc�C 2 Lot I Undicmte' ne_rest cross street) i, nic.' _ E. it; PTI N 40A QAl .0 1 W- atexshed w rsr %pfi,.rCtA S7; , P =- cCOLAMC?V T S"I' D.�2? ? G' t-D TO BE SiRm-7 - W E P.PPLIC� rz�.r 4� 2o�gZ Date of Perc�laticn /-TICNS cf�Scaking HO—r:7 NTC? -= C TI`S' P--R= GN P�CJL� CSI Run Bl %e Deoth Water E`zan F, ter ieval hc. Ti-Ye Ground Surface L*i LnChes Sail Rzte. Start St✓o M— n . Sta L Ston Droo T'' M -inlLn Drco LncCles Lnchps L*1G S 2 1Z 40 – WS-7 2A'' Vz µ 3 G 5 3 CL' 5'i - � ' (S 1 � MIS, 2a Z-7 3 u (o, v 5 2 1;l - l;SI 5 Mia, 24�' 3 l i 51 - 2' 17 -�,G mid. 2� I/ Z7 " '� l r 12, 0 5 k it 2 11 2. u .L 5 -- No=- 1. Tests to be rexated at s.me depth mi it aR?ra clmma .ely eVa_l soil rats are obtained at eacn ge:colation test hole. A11 drta to'be Sahmi*' for review. _ Deoth reasi--arents to be trade fran too of hole. TEST PIT DATA REQUIRED TO BE SUamj= WZ'IM APPLICATION DESCP=ICN OF SOILS EiXXXJDPIERM IN TEST E=- Hou : .� b fiOLE NO _ S HOLE NO G.L. —I'o�5 v� L `Go�'Sol L .. ... . 2' 3' �p � ' rr 1 % DEW 5° ' 6' 7' 8' 9' 10' 11' 13' INDIC1= LB' FEL AT ;IaMli CcZGL IS ENCOUNTERED f ITiU P1 DICATE LENM TO WaCH iv-KE4 T.:r:v�L RISES P BEING =CJ!rN' D DEEP HOLE CBSF- WATIONS M_AME BY: DP DESIGN ��4� S► Soil Rate Used i r� Min/l" Drop: S.D. Usable Area Provided 4 No. of . Bethcans Septic Tank Caracity Z gals. Type C o a j e Absorption Area Provided By L.F. x 24" width tren&. Other Name f'R'f . flAti.+® Al F.ddress ,p, nit ��,, �,,� `�Cc� . • THIS SPACE FOR USE BY EEVM DEPAMENT ONLY: a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL. OF PLANS FOR A'WASTEWAT'ER'TREATMENT`SYS`IER ::.°'� .. 1. Name and address of applicant: -hoN i �OXM.a -R'l SPA-ND Q-R- -4 Rod Ss.G rD scr+�NE��s NY 2. Name of project: W, - rE9-FA u. NE 3. Location TN: J!, -7-tjh %i v4. (.t_t y 4. Design Professional: (10 C(Lr ,`s . LA yobA L(_. 5. Address: 1 SSr C P-o s S ab . 6. Drainage Basin: 7. Type of ro'ect: Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision k D (-f 64; AK) &Ake AN /D-74-7 Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status check one Type I Exempt ✓ Type H Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ,v a 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 1.1. Name of Lead Agency _ �A 12. Is this project in an area under the control of local planning, zoning, or other ocaals,..ord�nances� _._...�....�.__c...- ..... -r..v .v...e..a.e........na... •......•. a.. w..• tae..• as.... ........•...•...........�e_'!.. al�•.._�... 4�����5: -Z'. :.... ...i n.._. 0� 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... A- 17. Waters index number (surface) ........................................... .............................:. 18. Is project located near a public water supply system? ....... ............................... . N D 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ..... ............ A/0 21. Name of sewage system (V'/'a Distance to sewage system T 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ............. _._ ............ , ,_............................. 0- Q GPI 25. . Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... ILIo 26.' - Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 d 27. Is any portion of this project located within a designated Town or .State wetland? NO 28. Wetlands ID Number. ............... .,......:.�.. �, „,.... �.... �.....�. ..... :_,�,. - ._._...�_ ... 29. Is Wetlands Permit required? .............................................. ............................... A/o Has application been made to Town or Local DEC office? ............................... Al 0 30. Does. project require .a DEC Stream, Disturbance Permit? .. ................:.............. nl a 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/No tv o 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No A)D DESCRIBE: 33. Is there a local master plan on file with the Town or Village? 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... No r 35. Are any sewage treatment areas in excess of 15% slope? . ............................... fv y 36. Tax Map ID Number .......................... ............................... Map Block Z Lot /S- 37. Approved plans are to be returned to ..... Applicant _� Design Professional IVDTF.� All.applications -for re ��ic We d =ap rov��i of a new S� T S io be`located wittiui the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater'plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,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 to the best of my knowledge and belief. False statements made herein are unishah a Class A misdemeanor pursuant to SectiotP10.45 of fhAPenal Law. SIGNATUPES & OFFICIAIL TITLES: JLJ 2- - ZI Mailing Address • s "t s s RA - +- ^a^. -^a. .R �r�'m,- +- . ^^^"^ ^'^...�.q 5 Z3 mss--. • $ o d•. _ 1 OF 6ALTS i.• J � �° 5 3 a FOTNA�[ OODl11'Y D�Ati11D3[Pt H n n �"� QOIISi�IIC1fON FERldQ 1!�'•�iYA� DtBlO�AL SYS'lBM� ��Pd�talt w t:,,�1'L fs r;��❑ '� ❑ F M.i111 Aa;e. �r7 d Q. lr• , LdQt'�S )1 t (,� Town tia 3� -Fee :Enclosed .r�JSi'r DatP�Subdivision Aunroved �� �7 al+±rs 3 b n LM '4 Deb 7:veia�p Nttba• dI Bi�aass Dea)�t_ Fbw G P D [i li.. PCHD Nelmaltlne M �equEied When F ®b oa�pMtd w s�waa,srtr. a e..a>fat ai 1 2�0 G.a.. Sipue T..k .nd_?z - Ti M ea�ead � . ,. Adihi+a r :Dried, Oliaa ��aalb :'. 1'►tpreMnl YINt 1 am wholly and eompMtal rpsponaipl� for the desgn and• location, of tM proposed gstim(s► �1); tMt tM aWrat�'•�wa�i dispo�l slam ,allow dpt►r0ed will:a eonitructa0 as'fliown on the apOrowA�amtndment tAera to grid >in accwdaba wltfi;tM stinAard; rulef pnq �puw[wns o7- ^[M wmTm • ic"kY; O�part. it.:. -�6ity ini that on'c6mpmion;[liariof i Oa`wlsmltt�0 to tM- Oapartnlpnt atn0 i wrlttan•ywrantNrwill' in po0,hoa►atNr/ conAHion aey ,part otl,iaa sawaye, ,Alfa aiie o1 tM`�appraral- of 'tni �CatNkatc of . Conilruction COmpl wMtse Ioritp0 as fAOwn on tM,app," plan andthat mi0 well wii Ceunty DaOa, f ""Uh a SAddrag ft,�pPROVED�FOR CONSTRUCTION This approval expNpi,tw � ravoNeb for,',a or'may W amendad,or modNied when co d re0uiref a It. Approved for ,Aifpofal of domeft 0/88 oat." er nti ota of t:onstructioe`Compliance sptisfacto y:to•the Cornmisflomr,of Health will urnishA tM oiwnar hii tucasaors, ;MMs a_ assign _by tna_suildar .that iaa OulMar will syRirn duriny..tM perbA of two ^(2) yepf lmrnadiatily following tllidab of`tM Msu- 1 of, tfia orgfnal ^system o► a'' �rap�ks tMnto 2) thit'.tM.:WHNd _wNCdasol0� plow InstalNd accordan' wit iM stanwras, uMS pnd rpu,aZi%es ot. tha!PutMm , 1 mtl i dab i}sued u NSS const�uctfon of tM t►uiaing M }_bMq uMarbkan and is etaary 0y Commisiioner Of MNlth= Any- change Or,:.alte►atlOn of construction aye a / M ab water wpply only. J� Title •�� r -. Y.'. y.•:.- 4Yn�nn�n.�r.r•._.e. . o+-++ v+ n-..... r- i. �... �. r. er,..+-.+. s- s...+ n. +!•-...•. m^^' pe'+ aY'+.. !+rv.'1?.e,- 5!r�^'FT \�1+_^.s.FTS .. :...Y•R "Yr:+'��J'i4+"+?f.� . _ _ .r r. � �a r� .�.. _. .. - .. ,. ....... PUTNAM COUNTY DEPARTMENT OF HEALTH d �TISION OF ENVI ONMENTAL HEALTH SERVICES r � -... _� ��v. ...N _.v.....rr -.. - .K i_�..ucv.. -t-.ti si0 - �.r.pc+v2 v.�.wn -sv -2• 4. ..62'... .G a:t:.+a._.w �.v.arr..r.•+.. .. -.t ..... .r.v��• -.un "t'u.avra .u. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM # PV- /3- Located at V,41 a" ;e� 1, AtN r Subdivision name FD uSr_ P - Subd. Lot # Date Subdivision Approved _ 9 h) -7& Owner /Applicant Name D D M S A4t ) Mailing Address Amount of Fee Enclosed Town or Village ?Urot,� VALtt 9 Tax Map 2) Block Z Lot JS- Renewal ✓ Revision Date of Previous Approval 4 Building Type 3 - 4drM I StLot Area LA"—N, o. of Bedrooms Design Flow GPD__&DD Fill Section Only Depth 9.9 , Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / ;)6Z9 gallon septic tank and .3 7� L. F WC #es Other Requirements: To be constructed by Address Nate u 1p°. _ Public Supply From Address- or: Private Supply Drilled by � w � 4 T � Y - 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 "airs thereto. n Signed: P.E. / ✓ R.A. Date Address N #Ha 1-kLE il lu*-) License # ®J A 75�).. 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 permit. Approve a of domestic sanitary sewage only. By: Title: S �—� Date: -' -09 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profession Form CP -9' r i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL (� please print or type PCHD Permit # Py— 13 9A 1 71116 This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. -- ............. . .... "I I ;,;';' ;'-­'��> I Date of Issue OL'C1�27 �� Permit Issuing Official -t--- Date of Expiration 9T� Title:. Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Well Location: Street Address: Town/Village Tax Grid # WA 77L r G "TtJ4/h V4ilt V Map Block Z Lot(s) Well Owner: Name: Address: Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation 1- rima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ur gpm # People Served Est. of Daily Usage W) gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling —A'—�ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision?—** . ................................ ............................... Yes v-`*' No Name of subdivision FP &C!2 " A,4jLY- Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No ✓ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided o crate sheet/pl Date: 4 P4 Applicant Signature: 1 71116 This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. -- ............. . .... "I I ;,;';' ;'-­'��> I Date of Issue OL'C1�27 �� Permit Issuing Official -t--- Date of Expiration 9T� Title:. Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPAIBTME1V1' OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER Old AUTJH[ORIZATRON RE: Property of D,V SP,4N0 Located at W4 VA T/V �uTNAoA V.+u t`( Tax Map # J .30 Block. Lot /S Subdivision of _ ,Q _ Ux Subdivision Lot # g Filed Map # /St Date Filed Gentlemen: This letter is to authorize z.- 12, ri 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 supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the - Putnam County Sanitary Code..._._ _. Countersigned: 4A jy P.E. R.A., # Ds'a 7 5-a Mailing Address Ls'C.1 edoss )2eA D NW 64tJ -1—,91C State Zip oS" V 7 Telephone: 9) µ - sa 9 - /6 4o t ,1 Very truly yours, . Signed: �' 1 Owner of ift6perty) Mailing Address: X IL i ,Brut. SI & State AV� Zip /,.)IS_c Telephone: 1-J$ Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR _ ...... AST-E EN'P SY S Tl�M I. Name and address of applicant: lok) �vsEM.4 -2H SP4Nz:) 80)L ►o A 6 - 56 H6NEVck NY / ISs 2. Name of project: W,41 -FaFA u. t,Pr NE 3. Location T/V: ,yAL.r.y 4. Design Professional: _r D A cp_T- y . LA r,)bA LL 5. Address: JSSr C Ro s S IP-p . 6. Drainage Basin: iM a �-f E -,4pj &Ake a _IDS -4 `7 7. Typeof rWect: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt ✓ Type II. Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required. .... ,v n II 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is'this project in an area under the control of local planning, zoning,.or,other, ordinances? ............................................ .............. S 13. If so, have plans been submitted to such authorities? ......... 14. Has preliminary approval been granted by such authorities? Date granted: N� 15. Type of Sewage Treatment System Discharge................. surface ''Water groundwater 16. If surface water discharge,: what is the stream class designation? ...... ............. ... 17. Waters index number (surface) ...........................:............... ................................ —A4ZA_ 18. Is project located near a public water supply system? ....... ............................... /V P 19. If yes, name of water supply Distance to water supply A/ 20. Is project site near a public sewage collection or. treatment system? ................ �j n 21. Name of sewage system Distance to sewage system wfL. T� 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ........ ` .. ............................... .r . 1000. GPI 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... �Ip 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 f{ 27. Is' any portion of this project located within a designated Town or State wetland? )ND ' J 28. Wetlands ID Number.......:......: .......................................:.... .............:..:.............. ,v�A I- s= ��Jetl-ands' -Pe �_--' - - .. Has application been made :to Town or Local DEC office? ... ............................. A I 30. Does project require.a DEC Stream Disturbance:Perrnit? . .:................:............ �a 31. Is or was project site use d: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 rV o 7. i:a., { 32. Is proje "t'located within ",000 feet of existing or abandoned landfill, hazardous'waste'site, salt'siockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No W-D DESCRIBE: 33. Is there a local master plan.on file with the Town or Village? .................... 34. Are community water and/or sewer facilities planned to be developed within f 15 years in or adjacent to project site ? ............................................................... _ NP 35. Are any sewage treatment areas in excess of 15% slope? . ............................... to y 36. Tax`Map ID Number ......................................................... Map Block 2 Lot 1S" 37. Approved plans are to be returned to ..... Applicant _� Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC. Watershed shall _be sent to the Qxutue�nt,.and=ed- not be sent- in- c-uplicate€o4i� BEP�gh -the- pnrject~may-requim- DEP'':"-- approval ,of the SSTS ' prior to final approval ,by the.. Department. Projects .within the watershed may also require -DEP review' and approval of other aspects of a project, such as stormwater,plans or the creation of impervious-surfaces, and the project applicant should obtain the appropriate formsYfor such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other:than the applicant shown in Item' l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision maybe grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form,is true tb1he best of any knowledge'and belief. False statements made herein are punishable as a Class A misdemeanor pursuant -to Sectio 1 ®.45 oft I Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing-Address: �.7 �y , ft� &A L 10,5 --1 f PUINAM- CCiJNMY DEPA. 'T OF HEALTH DlV-iSICN. OF EVVUMMWM H ALT.4 Sr"':kVICES DESIGN MM-1 SHE—r-r- SUrSucACE Sr`3 -- DISPOSAL SYST -1 Fes.:, ICU. Owne_- 1,3 k-K) -t R-A&MAltr{ ,J u Address KA- I—A Lk I Lcc.. = -t :-d at (Street) Rtc.1�IgR�DS y �U �� �i, Sec. Block 2 Lod .1 Undi cate' ne?rest t=oss street) ttu ic; a! �tv Plnn� I�VH U1�rLl,�`� h "ate►-s:.� W Cyc ZRA�M � P,—; R L;- ,TTcN- SST' akp. R. .! `Z!� TO BE SMkg'I - W C AP LIC.Z�ICNS Date cf .'re - Staking 4 12 o 1 � 2 Date of Percolation Test 41Z l Z` 5 i - -1 11-:44 - I .l M132 k4w, Z4 17 " 1 o, 7 r 3 1'151 -V-17 --�,6 MJAJ, ZQ�, Z-7 -3 4' 5 O 2 1',72& - 2:14- 155' .!. -7-4 � LI fl 3, 2'. tS- —2 ; '312 '?A 2 Z 3 13.0 5 NOM: 1. . Tests to be receated at sire depth until approximately equal soil rates are obtained at each percolation test hole. All cam to' be l 'fled for review. 2. Decth reasuran2nt_s to ha Tramp f rrm t-no of hnl P YL2,1 =' C Tarr' ION C PER OLATITUN Run Dla--e r Water CL,AT Depth W to ater lan Wc to r LeLl el No. TL" e Ground Surface In Lnc1es Soil Rate St "-L�- too Min. i Sta -t Stop Drop Ln M -1n/Ln Drco Ln- dhes Lnches Inc es Q 1 I'LU -IVAD 19 M, J, 24 27u 3 (003 - -- 2 t2',4o —WS-1 1-7 w►►�,. U�� Zsµ 3 t2�5'l. - ls lP, 041,0, 5 i - -1 11-:44 - I .l M132 k4w, Z4 17 " 1 o, 7 r 3 1'151 -V-17 --�,6 MJAJ, ZQ�, Z-7 -3 4' 5 O 2 1',72& - 2:14- 155' .!. -7-4 � LI fl 3, 2'. tS- —2 ; '312 '?A 2 Z 3 13.0 5 NOM: 1. . Tests to be receated at sire depth until approximately equal soil rates are obtained at each percolation test hole. All cam to' be l 'fled for review. 2. Decth reasuran2nt_s to ha Tramp f rrm t-no of hnl P ,TEST PIT DATA TO BE SUBMIMED WITH APPLICNTION .FNCC)UNI'ERED IN. TEST _EOLrE DEPTH HOLE NO. A ROLE NO. 5 HOLE NO. INDICATE LE%rte, AT WHICH GROUNDSvATE'R IS EN =EKED t- INDICATE LEVEL TO WHICH k -kTE.R IEVE RISES BEING E"IOOUN712L . DEEP HOLE OESE:.R. TIONS MADE BY: DATE: DESIGN Soil Rate Used .0 Min/1" Droo: S.D. Usable Area Provided 4 ' No. of Badrocros Septic Tank Capacity �� � gals. Type C o 1j C, . Absorption Area Provided By 311t L.F. x 24" width trench Other Name �p Signature Address 1 Cpl C aka SEAL THIS SPACE FOR USE BY HEALTH DE.PAR'I'P..M ONLY: pt1l:z�m ccuwr`! DEPARIi'T ' OF .F-u ii DIVISION OF.. HEALTH SERVICES DES:.GN MTA SHAT- SUBSUEF CS SENTAG" DISPOSAL SYSTIN - . Fes, . it7 :-LL Owner 't>o,) k- 4 R-z5f mk N <-AOAJ u Address W 4-1 zA. 1--A Lk- A,,) E' Locate at (Street) Sec. 30 Block 2 Lot i S (indicate nearest c_oss street) r=ici pr! ity Pima NVNA �) � hater- e3 _ w MV �,RA,Jc�► -t wI~i, P-- N SST DATA REQC,- -RM TO BE SU&M -- J evil =' APPLIC. M NS Date of Pre- Scaking 4 ISO 192 Date. of Percolaticn _-est 4 12.1 Z-.� HOLE NL'C' a= TDI- -- P-I2CO=C N PERCYO=C?. RLm Ela e Depth to Water Fran hater Lo el No. Tire Ground Surface Ln .Lnches Soi? Rate Sty �-Stoo Min. Start stop Drop L1 Min/Ln Drcp Lnches L*iches Lnc es Q 1 1 V-1-1 - 12',40 19 MIA/, 24u 2- u 3,� � .3 2 ►2',40 —12'SZ k1 m) A), 2i 3 a S►-7 3 % L 51 - 1 ' [ S I F, m A), 2A`" 21 ! 3 ° (D; v 5 11: 44 1 1 1 ,z,R�� 24 2 14 u 111-7 3 l i 51 - 2,27 ,Z7 4 5 V ►� H rf JA 2 -L4 27 3 12 7 ci It 4' 5 N=- 1. Tests to be reneate3 at same depth until approxi_*•ately equal soil rates are obtained at each percolation test hole. All data to' be sulLitted for review. 2. Depth measurements to be made from top of hole. r� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 _. (914) 278 -6130 APPLICATION TO CONSTRUCTfA WATER WELL PCHD PERMIT # WELL LOCATION Street Address 'C��YLI LA, Town Villa a City Tax Jt �.t1 Grid Numbe ' Z - I WELL OWNER Name Mailing Address 0Private 0 Public USE OF WELL trims 2 - secondary RESIDENTIAL ® BUSINESS 0 INDUSTRIAL ® PUBLIC SUPPLY Q AYR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL 0 STAND -BY ® ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT 5- gpm /# ® PLACE EXISTING SUPPLY ®'NEW SUPPLY NEW DWELLING PEOPLE SERVED, /EST. OF DAILY USAGE �L�pBa]l O TEST/ OBSERVATION 13 ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR . DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVEL. OOTHER IS WELL SITE SUBJECT TO FLOODING? YES 1' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF.SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name. Address: YS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF,PPLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST .WATER" MAIN`:` LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET a t",aer (date) (si a ure) 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 thirt -y (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 drillin operations be contained on this property and in such manner as not to degrade or othe ise contaminate surface or groundwater. log Date of Issue: 19 f1Z dl &A, Date of Expiration-Wit- xpiration ( / 19 Pe Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller �LTTNAM COUNTY DEPARTMENT OF H�AL.TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSM SYSi EX t. Name and Address of Applicant: IIZIr Cn. inCt �'1- -► �� � Vt� -�- ?. Name of Project: �P�U +(�zx'toF.rC.rr 3. Location T/V /C: APCA40A -- 4. Project Engineer: �a6;-1� J r4,jD 4 L �, 5. Address: 151t &5S MoH64,.t 1 1KA� e Y DAl License Number: 0527' Z Phone: 528 - tai 5. i voe f Project: rivate /Residential Food Service Ccrrimercial Apartments Institutional Mobile HI-me ?ark Offite Building. Realty Subdivision Other (specify) 7. Is this project subject to State E. ^,viror. ;;,ental Quality Review (SEOR)? Tvoe Status (Check One) Type I.. Exempt Type I:. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? dD 9. Has DEIS been completed and found acceptable by Lead Agency? N.� N.�me:.:or .Lead Agency 11. Is this project in an area under the control of local planning, zcr i'1Ic; ' ` - - - -° -- ............. or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? N 13. Has preliminary approval been granted by such authorities? Date Granted: 1;. Type of Sewage Disposal System Discharge...... Surface Water G c_nd Waters 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 pile+ 0, Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... ob 20. Name of sewage system Distance to sewage system 21. Date observed: 23. Name of Health Inspector: 24. Project design flow (gallons per day ) ............................. ......' Il�a�1�TY n DEPARTMENT OF HEALTH Division of Environmental Health Services r_ TWO COUNTY CENTER - CAP-MEL, N.Y. 10512 (914) 225 -3641 A-pPLICATION TO CONSTRUCT A WATER WELL . `~ PCHD PERMIT T WELL LOCATION Street Address Town /Village /City Tax Grid Number Wh F-mL, LA. PtTA V w WELL OWNER Name T Address ❑Private. Q Public USE OF WELL RESIDENTIAL ❑PUBLIC. SUPPLY ❑AIR /COND /HEAT PU2•t? 0A..BA1qDONED - primar 0 BUSINESS O FARM ❑ TEST/ OBSERVAI�l ON ❑ OTHER (specify 2 - secondary ❑ IND,USTRIAL ❑ INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT gpm /1 PEOPLE SERVED / _ ,OF D ;,ILY USAGE -gal REASON FOR j NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION DRILLING I O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DETAILED .REASON FOR DRILLING WELL TYPE � MDRILLED aDRIVEN F-1MG EIGRASEL. � OTHER IS WELL SITE SUBJECT TO FLOODING? YES V NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISI.6N.: FXit Lot No. i WATER WELL CONTRACTOR: Vane IS PUBLIC WATER SUPPLY AVAILABLE T9 SITE: Address: YES _A/—NO TOWN /VIL /CITY bYi.�UJ 0• FaUBi ,��- :&I�I'ER.:.SiTP..�'LX; .:�:.:.�� • DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION ON REAR OF THIS APPLICATION cc (date) PROVIDED � ON - 'ABATE Sul T S3-gnatL1W PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the•well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: Date of Expiration: Permit is Non - Transferrable M] 19 Permit Issuing Official 7// State Pollutant Discharge Eli,�ination System (SPDES) Permit required ?.. 1�JO Has tP'6ES App Ii catrorr' be a >nscrbmit e ;,to Iocal...DEC Office? .. r «, .. ....... � ... ..... 27: Is any portion of this project legated within a designated Town or State wetland? .................................. ............................... Mo 28. Wetland'ID Number ........................ ............................... 29. Is Wetland Permit required? x.14 Has application been made to Town or Local DEC Office? .................. 0 30. Does project require a DEC Stre_ .Disturbance Permit it? ................... 31.. Is or was project site used for acricuitural activity involving arP icaticn of pesticides to crchards or c-her crops, solid 'or hazardcus waste disposal, O landfilling, sludge application or industrial activity? ........ Y =S or' NO 32.. Is project located within 1,000 -let of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal sit= or any other potential known scurce of contamination? ..............Y;= or NO DESCRIBE: 33. Is .there a local master plan cr f•ile with the Town or Village? ........... 34. Are community water, sewer ,"aciiities planned to be developed within 15 years? -0 z. 35..,Are any sewage disposal areas in excess of 15- slope? ........................ N y 36. Tax Map ID Number .....•............ ............. .. : : :. :...-.... , ..... :.... 3c�: ^ 2 -��5• 4' \ 37. Approved Plans are to be returned to: ................ Applicant V Engineer If the application is signed by a person other than the applicant shown in Iten. 1, the application must be accompanied by z Letter of Authorization. Failure to comply.with this provision may be grounds for the rejject' do Of any submission. I. hereby affirm, under penalty of perjury, that information provided on this for;n is true to the best of my knowledge and belief_ False statezents gag's herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 o the Penal Law. SIGNATURES & OFFICIAL TITLES: r t MAILING ADDRESS: ( psi CkT5-5 4,vw&4,f k)Y 16547 S�2y -1 640 DEPARTMENT OF HEAL .TAe 12, 1992 Division Of Environmental Health Services Robert Randall Geneva Road, Brewster, New York 10509 1551 Cross Road (914) 278 -6130 Mohegan Lake, NY 10547 Re: Proposed SSDS: - Spano Waterfall Lane (T) Putnam Valley Dear Mr. Randall: t�-- JOHN KARELL Jr., P.E., M.S. Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. Erosion control barriers are to be constructed around fill section, e.g., hay bales or silt fencing. Erosion control barriers are to be shown on plan. 2. Construction permit has not been submitted (enclosed). xj 3. Standard application to construct a water well has not freen submitted 64, (enclosed). 4. North arrow is to be shown on fill plan. OA&- le e 5. Proposed fill volume is to be noted on plan and construction permit. S. Depth gauge locations are to be shown on plan. Olt, 7. Septic tank location and size is to be shown on fill. 8. Fill must extend 10 feet horizontally from the edge of the absorption 0A -' trenches and ihL --- °slc�e 3::1,.(4 .iaradee Therefore the minimum distance an. absorption trench may be to the property line is 17.5 feet.' Flans 'show trenches 10 feet from the property line. 9. House is to be labeled as three bedrooms. 10. All existing or proposed wells within 200 feet of the proposed SSDS and all existing or proposed SSDS within 200 feet of the proposed well are to be shown on the plan or a note is to be added that none exists. 11. It is advised that the proposed SSDS be designed with approximately equal trench length. 12. Drainage easement is to be clearly labeled. N 13. Proposed well is to be labeled as such, i.e., proposed well. olt- 14. It is advised that the proposed well location is revised as per enclosed «) to plans. This will allow a greater potential SSDS area. f�' A . , b Upon Receipt of a submission, revised to reflect the above comments, this application vill be considered further. RM /jp Ver my yours, Robert Morris Assistant Public Health Engineer I 15. It'appears the SDS is proposed vithin a natural drainage channel. The &670JJ drainage floe must be carried by a solid pipe past SSDS. lb. Due to the separation constraints, junction boxes may be proposed, in lieu of A� a istmibvtion r box, •-if-- �ele�a ns- areraCept:ablev _. ._. _ -. r � /'��y..� 17. Finished floor elevation is to be noted on SSDS profile. ._.. 02- 18. Effluent lines from a distribution box cannot be split by a junction box as shorn on plan. Upon Receipt of a submission, revised to reflect the above comments, this application vill be considered further. RM /jp Ver my yours, Robert Morris Assistant Public Health Engineer I -- 0 . ' N U'U I G { � tLoD.wt . (� lay -o 1c1�4'-a Ltd we. 1`ww K[.kL­�j! K-6 ° tv\ MAO IrLoof 9LA�J PUTNAM COUNTY DEPARTMENT OF -HEALT1i HOUSE PLANS - APPROVED FOR �'jOOM COUNT ONLY; �JED to uu 9 t urlL Signature & Tit-''e D�$� W'_ 0 �c (4 o - G 1F��a1L�{ (Lo�,►>ti 3 A Pa l ,i tl _ I TEST PIT DATA REQUIRED TO BE SUBMITTED WI'T'H APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST H= ,...DEPTH HOLE NO. .,. ,�,- ....:.... HOLEyNO:. rr,u ,,,- ;::..:; ..HOLE G:L. 1' 21 3' 4' 5' 6' .7' 8' 91 10' 12' 13' A RUE- ,P Sol l_ (�JC.JC 4 -� D61�►° INDICATE LEVEL AT WHI .n GROWDWATE.R IS ENCOUNrZMED !?iU t MICATE LEVEL TO W'rIIM WATER LEVEL RISES BEING ENOOUN'7_ D DEEP HOLE OBSERVATIONS MADE BY: - DATE: DESIGN Soil Rate Used Min/l" Drop: S:D. Usable Area Provided 4 ' b No. of Badroans �' Septic Tank Capacity 12 gals. Type Absorption Area Provided By 3$ L.F. x 24" width trench Other Name eA FIK =:� . 11N.+D A'Lk- THIS SPACE FOR USE BY HEALTH DEPARDIFM ONLY: ��w Soil Rate Apprbved _ sq.ft /gal. Checked'by Date z ,t� PUrNAM CO(JM DE PAR'Ir M OF HEALTH DIVISION OF ENVIRO&MaMJ L HEAMH SERVICES DATE:�I 5��2 RE: Property of Q ID KA ` h+-� r-7., P ek h'.0 Located at L 'J� (T) ay Section_ Block _Z Lot i ,•; .'< • Subdivision of Subdv. Lot n Filed Nzp Date Gentleren: I7iis,. �1etter, is��to authorized I�o 1i OALL a duly licensed professional engineer V or registered architect (indicate) _ to apply for a Construction Permit, for. a separate- sewage system, . to serve •thie- " above noted property in accordance with the standards, rules or regulations as promulagated by the Camdssioner 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 ccnstruetion of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P. E., R.A., i 0 S27 Address Telephone ✓` � q,0 very truly yours, Signed: Ow r Property:: Ry Glf Mdress LfC ����G���� � -' C l�•y� , ' ';'fir Town 10 , <r • y Asa -- 9 Telephone s4rill 1, 19 fit t -' Irl ,•1 'C1 c, 1t , U • C,1 rr 1.1. U . UI u 1, •It it C y t11 �I 1'r1 Irl .» LI: t1.11 111 1 +1 l:J 1 =1 I`1 p,` M U 1,1 to fn 1.1 I-J , I!I fn J l) t_, 1 1 �: IG (') U (U 1.•. (il 11( 111 F • U U+ 1 -+IL., h' N I-•' tJ I-• U lU 7., ,. r. C) V 1 '• C) U, , "U O I -' >, >, 10 t I I �I tl1 1't I-• o r o r_, Cn U, v o u o l� r, U U, U11 1(,) I-• In HI 51 (I) CJ r) < 1 I••• in I-• rl 11 I-' lu N CI 111. (-' N p, N I ,�• F� In S - F - - r - o C - - n, �U III IJ IU U) (U !� 'U I ((t h1 LCl 1 1 t(1 tCl l -I rl IC) 1'• I-1 � r, N U n rF. - - to t> I S I1,) ut 1't ti, >; S) LJ �( t'7 n LI 'd (U ID O 'Cf <; ty J Flt N• rl'.'U rl- rF rl• 1 11) (1) In Irl• R, 1 ('. I -•. (U O N l) f:, ITt t t �'j ..) (], 1'1 1•'• (n L'I n 1t) r-' F'( r O., U F rt• U U 1-1 1( (U )a' V 1'1 1 n t IA Ul lJ (1) (1) C U) (p 1• U U O l)1 II' (n :' 'i (U Ill (7 (}I rl. II) lU ) rlt I<: I< tJ .-. 1�• 11 rf' y , (U , '� cJ hJ 'U 11 U) to I(`,• ;�: cn C� {� .) ru 1. M ) r Imo. ,... L• I•'• (n u, t„J J H n1 ) O, 'U 17 U 1)I! rl• I.1 (/) U .. 1 I11 • , I , , J t 1'.10 ill r t d) Ul L�, '1 1 U rr t i �)� 1� I �� �) ;: � � u, , ( , r (✓ L'' l7 'z. (1 r'I' V, I't iu , r V, ,:) ;� 1• I lU ( <� 1 'rt U U Imo• tUr J' I•• hS F' 1 -1 i IU - U 'ti! U rl• •1' (U 1•- I'I' 1 ly ty 1:;� (A b i 1"1 1) I j], (n t1 UI 111 1-1, 1'. w I... 0 li C) l� 'i 1 'ii (n (11 R� ` 11-I.\ IjKj In (() L J' iri t �• fn In .. a ; -I I-' :� rr — . ; 1.j ( IC► IT, U )ll (n ) •I) )U 1 =1 a "t 1 1 In J U U I •. In j �7 � C-{ rl' cj ly • \ II) a+ 2; 11 In (U Ip , �'1 ly rl I I ' (! I'�: h l f 1'1.1 (n I ( O rl' 1-•• r SU J rr to (� N r• r1 1' J� n \ lt1) a1 'r In , �) ul (7 to �� N (put, Y rr Jh i-'• v O L,. � `U - (U fit) h• tl, U, I •'• fU \ :=1 a n h� �• .. P. lU; :� i� r o :} c � U \ In U :1 t U f' I n t -I I t' 11 1 O � f� Ib r)I ' 1 ' O , - Y {1( - I• l , (! G fe ' c) l , pl to Fi jt .. r11 ) 1 III Vl (.' 1 (•, (' �. .) (U li' "1 I ru lam. (� !1i cl .� I In 111 I Y , >, )), ri' (u 1 IJ r�y�j' �11 `• ICJ (� .I'• ri' 1•'• (1, •. Cl I -' V, 1-� 'U 'll' 1• III '(J'' 1 1' I '• lU 1-'• III 111 In Ui • I' � I Ci ••I lJ tL) t ( (U :J Irl trl I "' 111 ,.•• 1.•• -1 II) .:J 1 1• ► <: I u, U) ;( I ( 1... rr rP r.), r) L•. I• I1) n n Imo. vl u, I-, I'1) .rs tC. U P. IU 1-•• '1 11) 1-( .1 I rr U fh G IV Uu. •I U t'J U) _ O U1 - 1•h (n a L], rt 7 (U :7 IU i'•' <, (11 1[1 't�• I n ul 1U f,, )-, .. 1 ( r r r ;U U) 'r: rl ID tVt I' �' I j i / h, l,J v 1s. (1 r't ' 4 I IU Imo• ('J I , fit to 1.1 1'S 1.11 Itl „ 1� . M T) N, IG U f+ �:7 � 1• uH .) 1O 1J \ U , l C,' O :� , U, 'fb IU O to tU • i� r <; ff G I- rl 't ib •�-- n (u ( ,. F� ru 1) 1,1 N 11, , , o t �, I'• �i rr cu +i u I 1 (Will n� ( ut �- r• iu }p � lu u, �u Iv i) i�. � ,(1 r � in 1 I Ii, u) '� 11 n fit , to tit II` �I a wi lot ;a ,.,. c -) I 10 C) Ill 11, Ui c•, �r t r Ir rl I-1 +1 Irj (U U �, fu /U U(D C, rl tz '7�U1 .�i n t pp h i In C11 tjJ (t r r 'v i 0 r1i O I ul �� (U tU �) (11 �� 'r1 i� 't1 (r rr 0 1 (U I 11 1'• h 'U 0 M i' O lu 10 ru 111 (�) n in 1-•• rr :) n IT h•• rY rl' C) (u U rl a ut n. 1-r U1 (n n hi 'U (n u, i -1 �It Irl I -• rl 1:! I I I Erg ' , -I n I 7 I rJ, (it 1•� i-i '11 I,t IJ 1t1 J 1' 1 ,s. tZ J f-1 LIJ I�1 141 ►''�} 114 I! iV Ci iy l +l ( f ilY to r� I 1J1 rA ,) 1 -I U lo i -1 )-11 1-1 W '1 IJ � - t� r (r) n 1� •Y /I l 11y Ill a (n L-+ • to I, ul (D tD —� (-I o C) ' O (], 'I rh h' • I P. o LLLL -I r )fi N, li 1 to rl (T 171 Gl in rl• (t-i' I <, rl a (ll In r rt 1y I h I • f) IU 1y �iJ { ,�• •• 111 IU In Ilt l r) r' t) IU I••• In ll� 11i III ID u) fit t -' Irl ,•1 'C1 c, 1t , U • C,1 rr 1.1. U . UI u 1, •It it C y t11 �I 1'r1 Irl .» LI: t1.11 111 1 +1 l:J 1 =1 I`1 p,` M U 1,1 to fn 1.1 I-J , I!I fn J l) t_, 1 1 �: IG (') U (U 1.•. (il 11( 111 F • U U+ 1 -+IL., h' N I-•' tJ I-• U lU 7., ,. r. C) V 1 '• C) U, , "U O I -' >, >, 10 t I I �I tl1 1't I-• o r o r_, Cn U, v o u o l� r, U U, U11 1(,) I-• In HI 51 (I) CJ r) < 1 I••• in I-• rl 11 I-' lu N CI 111. (-' N p, N I ,�• F� In S - F - - r - o C - - n, �U III IJ IU U) (U !� 'U I ((t h1 LCl 1 1 t(1 tCl l -I rl IC) 1'• I-1 � r, N U n rF. - - to t> I S I1,) ut 1't ti, >; S) LJ �( t'7 n LI 'd (U ID O 'Cf <; ty J Flt N• rl'.'U rl- rF rl• 1 11) (1) In Irl• R, 1 ('. I -•. (U O N l) f:, ITt t t �'j ..) (], 1'1 1•'• (n L'I n 1t) r-' F'( r O., U F rt• U U 1-1 1( (U )a' V 1'1 1 n t IA Ul lJ (1) (1) C U) (p 1• U U O l)1 II' (n :' 'i (U Ill (7 (}I rl. II) lU ) rlt I<: I< tJ .-. 1�• 11 rf' y , (U , '� cJ hJ 'U 11 U) to I(`,• ;�: cn C� {� .) ru 1. M ) r Imo. ,... L• I•'• (n u, t„J J H n1 ) O, 'U 17 U 1)I! rl• I.1 (/) U .. 1 I11 • , I , , J t 1'.10 ill r t d) Ul L�, '1 1 U rr t i �)� 1� I �� �) ;: � � u, , ( , r (✓ L'' l7 'z. (1 r'I' V, I't iu , r V, ,:) ;� 1• I lU ( <� 1 'rt U U Imo• tUr J' I•• hS F' 1 -1 i IU - U 'ti! U rl• •1' (U 1•- I'I' 1 ly ty 1:;� (A b i 1"1 1) I j], (n t1 UI 111 1-1, 1'. w I... 0 li C) l� 'i 1 'ii (n (11 R� ` 11-I.\ IjKj In (() L J' iri t �• fn In .. a ; -I I-' :� rr — . ; 1.j ( IC► IT, U )ll (n ) •I) )U 1 =1 a "t 1 1 In J U U I •. In j �7 � C-{ rl' cj ly • \ II) a+ 2; 11 In (U Ip , �'1 ly rl I I ' (! I'�: h l f 1'1.1 (n I ( O rl' 1-•• r SU J rr to (� N r• r1 1' J� n \ lt1) a1 'r In , �) ul (7 to �� N (put, Y rr Jh i-'• v O L,. � `U - (U fit) h• tl, U, I •'• fU \ :=1 a n h� �• .. P. lU; :� i� r o :} c � U \ In U :1 t U f' I n t -I I t' 11 1 O � f� Ib r)I ' 1 ' O , - Y {1( - I• l , (! G fe ' c) l , pl to Fi jt .. r11 ) 1 III Vl (.' 1 (•, (' �. .) (U li' "1 I ru lam. (� !1i cl .� I In 111 I Y , >, )), ri' (u 1 IJ r�y�j' �11 `• ICJ (� .I'• ri' 1•'• (1, •. Cl I -' V, 1-� 'U 'll' 1• III '(J'' 1 1' I '• lU 1-'• III 111 In Ui • I' � I Ci ••I lJ tL) t ( (U :J Irl trl I "' 111 ,.•• 1.•• -1 II) .:J 1 1• ► <: I u, U) ;( I ( 1... rr rP r.), r) L•. I• I1) n n Imo. vl u, I-, I'1) .rs tC. U P. IU 1-•• '1 11) 1-( .1 I rr U fh G IV Uu. •I U t'J U) _ O U1 - 1•h (n a L], rt 7 (U :7 IU i'•' <, (11 1[1 't�• I n ul 1U f,, )-, .. 1 ( r r r ;U U) 'r: rl ID tVt I' �' I j i / h, l,J v 1s. (1 r't ' 4 I IU Imo• ('J I , fit to 1.1 1'S 1.11 Itl „ 1� . M T) N, IG U f+ �:7 � 1• uH .) 1O 1J \ U , l C,' O :� , U, 'fb IU O to tU • i� r <; ff G I- rl 't ib •�-- n (u ( ,. F� ru 1) 1,1 N 11, , , o t �, I'• �i rr cu +i u I 1 (Will n� ( ut �- r• iu }p � lu u, �u Iv i) i�. � ,(1 r � in 1 I Ii, u) '� 11 n fit , to tit II` �I a wi lot ;a ,.,. c -) I 10 C) Ill 11, Ui c•, �r t r Ir rl I-1 +1 Irj (U U �, fu /U U(D C, rl tz '7�U1 .�i n t pp h i In C11 tjJ (t r r 'v i 0 r1i O I ul �� (U tU �) (11 �� 'r1 i� 't1 (r rr 0 1 (U I 11 1'• h 'U 0 M i' O lu 10 ru 111 (�) n in 1-•• rr :) n IT h•• rY rl' C) (u U rl a ut n. 1-r U1 (n n hi 'U (n u, i -1 �It Irl I -• rl 1:! I I I Erg ' , -I n I 7 I rJ, (it 1•� i-i '11 I,t IJ 1t1 J 1' 1 ,s. tZ J f-1 LIJ I�1 141 ►''�} 114 I! iV Ci iy l +l ( f ilY to r� I 1J1 rA ,) 1 -I U lo i -1 )-11 1-1 W '1 IJ � - t� r (r) n 1� •Y /I l 11y Ill a (n L-+ • to I, —� in � Ci� 1 ;j, f� �,t :; i 3. �t ' .� �' E 1, f k�: !. :� - TA X82 F1'