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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -15 BOX 19 1 ,w4 02176 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE: Exact location of well with distances to at least two permanent landmarks to be prided on a separate sheet(plan. Well Drill s N e 1) I,LING, INC. Address: 75 Putnam Avenue Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 341 Lake Shore Putnam Valley Tak-6 6f 4 Map30,jbBlock Lot(s) /57 Well Owner: Name: Address: See Home Improvements '70 Croton Ave., Ossining, NY Use of Well: 1-primary XXX 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 x Open hole in bedrock Other Casing Details Total length --ka—ft. Length below grade 4 . ft. Diameter 6 in. Weight per foot 1_7 lb/ft. Materials: X_ Steel Plastic — Other Joints: Welded , Threaded Other Seal: Cement grout --- Bentonite- Other Drive shoe: X Yes No ILiner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface-static (specify ft) 20. During yield test(ft) 500 Depth of completed well in feet 605 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 3 Clav!&.Broken Ledge 3 605 Granite.with Quartz If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Infb6atiom6 300 2 Pump Type q,,,k Capacity . 5 Depth 940 Model -SC--c,10412 Voltage, 2.2c). HP i Tank Type diap VQlurne62 400 3 500, 4 600 5 Date Well Completed 12/.2./03 Putnam County Certification No. 2 jDate of Report 12'/3/03 e I D Sig NOTE: Exact location of well with distances to at least two permanent landmarks to be prided on a separate sheet(plan. Well Drill s N e 1) I,LING, INC. Address: 75 Putnam Avenue Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 COUNTY DEPARTMENT OF HEALTH i, $ � 't `'°� lA� '�. 1�1 � y `'s � � Ear` ��� • � « F : � «_� � .�. � 1 9 �. '� 1 � i � " "� a. �!' ' 1' ,��„ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS PCHD CONSTRUCTION PERMIT # Located at 224 d 4A L° Ue Town or Village Owner /Applicant Name St` AG +oIMTIC S' tNC.Tax Map Block _� Lot Formerly f0fc.. ,40 S3U P—E Subdivision Name �Ifi gL� Subd. Lot # D Mailing Address .C) e -7r3 C_✓0MIb/ 0 Date Construction Permit Issued by PCHD Zip Selpairate Sewerage System built by �Y^- .�� s,� Address. 70 Y. iafW Consisting of ® Gallon Septic Tank and -e 2f ¢ & Other Requirements: Wateir Supphv: t/ iwiia . 6x,*'fi(, P '' o,-, /e... g. 'a Public Supply From Address I -# on Private Supply Drilled by � !/L ��/L(.i�f� 11'e, Address �S ��n�r� � . 16�" Baildi -Type' iY� ��- _ 'Has, erosion -control°been -completed ? - h Number of Bedrooms Has garbage grinder been installed? �Vv 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 regulatio the Date: 71 �_ ®' Certified by /.N�. Address Department of Health. P.E. V R.A. License # 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, modification or change is necessary. By: Au� Title: h9"w� Date: 7 o21 0 Whi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 FQ.EY .,_..,.::;.:...- . , .... - Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845)279-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Sea G Ptu e,-c P--n Ls w e - TAX MAP NUMBER: '3v • if& — 1- 15- E911 ADDRESS: 04 ) TOWN: AUTHC stinRj� M-2 (Signature) . DATE: LP �I �y 00 The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verftm) IP>IJTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Wze ➢D o atio ,.�. e _. un:.._. _.. :Street:Addrees: .d_.........- . _ y,b w 341 Lake Shore - - T�v�nf4ril�lage• .- Putnam Valley Tax Enid _ ... ,_ ..... . 1Map3q.j6Block Lot(s) /5- Well Owner: Name: Address: See Hone Improvements 70 Croton Ave., Ossining, NY Use of Well: I- primary XXX 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Y Compressed air percussion Other (specify) Well Type Screened Open end casing x Open hole in bedrock Other Casing Details Total length __4_1_ft. Length below grade eft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X_ Steel Plastic Other Joints: —Welded Threaded _ Other Seal: Cement grout - Bentonite Other Drive shoe: X Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours Yield _5 gpm Depth Data Measure from land surface- static (specify ft) 20 During yield test(ft) Depth of completed well in feet 500 605 Well Log If more detailed information descriptions or sieve analyses are availible - - please attach. Depth From Surface Water bearing Well Diameter(in) ]Formation )(Description ft. ft. Land Surface 3 Clay & Broken Ledce 3 605 Granite �� d If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 300 2 Pump Type SttI, Capacity_ Depth 540 Model 5rc i 0412 Voltage 2go_ HP 1_ Tank Type dian Volume62 400 3 500 4 600 5 Date Well Completed 12/.2./03 Putnam County Certification No. 2 Date of Report 12/.3/03 ell D r NOTE: Exact location of well with distances to at least two permanent landmarks to be proided on a s*arate sheet/plan. Well Drill tde TMiA, A LLING, INC, Address: 75 Putnam Avenue Signature: Date: % U White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 V 051 '25/20-14 1:.: 57 ME PAGE b':/Ul PMAM COUNTY DEPARTMENT OF HEALTH __.__....... -T I' EN��t MEN I I . �. � 1T . TA�;,HEAi.'M��ER'V' 4:E.... . GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM s "CSC-. -f/u P ir.)f Owner or Purchaser of Building Building Constructed by 3V / L-AlLC14 011 £ M Location • Street Building Type Tax Map Block Lot Town/Village Subdi ' ivrs on Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, con*ucdon and drainage of the sewage ueatment system serving the above - described property, and that is has been constructed as shown on the approved plan ac approved arneidcmnt dweto, and in amr+ds=e with the standards, rules and regulaations ofthe Putnam County Depart+nent of Health, and hereby.guarantee to the owner, his successors, heirs or assigns, to place in good operating cozAtion any pan of said system, constructed by me which fails to operate for a period of two years i nmediatoly following the date of approval of the "Ce&ficate of Construction Compere" for the sewage ttrnent system,, or any repairs made by me to such system, except whm the failure to operate properly is caused by i to willful or negligent set of the =went of the building.uilizing the system. The under$1 ed {�trthei gii agrees to ancept as"cobcltrsivc' the of ti+e-::lic lieetth "' "' Director of the Putnam County Department of Health as to whether or not the failure of the "am to opemte was cmed by the willful or negligent act of the occupant of the building utilizing the System. Dated: Month .A" _Day year -' ` f /, General Contractor (Owner) - Signature Lac P�O ,P�E Corporation Name (if corporation) Address- 7iO �"►� (� " State � jo _ /r' P✓V Zip 01P. Corporation Name (if corparetion) -°-State Form CS-97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET J $ STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Collector's Information: Blame: Mill Drilling Co. Client: See Home Improvements Name: Russ Address: 75 Putnam Ave Address of site: 341 Lake Shore City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Telephone: Pax: 845 - 279 -5075 Telephone: Sample's Information: Site: Kitchen Tap Preservative: HNO3 Temperature: <4C Date Collected: 2/20/04 Time Collected: 13:00 Date Received: 2/21/04 Time Received: 12:30 Lab No.: J041313/J042478 Date Analyzed Test (dame Result MCL 2/21/04 13:00 2/21/04 2/21/04 2/21/04 2/23/04 2/23/04 2/23/04 2/23/04 2/23/04 2/23/04 2/23/04 10:00 3/24/04 2/23/04 2/21/04 2123/04 Total Coliform Absent Absent Chlorine Free Residual <0.1 mg /L N/A Color ND 15 Units Odor ND 3 TONs Iron <0.050 mg /L 0.3 mg /L Manganese <0.050 mg /L 0.3 mg /L Sodium 4.27 mg /L N/A Chloride 13 mg /L 250 mg /L Hardness 74 mg /L N/A •-Nitrate -;: -.:� _ � , 1.50 mg/L _ _ 10 mq Nitrite <0.1 mg/L 1.0 mg /L *pH 7.32 S.U. 6.5 -8.5 S.U. Sulfate 23.4 mg /L 250 mg /L Turbidity 0.39 NTU 5 NTUs Lead <1.0 ug /L 15 ug /L Comments : , * Lab number J042478 recollected on 3/23/04 at 8:30am for pH At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable S.U.= Standard Unit MCL- Max. Contaminant Level ug/L- micrograms per Liter s . Signature: Michael Lapman mg /L- milligrams per Liter NTU- Nephelometric Turbidity Unit TON- Threshold Odor Number Method SMWW 9222B SMWW 4500CIG SMWW 2120 B SMWW 2150 B SMWW 3111B SMWW 3111B SMWW 3111B SMWW 4500 Cl C SMWW 2340 C SMWW 4500 NO3E SMWW 4500 H B SMWW 4500 SO4F SMWW 2130 B SMWVV 3113 B ND- None Detected Reviewed by: Sharon Houlahan, Director State #: PH -0218 ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF'11EALT1I DIVISION OF, ENVIRONMENTAL IfEATLTI SERVICES F CTIVITY'REFORT""' EELD'A ej Street Town State Zip PERSON N CHARGE. 5 - 0--X Tat '3o i F- i - (s- M. TEST DOSE TEST REQUIRED GALLONS o3 . EL. START 0. v EL. STOP rNJ.qPFr-TnR• TR-T,! Signature and Title gppnpj: grroym RV., I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 0 0 0� . EL. START 0. v EL. STOP rNJ.qPFr-TnR• TR-T,! Signature and Title gppnpj: grroym RV., I acknowledge receipt of this report: SIGNATURE: 02/96 Title: PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION Or ENVIRON _MEKTAL_IIEATLILSERVICES, - „u...._ FI lff' CTIVITY REPORT Street Town State �JU'—G�iP PERSON IN CHARGE OR TNTFRViEWF�: r; � 1� TEST El. DOSE TEST .. � � �.� errs -- ✓2.,.�6 12,0. ,0 5y O , . ", A REQUIRED GALLONS EL. START EL. STOP TN!ZPFCTnR: TFr o - Signature and Title RFPnRT RTzCFTW BY,- _ I acknowledge receipt of this report: SIGNATURE: 02/96 Title; 7I�o -oo� 5y O , . ", A REQUIRED GALLONS EL. START EL. STOP TN!ZPFCTnR: TFr o - Signature and Title RFPnRT RTzCFTW BY,- _ I acknowledge receipt of this report: SIGNATURE: 02/96 Title; 05/28/2004 10:09 1026 T, PAGE 01/01 (YV l77 g - 17-t ) BRUCE R. FOLLY Hedth Diftwmr IDRB'1'TA MOLINARI R.N., M.B.N. dr orate Pub& Hadt h DbWdW Lhmdw Cf Path" &Pvkw DEPARTNIN'T OF BEALTH 1 G=vs. Road Dowda, New York 10509 ATTENnON: )OMPH PARAVATI . 17 GENE REED AD laformatfion below most be hft complet+ed:prioc to auy sctie WWg... BATE: C126 1,0ei ENGMUR OR FIRM: �. y1�� /� PHONE #: m oy--4ta REASON: DEEPS: c • , ' P CS: o PUMP TEST: ROAD /S'T'REET: TOWN: Lr7WA^. 11,4jZ 4 TALC 14fAP+if: . / $ %' IS svBalVrsro�r: LOT#: OWNER: yca�p i�:5 PL1fCVEP CRITERIA FOR JOINT REVIEW AND MZMjMRiG 91' TMG YES NO v _ ......' . _ . Prolmsed 5STS within the dra eAp basic of West Branch or l6yds Corner Reservoim p- roposed 8619 wit" Soo feet of a reservoir, mervoir stem or 000rol lalm. o Proposed 5355"1'3 with 200 'feet of a wateftVarse'or a DEC wetland. o dt Fropond SUS design flow greater thsLA 1000 galloud ray or SPDES Permit repaired. o Proposed SSTB her a Camscrcial M ject. It is the responsibility of tht dealga professional to provide tk abovo idlormatiion prior to mail testing. This lleparhneat will determine the NYCDEP project atataw (Joist or Delegated) based on tote regxwe. If you amwered Xg to any of the questions, NYCDEP moat witness dw toil tam. This Deparhaemt will coordinate a niistaaliy srtitable time fior Seld tenting with theDesip Professional sad NYCDEP. If a project has been detexrnined to be Delegated based.on the ikbow response and tbee subsequent information Indicates NYCDV 6 req *hied bo.,witsess. the soil teats, it will be the tole ruponsibilky of the design prafessiaW to wAodule re- witnessing of the suffft tiag witb W.DEP. FOR COUNTY Uz 04LY Ca I COlYld1EM'S. .. MAY -28 -2004 FRI 10:09 TEL:e45- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 -178 – 7iZZ 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION � JOSEPH GENE REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. For: bill Trenches PCHD Contra ion Permit # �y " 2 2— Located: v,�,0��vI SST' (T) (V) Owner /Applicant Name: 5oW" 1>'AL e57A - #J020 TM 3048 8 Block --l'= ��Q . ��'� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ION PERMITFOR SEWAGE.TREATMENF;SYSTEI:.. __.-CONSTRUCT PERMIT # Located at i; �� -r%�0 �� P o A D Town or ge ,j fia ''t Subdivision name E V EL Y0 �L yC IZ Subd. Lot # J— Tax Map 3 0 • l8 Block 1 Lot 15� Date Subdivision Approved 5u/J45' 6- / 5�2 Renewal Revision Owner /Applicant Name raAv 19. _DW L F SSPN D R 0 Date of Previous Approval _ Mailing Address S3 L AKLr ,fN o R� RaA_t) Pj TN ✓q ✓`1 VA L L C LI N . y Zip Amount of Fee Enclosed -? 00 Building Type SoJ GLE�' r m x `'t Lot Area A /q c- No. of Bedrooms _�_ Design Flow GPD S 0 O Fill Section Only Depth 2 " Volume 6 3 Cco, V0, PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /2 S O gallon septic tank and !�00 L, F. a r P/pj�_ lAJ 24 N 69/4VL —L C C.l� Other Requirements: 2`i %'`'!i,' OCP-r/1 b F X/4,4 KR 14A/ 2 i9 Pyr-t To be constructed by K S 1`TL -r A KLO P/Y&/T Address 6o Ltl KC - 1'Na12&r 2a. �'� T V� «e 61 , N• �/ Water Supply: Public Supply From Address 1,5-2 7_n 2ccy,1 fT or.._= Private Supply Drilled by /J oR/1-1/;^j 19/J_;2eRf61j Addresspu'r VgueLl /J. /oS�S T 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 reg5�' ulai of the Putnam County Department of Health, and that on completion theredf a "Certificate of Construction 6pii�'i�co'b t�sfactory to the Public Health Director will be submitted to the Department, and a written guarantee e ner,. his successors, heirs or assigns by the builder, that said builder will place in good operatin ci3 i'bn an art's m sewage treatment system during the period of two (2) years immediately follow' the date of a iianc appro I the Certificate of Construction Compliance of the original system or any pairs ereto. .r` °.,;' w Signed: Address 2 dN� W �+t -ll9 TIG t Date (� Z �" ;qAA ✓ IJ.. V. /0 S6 C License # U 6 z ','I F6 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 p4mit. Approve for discharge of domestic sanitary se age only. By: — Title: c Date: White copy - HD F e; Y llo copy - Building Inspector; Pink copy - Owner ran py - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT OF HEALTH IIDngSff(DN OF ENWROlYMENTAL HEALTH SEIEBWcCES APPLICATION TO CONSTRUCT A WATER WELL � =PCHD hegira,# Well Location: Street Address: Town/We Tax Grid # LA Y(--r -Ma fZ6f j90A 0 ?Q VJii6 VP/-(6r Map 3d .14 Block i Lot(s) 15- Well Ow®er: Name: - y Addre - CHa fZC-' fZ d &p L e sjT 91JPR 0 1 `'pJTnI0/1-1 V � LL C -!- 1J l a Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- inrimary Business Farm Test/Monitoring Other (specify) 2-secondary. Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served __�L Est. of Daily Usage b'o 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply IlDnrilllinng, k New Supply (new dwelling) Deepen Existing Well Detailed Reason fJLr lj V jji -rcrL -Cu (T L F-6 7L /J 4�F 1-v 12eriDai CE- for Milling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision 45-U4 L Yw TL Y & -/Z Lot No. D Water Well Contractor: NG (Z.Y'' AP AIJPi 2. OIJ Address: /S2 '2974r264�t7 X y�« LS`1 Ill Y Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: u Lp TownNillage Distance to property from nearest water main: Proposed well location & sources of contaminatio o be rovided on separate sheet/plan. Date: '7 - U Z 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. 4 1-11 Date of Issue a Z Permi Date of Expiration _ 9 - ZA 4 4 Title: Permit is Non -Trap sfferrablle White copy - RD file; Yellow copy - Building Inspector; Pink copy - owner; orange copy - Well driller Form WP -97 ,l 617.20 SEAR • Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: JOHN D'ALESSANDRO SSTS, LAKE SHORE ROAD 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) Nourth side of Lake Shore Road 5. PROPOSED ACTION IS: ®New ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and a water service connection for the construction of a single family house 7. AMOUNT OF LAND AFFECTED: Initially 1.185 acres Ultimately 1.185 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? IYYes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ❑Industrial ❑Commercial ❑Agricultural ❑Park /ForestlOpen space ❑Other Describe: Surrounding lands are zoned single family residential 10. WES ACTION I VIOLVE -A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY - FROM- ANY'OTHER"GOVERNMENTAL-' AGENCY (FEDERAL, STATE OR LOCAL)? jYes []No If yes, list agency(s) name and permit/approvals Town of Putnam Valley— Building Permit, Putnam Co. Health dept— SSTS & Well Permits 11. DOES. ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes Wo If yes, list agency(s) name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? []Yes. jNo .l CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor name: Cronin E ineerin P.E. P C. /Kenneth Mu h date: 08 -27 -02 Sgnature• If the action is in a'Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER 1 PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) . s,.: RONIN ENGINEERING, P.E. P.C. nix ',.:,� The Lindy Building, Suite 200,2 John Walsh Blvd., Peekskill, New York 10566 Tel. - 6736 -364 o Fax. (914)736 -3693 - Shawn Rogan, Public Health Technician Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: John D'Alessandro Tax Map #30.18 -1 -15 Lake Shore Road Town of Putnam Valley Dear Mr. Rogan: Please find enclosed: September 17, 2002 I,I Tti�R E �0�Dd�D 1.) Three copies of the revised SSTS plan 2.) Copy of the revised survey showing neighbor's well location 3.) Copy of certified mail for neighbor notification. The information was revised based on your comment letter dated September 6, 2002. Kindly review the above and should you have any questions or require additional information please contact me at the above number. Thank you for your time and assistance in this matter. Respectfully submitted, A neth M. Murphy Project Designer do do ru 0 -10 F F I-q -0 C3 postage S 160 WOW Fee 0• 34) 0 C3 I= C 1!6 C�6m �fiaot ri. 3 C3 RestrictdDell-yFee 0 ❑ Qittlar«mmt Rarldbrod) Total Foartage a page 0 -0 = sent To ru C3 Stephen & Shawneen B. Hieber 0 0 ru sl— 175 Long Ridge Road r- C3 -Itl--17 Danbury, CT 06810 Ln Ln ru do Ind C3 pouaga ra 0 -q M1 r, Cafflnd Fair ru ru to o o M C3 Ft. Do F. 0 0 (End=wt=k*M 111111111"'I"we"' 0 C3 TrejPqataqa&Fe*s ent to 6;1V E 0 to Adalbert A. & Josephine T. Konrad - ru 342 Lake Shore Road 0 o or PO Be. No. 0 Putnam Valley, NY 10579 -1314 C3 M cc CC) rn m C3 M to 0 peat-P rq r-3 `n -11 CortIflod Fee r- r- ru ru 00 0 0 ROMWI). M (Endonaarrol= _n 7V a t To C3 0 4 Apt. No.; ru Po a. Na " Of C3 0 • CERTIFIED MAIL RECEIPT complete (Oomestic Mail Only; No Insurance Coverage Provia!6�),' Item 4 it F- Print your so (hot w. Cc Att.ch thi. co ru al F or or, he I peerage $ Article Add, 10 p rq O*rUUd Fee '' R6liun • IF i Frank C:) • o ;=gr 333 LP rO qz Putnat =0 Total postage & Feet $ 110 ............ ..... Frank & Angela Casella ........... rrU street Apt N.. 2. Co mPOBmNo.' 333 Lake Shore Road Article N-v ro Putnam.Valley, NY 10579-1318 ......••••. 3 (Pansfer ft. I" PE PS Form 381 U.S. Postal S , ervice CERTIFIED MAIL RECEIPT (Domestic 41ail Only; No lOsUranCe Coverage PIOVid6d) ■ comple, Item 4 it 1111 Print yo, ti ===!n=== so that F ■ 6 Attoachh1l do ru 0 F or n r1— • .3 0 Postage 8 60' 0 I. Arlicloft _0 Wifted Fee fare ❑ 0 Reableted D.9my Fee It Susan ❑ 0 Pularearrent RwhO 337 La' °° TbWpoatog.sir— $ Putnan -0 .1' Sent To C3 0 Susan Stern W ru Street. Apt. N.4 337 Lake Shore Road ... ❑ o " PO a- No. Putnam Valley, NY 10579-1318 N-- 00 4 ! 2. Article Nur .J�nuwr'K20(� Rcvers�ler!n�.Iruction mansfer h. PS Form 38 Mark Abdoo 131 Prospect Avenue White Plains, NY 10607-2022 rpost 'I a Service '; V '.A'. CERTIFIED " ERTIFIED MAIL RECEIPT (DoinosH6 Mall Only; N6 Insurance Coverage Provided) r'u q r ,CERTIFIED MAIL RECEIPT 1 or on ru Item 4 It ■ Print yot 0 .0 that v 1. An Icle Ad ❑ poat.q. It Postage 3 '60 1. Article Ad rR ru :CE.._.' .4.0 pol�rada ru Return RI Fee Here C3 C-once cg:= p4qz 345 Li Tbtal laodag.AFee $ Putnai 0 10 n cartned Fee 0 0 Conception Petrone ru :ru she" Apt Na 345 Lake Shore Road 0 "rpoe"N' ru Rat— R .0 Bj,'j;;j;-jjWj Putnam Valley, NY 10579-1318 2. Article Nun Michas pansfor M PS Form 38 115Jo ❑ Restricted Dd�" F. Mahop ❑ Mvelonrenterri PAq*.o Fw Total ft•tage A F". $ 0 ftn� o 3 ichael &BWIrW 0011'gir ru Ap. 17-- 8 -t. A "7iF4,7x-'-" 115 joniihan Drive 0 PO 0 or Po a" N% Mahopac, NY 10541-2209 Article Nur, .1 n ar '.'m 38 S: Posta So-ry-Ice ISENDEIV ,CERTIFIED MAIL RECEIPT 1 0 complef (• • mestic Afall • Only; No Insurancp'Foverage Provide,d). Item 4 It ■ Print yot 0 .0 that v M do P/ . '. 1-0 0 F F h 1A ■ Attach 0 or on th( ru f Postage 3 '60 1. Article Ad -.o certified Fee ru :CE.._.' .4.0 pol�rada ru Return RI Fee Here C3 C-once cg:= p4qz 345 Li Tbtal laodag.AFee $ Putnai 0 10 n 0 0 Conception Petrone ru :ru she" Apt Na 345 Lake Shore Road 0 "rpoe"N' .0 Bj,'j;;j;-jjWj Putnam Valley, NY 10579-1318 2. Article Nun pansfor M PS Form 38 eft „II+ WIN Complete •, • li • r • • • item 4 it I. Print your ® s i � •.a so that vn ru M1 -21 q �� �� a ar7 /1y Q'� A � fJ o Attach thi ® ° N ®F F 99rv4 -rte J CN ti11�Y'.�(i 'S„ PV',.! a�'.9 �tR or on the' ® .n O Postage S 1&0 �. `I� Postage S .;..... .Article Add 171 11 . oCaNnee Fee CeMp Fee, ti .. U�O . O CR (Fndragenn.'.Pu _- P” Frank ° W.. ° ReatrlctedDegmyF. ° � D= l�� 333 La ® ° ° (allotment ReWbodl 1' 77 C° 1fl $ Pulnaf s ° Total POSfnpeAFeas $ - - _° mtalPoslsgaaFees ° Y Cy' Sent TO Sent o ° Frank & Angela Casella C3 ° stre•_•_•_-� Stephen & Shawneen B. Hieber — — ••- •_ - - - -• 9 ® Stn•C Apt No.: — rtl orroef, Apt. Na; . ......... ° f1't or POOuNa 175 Long Ridge Road z. c° e.voee,Na. 333 Lake Shore Road " • AnWeN w ° cdy,seei:;iid:a Danbury, CT 06810 r` ary,srre,ziw:. y, NY 10579 -1318 R,ens(ertro N P� PS Form 381 I a •• � •I a . , el a' '• a Comple• a , • item 4 it IT Ir M a Print yol ° �• ® • / p' so that, ,I m m ut ,�^� iA I a Attach tl ® N W '�d 7 /F txGC✓ ✓t4LVN.oI.� 0 �:' e Ems:. N N . ll�rJ Or on lh, �cl� fL ° ° Postage S . r-q 91 i 1, Article Ad ® ° Postage ! 60 Poe ��^ ,l �d �d CeNaed Fes - ` Return Reeelpt Fes ' ,�•� t` pT.���un&k '• N rut (�dmeman Requ6aa) ru ru End —t 4� I� f r ^°1B f�' °° Rastrlcted Wllvery Fee �St I SUSafI ° C3 ReaWCdadDeMaryFee r )�) ° ° (FndorsamedRagueedl 337 La! ° ° (Endafe nnifleVda� �7 ® ° ° 7DtelPo.mgeaFaa $ Putnan ° � n 7 Snabntd t Po o stage a Faes � .... enf ° -n " o Susan Stem _ ...._- .........._.. ° ° ru rtl Stmarr, ApL NO.; 337 Lake Shore Road Adalbert A. & Josephine T. Konrad _ 00 "Poeaa Na Putnam Valle NY 10579 -1318 o S".4 ea ''r"a" 342 Lake Shore Road 0 ° c/ry smie;ay.i y' z. Article Nu.. ® ° °° .......... ..._-. -..... Putnam Valley, NY 10579 -1314 - r Clf-- Sears, 9Pa - (Frenater fn r` PS Form 38 e M,elmnl onow •� M � so that v ru Alto h it or y g . q {� p on the ® ru ° ° ,y� ® 0 Postage S 1 Article Ad ° co F '� t.s A ® ra g rn m ® N Cedlned Fee 2. �y D Posrmaik %':- ° ° Poatea s !'C� ru �s 115Jo • a ra - �1; -! ° � :•-.� 115 Jo Dertlfled Fee Rutdoted DeWary Fee ry r 3� sue.+ o (Endoremna -tune) t i Mahop 1 ru ell Re 1WmaR P /' 7 ® ° 7btd Postage a Fees $ %f/• �S ° ° ? .n ° ° RgWcted DeOvery Fa G _r sent To — r3 .. if - o_° (Fnaortemmtl7eQUm0) v'�1,\ _ .� ° _ Michael B.Reglna GRlfer - - • Tofd Postage a Foss $ / \ Birset, Apt. lJC.; ••- ® ° ° ru olPOBOrNa 115 Jonathan Drive .n -p one °° - -- Mahopac, NY 10541 -2209 ° ° Mark Abdoo r C/ y, State, ZIP.1 NoomP'onw•eo•; 131 Prospect Avenue sFonn ° ° _........ ;_..�._ White Plains, NY 10607 -2022 •- -••••- M1 M1 Clty Steta ZIP a r n s e ■ Complel • • item 4 it a Print yot ° CO so that r ® -0M e r E ��" �� a Altach it era 0 F !- ✓ /r7� � ff7f/� �.,9j� ':�i � or on IN rut rru ° f ° Paw, It Q 1. Article Ad -0 a ar `-� ® .o r-a Cadillac! Fe. r` ;r, + ° Feee S s `\ Pam ru to ' Conce I° (Rdagfsd 345 Lr O ° n flF \-- Pulnat ° mtdlwdagesFeas $ 'a '�• sent To S . ° I° • _ Conception Petrone ti SineyAPI"; 345 Lake Shore Road fU I° or PO Box No. •_,• 2. Article Nul ® °o !M1a -ap�y Putnam Valley, NY 10579 -1318 Ransfaro, M1 ' • :1, �. '.. ..,x, -:.;" ' PS Form 38 .. -13RUCE Public Health Director . "LOTtE'ITA "7Gf6Y:lNkid' k.'14 `M:S.N. -._. 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 6, 2002 Timothy Cronin, III The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Re: Dear Mr. Cronin: Proposed SSTS - D'alessan Lake Shore Road, (T) Putnam Valley TM# 30.18 -1 -15 Review of plans and other supporting documents submitted at this time relative to the above reg ded project has been completed. Comments are offered as follows: Please have the existing well on Lot C survey located: This Department will require the survey prior--to any:approval -on this -lot because of the possible impact its -actualJocation + would have on the proposed SSTS area. ....�_ _... _, .. _._ .._.... _ Provide the standard fill specifications on the plan. �3. Provide the hydraulic profile for the SSTS. Provide the force main detail. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, qa—. — Shawn Rogan 4 Public Health Technician SR: cj f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS Y- - ;REVIIE'V SHEET F01)Ri �� ONSTRUCTIONPERMI NAME OF OWNER: °1'`' STREET LOCATION: g IS— REVIEWED BY: RM, OR, AS, GATE: TAX MAP #: (CONFIRMED) (ZY N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'DI L__)PERMIT APPLICATION (-,-I( )WELL PERMIT OR PWS LETTER �(� 0 ULETTER OF AUTHORIZATION C,,6L_)DESIGN DATA SHEET (DDS) (JL,,ICORPORATE RESOLUTION V)USHORT EAF UUPLANS -THREE SETS (.!JL-)HOUSE PLANS - TWO SETS (� (-_)UVARIANCE REQUEST ((`)LEGAL SUBDIVISION UUSUBDIVISION APPROVAL CHECKED UUPERC RATE UUFILL REQUIRED DEPTH C--)L—)CURTAIN DRAIN REQUIRED GENERAL UULOCATED IN NYC RSHED L_)(_JPLANS SUB D TO DEP UUDEL ED TO PCHD (� P APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED )PERCS TO BE WITNESSED UEX- APPROVAL SSDS ADJ, LOTS U(,,.,fJWETLANDS (TOWN/DEC PERMIT REQ'D ?) L (,J�( )DATA ON DDS PLANS & PERMIT SAME (QUPRE 1969 NEIGHBOR NOTIFICATION ( J(,:::JLETTER BI/ZBA ;CUL%1�.0c! YR .•.FLOOD - ELEVATION V,,'I200' C_JC/ SOIL, TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON . LANS �( )SEWAGE SYSTEM - (NORTH ARROW) PROFWE (� GRAVITY FL W CONSTRUCTION NOTES 1 -15 �e,)(_)DESIGN DATA: PERC & DEEP RESULTS WC_)2' CONTOURS EXISTING & PROPOSED WLJDRIVEWAY & SLOPES, CUT (U(_)FOOTING /GUTTER/CURTAIN DRAINS L ) _)USDA SOIL TYPE BOUNDARIES (/)(TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# ()UDATE OF DRAWING/REVISION C.2(DATUM REFERENCE )(_JLOCATION OF WATERCOURSES, PONDS LAXES,WETLANDS WITHIN 200' OF P.L. U( JPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (A )WELLS & SSDS.'S W/IN 200' OF SSTS (�L JPROPERTY METES & BOUNDS (�( _)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMIi MNTS: (REVSHEET)09 /01 /00 (,/(__)HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (,-0UN0 BENDk, MAX BENDS 45' W /CLEANOUT RENEWALS L_)C___)SITE NOT 0 PIANGE) FILL SYSTEMS PAST TRENCH SLOPES 3:1 TO GRADE NOTES 1 -5 FII;L PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER TIL4N2 FEET �C--) CLAY BARRIER UU U C-_)(__)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS C--)C—)SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH ((�. (ELF TRENCH PROVIDED_ 60FT MAX. )L )PARALLEL TO CONTOURS U(__)100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM 'SSTS (--jC__)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (.:::ftU20' TO FOUNDATION WALLS (/�U100' TO WELL, 200' IN DLOD,150' TO PITS �(n ___)100' TO STREAM, WATERCOURSE, LAKE (inc. expan). /f 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER X10' :TO.WATER.Y INE, (p.its - 20') �(�50' INTERMITTENT DRAINAGE COURSE / )1 1200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (_ (-J10' MIN TO LEDGE OUTCROP SEPTIC TANK (� 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES (L)(_JLOCATION OF SERVICE CONNECTION (_jUMIN 15' TO PROPERTY LINE SLOPE -t!::�L_-)SLOPE IN SSTS AREA fJ (S 20 %) (_)DEGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS ((__)PUMP NOTES (_JDOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED _.� UUDETAII FOR FORCE =MAIN, (PIPE TYPE, ETC.) C—,�(�PIT AND D -BOX SHOWN & DETAILED C,,3t__)1 DAY STORAGE ABOVE ALARM TAIN DRAIN UUSTANDPIP BO SIDES, DETAIL MIN to C = >5% 20'-4%,151-3%,35'-16/o, 100 % - <1% )20' MIN t CD D GE /100' with 182 cons day discharge (�( )10' to NON - PERFORATED PIPE LETTER OF TRANSMITTAL CR0i i 'E G— INEERING- '?.'E: ;'P:C: «: ..�r......_ .... --- The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: WELL & SSTS CONSTRUCTION APPLICATIONS JOHN D'ALESSANDRO LAKE SHORE ROAD TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED Ef FOR REVIEW AND COMN ENT X PLEASE REPLY WE ARE SENDING YOU attached 1.) Three copies of subsurface sewage treatment system plan ._: :2.)`Three SSTS construction. permit.appl_ catioh 3.) Letter of authorization 4.) Application for approval of plans . 5.) Soil data sheet 6.) Short environmental assessment form 7.) 2 sets of house plans 8.) Updated survey 9.) List of property owners notified 8.) $300 certified check for application fee The information is provided based on our June 14, 2002 joint site inspection with Gene Reed and ensuing discussions. Please review at your earliest convenience. Thank you for your assistance in this matter. Respectfully submitted, Kenneth M. Murphy Project Designer I,� � � p 5 �•/9 � 1,„ i i �R ji �•� r/} �i � � i e �� � � � � �, g � i i �', '�` , P � ..7 1 ! { .,,..... - ... Y..... .. ,. .... �,._:...v.. -...c. • -. ..c.v �JLITTJL'J� 0li' AYJTH` PIZATf0'N .....cam.. - -r. •,. .,s :> .:�.. RE: Property of Located at Z, /G, z ROAM TN IvTNAr, IALC CY Tax Map # 26,N A�Rc) Block I Lot / S Subdivision of 9 V5t `; N 7?'1- YOZ Subdivision Lot # D Filed Map # 65s'_ Date Filed J uN/6-r 6, °!S2 Gentlemen: This letter is to authorizei�c� a duly licensed Professional Engineer ,�(- or Rtgistered Amt 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 a 145 and/or 147 of the Education Law, the Public Health Law, a�Phe u�am County S*ita k N141 IN Coun ersigned: %. X 0 a ,� P.E., ., # �%� � � �� ,� G248�0 _. �'� "'HO Mailing Address. CROM.-1 2- o/ Xj w/► c--re . T<-U p )2c-'V rsKt '.� . Stateti6y Y61ZK Zip 6 Telephone: L % /,Y) C yours, Very truly &M, / / Mailing Address: J0 11X A W1e0 State Zip � , Telephone: of o2alr;, 7:2. 91 ,51V Form LA -97 2) Situs: 333 LAKE SHOE RD, PUTNAM VALLEY NY 10579 -1318 R001 PPN: 2800 -030 -018 -0001 13 -000 Rec/Sale Dt: 03/10/1986 02/0111986 Total Value: $187,000 County: PUTNAM, NYC Sale Price: $18,000 Land Value: $29,300 Use: SFR Doc #: 886 -129 Impry Value: $157,700 Card-M.... . _.. :::..._ :........ Mali Pg: - 2800 -030 -018 1st.Mtg.$:. e . .- ...,..:� .: >a,:,....... -. ... _: . ,. Prop Tax... . $1,696.50 - - Munic: PUTNAM VALLEY TOWN State Use: 210 Lot Area: 28,980 Township: Cnty Use: Zoning: Lot Area: Owners: CASELLA FRANK & ANGELA Census: 110.00 Zoning: Phone: 9141528 -0905 Mail: 333 LAKE SHORE RD; PUTNAM VALLEY NY 10579 -1318 R001 110.00 2) Situs: 337 LAKE SH��I�E RD, PUTNAM VALLEY NY 10579 -1318 R001 APN: 2800 -030 -018 -0001 -T!; 00 Rec/Sale Dt: 12/26/1996 Total Value: $185,500 County: PUTNAM, NY Sale Price: $170,000 Land Value: $46,500 Use: SFR Doc #: 1368 -201 Impry Value: $139,000 Card #: Map Pg: 2800 -030 -018 1st Mtg $: $125,000 Prop Tax: $1,682.89. Munic: PUTNAM VALLEY TOWN State Use: 210 Lot Area: 44,431 Township: Cnty Use: Zoning: Lot Area: Owners: STERN SUSAN Census: 110.00 Zoning: Phone: 9141528 -8496 Mail: 337 LAKE SHORE RD; PUTNAM VALLEY NY 10579 -1318 R001 110.00 3) Situs: 284 LAKE SORE RD, PUTNAM VALLEY NY 10579 -1313 R001 Phone: 8451526 -1159 APN: 2800 -030 -018 -0001-015 -000 Rec/Sale Dt: 03/0811996 Total Value: $48,100 County: PUTNAM, NY Sale Price: Land Value: $48,100 Use: RESIDENTIAL ACREAGE Doc #: 1328 -250 Impry Value: Card #: Map Pg: 2800 -030 -018 1 st Mtg $: Prop Tax: $436.37 Munic: PUTNAM VALLEY TOWN State Use: 311 Lot Area: 50,094 Township: Cnty Use: Zoning: Oumers: G.ORNIAK MATTREW 8'& ANGELA D' _ ........ ,.... _ ........__ :... � -Census: - , -- 110:00 -- . - Phone: 8451526 -2672 Mail: 284 LAKE SHORE RD; PUTNAM VALLEY NY 10579 -1313 R001 4) Situs: 345 LAKE SHORE RD, PUTNAM VALLEY NY 10579 -1318 R001 APN: 2800 -030 -018 -0001-01600 Rec/Sale Dt: 07119/2000 06/30/2000 Total Value: $187,200 County: PUTNAM, NY Sale Price: $215,000 Land Value: $47,000 Use: SFR Doc #: 1516 -236 Impry Value: $140,200 Card #: Map Pg: 2800 -030 -018 1st Mtg $: $155,000 Prop Tax. $1,698.32 Munic: PUTNAM VALLEY TOWN State Use: 210 Lot Area: 47,045 Township: Cnty Use: Zoning: Owners: GELFER MICHAEL & REGINA Census: 110.00 Phone: 8451526 -1159 Mail: 115 JONATHAN DR; MAHOPAC NY 10541 -2209 C003 Ac < ".1 C) v, r � I D 1996 Win2Data 2000 Page: 1 of 4 %0 11) Situs: 340 LAKE SHORE RD, PUTNAM VALLEY NY 10679-1314 R001 APN: 2800-030-018-0001-053-000 Rec/Sale Dt 07/13/1999 06/30/1999 Total Value: $278,200 junty: , PUTNAM, NY Sale Price: $380,000 Land Value: $66,200 Jse: SFR Doc M 1475-371 Impry Value: $212,000 Card -#:.. Map Pg:, 28.00--030-018 1st Mt.g.$:-. - . ..... . Prop Tax: $2,523.89 77 Munic. PUTNAM VALLEY State Use: 210 Lot Area: 28,000 Township: ROARING BROOK LAKE MAP 03 Cnty Use: Zoning: Lot Area: Owners: ABDOO MARK Census: 110.00 Zoning: JOANN S A Phone: HIEBER�PWKFN $HAWNEEX'13. - Mail: 131 PROSPECT AVE; WHITE PLAINS NY 10607-2022 C003 .......... 110.00 %0 11) Situs: 344 LAKE SHOE RD, PUTNAM VALLEY NY 10579-1314 8001 APN: 2800-030-0118-0001~051..000 Rec/Sale Dt: 10/10/2001 10104/2001 Total Value: $304,800 County: PUTNAM, NY Sale Price: $600,000 Land Value: $79,600 Use: SFR Doc #: 1565-252 Impry Value: $225,200 Card #: Map Pg: 2800-030-018 1st Mtg $: $376,000 Prop Tax $2,765.21 Munic: PUTNAM VALLEY TOWN State Use: 210 Lot Area: 28,900 Township: Cnty Use: 110.00 Zoning: Owners: - HIEBER�PWKFN $HAWNEEX'13. - Mail: Census: .......... 110.00 Phone: 845/528-2792 Mail: 175 LONG RIDGE RD; DANBURY CT 06810 12) Situs: 342 LAKE SHORE RD, PUTNAM VALLEY NY 10579-1314 8001 APN: 2800-030-018-0001-052-000 Rec/Sale Dt: 09/28/1967 09/1967 Total Value: $202,000 County: PUTNAM, NY Sale Price: $5,000 Land Value: $65,500 Use: SFR Doc #: 655-363 Impry Value: $136,500 Card #: Map Pg: 2800-030-018 1st Mtg $: Prop Tax: $1,832.58 Munic: PUTNAM VALLEY TOWN State Use: 210 Lot Area: 24,500 Township: Cnty Use: Zoning: Owners: KONRAD ADALBERT A & JOSEPHINE T Census: 110.00 Phone: 914/528-7241 Mail: 342 LAKE SHORE RD; PUTNAM VALLEY NY 10579-1314 8001 ©1996 Win2Data 2000 Page: 3 of 41 Gentlemen; This letter is to authorize John 'S. Romeo a duly licensed professional engineer I. or registered architect (Indicate) to apply.for a Construction Permit for a separate-sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said •s stem • or s _ y _.._...: _ ,.y tems- in._co.nformity- wi- th.- trhe,..provisi-ons' of" `Arti61e 71.5 :or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed weer of Property Countersigned: ��-`> A ress 0278.6 ..... P .E. , 3�7t1IX , # Te 'e one �•^ �.�.�� I Northridge Road (Se ° s; Rp � •' p Address' Peekskill, , New York 10566 737 —.'105'6 • Telephone . '•;?!!j rp��:, Ii iI i II + l RIP7 . s4..1 -{ p y �rl--�n- UL-9 t mil i' V1✓ ��'�-_V i 0 �, C.. � ^D -�yQ V e i G t cr LC' t i, I' i 1 L4 v CIL lit cc V,%-- u L, G-__la --u-T-T X3 ) ° V I MTNAM M*NTY M:MUT�MINT nr ITAT.T11 DTVTSTn\* or MA `f ",3!'7-'r-NTA1, .1fF LT Date October 219 1975 Re: Property of Frank Grolli. Located at lake Shore Road Section Map 655 Block Lot D Gentlemen: This letter-is to authorize John S. Rom ®o i"duly licensed professional engineer X' or registered architect (Indicate) to apply 'for a Construction Permit for a separate sewace- system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County 0 -Department of. Health, and to sign all necessary papers on.my behalf in 0� connection with this matter. and to supervise the construction -of said system or systems in conformity with the provisions of Article 145 or 347, Education Public the Putnam County Sani- tary Code. Very truly yours, Signed Omer of Property ountersicned: Address .E., X=qX 4' 0278,46 1 %Irthridge Road R041 • Telephone 1dress s 3 P , • Peekskill, New York 1056;'= 737 = 1056 , 00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN! OFFICE BUILDING;CARMEi;,` N..'Y: 10512 ' ' DESIGN DATA .-SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Frank Grrolli Address Box 340 Putnam Valleys N.Y. Located at (Street Ike Shore Road Sec�p 655 Block Lot D �-Indicate-nearest cross street) , Municipality, Putnam Valley(T) Watershed Feekskcill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) 1 11,53 12:04 11 13.00 16,00 340 3.67 2 12 :05 12:17 12 12:75 16.75 4.00 3.00 3 4 5- (2) ' 1` 11:50 12:08 A 14.50 17050 3.00 3.33 _.4.33..... 3. 1 2 3 4 Notes: 1) Teets to be repeated at�same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted r for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED "'IN TEST HOLES ' EPTH HOLE NO. 1 2 3 D _ HOLE NO. HOLE N0. 3 eo .. - Tousoa 3 5 Topsoil - 61f sandy gravel (Brown) sandy gravel (Brown) Sandy gravel (Brown) 12" - -`° 24" w' 30" 36" 42" F -- } f 54 II 60" 1 ` ' 66" r _.r 78„ 84" INDICATE 1VEL AT WHICH GROUND WATER IS ENCOUNTERED None INDICATE I VEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ° TESTS MADE BY John S,. Romeo - Date. ..August ,239 1975 D_ESIGN__ 5 Soil' RaLte Used S 'Min%1 "Drop:' S:D. UsableArea' Provided 0003F+ No. of Becrooms 3 Septic Tank Capacity 1000 Gals. Type Masonry Absorptiort Area Provided By 150 L.F.x24" 36 x w]..( ok. pnch. 1�+'r� e!Ptl/1y Lo o Name. -Te%hr A Raniza Signature >; Address 1 Northridge Road SEAL o 1 o= �a Peekskill 0 0 10566 0 ` C THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: 009%�� Soil Rate Approved Sq. Ft /Cal. Checked by TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN..TEST HOLESI HOLE NQ.: .:....HOLE_ PTO: HOLV, N.O. G A 75, N, 7— 13 3 0;'� 4.0! 4S 5.01. 5.5 6 .01 6.5 7.01 7.5 8.0 8.5' 9.0 10.0 Indicate.level.at which groundwater is. encountered Indicate level at which. mottling is observed 4.1 Indicate level to Which water. level rises after being encountered Deep hole observations made by: &r', V� `12 B P, t1, Date Design Professional Name: Addre*s's:- Signature: Design Professional's* Seal 2 r. PUT NAM COUNTY DEPARTMENT OF. -HEALTH, DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner - Address IAkE Sffoyl"e F'�z Located at (Street) Tax Map30j Block Lot (indicate nearest cross street) Municipality TuTw V LL Watershed �elj?!5o 7Z1 V45: I SOIL. PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation 'rest ep e a. .... ....... Sro el r P Tame uda e V . .... ... . ... ... s a r1 hite s un: tar u, NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min f6r 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 2 3 .4 5 2 3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min f6r 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 2 27. Is any portion of this project located within a designated Town or State wetland? A/6 .... 28. Wetlands ID Number :...�:._.�_,....... _ ,r, _ , :.... ........M. ; ..:.........._�.._ 29. Is Wetlands Permit required? ............................................... ............................... of 0 Has application been made to Town or Local DEC office? ............. /i !-' 30. Does project require a DEC Stream Disturban ce Permit? ... ............................... /J 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous. waste disposal, landlilling, sludge application or industrial activity ?. .......... Yes/No 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 X10 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 ? .................................................... ............... fd 0 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /y 36. Tax Map ID Number .......................... ............................... Map 30. /S Block i Lot i �9_ 37. Approved plans are to be returned to ...,. Applicant Design Professional NOTE: All.applications for review .and. appr_cwal: of anew SSTS to be- located within -the •NYC Watershed shall - --- besent 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 th'e Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwaterylans 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 is provision may be grounds for the rejection of any submission.. New �� �E ._..... Yoh I hereby affirm, under penalty of perjury, that information rov' o'n`t re isitrue_ .- to the best of my knowledge and belief Fals ents a der ' r, puq -e as =. a Class A misdemeanor pursuant to Sec on 21 X of 9 enal ;,, SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... 2 'y6H LJ_H Pv�/JKOL(, 0,Y. 16S6C PUTNAM COUNTY DEPARTMENT OF HEALTH DIWSION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWA'T'ER TREATMENT SYSTEM _ 1. Name and address of applicant: 0%CV'.rrt41J-0Rb S3� C,gKcs J'N6f�� %2aA� 2. Name of project: SsTf ,641(V JA16fW' P-6An 3. Location TN: 0,rA)Aih 4. Design Professional:C&�IJIN &N61rv80111( 5. Address: S -�-6NW WA X111 V« 6. Drainage Basin: 2-a-CA C k1a c (-a w (LL, N -V. 16"C 7. Type of Project: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision 8. Is this project subject to State Environmental Quality Review Type Status (check one) ....................... ............................... 9. Is a Draft Environmental Impact Statement (DEIS) required? _ Commercial _ Mobile Home Park _ Other (specify) (SEQR)? Type I Exempt Type II Unlisted .0a 10. Has DEIS been completed and found acceptable by -Lead Agency? ............... 11. Name of Lead Agency ft 12. Is this project in an area under the control of local planning, zoning, or other -off cials; oird- inances,. .....:.:.:..:::::... F...:.:::..:.... ....:...:.....::..:.::...:`..., 13. If so, have plans been submitted to such authorities? ........ ............................... 0i b 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water k groundwater 1 16. If surface water discharge, what is the stream class designation? .................... N � 17. Waters index number (surface) .................... ....................... ............................... N n 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name-,of water'supply 1014 Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system �^`� Distance to sewage system ^' 22. Date test Boles observed -' i�8 /, 2 00 2 23 . Name of Health Inspector 24. Project design flow (gallons per day) ..................• S C)O 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /� o 26. Has SPDES Application been submitted to. local DEC office? ......................... Form PC -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES... DEPTH HOLE NO. D 1 f 2 HOLE NO. 3 HOLE NO. G.L. ., Tc) P's o I L (so - e Pfb I L 0.5 r /�yc .fA../� L o Ar�-r f�N� J /.}ND''l La /1/'1 riti � .1W N0 c. a e4f,• 1.0' 1.5' 2.0' 2.5' 3.0'' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' ._ ... 6-1ZA VV-C- u,,nray MV47t ` Roc-K �ocK. r141JD 19NO 6MVL- L_ r I 8.5' 0 10.0' I ' Indicate level at which groundwater is encountered a0 /Jcs CSC o TC2 Ll� Indicate level at which mottling is observed Indicate level to which water level rises after being encountered /j6 wry 7-611 Fr' to j w Te N,� Deep hole observations made by: Date 6- t4 - 0 'Z- Design Professional Name: Tryon Address: 2 -:3-6111j- w191 -f'l'l Signature: Design Professional's Seal v 62980 '- *FESS�� � PUTNAM COUNTY DEPARTMENT OF HEALTH IIDMSHON OF ENVIRONMENTAL HEALTH SERVICES S1UBSLTRFACtS'ENVAGE TREATMENTT SYSMI - _...,_... S3s- 4AKe- SH0R(s Fa 3't=' Owner —JaKd I�, /' L 1-61A R o Address 'Pgrmq /'z? UFl (-cc7,� . Located at (Street) 4,AKk' _rH a 1Z is folQ '�P Tax Map 3d 1 g `Block ., ; l , Lot (indicate nearest cross street) Municipality fu EtM) tl L (e` Drainage Basin Na LCo w Qzene< < SOIL PERCOLATION TEST DATA Date of Pre- soaking w Al 8- / t So 0 2 Date of Percolation Test _ 3 / �; 2,6(m Hole No. Run Into. Time Start - Stop Ela se Time. i Iin.) Depth to `Pater rom Ground , Surface (Inches) Start Stop Water Level Drop n Inches Percolation Rate Min/Inch 2 3 4, �i %S / 3d 's S 5 %o�� ivy 214 3.: v 4 �� ZS- �i3 i 5 1 2 3 4 5 NOTES: 1. , Tests 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 s submitted for review. Depth measurements to be made from top of hole. Form DD -97 SITE Iii ISPEC'TION FOR FILL PAD . Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Required Length_ Fill Pad With Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) j Additional Comments: Reserved for Field Sketch if Applicable PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: // CC Inspected by: `I� P_ Street. Location _�;c.. Z tl�,� .t'� . ,: .: Owner Town V Permit # � V %42 , -0-3- TN1 # Subdivision Lot # 7 LzLA,- 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width. Avg.Dpth c. Natural soil not stripped .................... .............................. d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic-tank size - 1,000 ...:.....1,250.. . ..other ................ b. Septic'tank installed level ............. ............................... c. 10' minimum from foundation ............................+ d. Distribution Box �� 1. All outlets at same elevation -water tested....... outL 2. Protected below frost ............. ............................... 3... Minimum 2 ft. Original soil between box & tr e. Junction Box - properly set .................�/.�.': .............. 6. Irenches 1. Length required f�1 O ' Length installed 4`y 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... S. Size of gravel 3/4 - 11/2" diameter clean .............. .....: 9. Depth of gravel in trench 12" minimum .......:........... :10:..Pipe ends cap ed ........................:.:. g'' ?iiinn or W&sed S*sterns 7 rf 1. Size of pump chamber ...... %.V'�,� J.....�:. J7 ....:.:..... ..!.�.1 '� 2. Overflow tank ...................... jY.. � 3. Alarin~visuavauaio. ..:......... ............................... 4 Pump easily accessible, manhole to grade ................. 5. First box baffled.-,.: ..................... ...:........................... 6. Cycle witnessed by H.D.estimated flow /cycle. ........... M. House/Building a. House located per approved plans .............. I........:....... .. b. Number of bedrooms .................................................. . IV. Well Well located as per approved plans .......:...... b. Distance from STS area measured 0%c; 0 c. Casing 18" above grade ................. ............ .................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ........................ ........ d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan�jj . f. Curtain drain outfall protected & dinto exist waterco rse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :.......................... i. Erosion control provided ................. ............................... Rev. 12/02 1 YES NU COMMENTS 1 .%! T4_ 4 gf -t (,js G �� :7� �v Form a 01 .:SECTION-D. =DRAINAGE No 18. Will proposed grading materially alter the natural drainage in this or adjacent areas?F--] Yes 19. Will groundwater or surface drainage require special consideration? ........................ F--],Ye,s N 20. Will gullies, ditches, etc., be filled and watercourses be' relocated? .......................... . Yes No F7 YNo SECTION E.* REMARKS. 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? .................................................................. F__] Ye's o N E� Inspection data 22. Do adjacent well's and/or sewage'systems exist ?........... or�-X. %6. E?T es Y 23. Additional comments 24. Site observer /inspector and title Fe_i� 1) 25. Date(s) of obseivation(s)ins ection(s) W/ TEST PIT PROFILES Hole .# -Lot #. Hole # 'Lot# Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling ^M Depth to mottling Depthlb-Codk/imp." Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0- 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0- 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 I . Pi.T']I'NAM COUNTY DEPARTMENT OF YYEAlt,TgY IIXVi[S][ON O&' ENR1O1ENTAB, HEALTH SERVICES._......_.. INITIAL INDIVgDUAL /COMMERCIAL SITE INSPECTION ]FORM SECTION A. GENERAL 04FORMATION Name of Project J�AJ666& (V) ,v M eyCounty pyr�V. isr° Site Locatiori_,4k1J;; .614o7tE,� LTZZ .L ®T b Building construction begun Is property within NYC Watershed ? ................. Extent , Yes No SECTION B. TOPOGRAPHY (Please check all appaop�iate boxes) 1. F--]'Hilly 0 Rolling a Steep slope Gentle slope 0 Flat 2. F__] Evidence of wetlands ;, Low area subject to flooding F__] Bodies of water 0 Drainage ditches RoQck . utcrops Le. . 3. Property lines or corners evident ....................... ............................... 4. Do water courses exist on or adjoin the property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? ................. ............................ .... S.'.' Will extensive -fill-be 'necessary for SSA S-?.. :...:..:..... .. 9. Do filled areas exist within the SSTS area? ........ ............................... If yes, what is the condition of the fill? Yes F7TNo 0 Yes 0 No 0 Yes No 0 Yes No Yes �o Fl Yes• D ' No. ` r?J_"No F__] Yes SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand 0 Gravel ELoam 71 Clay F-1 Hardpan F_1 Mixture 11. Observed from: Borings Bank cut �Backhoe excavations 12. Soil borings /excavations observed by �00 j 17, on ©� 13. Depth to groundwater 4zm on 14. Depth to mottling _'41 Z4 on T 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by 4 7ZeWxI / ",.gl on 17. Soil percolation tests witnessed by C76)411JU on R SECTION D (on back) Form ST -1 TEST PIT DATA M QUIRED TO BE SM3MIT` ED WITII APPLICATION >' DESCRIM'101J OI?: SOTLS .Ii.fdC0II1�':CI�;Pf;D IN '`l'I.S`P .IiOUES ; DEPTH HOLE. 'NO. 1 HOLD N0. HOLE NO. J G.L. 311 Topsoil. Topsoil *. :.: V y 611 sandy gravel (brown) Sandy gravel (Brown) sandy gravel (brown') °` 1i 1211 10711 u 2411 i,; ''•' 1 3011 Z ' 4811 54 it u 66 7211 8411 ` . . ;ra INDICATE LEVEL AT VMCH GROUND WATER IS ENCOUNTERED: None INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING-ENCOUNTERED' TESTS MADE 'BY • John• S.. Romeo Date: Aitust 239 :1975 E I Boil" Vate 'iJsed • 0_5, Mi�/V'Drop: ' S.D. Usable Area Provided 5000SP + No.,'of Bedrooms 3' Septic Tank Capacity 1000 Gals. Type! *o -sorry Absorption Area Provided By 250 L.F.x2411 x_a Address 1` •Northridge 'Road Pee kill, N.Y. 105 SEAL7 THIS SPACE FOR USE BY BEAUPH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by •°e U�7,. I � 1 !� PUTNAM COUNTY DEPARTMENT OF HEIALTH DIVISION, OF 1 NVIRONr- JMT1TAL WINT -1 SERVICES . COUN`l'Y OFFTCE•.PUTLDIPIG, CARMI ?L,, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM. FILE NO. Owner Frank (rani Address Box 340 Putnam Valley, N.Y.* Map 655 ..D .D Located at ( Street Lake Shore Road Sec. Block Lot �Indicate neares - cross street) Putnam Valle Peeksl�ill ' Municipality y (T ) Watershed' rshed SOIL PERCOLATION TEST DATA REOUIRED TO BE SUBMITTED WITH APPLICATIOPIS . Role Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth. to %a ter Water ve No.' Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches; Inches Inches (1) 1 11a53 12:04 11 11,00 16000 3,,00 3667 2 .12 0-05 12:17 12 12075 160.75 3000 3o00 3 4 (2) 1 11:58 12 :08 10 14.50 17,50 3000 333 2 1z :09 ., 12 :22 13 ....__..:.. llo7.5.. _.: 14M5 3000 4033 3. 5 Notes: 1) Tests to be repeated at same depth until a.Proximately equal soil rates are obtained at each percolation test hole. data to be submitted for review. 2) Depth moasurements to be made from top of hole. PUTNAM CO,A N DEPARTMENT Division of;; En ron ►ental ^'Healfh. Services Carine% N Y 10512 I ` -�. 1 Putt'` CONST ,RUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM am Valley . (T) Niap 655 Y. Town or. .Village Located at Labe. Shore Road t Tax Map CJ Block Job_ ..� . ;Owner Frank .Gro1 li Box '34a Pd nam Va1.� ey `, raised Ranch Acre + �BUllding TY e „ Lot Area ° ^ .. 1 Total.` Habitable Spac 125Q Square Feet 2. Number of Bedrooms _� - .Design Flow 1000 250 LF od 24" °trench Separate Sewerage 'system ,to consist of Gal Septic Tank and F TQ De constructed' by r' R Vlg�ent3ni Address HOIlLeste&d Aveii r ., .,. _ � � •Peekskill; N.Y: Water Supply Public Supply from X ^Private Supply, •to be drUletl by ` " Anderson' We11 drillers + A' ddress Barser' Street putnaw `Vaile4 Other Rei;��rements ROB Fill < to :be laced to make. a level afiea even: t h material is ood i - plaee. Y�? C®w b ;: ' ('.represent that Lam wholly. and compieteiy- responsible for =thedesign, and location of :the proposed system(;),_1� serage`disposaI system constructed as'shown on the approved amendment there to and. in accordance with the sta�i •3 aq Qs o e u nam County— dDei artmentbof, Health, :and that on completion'thereof a Certificate of;,Construction Compliance" sat a l4ner.of Healthwill P F r ' ..be submittetl to ,the Department,'and a ,written: guarantee will De furnished the, owner his,successors heir: y ui19 ,GHat said builder will x �, , ., e' of the `issu �. place In:;good operating :condition any' "part of said sewage disposal system during the�periodofitwo(2jV m ow,i y�,edat erica Of.; ilia. approval of She .Certificate; of Corsfruct�on ;Compliance p, the original system`. -or an "repairsst a o; 2j ill ((•described .above will,beaocated as shown onYhe approved plan and that said well will be instalied in accordance ;with the,,star l rule la i f •the Putnam ca County Department of Health k4 �,•`� a ' ' T 20 1977E t r 2I8�6 P.S R.A. •Date {. ! + ": Signed,= ' �: r r i 027846 Address 1 Northr dge, Road ekskill, N.Y 10566, 'i A : )& r • APPROVED FOR >CONSTRUCTION j.hls approval'.' ires;one year from the date issued unless construcUOn' of the;�tliltlih4.�ias been' undertaken and is ' .reV wires! of new ca u. permdma Approved f or: d�sposaC of domestic ;salt dy sewage,..a d /ore P o�m a Iss terrsupply�omy Any' - change or alteration of construction i ,, p Date ~ � By �i`��C)ws Tale r 1 JJ !' `h / . / PUTNAM COUNTY D,EPARTMEN_ T. OF-HEALTH.' :Division . of Environmental Health' Services; mel, :N Y. 1002 CONSTRUCTION PERMIT FOR SEWAGE' DISPOSAL 'SYSTEM' ts�am Valley Village - Located at Ore Section ck .. Roan Br Subdivision e1 - Lot' Job Owner Fra SSLI. ,' X `i a1{i 'V N.i• Rais ch: F.4 Bw,ding _Type Lot Area Number of Bedrooms To I H eb e,� Squ t 1000„ _ tx Separate Sewerage."' m list .of Gal Se Tank ineal feet`: X\' _ wid nc alaar Cons meste d 'sue To be, con ucted Address eekskill, NY 56 Water 'Su pp blic. Supply From trivate supply -to ill y - s PIaCC 11'.dri11 ers . prow o Road ieekskill, NYV'- . A -ddr Other Re re ea fa o- f of • R ' O . re Uir' - ae I represent t t I am wholly an compl I responsible f e design d lot' o of the proposed sy m(sr a age disposal tem above descri will be' con stru class w on,the appr d amend nt. t ' to and in' accordance wit lies �r so t e am County: ;Dap tment of Healt nd,'t t n completi. hereof a_' ertif' t f Construction Co li i ry ner of F I be submitted to the Departmen rid ritfen: gu tee' will fur a owner, his suc'e rs, - ssig uild twot said b place' in •good operating conditio n. art of sa" sewage dis sal 's wring the perio o r 'im to r$�tl�pdate o e iss ance of the approval of the Certi to of Const tion Compt rice- of riginal system ii to;' I ell described above will be located as shown on the appro d plan and t said _well w , instal _ ' in accordan ith ': sta �dard ru n of Putnam County Department of- Health: •. -Date Oat 21s" 1975 s. ed • Q. R.A. l Northridje' RO � eekSla ' 10 ••� 846 Address - �_ H`NO, APPROVED'FOR CONSTRUCTION -, This.approval expires one yearfrom'.the'dafe issued;vi, construction' of i g has been ertaken and is revocable for cause or May-be amended or modified when.considered necessary..,by the Co'mer :of Health" A or.alte n f construction requires a new permit. Approved for.disposal of domestic sanitary-,sewage ,:end /oi private water-supply' only: Date .. . BY • . ,.? ...- k , T.itte o i,t'e PUTNAM" COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION` PERMIT FOR SEWAGE 'DISPOSAL 'SYSTEM::, Town or Village Located of Section Block Subdivision Lot Job Owner Address Building Type Lot Area ' Number of Bedrooms Total Habitable .Space Square Feet Separate Sewerage- System to consist of - Gal. Septic Tank'` lineal feet X width trench To be constructed by Address Water Supply: Public Supply Frorrl;` Private Supply to be drilled by Address Other Requirements, I represent that I am ,wholly and completely responsible for the design and location of :the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o t e u nam County Department of Health, and that on completion_ #hereof a' ?Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee wiif 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 disposai system during the period of two, (2) years Immediately following the date of the issu- ance of• the approval of the Certificate of Construction Compliance of. the original system or any repairs thereto; 2) that the drilled.well described above will be "located as shown on the approved plan'and that said well will be installed In accordance with thee- standards, rules and 'regula ions of the Putnam County Department of Health. Date 5,gned P.E. R.A. Address License No. APPROVED FOR CONSTRUCTION; `This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended-.or modified whenconsidered necessary by the Commissioner of Health. Any change or alteration of construction requires- a new permit. Approved -for disposal of domestic sanitary sewage ,-and /or : R7 y ■ Li ti t-, 1 13 14 Sh t O O U771jry glqS_777� jr�z, 92.00 sm - 0)4_;� �1 P. ' 1392432 "W LOTE ti/ — D OnYR• BOX W/ SPQ60 LEVEIAZf• *0 L.F. 4- 2¢'Le4c//N4 - r" -4/E! e. 0 i i 1 i t i is i 1 f 1y��5P t" i� �c P"'p�.l'AaoF,g 1 1 Ti o LOCATIONS A C 1 553!' A B 3 87' -G" 8.1 , 0 " 4 99'- 3" 93'-O* 6 q'r,- o r, 991-01, 7 9S' -6N 1001.1" 9 R9' -0 107' -O'� 10 ItX>'- pi/ 11 to*'- o" -� 12 /C'3'- O'r 13 lIq/ -o" Ifd -oy 14 ►¢S = 3" 177 '' 15 ► 3' -0" Its, =o° 16 t2,- 4" 17 I t3'- 4" 18 tz'- 0" /-to,- o 19 143!- 3" 137'-o CONCRETE 4, FOUNDATION w — l .l • a 1 i 41 CRA11 P � j �6 it STONE RET. WALL DIRT DRIVE 170.3' POSE ES 402.03' g. h., i T I 0XV Ile o I ti. oNi I I � y ' I } W ' 3 N3924 , 32"W 44 OAK W. PINE CP'IoK" Irm CRA VEL PARKWGI AREA • LOT Y. 22* '.20 OAK OAK (32 a. fil W. 402.03' V 0 7.;57' LE TOPOGRAPHIC SURVEY OF PROPERTY QMI I A"r= Ins "rWIF n.