Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2215
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -6 BOX 19 1 ro I' . 11 "Is Tm .. �r'.'1 T ji. E" a 6 � 02215 NAM COUNTY DEPARTMENT OF HEAL .c '.1,,, .:..- : >,..:..= :KM.= �.,�:,t.:� .,�.'•3'► ii:� .lL+.SRO.L-A�1` Sid .�:d1= 1TA�J..:H:E,:7AL.:S:.'■ 0-:�ER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT S PCHD CONSTRUCTION PERMIT # 01 O Located at 15 af(RtmaVR I y 4s;�r Village l ITN- m V4aF.y Owner /Applicant Name' Cff,4 REP- vE 9CHR0€DAR Tax Map 71.0 5 Block Lot (O Formerly Subdivision Name RMRLi1A bR601( L,+02—' Subd. Lot # 606 Mailing Address 2555 H-ay-A t j /RD, ZT RVNVI,� TO[�/4 J�/f.G1/ �OR'K Zip Date Construction Permit Issued by PCHD 6gl08/-z 00 9 (Ti M wscw 15.4 ✓ &An1 Cr Separate Sewerage System built by ARkG) AVAi T 14C -. Address H jut/Cr9N, Al 2535 — Consisting of 1-000 Gallon Septic Tank and 3�.5L. OF Wft*A+r&72 Other Requirements: Water Supply: ' Public Supply From Address / i EN �V D 0 T or: V Private Supply Drilled by� C . Address C49Mfl g N y -106-t7- Building Type SI1�Gi tE Has-erosion-control- been completed ? -- V�$ Number of Bedrooms 3 Has garbage grinder been installed ? I certify that y �is'1? i built plans opi .'f h ate. w i plans the ar s s;A i ,< gulat on Date- t r- Cd A Address 2, 44mli the above premises were constructed essentially as shown on the as- giccordance with the issued PCHD Construction Permit and approved of the Putnam County Department of Health. P.E. / R.A. License # 66 2-9 80 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 c ge is necessary. B GG c Title: Alb le Date: �O ` e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH _.... _:. ... _ ..DIVISION ...__ ION OF ENVIRONMENTAL HEALTH .SERVI E _ WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # fGPS , Map %0�Block �� Lot(s) Well Owner: Name: %d dress: /X Use of Well: Residential _Public Supply Air cond /heat pump' _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial - -- _ -Institutional Standby_......_„ Drilling Equipment _Rotary _Cable percussionLOCompressed air percussion Other(specify) Well Type - Screened _ Open -end casing °-Open hole in°bedrock. Other " Total Length OW _ft. Materials: Steel Plastic Other Casing Details Length below gradeVft. Joints: Welded Threaded Other Diameter in. Seal: X Cement grout Bentonite Other Weight per foot �lb /ft Drive shoe: ->6 Yes _ No Liner: _Yes No Diameter (in) Slot Size I Length (ft) I Dept to Screen (ft) Develo ed? d it yiera was testea at different depths during drilling list: ressed Air (Hours Well Diameter .Water Bearing in Gallons Per Minute Purnp/stoi Pump Type gu= Depth -7-90 Voltage -P30 Tank Tvoe w)6 as o _Yes No Hours ion uescrt tion ' ^ -I nK intormation Capacity S_ _ Z6- l°eh Model pyLw HP_! Volume y`IG -a. kj NOTE: Exact Location of welt with distances to of least two permanent landmarks to be provided oea separate sheeW. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Screen Details First Second Well Yield Test Bailed Pumpe Depth Date Measure from land surface -state Well Log If more detailed inf6ftgtion , _ .1-and descriptions or sieve analyses are available, please attach. Depth From Surf, ft. ft. Surface .. _.. d it yiera was testea at different depths during drilling list: ressed Air (Hours Well Diameter .Water Bearing in Gallons Per Minute Purnp/stoi Pump Type gu= Depth -7-90 Voltage -P30 Tank Tvoe w)6 as o _Yes No Hours ion uescrt tion ' ^ -I nK intormation Capacity S_ _ Z6- l°eh Model pyLw HP_! Volume y`IG -a. kj NOTE: Exact Location of welt with distances to of least two permanent landmarks to be provided oea separate sheeW. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 '07 -10 -04 15:55 F90M- ... ; .�.a.,...._, • '.�kUi✓E�'IL: Ft51:L11 � .-- ......,... � n ,.,. a ....,: _., ..; Public Health Director T -584 P002/002 F -492 LORETTA MOLINARI R.N., �M.S.N. Associate Public /fealth Director b/reotor of Patient Services DEPARTMENT OF HEALTH 1 Geneva, Road, Brewster, New York 10509 Rnvironeantat Health (84S) 278 - 6130 Pox (84S) 278 - 7921 Nuning Servitor (845) 273 - 6338 WIC (843) 278.6678 Pax (843) 278.6085 8ady. Intervention/Preschool (843) 278.6014 Fax (343) 278.6648 f E911 ADDRESS VERIFICATION FORM OWNERS NAME: Cr�-v �Gk�e�oR TAX MAP NUNMER: �/S•o5 -- 13911 ADDRESS: �5 ogKr2►p4 E t�Q TOWN: t y :�� AUTHORIZED TOWN OFFICIAL: DATE: /D P a 0 The Putnam County Department of Health will not issue a Certificate of construction Corripliance 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 Cortificatc of Construction Compliance. (B91 lvetftm) •���. t�� 1. up I NIA�w a -RE T- :_SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building - Buildini.Constructed by rr Oakridge. Drive Location, - Street Single. Family Residence Building Type 41.05 6 Tax Map Block Lot Putnam Valley TownNillage Roaring Brook Lake Subdivision Name 506 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. i ir�vd A �ZN to Da Month 9 ay 2� Year Signature:'` �y� �,'p2. et % Title: Z r eSi General Contractor (Owner) - Signature C, M A166 OC, . I /A/C �f��U' a�a i Corporation Name (if corporation) Corporation Name (if corpora ion) Address: 255 /VMOVAI r f'M M State JIOW4Yod fl) � Zip -'0533 Address:ljwtr� tl�L, 6 __ e �J` ✓ State /�� I - Zip Z zS-3 3 Form GS -97 YML ENVIRONMENTAL ',SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 r..,... . ; -_ ....._.... .. o_ ;;..,. ,a:y.dn, :.:ATbert.tH: �Padovarii;, virector � ._ ._.....�.,_.,......�.�•yN� -..w. ,.....s..,....- .��,...:, LAB ##: 1.704988 CLIENT #: 60366 PATEMAN- SCHROEDER, CHA 15 OAKRIDGE "DR PUTNAM,.VALLEY, NY 10579 SAMPLING SITE: 15 OAKRIDGE DRIVE PUTNAM VALLEY, NY 10.579 COI;ilb,:;BY:....CHARLENE PATEMAN SCHROEDER NOTES -KITCHEN TAP DATE FLAG PROCEDURE NON STAT PROC PAGE: 1 of 2 DATE /TIME TAKEN:.09 /06/07 DATE /TIME RECD: 09/0,6/07 10:10 REPORT DATE: 09/13/07 PHONE: (845) -216 -0853 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/06/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 09/06/07 LEAD.(,IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B `- NITRATE NI.TROG 0.56 MG /L 0 - 10 SM18- 20450ONO3 ,09/07/07. 09/07/07 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 09/07/07 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 09/07/07 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 09/07/07 SODIUM (Na) 18.8 MG /L N/A SM 18 -20 3111B 09/06/07 pH 6.6 UNITS 6.5 -8.5 SM18 -20 4500HB 09/07/07 HARDNESS,TOTAL 148 MG /L N/A SM 18 -20 2340C 09/07/07 ALKALINITY (AS 54.0 MG /L N/A SM 18 -20 2320B 09/07/07 TURBIDITY (TUR <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: FAX TO 478 -1066 COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATE (WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 100 of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential.. Fe /Mn .If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (_g.14 ) 245 2804 - Albert H. Padovani, Director LAB N# ry1.704988 CLIENT M #: 60366MNNNN� NNNNryNNNNONNSTATNPROCPAGE: 2�of -2NN PATEMAN-S.CHROEDER, CHA 15 OAKRIDGE DR PUTNAM VALLEY, NY 10579 SAMPLING SITE: 15 OAKRIDGE DRIVE : PUTNAM VALLEY, NY 10579 COLD BY: CHARLENE PATEMAN SCHROEDER NOTES...: KITCHEN TAP DATE FLAG PROCEDURE DATE /TIME TAKEN: 09/06/07 DATE /TIME RECD: 09 /06/07 10:10 REPORT DATE: 09/13/07 PHONE: (845) -216 -0853 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM Y . ,.CONCENTRAT.ION, BOTH_ EXPRESSED AS CALCIUM CARBONATE ; _ IN MG /L . THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (l grain /gallon = 17.2 MG /L) SUBMITTED BY: . nj -aa---o Albert H. adovani, M.T.(ASCP) Director ELAP# 10323 COUNTY DEPARTMENT OF IVISION OF ENVIRONMENTAL HEALT] CONSTRUCTION PERMIT FOR SEWAGE TREATME PERMIT # v — Located at (�4y- i Subdivision name ,�Seubd. Lot # �OCo Date Subdivision Approved 7 -1 Owner /Applicant Name e,,% Town or Village Tax Map \ p& Block I_ Lot (_ Renewal -- Revision — Date of Previous Approval Mailing Address 1� l�lurw.�S�+c.X \� ��. �,,.,,,:���� Zip \Z -,gZ. Amount of Fee Enclosed Ajp Building Typ Lot Area (�. �iZ9ty _ No. of Bedrooms _]S_ Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of N ®C3© gallon septic tank and `2 -1S Lf Other Requirements: it - �`V,� To be constructed by-T7V> 1 Address Water Supply: Public Supply From Address . Private -Su ppl 3 t Drilled b Y.... 'V 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 sv tem 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 Constructi omp�wi,,," satisfactory to the Public Health Director will be submitted to the Department, and a written guaran e�,4ilLbe'far A'W* )eowner, his successors, heirs or assigns by the builder, that said builder will place in good opera g rlidition any' d sewage treatment system during the period of two (2) years immediately following the -date * �sua '.0f,the ° , of the Certificate of Construction Compliance of the original system or an re airs thereto.,t Y Y 1? ..: :,:. ".'A Signed: Address 4J P.E. I R.A. Date 'S -Z - -(36, License # "Q°�o 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 perm Approved for charge of domestic sanitary se ge only. r By: G Title: Date: White copy - HD File; ello c)y - guilding Inspector; Pink copy J-)wne, Orange copy -Design Professional Form CP -97 P T NAM COUNTY DEPARTMENT OF HEALTH H DffVffSION OF IENTROD M ENTAL HEALTH S EI1 WCIES _ .. _.. APP)PCATI ON,, 70 CONSTRUCI A. WA,TP.�,X LL _ _ .....,. ,......µ� .w , please print or type _ PCHD Permit WeRR Location: Street Address: o Tax Grid # MapA%,c>S Block \ Lot(s) WeRR owner: Name: Address: e G\ G f • n Mx_ � - l`M � Use off WeIlIl: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served_ Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply dDiriIlIling New Supply (new dwelling) Deepen Existing Well Detailed Reason o for )IDirifling Weep 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 � ;�VV IA,--* S ,�� Lot No. SO(o Water Well Contractor: 7ES0 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 contaminat' bppr.vded separate sheetlplan. Date:�3��Z'Z ez>6 Applicant Signature: PEST 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. APPROV EIlD.POR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. / A - Date of Issue -Z Permit Date of Expiration — --0 _ Title: _ Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner Orange copy - Well driller 6 Form WP -97 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: ROBERT J. BONDI ...... _....._... .. .._...:�CbuHty�rrecutide .. .. ..... ..... _ . . j DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 _ � Q E NAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER rye 5ui Gf". ;..�'l %.►� 1��J- �(i (/� rt r L/ � `�/�- � c-�t �;� 6f `.�- ..�c�. �Uf9d .1/� � C •L2.�- / !1/00 SPECIFIC WAIVER y� _ 10 REQUEST: �- DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? _....... YES' ❑__, .._._._....,.. 'N6 WILL DISAPPROVAL, RESULT IN A SIGNIFICANT HARDSHIP? . YES ) NO ❑ DISCUSSION REQUEST APPROVAL OR DENIED APPROVED t DENIED ❑ REASON FOR DENIAL DATE COMMISSIONER OF HEALTH (3PECwAIVER) Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 S(-U-1 -%ver NEW YORK STATE DEPARTMENT OF HEALTH - _ Spec S fl p Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ............. ............. .................................................................................. ........ 2. Proposed design or conditions of waiver: ..........s ?. a.... f ..........`"......'"�' F a.l... .. P......... .............................................................................................. :.............................. 5.... c�:....s.. ....... ... .................... ,................................................................................................................................. 'GL..�,.......... ""-' ........:....................................:................................................ ............................... ........ . . : . . . . . . . . ... . . ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. LJ Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) .......................................................................................................................................................................... ............................... Q �, ....................................................................................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. .. ....r .......................... ............. ... ........................ ............................... EPRESENTATIVE OF M!AISS N OF HEALTH ORIGINAL -Local Health Agency COPY - Applicant/Design Professional DATE DOH -1326 (7/92) (GEN -152) 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: Fingle JECT NAME: Adrienne Pateman family residence construction 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) Lot 506, approximately 1 mile from intersection of Pudding Street and Taconic State Parkway 5. PROPOSED ACTION IS: ENew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construct a new single family residence 7. AMOUNT OF LAND AFFECTED: Initially 0.7296 acres Ultimately 0.7296 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ■§Yes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial OCommercial ❑Agricultural ❑Park/Forest/Open space ❑Other Describe: Surrounding lots consist of single family residences 110. DOES ACTIONW INVOLVE A PERMIT APPROVAL, OR FUNDING :Nd 'OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑■ Yes ❑No If yes, list agency(s) name and permit/approvals Town of Putnam Valley— Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes I■ No If yes, list agency(s) name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes E■ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sp or ame: rro ' En inee in 13 . P.C. /John L. Cronin! date: March 21, 2006 Signature: If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment UVLK 1 PART II- ENVIRONMENTAL ASSESSMENT To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process use the FULL EAF ❑Yes QNo B. WILL ACTION RECEIVE COORgINATEp; RE!/IEV1j. AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If.No, a negative declaration may be superseded by another involved agency. ❑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: No — Construction of a single family residence in a residential neighborhood C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No — Construction of a single family residence in a residential neighborhood C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No — Construction of a single family residence in a residential neighborhood 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: No — Construction of a single family residence in a residential neighborhood C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: No — Construction of a single family residence in a residential neighborhood C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: No — Construction of a single family residence in a residential neighborhood C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: . No — Construction of a single family residence in a residential neighborhood D. WILL'fl!E PRO4F9T HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL tOVIRONMENTAL AREA (CEA)? ❑Yes INo If Yes, explain briefly: E. IS THERE, OR lam` HERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ` ' §No ItYes, explain briefly: Part III PE , T , E - RMI ION OF SIGNIFICANCE (To be completed by Agency) INSCTI S: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise signifcai�t. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)eversibility; (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. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the on the environmental cnaractenstics of true ULA. ❑ 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: A;CAZ -z /'� l d z,�sa-,- or Print or Type Name of Responsible Officer in Lead Agency Signature if Prepa r If different from responsible officer) of Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency -7 -Zl -a(;., date I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF, ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of ���' /�I�J Located at Subdivision of �c_lle Tax Map # AN.o'& Block 1 Lot (o Subdivision Lot Filed Map # Date Filed - 1 -� -�� Gentlemen: This letter is to authorize a duly licensed Professional Engineer Vr Registe4 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 supple systems in conformity with the provision.. le 145 and/or 147 of the Education Law, the Public Health Law: and the Putnarri ',r �.EW. ,. Co o rev Sanitaryo .... - _ . ,.. . Very truly Vours. Countersign �d< �`' igned jors L-1, 1 P.E., R.A., # Z� � / ; (Owner of Propem•) \off, 62qW.A 0 Mailing Address 2 State Zip Telephone: • jMailinor Address: State �1iZ Vj �I`CJ /Ul. Zip Telephone: 63y) �J&—O&Z3 Form LA -97 -PUTNAM:- COUNTY - -DEPARTMENT O- HEALTH DIVISION OF .ENVIRONMENTAL HEALTH SERVICES ...: APPLICA7CION -FOR APPROVAL= OF;PLANS->F'O�t A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: _rCdtr; e-n C A- 2. Name of project: i!5>S \ 5 3. Location TN: g \.OS { \ . SoG 4. Design Professional: �a,;,� 5. Address: 2 6. Drainage Basin:ye-4 -S \u \i \)6\\ 0-21 C.-I, 7. Type of Project: 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 YP ( one) ....................... ............................... Type I Exempt Type II Unlisted ?C 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N� 11. Name of Lead Agency I�1P 12. Is this project.in an area under the control of local planning, zoning, or other. _ _..:officials; ordinances� .:.::.:.::....:..:' ............... ............................... .... ..............: _ ... , .........._...... 13. If so, have plans been submitted to such authorities? ........ ............................... lAo i 763%'N!�o 14. Has preliminary approval been granted by such authorities? 1 , Date granted: IAN 15. Type of Sewage Treatment System Discharge ........... ...... surface water X groundwater 16. If surface water discharge; what is the stream class designation? .................... JAN 17. Waters index number (surface) .................................:........ ............................... • NR 18. Is project located near a public water supply system? .... ............................... D 19. If yes, name of water supply Distance to water supply !b\ 20. Is project site near a.public sewage collection or treatment system? ................ NO 21. Name of sewage system P1 Distance to sewage system 101 22. Date test holes observed 73-1(O— 06 23. Name of Health Inspector 24. Project design flow -(galloris per day) .......... . ....... ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... �n 26. Has SPDES Application been submitted to local DEC office? ......................... NN Fomi PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? 1l0 :..:,.. 28. Wetlands ID Number ...................................... .. .............. .... ........ ::.:..:...... �A 29. Is Wetlands Permit required? ......... ................ ................ ............... 110 Has application been made to Town or Local DEC office? ............................... jVP 30. Does project require a DEC Stream Disturbance Permit? .. ............................ .... go 31. Is or was project site used for agricultural activity involving application of pdsticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes&. 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? ............................... Yesg) DESCRIBE: 33. Is there a local master plan on file with the Town or Villages 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? �i 35. Are any sewage treatment areas in excess of 15% slope? - �-Z. .. 0 ! o 36. Tax Map ID Number .......................... ............................... Map ,v5 Block \ Lot (0 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE;. -.11 appUc.ationsToz review and approval of a new SSTS•to be located-within- ffieNYC 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 true to the best of my knowledge and belief. False 70'44'5 en41 made herein are punishable as a Class A misdemeanor pursuant to Section he Pe aw. SIGNATURES & OFFICIAL TITLES: Mailing Address �� C� PUTNAM COUNTY DEPARTMENT OYHEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.... _ _._. _ 1., �.,_ .. . ,::....,._ ._;._`DEESIG`N -DAT SHEET- 'SUBSURFAC:E"SENVAG 1" A`I'IVI NT SYSTE1vI Owner V ;f_Y1NV.A_ Q��e�,.C.,� Address 14 Located at (Street) (01y- �� ;.,,e_ Tax MapA\.OS Block l Lot (o (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking 7\Q� --0 ro Date of Percolation Test iv v i L3: t . r ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ,(i.e: s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2., Depth measurements to be made from top of hole. Form DD -97 De_ppth to Water Water From Ground Level Percolation Hole No. Run No. Time Start Stop Ela se Time Surface (Inches) Start Stop Dro In Inc�es Rate Min/Inch - illin.) 1 ' 1 Vr_ \'° 21(t) 2t Zy 3 0 2 2 '- \�Z o Z\ z3 5 z "s Z I l "y z 1 z3 2. 15 4 Z`5 - 1Z4� 3c= z� z3 2 IS 5 Z 1 10us _ ►� 30 20 22 ,s 21 S Z _. 2..._ .._..1`,�_...� , 11q� 3o so 3 & 30 zo z z 2 \5 4 - 1 Z 30 10 2. z Z 15 5 1 OS� W -1 zo Z 3 3 C� 2 11�� 11yA 3© 1.o, 3 11s� IZZ� 30 4 1 Z 3 Zs 3 3c> zo 22 L 5. IZSS IzS 3d Zo zl,'S Z.J IL iv v i L3: t . r ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ,(i.e: s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2., Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' OA TEST PIT DATA .E,SCRIPTION Off' SOILS ,ENC-OUN-T,E-RED-IN TEST iEIOLES - - — HOLE NO. HOLE NO. -70 " "..A 7.51 8.0' 8. 5' - .. ..... 9.01 95 10.01 HOLE NO. Vj N a- Indicate level at which groundwater is encountered c�' Indicate level at which mottling is observed M Indicate level to which water level rises after being encountered V1- 5 n3- Deep hole observations made by: Date S];L'i k Design Professional Name: Address: Signature: Design Professional's Seal 62 PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ °DESIGN DATA S IE`ET'= SUBSURFACVSnVAGE• T REA' IVIENT SYSTEM Owner �L* •C r.-,c.,,, Address kLi \Ab .,.&-, S�,�F.1� Ci- . �%r N,�, • 11� 1 Located at (Street) Tax Map I.o " Block` 1 Lot (o (indicate nearest cross street) Municipality "Qv�-�, v Mz_ Drainage Basin 91z4 AIM ;1i SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time . Start - Stop Ela se Time (pli Iin.) Dfe th to Water )rom Groand Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Nlin/Inch 1 ,2 4 5 3 4 5 1 2 3 4 5 NOTES: 1.. Jests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s, l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA -ED, IN-T-EST HOLES: . ...... DESCRIP-TIONOF,.$QILSENC-OUN-TE-R- DEPTH G.L. 0.5' 1.01 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' 8.5' 9.01 9.5' 10.0' HOLE NO. HOLE NO. HOLE NO. 2 G� ;= Indicate level at which groundwater is encountered NN Indicate level at which mottling is observed MN Indicate level to which water level rises after being encountered hl Deep hole observations made by: Date 0 V. I W Design Professional Name: Address: ? . �;1_ -,--) \ Signature: _ � - MOM Design Professional's Seal CY_0: Ui Ui 62- PRO Indicate level at which groundwater is encountered NN Indicate level at which mottling is observed MN Indicate level to which water level rises after being encountered hl Deep hole observations made by: Date 0 V. I W Design Professional Name: Address: ? . �;1_ -,--) \ Signature: _ � - MOM Design Professional's Seal CY_0: Ui Ui 62- PRO ostar serviceThl :CERTIFIED MAILT. RECEIPT M 1 CERTIFIED MAILT. RECEIPT M I O Do (mestic Mail nly; No Insurance Coverage Provided) U.S.. Postal ServiceTM (Domestic Mail Only; No Insurance Coverage Provided) ru ru For delivery information visit our website at vvv;w.usps.comb Ork -0 F "F I C I A L .-US E OFF I C IA L U SE C3 P00*0J M M Certified Fee 1ACK Nk C3 Certified Fee C'L �" �--41yv'k C3 Cq, V0 / �'\ C3 C3 Return Reclept Fee Ptmark� M �:;, Here (En Return Reclept Fee Here (Endorsement Required) C3 (Endorsement Required) 101) C3 Restricted Delivery Fee C3 Restricted Delivery Fee Ln (Endorsement Required) LTI (Endorsement Required) M M Total Postage 9L Fees /4/ r4 -Total Postage It C—Q t' o c3Melba Garcia — C3 Sent To Cl Meichelle Ann Bell spo - Nicasio Garcia N&Wjf'AWf? .-.- 171 WC or PO Bax*N 19 oakridge Drive or PO Box Na 12 Oakridge Drive '15FEiii,2 Putnam Valley, NY 10579 Putnam Valley, NY 10579 Er ru ru For delivery information visit -T our website at www.usps.comD- -�/ F F I I A L U E C3 M Postage $ M Certified Fee 0 C3 C3 Return Reciept Fee Postmark Oro (Endorsement Required) C3 Restricted Delivery Fee Lr) (Endorsement Required) M Total Postage & Fees C3 -39-t o Roaring Brook Lake District C3 17- . �RWCAWFW Town Hall or PO Sax No 265 Oscawana Lake Road -State, -Zi Putnam Valle y...NY..19579 M Restricted Dellver, Fee u (Endorsement Required) M Total Postage & Fees $ C3 Sent C3 Barbara Jenkins ......... URWE orP01 11 Oakridge Drive city, si Putnam Valley, NY 10579 ......... PS Form 80 U.S O. ta l c sF S r vC TI . eI ice CERTIFI ED MAI�T RECEIPT . (Domestic Mail Oni y, No Insurance Coverage Provide d ) For delivery information visit our website at www.usps.corqD 0 I C F F A E U3 AIL - M Postage V) r M Certified Fe,&-- C3 : C3 C3 Return Re Fair, orsemerrt C'ep' (End Required)- o stm ark iv,,jilera M Restricted Dellver, Fee u (Endorsement Required) M Total Postage & Fees $ C3 Sent C3 Barbara Jenkins ......... URWE orP01 11 Oakridge Drive city, si Putnam Valley, NY 10579 ......... Sheet of __. PUTNAM COUNTY. DEPARTMENT. OF HEALTH _ VISI ®& -,-dr k&WR®INMEN;f ftEnffi S]E➢.tVICES FIELD AC'T'IVI'T'Y REPORT NAM'F• ,4%0 I F VA16 6P7CQ✓ Tel: Street Town State Zip PERSON IN CHARGE 7/2,� U Name and Title TYPE OF FACILITY :/ FINDINGS: S6 vl 3 DW / Wh S c6tc K PC$ LL Sbc7 tool 'J &-i-1,vCP- 5zoo4,�017-7-E? .51rA)0j 7 e:rl n.TCn12r'rnn. /(/ / %a 1-f X TTU Signnd Title RFPCIRT RFCF.TVF.T) BY-* -- I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. Title. 7� .1Y fi 1. -TT)R 'p" u TNA m, tN tPOF"HEALTH N IVII. _�O P". IUT ,- Y +:L'.-IND -4:: i N .............. Y-i 7i. ti R::: 7 ..... ..... Q :Y 7777-777.���� 77 iturb and 7itle'' VA .w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH MTVID.UAL W.:ATER,SUPPL•Y -& SLRSURFACE SEWAGE`Il EA Mi" SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: d• e ""� STREET LOCATION: D&k-ni&e- n REVIEWED.BY: RM, G Jat�, SRDATE: 1 ©�" TAX IvIAP#: (CONFIRMED) DU ' C� T DOCUMENTS Y . N, fREOUYRED DETAILS ON PLANS CONT'Dl JPERMIT APPLICATION r ✓ HOUSE SEWER - 2' FT. 4 "0'; TYPE PIPE.CAST IRON _)WELL PERMIT OR PWS LETTER CZ- U �/ l\TO BENDS; MAX BENDS 45' W /CLEANOUT JPC =97 RENEWALS -'' _)LETTER OF AUTHORIZATION G (NO CHANG:...'---,--� GN.DATA SHEET (DDS) ?ORATE RESOLUTION RT EAF 4S -THREE SETTS r/ SETS SUBDIVISION (i—I/l ON (- LEGAL SUBDIVISI ' =SUBD•IVISION APPROVAL CHECKED ED U T RAIN REQUIRED V "J GENKRJLL UC.6i6CATED .IN NYC WATERSHED NUTTED TO DEP E TO PCHD U VAL, IF REQ'D C__)DFi, TEST HOLES OBSERVED _ )(RCS TO BE WITNESSED _)- APPROVAL SSDS ADJ, LOTS _} WETLANDS (TOWN/DEC PERMIT REQ'D ?) O"D— S7PLA.NS- &-PM0M SAME ¢ TGHBOR NOTmi- ', =�. _ ' L,L • TTFc STG`e�BA - �(t 1 YIt: FLOOD ELEVATION W1I 200'' SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS AGE SYSTEM PLAN - (NORTH ARROW) ,- J�CONSTRITCTION NOTES 1 -IS DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EMTING & PROPOSED r DRIVEWAY & SLOPES, CUT DRAINS SDA SOIL TYPE BOUNDARIES 4 TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# A DTE OFD%SAWING/REVIS %ON � DATUM REFERENCE . L,LOCATION OF VIATERCOURSES, PONDS )LAIM,WETLANDS WITHIN 200' OF P.L. L,PROPOSED FINISH FLOOR AND - As SSDS'S WIIN 200' OF SSTS . (EROSION CONTROL FOXHOUSE, WELL do SSTS, EROSION CONTROL NOTE SLOPES 3:1 TO GRADE / (lj6L )FILL IN EXPANSION AREA FILL GREATER THAN FEET -L)L) CLAY BARRIER, UUFILL •CERTIFICATION NOTE (—• )L JDEPTH GAUGES UL—)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (__)(SEPARATION DISTANCE FROM•TOE OF SLOPE TRENCH- . W=-DETARJDUST.FME F TRENCH PROVIDED 60FT MAID ARALLEL TO CONTOURS CRUSHED'STONE OR WASHED GRAVEL EOTEXTtt COVER SEPARATION DISTANCES ON PLAN, FROM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. Lj4�20' TO FOUNDATION WALLS L� 100' TO WELL, 200' IN DLOD,150' TQ PITS L�100' TO STREAM, WATERCOURSE, LAICE•(iac. expaii):. _.:.:.s, _ • -• L)50' -TO CATCH BASIN, 35'. STORYYDRAIN, PIPED WATER L�10' TO WATER LINE (pits - 20') )50' DRAINAGE COURSE U 20011500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (z10' MIN TO LEDGE .0U* TCROP SEPTIC TANK ( G10' FR011% FOUNDATION; 50' TO WELL t(�� IMENSIONS i0 PROPERTYL LOCATION OF SERVICE CONNECTION L�MIPI IS' TO'PROPERTY:I;Y1QiE PE LOPE' IN SSTS AREA (520%) C_ J�. o (___)L�REGRADED TO 15 /o, EP REQUIRED DOSE/PUMP SiTsmm LJ(—)P.UMP NOTES . �6 {(_,__)DOSE 75% OF P OSE VOLUME NO L—.JL_)DETAIL RCE-MAIN, (PIPE TYPE, ETC.) (�U D -BOX SHOWN & DETAILED 1 DAY STORAGE AB®VE ALARM'S i ,! 5' to %, 20' -4 %, Z5' -3 %, 35' -1 %,100 % -<1% (—)L,20' o CD DLSCB[ARGE/100' with 182 cons day discharge (—JL�}t6' MIN to NON. PERFORATED PIPE 'A�1MEIdT5: �i� c���ws -- v�.�.� v'� � tv-�i �z - -� ��.,�� p�,�= d :•.� ..• , Q(r GyEj fJc c •s PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # SW '' Located at OAKS& –DRIVE 00 4 Subdivision name G F Subd. Lot # 506 Date Subdivision Approved a01 �19 X19 Owner /Applicant Name ADPLI E N F- 'P-4TF E31or VillageTbnm V 141E Tax Map 111.65 Block 1 Lot Renewal — Revision _ Date of Previous Approval Mailing Address 1q h14N rm 14 UQCLE CT, $TOlt In V I L(.F,, Al y. Zip 125 82 Amount of Fee Enclosed O• �29�, Building Type RG T/ S �DENAL– Lot Area AG 3 � No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD.NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of :1-,,000 ` gallon septic tank and 3 75 L • F. Other Requirements: F X ►S T /A/4 PA-I> To be constructed by T16i) (Liceww CWreRt,yaR Address Water Supply: Public Supply From Address •or:... ,,/ Private -Supply Drilled. by Tl .., _ 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 systein described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations o , County Department of Health, and that on completion thereof a "Certificate of Construction Complian 1�ti" w e Public Health Director will be submitted to the Department, and a written guarantee will be ' fu h th &,o is s cessors, heirs or assigns by the builder, that said builder will place in good operating condition 'ny of evi�ag� r , tment system during the period of two (2) years immediately following the aof the issuanc 'of ap �;,(p,the C ifi ate of Construction Compliance of the original system or any repair ereto. Li R.A. Date OS D (a 4v- License Address Z 40ffA1 &JAiM 30UL # �� 29 a 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 jy: it. Approved for discharge of domestic sanitary sewage only. t� jjGG Title: Date: O d L07 - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner A -Dr—I6NNE TARMAd Address 1y 1?oN6y5uctcc5 GT. Located at (Street) KRIDG 721vt= Tax Map .05 Block 1- Lot. 6 (indicate nearest cross street) Municipality FuTA/Rnm Vmg F.A4 Watershed Itra, goc Low G e"K, SOIL PERCOLATION TEST DATA Date of Pre - soaking %(o�o�` Date of Percolation Test Or7-h7/07 No. Run Run No. Time Start -Stop Elapse Time (Min.) Depth to Water From Ground 'Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 1 9:03- 9:09 (0 2Y" 2+ 3'' 2 2 9: -9: 19 9 ZY" 2.71' 31# 3 -3 9-26 —9:32 12 2q" 23" y 4 9 :33 - 9: y5 J7 2y" Z31' 3" Al 5 2 1 9:50 -9:59 9 2Y' Z ? ►' -5 3 4 '�- 22 Zy'- . y @Tr 31' y 5 2 3 4 Tests to be repeated at same depth until approximately equal percolation rates are, obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 minhnch <_ 21 min for 31 -60 min/inch). All data to be submitted for review. Depth measurements to be made from top of hole. 7 Fomi DD -97 Ps. I of-2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered. Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional=s Seal Ld F S1 PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVMONiMMNTAL HEALTH SERVICES ]FINAL SITE INSPECTION itreet Location a,� Coven f!TNAM y Lid' ...... - GM W., D Date: Inspected by: ' Owner /i P�o%s�! n N Permit g 19V -0y -06 Subdivision Lot # S-0 L. Sewage Svstem 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. 1 00' from water course /wetland ...... ............................... OL Sewage System a. Septic tank size - 1,000 ... ' ...1, 250 ......... other ................ b. ' Septic'tank installed level ......... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. All outlets at same elevation -water tested ...... :........... 2. Protected below frost ................... ............................... 3 Muumum 2 ft.Original soil between box & trenches e. Junction Bog - properly set ...... .................:............. 6. rent es 1. Length required Length installed. 37� 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 % ......................... 8. Size of gravel 3/4 11/z" diameter clean ............... .... : 9. Depth of gravel in trench 12" minimum ........ :........... 10. Pipe ends ca ed ................. ............................... g. Puma or Dose vstems 1. Size of pump chamber.........' ....... ........:.............:........ 2. Overflow tank ......................... .......... ......... I ............... 3. Alarm, visual/audio ........:.... ....... .. ............................... 4. Pump. easily accessible, manhole to grade ................. 5. First box baffled.....' ..:.................. ............................... 6. Cycle witnessed by H.D.estimated flow /cyc ........ III.. House/Building a. ' House eroof be er ap . p roved plans .............. ..�. ......... b. p ..................... ............................... IV. Well Well located as per approved plans.:..... ;.......... b. Distance from STS area measured fa . ft........... c. Casing.18" above grade ................ ............. ................... d. Surface drainage around well acceptable .........:............. V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipe's installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.......:..... I .................... i. Erosion control provided .................. ............................... Rev. 12/02 RONIN ENGENEERffNG, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 Te1.: 914 - 736 -3664 o Fax: 914 -736 -3693` November 15, 2007 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Pe: Charlene Shroeder (Certificate of Construction Compliance Revision I 15 ®akdidge Drive Town of Putnam Valley, New York 10579 Section: 41.05, Block. 9, Lot. 5 Dear Mr. Paravati, Per your comment letter dated October 22,.2007, enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: -41 Four(4) revised Sets of "As- Built' Planss�gned:arDd sealed.:by- the-the _... _ Professional of this office. 4 2. Three (3) Copies of the Well Completion Report, signed by the Well Driller and the Pump Installer. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, mes W. Teed Project Engineer cc: File- Pateman -15 Oalvidge Drive, Submittal, PCDH,Transmittal Letter, 11- 1547.doc C.M. Pateman & Associates, Inc. - General Contractor SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . ' `` "" ' " "1 Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster,' New York 10509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT J. BONDI County Executive ROBERT MORRIS, PE .. -.w .,.,.....,I Director of Environmental Health October 22, 2007 Re: Construction Compliance — Schroeder 15 Oakridge Drive, (T) Putnam Valley TM # 41.05 -1 -6 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. The well completion - report waa not.Co -tnpleted .otnd:3k.as:.uoL.signed by .the pump_ilastaller;. - -. -- - -- - -•. •r - -• 2. The plans make reference to "The Town of Cortlandt Tax ID: ". 3. The dimensions measured from corner `B' appear to be incorrect. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:ens Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 RONIN ENGINEERffNG, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 . Tel.: 914- 736 -3664 o "Fak: 914- 736 =3693 October 10, 2007 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Pe° Charlene Slnroeder Certificate of Construcgo®n Compliance 15 Oakridge Drive Town of Putnam Valley, New York 1 0599 Section: 41.05, Block. 1, Lot. 6 Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: 1. Four (4) Certificates of Construction Compliance 2. Four (4) Sets of "As- Built" Plans signed and sealed by the Design Professional of this office.. , . _.... Three (3) Copies of a two (2) year guarantee, signed by the Owner. 4. One (1) Copy of Satisfactory Results of a Water Analysis by a NYSDOH Approved Laboratory. 5. One (1) Well Completion Report, signed by the Well Driller, including the results of a 6 hour Pump Test.. 6. One (1) E911 Address Verification Form 7. One (1) Copy of Approved Construction Permit 8. One (1) Certified Check in the amount of $300 de payable to the Putnam County Health Department. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfull Submitted, J Teed - roject Engineer Cc: File- Pateman -15 Oakridge Drive,Submittal,PCDH,Transmittal Letter, 10- 10- 07.doc C.M. Pateman & Associates, Inc.- General Contractor SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road,, Brewster, New York 10509 August 15; 2007 Cronin Engineering. The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Attn: James Teed Dear Mr. Teed ROBERT I BONDI County Executive Director of Environmental Health Re: Field Inspection — Pateman 68 Oak Ridge Road (T) Putnam Valley, T.M. # 41.6 -1 -4 The above referenced separate sewage treatment system can be backfilled. The bedroom count and well inspection were also 'performed today. There are no further concerns at this time.. If you have any further questions, please contact me at (845) 278 -6130. JD:ens Sinc eIY, . . P.k Joseph Digit Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278-6014 Fax (845) 278 =6648 '07 -08 -15 10:14 FROM- T -478 P001/002 F -213 3M THE LINDY BUILDING, SUITE 200 2 JOHN WALSH BOULEVARD, PEEKSKILL NY 10566 (PH) 914 - 736 -3664 (FX) 914 -736 -3693 August 15, 2007 Too Joe Paravati Fax: (8451278-7921 Phone: (S4 a) 270 -8130 ext- 2157 Pages: 2 Including cover sheet) _ From., Jaynes W. Teed,, ftedalcroninengineering.not RE. Request for Final Inspection- Trenches Pateman, Adrienne Oakrldge Drive Town of Putnam Malley, New York Section,* 41005, Block., 1, Lot-1, Sublot., 508 CC: l� Urgent [x] For Review d Please Comment [x] Please Reply Please Recycle Comments; Attached for your review and inspection is the request for final inspection of the trench system at the above referenced lot. Please do not hesitate in contacting me if you have any questions or require additional information. Sincerely, �Y s W. Teed Jr. Cc: File- Pateman,Oakridge Drive,Paravati,Pax,08- 15- 07.doc '07 -08 -15 10:14 FROM- T-478 P002/002 F -213 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SER'V'ICES ATTENTION ✓1 JOSEPH REQUEST FOR F1Ti_ AL TNSPECTM 1] GENE All infomnlation must be fully completed prior to any inspections being made_ For: Fill Trenches PCHD Construction Permit # 1XV -12 -06 / PV -04-06 Located. Oskridro Wive !Vl Putnam Valley Owner /Applicant Name: Adrienne PAtcmarr TM at'us Block 1 Lot 6 Formerly; Subdivision Name: Rearing Brook Subdivision Lot # "1 Is system fill completed? Yes Date: 06-2 8.200' Is system complete? Yes Date: 06 -14 -2007 Is system constructed as per plans? Yes Is well drilled? Yes Is well located as per plans? Yes Are erosion'control measures in place? Y I certify that the system(s), as listed, at the above prerni& and verified their completion in accordance with approved plans and the Standards, Rules and�u ' ..:. ,... Health..... .. _ . : - .... J Date: 08 -15 -2007 Certified Address: 2 John Watch Boulevard, Reakskill, NY 10566 Date: 12-20 -2006 ;tructed and I have inspected onstruction Peml t and County Depmtneint of PE " RA 52980 `a . ^'OF�BS� °�'� 062980 Comments: System constructed by Tim Zubradt- Arrow Excavating Inc. Form Flit -99 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 27, 2007 James Teed, Jr. Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT' J.BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Pateman 15 Oakridge Drive (T) Putnam Valley, TM # 41.05-1-6 A reinspection of the fill pad was made . today and all concerns of the letter dated June 29, 2007 were- If you have any further questions, please contact me at (845) 278-6130, ext. 2155. JD:kly UIO/001 Engineering Aide Environmental Health (845) 278-6130 Fax (845) 278-7921 Water Supply Section (845) 225-5186 Fax (845) 22 1 5-5418 Nursing Services (845) 278-6558 Fax (845) 278-6026 WIC (845) 278-6678 Nursing Home Care Fax (845) 278-6085 Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health L X10'1 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster,'New York 10509 June 29, 2006 Cronin Engineering Attn: James W. Teed, Jr. The Lindy Building, Suite 200 2 John Walsh Blvd. . Peekskill, NY 10566 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection- Pateman Oak Ridge Dr (T) Putnam Valley, T.M. #41.05 -1 -6 Dear Mr. Teed: A fill pad inspection was made today and there were a few concerns that need to be addressed. V1: Silt fences must be erected and maintained as per approved plan. - - ,�2. Deep holes' for fill pad need to be dug (I Primary /I Expansion) 3. Stock pile of run of bank in middle of primary area. Please clarify. l4-40 If you have any further questions, please contact me at (845) 278 -6130. JD:ens Sinc ely, J igit. Environmental Health Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 UsvJ �� '07 -06 -27 10;29 FROM- THE LINDY BUILDING, SUITE 200 2 JOHN WALSH BOULEVARD, PEEKSKILL NY 10566 (PH) 914 -736 -3664 (FX) 914 -736 -3693 T -382 F001/002 F -952 June 27, 2007 To: Mr. Joseph S. Paravati. Jr. -- Fax: (845) 278 -7921 Phone, (845) 278.6130 Pages: 2 including cover sheet) _ From: James W. Teed 'teed croninen ineso`in .net RE. Patemanp Aalrrenne Oakridgie Drive 'Town of Putnam Valley, Now York Section: 49.05, Block. 9, Lot. d CC: [ ] Urgent [x] For Review 0 Please Comment Ex] Please Reply � ] Please Recycle Attached for your use please find the final inspection request form (fill only) for the above referenced lot. Please do not hesitate in contacting me if you have any questions or require additional information. Sincerely, fl e�"Ivo JA A. James W. Teed Jr. Cc: File- Pateman,Oakridge,Court, Fax, 06 -2707 '07 -06 -27 10:29 FROM- T-382 P002/002 F -952 PUTNAM COUNTY DEPARTMENT OF EMALTH DIWSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION a JOSEPH 0 GENE REQST FOR P AIN L INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # PV -04-06 Located: Dakrid %e Drive l •) Putnam VAllcy Owner /Applicant Name: purieanei'atemart TM x1.05 Block 1 I.Ot 6 Formerly: Subdivision Name: RoarmgBrook SubdivisioA Lot # 106 Is system fill completed? Yes Date: 08- 26.2007 Is system complete? No Date; Is system eonstrUcted as per plans? nla . Is well drilled? 03 Date: 12-20-2006 Is well located as per plans? Yes Are erosion control measures in place? Yes I certify that the system(s), as listed, at the above premises and verified their completion in accordance with the approved plans and the Standards, Rules and Rcgulai :. _. _ ... Health. , Date: 06 -27 -2007 Certified by: ieso Pte,, Address: 2 JOHN WALSH BOULEVARD, PEEKSKILL. NY 10579k��`u\ Comments: Form FIR -99 I have inspected ;ion Permit and j Department of 0—'RA- 62980 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914)736 -3664 o Fax: (914)736 -3693 July 19, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: Well & SSTS Construction - Pateman Property Oakridge Drive, Town of Putnam Valley Lot #6 (506) of the Fifth Map of Roaring Brook Lake Dear Mr. Paravati: Please find enclosed three copies of the revised Fill Placement Plan per your comments. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. R990c _ ly su i �......:. ... ... ohn L. Cronin, roject Engineer i RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel.. (914) 736 -3664 • Fax. (914) 736 -3693 -. July 14, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster NY 10509 Re: Well & SSTS Construction - Pateman Property Oakridge Drive, Town of Putnam Valley Lot #6.(506) of the Fifth Map of Roaring Brook Lake Dear Mr. Paravati: Please find enclosed revised Subsurface Sewage Treatment System and Fill Placement Plans per your comment letter dated July 11, 2006. Please note the following based on your comments: 1) The plans now note that the proposed residence is to be 3 bedroom. 2). An updated,fill plan is now, included, with the same reference to.a 3 bedroom . residence as the SSTS plan. 3) 'A note has been added on Sheet SP -1/2 indicating that final grading must be consistent with what is shown on the plan. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. _ p ctf y su tte ohn L. Cronin, roject Ep9jneer SHERILITA AMLER, MD, ISIS, FAAP Commissioner of Health 1LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 11, 2006 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 John Cronin Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Dear Mr. Cronin: Waiver Determination — Pateman Oakridge Drive, TM # 41.05 -1 -6 (T) Putnam Valley R ®BERT .D. BON ®1 County Executive ROBERT MORRIS, PE Director of Environmental Health The Putnam County Health Department reviewed the waiver request for the above regarded project on July 11, 2006. The following determination has been made: ❑ The Waiver request was approved. rXI The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. ❑ The Waiver request was not voted on. Explanation noted below. 1. Plan to note 3 bedrooms on the house itself. 2. A two sheet septic plan is required (3 fill plans and 1 trench plan) fill plan is to be separate from the trench plan. 3. Please be advised that if the proposed contours are not constructed exactly as shown on the plan (i.e., "bent "), the permit will be null and void. If there are any questions regarding this matter, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Very truly yo 1 Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite, 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736 -3664 • Fax. (914) 736 -3693 June 21, 2006 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County 'Dept. of Health 1 Geneva Road Brewster NY 10509 Re: Well & SSTS Construction - Pateman Property Oakridge Drive, Town of Putnam Valley Lot #6 (506) of the Fifth Map of Roaring Brook 'Lake Dear Mr. Paravati: Please find enclosed a revised Subsurface Sewage Treatment System plan for the above referenced property. In addition, please note the following information based on your comment letter dated June 1, 2006: 1) We respectf Ily request waivers be granted for each of the following items: ,aoe of slope adjacent to property line side slopes to be sloped 1 vertical to 2 horizontal p r re- grading purposes fill�ad2ma�x� m of 48° for area o o - -- -2� The plan has been revised to ensure the fill pad extends at least 10' beyond the tench ends and all trench ends are a minimum of 10' from the proposed driveway. Fill for the subsurface sewage treatment system plan is within the property lines. Extra fill material is proposed in the front of the subject parcel for re- grading and aesthetic purposes as well as to match the grading on the adjoining properties to the north and south. This re- grading proposal is currently being reviewed by the Town of ..Putnam Valley Planning.Boaro as part of their Site. evelopment Plan review and is „ _ o proposed utside of the SSTS area. Side slopes are ro osed to be 1 vertical to 2 horizontal. All notes and reference to the side slopes have been revised. See also item #1 above and enclosed waiver equest. Fill. notes have been revised as requested. In order to maximize the beneficial use and effectiveness of the subsurface sewage treatment system area, it is important to propose grading that is relatively smooth and consistent through the area. Since the existing grade on the site is not smooth and "consistent, the proposed grading must be completed as currently shown on this plan. Proposed grading has been revised to ensure all areas of the SSTS have at least 1' of bankrun. Enclosed is the Specific Formal Waiver Request, form DOH -1326. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. /!�t 3 `�. R ull y mi d, ohn L. Cronin, roject Engineer SHERLITA AMLER, MO, MS, FAAP Commissioner.of Health. ,.,, - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT .D. BONDI Countv .Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 1, 2006 John Cronin Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Proposed SSTS — Pateman Oakridge Drive, (T) Putnam Valley TM# 41.05 -1 -6 Dear Mr. Cronin: This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The following does not meet current code: a.. Toe of slope less than 10 feet from the property line. Based on the above, the application is denied. However, it is the right of the applicant to `.request a,wa�ver,. from t e current co. e: ... _............ _ w . 2. Please make sure that the. fill extends 1.0' horizontally past all trench ends and that all trench ends are a minimum of 10' from the driveway. 3. The fill pad regrading needs to stay within the property line. 4. Please clarify whether side slopes are to be 3:1 or 2:1. 5. Based on field testing, the amount of fill required is 1'. Fill note # 3 should note a requirement of 1'. Any fill beyond that is for grading purposes only. 6. Since only 1 foot of fill is required, please check and see whether the fill can be proposed in a way that reduces the amount of fill closer to 1'. 7. There are some areas in the fill pad where less than l' of fill is being provided. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours, 5` ._�ioseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kIy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914)736 -3664 • Fax. (914)736 -3693 May 5, 2006 Joseph S. Paravati, Jr., Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 1 Geneva Road Brewster, N.Y. 10509 Re: Well & SSTS Construction - Pateman Property Oakridge Drive Lot #6 (506) of the Fifth Map of Roaring Brook Lake Dear Mr Paravati: Per your memo to me dated April 12, 2006, provided is an updated Subsurface Sewage Treatment System Plan set along with the required fill pad drawing for the above referenced property. Also enclosed are receipts from the certified mailing to adjoining property owners notifying them of the project. Please call me.at,the-above� number if you have additional_questions.or comments.. =Thank you fqr:'. _ your assistance in this matter. R e' ully s itt , ohn L. Cronin, Project Engineer enclosure r b' SH-IERLITA AMLER, MD, MS, I:AAP Commissioner of Health LORETTA MIOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 John Cronin Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Cronin: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health April 12, 2006 Re: Proposed SSTS — Pateman Oakridge Drive, (T) Putnam Valley TM# 41.05 -1 -6 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. .6� 4/V1 °L c ✓t'9� b7 c�P( S;ac i P >k- xzy,:a "s yet r� tl ` ( h u �vi ✓�' r7 !/ rzvi* •%c /-o t l 't, t�L _e.�4 �'� U(°J S Environmental Health (845) 278 -6130 Fax (845) 278 -7921 I ea'� Water Supply Section (845) 225 -5186 Fax (845)225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 Neighbor notification "is_required,per Bulletin ST -19, Section 4.a.11. I Since the fill being provided is greater than 2 feet, a 2 sheet plan is required. A SSTS profile and fill profile are required. Please show all existing wells and SSTS's within 200 feet of the proposed well and SSTS, including across the street, or note none exist. Please provide the USDA soil types and boundaries. Proposed contours being provided are shown "bent ", i.e., not straight across. If the contours are going to be shown this way, the fill pad must be built that way. If upon inspection the pad is not built that way, a revised plan will have to be submitted and re- inspection made before the trench plan is approved. The fill pad grading appears incorrect, specifically, there appears to be some areas where cut is being proposed. Fill note # 3 notes required depth of fill to be 36" to 60 ". There appears to be a maximum of 48" of fill. Please clarify. The expansion area layout is to be shown like the primary (boxes, 2 foot solid pipe, etc.). / I "! � L�yv�t9✓✓ ,� n o f' P�nt�vs -csi S.o �2,...� / ` ,f t'C ( i S /yc. rf '°ate i i 10.) Top of fill needs to extend 10 feet horizontally before side slope regrading begins. �s Dimensions from the well to the property lines need to be provided. This office will continue its review upon consideration 'of the above- mentioned. comments. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP/kly IMMUNEa OF sl MITTAL CRONIN ENGINEERING. IP.IE., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, IVY 10566 914- 936 -3661 Fax 9 14- 936 -3693 Josephs. lParavati, Jr. Assistant Public Health Engineer Putnam County Department of Health I Geneva Road Brewster, N.Y. 10509 RIE: SSTS CONSTRUCT ON AIPPUCATION Adrienne IPateman Lot 506, ®akridge Drive THESE ARE T RANSMTT'1ED as checked below: DATE: 03/24/06 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESMD ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE Alm SENDING YOU attached 1.) Three copies of subsurface sewage treatment system plan 2.) Four SSTS construction permit applications 3.) Letter of authorization 4.) Application fair approval. of..plans... 5.) Soil data sheet 6.) Short eavironmental assessment form 9.) 2 sets of house plans 8.) Application to Construct a Water Well 9.) Survey 10.) $400 application gee The information is provided based on the March 16, 2006 joint site inspection between Keith Staudohar and myself fro® Cronin Engineering and Dike Luke from your office. Please review at your earliest convenience. Thank you for your assistance in this matter. Respectfully submitted, John L. Cronin Design Engineer .. - ...I ]PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project (T)(V County Site Location ��.. . Building, construction begun AJO - Extent Is property within NYC Watershed ?.. .. .............. a Yes No SECTION & TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly • Rolling Q Steep slope �ntle slope a Flat' 2. widence' of wetlands �ow area subject to flooding F7 - Bodies of water. Drainage ditches E;1_�O ck outcrops - 3 . Property lines or comers evident .................:..... ................................ No 4. 'Do water courses exist on or adjoin the property? ............................ NYes Yes a No 5: Will these affect the design of the sewage system facilities ?.......,.... ❑ Yes �No 6. 'Do watershed regulations apply in this development ? ....................... Yes Q No 7 Will extensive grading be necessary? ..:.............: ...... .......................... �'�es No g... Will extensivefill be necessary for SSTS ? .................es No' 9. Do filled areas exist within the SSTS area? ....... ........................ ...:.... • 0 Yes. No If yes, what is the condition of the fill? . SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: and �avel Loam a Clay a Hardpan Mixture 11. Observed. from: F-7 Borings Q Bank cut Backhoe excavations 12. Soil borings /excavations observed by f�l ~K-c (�=-� on 13. Depth'to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas....: ......... ................... . Yes E] No 16. Soil percolation tests made by-.* on 17. Soil percolation tests witnessed by on . SECTION D (on back) Form ST -1 2 24. - Site observer/inspector and title 25. Date(s)-of observation(s)inspection(s) -3 114_10� TEST PIT PROFILES Hole 4__L_ Lot #.. Hole 4 Hole -V Lot f, Depth to water Depth.to water /J ater, Depth-to faothng N µ Depth to mottling .0.5 Depth to mottling SECTION D. DRAWAGE Depth to rockThp. 2.0 18. Will proposed grading materially alter the natural drainage in this or adjacent areas?= Yes 1-9. Will groundwater or surface drainage require special consideiation? ....................... =Yes [2-1To 20. Will gullies, ditches, etc.-, be filled and watercourses be relocated? ......................... =ye s E_ Ko SECTION E. REMARKS. 6.0 21. If a co=on water supply is p-roposed, has an inspection been made of the existing or proposed source and facilities? ................................................................. Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist ?........ .. y es Eil =.-No 23. Additional comments 24. - Site observer/inspector and title 25. Date(s)-of observation(s)inspection(s) -3 114_10� TEST PIT PROFILES Hole 4__L_ Lot #.. Hole 4 Hole -V Lot f, Depth to water Depth.to water /J ater, Depth-to faothng N µ Depth to mottling .0.5 Depth to mottling Depth to rock/imp. Depth to rockThp. 2.0 -7 l Depth to rocJimp- .0 2 G.L. Tl 3.0 G, 8.0 9.0 10.0 .0.5 1.0 Yawn .1.0 2.0 .0 2 3.0' 3.0 4.0- 4.0 5.0 5.0 6.0 6.0 8.0 9.0 10.0 0.5 1.0 2'.0 3.0 4.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 6-r#-.1 �" y h '� Yawn 0.5 1.0 2'.0 3.0 4.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 6-r#-.1 �" y h '� BRUCE R FOLEY Public Health Director ATTENTION: DEPARTMENT OF HEALTH 1 Geneva Road - Brewster, New York 10509 a JOSEPH PARAVATI a GENE REED LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services All information below must be fft completed prior to any scheduling. BATE: 0 t 7 ENGINEER OR FIRM: PRONE #: 'tic!- 736 - 3664,1 REASON: DEEPS:) • PERCS:)i PUMP TEST: ❑ ROAD /STREET: I TOWN: \IA LLia TAX MAPS#: . J5 SUBDIVISION: _9VM%ri (2 -32e)nK LOT #: GLC; R t A 'BV R.K.S J cv Vj"M OWNER: AVb:Rt G NlJla A. '�ATff MAP, C.D t--1TR ART M DEP CRITERIA FORM REVIEW AND WITNESSING OF SOIL TESTING .. YES NO ❑ Jlj Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. o Proposed SSTS within 500 feet of a reservoir, reservoir stem'or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you'answeredyes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: Tom: Y, '< RONIN ENGINEERING P.E. P.C. Xk The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736 -3664 - Fax. (914)736 -3693 January 12, 2006 Robert Moms, P.E. Senior Public Health Engineer Putnam County Department of Health Division of Environmental Services 1 Geneva Road. Brewster, N.Y. 10509. Re: Well & SSTS Construction - Paternan Property Oakridge Drive Lot #506 of the Fifth Map of Roaring Brook Lake :Dear Mr Morris: -Please find enclosed -the necessary site plan -to- schedule fieldwork on -the above - referenced property. I understand there may be a delay in scheduling this work per Michael Budzinski's December 14, 2005 memo however, please let me know as soon as the suspension on soils testing is lifted. Thank you for your assistance in this matter. FhnL. su in, neer I VI or. ff ii� PUTNAM COUNTY DEPARTMENT OF HEALTH I fJ P DIVISION OF ENVIRONMENTAL HEALTH SERVICES WFI I 1'nUP1 FT1rW RFPnRT Well Location Street Address: Town /Village: Tax Map # Map %O�Block �•. Lot(s) GPS ':;;;',,` Well Owner: Name: Address: �� li 251 z , � v L� Use of Well: 1- Primary 2- Secondary 4 Residential _Public Supply Air condlheat pump _Irrigation Business Farm Test /monitoring —Other(specify) Industrial Institutional' Standby - Drilling Equipment Rotary _Cable percussior1Compressed air percussion —Other(specify) Well Type _Screened _Open end casing —).6 'Open hole in bedrock _Other Casing Details Total Length / ft. Length below gradeiii Diameter 4/O in. Weight per foot �Ib /ft Materials: Steel Plastic Other Joints: Welded° Threaded Other Seal: Cement grout Bentonite Other Drive shoe: _>0 Yes _ No Liner: _Yeses No Screen Details Diameter in Slot Size Length ft Dept to Screen (ft) Develo ed? First _Yes _No Hours Second Well Yield Test _Bailed Pumped' Compressed Air .:Hours . Yield gpm Depth Date Measure from land surface-static (specify tt) During yield test (ft) Depth of completed well in ft. Well Log If more detailed informatiW •..— _ _ -_ descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Sgrface n lG iii qo S If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Sulkn—ii,W_ Capacity S_ 7 U p�''' Depth _2.80 ` ModeldytAto 'IV siiryc_oi Voltage -130'1 HP �z_ Tank Type W A9`0 GUadd4.Volume YV 6 � e Date weu Comp eted k Well Drlller� PC C iflcate # �0 Pump_Installer'PC Ceitiflcate #, ' NY State # �/ NY Date of Rep rt'' r Ier�Name &Addre JI IgI n tuWell,Dri I II Pump Installer Name 8 Address a 1 � . t . /':;�.iCA. ?. rill .. . ": .G.. .4 :: . .: v. .. .. Y. .I.. t Pum ns I; �1. N j3 Nt, I - 1 :•�t. ,:_ ;; . NOTE: Exact Location of well with distances to en least two permanent IanumarKS to oe pruvrueu vlt d acNd1 aLG Z)1 MOUP101 t. White copy: Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 DRev. 3/06 2) ENGINEER WAS NOTIFIED PRIOR TO STARTING WORK AND PRIOR TO BACKFILLING TRENCHES 3) SURVEY INFORMATION SHOWN HEREON WAS TAKEN FROM A PLAN PREPARED BY: BAXTER LAND SURVEYING, PC, ENTITLED, 'BOUNDARY AND TOPOGRAPHIC SURVEY OF PROPERTY PREPARED FOR ADRIENNE PATEMAN..." DATED NOVEMBER 12, 2005 AND ALSO FROM A SURVEY ENTITLED: "PARTIAL TOPOGRAPHIC SURVEY OF PROPERTY PREPARED FOR CHARLENE PATEMAN" DATED JUNE 17, 2007. 4) PARCEL SHOWN HEREON IS KNOWN BEING LANDS DESIGNATED AS LOT 506 ON A CERTAIN MAP ENTITLED'FIFTH MAP OF approximate location of exlsting ssts y , M AS -BUk T SUBSURFACE SEWAGE TR CONSTRUCTION PERMIT # PV-04— SEPERATION DISTANCES DESCRIPTION A 11 B C 11 D a 13.6' aPof /ssts!on u1sting g6 - w / roof leaders and footing drains discharge away from ssts area — to day /ght 3 +weern. sd,.g. S 48'28'10' 8 JUNCTION BOX # 2 36.6' w C 42.0' 'r RETAINING t I WAt1 473 34.7' 8 �I 3'�b1�Vll'b 11 bf,, 1 JUNCTION BOX # 5 11 l 39.6' /71Q5' M£L[ n7 1 Ill I I 1 1 Ill III Ill Ill Ill JUNCTION BOX # 6 166' NEIL 1D Flt FROV7 a Ill Ill Ill Ill III Ili I 64.5' srtsthg wt. mib � � 1 Ill III III Ill lI ��� 1 Illl Ill Ill Ill Iill �h, T czymfRAIENow .44.0' umBP rn1mwnaY �� I II II 'EA III �fsoG A�I � ,lladll4 ' U I.l�a� , II, ddm?l1C Mu 22.6' ' \ � ;III .I li ili ili ili 79' 48.6 27.4' ili it ili ili ili ill � Q � ! N '► / � J � I f 7 32.2' X 55.2' rw -. a rsrstra s approximate location of exlsting ssts y , M AS -BUk T SUBSURFACE SEWAGE TR CONSTRUCTION PERMIT # PV-04— SEPERATION DISTANCES DESCRIPTION A 11 B C 11 D SEPTIC TANK CENTER (NEW) 13.6' 45.7' JUNCTION BOX # 1 31.6' 227 JUNCTION BOX # 2 36.6' 25.9' JUNCTION BOX # 3 42.0' 30.1' JUNCTION BOX # 4 473 34.7' JUNCTION BOX # 5 52.7' 39.6' JUNCTION BOX # 6 58.8' 452 JUNCTION BOX # 7 64.5' 50.4' T .44.0' 19.2' ' U 45.9' 22.6' V 48.6 27.4' W 51.6 32.2' X 55.2' 37.4' Y 59.9' 43.6' Z 46.7' 52.9' SUB DESIGN BASED OP DROP SOIL AND C- 375 L.F. OF 4 "0 PE BANKRUN FILL. SEWAGE TREATME TIMOTHY ZUBRADT ARROW EXCAVATIP 15 AVALON CT. HOPEWELL JUNCTII (845) 629.0024 WATER SUPPLY: DRILLED WELL BY: BOYD ARTESIAN WI 1054 ROUTE 52 CARMEL, NEW YORI