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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.09 -1 -20 BOX 20 02294 mi J 0 'T 1 , ,; i . r- NoWel 02294 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit N on CERTIFICATE OF C Q Q CONS UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM pmt N —CJ tJ Cove Road Putnam Valley Located at Town or Village Subdivision Name _Roaari ng Brook Snbd, Lot q 432 T. Map 11 Block 2 Lot 4 Owner /AppB=nt Name Richard Bergin Renewal —roc Revision ❑ Date of Previous Aobrovel 1988 Mailing Address 52 Oakridge Drive Putnam Valley, N.Y. 10579 Town Zip Building Type __2 story frame yet Area 23,500 SF F_'PCHD Section Only Depth Volume Number of Bedrooms 3 Design Flow G P D 6 OO Notification is Required When FIB Is completed Separate Sewerage System to consist of 1000 Gallon Septic Tank and 84 IM I F n f 4 x 4 galleries To be constructed by Howard Gragert Address Oscawana Lake Rd Putnam Val 1 ey., NY Water Supply; Public Supply From Address or. X Private Supply Drilled by N Anderson Address Barger Street, Putnam Valley, NY 0th Reanlre to 3 ft of ROB Gravel to be D1 aced in septic area. er men 1 represent that I am wholly and completely responsible for the design and location of the prop, d,e above described will be constructed as shown on the approved amendment there to and in accorda County Department of Health, and that on completion thereof a "Certificate of Constr J4, be submitted to the Department, and a written guarantee will be furnished the owner, his place in good'operating condition any part of said sewage disposal system during thI: QOt ante of the approval of the Certificate of Construction Compliance of the original syat' any will be located as shown on the approved plan and that said well will be installed in cco►dar ith tl County Department of Health, o Date ® Feb 8, 1990, Signed _ "Aed`resi �-.1..11l�rrt fgirVi dQe _ Rro�d�eirski 1-1 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued JIN revocable for cause or may be amended or modified when considered necessary by the Comm!, re0uiros a w 'permit. Approved for disposal of domestic sanitary fbDvs poserr jLriva te 87 Date G PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Cannel, N.Y. 10512 CONSTRUCTI PERMIT FOR SEWAGE DISPOSAL SYSTEM �t�at the separate sewage tlisPOSaI system cFs. rules an regulations o e Putnam .tory to the Commissioner of Healthwill S by the Duiltler, that said builder Will year n llately following thedate of the issu- t reto 2� hat the drilled well described above de r I afid regu aeons of the Putnam j e C ` P.E. Z /X R.A. — JLicense No 278+V `- •� tq* building has been undertaken and is ait1l. Any change or alteration of construction Title Engineer to Provide Permit # on CERTIFICATE OFqOMPLIANCE Permit a l/ — G — 4Sg Located alcove Road Putnam Valley Town or Village Sabdlvlsion Name R0aY' 21g RrOOk Lad isa. Lot N 432 Teat Mp 19. Block 2 I t 4 Owner/Applicant Name__ Richard, Bergin Renewal —E1 Revision ❑ Date of Previous Approval Mailing Address 52 Oakridae Drive Town Zip Putnam Valley, N.Y. 10579 Building Type 2 stvDy Frame Lot Area- 23,500–+ FBI Section On1 i _ Y Depth Volume Number of Bedrooms Design Flow G P D Is Required When FIB Is co mpleted Separate Sewerage System to consist of 10 0 0Gallon Septic Tank ank?'I LF To bo,o=tructed by Howard Gregart Aaareet Water Supply; PefbBc Supply From Address or. X Private Supply Drilled by N. And.era Atom,, Barger Other Reuttirements30 of ROB to be Diaced. in .Rnnti_n /iron 1 represent that I am wholly and completely responsible for the design and location of the proposed sysl above described will be constructed as shown on the approved amendment there to and in accordance with County Department of Health, and that on completion thereof a "Certificate of Construction Complia be submitted to the Department, and a written guarantee will be furnished the owner, his successors, place in good operating condition any part of said sewage disP_os@I syAgM during. the perjgg..oL,tWG:. «ante of -fife °app rsrt=Gt - tt ;�yYe of t;o`ris`fruction -Compliance 'of the originarsystem or any re; will be located as shown on the approved plan and that said well will be installed in ccordance with the t County Department of Health. Valley, N,, Y., ,m 4�Ak psioner of Healthwill Mat said builder Will . .. .... _.- ...- -- - - _ __ . ... . rtIl described above 6of the Putnam Date NOV 2�, 198 Signed Vq5t- E.� R.A.Addreu 1 Northrid, eRoa Peekskill a Yt.�7846 APPROVED FOR CONSTRUCTION: This a pproval expires two ears jc.. the date issued unless constructtbn'n undertaken and is revocable for cause or may De amendeC /or motlified when torsi red sary y e Comrrlj�ssioner of HeaRfp pA tion of construction repuires a nefw•,permi , proved for disposal of domestic arape, n o pri ste wa r supply only. ® ' 1%A nor. .r frI' L f .l _ u o n a e 00 �bllf = -.. lavabo alt_ �r.::;ynx�e e1 Fes, rte•- ,�nnaa�F �w ... , ,o,.:�, ^, ; _ �, s �.•': , j . , ,,.,, v t, .,.... - az • a ' .r� r f / 7.9 Veletas Timber d 591ows. r Fbv G F D 16 FM pladaildw b Rombid Wbea FM b amkbd Stamm BOUGMW 8 b c'1 ea �c! 1t v To ho sanowsba tv- I represent that 1 em wholly 04 COmO 4®Oy reMonaipb for the design and location Of thO pvopO=d systern(Q). 1) that the separaft ObwaP di eel stein above doss MM will ODe constructed Os ahMn en thO OPPMUEd OfflOndMent t4=0 to a" in accordance with tho Standards, rules a rtpu s o county Department Of Rolem. std that on completion thtvoof a "Cptif ruction Complismo- satisfactory to the Commissioner of H"Unwin be phmitt� to tide Dsi MtwxSat, arq 0 writtga G"Onew will be fu Q his s, hops or aeelo ns by the builder. that said builder will OIM in good .�atuse G ItIft.02V Mn of C9ka fie ® � led of two (2) years immedlatoly following the date of the tasu- ahw of the of til¢r Cwtvieft W CoRatuctisn Coaapib Itb ' 1 ttksh�,\sa any vaE.bs t 12) that the dviHad well described above WE bt located as Ilatlwn OR lisp tp�xZ3 PM 070 that mlo cra000 exiiI IBad its It toe s. rules and rellUsl ns of the Putnam county 89wartelAa@ of 14MMCL r . P.E. _ N.A. AO OVEO i *OW COP YQ OOFO Yq� 1 anpirvs two Veer r�eo'a 4kc��QO@0,, ice' un eoaDStruc4lon of 4ht tDleiidirp Ass aeon undertaken and Is ravota to for Baum or may so OR== Or mosl9mg witon son vy ®g tM C, stiaemr of 64aatth. Any Change or alteration of construction e m At2 fCV OlE al of oaoazx�ix ©_ aid O Mter supply only. YiYaa ReV,. LI FUJMM COUNTY DMA31' 1A OF IMAM �� swvb= can" X.T. 4FS4t b PwvNa Faslt i �MMEfCAM OFCO_ C0MM ETON BMM FOR SSWAGR DWOSAL STSd'Sl1[ Leeabi •4 tl--(57 re /Yes grZ SbbMAden NWO c d r- %� ��z�l Sb.L Let a o..@dAp ilcont Mails Address; FaMt i Two at Tax Map — Mesa % 14 — RM "'--A eev)ebb a Daft of Previews Aoosoval ✓ Sel+bs Tjpt �f try %!Z G<C dot Aram 2 3, Fm SwtleO Only pre ; � : wMane N®ber d me eelsa �� Design Flaw G ! D G o a FCHD NotlBalba Is Required Whew Fie Is ooaspbied S" Ma Salraw Spaas b aesebe d te � Sq* Talk gad `/ L X4 To be taestesets' by Aa4s�te@a water Sapp: is one Sop* Free Address at —e Plilvab Supply DOW by A946— oeba -3 1�?0 I represent.that 1 am wholly and completely responsible for the design and beatio of the proposed system($; 1) that the separate swage posa disls rstem .bow described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ns o County Oeoertment of Health, and that On completion thereof a "Certificate of Construction Complianu;: ,Wsfaetory to the CommisafOner Of Health Will be submitted to the Department. and a written guarantee will be furnished tho owner, his successors. by the builder. that said builder will place in good operating condition any port of said sewage disposal system during the period of IS tely, following thedate Of the isw- sow of the approval of the Certificate of Constructions Compliance of the original system Or 4ny4 2 the drilled Weil described 060w will be located as shown on the approved plan and that said wall will be installed in accord@ wit A ithhe � r0 r feDUSTO s-of the Putnam County Oepertmor t Of "with. f A Do" Y Address giggle t' P.E. N.A. r a c 4nse No /J !!!+7" APPROVED FOR CONSTRUCTION. Th approval expires two ypOIN from the data issued u dye gq� Ing has been undertaken and is far m when use of anaV be a or modified wh consider aeeessary by commission er'�pf:� n hgo or anOation of construction I represent that, t am wholly and Completely responsible for the design and location .of the+. proposed, system(s); 1) that the separate sewage di sal s stem above described will be constructed as shown on the, approved amendment there to and in accords andards. rules a regu root o ream count* department . of MMlth, and that on Cornpletion;thereof a ^i be ulbmittad= to the 0epaitment. an'd's writtari ouaraht" will be place in good Operating Condition any part of l said sewage dispoi since of .ten ipprovel of the CertifiCate of Construction ComplYn WNf" located as shown on.the epar6ved plan and that said well wiUb County Oqpartment.ol Meilth L / / Date ��/ q. Siinee Address �/ -';e APPROVED F R CONSTRUCTION: This'ap o proval expires tw yearl revocable for use may be amended or modified when considered S requires a per .it. Approved -for disposal of domestic Rev. jj� 10/88 Date By of Construed p �. acto'ry to the ConimisNOnw,of Msialthwill the owner; , 1 iyns by the builder, that said bulkier will during the Mediately following thedate of the issue original sY ny ifs, ) that; the drilled all desa'bad above m d 4i*b h sa`and r�qua�TiM oT' th Putnam . _ R.A. _ LiCense No date iswed s + building Ms been undertaken and is -; -y :`the .0 b wy.wy- Any ehanpe or alteration of construction and .` a fU Title Complaint Information rpLANK 2xCC 1 c/ I`{ 77,7 276a IJ - - - -- �W 1- ke- Ghee / .. lyt,OAr `( -Log I _.. 1-_ Received From: �:�.�orapla�nt•Rct;i: ;lGrt?; 2uu3 °'' ' `"ceived By:aioney,iAnne Time Received: Assigned To: Paravati, Joseph Complainant (Person Making Complaint) First: ARTHUR Last: SHERIDAN Address: 21 COVE RD compiaint Origin of Complaint: Street #: j if St Name: COVE RD City: Zip Code: Location: Town of PUTNAM VALLEY Operation Type: Nuisance (Public Health) Phone: 845 - 528 -7301 City: PUTNAM VALLEY State: Zip: Apt M St Type: Phone: �t,ompiaint Nature of Septage to surface Complaint Needs Investigation Date Complaint Status g ResolvedS d Description: ActionTaken: GRASS IS GREENER OVER THE SEPTIC FIELDS yr`c2n c v4 r" ��� 5.- L� Le .�.�� �✓ pP�s via 1!�e 4-k Sep4,r- <!M-w�cot!...� -�. �.oct.�C Gv�i r.�s `CS� m•� Gv�o�cv�� 4,44 P!v Y �� t/!�` Fmk asi,G► %n . /1�= - ' PJ�(cr� 1'r�4 (Yp�,,, rCC�r�S cc l .4'SCV552,4 MU+ -4,r4 A,'M Oh Mnd,-j of St-A. �% ap . 5pokc. WPh f,� (��.s�a . T�,�t ��+ ,�- rr�+.✓ r3 d 4/� �lol�.- ��v ems ,» 'age 1 of 1 Sq eon'°` D t Printed June 05, 2003 S��c w +-� Z► 't. r� . f-fe . Af pe.o.r5 Bwru -v- �5 5 +l W41 sc co o+ no-f -'cr2. aF�►vie - cs�o+.1o�i�.nGQ d► �ti,•e 14,:w rC fvft� �JLLa+ /-/, La(: yy oAor- IS now Iww;" Pure -va y . 3 ,F'eids Mm4-e over -s vrwko�. a P JV PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL _ HEALTH-SEH-VICES CERTIFICATE OF OF CONSTRUCTION COMPLIANCE FO * ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # —66 Located at 11 vv' P.-4-0_ Owner /Applicant Name AO �% 1( i3, i_ Formerly Mailing Address Town or Village 1,14p, V,9 i / is Tax Map 'f Block I Lot Subdivision Name 1'✓Jq p 1 /2i''w B�-c1G� -�' Subd. Lot # 43 / 4 43 z--, Zip Date Construction Permit Issued by PCHD 3 L51 100 i Separate Sewerage System built by--," '%194- &L ig Address { i��,Mono Consisting of _J25D Gallon Septic Tank and 4!5Z) F rr,4 2Fr i y,, 4>0 -'V"C.�e s. Other Requirements: 12..60 6/11 Water Supply: Public Supply From Address or l� Private Supply Drilled by - ��/A'T1r Address Building Type _.... Bi,'° Has erosion control beenomplet d?' ,..,'Number of Bedrooms ~ L. Has garbage grinder been installed? �o 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 of the Putn County Department of Health. Date: q LZ; o0 Certified by P.E. w"R.A. Address p j( (Design fe ' nal) 041 License # �9 ,S 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, modificatio is necessary. Bye/ ' ' Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT T OF HEALTH TH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Il..Lecatioib > Succ Ac;uicss:."° '° '" "W TownJVillage: Tax Grid # Map /,Q Block Lot(s)7 Well Owner: Name: Address: ,l Use of Well: 1- primary 2- secondary � Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion V Compressed air percussion Other (specify) Well Type Screened Open end casing V Open hole in bedrock _ Other Casing Details Total length _2 [_ft. Length below grade �O ft. Diameter 7 in. Weight per foot 17 lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Y Cement grout _ Bentonite Other Drive shoe: JZYes No Liner:— Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed Pumped Compressed Air Hours � Yield gpm Depth Data Wea–sure 'from land surface- static (specify ft) S- �ee� During yield test(ft) gatot Depth of completed well in feet 601 - 106 e- f 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 Id- �- o - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type ho,J J Capacity Depth 6QGIf Model f� 3 Voltage HP Tank Typejr 1-X Volume �czQ Date We 1 Comp eted 70700 Putnam County Certification No. o07 Date of Report Well Driller (signature) Nu; -z: exact location of wen wttn instances to at least two permanent tandmarxs to be provtaea on a separatesneevpian. Well Driller's Name 91-Am Address: /- e Signature: Date: 71,:9-016-o White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML EgyyjRRNMEN5tre gRVICES ear Yorktown Heights,. N.Y. 10598 ._.._ Albert H. Padovani, Director /0v LAB #: 32.005754 CLIENT #: 11705 NON STAT PROC PAGE i M N N NNN N N N --- MI M NNN NNN NNNNN NNN N N N N N N N N N N --- N N NNN - N N N N N N N N N N N N N N N N N N ------ N N N --- MIRABILIO, JOHN DATE /TIME TAKEN: 09/08/00 09:OOA 1 RICHMOND RD. DATE /TIME RECD: 09/08/00 01:30P POUGHKEEPSIE, NY 12603 REPORT DATE: 09/20/00 PHONE: (914)- 471 -5199 SAMPLING SITE: SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: JOHN MIRABILIO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF -------------- NNNNMNNNNNWNNN NNNMNNM- -NNNNN--- ~----------- NNNNNNNNNN DATE FLAG PROCEDURE RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 09/08/00 MF T. COLIFORM ABSENT /100 ML ABSENT 09/08/00 LEAD (IMS) <1 ppb 0 -15 ppb 09/08/00 NITRATE NITROG 0.41 MG /L 0 - 10 09/08/00 NITRITE NITROG <0.01 MG /L N/A 09/08/00 IRON (Fe) <0.060.MG /L 0 -0.3 mg /l 09/08/00 MANGANESE _(Mn) <0.010 MG /L 0 -0.3 mg /1 09/08/00 SODIUM (Na) 5.89 MG /L N/A 09/08/00 pH 7.1 UNITS 6.5 -8.5 09/08100 HARDNESS,TOTAL 306 MG /L N/A 09/08/00 ALKALINITY (AS 290 MG /L ..N/A 09/08/00 TURBIDITY (TUR _ C.i _ .NT.0 _: - - = 0 -5 - NTU _, .. -- Cl71MM TS-. BACT THESE RESULTS INDICATE THAT THE WATER AS ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. "b /Gu LEAD limiis for pi EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive e /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. a 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. METHOD 1008 9101 9139 9146 2037 2037 9043 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown HeiSht4A,.. N.Y.. Albert H. Padovani9 Director LAB #: 32.005754 CLIENT #: 11705 NON STAT PROC. PAGE 2 N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N MIRABIL109 JOHN DATE /TIME TAKEN: 09/08/00.09 :00A 1 RICHMOND RD. DATE /TIME REC'D: 09/08/00 01 :30P POUGHKEEPSIE, NY 12603 REPORT DATE: 09/20/00 PHONE: (914) - 471 -5199 SAMPLING SITE: SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL D BY: JOHN MIRABILIO TEMPERATURE..: < 4C NOTES ...a COLIFORM METH: MF .N N N N N N N N N N N N N N N N N NN N N N N N N N N N N N N N N N N N N N N N N N N N N NN N N N N N N N N N N N N NN N N N N N N N N N N N N N N N N N DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE.OF THE.IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE¢ IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L9 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 M I LL.I.GRAM PF ER_. L..I TER - .._....m.:.: - HARD•- WATtk i-. -1,a�0-300 -M&& rt 2.1 � grain /gal lon = 17.2 MG /L ) SUBMITTED BY: t Albert . Padovani, M.T.(ASCP) Director FLAP# 10323 . r BRUCE R. FOLEY --LORETTA MOLINA IU R-N., ..M.S.N. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER: 4- 0, E911 ADDRESS: ' co �e TOWN: UC4 Ae' AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 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 VERFRNO "�T CAW v Shect oT (. x- Pi3TNAM -COUNTY DEPARTMENT OF HEALTH: :DIVISION OI+' El�t`V ONMI N'�A` I EATLI C1�FS�aCES f ' FIELD ACTIVITY REPORT o . t _ Street :Town ' State Zip T PERSON IN CHARGE �- 4 Name and T t TYPE- OFTACELITY . _ " n.t0 . S 7 '7) _ FINDINGS.• - '1 J F: Z3S r - 4 .. _ jll a - r V. n , 1. I .1 ri t _ - f Signature and itle s ' �3EPnRT i acknowledge receipt of this report . 'SIGNATURE`S „ 12/.96 - Title. - r+ Rev _ PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENT. .,-H- ,ALTH- S-ERV- 10Esy" - " -u_.. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM p6 12X} 1Utr� j (�V. - Owner or Purcha er of Building Tax Map Block Lot 9--L-An MIM&&O Building Constructed by Location.- Street Levi Building Type wr TownNillage AAtYltty� Subdivision Name 431 44-32- 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 thp.o— cupant of the building.utilizing.the - system. y 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 build* utilizing the system. `j //% 417-1 ]EM-7311- RIM Corporation Name (if corporation) Corporation Name (if corporation) Address: % 2!G f2o,<) iZon k kevpsr Address: % / cL o;, %la? Po*&v State Zip fz&0_3 StatX__ZiP 12AL_(,)3 Form GS -97 BRUCE R. FOLEY Public Health -_ Director. October 4, 2000 LORETTA MOLINARI R.N., M.S.N. =_ - - m �htssociat� Public `-Realth"lltrecfor` °" - Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Mr. Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Application of Certificate of Construction Compliance, Mirabilo, 11 Cove Road TM# 41.9 -1 -20, Town of Putnam Valley Dear Mr. Fredriksen: This office has determined that the above referenced Certificate of Construction Compliance application, received by the Department on October 2, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. 1. Tax Map # is incorrect on all documents. 2. Application CC -97: G '5�,4� a. E -911 street address to be noted "located at..; ew 3. Application Form WP -97. �/• c.�, <.. �. _ _a.. _—E-91-14 to-be-included on form. b. Well owner address to be completed. -'' C. Pump /storage tank information to be completed. 4. As -built drawing. ja c� a. Well is less than 15' to the property line. �✓v a "✓° -'�' b. The system is less than 10'0" to the driveway as scaled from layout of trenches on survey. 5. Survey prepared by Raymond Uihlmire, LS. a. Survey differs from as -built plan submitted. All original documents were returned to you on October 3, 2000. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, a Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES _.... _._ ............. _. _. FIELD ,, -AC7[' X,RF,P.OR-T- -7 • -bT)Rlp • Street .: ,1. - -- -' Town __p State Zip T%-7 a2 lU U r Signature and itle RRPORT BF- RTVRT) RV: I acknowledge receipt dthis report: SIGNATURE: 02/96 Title: PUTNAM IX JNTY, F WA L- 7.'H: DEPT :. DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health 7NAM1� ADDRESS erV ,.' i /0 ell _1P 4(V/ - FIELD ACTIVITY REPORT - Sheet of Street Town Orig. Routine �.1 Orig. Complain e / _ Orig. Request TH No. _ Compliance Complaint Comp MAILING ADDRESS P.O. Box Post Office Zip Code • pi• • • • 5 A -N AUN OWNCij 4 ?,N9 p� Name and Title DATE / TYPE FACILITY TIME- i /J TIME LEFT 2 Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Eacplain INSPECTOR: TELEPHONE: Signature.and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE :' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE & SUBSURFACE SEWAGE TREATMENT SYSTEM o� �Zjq �L�� �410� l zc� Owner or Purcha er of Building Tax Map Block Lot :To Building Constructed by J ` a— { �1 Location - Street tf R. -- Lam► Building Type /e� Tow illage Subdivi ion Name 431 *43Z_ Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by .me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the build "** utilizing the system. /j Z/ /j Dated: Day _�g mar C1 U Signature: 7114"ntracdbi'(Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) I !� y,� ,�� � �� a PoL��� e. Address: �G --r �yD i,�,�s�� Address: % l � r�taHT r State i4 Zip 126-03 State Zip _L ?_6 c� Form GS -97 BRUCE R FOLEY 1] LORETTA...I OLMARI..R.N.:�_.M.sSS:IdR " " ` " ':4ssociale Public Health Director ,...... Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)2781-6130 Fax (914) 278 -7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: � TOWN: L YI ! AUTHORIZED TOWN OFFICIAL: ti, 0��o (Signature) DATE: - 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 VERFRK PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location -.:. _ . Street Address: l rii✓ i ...... ....,_. - TownNillage: _ -_- .. Tax.Grid Map /.OE Block Lot(s)Z0 z Well Owner: Name: Address: A v & ,l Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion V Compressed air percussion Other (specify) Well Type Screened Open end casing I/ Open hole in bedrock _ Other Casing Details Total length ft. Length below grade Oft. Diameter 7 in. Weight per foot /7 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes —No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours � Yield -,5 gpm Depth Data Measure from land surface- static (specify ft) -iOce7- During yield test(ft) ,6,6 n Depth of completed well in feet 66' Z-r✓e, f 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 71-11 �- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 711'�71ao Putnam County Certification No. 007 ' Date of Report Well Driller (signature) 1 A &�' NUji'E: Yxact location of well ,�with distances to at least two permanent landMarxs to be provtaea on a separaXneevpian. /J Well Driller's Name I �I ! !0 I l / Address: /� O G►yl / L1 Signature: Date: 7 a G White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 L( C q7 IV. tzn� 4, ) "A e,-.z tJ 14 It- C-DSC577il., fz IS" DIVISION OF ENVIRONMENTAL HEALTH SERVICES AT17ENTION OADAM 0 GENE = oxii-11-m 4,191A WAIMM&I j TOW17 All information must be fully completed prior to any Trenches inspections being made. PCHD Construct*on Permit # cc;k) 06 Located.- . Construct &,2 (T) AA A OM Owner/Applicant Name: MiP__,4j$iLi0 TM a9 Bloc Lot A4!!Yl —9 Formerly: Subdivision Name: �Aizjngj NraoK_ e5 Subdivision Lot # I.J Is system fill completed? Date: 3 6Q Is system complete? - ye5 Date: Ta r _j opm constructed as per r 1"qq V e.5 Is well drilled? Is well located as per plans? Are erosion control measures in e5- Date: 913 A ,40 C I / I wr* that the system(s), as listed, at the above premises has been constructed and I have inspectqd and verified their completion in accordance with the issued PCHD Cpnstrurtion Permit and approved plans and the Standards, Rules and Regulations of the Putnam'County Department of Health. -D -Certified _kA DAY ign Professional Address: MA&nep Lic. #I Comments: Form FIR-99 BRUCE R. FOLEY Public Heo!th Director, DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. f-ywoc7iate. I hbl.. ! �-a tl D TenZor Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 August 17, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Mr. Roy Fredriksen, PE PO Box 950 Mahopac, New York 10541 Re: Mirabilio, Cove road. TM# 41.09 -1 -20 & 21 Town of Putnam Valley Dear Mr. Fredriksen: This office has conducted a final site inspection as requested Tuesday, August 15, 2000 on Wednesday August 16, 2000. I offer the following comments for your consideration. A. Erosion control measures are not installed according to. approved plan. * Erosion control "silt fence" must be installed properly for it to be effective. This is a violation of the Putnam County Sanitary Health Code. .B. Trench syster' not - installer? according to approved pl;:. Trend: to begm•2' -0" ftm— cnd of effluent distribution (solid) line. Two foot separation to be solid pipe. C. Well to be located on as -built survey for purposes of verifying location. *Certified copy of survey to be submitted with SSTS as -built plans. D. Remove all backfill material 4'0 and over during backfilling procedure. E. Suitable material to be used as backfill. * Remove all building material debris, wood, and trees prior to backfilling. F. Driveway to be a minimum 10'0" from end of trenches. * To be shown on as -built survey. G. Pump dose test required. H. House bedroom count inspection required. Please contact this office to schedule a joint site inspection to re- inspect the above listed items. i ini's oft "it;e veil l'ddftiinue,its-reVidWli �6ii-d6fisid6raiio'n6fth6-aB6,V6'ih'eiiti6ii6ac6*m-,"-m–e–n"ts.",:–'-"'�'-*"—,–,*,;!–"" Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj UTNAM C0,11INT.-Y. DEPARTMENT OF-B-FAILTH AMLT H SERVICES ]DIVISION OF ENVIRONMENTAL B ATfENTION -0-ADAM 13 GENE MQUEST FOR MALINSEEMION For: Fill All information must be My completed prior to any Trenches inspections being made. PCHD Construe 'on Permit 0 Located: (T) M PV, 4 0M Vq Owner/Applicant Name: MiZA&LIQ TM -Dj Bl ck - I Lot Formerly: Subdivision Name: 9-bA1Z4ekf4 Mon K-- Subdivision Lot # Is system fill completed? -,Y�s Date: 9/3/co 'Y Is system complete? e5 Date: Is system constructed. as per plans? 65 Is well drilled? 5. Date: 13 A Is well located as per plans?. eS Are erosion control measures in place f )Le.-S I certify that the systern(sj as listed, at the above premises has been construe i ed and I have inspected and verified their completion in. accordance with the issued PCHD C Dnstruction Permit i approved plans and the Standards, Rules and Regulations of the P County Depart�eAi "of utnal Health. Date, Ac. - Certified - bv. Fip rofessio ro ssional Address: hno 14C. of Lic. Comments: I Form FIR 99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE GE TREATMENT SYSTEM PERMIT # �Y 6 -' 1- 3 - 20- - Located at � re /V o ci Town or Village Subdivision name i&.,&ubd. Lot # Date Subdivision Approved Tax Map 41,17f Block / Lot Renewal Revision Owner /Applicant Name d VfAy /V%r 6, %,'a Date of Previous Approval ra AI 9 Af Mailing Address - / % a�� O��cdc /'� v g��'� �Si C �y —zip,; 2_6V_3 Amount of Fee Enclosed Building Type A ;1 e,0 Ce. Lot Area % G No. of Bedrooms � Design Flow GPD 10-1 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / gallon septic tank and ,015'e I-r Other Requirements: i °�%� �ra- r��� /� �� ��' �ys��✓� To be constructed by Address Water Supply: Public Supply From Address ff: _. : prly: *te_S " ply i.4 ed-h pp.� y. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. NEW P Y Signed: g� c - R.A. Date Address icense # APPROVED F CONS RUCTION: s apnrovafi exni �cear� a date issued unless construction of the sewage treatment system has been completed and inspected by thN evocable for cause or may be amended or modified when considered necessary by the Public Health Director.' • ion or alteration of the approved plan requires a new pe it. A oved o dis ar a of domestic sanitary sewag only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location: Street Address: TownN'll ge Tax Grid # f-1.o 9 C, �o a PW %yia�u %/G Map . Block i Lot(s) :�_0 a1 Well Owner: Name: M / Address: />'•`o�i�lU✓ �v�� Po��� f%� �/`� Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5'-' gpm # People Served .4 Est. of Daily Usage eo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling J/'New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling _ Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ✓`No Name of subdivision '6 r-c' did Lot No. Water Well Contractor: IVY e4ev—s Address: /3 o ry �r �� p J/• Is Public Water Supply available to site? .................................. ............................... Yes No e/ Name of Public Water Supply: _.. TownNillage Distance to property from nearest water main: 1 Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: La 5 t�o"%L 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 cert' led by Putnam County. Date of Issue 3 Permit Issuin Official: Date of Expiratiod 31iol wa Title: PTV 41E Permit is Non- Transfer abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of TV,49 Located at C, "f 15�,o a TN %a lam Ila %%may Tax Map # Block / Lot? -��i� Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: 'This letter is to authorize K#%i I/a ✓l a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code: _ Very truly Countersigned: Signed: P.E., R.A., # Z z1 S'qs ( Mailing Address 29.1,)— —1 State Zip Telephone: 2 Z Z State Telephone: zip 12yla 3 Form LA -97 PUTNAM COUNTY 'DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. H A:L- - SERVICES _CQr-45TRLC -716N FERMIT FOR SEWAGE TREATMENT SYSTEM w %KNIT tI !0cated r�. w J 1 at ` ;a Town or'Village G� j ubdivision name/• c-,%rrJ ! .1,v ar A Subd. Lot # Tax Map Block t Lot y� Subdivision Approved Applicant Name /fo c' 1r.. d ge_.e-g ,10 Renewal "''P Revision ✓__ Date of Previous Approval Mailing Address p�-Y Rific6 1f v : �v u n� !" �* i %`� 7l Zipjo_ Amount of Fee Enclosed 3a Building Type mss, d e,,,e. Lot Area / #44 -& No. of Bedrooms j_ Design Flow GPD o/ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / sU gallon septic tank and �y Other Requirements: 2-1 170 Ma .7 y ,$ mot' To be constructed by s v e " y�� Address Water Su®uly: Public Supply From M ti - Address: - Private Supply Drilled by. `- �. J� �` . :�'- ;sro -�y� Address 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the yep rap sewage, treatment sys m 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 hereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the )epartment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said uilder-will place in good operating condition any part of said sewage treatment system during the period of two (2) years lmediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original 'stem or any repairs thereto. ,ned: .,�iay Al 2 (�1� --�-� P.E. co " s'` r Date Iy Tress 2%' 7Z r/?Grtj7 'ROVED FOR CONSTRUCTION: This approval expires two year unless construction of the ge treatment system has been completed and inspected by the PCHD use or may be amended or fied when considered necessary by the Public Health Director. Any rethe approved plan requires Pe Tit. Approved fqr; discharge of domestic sanitary sewage only. Title: t.- Date: 1.7- L 9� copy - HD Fils; Yellow �opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form 1� r' TOWN OF PUI'NAM: V. L EY I ►i �� - l CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: DATE PERMIT EXPIRES: APPLICANT /SPONSOR: PROPERTY LOCATION: March 11, 2000 March 11, 2001 John Mirabilio 1 Richard Road Poughkeepsie, NY 12603 Clove Road TAX MAP #: 41.09 -1 -20/21 SIZE OF PARCEL: 1.0 acres ZONING: R -3 PROPOSED ACTION: Construction of single family residence, driveway, septic . system, well, within wetland setback area to Roaring Brook Lake. MATERIALS REVIEWED: 1. Application Materials, file # WT -277, and WT -336. 2. Proposed Sewage Disposal System Plan, as prepared by J. Sullivan, P.E., dated 12- 28 -99. CONDITIONS OF PERMIT: 1. All erosion control measures shall be implemented as shown on above referenced plan. Silt fence shall be extended to run along the entire length of the property along the 104 contour line. 2. Proposed lawn area in front of residence only permitted to extend for 40 feet. Remainder of buffer area to remain in a natural state. No mowing of this area permitted. A planting plan shall be prepared consisting of native shrubs to be planted along this boundary. Purpose of plantings is to provide a permanent barrier to the remaining wetland buffer and to protect the shoreline area of Roaring Brook Lake. Planting plan shall be submitted to Wetlands Inspector for review and approval prior to the start of construction. Page I of2 mirabdiopw q.; 3. The Building Inspector shall be notified once erosion control measures-are in place =d at Ts =ldasr 4& tiodr's'pnor "fo the initiation of any site work. 4. When Erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with conditions of permit have been completed. 5. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 6. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 7. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762 -7288, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: March 11, 2000 d . Stephen W. Coleman Town Wetlands Inspector cc: Applicant Building Inspector Planning Board Environmental Commission Page 2 oft mvabiiliopw BRUCE R.. FOLEY _ - Ahb. �ic�.:' eaithxlli��ct�ir=.<.,,- 7,,,..,-_•.-., � ,_.._.,.,..._..,<._..,_.. -.,�.. January 18, 2000 LORET.A MQ Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Mirobilio, Cove Road TM# 41.09 -1 -20 & 21, (T) Putnam Valley Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. 1. Correct all documents with "correct" Tax Map # 41.09 -1 -20 & 21. 2. Submit a current wetlands permit waiver. (Waiver of record expired October 28, 1999). * Entire submission returned for correction(s). This office will continue its review upon consideration of the above mentioned comments. -� -° - - .Pe °asp feel° >4ree`to'contacf me afext:' 2157'if any questions anse. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj . 4 I _ ......... _. _ _....__t -ICONS R UCTIO1`- PEI yT s lF G "SEWACI 'T1[WA' PERMIT #�_� Located at � / c o —t— Subdivision name 6 r -, -1,A Subd. Lot # Tax Map �f 9 Block J Lot Date Subdivision Approved Renewal `" Revision e' Owner /Applicant Name ,%i`a�ia, /c %� �y ;o7 Date of Previous Approval Mailing Address Amount of Fee Enclosed ,fie 19! Fd Zip..V -< � Building Type -,1,,J-o -pe-e Lot Area No. of Bedrooms 44 Design Flow GPD Aloof Pill Section Only Depth Separate Sewerage System to consist of / 2 -cl Other Requirements: To be constructed by �� ' e-,. %r' Volume gallon septic tank and Address 5° r 4- ,- Water Supply: Public Supply From Address !1!t is ;� Priyate._S1up ly. T3tille�l_by_ '.ex = � .. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. OV. NEW Signed: 74 ec2 l I I-` � jam.✓ Address ;2 ? 72- ,•rr� �'-rs r> jR..A.. Date /0 - 3 = 77 I.1c nse # APPROVED FOR CONSTRUCTION: This approval b"x tr s; . Fv om the date issued unless construction of the sewage treatment system has been completed and inspected'by the P is revocable for cause or may be amended or modified when considered necessary by the Public Health Director ion or alteration of the approved plan requir, a new pe it. Approved f discharge of domestic sanita sewage only. A ,p By: / Title: u (. Date: Z i 9� White copy - HD Fil Yell w opy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi:� PUTNA74;,,COUNTY DEPARTMENT OT`�ZEALTH DIVISION of ENVIRONMENTAL HEAL -? -I SE�'CESy APPLICAT CllN—T—O CON S`MUCT~A WATER WELL -- •rt,�s��riit�"o "fiypeY PCHD Permit # --� - Hlocation: Street Address: Town/Village Tax Grid # re- 4r rm P/a Map ¢F. Block J Lot(s)� -�� Nell Owner: Name: Address: 'Use of Well: Residenti Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought � ' gpm # People Served . Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling kL New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ✓ Is well located in a realty subdivision? .................... •�. Yes ✓' No Name of subdivision i� r��- �`r� ry er�i Lot No. Water Well Contractor: � Address: Imo. err✓ 1��•t1f T Is Public Water Supply available to site? ............................... . ................... I............. Yes No ' Name of Public Water Supply: Town/Village �- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/ptaii: Date: 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 :ontaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless )nstruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be Mended or modified when considered necessary by the Public Health Director. Any revision or alteration the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam unty. e of Issue 1 t S i Permit Issuing Official: &��0� of Expiration z zo oD Title: e Q rtL. nit is Non-Transferrable copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller TOWN OF PUTNAM VALLEY > I w yu xYah: _ ►/ CHAPTER 63: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. RATE PERMIT ISSUED: October 28, 1998 DATE PERMIT EXPIRES: APPLICANT /SPONSOR: PROPERTY LOCATION: October 2821999 ;- { Richard &. Joan Bergen Anthony Lifrieri 52 Oakridge Drive Putnam Malley, NY 10579 Cove Road . TAX MAP #: 41.9 -1 -21 SIZE OF PARCEL: approx. 1 acre ZONING: R -3 PROPOSED ACTION: Construction of an Single Family Residence within wetlands - . .. - bufllrer- to Roaring-Brook Lake R _ .T... _ _.. MATERIALS REVIEWED: 1. Application Materials, file # WT -277, dated 10- 06 -98, received 10- 19 -98, CONDITIONS OF PERMIT: 1. When erosion controls are required, they must be maintained properly throughout the construction process, and remain in place, until final site inspections for compliance with conditions of permit have been completed. Erosion controls are necessary for this project and should be installed along the entire Northern boundary across the lot and along the. western edge of the proposed driveway as shown on the Proposed Sewage Disposal System Plan, prepared by J. Sullivan, P .,E., dated 10- 05 -98. 2. Erosion controls must be inspected by Building Inspector for compliance with plans and prior to commencement of construction. Pagel oft bagWw V 3. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to insinect -the project from time tc time. - - .,_ r_- _ . , -.• .r -.. , > _... _ .. q. 4. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 5. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914) 762-72R8, or the office of the Building Inspector (914) 526 -2377. Date Permit Waiver Prepared: October 28, 1998 %,04J�24c to - 6)kj;�� Stephen W. Coleman Town Wetlands Inspector cc: Applicant Building Inspector Planning Board _ Environmental Commissiciiii Paget d2 1416 -4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review _ SHORT _ENVIRQ.NMENTA . SS ESSiF L FO.R �: - - - - r - °-' For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: /'; Municipality / y' �; County 4. PRECISE LOCATION (Street address and road Intersection rominent landmarks, etc., or provide map) Ce >_e 1.?dd � ��i'r 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration E. DESCRIBE PROJECT BRIEFLY: �� �'lG� ' � ✓.� �/� /�Pif / ��� O'er / �- e-. 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately , acres 8. ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? AYPROPOSED es ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential [I Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesUOpen space ❑ Other Des rib e: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? U Yes No If yes, list agency(s) and permlVapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Ayes No If yes, list agency name and permlUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes No /' GCS ✓'d P I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE a Applicant sponsor name: 191 4r /iwll "'&� Date: ✓ �% Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PUTNAM CQ? NTY DEPARTMENT Q' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ ..LETTER R. !,ZF AUTHGRsZATION' , RE: Property of f Located at '�L d Z �a T/V Tax Map # .:F- . �` Block / Lot Subdivision of f'43,1 --'4 -3� Subdivision Lot # Gentlemen: Filed Map # Date Filed This. letter is to authorize O4 0 � � /`� a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance: with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E,.., # Mailing A State Very truly yours, f Signed: (Owner of Property) Mailing Address: State` Zip lases Telephone: Telephone: oZ of 5 3 6 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES- -Date Re: Property of rl4)- Located at Co Section Block Lot Subdivision of Subdv. Lot .3 2, Filed Map # Date ''Gentlemen: This.letter is to authorize a duly licensed, professional . engineer loo' or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with Ahis. mant-ter, and to_ supervise the cons truc tL.nn,'..of.,.sa id.. . system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign OP P.E. I R r Address 44 Te.lephone Very truly yours, '41 Signed 'i(e Owner of'Pr W prt7 I Address Town Telephone NORMAN ANDERSON, INC. WELL DRILLING 152 BARGER STREET PUTN!►M , -YORK _ (914) 529 -8698 (914) 528 -1491 z9; /5", �4_ _. allel� r _ .. r . a DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 7, 1995 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Rich Bergin TM# 48.9-1-20-21 (T) Putnam Valley Dear Mr. Sullivan: BRUCE R. FOLEY Public Health Director This office has received reviewed the most recent set of plans for the above mentioned project We would like to r the following comments for your consideration. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property ....owners . contiguous to the property in .question.- :A location man.; showing the contiguous properties alons, wiffi t-lie property owner''s name and t map nu�must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either the following: Copies of registered mail receipts. Copies of the nitrification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. Letter to: Joseph F. Sullivan, P.E. - April 7, 1998 -2- Transmittal of this notification should be sent to the contiguous property owners by Design Professional. Utf. Deep Test holes must be witnessed by the Putnam County Health Department, or proof provided that a representative of this office has witnessed them. (linePlease clarify discharge line out of pump pit to distribution box. Discharge is not clear, being mixed in with contours. Well must be 15' from property line. Well on plan appears to be within 10' of rear property line (Lake Shore). Please also provide letter from well driller RAC r� statin r easibility to drill and service. ` oposed well is within 50' wetlands control area of Roaring Brook Lake, fl' ,- C- 6 t' d prior to Heath Department approval a wetlands perniit will have to be ----'� obtained from the (T) of Putnam Valley. Please place erosion control measures at outflow of footing drain pipe. All horizontal separation distances involving till greater than 2 feet in depth are measured from the toe of the slope of the fill. Please provide 10' minimum �... �PlaarAtioii` norr.frofit of- propert; lme to- toe -of slope. Notes: Construction notes to be pursuant to Putnam County Health Departntenu Bulletin ST -19, Append C. Notes for commercial SSTS should not be on residential notes /detail sheet. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, r Adam B. Sttebeltng Asst. Public Health Engineer ABS:tn P.! - DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 7, 1998 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Rich Bergin TM# 48.9- 1 -20 -21 (T) Putnam Valley Dear Mr. Sullivan: BRUCE R. FOLEY Public- Health Health Director This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. A. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided With proof that notification of the application for construction was made to all property... awrers coritisuous to fihc property in qu�stiun:° A I' ocation ;nap`, sliowin� the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the nitrification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. a Ila Letter to: Joseph F. Sullivan, P.E. - April 7, 1998 -2.- Transmittal of this notification should be sent to the contiguous property owners by Design Professional. G eral: Deep Test holes must be witnessed by the Putnam County Health Department, or proof provided that a repres ntative of this office has witnessed them. Plan: C. Please clarify discharge line out of pump pit to distribution box. Discharge line is not clear, being mixed in with contours. D. Well must be 15' from property line. Well on plan appears to be within 10' of rear property line (Lake Shore). Please also provide letter from well driller stating feasibility to drill and service. Proposed well is within 50' wetlands control area of Roaring Brook Lake, prior to Heath Department approval a wetlands permit will have to be obtained from the (T) .of Putnam Valley. E. Please place erosion control measures at outflow of footing drain pipe. F. All horizontal separation distances involving fill greater than 2 feet in depth _' �._....._._.__ _......;_:_... are measured.fr( )mtheto.e.ofth� sldpie efthi— l- .Please.pTevide 10' ..i ir.aYr:. separation from front of property line to toe of slope. Notes: G. Construction notes to be pursuant to Putnam County Health Department Bulletin ST -19, Append C. Notes for commercial SSTS should not be on residential notes /detail sheet. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Asst. Public Health Engineer ABS:tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER'SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION �0�11� NAME OF OWNER REVIEWED BY /� DATE �� P> TAX MAP # �I �• q— I Cf✓/ �� Y DOCUMENTS RMIT APPLICATION 'ELL PERMIT _ PWS LETTER ETTER OF AUTHORIZATION F,SIGN DATA SHEET (DDS) ORPORATE RESOLUTION N .IORT EAF LAT9 - THREE SETS SE PLANS - TWO SETS ARIANCE REQUEST SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED RATE e tEQUIRED 3 DEPTH AIN DRAIN REQUIRED STANDPIPES GENERAL TED IN NYC WATERSHED S SUBMITTED TO DEP GATED TO PCHD 1E /Its, HOLES OBSERVED AL SSDS ADJ. LOTS (TOWN/DEC PERMIT REQ'D ?) DS PLANS & PERMIT SAME 969 NEIGHBOR NOTIFICA .'R. FLOOD ELEVATION ER REQ'D PERMITS) REQUIRED DETAILS ON PLANS VITY DATA: PERC & DEEP RESULT DURS EXISTING & PROPOSED 'AY & SLOPES, CUT 3 /GUTTER/CURTAIN DRAINS COMMENTS: Y N' ROSION CONTROL:HOUSE,WELL, SSDS e PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE 14IF PUMPED, PIT & D BOX SHODETAILED OUSE - NO.OF BEDROOMS Q —11112 WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS LAY BARRIER IO- FT. HOR.IZONTA 3:1 TO GRADE FILL SPECS // FILL NOTES PROFILE & DIMENS I X IFILL IN EXPANSION AREA F TRENCH PROVIDED,, 49 60 FT MAX. ARMt -LEI TO-CONTOURS' _. 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 1 ' TO P. DRIVEWAY, LARGE T APP OF FILL 0' T FOUNDATION WALLS 15'WELL TO PL 00' TO WELL, 200' IN DLOD, 150' PITS 00' TO STREAM WATERCOURSE LAKE (inc. expan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35' -1 0/o,100' - <I% 20,'min to CD discharge /I 00'with 182 cons day discharge SEPTIC TANK X10'FROM FOUNDATION; 50' TO WELL FORM ST -2 4.0 CONSTRUCTION PERMITS Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Department; those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. 0 truction Permit Application. (Appendix K) of Authorization for Design Professional. (Appendix K) Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) Corporate Resolution (if corporate ownership). (Appendix K) Short Environmental Assessment Form (EAF).(Appendix K) . Design Data Sheet. (Appendix K) NOTE: All submitted Department application forms shall contain original signatures (no photo copies). . Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minim 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall inc e, as a minimum, the' following: Property survey with metes and bounds descriptions and major physical features. The plan shall make reference, by note, of the survey sow in .the c9pof. lots not subject to a filed map, a certified copy of a survey shal provided. VA datum reference is to be provided (i.e., National Geodetic Vertical Daturp 1929, or assumed/other). ouse location ,,vith proposed finished:: floor and basement elevations specified. Plan and profile of the SSTS, to include 100 percent reserve area, construction details of absorption system and components including septic tank, distribution or junction boxes, pump. it, dosing si ete-_ " "Location of driveways. daa ��5�V4 � � f. Location of well or ppublic water main and -house service connection Two -foot contours of the property: I ground is to be cut or filled, both f / existing and proposed contours must be shown. I�— Location of any watercourses, ponds, lakes or wetlands on, or within 200 feet f property. Accurate location of all deep test holes and percolation test holes. Omission of soil testing on lots in recently approved subdivisions will be at the discretion of the Department. Location of all existing wells and SSTS within 200 ' feet, of oroposed-55 d--5''T - and wells, or -a rgtc:st ±ing -that t irorie-dkist within 200 feet. k. Title box indicating name and address of property owner; parcel tax map identification number; property location, including street -and municipality; name, address and phone number of Design Professional; date of drawing, including dates of any revisions; and scale. ocation and discharge points for gutter, footing, storm and curtain drftins. Design criteria on plans to include number of bedrooms, soil percolation rate and deep test hole soil information, and sizes of SSTS components. n. onstruction notes pursuant to Appendix C. Space for Putnam County Health Department approval stamp (minimum 3" x 5 ") preferably at the lower right hand portion of the design plan. Location map (minimum scale of 1" = 2,000'): 12 9q. Eros' control measures for house, well and SSTS. Z�>nA-i*4 When a pump pit is proposed due to insufficient elevation for gravity flow or for dosing purposes, the pump pit design/detail shall include, as a minimum, the following: - Make and model of pump to be used and operational characteristics. - One -day's storage past the high -level alarm within the pump chamber. - Check valve. - Gate valve. - Unions - Operating and alarm levels for pump. - Means for pump removal for maintenance. - Pump curve should be supplied with the engineering report. - The pump operating range'should be indicated on the pump curve. - Pump dose volume to be equal to 75 percent of the volume available in the SSTS pipe network. - Minimum velocity of 2 feet per second to be provided in force main. - Baffled distribution box to be. utilized for SSTS. - Trench detail for force main, specify pipe type and rating, bedding and cover. Note stating, "All electrical work and material for pump installation shallcomp.1y.with tbe. National.Electrical Code:-" ...... Note stating, "All pump power and control wiring shall be made directly to the control panel without any outside splices. " Note stating, "The pump control panel, disconnects and alarms shall be located inside the house. " Two (2) sets of house plans with title block as specified in 7. k. above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality.., Upon approval of the Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only' If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. Well Permit Application, if required. (Appendix K) 11. pplications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map; showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each. contiguous property owner of a copy of the notification form in Appendix .E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2 Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. Trans - ttal_ of this notification should be sent -to-the e -ont�iguo!Apraperty 6y'-- e Design professional....._..` ...... _ Fee - See Appendix I. B. Construction Permit Submission Requirements For Lots Requiring Fill Greater Than Two Feet in Depth 1 -6. Same as Section 4.0 A. - 7. Same s Section 4.0 A., except for d. T�vo separate plans will be required; the title box for both plans must contain the statement, "Preliminary Design For Fill Placement Only" . I 14 i. Plan and Profile of Fill Section - Three (3) copies of this plan will be required showing the dimensions of the fill pad (i.e.. length. width and depth._ too bottom slopes of oerinhery of the fill) depth gauge locations. well. septic tank. house and driveway locations. This.plan shall not show the design of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. All horizontal separation distances involving fill greater than 2 feet in epth are measured from e toe of the slope of the fill. The estimated volume of fill in cubic yards must e specs ied on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e., one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1). copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. This plan will be retained for the Department's files for future _r e::ee... After a "Construction Permit" for the placement of fill is issued by the Department, a copy of the "Construction Permit ", one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building Inspector in the respective municipality in order that a `Building Permit" may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that `the SSTS is constructed in accordance with the approved plans. If any significant departures from the approved plans are proposed. because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Same as Section 4.0A. 13. Fill must be stabilized in accordance with fill note 41, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: e 1� a. Results of a minimum of two (2) soil per .colation tests in the stabilized fill. b: Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on ttate and does hereby cert & that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is considered suitable for use in a subsurface sewage treatment system The soil percolation rate in the settled fill based on percolation tests after stabilization is min /inch." SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) rears old, regardless of whether the same or a new owner is involved. 3.0 CONSTRUCTION PERMIT REAWALS The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization ? 2. Construction Permit Application S 14 i. Plan and Profile of Fill Section - Tlre.e (3) copies of this plan will be required showing the dimensions of the fill pad (i.e.. length. width and depth. top and bottom slopes of periphery of the fill) depth gauge locations. well. septic tank. house and driveway locations. This plan shall not show the design of the trenches, distribution box, etc., and this plan will be approved by the Department to allow placement of fill. The Department must be notified of the date of placement of fill. All horizontal separation distances involving fill greater than 2 feet in depth are measured from the toe of the slope of the fill. The estimated volume of fill in cubic yards must be specified on the plan for the ROB, unclassified and impervious soil materials. An equal distribution box rather than drop or junction boxes should be utilized in fill sections, with its foundation set below frost. Depth gauges will be required in the fill section (i.e., one (1) at each corner and one (1) in the center of the fill pad). The SSTS reserve area fill is required to be installed at the time of primary fill placement. ii. Plan and Profile of the Fill Pad and SSTS. One (1), copy of this plan will be required showing the design of the absorption trenches in the fill area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. This plan will be retained for the Department's files for future ef.rence - - After a "Construction Permit" for the placement of fill is issued by the Department, a r.,: co: py of the "Construction. Permit ", one (1) set of the approved plans, and one (1) copy of the stamped house plans should be presented to the Building. Inspector in the respective municipality in order that a "Building Permit" may be issued. The local municipality should be contacted for their particular requirements for a Building Permit. A Design Professional is required to assure that the' SSTS is constructed in accordance with the approved plans. If any significant departures from the approved plans are proposed because of field conditions encountered during construction, they must first be approved by the Department. 8 -12. Same as Section 4.0 A. 13. Fill must be stabilized in accordance with fill note n 1, located in Appendix C, after which time a second application for a Construction Permit must be made to the Department and shall include: • ya 1� a. Results of a minimum of two (2) soil percolation tests in the stabilized fill. b. Three (3) sets of plans pursuant to Section 4.0 A.7. including the fill certification note contained in Appendix C. c. The following certification statement is to be added to the construction (trench layout) plan: "This Design Professional has inspected the ROB fill material on date and does hereby certify that such material has been placed and stabilized in accordance with the requirements of the NYS Department of Health, the Putnam County Department of Health and the approved fill plan. The material itself has been tested and at this time is considered suitable for use in a subsurface sewage treatment system. The soil percolation rate in the settled fill based on percolation tests after stabilization is min/inch. " SIGNED: Design Professional All Construction Permit approvals are valid for a period of two (2) years from the date of issuance. Construction Permits are required to be renewed when a permit is over two (2) years old, regardless of whether the same or a new owner is involved. 5:0^.._. COI` STRUCT ON PERMIT RENEWALS The purpose of issuing permits with expiration dates is to provide the Department with flexibility should standards or site conditions change in the future. In addition, the Department must be assured that a Design Professional is employed to assume responsibility of the proposed design and to supervise and inspect construction. Approval of renewals will not be granted until the Department makes a site inspection and the following items are submitted. A. Construction Permits being renewed by the Design Professional who obtained the original permit (original or new owner). SUBMIT: 1. Letter of Authorization 2. Construction Permit Application Flow Flow 7.51 - 18.2 - 5.52- 8.40 -- 3.35. 242 2:42 2.35 IUD 1.01 1.30 .264 GPM -P M 40 8. 59 1/2 6.30 10.7 E3.5 - 3.8.'i -- -- 1.52 - v H f V mf v -- it 2" 21h- - 9.67 3 3" 4" 6" --- - ---- 37� .371 2.68 - 1.28 1.74 .444 I v Hl v V H Ht V v H v H v --- - H v Hl 2 2 743 .743 _ - - _ IF .380 .429 42 9 .102 4.3('),: 38 185 --W 1.95 .552 1.13 f:! 3 1 11 i .775 1644 .208 .473 .099 16.5 4.7fi 4.68 ;4 68 3. 1.93 2.17 4 1.49 1.31 .858 .346 .630 164 70 9.47 23.6 5.7 5 1 86 1 86 1 92' 1.07 .515 .788 .175 - - .247 --- - -- ------ - 80 6 2 223 2.70 1.29 .714 .946 .334 .574 102 3.04 1.25 1.76 .330 8 9 97 4.59 1.72 1.19 1.26 - 556 - ^ -' " 65 " -- - - - 7.65 -- 11.5 10 3.71 6.90 .2.15 1.78 1.5 8 .834 .168 .9,56 249 6,03 -10-0 15 - - - - - - 5.57 - - 14.7 -- 3.22 3.76 2.37 1.7� 1 516 .670 .106 20 -- 7.43 --- 25.2 -- 4.29 - 6.42 3.16 2.96 -- -- 1.9) 1.01 .217 2.42 --- .627 .083 25 9.28 38.6 5.37 --j.- 74 -j.- 9-4 - .866 1.34 .365 .868 129 8.38 1 a 9 5.43 - 3-72 3.15 --- .959 1.39 4.46 2-319 .1.29 1.68 .540 1.09 .191 175 6.44 13.6 4.73 6 27 X1:'81,` 2 n, 3 78 1.34 1.67 .178 35 ---- 7.51 - 18.2 - 5.52- 8.40 -- 3.35. 242 2:42 2.35 IUD 1.01 1.30 .264 40 8. 59 2 3.6 6.30 10.7 E3.5 - 3.8.'i -- -- 1.52 - .348 - 882 .095 * 0 C) 45 - 9.67 . 29.5 CD 112 3 ' 2 --- 2.68 - 1.28 1.74 .444 1.01 .120 m :13 cn 1.54 --- 50 ,m 7.09 1 5 4.3('),: 38 185 3.02 1.95 .552 1.13 f:! --- 60 m 7.88 16.5 4.7fi 4.68 ;4 68 3. 1.93 2.17 .665 1,26 .148 70 9.47 23.6 5.7 6.6?, 4.02 - �.72 2.60 938 1.51 .175 - - .247 80 6.76 --- 886 ---- 4.69 3.67- 3.04 1.25 1.76 .330 90 7.65 -- 11.5 5.36 469 3.47 1.59 202 .415 6,03 -10-0 8.60 14 3 5�83 3,91 1.�09 2.27 .517 125 6.70 7.13 4-34 2.42 --- .627 .083 252 150 8.38 1 a 9 5.43 - 3-72 3.15 --- .959 1.39 -- -- .127 175 6.51 5� 16 3 78 1.34 1.67 .178 200 7.60 -- 6-90 -- 4A) 1.79 94 - .236 225 868 893 504 2.27 2.22 .300 250 9 9 17 11.2 ' 5 67 56 284 2.50 374 099 1.44 - 63 630 0 i37 78 50 1.60 275 AiB 300 --- 69 693 4.13 3.05 540 1.76 141 325 - -- 7 56 4 87 333 635 19 2 166 350 8 19 5 70 361 738 - 208 192 375 8 862 6 656 389 848 224 219 400 4 16 960 240 250 CODE. V Velocity in Fl./Sec 4 44 1 09 256 280 1 H f Head Loss in F1 /100 ft 01 11w v31"01 to, velo(.,Iy f I-01011 . fee, "Soo baled o" pipe 1"Shl"Ic . S 1"Qq0S1fM v•l"... pj;'fj-'. 11-1W. PVC !'011 1 40 p., - Of ".".% ...... � J"' pv(; I yp". Soll 2(; i, . 71 0 '.0 * 0 C) > 0 CD t)3 < rm 0 m :13 cn L 0 0 ,m f:! m C) m nnW N PW. � Goulds Phase �_..� RPM -- .-Nc - -- - i' - � 7 KUE Submersible Item No. Descript lion ion'- � 1 ' 'I „yeller ....Casing 1750 Effluent Pump 2 230 -_... WE0318L ._._. .......{ _ 3 - _Mecnanlcal seal 5.4 cwE0311 Mr :: 7- 75 -j5-,F Snati -Motor "------- - - -... _. WED312M 230 200 .... -- WE0318M WE0511H 54 4 6 ^ Bearings - upper and lo:rer 8 3500 _... 1 3 3885 Polr,el cable 8 _.- i0•nny - - -.- 1 WE0518H 200 2 .� 200 MODELS Order No HP Volts' Phase Max. Amp. RPM 39 Heater Size KUE WE0311L WE0312L •.; 115 1 9.4 1750 N/A 56 230 4.7 WE0318L 200 5.4 cwE0311 Mr :: 7- 75 -j5-,F 94 WED312M 230 200 4.7 -- WE0318M WE0511H 54 - 115 230 145 3500 _... 1 60 WE0512H T3 WE0518H 200 8.4 WE0538hi 200 3 3.9 K32 ^WE0532H 230 34 K32 WE0534H WE0517HH 460 1.7 K21 115 1 14.5 N/A WE0_512HH1 230 7.3 - WE051 HH 200 8.4 WE0538HH 200 3 3.8 K32 WE0532HH 230 3.3 K31 WE0534HH 460 1.65 K21 _ _ WE0712H WE07'8H 230 1 10.0 N/A 70 200 11.5 WE0738H 200 3 6.2 K49 _ WE0732H .42 230 5.4 K39 _ WE0734H 60 460 2.7 K28 .. WE1012H -WE 1018H 1 230 1 12.5 N/A 200 144 - WE1038H WE1032H 200 3 8.1 K43 230 70 K43 ^WE1034H 460 3.5 K32 WE1512H r - :- _.WE1538H_. WE1532H _ .. , 1 ' 230 1 15.7 N/A 80 -. -2n0 :. - _r. 3 .,__tO.F ._ K53.._ K50 30 9.2 WE1534H 460 1 4.6 36 WE1512HH ^WE1538HH 230 1 15.0 N/A 200 3 10.6 K53 WE 5532HH 230 92 K50 WE 1534HH l 460 4.6 K36 ' for 575 V consult lactory. METERS FEET 120 35- 110 WEISHM 30 r 100 ` 90 W Vie.. u :5 •.. e0 :.••. w Z 70 0 2.- oi! o �s- 5J WE06HH 40 107 36 5 20 - 10 0• u0 .. 101 e0 -10 - 40 50 - 60 CAPACITY GOULDS PUMPS. INC. WATER TECHNOLOGIES GROUP SENECA PALLS NEW YOW 13148 35 (LIDS PERFORMANCE RATINGS (gallons per minute) ' WE031111 WE031 tNED7124; WE03/L �., WE03i1M WE031 /Mi WEOSIIN WE0512M 38N WEOS32N WE5 WEDS4N WEDSI /N WE0712N WE073BN 732H WE0N0. Wf0734N WE0711H WEIOI2H W11031H W11032H WE103411 Wf101EN Wf 1312N WE 153SH WE 1532H WE1534H 3500 WFOSI tHM1 WEOSI2HN W05381111 1011105321111 WE0534HH WE0511NN 3500 - -- W[1512NHi WE1S34HHDrder WE1S32NH wE153INH 3500 HP V3 1/1 14 3500 3500 RPM 1150 1750 3500 5 10 80 65 - - - 56 84 15 20 60 36 57 45 69 60 90 83 104 98 128 _1; 2 53 48 82 77�_ 25 25 50 76 92 116 45 75 °i 30 38 67 85 109 40 73 3 5 9 35 1 26 58 78 70 62 52 102 94 86 77 35 30 25 • 18 70� 117 3 6464 60 40 45 15 47 36 50 25 55 17 .42 67 12_+_58 60 8 32 56 3 54 65 21 46 1 51 70 11 351 75 25 _ 43 �- i0 80 15 90 _ 33 100 24 120 1 i 5 _ DIMENSIONS (All dimensions are in inches. Do not use (or construction purposes I D' ''A.'h,' /, and 1 HP = 15' except for model WE0712H and WE1012H = 18'• 1 Vr HP = 18' 12'/2 5 %" 1 ROTATION � D- I KICKBACK t EFFLUENT EJECTOR SYSTEM PT 1 1 Effluent elector system Package Includes: offers ease of ordering Sunmers ole Enwent Pimp WE0311L and installation. A single 12L or WE031IM. 12M WE0511HH. 121i1M Mechanical Level Control Svnicn ordering number specifies A2-5 015Vi .2.6125041 70 e0 90 100 GPDS a complete system designed Basin A716015. Basin Cover A8.1622 -- - - -20 - m31h for most residential and do �, Cneck Valve A9.2P commercial sump and ' Order No SWE031IL SWE0312L. effluent pump applications. �_ SWE031IM SWE0312M SWE051IHH, SWE0512Hr+ SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE, PRINTED IN U.S A . u O .. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/4" maximum. • Discharge size: 2" NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon carbide - rotary seat/silicon ._ . ..__ __. ....._.csfbide-SiailOnary'seat, 3CC '° series stainless steel metal parts, BUNA -N elastomers. • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor Single phase: • '/3 HP,115 V. 200 V, 230 V, 60 Hz, 1750 RPM;' /2 HP, .115 V, 60 Hz, 3500 RPM; %2 HP —1'/2 HP, 230 V, 60 Hz, 3500 RPM. • Built -in overload with automatic reset. • Class B insulation. Three phase: • '/2 HP —1'/i HP 200/230/ 460 V, 60 Hz, 3500 RPM. • Class B insulation. f r' • Overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower. • Power cord: 20 foot standard length (optional lengths available). Single phase: •'/3 and 'h HP —16/3 SJTO with 115 V or 230 V three prong plug, • 3/4 -1' /z HP —14/3 STO with bare leads. Three phase: • %2 -1'/2 HP —14/4 STO with bare leads. On CSA listed models — 20 foot length SJTW and STW are standard. FEATURES ■ Impeller: Cast iron, semi - open, non -clog with pump - out vanes for mechanical seal protection. Balanced for METERS FEET 25 90 F .. �. ..,. 80,_ - -�- WE-115H 70 20 a WE10H so W = ir i WE07*1 a 15 Z 50' - - -* �_..... 0 40' WE05Fl _J a ; ; 0 10 30; :: WE'�►: 20- 5 I ..........;...... . 0L 00 0 W 0 0 smooth operation. Silicon can be operated continuously bronze impeller available as without damage. an option. ■ Bearings: Upper and ■ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge adaptable for slide rail systems. ■ Mechanical Seal:.SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA -N elastomers. ■ Shaft: Corrosion - resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation ■ Motor: Fully submerged in high -grade turbine oil for lubrication and efficient heat lower heavy duty ball bearing construction. ■ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ■ 0 -ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS SP Canadian Standards Association nu, Underwriters Laboratories transfer......_... ■ Designed for-Continuous`- Operation: Pump ratings are within the motor manufacturer's recommended working limits, 10 20 30 40 50 60 10 j SERIES 3885 SIZE: ?,;" SOLIDS ..................... . RPM: VARIOUS GPM 70 80 90 100 110 12o 130 GPM CAPACITY 20 30 m3 /h 1995 Goulds Pumps, Inc. Effective May, 1995 83885 =o, ;u eo so. ROARING 90 ip ° \ 62 N 413 0 60 O 193.2 H a26 J` } , O N� 3.2 a J8.7G 7s 7 5 a ' i 2 N ' %�� 5 ® N ba ?z o , 1 , * _ �� ° 436 m / �'t I - 3 / �pP� 8 W e 40 7s �s 7s 43.27 �� N 3 � Oar C39 0 9 . • 10 6 �1 a . 3 poi _- a ool laso � I r -e "Lam"MMIAL_ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 - - -' ::� ^�'T 'InN - TO . -- PCHD PERMIT WELL LOCATION Street Address Town Village City Tax . Grid Number WELL OWNER Name Mailing Address 9rG�cr/ ��/ �� C1G%�i e'. Wrivate E3-Public .USE OF WELL 1 - primary 2- secondary XRESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT Crgpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE e�'0 Sal EI REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION LIADDITIONAL SUPPLY gNEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED 13DRIVEN ODUG 13GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name IV g97C/ !//! Address: & /�Gs7? dam` r' IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES d NO NAME OF PUBLIC WATER SUPPLY: -- TOWN /VIL /CITY DISTANCE. TO. PROPERTY. FROM. NEAREST WATER MAIN: 4-1;1 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE 3� J �Z WN SEPARATE SHEET `(/date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in suc a manner as not to degrade or oth r ise con inate surface or groundwater. Date of Issue: 19 Date of Expiration 19 f Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELLU ljg WELL LOCATION treat Address Town Villa e C ty d1 0— e O eY 2 l� raj Tax Grid Number �e` f WELL OWNER Name ailing Address Ar/` Cj/ ! / 4r;p APrivate O Public -USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL O INSTITUTIONAL Q AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O OTHER (specify' O STAND -BY AMOUNT OF USE YIELD SOUGHT ;6"' gpm /# PEOPLE SERVED /EST. E3 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION W SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL OF DAILY USAGEZpd gal 11 ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ®GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES r✓NO IF WELL IS LOCATED IN A REALTY.SUBDIVISION, NAME OF SUBDIVISION: ,- 07ir2r Lot No. WATER WELL CONTRACTOR: Name 4/. J-�'W Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:f,`JG LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (d e) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt -y (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or other a contaminate surface or groundwater. Date of Issue: 312_ 19 -15/ Date of Expiration 19 46 Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services i ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO . CONSTRUCT A WAT13., WELL _ PCHD PERMIT:,# WELL LOCATION street Address down Vill ge City Tax Grid Number 1�a�x tiF7?41rr� i� /lam �l - z WELL OWNER Name Mailing Address i Ci�j�✓'� Public USE OF WELL l.- primary 2- secondary $;RESIDENTIAL O PUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL O INSTITUTIONAL O AIR /COND /HEAT PUMP 0 ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY Q .AMOUNT OF USE YIELD SOUGHT j' gpm /# PEOPLE SERVED ¢ /EST. OF DAILY USAGE 15e�Cr sal ;REASON FOR ..DRILLING E3 REPLACE EXISTING SUPPLY O TEST /OBSERVATION L?. ADDITIONAL SUPPLY 1VNEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING ° WELL TYPE DRILLED DRIVEN ®DUG []GRAVEL ❑OTHER . -IS WELL SITE SUBJECT TO FLOODING? YES it NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: — Lot No. WATER WELL CONTRACTOR: Name Address: ,c rr��✓� 1� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME, OF PUBLIC WATER SUPPLY: — TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: .LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MN SEPARATE SHEET ---T r (date)' (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty. (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. A "'wring all well drilling operations, the applicant shall take appropriate action to assure that rn \and all water or waste products from such well dril operations be contained on this re;'erty and in suc a manner as not to degrade or of rwi a contam ate surface or groundwater. %f Issue • -1' 19 Expiration 19 Permit Issuing Official 'Non - Transferrable White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - - - APPL,1_'..AT1.0N: TO— ONSTRUCT-;__r.:..:r�r WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing ei 804i,61N 5-2- Address ®Private Ohr o Ga DMWf- Pµt*kd- V11"Py 0 Public USE OF WELL 1 - primary 2 - secondary ®RESIDENTIAL PUBLIC SUPPLY QAIR /COND /HEAT PUMP 11 BUSINESS D FARM O TEST /OBSERVATION ® INDUSTRIAL C3INSTITUTIONAL O STAND -BY ®ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT .„r gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 4o© gal REASON FOR DRILLING 19 NEW SUPPLY OREPLACE EXISTING SUPPLY O PROVIDE ADDITIONAL SUPPLY ®DEEPEN EXISTING.WELL ® TEST /OBSERVATION DETAILED REASON FOR DRILLING rf ►� r WELL TYPE 19DRILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES "K NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:,es Lot No. 43 Z WATER, WELL CONTRACTOR.: Name Wk"W. Awc X-4 Address: /3AP G��- �� . ATN/m IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES "�C NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY PR6P.'R__ FRO__M NEAREST WATER.K4k.1- :- - - _ ._. - ...nISTe�N.CF. TO__ F TV, F F ran T* . _ _.. . ,.. .,.. __'.. _.. _ . . __ .a.....__.... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION ®ON S PARAT SHEET jqAqL (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by, the Putnam County Health Department. Date of Issue: S' 19 Date of Expiration: / 19_ Permit Issuing Of fil cia Permit is Non - Transferrable White copy: H.D. File Yellow copy :, Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller • ' \I9 R PTMNI A 5 COUNTY DEPART'V= OF HEALTH - DIVISICN OF M7IRCR4ENTAL REALM SERVICES - INDIVIDUAL WATER ` a SJESURFACE .':U .AGE DISPC�L StST Y-s P==1 SHEET - CONSTRUCTION P-7RMIT DATE REEVIE ED : z6z-td Q V c kki BY . �. -1,,/ :+ac; e of Cwner) (Street Location) CC;TS YES NOI I kv Ix x i xl I I �I sl �c l tv 4 �I I I C1q14-F VS &Y C .F I I >< Lr trench provided �o lt reuir� .'Z r" 60 'Lt. max. 6' Parallel to contours /V b 100% e_xo. 1 x ♦cam No ,� AEt I X 2va d itsvE 3� �I v a p OZ FILL SYSTEMS clavbarrier - No 10 ft. fi � notes - lira► Uo Sieve- new szec. U depth Qauaes -No I 100 vr. flood elev. 200 ft. reservoir, etc. Li 150 ft. trigall /gall. IA40 i IJ% DCCLM ITS Pei^►it Apoiicaticn Corporate Resolution Plans - Three s`ts s/s Engineers Authori zaticn Design Data Sheet (DDS) SJ=171ISICN Deno Hole Log per` Consistant Perc Re -s1tS (3) Fill Perc Hole Deptn CA House Plans - Tr,ao sets Well y &'3 pe_r:ni t; FNS letter Vari- .ce Request Qv L Laval Subdivision Subdivision Approval Checked Ex- aoprcval SSDS Adj. Lots Cheaper Wetlard (Tcw-n /DEC Permit R & D) Data Cn DDS Plans & Pe* -•mi t Sarre REQUIRED DETAILS CN PLANS Seeage Systrn Plan - (north. a r=cw ) Seeage Sy ten Hydraul i c Prof it e - Gravity F_cw Fill Profile & Dimensions - Vo'Urne D or J Eox;Trencn /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over. Construction Notes (grinder rate) Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Out Fcotina/Gatter,Cur in Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flcw,suff. size If Putted Pit & D Box Shcwn & Detailed House No. of Bedroans Wells SD' Win 200 ft. of Propose: SysterLS Pro. erty Metes & Bounds House Setback Necessary (Tight lot) House Suer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /clencut SEPARATION DISTANCES SPECIFIED CN PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e_x_.an 15' to Drains-Curtain, Leader, Footing 35'to catch basin,storrrrlrain,oic3 waterccurs 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well , -- FumzK C'OL Nay- DEPa XMAIENr OF HEALTH — DIVISION OF ENVIROM&�1TAL HEALTH SERVI=, INDIVIDUAL k--D= S"JPPLY S'JBSURFP_C✓ SZN-A E DISPOSAL SYSTS S "L DATE: t .►S. C INSP. BY: (NEm of Cwner) ( Street Lcaticn ) INITIAL SITE INSP=ION YES NO CC&-M. S Wetlands on /or proximate to property .............. >} Prcperty.lines or corners found ................... >� Canestimate house lc.ticn ...................... . willdrivc-Nav need eat. ............... .......... mist trees be- rarvved - note these ................ Deep holes representative of e_htire SDS area...... Patios deep holes ne- ade3 ...................... Sufficient SDS area available considering drivegwi cut, hcuse location, separation distance- =,etc... r0jacent wells /septics ............................ L/ Access to urcccsed wz_i_.i.. _location for _c?ri l li rc. . D. H. 1 Lot. Death to G: Fi . Depth to rock Coil 0 ft. 3 ft. ?(� 6 ft. r 9 ,ft. . . D. H. 2 n,at Depth to G.W. Depth to root 0 ft_ 3 ft. 6 ft. 9 ft. . __ -12 •ft.� Soil De_=crinticn D -E. - Deeo F-cle G.w.-Lrcund a-te_r D. H. 3 Lot - Deot2 to G.4v. Depth to rcc:K - 0 ft. - 3 f t- . 6 ft_ 9 ft. Soil Lescrioticn - DATE: MIAL SITE INSPECTION INSP . BY : IMI NO Cm. M1 r-IS Ecuse SSDS located per approved plan ............. Length of trench me=_sured width of trench avenge Slope of tile line and trench acceptable......... Roan a?lcwed for exp--nsion trenches .............. Over 100 ft_ fran watercourse .................... Natural soil not stripped or SDS area unrecessarly graded ............................ 10 ft. maintained from property line and 20 ft_ fran house ............................... Distance well to SSDS (ft.).. ..................... Numberof be3.rcans chc ---K -s _ .... .................. . Stones, brush, stumos, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally frantrench .................................... Boxesproperly set ............................... Could surface runoff fran driveway, read.=_, ' crcund surface, etc_, channel near SDS are=.... Dces lot drainage appear OK%in' area of SDS.•:..... FLNAI CRP -DING OF SiT✓ P_CC Tn�L: _ _ ... - - - - • - _ l Date Engineer G17V S A JICIL Re: Proposed SSDS2G Cave Dear V }.,. , A . Review of plans and other suuportin5 documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: O"V 0 s "` Or Upon receipt of a submission, revised to reflect tZe above com*nents,. this application will be considered fur Sher. i Very truly yours, Robert Morris RM- Environmental Health Technician JOSEPH F. SULLIVAN, P.E. .. eonsurEing �ngfneea .. . � •Y2J'72 F "ERNCRESTI7RIVE ' YORKTOWN HEIGHTS, N. Y. 10599 (914) 962 -4245 Fe bruary 18, 1992 Putnam County Department of Health 110 Old route 6 Carmel, New York 10512 Gentlemen, Enclosed please find modified plans and,-:::::construction application forms for the proposed sewage disposal system for Mr. Richard BergiA -13 lot on Cove Road in the town of Putnam Valley, Putnam County , N.Y. (Section 48.9-1-21). A sewage disposal system was approved for.:-the same location on this lot in 1988( your file No PV 6 -88). The original lot size has been increased to 87,000 Sq, Ft. as shown. There have been no changes in the surrounding properties to adversely affect this disposal system. Very truly yours �74vx Joseph F. Sullivan P.E. 3 ol Al I@ ° P ,10 / ISO 80 60 7777�' .. . ...... . - ROARING , D 9 90 9 / i yQ 9g r `\ gp Z a a 425 (AJ SO LP WyS^v ° IV � p N / ag { m ao \ O I b 4i � N CY 193 n Vj/j}ryr4 7/ / v In J a 4 N 3.2 3.' 75 1 ryo 8 g ?lo // P ��//�•�• / !P ° 426 / °/ //� 5 ?z 2 N, 3 - H4 43.27 / � `s 3B a0 �5 75 -__ }� `327 . \ 9 300 q9 00, to _ 3.20 2 96 / �. P/ `J— 0 "Ap � 300 �3s ' I o 0 � w I I l I (2 2*0 ,'o PUTNAM COUNTY DEPARTMENT OF HEALTH 6 �VI)ON��N t-9ALTH S EAVR S � ._. _. . Date November 279 1987 Re: Property of Richard, Bergin Located at Cove Road.. Putnam Valley. N.Y. (T) Putnam Valley Section 11 Block 2.2" Loth Subdivision of Roaring Brook Lake Subdv. Lot # 432 Filed Map #_J0 Date Gentlemen: This letter is to authorize John S. Romeo a duly licensed professional engineer X or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in 6'onnection' with this matter and £o supervise' the construction of said system or systems in conformity with the provisions of Article 145 or 147,.Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed _)79AJ v Countersigned: Owner of Pro 7II-ty n P, E . , � . , # % 5'2- ®AA ")Tj D IF Address North rid. a Road. ° olA1 Address ;`'cLQ �� r.Ai ® Town Peekskill, N.Y. 105; , Telephone 914- 737-1056 Telephone log :1 200 Ali, PEI C6F HE Bra f. 00 3 era 7t- - - - - - ?, t. is i i Cl 44 'IJ ly 7 T F Xv It w I ---------- 7-7-= PUTNAM COUNTY DEPARTMENT OF HEALTH -. ,,,.. :... D'-I" V, 181 i v`: -01, D- NV��RO1N fENTAL HE ALT11 C -EG Re: Property of Date C-101 Located at Co ►-e- /7d lF (T) j"', Section Block Lot Subdivision of /'IUD r �+ ✓� ✓���j� Subdv. Lot # l9 3 Z- Filed Map # Date Gentlemen: This letter is to authorizes V`�' ��� ✓Oy a duly licensed professional engineer// or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in Ct�ya e%'�;3U7i' "Wltri t�1 ---mnat el --- amid -- t-a-- supery -i — ti:a -: E r� � :'G 3•Cn-- -of--s Ba 3 d- - ._» • system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign OF tl p• '� P. E. , �R/Jlj JI Address ``;�ti J a IIq;g95 C. iI Telephone Very truly yours, Signed Owner of Prop ty. Address Town Telephone d' JOSEPH F. SULLIVAN, P.E. & "4 &tigur "A 2972 Ferncrest Drive Yorktown Heights, New York 10598 (914) 962 -4248 March 4, 1996 Department of Health Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Gentlemen: Enclosed please find modified plans and construction permit forms required for the proposed renewal of the Sewage Disposal Design for Mr. Richard Bergen's lot on Cove Road in Roaring Brook, Putnam Valley, New York. (Section 48.9 -1 -21) _ A. sewage Disposal System was a.uproveddW., 4is lot in 1988 (Your File No. YV 6- $i3�Jand reapproved in'19y4: There have been no changes in this lot or surrounding lots to adversely affect this design. Very truly yours, e, 6 4, Joseph F. Sullivan, P. E. JFS %ats Enclosures 94 -13 7 ru unAtn k chin i t UrXAa AfV1,L„ ur ard%A,10 Division of Environmental Health Servloes. Carmel. N.YdO512 �Eng�dler to Provide Permit N 1 1 on CEBTIFICA.T'Pj� COMPLIANCE c� Permit= N - c6 CONSTRUC110NPERMIT FOR SEWAGE DISPOSAL SYSTEM (h _t Yuzimm valley Located at l ; oye Ro nd o— m. Village SwAvbdon'--+lame ?euric Br001L '5s IAtN 432 Owner/App1ltantName RichRrd Ber gin > P m"ing, Da 52 O�ridge Drive .0 105 79 mam Valey, N. , Tax Map,,rh 1 Block,. I of Renewal"R ❑ Revision-0 Date of Previous Approval Town tip 2 stf�yy r�2ma 23, 500+ ' Building T,'ype Lot Area [Fll Section Only DE,pih Volume Number of `Bedrooms 3 Design Flow G P D `' r'. '' PCHD Notification 1. Regalred When Fill Is completed Separate Shwerage System to consist of �0 GaHon Septic Tack anf>� '-' F of 4X4 G al l e r i et To be constructed by 1{'OVaard Gregart Address ?!!I<? 1�utrip,YA Valley, 1V. Y. Water SttP.*: MHe Supply From Air f 'onx_PriYa as supply Drilled by No And erson.d&,= 3 ger 6treet,t PutYagm Volley Other Ren- !;drements 31 Of ROB t3- be 2-aoed in Septic Area ,••'�•° ; , 1 represent" that 1 am wholly and completely responsible forttw* design and location of the proposed s above described will be constructed as shown on,the approved amendment there to and in accordance w County Uepartment of Health, and that on completion trfff of a ••Certificate of Construction Coml be submitted to the Department, and a wNten guarante"vill be furnished the owner, his successc Oil ce in 'Sood operating condition any partTej.- said sewale disposal system during the period of tl anee of the approval of the Certificate of cradestruction C;qmpliance of the original system or any will be located as shown on'the approved plan-and that said mW will be Installed in ordance with'" County D,'ipartment of Health.. Date Nay 279 1987 L "` "` Cr Signed j Address i Nor -T -u ® 3- , Peekskill .� APPROVED FOR CONSTRUCTION: This approval expiresjwo years from the date issued unless Co revocable' Cot cause or may be amended or modified when cMidered necessary by the Commissioner requires i - 11 new, permit. Approved for disposal of domestic sanitary wikage, /SM/ot:,.priv'te water Rev. 1/87 Date BY of Methyl 'tAAWAM supply onk!" • • u' p Title 1 f : lisfioner of Healthwill that said builder Will Iii U)"ate of the issu- well described above s of the Putnam �.E. x R.A. 27846 s been undertaken and is alteration of construction j(I`- , -. PUTNAM COUNTY DEPARTMENT OF HEALTH r y�1Vt"S7[i a :t?F*. , rZ0 -t}: E N TV.L -- _0- A --T lT-�..::SF.F.VICRS.::......_ Re: Property of -Date ®e 9' G4 0"04 V Located at 1. ® ✓eO Q' (T) /�.► d !i 'S.ection Block Lot Subdivision of / /dct�" Subdv. Lot # 41 3 Filed Map # Date Gentlemen: )) This letter ' is to authorize a duly licensed professional engineer v or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in ooianection` with this rat tar an --td- suYe�vgse ,the .corxstruction of sa:i:d: system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign o' P.E., R�. ." W M Address sFd ,�. tw, Very truly y. urs, Signed Owner o O'1xW foyhc 7 Address Town Telephone Telephone JOSEPH F. SULLIVAN, P.E. 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N.Y. IOS96 (914) 962 -4248 March 21, 1994 Department of Health Division of Environmental Health Services 4 Geneva Road Brewster, N.Y. 10509 Genitlhmen , Enclosed please find modified plans and construction permit forms for the proposed renewal of the sewage disposal design for Mr. Richard'Bargen's lot on Cove Road in Roaring Brook, Putnam Valley New York.(Section 48.9 -1 -21) A sewage disposal system was approved for this lot in 1988 (your file No PV 6 -88) There have been no---changes in this lot or surrounding lots to adversely affect this design. Very truly yours Joseph F. Sullivan P.E. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Basso 11 Cove Road Putnam Valley, NY 10579 Dear Mr. Basso: ROBERT J. BONDI County Executive - > ,.ROBERT I0'IORRI5; Director of Environmental Health i DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 29, 2007 Re: Addition — Approval - A- 055 -07 No Increases in Number of Bedrooms 11 Cove Road (T) Putnam Valley, TM # 41.9 -1 -20 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department dated March 29, 2007. The addition is approved with the following conditions: 1.. The total number of bedrooms must remain at _four without prior approval by this department. _ 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving, devices, i.e., new low flush toilets, restrictors for shower heads -and faucets, etc:- - - - 5 - - 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Sincerely, t Gene D. Reed Senior Engineering Aide GDR:kly cc: BI (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 F&x (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 ri Pr tit /01 xiS`� %�r�r5� F/oor PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSCI.I,t PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL ' SIGNATURE & TITLE fDA-T-E t -2q, PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY BEDROOMS A 7 75/41 ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL ", JA TILE -DAT� rn koo Inn fj©�E� Propose-c� sip k� !3zhircov-11) o vl��, le-cce"C� 7 Dfv, li UP TEST Piq��\ TA REOUIM TO LM--_ M_t-1:JLUW Ur DUIIA3 ,M"UAJNXZa= INt JdX WIAZ 41 51, 61 71 8! 91 � --i 131 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED None e.- -bottom of-, 7.e. --heAll INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Sean Patten (J.S.Romeo) Nove 23, 1987 MQ HOLE OBSERVATIONS MADE BY-0 DATE: 8-10 DESIGN 5000 SF + :oil Rate Used Min /1" Drop: S.D. Usable Area Provided Jo. of Bedroans. 3 Septic Tank Capacity 1000 gals. Type Masonry lbsorption Area Provided By L.F. x 24" width trench 96 LF of 4X4 Galleries -)ther John S. Romeo lam Signature fip k3dress 1 Northridge Road SEAL V JR, Peekskill, .N.Y. 10566 27846 MIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: V )Oil Rate Approved — sq.ft/gal. Checked by Date Ilk. Pere 2 Deep '10p DES HOLE NO. HOLE NO. HOLE NO. 6 Topso it 6" Topsoil 610 Topso it 601 Topso.' sandyesilty loam 77 sandy, silty, loam sandy,siltyt sandypsilt3 loam loam 21 sandyt silty. loami_ sand,y#BiltYqIpam —san Zy—o,—s—ilYy—o---sa—nTys—siltS 31 some elm some clay loa'mo some loam, some play olay 41 51, 61 71 8! 91 � --i 131 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED None e.- -bottom of-, 7.e. --heAll INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Sean Patten (J.S.Romeo) Nove 23, 1987 MQ HOLE OBSERVATIONS MADE BY-0 DATE: 8-10 DESIGN 5000 SF + :oil Rate Used Min /1" Drop: S.D. Usable Area Provided Jo. of Bedroans. 3 Septic Tank Capacity 1000 gals. Type Masonry lbsorption Area Provided By L.F. x 24" width trench 96 LF of 4X4 Galleries -)ther John S. Romeo lam Signature fip k3dress 1 Northridge Road SEAL V JR, Peekskill, .N.Y. 10566 27846 MIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: V )Oil Rate Approved — sq.ft/gal. Checked by Date Ilk. PC ZM COUNTY DEPARTMENT OF HF1}.L DIVI'` of HEALTH SEEM`, DESIGN DATA Sh=- SUBSUFACE'SDQAGE DISPOSAL SYSTEM FILE ice. z- ;QVe taw::_ A. ess— �e, 't�itPraf�n� "Valley 1Cy.._. Located at (Street) Cove ' Road Sec. 11 Block 2 Lot 4 (indicate nearest cross street) , Municipality Putnam Valley' Watershed i ew York City Date of Pre- Soaking Nov 23987 Date of Percolation Test Nov 24, 1987 21.23 0 90.33 3 .1_'56 X3825 29 18.25 21.25 HOLE 9.67 4 4827 4856 29 18.25 NUMBER a-= TIME 9.67' PERCO=CN PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate. Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches (1)1 2355 3120 25 17.50 20.50 3.00- 8.33 2 3 :23 3 850 27 17.50 2 ®.50 30.00 -9-.00 3 3 ®53 41d30 27 17.'50 20.50 3.00 9.0o 4 5 (2)1 2157 3x21 24 18.25 21.25 3.00 8.00 2 26. 9154' ..28 - . 18.25' 21.23 0 90.33 3 .1_'56 X3825 29 18.25 21.25 3.00 9.67 4 4827 4856 29 18.25 21.25 3.00 9.67' 5 1 2 3 4 5 NOTES: 1.. Tests to be repeated: at same depth until approximately equal.soil. rates are obtained at each percolation test hole.- All data to`be suhti.tted for review. 2. Depth measurements to be made fray top of hole. rev. 9/85 0 0 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, Director of Environme ADDITION APPLICATION RESIDENTIAL ONLY STREET I °u �Z TOWN � q1" NAME `U S S PHONE l Y� 9 "7 15-�rCHD# A -(i J 'Q MAILING ADDRESS DESCRIPTION OF ADDITION 1 S e �SSVIIA NUMBER OF EXISTING BEDROOMS_ PROPOSED # OF BEDROOMS_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please. submit- this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509; Phone: "845)'2118-613101 . 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 0 44 Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Town Legal Bedroom Count ROBERT J. BONDI Re: (Owner's Name) Tax Map #: 9 — 2. Address: -Q V Town: P` A\ Year Built: 2-000 According to records maintained by the Town, the above noted dwelling, is in compliance with Town Code. is-not - in- compliance, with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: Other: _. 4=�y -- Building Inspector 3 / oq Dat 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 SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 13, 2007 Mr. Basso 11 Cove Road Putnam Valley, NY 10579 Dear Mr. Basso: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Addition — Basso 11 Cove Road (T) Putnam Valley, TM # 41.09 -1 -20 The application for the above referenced project is incomplete. Please provide the following: 1. One set of existing floor plans and two sets of the existing and proposed floor plans shown as one finished product. All rooms are to be labeled and dimensioned and the drawings are to be to scale. Sketches by someone other than an architect are acceptable. _ Review of your application will continue once the above documentation is received. Please do not hesitate to contact us if any questions arise. JSP:kly Sincerely, (,.,/,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 i` f ii fig +I CA- i . Vvi- �vm � k �- 41— �",f+a. tnr°'�y ,.��.I�!; :• .£..r �i.. r2f �`t ... d i,�"^'i�.`?�'�,��i ��'Y'..,.ay +,v -� °�r� r"�.. �� �m e ,+�, �u x•w.m... F r r r y ,t.�;���.,k i Le e �, ��f tj lrr..hr r - ,.. L"_ E`, 1 .+- t ,v' l 1 a . t •Y ;�- afi r r - < . rre;` x7 t+„f�t i 'cry t 4 .-�.� Vtwml q 1 }`+'� �'.i�lt {y� -C1�.i !t ."" d x . t '•4. ,, �R5 1' Y.i'�s y •i .. .� x .rllP rr. +.,. .. ,LCS,dk,'y�.•sti �i ,r�.E. r k i ,d a u iq,. sr ,a y '4 -��4 ,d � _, ,� r,g• �2 : it 2-ir- ;�,4,b{ 5'T � �• x�� e f Y f r._ ,x 4 t,, s r ( # 'r �f t. 5 :., 2 r•A E s xtX,' axS� =rU: i � ...�ta d,,..t:a �.•,� t _ -. � F,���`� �'",1 `, �. .4. S °zux tr, s d is w+; ,u � :.,,t �,. .... .,.:,. 'e, �F v.i•�.:�. � ��i n� {t t ,.:�.y'.� - .. � i ,•y . � tn. �`f•� .S PT CERTIFICATE NO ': 2000 240 `r PERMIT NU.: 2000 130 TM#: :41.9-1-20 DATE: October :12, 2000 a�< , LOCATION. 11 COVE ROAD x ISSUED TO:. JAV BITILDEIaS, INC This certificate ,covers.,the,.const;ruction of: New One = family Residence W /i7ECK iGARAGE & i Family-Year Round Four bedroom FIREPLACE The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary Code, the Uniform Building & Fire Code and the .Laws in effect in the Town of Putnam 'Valley,'- Putnam County, NY,: having paid the required .fee therefor and.the_ undersigned havi,rig by personal inspection ascertained that the applicant has subsequently proceeded with the erection . or improvement of the proposed structure in compliance with the requirements of.the laws.as.'aforementioned;. that the said work.and materials.met every requirement of .the laws as aforementioned; and that the premises -have now been fully completed and are ready for occupancy pursuant to the provisions of law. Now, therefore, this certificate of compliance /occupancy is hereby issued under the seal of the Town of Putnam Valley. :. TOWN OF PUTNAM VALLEY, N. Y. _ BY CODE ENFORCEMM OFFICER t , `DEPARTMENTS OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 7, 1998 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Rich Bergin TM# 48.9- 1 -20 -21 (T) Putnam Valley Dear Mr. Sullivan: BRUCE R. FOLEY Public Health Director This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration. A. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the tious. properties along with the property owner's name and tax map, number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the nitrification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. -- Letter to: Joseph F. Sullivan, P.E. - April 7, 1998 -2- " "`- - "Transmittal of this notifcafion should be sent to the conttguous property owners by Design Professional. Deep Test holes must be witnessed by the Putnam County Health Department, or proof provided that a representative of this office has witnessed them. P1 t/ Please clarify discharge line out of pump pit to distribution box. Discharge line is not clear, being mixed in with contours. Well must be 15' from property line. Well on plan appears to be within 10' of rear property line (Lake Shore). Please also provide letter from well driller R6Gti.r�J statin J easibility to drill and service. 11 oposed well is within 50' wetlands control area of Roaring Brock Lake, prior to Heath Department approval it wetlands permit will have to be �---"� obtained from the M of Putnam Vallev. Notes: 6 Please place erosion control measures at outflow of footing drain pipe. All horizontal separation distances involving till greater than 2 feet in depth are measured from the toe of the slope of the till. Please provide 10' minimum separation from front of property line to toe of slope. Construction notes to be pursuant to Putnatn County Health Deparnilent Bulletin ST -19, Append C. Notes for commercial SSTS should not be on residential notes /detail sheet. This office will continue its review upon consideration of the above mentioned comments. !'lease feel free to contact us if any questions arise. Very truly yours, 7 Adam B. Stlebeltng Asst. Public Health Engineer ABS:tn DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 7, 1998 Joseph F. Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Rich Bergin TM# 48.9-1-20-21 (T) Putnam Valley Dear Mr. Sullivan: BRUCE R. FOLEY Public Health Director This office has received,_ao6 reviewed the most recent set of plans for the above mentioned project. We would like to qferthe following comments for your consideration. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous proverties alono with the ro erty- owner's name and tax map num er, must also be provided to the Departmerit. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either the following: 9Copies of registered mail receipts. . Copies of the nitrification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. DIVI OF ENVIRamMAL HEALTH SEEtVl DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL,SYSTEM FILE NO.( Owner Richard• .Bergin _ :Ar3dress 52. Oakridge Drive,._�Putnam Valley___ 105' Located at (Street) Cove Road. Sec. 11 Block 2 Lot 4 (indicate nearest cross street) - `Putnam Valle_ - -_ a orki: City �ftinicipality ; � _ Y _j Watershed -: . x Y J -0 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Nov 23 g 87 Date of Percolation Test Nov 24P 1987 HOLE 2:57 3:21 24 1825 Namm CLOCK TIME PERCOLATION 3:26 PERCOLATION Run 180.25 Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate __9.33 Start -Stop Min. Start Stop Drop In Min /In Drop 21.25 3.00 9.67 Inches Inches Inches 4:56 (1) 1 2155 3:20 25 17.50 20.50 3000 8.33 2 3123 3150 27 17,50 2eo50 3.00 9000 3 3 =53 4-:O0 27 17050 20.50 3.00 9.00 4 5 (2 )1 2:57 3:21 24 1825 21.25 3-00 8.00 2 3:26 3,154 28 180.25 21.25 3.00 - .. __9.33 3 3:56 4:25 29 18.25 21.25 3.00 9.67 Q,:, 4 4 127 4:56 29 . , 18025 21.25 3.00 9.67 + 2 n 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained.at each percolation test -hole. All data'to'be submitted for review. 2. Depth measurements to be made frau top of hole. rev. 9/85 n 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil rates are obtained.at each percolation test -hole. All data'to'be submitted for review. 2. Depth measurements to be made frau top of hole. rev. 9/85 .G.L. 1' 2' sand,y9 si ty, oami sandy, silty, loam sandy, silty, sandy, s ilty, - 3' � some' clay some clay loam,, some loam, some f clay clay TEST PIT TA REQUIRED TO BE, SUBMITTED DK: IIPTION OF SOILS ENCOUNTERED Pere 1 HOLE NO. 6" Topsoil sandy,silty loam rt rcU 2 Deep 3 D4ep HOLE NO. HOLE NO. _ 6 Topsoil 61' Topsoil 6" Topsoil sandy ,psiltyaloam sandy,silty, sandy,silty, loam loam 4' 6' 8' 9' 10, 11' 12° LO 130 O 14 �- J INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTEREIDX�, _._..._...� _....._.. _.. hol . . �. �. q ... .. at - �,,ottom Hof 79 `� r- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFT BEMG tAff6i�D DEEP HOLE OBSERVATIONS MADE By- Sean Patten (Joao Roar. DATE: Nove 239 1987 8 -10 - DESIGN — - Soil Rate Used Min /1 �� Drop: S.D. Usable Area Provided 5 000F + No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type Masonry .Absorption Area Provided By . L.F. x 24" width trench Other 96 LF of 4x4 Galleries � a Name John S. Romeo Signature a M9, 1 Northridge Road, SEAL �% o , eR aAddress Peekskill, N. Yo 10566 0 � 270 THIS - SPADE FOR USE BY HEALTH' DEPARD- YI' ONLY: 00000" Soil Rate Approved sq.ft /gal. Checked by Date J. S ROMEO. PE. LS JOHN S. ROMEO P.C. CONSULTING ENGINEERS do LAND SURVEYORS 1 NORTHRIDGE ROAD PEEKSKILL. NEW YORK 10566 814737.1056 December 5, 1987.. Putnam County Health Dept. Division;of.Environmenta; Health Services 110 Old' Route 6 Center Carmel, N.Y. 10512 Re: SSDS submission for Richard Bergin - Cove Road - Roaring Brnok Lav ATTENTION: Mr. Robert Morris: Dear Mr. Morris: Inadvertantly, the submission for the above SSDS did not include the pump pit details. I am enclosing them at this time. Very-_.trully. yours: ±_.:._.. mil- John S. Romeo P.E. & L.S. JSR: clr ;L 7 ZIC. rj 0 Dt rARTIVI1+;N T :.7 HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM _ Name and address of applicant: 2. Name of project: 57-::1 1j 3. Location 4. Design Professional: rka 5. Address 6. Drainage Basin: .._. 7. Type of Project: _L/' Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? �G Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ........ ... �........ 10. Has DEIS been completed and found acceptable by Lead Agency? ........:.......... 11. Name of Lead Agency. Exempt Unlisted 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ...................... .......... ................... ..............................5 All so, have plans been "submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: V e---> 15. Type of Sewage Treatment System Discharge ................. surface water ;' groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) .....................................:..... ...................... .......... 18. Is project located near a public water supply system? ....... ............................... All e 19. If yes, name of water supply 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 holes observed 23: Name of Health Inspector 24. Project design flow (gallons per day) . .............................90 o................... ..... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... X/ o 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 n 1 F17' 27. Is any portion of this project located within a designated Town or State wetland? V. 28. Wetlands ID Number ....................... ................. .............. ........... .... 29. Is Wetlands Permit required? .............. Has application been made to Town. or Local DEC office? ................ 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31.. Is or was project.site used for: agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste.disposal, landfilling, sludge application or industrial activity? ............................ Yes/No A/o 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ........................:...... Yes/No OV'G 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? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 4/6 36. -.Tax Map ID Number ............::.......... ............................... Map,�40'ff Block / Lot may) 37. Approved plans are to be returned to ..... Applicant y' Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the 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-tlie Departmment:' Projects within the watershed "m ay- 'also Y 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 I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision maybe grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. . ISIGNVATURES & OFFIML TITLES. Mailing Address: ................................... z r u i,A AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES I INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM,__:., ... r SEC i01 'A'. '-G1EI :RAL INFORMATION ti._l Coun Name of Project � (� l Count Site Location cO q e- Orr Building construction begun Ao Extent Is roe ,,within NYC Watershed? �1 P P rty ................. Yes o SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 71 Hill F7 Rolling � Steep slope F7 Gentle slope Flat 2. Evit of wetlands ow area subject to flooding Bodies of water Drainage ditches Rock outcrops 3. Property lines or corners evident ....................... ............................... F Yes CSI o 4. Do water courses exist on or adjoin the property? ............................ Dzyes F—] No 5. Will these affect the design of the sewage system facilities ?............ �es No 6. Do watershed regulations apply in this development ? ....................... 0 Yes 121-50 7 Will extensive grading be necessary? ....... I ................ 8. Will extensive fill be necessary for SSTS? 9. Do filled areas exist within the SSTS area ?...... - Ifyes, what -is the condition of the fill? 0 Yes o 0 Yes EE-N (o .............. �Ji. Yes._ -No - - - L- SECTION C. SOIL OBSERV TIONS 10. Appearance of soil: Sand ravel Loam a Clay F_� Hardpan ixture 11. Observed from: Q Borings 0 Bank cut ackhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater V A-M,�S S 6 L �' on q 14. Depth to mottling 15. Are test holes representative of primary & reserve areas. 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on es No on on Form ST -1 6 SECTION D. DRAINAGE 8: - .Will -- proposed -gn. Lg� naterially alter the nuiural drainage in tlus or adjacent areas? K-'es No 19. Will groundwater or surface drainage require special consideration? ..................... esIQo 20. Will gullies, ditches, etc., be filled and watercourses be relocated ?......... .. ............... F-1 Yes E;�'N0 SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been'made of the existing or proposed source and facilities? .............................. ............................... 7 Yes F-1 No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... es F--] No 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # !` Lot # 1 Depth to water _'_ Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 1 +� 3' 3.0 4.0 3 ' 5.0 6.0 (� 7.0 8.0 9.0 10.0 Hole # Lot r Depth to water ►-t �t Depth to mottling � Y Depth to rock/imp. _6 G.L. Hole # Lot # Depth to water =s Depth to mottling �- Depth to rock/imp. J6 LO G.L. sr - 0.5 0..5 ©' _� 1.0 C--2A-0A 1.0 2.0 2.0 ���- . ✓�" 3.0 3.0 4.0 4.0 5.0. '. 5.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9,0 10.0 �5 �, %- . C;' 9• f S.G6b03'00" E AN LOt ' N 12sp.� r t r--- ---- - --- -- - . 1 3 on I slope clay barrier;- �\ I � I � I � overhead udlfty line • X3p6 ggi7 PG Se I F - -_ Q — I 3 ROB w, ®wen 1 _—_—_- - —_-� I I CO I I i N N 77 °20, wi 0.80 31 1 I i LO t i> : I g. 1 on I slope clay barrier 1 G 1 �--- - - -- -- 0 Jf 352 w 1 N 67 °30'20" W 276.50'' formerly lands of 430- FM #308H sip P � Pj. ihe unwa °n;t, a ed 1nftil d tin w � . 6� 4 ` 11 1: L 11 ' i i 11' T -6" 2' 1 --T�— 8' 8'—:Y- I 49 Pressure Treated Wooden Deck with 2' Cantilever . — 6_6" — Said bearing wall with 5/8" fire rated Cut or expansion joint — - - — - - wallboard on both sides. -- to control cracking. + E; �. Garage Door j 8'-6" 8' 8' 8' t. 6' 8' 76" 8t_6" 8'_6" I 1 - - - - -- s '- Up -- -- -- -- -- 26' Garage Door �v -- Railing (both sides) 13' 1 hour fire rated — - - — - - self closing metal door. ; 42" x windows (6) s ' ' I ; ; } 64' _ — 13'--- - - -- -1 - -6' -6 Q' f�cssoxtSTL�� I y Y � S rl , h ; :Y I I 8 I 8. I I S .t 'lo' Pressure Treated Wooden Deck t with 2' Cantilever i .'' 6._6" —T -6.. - - - -- 26' 31._4,. _ Cut or expansion joint i 1 — - - — - - Stud bearing wall with 518" fire rated to control cracking. ' wallboard on both sides. -- r Garage Door 13' 7 I I ' I ' , 1= I. 8'.6" I! Garage Door i I� I� — T -6" - — - ER f�—:-- Up -- -- ' - f v Railing (both sides) ° �r 1 hour fire rated ' self closing metal door. 42" x windows (6) I r ---------- -- - - - - -- ----------------------------------------------- 16' 13' 6' -6" 64' Foundation Plan �jPCSSo f i Ex�STl�7C� 13' EXCEL HOM9.S' P.O. Box 69 DRA" 8!: J.N 10 Mifflintown. PA 17P59 . lievisilgiff: 717 436-6971".::'.- iii . NEW YORK STATE DIVISION CF HOUSING AND COMMUNITY RENEW- !IS PLAN APPROVAL pL OF IS AlRY !c' Car:) L RtrEIT )ft E FACTORY A;i-, CILITY. FACTU; 5 NEW YORX STAY= nlVa• ^N OF 'us!NG.AND C)!V,'-j•.-,T7 R,-�UFWAI STAM 7' G- fl, __. V A L IF A MODEL 0.-4 C.C- `PON-EN 04:7 Ara 11 I-iI5 14 V = el'11-1 eo V. -0& t4w z0o q---ole V to 249 MAN btttSR4 I)rpnmm OF TMATITH 11 rp 4 EXCEL HOM9.S' P.O. Box 69 DRA" 8!: J.N 10 Mifflintown. PA 17P59 . lievisilgiff: 717 436-6971".::'.- iii . NEW YORK STATE DIVISION CF HOUSING AND COMMUNITY RENEW- !IS PLAN APPROVAL pL OF IS AlRY !c' Car:) L RtrEIT )ft E FACTORY A;i-, CILITY. FACTU; 5 NEW YORX STAY= nlVa• ^N OF 'us!NG.AND C)!V,'-j•.-,T7 R,-�UFWAI STAM 7' G- fl, __. V A L IF A MODEL 0.-4 C.C- `PON-EN 04:7 Ara 11 I-iI5 t t4w z0o q---ole to 249 MAN btttSR4 I)rpnmm OF TMATITH 11 HOUSE PLANS APP! --OVrD FOR *Y 4 BEDROOM COUN.T G-1 ,^,BEDROOMS z— 'o YX n EXCEL HOM9.S' P.O. Box 69 DRA" 8!: J.N 10 Mifflintown. PA 17P59 . lievisilgiff: 717 436-6971".::'.- iii . NEW YORK STATE DIVISION CF HOUSING AND COMMUNITY RENEW- !IS PLAN APPROVAL pL OF IS AlRY !c' Car:) L RtrEIT )ft E FACTORY A;i-, CILITY. FACTU; 5 NEW YORX STAY= nlVa• ^N OF 'us!NG.AND C)!V,'-j•.-,T7 R,-�UFWAI STAM 7' G- fl, __. V A L IF A MODEL 0.-4 C.C- `PON-EN 04:7 Ara 11 I-iI5 i 3 ,LAbS1C. 4 •�►.dE�11�IC.�DE%.�TO�'��I'1�14 nl I_ lo,l `' ;t a� • t. HEVI Y %, STATE HOSE!_ VQ.CCJi::.J;Ory EcAi£;'A'L'.. .THIS .PIAN,AppnJYAI` tS A ?PLIC48LE ONLY TO ,_-• CON'O..E \TS GE FACTORED H� pIE THAT pf,E ASSEM 3(ED AND II- STALLED AT THE FACTO.TY MANUFAC::I::Ed'S FACILITY. NEW YORK 5747' 'YI'%lilr)N OF MOUSING AN7 C-:!V��n,i:Y '" vEWAI ' STAMP O APB;.-; %VAL FOR MODEL CR C ^:; ";�Ot7ENT Drv:a:eR 1i.. A...a. �: N a. 00497 A.°R 11 193_5- j NOTICE. Tx:s'J+.ov[•, sRa.t •R ox: Ov :l t• ii f• 9 7e RLl'EAATE CONST. DETAIS - - - •* TTPICNL nvAL: QUCi SYSTEM RF.. FtO CSPE nM.5 4•t-97 rtwl.r. 6 MOOLIF 2 STOiI' - l FM¢r i n® ni 2-®W er�a<iuos ntl PBOYC m O«ulR fete epammOT as m R Mma memcrre. ro Foe .m •,ms a. /at mOt wa +e00Or SOIIIab'S¢ oeORa ]a roe >Qao rYnat snYO ¢t6uA. 3-c Deana+ n A Far roR: enem �. aQ mwo m s l 0 FY rmo/ Op¢aa.wS gLNttll MR A 0 am FY -. . IRE GROW. N4 - RS RD AL ALL OT}ER9 - R4 CRGTRUCTION Tym MTL NY - Sb ' ALL OTTERS - LWMTECTED SEISMIC 20NC Nl VA - L ALL OTTERS le AL IWATC %g- I2: TR¢S 3- 6-4.98 12t }ail ALTERMTE 15 - t rAMILY 7. S19.- BOX CAM ROOF OPT. }22 x" 9atam noaR: 4 mw x m��xr�RRe�n P ST _ tei 01O..WOI000eOtxT mWC� IMRTOt a tm 1N z.• a r se2r6 rays Bern neTOmwmxiT Rezzam - - 7P CROSS SECTION fa m 3-1-93 2-t99e 7q CROSS SECTION Fm m 9 -t-93 6.4-8 To CRDSS SECTION Fx 2t 3-22.99 6 -4 -98' � _ i ---• 322-1 e. FRMIIlD AIlS 3.22-91 x996 t Set: v1tA nnR ao Am u t w a qc rasn 2-a R+�Irnnt smzc emn6c Oz3m 2 ®OCR IImCLS !UM Iae6G M 8M.4CCP6 . a awom .m, Re ..satyr wa a ]ecnnt 9RL ee rResNm tea '. lea° abalRZa.alr OmpIDlTlo�. rmzrmx a 9ntna+ >« rNr ,rraele i�o6LT MioQ LFpaiaiRa saL C � � A40n1pf SIRL Gf OiOI® O[M - nonaa ROM oyes ames l3aR, vO+r ew v+m . 6b FRMM ETAILS 3 -22-1 2-8-M S. PRRr1INC. OETRILS 3-22-1' 249-96 W rM%DG DETAILS 143-96 M to 3-22.91 2 -1998 2 FMRR¢D A39]Ltr 1CTR9 4 2 ¢r 3-22-1. rt9 98 9b rIRE w+rzD Assiar acrnas 2 FRM¢r sa-1 x19-96 FM WED "SEIAT WU'L3 UPPEWL06 R - 2.FMILT }ail x19.96 9c_t WA%E I ll2 2Am AVY M'9 S`l"3 x916 een NeRPit 9922 2222E a CaR® Nne YERD- LoT-Use Fux RATEO " Dtt�w u�w°:I'wo .on a s mew.® uml A55pIBLY OCT. - I ?TdT'2 It -tB98 2 -19.98 MiietrP�iL Ski¢ ML Sm�® KMBS ZERD0 CrriI1E FIRE RATED i amen tar s na ao[ Rn Mwam wawuvr< {L45FMeiT OCT - z 9talr ll-IB-98 rl9a �YNUrFY�won �-nma. 1.m�1Ip-aepns fWA YT9F f* - , I�j AL• APPROVAL VCy. coTo /AOroRY ^ MRSTER SERIES _ E'40a _ COVER SHEET =- MLNCT HOMES, INC. 1537 M ROUTE 442 EAST, PD. 60% 246 M*LY,.PA 17M ORN EY I DATE I SCALE - — -- - -- -- - - •* TTPICNL nvAL: QUCi SYSTEM RF.. FtO CSPE nM.5 4•t-97 rL9.96 i n® ni 2-®W er�a<iuos ntl PBOYC m O«ulR fete epammOT as m R Mma memcrre. ro Foe .m •,ms a. /at mOt wa +e00Or SOIIIab'S¢ oeORa ]a roe >Qao rYnat snYO ¢t6uA. 3-c Deana+ n A Far roR: enem �. aQ mwo m s l 0 FY rmo/ Op¢aa.wS gLNttll MR A 0 am FY -. . IRE GROW. N4 - RS RD AL ALL OT}ER9 - R4 CRGTRUCTION Tym MTL NY - Sb ' ALL OTTERS - LWMTECTED SEISMIC 20NC Nl VA - L ALL OTTERS . . ' 2. }22.91 x19-9 2b }ail x1998 TYPICi mac MCT SYSTEM 2 STM r OOC:s. .1-W ' x1998 m 1 }22$ 2-1998 }29 2-19 A h D }22- } 19M rt9-B • - � _ i ---• 322-1 19e b_I 924-93 2-19-M 0 3-22-M 2-19-96 to 3-22.91 2 -1998 A 3-2291. 2-1999 2e 3-1-93 2- 3-1-M 2-19-96 2 zr }22.93 T2-2:8 Z -1990 2-19-0 3-22-5' 2-19W-, .. ' fWA YT9F f* - , I�j AL• APPROVAL VCy. coTo /AOroRY ^ MRSTER SERIES _ E'40a _ COVER SHEET =- MLNCT HOMES, INC. 1537 M ROUTE 442 EAST, PD. 60% 246 M*LY,.PA 17M ORN EY I DATE I SCALE `t l; 4257" 10'-6" r�i BR 3 m m 1/2" 2' 0.. 3._O. O BR i i-TVNQ ro RM. (Cai w. - m - .;�.: BR 2 /2" 15' -2" 21'-2" 13-2" 36" o _ F 2 -4257 2 -4257 4257 If 6 1 w .n 2 141`11 1/2" 49' -11" ,c � 114`0 1 /2" o o PUTNAM COUNTY DEPARPENT OHEALTH X31' -4 i /z" SHTG HT. LT-1" HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, q�� LtLDROOhIS n FRONT CANT.= 12" LLT WR l� ` BUILT PORT Ne re t �� SIDEWALL= 2x6y p� �y q ® �y pp ALL SUBSEQUENT REVISION(ALTr TIONS TO THESE HOUSRRO Oro best of my knorledge. belief end: profeeslonel 7,d8ement CLG. HGT.= 8' -0" � 11 I<•EIVII�E BVILDERSDEC 7 1 99 PLAN UST BI EL 1, (hh Factory Menifecbced Moms (FMM plan h.. been egMd ' .. . YCDOH FO A%'D a eyetem tat of FMK pem p appro.W by Ripi. LABEL A OR elion No. 1387. Memfecturers No, 4387. E.0.tion P.O. 80x 337 ` N 17756 - nm 546-8" Dee 5.500..Neh has not been modFied' n my me - DESIGN SNOW LORD= 40 TRIPLE -M / BASSO oArA 2. ur portion of Un FMK yen hee bean preeared wng ROOF= 5/12 24 "oc 4437 6ICNATURE & TPfLE A n (R w K s o� Ue --= rT"I'l te— Eneygy Ca`emnl�wNnMC -- ltt .� - �° DEST = LAKE CARMEL, NY FLOOR PLAN "`j" F _6 I 1' I 72VINYL 3037 2-4257 W4230 I (N243D t13014e W1830 7 0 6' 8 112" , ® ®� m 10' -0 B18 DW az+ O pet in GARDEN TUB d e7WFt 11 12' -7" S 32, K PLATFORM h r \ KTT o BOTH 2 00 m .HEN (CATw �7� DININ, T� - -- - - - - -- i - i I m (OATH O n + 5' -8 1/2" 9 �T COLUMN �I 30" 30" 2.2('.24' ML � (2' -9 1 /2 "IC 20;-0" `t l; 4257" 10'-6" r�i BR 3 m m 1/2" 2' 0.. 3._O. O BR i i-TVNQ ro RM. (Cai w. - m - .;�.: BR 2 /2" 15' -2" 21'-2" 13-2" 36" o _ F 2 -4257 2 -4257 4257 If 6 1 w .n 2 141`11 1/2" 49' -11" ,c � 114`0 1 /2" o o PUTNAM COUNTY DEPARPENT OHEALTH X31' -4 i /z" SHTG HT. LT-1" HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, q�� LtLDROOhIS n FRONT CANT.= 12" LLT WR l� ` BUILT PORT Ne re t �� SIDEWALL= 2x6y p� �y q ® �y pp ALL SUBSEQUENT REVISION(ALTr TIONS TO THESE HOUSRRO Oro best of my knorledge. belief end: profeeslonel 7,d8ement CLG. HGT.= 8' -0" � 11 I<•EIVII�E BVILDERSDEC 7 1 99 PLAN UST BI EL 1, (hh Factory Menifecbced Moms (FMM plan h.. been egMd ' .. . YCDOH FO A%'D a eyetem tat of FMK pem p appro.W by Ripi. LABEL A OR elion No. 1387. Memfecturers No, 4387. E.0.tion P.O. 80x 337 ` N 17756 - nm 546-8" Dee 5.500..Neh has not been modFied' n my me - DESIGN SNOW LORD= 40 TRIPLE -M / BASSO oArA 2. ur portion of Un FMK yen hee bean preeared wng ROOF= 5/12 24 "oc 4437 6ICNATURE & TPfLE A n (R w K s o� Ue --= rT"I'l te— Eneygy Ca`emnl�wNnMC -- ltt .� - �° DEST = LAKE CARMEL, NY FLOOR PLAN "`j" F _6 J-4 Lid 01.i kl t CIA 09 �3nd oo. 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