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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -1 -21 BOX 20 rm 'T R IL '` i 06 - 02302 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES iCOUNTY.OFFICE BUILDING,.CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Margit Pap' Address 421 Cove Road,Putnam Va11ey,NY 10579 Located at (Street) Cove Road Sec. 12 Block 1 'Lot 16 ( ca a peare,%t cross street) .....r...._ ,.. Municipality „.. ::'Tu �iri' ref' P n `m :.val'iPV Watershed Hudsoi7' River • ;..SOIL PERCOLATION TEST DATA REQUIRED.TO BE 'SUBMITTID WITH-APPLICATIONS Hole Number CLOCK..TIME PERCOLATION PERCOLATION dun Eaapse Depth to Water a er LevejL. No. ...::......... ._...:._.::..'. Time From. Ground Surface in Inches •• Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop = Inches Inches Inches PTH #1 _1.. .9 :45'' _.: • 10 :1'5 30 15 17.75 2.75' 30/2.75 =11 2...10_1. , 10:49 30 15 17.75 .2.75 30/2.75 =11 11:23 .30. 15 17'_ 75 '2 _ 7-5 ” 30/2.75 =11 4. 5 PTH #2 1. •9':50: 10:20 30 16 19• 3 30/3 =10 2 10 : 21: .:..`In-9;1 is 1 A I Q, 3 .. in Z -A -1n 11:.22: 30 16 18.75 2.75' ! 30/2.,75 =11 3 4 Notes: 1) TeAts to.be.repeated;at same depth until a roximatelyy equal soil rates are obtained•Qt each percglation test hole. All data to be submitted for review. Depth measurements to be made from, top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. DTH #1 HOLE NO.DTH #2 HOLE NO. G.L. Top Soil 6" Sand & Stones 12" „ 18" to 24" " 30" 36" 4211 4811. It 54 �� n 60" u Top Soil Sand & Stones It 11 n 66" 7211 „ 7$” n 84 " n n 9611 11 I' A INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 4`-'011 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4' -0" TESTS MADE BY Joel L. Greenberg Date 4/3/85`, Soil Rate. Used 11- 1.5Min/l "Drop: D ° S.D. Usable Area Provided 5000SF No. of Bedrooms 3 Septic Tank Capacity 1000 Gals. Type Precast Conc. .Absorption Area Provided By L. F. x24" 3b"— width Trench. Other .128LF of Precast Conc Tri- Galleries Provide. 8ft. deep Curtain Drain & Name Joel L_ Ggeenbe_ra Signature 3ft Bank Address Muscoot No.", RFID #2, Bx 488 SEAL ED q run Fill Mahopac,_NY 10541 THIS SPACE FOR USE BY HEALTH DEPARTM- T ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by O' t LOil -40 NEW I� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner MARGIT PAP Address 111 SUNSET DRIVE,SARASOTA, FLORIDA 33577 Located at (Street) COVE ROAD Tax Map 41.10 Block 1 (indicate nearest cross street) Municipality 'TOWN OF PUTNAM VATd.F'Y Drainage Basin I V* Lei 0A9j 010 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Lot 21 Hole No. Run No. Time Start - Stop Elapse Time kNun.) Dep th to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 3 4 5 1 2 3 4 t 5 1 2 3 4' 5 1\ V 1 r,a:. i . i ests to oe repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA Indicate level at which groundwater. is encountered HOLE 41- 2.5 FT., HOLH , #2- 3.5 FT. Indicate level at which mottling is observed 3 FT. Indicate level to which water level rises after being encountered SAME AS ABOVE Deep hole observations made by: ADAM STIEBLING & JOEL GREENBERG Date 3/4/98 Design Professional Name: JOEL GREENBERG, R.A. Address: TWO MUSCOOT ROAD NORTH E MAHOPAC NEW YO 1 541 �� Signature: Design Profess' pal's Seal 0 N S 4 DESCRIPTION OF SOILS ENCOUNTERED IN TEST )MOLES 3/4/98 DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. G.L. 0- 6'! TOPSOIL 0 -8" TOPSOIL 0.5' GRAY. SANDY LOAM. 8" -16" OLIVE 1.0' " BROWN SILTY SOIL 1.5' 11 16"-34" BLACK 2.0' " ORGANIC SOIL 2.5' " 34 " -72" OLIVE 3.0' " BROWN SANDY LOAM 3.5' to MOTTLING AT 3 FT. 4.0' if 4.5' 5.0' " 5.5' " 6.0', CO 6.5' en 7.5' 8.0' c? -e-s 8.5 jr c° 9.0' 9.5' 10.0' Indicate level at which groundwater. is encountered HOLE 41- 2.5 FT., HOLH , #2- 3.5 FT. Indicate level at which mottling is observed 3 FT. Indicate level to which water level rises after being encountered SAME AS ABOVE Deep hole observations made by: ADAM STIEBLING & JOEL GREENBERG Date 3/4/98 Design Professional Name: JOEL GREENBERG, R.A. Address: TWO MUSCOOT ROAD NORTH E MAHOPAC NEW YO 1 541 �� Signature: Design Profess' pal's Seal 0 N S 4 w ; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project '?'A-? :21�? piqz mm 1J County Site Location' Z( Building construction begun ,d Extent j Is property within NYC Watershed ?....... ........... Yes ©�- o SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. F7 Hilly Rolling 0 Steep slope F7 Gentle slope lat 2. �vide�n of wetlands ow area subject to flooding ditche s ock outcrops J. Property lines or corners evident ......... ............................... 4. Do water courses exist on or adjoin the property? ........... 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ...................... 7 Will extensive grading be necessary? ................ . ............................... 8. Will extensive fill be necessary for SSTS? ......... ............................... 9. Do filled areas exist within the SSTS area? ........ ............................... If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS odies of water Yes No Yes F--� No E2`�es 0 No aYes No 5es F--] No Yes. F7 No Yes 10. Appearance of soil: F--J Sand 0 Gravel F7 Loam F--J Clay F--J Hardpan Mixture 11. Observed from: a Borings F--] Bank cut E4 �ac�oe excavations 12. Soil borings /excavations observed by on 3 13. Depth to groundwater 14. Depth to mottling — © on 15. Are test holes representative of primary & reserve areas ...... ...:........................... es F7 No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form ST -1 F , SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Ye No a 19. Will groundwater or surface drainage require special consideration? .................:... No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... FYes 0 No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ....................... ............................... Inspection data aYes F__J No 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... ,/ Yes 0 No 23. Additional comments @S 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # I Lot # Depth to water Z Depth to mottling aTa Depth to rock/imp. o N G.L. 0.5 Uri bu IJUIJ 2.0 (�- 2 +- C`� 3.0 4.0 5.0 6.0 _ 7.0 _ 8:0 9.0 10.0 Hole #_ Lot # Depth to water �� g n Depth to mottling -_ Depth to rock/imp. G.L. 0.5 C2 t f_;e_ Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 1.0 2.0 2.0 3.0 4.0 I ;��. +�Kve- 5.0 Q? o+ c 5-zOi 1-- 7.0 '12 1 L 1:�/ 8.0 R'n out 10.0 3.0 4.0 _ 5.0 6.0 _ 7.0 _ 8.0 9.0 10.0 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 61721 SEAR 4 Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Appiicant,or Project sponsor) 1. APPLICANT /SPONSOR PROJECT NA ME, MARGIT PAP, .2. MARGIT PAP. 3. PROJECT LOCATION: Municipality TOWN OF PUTNAM VALLEY County PUTNAM 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 421 COVE ROAD 5. IS PROPOSED. ACTION: ERNew ' ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 7. AMOUNT OF LAND AFFECTED: Initially 0.5146 -_.__ acres Ultimately 0.5146 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ClNo If No, describe briefly SIDEYARD SETBACK VARIANCE REQUIRED 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? _ ® Yes ❑ No If yes, list agency(s) and permitiapprovals PUTNAM VALLEY ZONING BORBD AND BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes In No It yes, list agency name and permlVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes ® No I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE GIT PAP 2/9/98 Applicant/ spon or name: Date: PROJECT ARCHITECT Signature: +r. t action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESS'- -T (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate tnn review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. 1 ❑ Yes ❑ No = i C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brieflyi C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or:related activities likely to be Induced..py the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1-057 Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural);. (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments of reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a' positive declaration. F-1 Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on' attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency _ Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 2 PUTNAM COUNTY DEPARTMENT F HEALTH DIVISION -OF iD6RONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: MARGIT PAP 111 SUNSET DRIVE SARASOTA, FLORIDA 33577' 2. Name of project: NEW RESIDENCE 4. Design Professional: JOEL GREENBERG, R.A. 6. Drainage Basin: HUDSON RIVER 7 Type of Proiect• 3. Location TN: TOWN OF PUTNAM VALLEY 5. Address:TWO MUSCOOT ROAD .NORTH, MAHOPAC, X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision NEW YORK 10541 Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... NO 10. Has DEIS been completed and found acceptable by Lead Agency? .............. N/A 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....... ................:.............. ................ ..........I.................... YES 13'. If so, have plans been submitted to such authorities YES 14. Has preliminary approval been granted by such authorities? Date granted: N/A 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A . 18. Is project located near a public water supply system? ....... ............................... NO 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system Distance to sewage system 22. Date test holes observed YES 23. Name of Health Inspector BILL, HEDGES 24. Project design flow (gallons per day) 400 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this pro f located within a,designated To l State wetland? NO . 28. Wetlands ID Number ........ :.................................... .............................................. N/A 29. Is Wetlands Permit required? ............................ ... ............ ............................... N. Has application been made to Town or Local DEC office? ............................... NJA 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 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 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? . ............................... NO NO �s NO NO 7 36. Tax Map ID Number . ............................... : Map 41.10 Block 1 Lot 21 37. Approved plans are to be returned to ..... Applicant x 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 the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans.or the creation of impervious surfaces, and the project applicant should obtain the appropriate'forms for such activities from DEP and submit those forms to DEP .for review and approval. If the application is signed by a person other than the applicant shown in Item 1.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: :111 "SET DRIVE'S Mailing Address: sARASOTA FLORIDA 33577 PUTNAM COUNTY DEPARTMENT OF HEALTI VISION .OF ENVIRONMENTAL HEALTH SERVI %,r.n 1 it KATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT Q Located at , C r), Rc)ac1 Town Q%N1M*wc Putnam Valley Owner /Applicant Name Lourdes Baxter Tax Map 41 .10 Block 1 Lot 21 Formerly Subdivision Name Fourth Map Roaring Brook Subd. Lot # 454 Mailing Address 44 Buckingham Drive, Yorktown Heights, NY Zip 10598 Date Construction Permit Issued by PCHD 8/21/2003 Separate Sewerage System built by Lemcar Excavation Address Buckshollow Road Mahopac, NY 10541 Consisting of 1000 Gallon Septic Tank and 250 LF of absorption trenches Other Requirements: 7 FT deep curtain drain and 3 FT bank run fill Water Suunly: Public Supply From. Address or: x Private Supply Drilled by Norman .Anderson Address 1 52 Barger Street Putnam Valley, NY 10579 Building Type g,, Ramily Residencpas erosion control been completed? vg� Number of Bedrooms 2 Has garbage grinder been installed? I certify that the system(s), as listed, serving the above pr ises ncons cted essentially as shown on the as- built plans (copies of which are attached), in ordance the Construction Permit and approved plans and the standards, rules and regula 'ons of a Pu Co ent of Health. Date: 10/20/2004 Certified by Address P.E. R.A.x 10541 1 License # 1 1 0 5 6 Any person occupying premises served by die(above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. t Title:. Date: copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Nov 02 , 04 12,:05p Planning Board (914) 526-3307 11101i2e04 23:01 8456282807 _10EL 6PM48ERG PAGE 02 C %t Bp,TjCF, P. TOLEl, LORETTA MOLINARI R.N., M-S-N- Public Hearfir Dirre.-for Associate Publie ff-alth Director Di,edDr of Parfcnf Services :-DEPARTMENT OF HEAUE I Geneva Road Brewster. New York 10$09 r.,j,00wCSuj Kcalth (914)275-6130 fox (9 14) 278.7911 Nurring Sinim (RI4)278-6558 WIC (914)278.6679 Fax(9114) 279-600 Early litervention. (914) 278.6014 Prtubcol(914) 27R-6082 Fax (9141278 - 6648 r911 AMBES5 _VE_K_ FUCAUMNYD-M OWNEUS NAME: LOURDES BAXTER TAX MAP NUMBER: E911 ADDRESS: COVE ROAD_ TOWN: __.JTNAM V"L Ey....- ------- AUTHORIZED TOWN OFFICM:' /* ]DATE-, 111,212004 The Putnam County pepoLrtwent of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is "signed by an authorized town official.. This form is to be subWtted with the application n for a . Certificate of Consvmctiou Compliance.' (r,911V);MM) p.1 Nno-P-PM4 TI IF -1 pip TPI !1Q41—*P7s4 --7QP! ";!Ar • CA YrfAnh, rnj lkl-ry nC"0n0'rMr7kr r r1r - r..'. 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Addr"ts: t //,(\'o -.- �Q w illage' Tax Grid # Mapql.IOBlock I Lot(s) Well Owner: Address: Use of Well: 1- primary 2- secondary _>e-- Resid&Atial Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _y, Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing n Open hole in bedrock Other Casing Details Total length ALQ ft. Length below grade jp�in. Diameter Weight per foot _Z6 lb /ft. Materials: _K Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: 7C Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes K No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped i0 Compressed Air Hours Yield S' gpm Depth Data Measure from land surface- static (specify ft) -go f During yield test(ft) Depth of completed well in feet _� 00 f Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Descripti-on ft. ft. Land Surface Ap / O oe If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Sv o Capacity _ 0 0L Depth . JR.0 ' Model 6ouie s Voltage 22O HP Y Tank Type 61& Volume ' Date Well Completed it G l ' � Putnam County Certification No. Date of Report 7/,V, Well Driller (signature) N(rTE: 1�act location of well with distances to at least two permaneq landgKarks to be provided on a separate sheet/plan. lo5`791l Well Driller's Name ���,1 e. Address: S Y Ja_� ✓/ Signature: �44 Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 PU TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Lourdes Baxter Owner or Purchaser of Building. KTT Builders Inc. Building Constructed by 421 Cove Road Location - Street Residence Building Type 41 .1 0 - 1 - 21 Tax Map Block Lot Putnam Valley Town/Village 4th Map Roaring Brook Subdivision Name 454 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 thybuilding utilizing the system. Dated: Month 10 Dav 2 0 Year 2 0 0 4 Signature: Corporation Name (if corporation) FA- aRTRUCING & EXCAVATION Address: 10541 State �:bi" -`3110 Zip Title: Corporation Name (if corporation) Address: f Ka., r- cf N" State tv � Zip i� ci%� Form GS -97 GREENBERG & ASSOCIATES, AIA, NCARB GSN CONSTRUCTION ARCHM-M -PIA MS- BULDEFtS 2WS000TROADNORTH MAHOPAC, NEWYORK 10541 T(845)628W3F(8g628W November 5, 2004 Mr. Joe Paravati Putnam County Health Department Geneva Road Brewster, New York 10509 Re: Lourdes Baxter 2 Cove Road Putnam Valley, New York 10579 T.M. 41.10 -1 -21 Dear Mr. Paravati, Attached please find letter from Roy King of KTT Builders certifying that he reset the line between the septic tank and the distribution box so that it has KTT BUILDERS 10 FOX TRAIL MAHOPAC, NEW YORK 10541 914 490 -4494 NOVEMBER 5, 2004 MR. JOE PARAVATI PUTNAM COUNTY HEALTH DEPT. GENEVA ROAD BREWSTER, NEW YORK 10509 RE: LOURDES BAXTER 2 COVE ROAD PUTNAM VALLEY, N.Y. 10579 T.M. # 41.10 -1 -21 DEAR MR. PARAVATI, THIS LETTER IS TO CERTIFY THAT I EXCAVATED AND RESET THE LINE BETWEEN THE SEPTIC TANK AND THE DISTRIBUTION BOX SO THAT IT HAS ADEQUATE SLOPE TOWARD THE DISTRIBUTION BOX. VERY TRUI Y YOURS, ROY tG KTT BUILDERS 11/89/2004 09:27 8456282807 eel `ti • • November 5, 2004 Mr. Joe Paravati Putnam County Health Department Geneva Road Brewster, New York 10509 Re: Lourdes Baxter 2 Cove Road Putnam Valley, New York 10579 T.M. 41.10 -1 -21 Dear Mr. Paravati, Attached please find letter from Roy King of K7T Builders certifying: that he reset the line between the septic tank and the distribution box.:so thaf.it has::',: 11/09/2004 09:27 8456282807 l.. JOEL GREENBERG PAGE 03 MAHOPAC, WEEW 'YORK 10541' 914490-4494 NOVEMBER 5, 2004 MR. JOE PARAVATI PUTNAM COUNTY HEALTH DEPT. GENEVA ROAD BREWSTER, NEW YORK 10509 RE: LOURDES BAXTER 2 COVE ROAD PUTNAM VALLEY, N.Y. 10579 T.M. # 41.10 -1 -21 DEAR MR. PARAVATI, THIS LETTER IS TO CERTIFY THAT I EXCAVATED AND RESET.THE .'..: LINE BETWEEN THE SEPTIC TANK AND THE DISTRIBUTION BOX SO THAT IT HAS ADEQUATE SLOPE TOWARD THE DISTRIBUTION BOX. VERY TRU Y YOURS, RO G KTT BUILDERS YML ENVlR TAL SERVICES 321 KearStreet Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.401604 CLIENT #: 57674 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BAXTER, LOURDES C/O ROBERT PANNY 41 KAITLIN DR MAHOPAC, NY 10541 SAMPLING SITE: COVE RD : PUTNAM VALLEY COL'D BY: ROBERT PANNY NOTES...: WATER TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE . FLAG PROCEDURE DATE/TIME TAKEN: 07/13/04 10:00A DATE/TIME REC'D: 07/13/04 12:1OP REPORT DATE: 08/10/04 PHONE: (914)-490-4493 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/13104 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/13/04 LEAD (IMS) <1 ppb 0-15 ppb 910� 07/13/04 NITRATE NITROG <0.2 MG/L 0 - 10 9139 07/13/04 NITRITE NITROG <0.01 MG/L N/A 9146 07/13/04 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 07/13/04 MANGANESE (Mn) 0.012 MG/L 0-0.3 mg/1 2037 07/13/04 SODIUM (Na) 15.9 MG/L N/A 07/13/04 pH 7.3 UNITS 6.5-8.5 9043 07/13/04 HARDNESS, TOTAL 154 MG/L N/A 07/13/04 ALKALINITY (AS 76.0 MG/L N/A 0703/04 TURBIDITY <TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic 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 Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAS #; 93.401604 CLIENT #i 57674 NON STAT PROC PA 6 E 2 BAXTER, LOURDES DATE/TIME TAKEN: 07/13/04 10:00A C/O ROBERT FANNY DATE/TIME REC'D: 07/13/04 12:101:1 41 KAITLIN DR REPORT DATE: 08/10/04 MAHOPAC, NY 10541 PHONE: (914)-490-4493 SAMPLING SITE: COVE RD SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COL'D BY: ROBERT PANNY TEMPERATURE..: < 4C NOTES... :'WATER TANK ' C[)LIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 & MAGNESIUMA` CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. TW `n HARDNESS `AY'RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE ' SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 3O0 MG/L MODERATELY HARD WATER: 70-140 MG/L ' MG/L = MILLIGRAM PER LITER, HARD WATER: 140-300 MG/L (1 grain/gallon 1 17.2 MG/L) SUBMITTED BY: A(D e Director ELAP# 10323 rL 09/30/2004 22:,57 8456282807 Id OCT -1 -2004 FRI 10:52 TEL:945-278-7921 JOEL GREENBEOG II Ilt II c I -.,--jT)Jod rt (A i if 4MF : PI ITKICYA 'f-ni IKITV nC'OnOTMr--k IT mr- PAGE 02 S 4 ! 1 O HEALTH A DIVISION O ENVIRONMENTAL 1 A 6 k s' SERVICES LETTER OF AUTHORIZATION RE: Property of ROBERT & LOURDES BAXTER Located at 421 COVE ROAD, PUTNAM VALLEY, N.Y. 1 0 5 7 9 T/V PUTNAM VALLEY Tax Map # 41.110 Block 1 Lot 21 Subdivision of FOURTH MAP - ROARING BROOK LAKE Subdivision Lot # 4 5 4 Gentlemen: Filed Map # 308 H Date Filed 2/4 / 4 7 This letter is to authorize JOEL GREENBERG, R.A. a duly licensed Professional Engineer or Registered Architect x 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 y i Countersigned: Signed: P.E., R.A., #. 1 1 0 5 6 Owner of Property) Mailing Address2 MUSCOOT ROAD NORTH Mailing Address: 44 BUCKINGHAM DRIVE MAHOPAC State NEW YORK Telephone: Zip 10541 845 628 -6613 YORKTOWN HEIGHTS State NEW YORK Telephone: 845 628 -856.2 Zip10598 Form LA -97 GREENBERG Architect 10/20/2000 PUTNAM COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 ADAM STIEBELING BAXTER, ROBERT ❑ PRINTS ❑ SPECIFICATIONS 0 SHOP DWGS ❑ SAMPLES El OTHER 29 APPROVAL ❑ YOUR USE ❑ REVIEW ❑ COMMENTS COMMENTS: ENCLOSED PLEASE FIND APPLICATION FOR RENEWAL OF SSDS PERMIT.THANK YOU. , I ., '�d 9Z � 00 FROM COPIES TO,,. J09L GRC-ENBC-RG. R.A. U PUTNAM A JNTY DEPARTMEN t ;' � �' HEALTH DI`ISRON OF IENWR®NM]ENTAL HEALTH SERWC ES ECONSTRU CTIIONY ERMIIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 421 COVE ROAD FOURTH MAP Subdivision name ROARING 13ROOK Subd. Lot # 454 LAKE Date Subdivision Approved 2/4/47 Owner /Applicant Name MARGIT PAP Mailing Address 111 SUNSET DRIVE, SARASOTA, FLORIDA Amount of Fee Enclosed $300.00 Town or Village PUTNAM VALLEY Tax Map41.10 Block 1 Lot 21 Renewal X Revision Date of Previous Approval 7/31/85 Building Type ONE FAM. RES. Lot Area 0.5146 No. of Bedrooms 2 AC Fill Section Only X Depth Separate Sewerage System to consist of 1000 WIDE LEACHING TRENCHES Zip 33577 Design Flow GPD 400 3' Volume 450 CUBIC YARDS WHEN FILL IS COM[PLET>ED gallon septic tank and 250 LF OF 2 FT. Other Requirements: 7 FT. DEEP CURTIAN DRAIN AND 3 FT. BANK VUN FILL To be constructed by RONALD FIORENTINO Address LAKE SHORt ROAD, PUTNAM VALLEY, NEW YORK 10579 Water Su�nly: Public Supply From Address or: X Private Supply Drilled by NORMAN ANDERSON Address BARGER ST., PUTNAti1 VALLEY, N.Y. 10579 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 dateof the issuance of the approval of the Certificate of Construction Compliance of the original system or Signed: Address P.E. R.A. x Date 2/9/98 NORTH, MAHOPAC, I N.Y. 10541 License # 11056 APPROVED -FOR CgNSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. A roved for discharge of domestic sanitary sewage only. By: Title: �� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 NEW YORK STATE DEPARTMENT'OF HEALTH Bureau of Community Sanitation and Food Protection Pe iA. S Specific Waiver from Requirements of Part 75 and Appendix 75- A,10NYCRR for individual Household Sewage Treatment Systems . . mow. naniv ns, ma. Name of Applicant pap Mdr i t No. Street Cityfrown Slate Zip Address 111 Sunset Drive Sarasota Florida 33577 Site Location 421 Cove Road Putnam Val l 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well from property line 5 feet, fill to Excessive slope. property line with no restrictive distances. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) Unable to meet required 100% expansion .area for SSTS. i ......................................................................................................................................................................... ............................... Unabl.e...to... meet... re.q.ui.r.ed....1.Q.Q.:....s .pa. rat.. i. an.... d. i. s. tance....f..r..o.m...l.ak.e.... to ................. area of SSTS. Site in .NYS ... DOH : approved... SD"1940..Approved ... w1ttr_.. 509'... expa.ns.i.on .... o.f ... SSTS .................................................................................................................................... ............................... Approved... v. tti.... 50.1....separ&ti-on...to...Lak*d 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... 4lell, House, fill Pad of SSTS must be staked by NYS License land surveyor, & ....................................................................................................................................................................................................... ............................... inspected as needed by Engineer /RA & PCHD representive. .............................................................................................................................................................................................................. ............................... ........................................................................................................................................................... ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) .................................................................................. ............................... ......................................................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by! "suing official for a change in conditions for which this waiver was granted. ..................... ........................ ... . ESENTA IVE COMMISSIONER OF HEALTH ............ ..... a..... 9 ..... ............................... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional DOH -1326 (7/92) (GEN -152) Y U-19220 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER Margit Pap BRUCE R. FOLEY, R.S. Acting Public Health Director ADDRESS: 111 Sunset Drive Sarasota, Florida 335 7 SITE LOCATION: 421 Cove Rd. DATE: 10/29/98 STAFF PRESENT: BF, MB,AS, RM, GR SPECIFIC WAIVER REQUEST: 1. 50% Expansion of SSTS 2. Well 5' from P L 3. Restrictive Distance of fill to PL 4. 50' separation lake to area of SSTS DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZA=RD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION Discussion of Project vrith group - Condition',W611,House, area of SSTS must be staked by NYS License Tand surveyor REQUEST APPROVED OR DENIED APPROVED DENIED REASON FOq- DENIAL X DIRECTOR OF PUBLI�C / HEALTH DATE: Ma; 10 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems Name of Applicant pap Margi t No. Street City/Town State Zip Address 111 Sunset DRive Sarasota Florida 33577 No. Street CityrTown State ZIP Site Location 421 Cove Road Putnam Valley N.Y. 10579 APPLICANT - D• NOT WRITE BELOW 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well from property line 5 feet, fill to Excessive slope. property line with no restrictive distances. LJ High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) .. Unable .... to ... mee.t ... r..equ.i.r..e.d ... .100 % ... e.xpans -i- on, ... area .... for ... SSTS...................................... ...........................Si. to ....i.n....NYS...DOH....upr.Py. d... U ....-. 1. 9. 4. 0... ap. p. r.. oved... wAt. h.... 5. 0 %...exp.ans.i.on...A.f....SSTS. .............................................................. ............................... 2. Proposed design or conditions of waiver: .............................................................................................................................................................................................................. ............................... Well, House, fill Pad of SSTS must be staked by NYS License land surveyor,& .............................. ............................... . inspected as needed by Engineer /RA & PCHD representive. ...................................................................................................................................................................................................... ............................... ................................................................................................................................................................... ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. fOther (explain) .......................................................................................... ............................... ...................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. . ............................... FiEP S.ENTATIVE OF Mh11SSIONEFt Of HEALTH / ORIGINAL -Local Health Agency ij�. /..Z7. /'.." ................'.,'. COPY - Applicant/Design Professional .................. (((..' C., DATE DOH -1326 (7/92) (GEN -152) NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: DEPARTMENT. OF HEALTH Division - Of Environmental Health `Services 4 Geneva Road, Brewster, New York 10509 ,(914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER Margit Pap 111 Sunset Drive Sarasota, Florida 33577 421 Cove Rd. 4/17/98 BF, MB, BH, AS, RM, GR BRUCE R. FOLEY, R.S. Acting Public Health Director SPECIFIC WAIVER REQUEST: 1. 50% Expansion of SSTS 2. Well 5' from P ?L 3.Restrictive Distance of Fill to PL DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION Discussion of Project with group- - Condition - Well, House, area of SSTS must be staked by NYS License land surveyor REQUEST APPROVED OR DENIED APPROVED DENIED X REASON FOFt- DENIAL DIREdM OF PUBLIC HEALTH DATE: PUTNAM �°OUNTY DEPARTME1. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV -37 -85 Located at 421 COVE ROAD FOURTH MiAP Subdivision name ROARING BROOK Subd. Lot # 454 Town or Village PUTNAM VALLEY Tax Map 41.10 Block 1 Lot 21 Date Subdivision Approved 2/4/47 Renewal x Revision Owner /Applicant Name MARGIT PAP Date of Previous Approval 4/27/98 Mailing Address 111 SUNSET DRIVE, SARASOTA, FLORIDA Zip 33577 Amount of Fee Enclosed $300.00 Building Type ONE FA:' .. RES . Lot Area 0.5146 No. of Bedrooms 2 Design Flow GPD 400 Fill Section Only X Depth 9, Volume 1,5n rv, c PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of DRAIN AND 3 FT. BANK RUN FILL 1000 gallon septic tank and 7 FT. DEEP CURTAIN Other Requirements: REFER TO SPECIFIC WAIVER ISSUED 4/27/98 FOR CONDITIONS: COPY ATTACHED To be constructed by RONALD FIOREN T INO Address LAKE SHORE ROAD, PUTNAM VALLEY. NEW YORK 10579 Water Supply: Public Supply From Address or: x Private Supply Drilled by NORMAN ANDERSON AddressBARc;Fg ST- . PUTNA`A' VALLEY, NEW YORK 10579 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sWarate 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 operati g condition any part of said sewage treatment system during the period of two (2) years immediately following the date f e issuance of the approval of the Certificate of Construction Compliance of the original system or acv rLepairs thereto. /) Signed: rwIff P.E. R.A. x Date l O I 6/ A6 s Address WO .� SCOOT GAD NORTH, YAHOPAC N.Y. 10541 License # 11056 APPROVk0 -11OR 9ONSTRUCTION: This apprg�al expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe . Approved for discharge of domestic sanitary s wage only. 01�jrv- By: Title: Date: `v Z White co y - HD Fill; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUT`T4M COUNTY DEPARTMENT-11,1 F HEALTH DffVISRUt4 OF ENVIRONMENTAL L H Erati_,Tgil SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # PV-37-85 Well Location: Street Address: TownNillage Tax Grid # 421 COVE ROAD PUTNAM VALLEY MaIA 1 .10 Block 1 Lot(s) 21 Well Owner: Name: Address: MARGIT PAP 111 SUNSET DRIVE, SARASOTA, FLORIDA 3357 Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Aaoaouaaat of Use Yield Sought ___5__ gpm # People Served _ _ Est. of Daily Usage 3 p p gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled x Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision ROARING BROOK LAKE -- - _ Lot No. 454 Water Well Contractor: NORMAN ANDERSON Address: BARGER ST., PUTNAM VALLEY, N Is Public Water Supply available to site? .................................. ..............................: Yes No x Name of Public Water Supply: N/A TownNillage Distance to property from nearest water main: N/A Proposed well location �i sources of contam' to be pi ovi a on separate et/plan. Date: 10/26/98 Applicant Signature: PERMIT TO C RU . A WATER WELL This permit to construct one water well as set forth abov , is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless... construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 1,01-2 0/Q 91 Permit�suin Official: Date of Expiration lo c Title. C. 11 o Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 XII'S'4-4 z NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems Name of Applicant Pa Address 111 Sunset Drive Sa Site Location 421 Cove Road P 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well from property line 5 feet, fill to Excessive slope. property line with no restrictive distances. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) Unable to meet required 100% expansion area for SSTS. ................. ... ............. na.al.e... to....mee ....re.9.ui.. red.... 1. Q: Q..:..:. se. pa r.. at: i. an .... dl. s. tance .... f.. r.. om... l.ake....t,o................. area of SSTS. ... ........ ......................Si.te...i n...N.YS.... DOH-approved ... SD-1940 ... Approved ... wf th .... 50% ... expa.ns.i.on_ of...SSTS ............................................................................:.............................................................. ............................... p.p. p 2. Proposed design or conditions of waiver: A roved"'twitfi""50" °'se a'rati'on"'to "'LatC ................................................................................................................................................................................................................ ............................... Well, House, fill Pad of SSTS must be staked by NYS License land surveyor, & ............................................................................................................................................................................................................... ............................... inspected as needed by Engineer /RA & PCHD representive.. ................................................................................................................................................................................................................. ............................... ........................................................... . . . . . .. . . . . . . . ... . .... .. . .......... ............ ...... . .... . ....... . . . . .. . . . . ...... .. . . . . . .... .... . . . .. ...... . . . . . .. ......... . . 3. The proposed design may have the following limitations (check appropriate box(es)): J Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ................................................................................. ............................... .................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by tfie-{s' suing official for a change in conditions for which this waiver was granted. R�PRESENTA� IVE'(��CONIMISSIONEFi OF�FiEAI.'fH ORIGINAL - Local Health Agency 6 a f COPY - Applicant/Design Professional dxfff.................................. ............................... DATE DOH -1326 (7/92) (GEN -152) NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10309 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER Margit Pap BRUCE. R. FOLEY, R.S. Acting Public Health Director 111 Sunset Drive Sarasnta, Florida 33577 421 Cove Rd. 10/29/98 BF, MB,AS, RM, GR SPECIFIC WAIVER REQUEST: 1. 50% Expansion of SSTS 2. Well 5' from P L 3. Restrictive Distance of fill to PL 4. 50' separation lake to area of SSTS DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION Discussion of Project With group - Condit.. on';W611,Nouse, area of SSTS must be staked by NYS License land surveyor REQUEST APPROVED OR DENIED APPROVED DENIED X REASON FOR - DENIAL DIRECTOR OF PUBLIC HEALTH q29Arl DATE: a NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,1ONYCRR for Individual Household Sewage Treatment Systems Name of Applicant pap Margi t No. Street City/Town State Tip Address 111 Sunset DRive Sarasota Florida 33577 No. Street City/Town State Tip Site Location 421 Cove Road Putnam Vallev N.Y. 10579 1. Reason why site does not meet 1 ONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Well from property line 5 feet, fill to Excessive slope. property line with no restrictive distances. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. j other (explain) ..Unat,le .... to ... meet... r.. equ.t r..e.d ... 100 % ... e.xpans - tan. ... area .... f-G r ... SSTS ....................... .............. ................ I .......... Site.... n....N. YS.. DOH.... approv.. ec1...$[ ?....-... 4. Q... ap. p. r.. p. ved...w.i.th....5.Ol...exp.a.ns i.on...o.f.....SS.T.S. ................................................................................................................................................................................... ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): increased risk of well or spring contamination. Increased risk of surface water contamination. _J Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) ................................................... ............................... ......................... ............................... .......................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. .......................... ............................... FiEP SENlAlIVEOF Iv1MISSIONEFiOFHEALTH ORIGINAL - Local Health Agency WP/.. � COPY - Applicant/Design Professional ................ ............................... DATE DOH -1326 (7/92) (GEN -152) DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: Marc) t Pap ADDRESS: 111 Sunset Drive Sarasota, Florida 33577 SITE LOCATION: 421 Cove.Rd. DATE: 4/17/98 STAFF PRESENT: BF, MB, BH, AS, RM, GR SPECIFIC WAIVER 1, 50% Expansion of SSTS REQUEST: BRUCE R. FOLEY, R.S. Acting Public Health Director 2. Well 5' from P3L 3.Restrictive Distance of Fill to PL DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION. Discussion of Project with group- - Condition - Well, House, area of SSTS must be staked by NYS License land surveyor REQUEST APPROVED OR DENIED APPROVED DENIED X REASON FM DENIAL DIRE OR OF PU LIC HEALTH DATE: Uhl h� PUTNAM _TIM DEPARTMENT OF HEALTH `. DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,COUNTY. OFFICE BUILDING,. CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE 140. Owner Margit Pap Address 421 Cove Road,Putnam Valley,NY 10579 Located at. (Street') :Cove .Road ` ` Sec.' 12 Mock 1 Lot ' 16 ca a nearee cross. street) Municipality. r �; : p•It.ri; i6- ..Vallgii Watershed .Hudsoi Ri�•er :..SOIL PERCOLATION TEST DATA REQUIRED.TO BE SUBMITTED WITH,APPLICATIONS .. o e Number :......CLOCK..TIME PERCOLATION PERCOLATION iun Biapse No..... ;:......... ...:.:...; .'. Time Start -Stop Min. _. Mpth to Water From. Ground Surface Start Stop Inches Inches Water ve in Inches Drop in 'Min. Inches Soil Rate /in drop PTH #1 .1...9:45• .- .•• " "• 10:1.5 2....10 :.19...... 10:49 30 30 15 17.75 15 17.75 2.75• :.. .2.75 30/2.75 =11 30/2.75 =11 10•:53 11: 23 • 30 a 5 17'_ 75 '2_ 7 -5 30/2. 75 =11 PTH #2_ ' .1..9..:50:.. •...�`; 10:20. 30 ; 16 19• 3 30/3 =10 2 10:21' �]Ll•..�1 3n. _: 1.i An n :.�..:.i n.�.,s, Y1:.22 30 ' 16 18.75 2.75 - 30/2.:75 =11 , 5 2 Notes: 1) Tuts to,.be, repeated at same depth until a roximatelyy equal soil .rates are obtained.at each percolation test hole. All data to be submitted for.review. .'2) Depth measurements to be made from top of hole. MAR -04 -1998 16:54 JOEL L.GREENBERG ARCHT. 914 628 2807 P.02 ,. �..__ TEST PIT D A TA liDESO 'n -k. -)N OF SOULS ENCOUNTERED I1 'a jM HOLES 3/4/98 DEPTH HOLE NO. _ � ^ _ HOLE NO.___ _2 1401Y NO. U.L. 0- 6" TOPSOIL 0 -8" TOPSOIL 0.5' GRAY SANDY LOAM 8�� -16,r OLIVE 1.0' " BROWN SILTY SOIL 1.5' 11 16 " -34" WAACK 2.0' 11 ORGANICS SOIL 2.5' „ 34" -72" OLIVE 3.0' BROWN SANDY LOAM 3.5' „ MIOMING AT 3 FT. 4.0, „ 4.5' 5.51 „ 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered HOLE # 1- 2.5 FT. #2- 3- 5 F'. . Indicate level at which mottling is observed 3 F.r. Indicate level to which water level rises after being encountered SANE As ABOVE Deep hole observations made by: ADAM STIEELING & JOEL GREENBERG Date 3/4/98 (Design Professional Name: JOEL GREENBERG, R.A. Address: M musaour ROAD NORTH M AHOPAC, NEW 1 541 Signature: 4. Design Prmffess vat's Seal l r. si TOTAL P.02 r DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 * Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER BRUCE. R. FOLEY. R.S. Acting Public Health Director NAM =: Robert & Lourdes Baxter $ t,DCicSS: 44 Buckingham Dr: Yorktown NY 10598 SITE LOCATION• 421 Cove Rd. Putnam Valley DATE: 12/05/00 STAFF PRESENT: SPECIFIC WAIVER REQUEST: 1. 50% Expansion of SSTS 2. Well 5' from PL 3. Restrictive Distance of fill to PL 3. 50' se arat* n lake to area of SSTS DOES THE PROPOSED VARIANCE k-TEST POSE A HEALTH HAWFID OR ENVIRONMENTAL COINAMINATION PROBLEM? + - - -+ + + x x + - - -+ YES NO WILL DI'S-310PROVAL RESULT IN A SIGNIFICANT H,41RDSHIP? YES NO DISCUSSION _ Discussion of Project with group.- Condition, Well, House area of SSTS must be staked by NYS License land surveyor REQUEST APPROVED OR DENIED APPROVED x REASON FOR.DENIAL DIRECTOR OF PUBLIC HEALTH DATE: DENIED PUTNAM C( )JNT'Y DEPARTMENT,. X HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ADELE & PETER RUVOLO Located at 421 COVE ROAD T/V PUTNAM VALLEY Tax Map # 41.10 Block 1 Lot 21 Subdivision of ROARING BROOK LAKE Subdivision Lot # .454 Filed Map # 3 0 8 H Date Filed 2/4/47 Gentlemen: This letter is to authorize JOEL GREENBERG r R.A. a duly licensed Professional Engineer or Registered Architect x to apply for the required wastewater treatment and/or `eater 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 ty S4q tary Code. Coun P.E., Mailing State NEW YORK MAHOPAC Zip 10541 Telephone: 914 628 -6613 Very tru Signed: NORTH Mailing Address: GARDINEER ROAD PUTNAM VALLEY State NEW YORK Telephone: 914 741-8574 Zip 10579 Form LA -97 PUTNAM C('__'1NTY DEPARTMENT F HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION MARGIT PAP Located nt 421 COVE ROAD T/V PUTNAM VALLEY Subdivision of Subdivision Lot # 454 Gentlemen: Tax Map # 41.10 ROARING BROOK LAKE Block Filed Map # 308 x 1 Lot 21 Date Filed 2/4/47 This letter is to authorize JOEL GREENBERG, R.A. a duly licensed Professional Engineer or Registered Architect - x 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 Co Code. Countersigned: P.E., R.A., # _ Mailing Address State NEW YORK Telephone o o • Very truly yours, i r I�� y Signed: t1d f �r_'4�7 l x (Owner of Pr erty) 01 o O 111 SUNSET DRIVE Mailing Address: MAHOPAC Zip 10541 914 628 -6613 SARASOTA State FLORIDA Telephone: 941 365 -1808 Zip 33577 Form LA -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 28, 2004 Joel Greenberg, RA 2 Muscoot North, RFD # 2 Mahopac, New York 10541 Re: .Field Inspection — Baxter Cove Road, (T) Putnam Valley TM# 41.10 -1 -21 Dear Mr. Greenberg: ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on September 27, 2004. The following OVI 10 comments must be corrected in the field. 1 o MkA v �`" ' � The pipe between the septic tank and distribution box is still back pitched in some areas. aLk M,11 (1:)/ The gravel was replaced with the proper sized stone, but it is still full of silt and fines. A I {�Q�'�lr�� determination will be made as to whether the gravel will have to be removed again. M� l0�' The trench layout does not match the approved plan. Please provide one copy of a preliminary as- built, showing trench lengths as constructed in the field. o ` ,� Il .x� b0464 ou have an further questions, lease contact me at 845 278 -6130 ext. 2157. �.o Y Y q p ( ) Sincerely, 1-2 Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 7, 2004 Joel Greenberg, RA 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT J. BONDI County Executive Re: Field Inspection — Baxter Cove Road, (T) Putnam Valley TM# 41.10 -1 -21 A site inspection was made for the above referenced project on September 3, 2004 and September 7, 2004. The following comments must be corrected in the field. . 0 noi,(,✓I. The pipe just before the distribution box is disconnected. The SDR -35 pipe is back pitched in some locations, especially near the distribution tZ�o;�box. 4 The last 15 foot of trench was not installed. k"Z��''`''�"`� �s �,,;,� A- T'� The gravel contains a large amount of dirt and fines and it is also mixed with gravel /.,-7/-;F, Ld less than 3/4" in size. The gravel needs to be replaced with washed dust free gravel �4 that is 3/4" to 11/2" in size. SV The roof leader /footer drains need to discharge away from the SSTS area. f/-The he fill pad has not been completed, specifically the impervious layer. well casing needs to be raised a'minimum of 18" above grade. If you have any further questions, please contact me at (845) 278 -6130, ext. 2157. 1w � �vlc 4 r 3 , J7, 24 JSP:km Sincerely, seph S. Paravati, Jr. Assistant Public Health Engineering LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (645) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 ' FACSIMILE TRANSMITTAL TAL ROBERT J. BONDI County Executive To: 71F 9. - 7 tiO ' From: .Toe__ Date: Re: Pages: 02 CC: ❑ Urgent ,: For Review ❑ Please Comment ❑ Please Reply CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL and legally protected information intended only for the use- of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845- 278 -6130) and destroy all documents associated with this facsimile. LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7.921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 7, 2004 Joel Greenberg, RA 2 Muscoot No. RFD 2 Mahopac, NY 10541 Dear Mr. Greenberg: ROBERT J. BONDI County Executive Re: Field Inspection — Baxter Cove Road, (T) Putnam Valley TM# 41.10 -1 -21 A site inspection was made for the above referenced project on September 3, 2004 and September 7, 2004. The following comments must be corrected in the field. 1. The pipe just before the distribution box is disconnected. 2. The SDR -35 pipe is back pitched in some locations, especially near the distribution box. 3. The last 15 foot of trench was not installed. 4. The gravel contains a large amount of dirt and fines and it is also mixed with gravel less than 3/4" in size. The gravel needs to be replaced with washed dust free gravel that is 3/a , to 1112,, in size. 5. The roof leader /footer drains need to discharge away from the SSTS area. 6. The fill pad has not been completed, specifically the impervious layer. 7. The well casing needs to be raised a" minimum of 18" above grade. If you have any further questions, please contact me at (845) 278 -6130, ext. 2157. Sincerely, seph S. Paravati, Jr. Assistant Public Health Engineering JSP:km PUTNAM COUNTY DEPARTMENT OF HEALTH `DIVISION OF ENVIRONMENTAL HEALTH SERVICES` FINAL SITE INSPECTION Street Location Town U�w► .l /.w6 TM# 1.1i. ifw i -a( 1. Sewaze Svstem Area a. STS area located as per approved plans.......... .. .............. b.. Fill section - date of.placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ....................... d. Stone, brush, etc., greater-than 15' from STS area......:. e. 100' from water course / wetlands ... ............................... R. Sewaze System a� a. Septic tank size - 1,000 ......... 1,250 ......... other ............ b. Septic'tank installed level ............. ............................... c. 10' minimum from foundation ....... ............................... d. Distribution Box 1. All outlets at same elevation -water tested .......:...... 2. Protected below frost ............. ............................... 3. .. Minimum 2 ft.Original soil between box & trenche e. Junction Box properly set s_... .............................. 1. Length required Length installed 2. is ance 3. Installed according to plan ...... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot.......... 5. 10 ft. from property line - 20 ft.- foundations....... 6. Depth of trench <30 inches from surface ............... 7. Room allowed for expansion, 100 % ...................... 8. Size of gravel 3/4 - 1' 12' diameter clean ................. 9. Depth of gravel in trench 12" minimum ....... :......... 10. Pipe ends ca pped ........ ...... . ................................... : g. Puma or Dosedp5vstems 1. Size of pump chamber........... ......... 2. Overflow tank ........... ....... ............................... 3. Alarm, visual/ o........ :.......... ........................... 4. Pump a accessible, manhole to grade ............. 5. ox baffled ................... ............................... 6. C� ycle witnessed by H.D.estimated flow /cycle...... M. Houselucildirig a. house located per approved plans ....................... .... b. Number of bedrooms ................ ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured 4-0t2' ft...... c. Casing 18" above grade ........... ............................... d. Surface drainage around well acceptable .................. V.. Overall Workmanship . a. Boxes properly grouted ............ ............................... b. All pipes partially backfilled ...... ............................... c. All pipes flush with inside of box ............................. d. Backfill material contains stones <4" diameter.......... e. Curtain drain & standpipes installed according to l; f. Curtain drain outfall protected & dir.to exist wa r_g Fop �n way from —ST area......... h. Surface water protection adequate ........ :..................... i. Erosion control provided ......... ............................... Rev. 12/02 Date: ASK Inspected by: Owner r �c l e r' Permit # SW -1 -4,? Subdivision Lot # f_V_ A /�T_ 08/30/20Q4 03431 8456282807 JOEL GREENBERG C,jtM"ojW6 86 ASW)CMTgjjr . prPAWJ"W C'st) copwmuc"O" :2MIN300" "K' . rxm4opAe, DIM .t.p4MG28AW93 Irch ATT19"TIOM-m FAX Hum commapair-l-c CS`A PAGE 01 ir 9 '2- CO C-x Ile 'MAtAWArFVAL -roTAIL PACES 9 OF YOU. bo"rr,.RjEarjVlE ALL Lr OF t)ON AS POSSIS PLEASO,cALL. USAS 9 of ir- era- arnrna mnKj it-,tpr, TPI - Pzic-%-p7.q-7qP1 t,IC4MF: PI ITNAM rni INTY nFPAPTMFNT OF P. 1 08/30/20B4 03:31 8456282807 JOEL GREENBERG PAGE 02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION El JOSEIPH REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. PCHD Construction Permit ,# PV -37 -85 11 GENE For:. Fill Trenches x Located 421 Cove Roalj� (T) (W) Putnam Valley Owner /Applicant Name: T niirdes— oaytee TM 41 Bloch 1 Lot ?_3J Forrxrerly: tit :x ��-- -- — Subdivision Name: E,,jjr_ . Map- n„a r; ng 1b�aok Subdivision Lot # 4sA Is system fill completed? yes Date: 2 / 1 H j4 % Is systern complete? Yes _ Date: 8 / 1 6 % 0 4 Is system constructed as per plans? Yes Is well. drilled? Y -a- Date: July 2004 Is well located as per plans? Ya s Axe erosion contzol measures inplaee ?� I certify that the system(s), as listed, at the above premises has been cncted I have.inspectod and veri fied their completion in -accordance with the issu d C lon Permit and approved plarxs and the Standards, Rules and lations PDepartment of Health. Date:. 8/30/2.004 - Certified by: PE RA x._ D sign P fession Address: 2 Muscoo Rd Lic. # _11056 Comments: Please c-Wi 1 Q i nom.= nct i on . t soon as pQr s;i ! e Form FIR -99 it _�ra_�raran WWI TP1 . Qdq-g7 7qq1 t•JAME: PUTNAM COUNTY DEPARTMENT OF P. 2 1v ` PUTNAM COUNTY DEPARTMENT OF HEALTH 1/ \ � DNISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM �D PERMIT # Pv -37 -85 514-1 Located at 421 Cove Road Town or Village Pni -nam Valley Fourth Map 41.10 Subdivision name R -acing —Brook Subd. Lot # 4 54 Tax Map Block �_ Lot Date Subdivision Approved 2/4/1947 Renewal x Revision Owner /Applicant Name Lourdes Baxter Date of Previous Approval 12 / 2 7 / 2. o n o Mailing Address 44 Buckingham Drive, Yorktown Hei g tG, N y Zip 10598 Amount of Fee Enclosed $300.00 Building Type One Fam _ RP s _ Lot Arga 514 6 No. of Bedrooms 2 Design Flow GPD 4 0 0 Fill Section Only x Depth 9 Volume 450 cv' s PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 7 ft deep Curtain drain and 3 ft rank run fill Other Requirements: Refer to specific waiver issued 10/29/98 for conditions - To be constructed by Ronald Fiorentinn Water Supply: Public Supply From copy attached Address Lake Shore Road, Putnam Valley, Address N.Y. 10579 or: x Private Supply Drilled by Nnrman Anderson Address Barger St, Putnam Va ey,N.Y. 10579 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of 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 goo ope atin ondition ny part of said sewage treatment system during the period of two (2) years immediately following ttte date of a issuance o the approval of the Certificate of Construction Compliance of the original system or any - repairs th eto. Signed: Y--/-' M-1r-X ->-K P.E. R.A. x Date 7/11/2003 Addresg 46s(JootAoad North, l ahopac, N.Y. 10541 License# 11056 APPROVI DTOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approved for discharge of domestic sanitary sewage only. By: Title: Date: Wh' copy -/HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 July 18, 2003 Mr. Robert Morris Putnam County Health Department Geneva Road Brewster, New York 10509 Re: Lourdes Baxter SSTS — 421 Cove Road Putnam Valley T.M. # 41.10 -1 -21 Dear Mr. Morris, Please find enclosed application for renewal of a construction permi or a sewage treatment system and money order in the amount of $300.00. Thank you in advance for your prompt attention in this matter. Ve truly yours, Jog Greenb g, R.A. JG:stw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL 1 please print or ripe PCHD Permit # PV-3-7-3s; Jib Well Location: Street Address: TownNillage Tax Grid # 421 Cove Road Putnam Valley Map41 .10 Block 1 Lot(s) 21 Well Owner: Name: =Address: 44 Buckingham Drive, Yorktown Lourdes BaxteHeights, w York Use of Well: Residential Public Supply Air/Cond./Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 3 0 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled x Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Roaring Brook Lake Lot No. 454 Water Well Contractor: norman And Gon Addressga-rgpr St Putnam Valley, Is Public Water Supply available to site? ...................................... y .....1 .7.9.... Yes No x Name of Public Water Supply: A To illag N/A Distance to property from nearest water main: NI Proposed well location & sources of con aminatio to b pro ided on separate heet/plan. Date: 711 1 / 2 n n Applicant Signature: ` .1/ 00 ect PERMIT T CON TWCT A WATER WELL This permit to construct one water well a set fo above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subp - of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue : • ! Permit Issuing Official: Date of Expiration Title: Permit is Non - Transfer abl White copy - RD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ` PUTNAM COUNTY DEPARTMENT OE HEALTH DIVISION OF ENVIRONMENrFAL HEALTH SERVICES ICES LETTER OF AIUTHORIZATION RE: Property of Lourdes Baxt Located at 421 Cove Road T/VPutnam Valley Subdivision of Subdivision Lot # 454 Gentlemen: Tax Map # 41 .10 Roaring Brook Block 1 Lot 21 Filed Map# 308 -x Date Filed 2/2/1947 This letter is to authorize Joel Greenberg, R.A. a duly licensed Professional Engineer or Registered Architect x 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. A _ Countersigned: P.E., R.A., #/— Mailing Muscoot Road North Mahopac State New York Zip 10541 Telephone.845 628 -6613 Very truly yours, Signed:G p (Owner of Property) Mailing Address: 44 Buckingham Drive State New York Telephone: 914 245 -1165 Zip 10598 Form LA -97 LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 OFFICIAL REQUEST FOR STOP -WORK ORDER Iry Sevelowitz Building, Zoning & Sanitary Inspector Putnam Valley Town Hall Putnam Valley, NY 10579 Re: Stop -Work Order Request: Baxter 421 Cove Road (T) Putnam Valley, TM# 41.10 -1 -21 Dear Mr. Sevelowitz: ROBERT J. BONDI County Executive June 18, 2003 The Permit SW -1 -98 for the above regarded project has expired. Inspection of property was made on June 16, 2003. Construction is underway without a valid permit. It is respectfully requested that a Stop -Work Order be issued until such time as permit has been renewed. Thank you, in advance, for your cooperation in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. Ve truly yours, �J,L� oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:tn cc: Joel Greenberg, R.A. PUTNAM COUNTY DEPARTMENT Off' HEALTH I� RIVRSION OF ENWRONM ENTAIL HEALTH S ERWCES h� ^�� V CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV- 3.7 -85j —' Located at 4 21 COVE ROAD Town or Village PUTNAM VALLEY FOURTH MAP Subdivision name ROARTN , Bgnnx Subd. Lot # 4 5 4 Tax Map 41 1 n Block —1 Lot _21 Date Subdivision Approved 2/4/47 Renewal x Revision Owner /Applicant Name ROBERT & LOURDES BAXTER Date of Previous Approval 10 / 2 9 / 9 8 Mailing Address 44 BUCKINGHAM DRIVE, YORKTOWN HEIGHTS, N.Y. Zip 10598 Amount of Fee Enclosed $300.00 Building TypeONE FAM . RES. Lot Area ° 514 6 No. of Bedrooms 2 Design Flow GPD 4 0 0 Fill Section Only X Depth 3' Volume 450 CY' S PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 7 FT _ nFFp- - CURTAIN DRAIN AND 3 FT. BANK RUN FILL Other Requirements: REFER TO SPECIFIC WAIVER ISSUED 10/29/98 FOR CONDITIONS COPY ATTACHED To be constructed by RONALD FIORENTINO Address LAKE SHORE ROAD., PUTNAM VALLEY, Water Supply: Public Supply From Address N.Y. 10579 or: X Private Supply Drilled by NORMAN ANDERSON —Address BARGER ST. , PUTNAM VALLEY, N.Y. 10579 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 s, stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system orb repairs theretyl n Address- P.E. • d P.E. R.A. X Date 10/20/2000 '.N -v- 10541 License# 11056 APPROVED/FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trNdhent system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when idered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . Ap ro d for discharge of domestic sanitary sewage only. By: Titl 6 ate: White cop - HD File; llow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH 5LJ DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # PV-37-85 Well Location: Street Address: TownNillage Tax Grid # 421 COVE ROAD PUTNAM VALLEY Map41 .1 Block 1 Lot(s) 21 Well Owner: Name: ROBERT & Address: 44 BUCKINGHAM DRIVE, YORKTOWN LOURDES BAXTE$ HEIGHTS, N.Y. 10598 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 6primary 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 300 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason upla for Drilling Well Type Drilled __X— Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision ROARING BROOK LAKE Lot No. 454 Water Well Contractor: NORMAN ANDERSON Address: BARGER ST. , PUTNAM VALLEY Is Public Water Supply available to site? .............................. N.Y. 10 5..9 ... Yes No X Name of Public Water Supply: N/A TownNil ge /A Distance to property from nearest water main: N_ Proposed well location & sources of contamination to be pro i d on sep ate sh t/plan. Date: 1 0/ 2 0/ 2 0 0 0 Applicant Signature: PERMIT TO TR CT 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 11 driller certified by Putnam County. Date of Issue ! Permit Issuinrqfflcl7l � , Date of Expiration 6 Title: Permit is Non -Trans a ab , White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ' `�L' J -/ -7fa NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,1ONYCRR for Individual Household Sewage Treatment Systems NameofApplicant Baxter Robert & Lourdes No. Street City/Town State Zip Address 44 Buckingham Dr. Yorktown NY 10598 No. Street City/Town State zip Site Location 421 Cove Road Putnam Valley NY 10579 1. Reason why site does not meet 1 ONYCRR Appendix 75 -A (check appropriate box(es)): X Separation distance cannot be achieved. We 11 f r o m p r o p.e r ty l i n e 5 f e e t, f i 11 t o Excessive slope. property line with no restrictive distances. L] High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ... 11.n.a b. 1 .....t.Q.....m..t*..1{.....r..q area ..for S S.T S Unable to meet required 1004, senarati.. o. n.... d... s. ta, n...,.... f .r.p.m.....i..ak.......q....,.. ....................................................................... ............................... area of SSTS. Site in NYS DOH approved SD -1940 ApDrnvp.d with .... ....................................................................................................................................................................................... ............................... _.... 50.% .. ..a '..... %Ps.l sTSAP. Q dith aap..X.at ian... ..t.Q.....Laka ............... 2. Proposed design or conditions of waiver: ....................................................... ..: .............................. ........................................................................................... ............................................................. Well, House, fill Pad of SSTS must be staked by NYS License ................................................................................................................................................................................................................. ............................... land surveyor, & inspected as needed by Engineer/ RA & PCHD ................. .. ................................................................................................................... ....... ... .................. ............................................... .:...........................- representive. ........................................................................................................................................................ ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): ILJ Increased risk of well or spring contamination. sncreased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. ether (explain) ... ......... ..............:............... _...._...._ ... ... ....... . ..... ......... _... ... .......... .............. ........... ....::......................... ................................................................................................................ ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. .. ................... I........... =R OF HEALTH ORIGINAL - Local Health Agency COPY - Applicant/Design Professional DOH -1326 (7/92) (GEN -152) 1A DEPARTMENT OF HEALTH Division Of Environmental -Health Services 4' Geneva Road, Brewster, New York 10309 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER SLJ BRUCE. R. FOLEY, R.S. Acting Public Health Director NAME: Robert & Lourdes Baxter ADDRESS: 44 Buckingham Dr: Yorktown NY 10598 SITE LOCATION: 421 Cove Rd. Putnam Valley DATE: 12/05/00 STAFF PRESENT: ZLLGr -. _ a 5 klo.. '?, SPECIFIC WAIVER REQUEST: 1. 50% Expansion of SSTS 2. Well 5' from PL 3. Restrictive Distance of fill to PL 3. 50' separation lake to area of SSTS DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARID OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISkoPROVAL RESULT IN A SIGNIFICANT HARDSHIP? +_X_+ + - -+ YES NO DISCUSSION Discussion of Project with group - Condition, Well, house area of SSTS must be staked by NYS License land surveyor REQUEST APPROVED OR DENIE APPROVED DENIED X REASON FOR. DENIAL DIRECTOR F PU LIC LTH n&Tl: • . ' /% 29� z BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLMARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 December 14, 2000 Joel Greenberg, RA RFD ;42, Two Muscoot North Mahopac, New York 10541 Dear Mr. Greenberg: Re: Baxter, 421 Cove Road TM# 41.10 -1 -21, Town of Putnam Valley This office has discussed the above referenced project at its December.14, 2000 Specific Waiver Meeting. I offer the following for your review. Your request for a specific waiver has been approved pending receipt of plans showing a legitimate two bedroom dwelling. Please reference our Department memo of 7/27/00 regarding "classification of a bedroom." 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 Assistant Public Health Engineer ABS:cj I DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New . York .10509 Tel. (914). 278 - 6130 Fax (914) 278-7921 FAX COVER SHEET Date: AO � ql q e l From: Adam B. Stiebeling A St. Public Health Engineer For your information For your review As discussed BRUCE R. FOLEY Public Health Director Fax #: V�? 'ZE�07 No. Pages (Including cover sheet) Notes/Messages ``9ll � t 1 Please respond Attached as requested Please call 1 G Ri�L 'iZv� Grp 0 1 �Crt. «A— a _� In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 October 26, 1998 Joel Greenberg, RA Two Muscoot No. RFD 2 Mahopac NY 10541 Re: 421 Cove Road, Margit Pap TM# 41.10 -1 -21 (T) Putnam Valley Permit# PV -37 -85 Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director This office hereby revokes Permit # PV- 37 -85, construction permit for construction of sewage treatment system, on the above referenced lot. It has come to our attention that an existing well exists on property to the south of the subject lot (TM# 41.10 -1 -22, N/F Higgins) which is less than 100 feet from the previously approved SSTS area. Current regulations require the minimum separation distance from a well upgradient to a septic area to be 100 feet. Any and all construction associated. with Permit # PV -37 -85 must stop immediately until such time as an approval has been granted by this office. Please fell free to contact this office at (914) 278 -6130 ext. 157 if any questions arise. ASBAn cc: John Higgins Bob Baxter, LS Margit Pap (T) Putnam Valley BI file Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 FAX COVER SHEET Date: To: TO � L From: A4 J Adam B. Stiebeling Asst. Public Health Engineer Z For your information For your review As discussed Notes/Messages 1z1. G;' -, , Fax #• 6 ? — Z807 No. Pages 2 (Including cover sheet) Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. DEPARTMENT OF HEALTH Division of Environmental Health Services . 4 Geneva Road Brewster, New York 10509 ; Tel. (914) 278-6130 Fax (914) 278-7921 October 26, 1998 Joel Greenberg, RA Two Muscoot No. RFD 2 Mahopac NY 10541 Re: 421 Cove Road, Margit Pap TM-T1-1' 41.10 -1 -21 (T) Putnam Valley. Permit# PV -37 -85 Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director This office hereby revokes Permit # PV- 37 -85, construction permit for construction of sewage treatment system, on the above referenced lot. It has come to our attention that an existing well exists on property to the south of the subject lot (TM# 41.10 -1 -22, N/F Higgins) which is less than 100 feet from the previously approved SSTS area. Current regulations require the minimum separation distance from a well upgradient to a septic area to be 100 feet. Any and all construction associated with Permit T PV -37 -85 must stop immediately until such time as an approval has been granted by this office. Please fell free to contact this office at (914) 278 -6130 ext. 157 if any questions arise. ASB:tn cc: John Higgins Bob Baxter, LS Margit Pap (T) Putnam Valley BI file Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer s. '. %, I DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 October 26, 1998 Joel Greenberg, RA Two Muscoot No. RFD 2 Mahopac NY 10541 Re: 421 Cove Road, Margit Pap TM# 41.10 -1 -21 (T) Putnam Valley Permit# PV -37 -85 Dear Mr. Greenberg: BRUCE R FOLEY Public Health Director This office hereby revokes Permit # PV- 37 -85, construction permit for construction of sewage treatment system, on the above referenced lot. It has come to our attention that an existing well exists on property to the south' of the subject lot (TM# 41.10 -1 -22, N/F Higgins) which is less than 100 feet from the previously approved SSTS area. Current regulations require the minimum separation distance from a well upgradient to a septic area to be 100 feet. Any and all construction associated with Permit # PV -37 -85 must stop immediately until such time as an approval has been granted by this office. Please fell free to contact this office at (914) 278 -6130 ext. 157 if any questions arise. ASB:tn cc: John Higgins Bob=B,-ax ervLS =t Margit Pap (T) Putnam Valley BI file Very truly yours, r IJ . Adam B. Stiebeling Assistant Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 October 26, 1998 Joel Greenberg, RA Two Muscoot No. RFD 2 Mahopac NY 10541 Re: 421 Cove Road, Margit Pap TM# 41.10 -1 -21 (T) Putnam Valley Permit# PV -37 -85 Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director ' am This office hereby revokes Permit # PV- 37 -85, construction permit for construction of sewage treatment system, on the above referenced lot. It has come to our attention that an existing well exists on property to the south of the subject lot (TM# 41.10 -1 -22, N/F Higgins) which is less than 100 feet from the previously approved SSTS area. Current regulations require the minimum separation distance from a well upgradient to a septic area to be 100 feet. Any and all construction associated with Permit # PV -37 -85 must stop immediately until such time as an approval has been granted by this office. Please fell free to contact this office at (914) 278 -6130 ext. 157 if any questions arise. ASB:tn cc: John Higgins Bob Baxter, LS Margit Pap (T) Putnam Valley BI file Very truly yours, 14"'t Adam B. Stiebeling Assistant Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914 278-7921 October 26, 1998 Joel Greenberg, RA Two Muscoot No. RFD 2 Mahopac NY 10541 , Re: 421 Cove Road, Margit Pap TM# 41.10 -1 -21 (T) Putnam Valley Permit# PV -37 -85 Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director This office hereby revokes Permit # PV- 37 -85, construction permit for construction of sewage treatment system, on the above referenced lot. It has come to our attention that an existing well exists on property to the south of the subject lot (TM# 41.10 -1 -22, N/F Higgins) which is less than 100 feet from the previously approved SSTS area. Current regulations require the minimum separation distance from a well upgradient to a septic area to be 100 feet. Any and all construction associated with Permit # PV -37 -85 must stop immediately until such time as an approval has been granted by this office. Please fell free to contact this office at (914) 278 -6130 ext. 157 if any questions arise. ASB:tn cc: John Higgins Bob Baxter, LS Margit Pap (T) Putnam Valley BI file Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer 25 APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date 10/29/98 RE: Department of Health Review of Proposed SewageTreatment System for Property Name: MARGIT PAP Address: 421 COVE ROAD Town: PUTNAM VALLEY Tax Map #: 41.10-1-2.1 Dear MR, HIGGINS, Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, LO-A ` Title: Received By - HIGGINS Address: 116 LAKESHORE DRIVE JOEL GREENBERG PROJECT ARCHITECT Tax Map #: 41.10-1-22 August 1997 i- FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT MS. EILEEN MATTES 6 COVE ROAD PUTNAM VALLEY, N.Y 10579 Dear pate 10/24/97 Re: De Part:%Qfrt of F:ea1 to Paviet•! of Procos=d c_aace Disposal Sys!-_ j for property. Name: PAP TO RUVOLO Address: 421 COVE ROAD Town: PUTNAW!VALLEY, N.Y, 10 579 Tax 41.10 =1 =21 Please be advised that an application for a Constrcction.Permit r--ative to the construction of a sewage system and /or well proposed for the captioned prdperty has been wade to th-? Putnam County 0.2partment of Health. Attached please; find a copy of the latest site plan. If you have any g0estions, concerns or 'information which may bear on the Eealth Departmen,t's review of this application, you wiay call Mr. Fledges XXXMXX;KWXKM of the Health Oepariment at 2WX -XWkaX 278-6130 RECEIVED 6Y: A very truly yours By rECT rYONS CJ TOTAL P.@6 OCT -19 -1+998 15:34 JOEL L.GREENBERG ARCHT. 914 628 2W? r'.M FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT JOHN P. 6 MARILYN HIGGINS 116 LAKE SHORE DRIVE PUTNAM VALLEY, N.Y. 10579 Oate 10/24/97 Re: t?epertrent of Heal try Review o' PrOPOSed Se:1eee O i sP-0<<1 SyS;t. -M for property: Name: PAP TO RUVOLO Address. 421 COVE ROAD Town: PUTINAM -, VALLEY, N.Y. 10 5 7 9 Tox Nee.; 41.10-1-21 DFzr MRo & MRs. HIormg, Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well "Proposed for the captioned prtipert)• has been made. to th+: Putnam County Department of Health. Attached Please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's revie -w of this application, you may call Mr. Hedges )§XA 'X 200XXV& o; the Health Department at X=§1X 278-6130 Very truly yours,^ By itl RECEIVED BY: %�4r Address r e;t /� � i+a p : � -; c„ L G ENBERG, PROJEC ARCHITECT 94004 628.6613 WITH A Y QUESTIONS FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT GEORGE & JEANNE MORRIS 117 LAKE SMORE DRIVE PUTNAM VALLEY, N.Y., 10579 Dear MR. & MRS. MORRIS, 0 Date 10/24/97 Re: G ?_rt:re t c," F'e?Ith R'evie:-1 o: ProcosBe 5_:qace Disposal syste ^► for property: Plar:e : PAP TO RUVOLO Addr_ss: 421 COVE ROAD Town: PUTNAWIV'ALLEY, N.Y. .10579 Tax M,p: 41.10 -1 -21 Please be advised that an application for a Construction Permit r�iative to the cor5truction of a sewage system and /or well proposed for the captioned 00 &13' has been made to thy' Putnam County. Department of Health. attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call "Mr. Hedges 24XXlgKXXXZXXWof the Health Department at 3X*=:11aX 278 -6130 Very truly yours By itl RECEIVED BY: rd��iress: T�2x •.t p : � J',',; cN NBERG, P 4 626-6613 WITH ARCHITECT Y. QUESTIONS OCT --19 -1998 15 :33 JOEL L.GREENEERG ARGHT. ••.114 hGits edvi r. via FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT WILLETT, RAYMOND, C. 13 LOTUS ROAD NEW ROCHELLE, NEW YORK 10804 bear MR. WILLETT, Oate 10/24%97 Re: Dep ?rt:rent cs Heel th Revipe, of Proposed Se•:rece oi<_Yosel Syste m for property: ME,re : PAP TO RUVOLO Address: 421 COVE ROAD Town = PUTNAM�IVALLEY r N.Y. 10.579 Tax Map: 41.10 -1 -21 Please be advised that a,i application for a Construction Permit relativO to the construction of a seviage system and /or well proposed for the captioned property has been made to the Putnain County Oepartrent o; Health. Attached please Find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Realth Department's review of this application, you may call Mr_ Hedges )§xMVX.X -*D0XX%X of the Health Departmerft at nBUX 278-6130 Y.ery truly yours, By i tl eJ EL GWENBERG; PRO,;. RECEIVEO 6Y: LL 9 '4 628 -6613 WITH Ad*d re s s ARCHITECT QUESTIONS OCT -19 -1998 15:33 FORMAT ,`UGN80R NOTIFICATIOM CONSTRUCTION PERMIT JOEL L. U1- fthNbhKU HKk-" I JAES DEBERRARDINIS 57 HILLSIDE ROAD LAKE CARMEL, NEW YORK 10512 Dear MR. DEBERRARDINIS, Date 10/21%97 Re: Cepart.ment of fealttn Revie:•r of Prcpos2d Sa:raee Disposal systa i for pr;p 'y: Nero: PAP TD RUVOLO Address: 421 CdVE ROAD Taws: F'tT%Ak !VALLEY, N.Y. 10579 Too Map: 41.10 -1 -21 Please be advised that an application for a Construction. permit ra:ative to the construction of a sewage system and /or well proposed for the captioned propert} has been made to the Putnam County D,partren� o` Health. Attach °d please find a copy of the latest site plan. If you have any questions, concerns or infornat on which may bear on the Health Department's review of this application, you may call Mr. hedges y4?fXmiGXm$?t!~Cw of the health Department at X3S=B6X 278-6130 Very truly yours 8y_� itl RE'CEIVEO GY: Ad'p'i e s s : - av;cj G ENBERG, P4A)( Ct:ITECT 4 628 -66'13 WITH UESTIONS 09/28/98 MON 09:22 FAX 9146218562 Baxter Land Surveying s s 0 -AIN W V WJUVI =GREENBERG Architect TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 12/15/00 1 ADAM STEIBLING SAx-m ❑ PRINTS 0 SPECIFICATIONS ❑ SHOP DWGS ® SAMPLES ® OTHER COMMENTS: ENCLOSED PLEASE FIND REVISED PLANS FOR YOUR APPROVAL. COPIES TO: OC-L GRQQNegRd R.A. k?VT RE APPROVAL ❑ YOUR USE ❑ REVIEW Q COMMENTS COMMENTS: ENCLOSED PLEASE FIND REVISED PLANS FOR YOUR APPROVAL. COPIES TO: OC-L GRQQNegRd R.A. k?VT RE , 8 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS /` REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION �Z 1 Co •t& NAME OF OWNER REVIEWED BY N DATE . Z �1' TAX MAP #14 ' Y DOCUMENTS Y ERMIT APPLICATION y PC -1 r VELL PERMIT _ PWS LETTER ETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) y CORPORATE RESOLUTION SHORT EAF ti LANS - THREE SETS HO SE P NS =TWO SETS A DANCE RE UEST FEE SUBDIVISION AL SUBDIVISION DIVISION APPROVAL CHECKED C RATE UIRED DEPTH .TAIN DRAIN REOUIRE5- STANDPIPES TED IN NYC WATERSHED S SUBMITTED TO DEP GATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED -S WITNESSED, IF REQ'D APPROVAL SSDS ADJ. LOTS 'LANDS (TOWN/DEC PERMIT REQ'D ?) A ON DDS PLANS & PERMIT SAME 149 NEIGHBOR NOTIFICATION TER BI/ZBA KR,�jg EVATION ER REQ'D PERMIT(S) AGE SYSTEM PLAN - (NORTH ARROW) 3 HYDRAULIC PROFILE_ GRAVITY FLOW 8TRUCTION NOTES IGN DATA: PERC & DEEP RESULTS )NTOURS EXISTING & PROPOSED ✓EWAY & SLOPES, CUT TAIN DRAINS COMMENTS: CONTROL:HOUSE,WELL, SSDS ATIVE OF PRIMARY & EXP eXREA; SHOWN; GRAVITY FLOW, SUFF.SIZE UMPED, PIT & D BOX SHOWN & DETAILED JSE - NO.OF BEDROOMS ?j LLS & SSDS'S W/IN 200' OF PROPOSED SYS. )PERTY METES & BOUNDS JSE SETBACK NECESSARY (TIGHT LOT) JSE SEWER - 1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS kY BARRIER FT. HORIZONTAL;SLOPE 3:1 TO GRADE VOLUME FILL IN EXPANSION AREA TRENCH !et` 1 RENCH PROVIDED 60 FT MAX. EXP Ell ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 0' 0 FOUNDATION WALLS 15'WELL TO Loo 00' TO WELL, 200' IN DLOD, 150 00' TO STREAM WATERCOURSE LAKE (inc. expan) 66TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 0' TO WATER LINE (pits -20') 0' INTERMITTENT DRAINAGE COURSE 00' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 0/o,35' -I %,100' - <1% 20'min to CD discharge /100'with 182 cons day discharge SEPTIC TAN m 10' FROM FOUNDATIO • 50' TO WELL C FORM ST -2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION zI Coy ,(, NAME OF OWNER ?43��s REVIEWED BY / � DATE v 99 TAX MAP P 41> 4 1 ZI Y N/ DOCUMENTS Y APPLICATION WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION N IX SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED PERC RATE FILL REQUIRED DFpTN CURTAIN DRAIN REQUIRED STANDPIPES GENERAL rxATED IN NYC WATERSHED PLANS SUBMITTED TO DEP E GATED.TO PCHD P APPROVAL, IF REQ'D 7DD�FEP TEST HOLES OBSERVE RCS WITNESSED, IF REQ'D EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) ATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION 100 YR. FLOOD ELEVATION QTHER REQ'D PERMIT REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS l�A l�.fI�RT AiT[+. EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES _LOCATE_Q _ ITPRESENTATIVE OF PRIMARY & EXPANSIONS LOCATION MAP FP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED, PIT & D BOX SHOWN & DETAILED +IOUSE - NO.OF BEDROOMS Z WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. 'YKOPERTY METES & BOUNDS HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES TION NOTE I -f JFILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. P TOURS 00% EXPANSION PROVIDED S 01 STANCES SPECIFIED ON PLAN - FROM SSTS Loo 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL 20' TO FOUNDATION WALLS ELL TO P 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) ATCH SIN, 35' STORMDRAIN, PIPED WATER 10' 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 %,35' -I %,100' - <I% 20'min to CD discharge /100'with 182 cons day discharge SEPTIC 10' FROM FOUN TION; 50' TO WELL FORM ST -2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT P/4p STREET LOCATION lzl C,/E NAIV F OWNER V Ln REVIEWED BY ATE- 17 TAX MAP # I• '� _ 2A Y N APPLICATION PERMIT PWS LET ?R OF AUTHORIZATION iN DAT SA HEFT DD ORATE RESOLUTION tAl a T EAF S - THREE SETS ,E PLANS - TWO SETS SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED RATE t REQUIRED -2' 4 DEPTH TAIN DRAIN REOUIRED GENERAL ATED IN NYC WATERSHED CIS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D ifTEST HOLES OBSERVED �S WITNESSED, IF REQ'D ST WETLANDS (TOWN/DEC PERMIT REOT iSATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA 10 YR. FL LEVATION OTHER REQ'D PERMITS) SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: �,'tArt � nGnl t t� a4 ►�t.li Y WELL, SSDS REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZ IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS Z WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS OUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS LAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GUAGES ILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 29D 60 FT MAX. PARALLEL TO CONTOURS 10 o EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 420'TO ' TO P.L., DRIVEWAY, LARGE T FILL FOUNDATION WALLS 15'WEL TO PL 0' TO WELL, 200' IN DLOD, 150' PITS 0' TO STREAM WATERCOURSE LAKE (inc. expan) 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. ,150' GALLEY SYSTEMS '15'min to CDS= >5 %,10'- 4 0/o,25'- 3%,30' - 2%,35' -I %,100' - <I% 20'min to CD discharge /100'with 182 cons day discharge 10' FROM FOUNDATION; 50' TO WELL qj FORM ST -2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS u REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION �pyw � OF OWNE REVIEWED BY DOCUMENTS APPLICATION MIT _ PWS LETTER F AUTHORIZATION ATA SHEET (DDS). TE RESOLUTION � I 'HREE SETS ANS - TWO SETS E REQUEST "7�0 SUBDIVISION SUBDIVISION 'ISION APPROVAL CHECKED PERC RATE 1 VILL REQUIRED S-0 DEPTH CURTAIN DRAIN REQUIRED STANDPIPES /1" GENERAL LQeATED IN NYC WATERSHED PANS SUBMITTED TO DEP 15 LEGATED TO PCHD EP APPROVAL, IF REQ'D TEST HOLES OBSERVED ERCS WITNESSED, IF REQ'D 5X- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) .RATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION L TTER BUZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) �" REQUIRED DETAILS ON PLANS WAGE SYSTEM PLAN - (NORTH ARROW) ,SSDS HYDRAULIC PROFILE_ GRAVITY FLOW NSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS ' CONTOURS EXISTING & PROPOSED RIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS COMMENTS: Y AXMAP# fb0' —I—?— I 0O N CONTROL:HOUSE,WELL, SSDS & HOLES LOCATED E-SENTATIVE OF PRIMARY & EXPANSION cun4xn.r. GRAVITY FLOW SUFF SI PUMPED, PIT & D BOX SHOWN & DETAILED & SSDS'S W/IN 200' HOUSE SETBACK NECESSARY (TIGHT LOT) q9USE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE L DEPTH GUAGES FILL PROFILE & DIMENSIONS IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 1,50 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED i SEPARATION DISTANCES SPECIFIED ON PLAN -FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL ? PD ,, 1j L r 15'WELL TO PL L TO WELL, 200' IN DLOD, DSO PiT . `. TO STREAM WATERCOURSE LAKE INTERMITTENT DRAINAGE COURSE 007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 5'min to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 0/o,35' -I %,100' - <I% 2 ' in to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL FORM ST -2 i RECORD OF TELEPHONE CONVERSATION PUTNAM COUNTY DEPARTMENT OF HEALTH IDivisi ®n of Envir®nmeanal Health Services Facility: 0,-4 01-0 Town: �J j Nv}+�.t yr4urE� Tune: IDate: '3 ► v Telephone # 6-a8-6613 Caller's Name: (DISCUSSION: (O ( jx V SSi S Aex7yfE 7S i �,/ [AizqAL- (NerD 4CC;,.;-kET t L� ,�o,e — YS t o" I i iJ j V ®r e>rtpo t JCf'ifiC. to l' Amy 00. —0 - - Signed: Ag_�� Date:- 2 11 8 Rev. 6/97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS r REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION `�� �� • NAME OF OWNER N1 p C, O REVIEWED BY DATE TAX MAP # 4r•1O "� Z l' / DOCUMENTS Y ,. PERMIT APPLICATION � L, SSDS PERMIT PWS LETTER F AUTHORIZATION iN DATA SHEET (DDS ORATE RESOLUTION T EAF� - THREE SETS XJ- - Two SETS 2 *' u r,,��"• VCE REQUEST 14ti i SUBDIVISION SUBDIVISION ✓.ZSION APPROVAL CHECKED TED IN NYC WATERSHED S SUBMITTED TO DEP GATED TO PCHD A ON AL SSDS PERMIT STANDPIPES SYSTEM PLAN - (NORTH ARROW) )BALLrC L FILE GRAVITY FLOW UCTION NOTES DATA: PERC & DEEP RESULT )URS EXISTING & PROPOSED TAIN OF PRIMARY & EXPANSION GRA_V.iTY FLOW SUFF SIB IF PUMPED, PIT & D BOX SHOWN & DETAILED OF PROPOSED SYS. PROPERTY METES & B HOUSE CK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45' W /CLEANOUT FILL SYSTEMS CLAY BARRIER 1o,I•T. HORIZONTAL;SLOPE O GRADE FILL CER CAT NOTE 'H GUA FILL PROFILE & FILL NOTES mFIfL IN EXPANSION AREA H TRENCHP VIDED FTARALLEONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS ' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 15'WELL TO PL 0' TO WELL, 200' IN DLOD, 150' PITS 100' TO STRE OURSE an) TO CATCH BASIN, 35' STORMDRAIN, PIPED W TER TO' TO WAT INE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 4'f'min to CDS= >5%,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 0/o,100' -<I% P'min to CD discharge /I00'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL FORMST•2 4.0 CONSTRUCTION PERMITS 10 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. A. Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet Beep or Less Construction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) n3. Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) �bu�f jy�Corporate Resolution (if corporate ownership). (Appendix K) 5. Short Environmental Assessment Form. (EAF).(Appendix K) 6. Design Data Sheet. (Appendix K) °� i;vf5l. NOTE: All submitted Department application forms shall contain original �. signatures (no photo copies). 7. 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 (minimum 1 inch to 30 feet horizontal and 1 inch to 10 feet vertical) and shall include, as a minimum, the-- following: Ca >operty survey with metes and bounds descriptions and major physical features. The plan shall m— ake�reference by -note; ofthe survey=source and =.zz, in the case of lots not subject to a filed map, a certif ed copy of a _,,ey. n- shall.be�provrded __ .1 b A datumreferen� ars_tr o be provided (i ems= National, Geodetic Vertical Datum — , =fT 1929, or assumed/other). 11 Zv0 House location with ro osed finished floor and basement elevations P p spe Tied. Plan and profile of the SSTS, to include 100 percent reserve area, construction details of absorption system and components inclu4irg septic tan ' distribution or junction boxes, pump pit, dosing siphon, etc. Location of driveways. f. Location of well or public water main and house service connection. > I tMet- g. Two -foot contours of the property. If ground is to be cut or filled, both r ' and proposed contours must be shown. n of any watercourses, ponds, lakes or wetlands on, or within 200 feet of property. 01!nA0fCsoil curate location�of all-deep_. test holes -and per- colation.test-holes. Omission testing on lots in recently approved subdivisions will be at the discretion of the Department. ocation of all existing wells and SSTS within 200 feet of pro osed SSTS and wells, or a note stating that none exist within 200 feet. itt t. "Tv W IS Sj 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. 1. Location and discharger M. esign criteria on plans and=deep -test hole'-si notes pursuant jf -7-.-& I.VC710 footing, storm and curtain drains—N M_ r of bedrooms, soil percolation Appendix C. opace for Putnam County Health Department approval stamp (minimum 3" 5 ") preferably at the lower right hand portion of the design plan. opocation map (minimum scale of 1" = 2,000'). L 5 " ->x, zz 12 . Erosion control measures for house, well and SSTS. r. 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 mod q of vuw to be used and operational characteristics. One -day's tora e p t ehigh- level alarm within the pump chamber. C a al I . Gate - Union `j - Operat g and ala levels for pump. - Means for pump re oval 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 shall comply with the 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 hoarse. " 8. wo .(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 G Inspector of the local municipality.. Upon approval of the Construction Permit, the house plans will be signed and stain ed: "Approved For Bedroom Count i�t0 �t 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 piessure. L M�- )� 13 I 0. ell Permit Application, if required. (Appendix K) 11. A�Dphcations for Construction P—nit§-fdf-lots ,cre�ted;p—ri-6Eto---f-9-69-=Vill7not be notification of wthe n.1--for constructio w '�''as",:m-'ade "to all - ;property owners `contiguots, to the property; in quest - ioh A location -map; ".,s, properties owner's ---narh' 9x, m apnu e-andA` 77`0bo provided -td.-thd Depdrtffie 'cid§�ftb�dri-y-owner--�-o6-f-a7c*op- Noti r9U 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. Transmittal of this notification should be sent to the contiguous property owners f "j by the�D. esi gPrQf q g 7� 12. Fee - See Appendix I. 1-6. Same as Section 4.0 A. 7. Same as Section 4.0 A., except for d. d. Two separate plans will be req contain the statement: S "IT ) QLI uired; the title box for both plans must rare Des�n,For: -Fill Placement Only" . 14 i. Plan and Profile of Fill Section - Three (3) copies of this plan will be required showing the di,mensi'ons of.the fillpad (ie l nth width 'aid not 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 est ami ed rather than drop or junction boxes should be utilize with its foundation set below frost. the.:fill- pad): -Tlie SSTS reserve area fill is required to be installed at the ti e of primary fill placement. 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 nv�l area. Such design must show that a reserve area of 100 percent can be placed on the lot conforming to all applicable restrictive distances. -744 This plan will be retained for the Department's files for future rA %.0 reference. ,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`ihe 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. 3. Fill must be stabilized in accordance -with fill note #1, located in Appendix C, after which time a second application for a Construction Permit must be made to7the Department and shall include: At q(01(-g12 t J 15 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 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) years old, regardless of whether the same or a new owner is involved. 5.0 CONSTRUCTION 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. tetter of Authorization 2. Construction Permit Application rt LL M, `.,;,:14-164 (2187) —Text 12 PRC!. ECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Ouallty Review SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME, MARGIT PAP. MARGIT PAP 3. PROJECT LOCATION: Municipality TOWN OF PUTNAM VALLEY County PUTNAM 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 421 COVE ROAD 5. IS PROPOSED ACTION: IRNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 7. AMOUNT OF LAND AFFECTED: Initially 0.5146- = acres Ultimately 0.5146 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ❑ lNo If No, describe briefly SIDEYARD SETBACK VARIANCE REQUIRED 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) and permlt/approvals PUTNAM VALLEY ZONING BOARD AND BUILDING DEPARTMENT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes In No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE GIT PAP 2/9/98 Appiicant/spon or name: Date: _ �' PROJECr ARCHITECT Signature: t action rs In the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESS; 'T (To be completed by agency) A. C )ES ACTION EXXC/EK ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate tno review process and use the FULL EAF. ❑ Yes (}d No B. WILL ACTION RECEOORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6 ?. If No, a negative declaration -- may be superseded nother Involved agency. El Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 1AOKI& C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 1 A0r�F_ C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats,.or threatened or endangered species? Explain briefly: IAn1,Ae C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. ' \o C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THE ELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes P<o If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check is box If you have identified one o - more potentially large or significant adverse impacts which MAY oc . Then proceed directly to the FULL EAF andlor prepare a'positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on` attachments as necessary, the reasons supporting this determination: CD Prin pe Name of Responsible Officer 0 Lead Agency Title of Responsible CIffice, LWPftjj5A es nsi le Officer in Lead Agency Signature of Preparer (if different from responsib a icer) 2 Date 2 7aA, Ti, DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 %larch 5, 1998 Joel Greenberg, RA Two -%,Iuscoot No. RFD2 Mahopac NY 10541 Re: Pap Septic, 421 Cove Road T�1r 41.10 -1 -21 (T) Putnam Valley Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director This office has conducted a second review of the FilliSeptic Design Plans for the above referenced project. Plans received February 12, 1998. This review is in response to letters sent January 30th, February 17th and February 19, 1998; and additional field inspection March 3, 1998; respectfully. 1. Please clarify elevation of Curtain Drain on detail and elev o day light out flow. Drainage at north side of building appears to be by means of a footing and leader drain. Please clarify and label on plan. Grading on north side of building is not clear, please clarify. Distribution box and related piping appears to be within 100 foot separation of well. As defined distribution box and piping is part of system - therefore t also must be outside the 100 foot separation buffer. Please show means of piping from tank to fields- also show method of protection under drivewa , wi „v� r6' House plans show stairs up down; this indicates other floors, please clarify. Pursuant to (T) Putnam Valley wetlands ordinance please show 50 feet boundary `Buffer- on plan, of Roaring Brook Lake. This office has received your letter of request for a variance hearing for the below mentioned: * Variance from 15 feet setback requirement from property line to well. * Variance from 100% reserve area required. ..: 1� Letter to Joel Greenberg - Re: Pap Septic, 421 Cove Road -2- A hearin, date will be scheduled when above comments have been addressed and plans are closer to approval. This office IVIVzll be continuing its review on this project. Please feel free to contact the sender of this letter if any questions arise. ABS:tn Very truly yours, Adam B. Stiebeling Asst. Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 March 5, 1998 Joel Greenberg, RA Two Muscoot No. RFD2 Mahopac NY. 10541 Re: Pap Septic, 421 Cove Road TM# 41.10 -1 -21 (T) Putnam Valley Dear Mr. Greenberg: WS 1--I L rf— BRUCE R. FOLEY Public Health Director This office has conducted a second review of the Fill /Septic Design Plans for the above referenced project. Plans received February 12, 1998. This review is in response to letters sent January 30th, February 17th and February 19, 1998; and additional field inspection March'), 1998; respectfully. 1. Please clarify elevation of Curtain Drain on detail and elevation of day light out flow. 2. Drainage at north side of building appears to be by means of a footing and leader drain. Please clarify and label on plan. 3. Grading on north side of building is not clear, please clarify. 4. Distribution box and related piping appears to be within 100 foot separation of well. As defined distribution box and piping is part of system - therefore it also must be outside the 100 foot separation buffer. 5. Please show means of piping from tank to fields; also show method of protection under driveway, with details. 6. House plans show stairs up /down; this indicates other floors, please clarify. 7. Pursuant to (T) Putnam Valley wetlands ordinance please show 50 feet boundary "Buffer" on plan, of Roaring Brook Lake. This office has received your letter of request for a variance hearing for the below mentioned: * Variance from 15 feet setback requirement from property line to well. * Variance from 10.0% reserve area required. Letter to Joel Greenberg - Re: Pap Septic, 421 Cove Road -2- A hearing date will be scheduled when above comments have been addressed and plans are closer to approval. This office will be continuing its review on this project. Please feel free to contact the sender of this letter if any questions arise. ABS:tn x: Very truly yours, Adam B.. Stiebeling Asst. Public Health Engineer e CIO 10512 ichardsville 19 KENT i I ahnestock I y o5 State i abet o I �UTNAM VALLEY P "W 10579 o,;o:, ee, � r j O W' Pudding Street g ioI"A0 ulbple Use Q � o,,�' o Area e4 Calilomia Hill I Multiple Use Area /h!4UA RD ir e °• t ADAM M'A. 10541. . 9;r G H FOR ADJOINING AREA SEE MAP NO.6 Sheet l of� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAMF• m ibCl i,.A,( -rbi-( Tel: ADDRESS: �� CO�IrG 1 /Jrt�iifcv+� �✓�c+rtz�/ �� D� Street Town State Zip PERSON IN CHARGE e % ()R TNTF.RVTFNVF.T): ��'�_ 'J �7 �L�►�i.�r- 1 DAtP: Name and Title TYPE OF FACILITY: FINDINGS: tick _ U"�� �Li�� ?�t'� �GtL- I,�i�✓�L��� l�S� %� � t�2S ( /l-��tCtti T p --1 "ice - T "c e- , - - -- oC- Eco - . m;,:zsx .:,�nw. , a� ��., smcxxruA ,ss•mrm�rvawrn�Hw�wasu�.+: ramauoxmn�t.?scc:rnAw:nrdae!sc .mra:m:er�:r -: , °n= svxew. ��nezntiewo��ramiueetvaus�urwe: �Yn�KC• arsmrrsmxwxr .�:�racesmr:�a�+.rrna Signature and Title v REPORT RECEIVED TAY.' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev, DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 February 19, 1998 Joel L. Greenberg 2 Muscoot Road North Mahopac NY 10541 Re: Margit Pap TM# 41.10 -21 (T) Putnam Valley Dear Mr. Greenberg: BRUCE R. FOLEY Public Health Director This office has received your letter of February 12, 1998 for the above mentioned project. At this time prior to scheduling a Variance Review Meeting, we would like to witness additional Deep Test Holes on the site. A site inspection would show holes previously dug with standing water in them, as per our conversation. Please call to schedule Deep Test appointment. 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 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 February 17, 1998 Joel L. Greenberg Muscoot Road North Mahopac NY 10541 Re: Margit Pap TM41 41.10 -1 -21 (T) Putnam Valley Dear Mr. Greenberg: Please find enclosed applications for SSTS and Well. Please fill out and resubmit. BRUCE R. FOLEY Public Health Director This office is continuing its review of the above mentioned project. Please feel free to contact us if any questions arise. Very truly yours, C � . �� Adam B. Stiebeling Asst. Public Health Engineer ABS:tn RECORD OF TELEPHONE CONVERSATION PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility:�: d w �a, Town: r Time: Date: Telephone # Caller's Name: J ° la H �-�! �(,-� +� 5 DISCUSSION: l++ oor f 5 !Z r 1 I-07SV --C;V1 Signed: Date: Rev. 6/97 BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: A I1 XZG. +T ADDRESS: �l S��Srl:i �2Ly�E �rR2�1saT ( c'9 SITE LOCATION: �Zt Cow DATE: STAFF PRESENT: F A rj� SPECIFIC WAIVERO REQUEST: �O (o � S1C+4 F- STS `" Q t'c,Si%w -nv� �i5rwn+�►� O ;1u S5 1 ?1 d r- Flu, - DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD ORE IRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIG FICANT HARDSHIP? YES NO DISCUSSION �t >c."r 5-,-A 0;-e O /` i ,N�kD r n rCS L3 6CA_1 l,�VJSLI U 4�� O rr SS f `> { + S� ►2�la.1�or� REQUEST APPROVED OR DENIED 'APPROVED , DENIED REASON FOq.DENIAL DIRECTOR OF PUBLIC HEALTH DATE: PUTNI'"T COUNTY DEPARTMENT C "IALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # / 4 Well Location: Street Address: Town/Village Tax Grid # 421 COVE ROAD PUTNAM VALLEY Ma01 .10 Block 1 Lot(s) 21 Well Owner: Name: Address: MARGIT PAP 1111 SUNSET DRIVE, SARASOTA, FLORIDA 33577 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary . Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 30gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling �— New Supply (new dwelling) Deepen Existing Well Detailed Reason NEW HOUSE for Drilling Well Type Drilled X Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision ROARING BROOK LAKE Lot No. 454 Water Well Contractor: NORMAN ANDERSON AddressBARGER sT,., PUTNAM VALLEY, N.Y. 10 Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: N/A own/Village Distance to property from nearest water main: Proposed well location & sources of contami ation to a provi ed n separate sh et/plan. Date: 2/9/98 Applicant Signature.: PERMIT TO C UNST U A WATER WELL This permit to construct one water well as set ve, is granted under provision if 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 w well driller certified by Putnam County. well Date of Issue t4 2 kv, Permit I' g O icial: Date of Expiration 6 n Title: t" Permit is Non- Transfe'rradle White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 X79 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Community Sanitation and Food Protection Specific Waiver from Requirements of Part 75 and Appendix 75 -A, 90NYCRR for Individual Household Sewage Treatment Systems Name of Applicant 'rA ? A ft(, t -r— _ No. Street ^� City/Town State Tip Address (� S i`��vivi'" Vr i26gSm T- '33S77 No. Street City/Town State 4p Site Location z ( Co V& D�n 1. Reason why site es not meet 10NYCRR Appendix 75 A ( heck apQropriate box(es)): Separation distance cannot be achieved. Excessive slope. r �m 'Z sMiC-n.rn High groundwater. �� `rV _ Inadequate depth to bedrock or impermeable layer. So' nsuitable. Other explain . ( P ) A1( v :n,,o fcyv l� �X�5«,rdf ..........1..,o ..........`..... ..., ........................................................................................................................ ............................... ............ ..c.> ? .........� o- �...........l�S `r.C,��° . �{........ �/� r .vc ?. .......��....................... ...� ...:! ° u,�e c�..... W....... ................................... ..........................trl.` o........ .!t .s.�.a. t..........ar......... . . r:......................................................................... ............................... 2. Proposed design or conditions of waiver: ......- ...... ........................................................................................................................-..............................................................................................'-- ............. tGi!! .......I S..it......�. ".�!rl ........ .......Q..l ......... C--'....5...........�/`' ..�r. .......j .! f .. r.... ............................... ................Srwlcfi......... ��Y.. r�.......Rv�.Y- ...... E.......�. s.p. ......ii�........1 G.!. k. aN .:.±, .......................... 9 ......_�.ctz.....�L . Y .,.....L!�c�!,±arCL•..l_....... EG..F ....... 2, 2r�sr �r. cn•rrc.a ....................... . . .. . . ... . . . . . ..... . . . . . . . . .. . ... . . . .. . .... . ... . .......... . .. . . . . . . . . . ... ......... . .. . .. ... ..... .. . . . . ........ . .. ... .. .... . ... . .. . . . . . . . . .. . .... .. .. . . .. . . . ............ . . . . . . ....... . . . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ................................................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. ...... ............................................................................ ............................... REPRESENTATIVE OF COMMISSIONER OF HEALTH ORIGINAL - Local Health Agency COPY - Applicant /Design Professional .................................................................................. ............................... DATE DOH -1326 (7/92) (GEN -152) i - i� 1 REENBERG ARCHITECT 2 MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 (914) 628 -6613 FAX (914) 628 -2807 February 12, 1998 Adam Stiebeling, Asst. Public Health Engineer Putnam County Department of Health Terravest Park Geneva Road Brewster, New York 10509 Re: Margit Pap 421 Cove Road Roaring Brook Lot #454 Town of Putnam Valley T.M. # 41.10 -1 -21 Dear Mr. Stiebeling, As per our conversation, enclosed please find four sets of revised plans for the sewage disposal system and well for the above mentioned lot. Please note the following: 1. I respectfully request a variance from the well setback requirement of 15'. While the proposed well is 35' from Cove Road, it is only 5' from the northerly property line. This is required in order for us to provide the required 100' separation between the well and the septic area that meets the requirements. 2. The expansion area shown is 50% instead of the present requirement of 100% due to the fact that the lots in this subdivision were approved by the New York State Health Department in the late 1940's when only a 50% expansion was required. 3. The existing culvert pipe under Lakeshore Road is pitched in a westerly direction away from our proposed septic system, while the direction of flow for our septic system is in an easterly direction. Thanking you in advance for your interest and cooperation. Please call me if you have an questions. trul II-E, r - 2 MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 (914) 628 -6613 FAX (914) 628.2807 February 12, 1998 Adam Stiebeling, Asst. Public Health Engineer Putnam County Department of Health Terravest Park Geneva Road Brewster, New York 10509 Re: Margit Pap 421 Cove Road Roaring Brook Lot #454 Town of Putnam Valley T.M. # 41.10 -1 -21 Dear Mr. Stiebeling, v ?, As per our conversation, enclosed please find four sets of revised plans for the sewage disposal system and well for the above mentioned lot. Please note the following: 1. I respectfully request a variance from the well setback requirement of 15'. While the proposed well is 35' from Cove Road, it is only 5' from the northerly property line. This is required in order for us to provide the required 100' separation between the well and the septic area that meets the requirements. 2. The expansion area shown is 50% instead of the present requirement of 100% due to the fact that the lots in this subdivision were approved by the New York State Health Department in the late 1940's when only a 50% expansion was required. 3. , The existing culvert pipe under Lakeshore Road is pitched in a westerly direction away from our proposed septic system, while the direction of flow for our septic system is in an easterly direction. Thanking you in advance for your interest and cooperation. Please call me if you have any questions. trul)( yours, U DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 January 30, 1998 Mr. Joel L. Greenberg Architect Two Moscoot Road North Mahopac NY 10541 Re: Ruvolo Septic 421 Cove Road Roaring Brook SD Lot #454 (T) Putnam Valley Dear Mr. Greenberg: >Cc. h•= L cif ?�'?�.r 2. Plans: Note: referencing source of survey; to include Datum Reference BRUCE R. FOLEY Public Health Director . ?, - -�IGv lei 3t SI 96 — This office has received and reviewed the most recent plans ,for the above mentioned project and would like to offer the following comments for your consideration. 1. Applications: Notation of fill section required; including depth and width on Application CP -97, for SSTS construction. B) Application for Approval of Plans for a Waste Water Treatment System (Form PC -97) required. 11 � Short Environmental Assessment Form (EAF) required. — 3&-r L AN0 T4`I*c*r04rP JK SSTS Design Data Sheet (DD -97). V(a�Z11ei��tffC N�Aati�D C--C> (c —t���0 ?tire A*IZ- C t, 04v i' `( Or C(> �eTy- 2. Plans: Note: referencing source of survey; to include Datum Reference of Elevation. Locations of well from property line. Minimum distance from property line is 15 ft. Accurate locations of the Deep Test Holes and Percolation Test to be shown. D�Holes Please locate well and septic of lot to southwest (Lot #455) and West (acrossed street) or provide note stating "no well on septic within 200 ft." Curtain Drain appears to drain into footing drain. Please clarify. V(a�Z11ei��tffC N�Aati�D C--C> (c —t���0 ?tire A*IZ- C t, 04v i' `( Or C(> Jllr "" Mr. Greenberg - Re: Ruvolo Septic -2- Please show detail of Curtain Drain on detail sheet. Please also clari dr i a fl North side of house. ® `® F) Please provide design criteria—, -Deep Test Soil information, and YOJ 3>o size of SSTS components, (i.e., septic tank). Plans states 1000 _ry gallon tank, details refer to 1250 gallon tank. Please clarify. Co , Please provide construction notes pursuant to Appendix C. (Putnam County Health Department Bulletin ST -19). Please provide space for Putnam County Health Department approval stamp. Please provide location map of project area. J) Please clarify house plans: Plan show stairs to second floor, if so; please provide plan of entire house, including basement. A well construction permit needs to be submitted. Please provide notification of application for construction to all property owners contiguous to the property in question. Please also submit to this office a location map showing the contiguous properties along with property owners name and tax p number. Fill plan for lot requiring fill greater than two (2) feet should be on a separate plan(s). As defined in Putnam County Health Department Bulletin ST -19 section #4.B. Please also note required "fill placement" n tion sta e�ment. N) e o equa istri ution oxes than junction boxes, when "fill" sections are proposed This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact us if any questions arise. ABS:tn Very truly yours, Adam B. Stiebeling Asst. Public Health Engineer r U 1 IN AA1 U U iV T X DEPARTMENT OF HEALTH DIVISION Of NVIRONMENTAE HEAD AM SERVICES r DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT SYSTEM Owner MARGIT PAP Address 111 SUNSET DRIVE,SARASOTA, FLORIDA 33577 Located at (Street) COVE ROAD Tax Map 41.10 Block 1 Lot 21 (indicate nearest cross street) Municipality TM OF Bumm vA= Drainage Basin HODSON RTVER Date of Pre- soakin 1 /ii /n ^ Post-It- brand fax nsmittal memo "i'6Yt 0 pages goo To sm GO. c4 :st percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 minlinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date June 3, 1985 Re: Property of Margit Pap Located at Intersection Cove Road & Lake Shore Drive (T) 12 Section - - - - - -- Block 1 Lot 16 Subdivision of Roaring Brook Lake (4th Map) Subdv. Lot # Gentlemen: Filed Map # Date This letter is to authorize Joel L. Greenberg a duly licensed professional engineer or registered architect xxx (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 this matter and toj supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law ./ tary Code. Countersigned: P.E., R.A., i.c Health Law, and the Putnam County Sani- Muscoot No.,RFD #2,Bx 488 Address Mahopac,NY 10541 628 -6613 Telephone Very truly yours, Signed C /' Owner of Property 421 Cove Road Address Putnam Valley,NY 10579 Town 528 -6515 Telephone GREENBERG Architect TWO MUSCOOT ROAD NORTH MAHOPAC, NEW YORK 10541 914 628 -6613 FAX 628 -2807 10/27/97 PUTNAM COUNTY DEPT. OF HEALTH GENEVA ROAD BREWSTER, NEW YORK 10509 BILL HEDGES RUVOLO 0 PRINTS ❑ SPECIFICATIONS ❑ SHOP DWGS [] SAMPLES ❑ OTHER ZI APPROVAL ❑ YOUR USE 0 REVIEW Q COMMENTS COMMENTS: ENCLOSED PLEASE FIND SUBMISSION FOR RUVOLO. I AM MEETING WITH THE ZONING BOARD ON THURSDAY EVENING TO REQUEST A VARIANCE. THE BOARD WOULD LIKE TO SEE THE SEPTIC SYSTEM APPROVED AT THAT TIME. I WOULD APPRECIATE ANY ASSISTANCE YOU CAN GIVE ME. FROM J0/-Lj GR&N' eC-RG COPIES TO: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT( o-0 i -Q Well Location a Street Addr �j _ wn/Village Tax Grid # Map q1,10 Block I Lot(s) o I Well Owner: Address: Use of Well: 1- primary 2- secondary _>:� Resi tial Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _>�, Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing � Open hole in bedrock Other Casing Details Total length Length below grade 8. Diameter in. Weight per foot lb /ft. Materials: _2<_ Steel Plastic Other Joints: _ Welded ,<_ Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes ,>< No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped is' Compressed Air Hours Yield S'" gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing TWell Formation Description/ ft. ft. Land Surface -4 O ' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type-Sillbm Capacity A OJOL Depth Model GAUfdS Voltage ?.ZO HP Tank Type t3/t Volume �1k' r'�'''`S> Date Well Completed A Putnam County Certification No. Date of Report 7 417o Well Driller (signature) • NTE: 1�act location of well with distances to at least two permanegf landgiarks tb be provided on a separate sheet/plan. A,6,, 1 1 Well Driller's Name C Address: I Signature: s(�,,,.,,,�_- Date: J' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 9,Ap. less coves ep P ,dTm io &4. L)ALL r. Y, At Y. JOEL LAWRENCE GREENBERG ARCHITECT - TOWN PLANNER RR # Z MUSCOOT NORTH :1 MAHOPAC, NEW. YORK 105417' (914) 628-&&13✓-" 1. tl"��' 0 s8 5 " 6 bat a g8 w 3 p 0 r' B peO .0 n , 19 f�k .� r/k R�� b� ¢a .11 O a i 8 20 $ ;9 4 /rT1A I R :7 2 I a ¢ I4 8 p 23 '•gym -�. �``iSro •., tto I �f• ''t� m 27 k IAII -4) y s I $I a �I 26 FOR ASSESSMENT PURPOSES OKY N07 TO BE USED FOR CONVEYANCES JAMES W. SEWALL COMPANY 147 CENTER STREET, OLD TOWN, MAINE � e'• 0 29 T ` 29 '\ ROAD � m . /l� P/0 41.14-11,20' - P/041.14- 1 -19--/ - -- - -' ............... {y o a e E 8 \ IT a 5 5 s \ \ 14 g O ;3 $ i \ 1 ! 19 ` ,o 12 i —"•F a N l 9 1 � 1 a 1 l L NI P/0 11.11-1.39 sun uK 1 s11 , OlYlll lIK (p01� —_— PREL p TOWN OF PU PUTNAM COU' YllaK IIK ---- 1IItr'd 1001IY11 _ — — ,al.� Avglt lIK Nid wl amKl In uli _ _ _ 7M1 W w &!0!C- JAL / 37 a � 65 ' 04 /l- /P 41\ LEGEM) 41.06 41.07 PREL p TOWN OF PU PUTNAM COU' 41.09 41.11 41.14 41.15 A 1 W 0 v - _ —�ry rc N catch basin Z 01 CT N O_ i 'A y d t J" SURVEY REFERENCE AS BUILT SURVEY PREPARED BY BAXTER LAND SURVEYING; P.C., N.Y. STATE LICENSED LAND SURVEYOR NO. 49434, DATED AUGUST 16, 2004. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM HAS BEEN CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT I INSPECTED THE SYSTEM BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND a •S 4806'00" E 11.00' " Q S �j ro-°os c^ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. 644"t sl'j- I -4 APPROVED AS NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE P NAM COUNTY HEALTH DEPARTMENT. iNURE TTL A :i ,y4 .. � rra] 'eaufpl STN YS TY]i CL TTY N'I SY � Y9 p1Y1 AlfM1.V�fC Q �'•i v \ � \\ &� tYv1Gt h1 +11q ]0 ,Tld > w HJf3 ul i,Y15 SIYI! 31 T4 3L' !�! t1V1 usxlel car. ;n » s?«Y_ rr! nt;l] ,f TYV NI nwuv xr,�a zt Tma s.-r.: £ 4: CPM O.Y 'S3G1; )4) � 1.'LIHIL V ,1� Jl: NI FXt3&3 ?!'MS Y 1,^(i •Z Vl _ 1 `V 'STN lAZSrt[Y 3LL 'NIL'NV A:nq;: CJ „' � `Q Nc, rca Y nl c.r enym � In w 9p 6 Y » xt ]c n aw ]q r. ss cn:? •i � �V `� ° ° O � � �L,fim2]AbY'QliifGY> wl tL! IAI ' i ^� `�) [n V 1 �Tlsut� _l EOttix]N ,]]ti'SYiq]Yi `r1 • rrotaoi Yv s]an. cn+v oaw i ! rt o- •d •�. ® , •` ' 1. S. nb-7.. �5,:!atYLS- Q1,".'TI:o771� 7S.= .�7_Y_7:G1'::N ®/J/ I. MfT- Y,., Yt: w!]],�Yi....•::,.� „�:c:`;, °h`Y� r^ �f: "� � � � ,_,1� i I�gS vMc on10036 � 4 S6/ TS o `�3 S 901 N BGI �40 I QjJ ,J� O Zoe i RZ I •i. i. ice/ �- / l •Sfp� � 001 � I �~ � .. ..- � � IL � 4 . / p p 5.61 11L o 6 10 �c5`l' 2 Di r�� „vin ®tx®c, - -- ®1� wN/ r} k IQ �N sough catch cu /�r�t basln zq, y,. wtres _ g, pole O �o t cable N 7279 00 " -W S N. fit- OS.ip• S 4806100" E ✓� 90.0" 11.00' ` y� S 274700" W I s\ 6.70' PJ e 'Oa's 100, WrnANDS BUFFER �\ Q to LOT 454 00 AREA = 22,415 SO. FT. o ( 0.5146 Acre) S 100000" E 11.40' g O S 740100" W �� \ 11.40' mason stone let. wall Hrogulor rubble retoining wall 206.70' S 77.3'00 9.5.3' LOT 4SS - - - - -- - PUTNAM COUNTY DEPARTMENT . OF HEALTH .: 6%V %SIOn of Environmental Health SewiceS; Cerme! N. Y. 10512 .` CONSTRUG ON PERMIT ,FDR SEWAGE- :DISPOSAL SYSTEM" >. pu.tnam Va1:1ey F Town or vil lage. '' Locatetl at ` 'C6Ve Road Tax Map 2 'Block 16 Lo : 1 1. Subdivision ROatj n Rr,p� ' subd.- LOt N QGj Q. ' Renewal �,Q _ Revision _❑ - MAr( Pap 421 Cove - Rd Put -: Vd11'ey NY . Owner /Address + DateOf Previous Approval - One Fam Re'so 0 5146AC `10579 Building Type Lot Area Fi11- Section On. y (] Number of Bedrooms- 3 :Design Flow_•G /P/D 000 � P.C. H D - ROtificafion Required Separete.Sewera9e'System to•cons�st of.., lboo Gal Septw Tank and- - -128L :of .Pkecast.:..Conc Tri— Callers, To be' constructed by ' onald Forentino Lake :Shone Rd ; West, Put.. Val o Address -Water Supply: Public Supply From XXX Private Supply ;to be -d r' by .: Norman :Anderson i- Barger..5treet, Putnam Valley; NY 1Q579 •' Address .Other Requirements • 8FT: :deep= Curtain Drain, & ;,3FT Bank Ruh- 1 represent that I am wholly and completely responsible for the design and location of, the proposed s-_ M'(s);-1). that the separate` sewage disposal system above described -will, be con as shown on --the approved amendment there to and in accordance with th`..: standards, rules an_ regulations o e 'Putnam . County Depart Merit ,• of" Health,and thaton completion thereof a 'Certificate of Constru' ','satisfactory' to'the commissioner of Healthwill be. submitted to the' Department; and awr�tten, guarantee will befurnahed the own ��e �so%a;� r assigns by :the uid:DUilder, will place.In good operating condition any part oL'said sewage tl�sposal system durin IQf' _ immediately following the date of the isw ._. _ . once of the a g', pproval, >of,. the • Certificate ;.of.Construction'Compliance of.the' or i r any r to;2);that the drilled well described above will be located as shown on the approved glen and that said welt will be install in'' a w st rules and regulations of •.fhe 'Putnam ?: County Department of Health Date June 24 r 1985 xkk Signed P.E: R A. Museoo;t Nq.., RFD#2, , - a ® 1 license Noi 11056 '. Address t� APPROVED FOR CONSTRUCTION: This. approval expires one year from the at 1Y. d unless ` o 'structi t building has been undertaken -and is revocable for eause,or may be.amended.or modified when Considered _neces by t ssio r: FQf Any change teration. of .constructlor. requires a new permit. Approved for disposal'of domesti sane, y sewage; and f Date BY Title Rev _o_ni ! h, ..c8fdd0 you .o .o ......o. a... �. -w. j � . !Attach this form to the front of the mailpiece, or on the back+ , f, 'm 4 permit ■ Write Rerum Receipt Requested' on the mailpiece below, thi ■The Retum Reddo will, show to whom the artide was detive r delivered: � 3. P. ' ;:N ;MORRIS,. GEORGE & JEANNE 'E 117 LAKE SHORE DRIVE o , � PD.T'NAM VALLEY, N.Y. 10579._ c L I� 717 "7 o00 ends if space permits. Otherwise, affix to back of article. Endorse front of article RETURN RECEIPT ' o . REQUESTED adjacent to the number. in 5 Received By (Pnnf Name) ,. 1. LU '` ..' {t•r• �+ S�yl/gnatur ( res§ee, or Ager3tJ v d 5. Enter fees for the services requested in the appropriate spaces on the front of, this receipt. tf 0 u PS;Fo 3 1k1 December 1994 JI J t r Lalso wish to receide the , ,; ff followtngsernces (for an ;, a extra fee):. A D Addressee's Address € � 2 ❑ Restncted'beilve - Consult postmaster for fee , - Nu b m STH;r, POSTAGE STAMPS TO ARTICLE TO. COVER FIRST CLASS POSTAGE, v CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES (see front). '+ 71 7 iJ 1. If you want this,. receipt postmarked, stick the gummed stub to the right of the return address io leaving the eceipi artached and present the article at a post'bffice service, window orhand it to ;:N your rural carrier (nog extra charge).. 2. If you do'not want this receipt- postmarked, stick the gummed stub to the right of the return address of the article;,date, detach and retain the receipt, and mail the article 3. If you want a return'receipt, write the certified mail number and your name and:address ad:a c L return receipf'•card, Form 3811, and attach it to the front of the article by means of the gummed o00 ends if space permits. Otherwise, affix to back of article. Endorse front of article RETURN RECEIPT ' o . REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or. to an authorized agent of, the addressee, 'CO endorse RESTRICTED DELIVERY on the front of the article. d 5. Enter fees for the services requested in the appropriate spaces on the front of, this receipt. tf 0 u t return receipt is requested, check the applicable blocks in item 1 of Form 3811.. d 6. Save this receipt and present it if you make inquiry.- ` ' 165603 -93. 13.0218 3x v '+ 71 7 iJ o D- o o! m( e aLr 3 : C() go G]��. !t c L o00 o . th CL ;. d a i o -< HC tzi ._ v Z. G),� 3 3 c•r m o 4 s your R RETURN A ADDRESS'completed o on t the reverse sides ' `1 o00 o . mym��m a r3 rn'-' G)i B ._ v G),� 3 3 c•r m o L7, _W vy .]' � �. a W O A �,fD r r 0 0 3, � � 2 2 L L:. f f o t c } a 0 cD. v vi 3 3..s �_ ' }�• m m a, F C H ? C) i ,{ C C , ,CD m t3] 9 C ..... , Cr IN O i w w° o5 c m > as v 91 'f g m n' s a,a w w r r,m m m y' r rt7'm y y .m m w wZ m J 0. a'.Q �.. .o m, C .. N CO -, 0 ❑ m�f S110- �. N ..,H -..a.," m O . A -� m .� m m g• ��: CCD y 0 m m .n m. 1 v,.a.. ? y. Q .m a .. ... Tharik vou,for, using:Return Receipt.Service. _ i •`� `\i. lJ Jy�A �' SENDER `�/ slap fp �lj! §oo ■Complete items t and/or -2 for additional senrices - I also`wish to receive the. rn m late items 3 4a and 4b Come i sae d ■Print your name and address on the reverse of thisrfomi so that we can return this .f0110W1n j S8NIC8Sx(for.an s6eisod lb v4 Q card to you > eX_ tra fee)'.., sa, pb s aassa, 101 " > ■Attach this form to the front of the maiipiece or on the bads if space does not v woyNl..o1 6w,HO4S dP �a ❑e 'abed fF ,` pe'mut : ;1 ❑Add_ ressee s Address t paiani+ap'a�e a wnraa d :Write Rerum Becsrpt Requested .on the mailpiet e.below the article number d.; d , iuoy yt o °� $ The Rat m:Receipt wtil show to whom the artide was delivered end the dale': 2 ❑ ReStncted Delivery y i - Bwnao4S.ldiaoe" deliver z . a ° "''aa o Consult postmaster #or fee i aaj �,a� a b 3 �►rtC1 Addressed to ~ 4a Article Nti PalJUISO d + um ---�� g get 'II I.1 mT ¢ i ANEW R: r�:I;LE 4b Service Type.'.'.: �y aad pawli, N '... N" Y . log 0 ❑Registered ' ` ` B'Certlfied F W.` ._. r, ❑ Express Mail sured. aee1SO ❑ _ In d. ® Gas ; ❑ Return: Recel t for Merchandise P ❑ COD -apps d1Z pug alerS..�.� 7 Date of Delivery E o ._t cc cc V y q/ $ got 5 Receroed By (PnntName) 8 Addressee's'Address'(On /y! /requested And -foe is paid) Q�rU� r1�W2I�J >I ( 6 Signature ddr ee rA +nt) �' x / S.T.NJ'Q�IVNQ S ?'TLH. r t #t �� V BBe� 1Qi s�'W�r�l PS Form 811, Decemb 1994 7 7-77 �® es fleturn Receipt u LE fi d :SENDER 1 t " I also wish tip'recci�rvo ■Complete items 1 and/or 2 for�adddional aernce`s fn - - - -- _ late Hems 3 4aand 4b f following services (for art your name andkaddresa =on the reverse of�his form so that we can "return this, extra fee) ; t to "you iece or on the back if space does not t ❑Addressee's Address Z �Ch this form to the front of the mailp Q N i. / m x IkitRetum Receipt Requested on the m' it iece below the artrde number 2 ❑Restricted Delivery �Relum Receipt will show to whom "the silica was delivered and the date N Consult postmaster for fee' 3 bred d a 4a Artcle. Numb tjC • N �' seed �, f 4b Service Type =� ssaipPV'PUe 81eQ ,COVE 'ROAD Certifiedf [j Registered Dunn 'd10oali wntad NAA1 VALLEY, N ..Y : 1 0 5 7 9 ot'6wrnoUS ❑ Ir1SUred ate0`9 wounn of ❑ Express Mail Xa! aranila0 ` 7 P, 6uiMO4S tdiaoeFi wmeN, Returri,ReoeiptfoI:Merchandise ❑COD w , atoutsa . Date of tea.' -ti ' ived By (Pnnt Name) �, ' 6: ddressee s Address (Only ff requested rid fee fs paid)` 5a ' ttur (Ad ass * r ent)' r Ica 1 aBe} _ e • � I 81 #1,De e� r 0941V- A. – lC dSEFIDER: ( )13. �; ZZSHOO�i Ifi3I�I f ; o ■cdmplete gems 1 and%