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HomeMy WebLinkAbout2365DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.14 -1 -49 BOX 20 02365 10 PUTNAM COUNTY DEPARTMENT OF HEALTH 'IV .,.,_ - ._.:::DIVISION: OE: EN R.ONMENTA.L -HEAL:TH iSERV10ES:- -_.Z,_._1 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT # Pv- f- 9 r %-1C -03 Located at''A-1245(i T U S 64ANt Town or Village ,�(/�/�/� y4a, � y Owner /Applicant Name l))1§E/y Ad,D,eloe7 j% ,6s Tax Map 41-14 Block �_ Lot Formerly Mailing Address Subdivision Name uz,� Subd. Lot # /3s- 71VA 'I U Zip I S Date Construction Permit Issued by PCHD 1 - Separate Sewerage System built by -J-n ill I LSD Address % 'G �- lV %` Mq1 L Consisting of lQQ 0 Gallon Septic Tank and 2 2..cP L-r- ZF? Other Requirements:_ Water Supply: Public Supply From. Address, or: Private Supply Drilled by AP O z O /*1% Address A11-✓A -1 U14 aL , Building Type-WW- Has erosion control been completed? qe, , Number of Bedrooms Has garbage grinder been installed? 00 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulation of the utnam County Department of Health. Date: 1 7--01 Certified by �&I P.E. X R.A. i C c �M n n ( sign pEo 2 sio �) i A I License #-1-3707 Address > '� /�'(J /1 J / �/ / 4 5b3 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat' n, modificatio r change is neces By: Title: c Date: White copy - HD ile; N61ow opy - Building Inspector; Pink copy - ner; range copy - Design Professional Form CC -97 RUCE Vic Health Director. LORETTA MOLINAM RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, . New York 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 WIC (914)278-6678 Fax (914) 279-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6649 - - - 1 1 . - -- =4 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: !I ei) P-o Dp- i c7 V S AUTHORIZED TOWN OFFICIAL: (Signature). DATE: 4 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official: This form is to be submitted with the application for a Certificate of Construction Compliance. (139 11 VERFM V i d 4 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official: This form is to be submitted with the application for a Certificate of Construction Compliance. (139 11 VERFM V �i ;J o try a CD o� _O V c O CO ° ° '!'4 V" CL c. CO ZD O Y' a + r a N � CL �a' y I C, .. 5661, Ludd'008£'tw04'Sd , L Q.. Ul V— CL Lu Lu t ti? Ln Q d rn Y LL Li ca �``Alv m O a, 11 m O Q. y t 7 m •, '& X 10 C, yo`d.y LL o a. d r.. it( f 5661, Ludt' `008£ wJbzl Sd "I :r �r e i. SENDER *, ° !�r x I also wish to receive the follow W ;, ❑Complete items, t en dlor�,for.addaonal sernces .-- _ 5 ,; ' •,•ing seNioes (for an extra fee) r m . Complete items 3; 4a r y p Print.your name and address on the reverse of tins form s�o thapwe can return this at_ ; d card -to you F .:1 0 Addressee's, Address m ❑Attach this form to Welton-, of the mallpiece or on the back d space does knot ` perms .2. ❑ Restricted Delivery N , i p Write 'Retum Receipt`Requested on 44e rm tlpteoe below the article number .• •t . ; "❑ The'Retum Repeipt will show to whom, the erode was deliveredfand the date �! a delrverad m ° 4a Aiticle Number m' 3 rticle Addressed y / W. d G 1 ° f a 4b Service Type m' o a x. s ertrfied `�` adsExpress Mail � F' ❑Insured r 7 Date of Delivt former ha pS7 . ndise I COD I y.. 8 Addressee s Address (Only tf requested and 5 Received By "(Rent rrie) All r fee`ts paid) ` t 7. ur e s e nr .b� y - r 4hn� to e-o223 Domestic Return Receipt' T tr s. 'pr :SE ER ■Compete items •t and/or 2 for addition servir es. ?f. I also wish to,` "receive'the ■Complete items 3 4a and gib following services (for an 1 ,' ■Print your name and address on the reverse of this Conn so that trre oan tMe eXtfa ,f88) � w card to,yyoou ' ■Attach'thia form to the front of the meilpiece or on the bade if apacetwt f 1 Addressee S Address Z dam: pat( nit;':, a ,, _' to . ■ Write'Retum Receipt Requested on ilia mailpiece belovr the amide n er 2 ". rReSttiCted D8livery + : ••,, ■Ttie.ReWm Receipt will sftw to wliom,ihe artidewas deWered and tti ate t delivered Consult posirriaster for fee 3 Article Add ed to,,,' M � Article'Number , �U 3 r b` ervice Type { f t i GUs9 j �W R"" egistered ❑ cerflfied,k i Y4 IV. (Ps P U T/� ❑ :Insured A, aF s t A �� ;?,� + g'j''.+^e S V'� ❑.Karam rye ❑ COD 7 CT aS C, C -5 t.. o; r R ed By (P nl W 8. 'Addr Addr requested, c 8nd fee m; 'or gnajure (, ressr ;oFAgen) i. �y.X. Y..) h 1 .�•) )� � '��`-�- d.+ -..i.- l^^ 3 �(,` F1 ". �, �� �,!_ 4 kit � � � � PS Form 3811, fiDecelnber INC. . 102§95-97i"179 Domestic Y4etum Rece 't. 1 ' i A N-A cc L Q.. Ul V— CL Lu Lu t ti? Ln Q d rn Y LL Li ca �``Alv m O a, 11 m O Q. y t 7 m •, '& X 10 C, yo`d.y LL o a. d r.. it( f 5661, Ludt' `008£ wJbzl Sd "I :r �r e i. SENDER *, ° !�r x I also wish to receive the follow W ;, ❑Complete items, t en dlor�,for.addaonal sernces .-- _ 5 ,; ' •,•ing seNioes (for an extra fee) r m . Complete items 3; 4a r y p Print.your name and address on the reverse of tins form s�o thapwe can return this at_ ; d card -to you F .:1 0 Addressee's, Address m ❑Attach this form to Welton-, of the mallpiece or on the back d space does knot ` perms .2. ❑ Restricted Delivery N , i p Write 'Retum Receipt`Requested on 44e rm tlpteoe below the article number .• •t . ; "❑ The'Retum Repeipt will show to whom, the erode was deliveredfand the date �! a delrverad m ° 4a Aiticle Number m' 3 rticle Addressed y / W. d G 1 ° f a 4b Service Type m' o a x. s ertrfied `�` adsExpress Mail � F' ❑Insured r 7 Date of Delivt former ha pS7 . ndise I COD I y.. 8 Addressee s Address (Only tf requested and 5 Received By "(Rent rrie) All r fee`ts paid) ` t 7. ur e s e nr .b� y - r 4hn� to e-o223 Domestic Return Receipt' T tr s. 'pr :SE ER ■Compete items •t and/or 2 for addition servir es. ?f. I also wish to,` "receive'the ■Complete items 3 4a and gib following services (for an 1 ,' ■Print your name and address on the reverse of this Conn so that trre oan tMe eXtfa ,f88) � w card to,yyoou ' ■Attach'thia form to the front of the meilpiece or on the bade if apacetwt f 1 Addressee S Address Z dam: pat( nit;':, a ,, _' to . ■ Write'Retum Receipt Requested on ilia mailpiece belovr the amide n er 2 ". rReSttiCted D8livery + : ••,, ■Ttie.ReWm Receipt will sftw to wliom,ihe artidewas deWered and tti ate t delivered Consult posirriaster for fee 3 Article Add ed to,,,' M � Article'Number , �U 3 r b` ervice Type { f t i GUs9 j �W R"" egistered ❑ cerflfied,k i Y4 IV. (Ps P U T/� ❑ :Insured A, aF s t A �� ;?,� + g'j''.+^e S V'� ❑.Karam rye ❑ COD 7 CT aS C, C -5 t.. o; r R ed By (P nl W 8. 'Addr Addr requested, c 8nd fee m; 'or gnajure (, ressr ;oFAgen) i. �y.X. Y..) h 1 .�•) )� � '��`-�- d.+ -..i.- l^^ 3 �(,` F1 ". �, �� �,!_ 4 kit � � � � PS Form 3811, fiDecelnber INC. . 102§95-97i"179 Domestic Y4etum Rece 't. 1 ' i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM I�An- RAM( C (/ S : Owner or Purchaser of Building Building Constructed by Location - Street Building Type Tax Map Block Lot Town/Village Subdivision Name 13� Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. _ The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month ox /.;0 . Day O3 Sign' General Contractor (Owner) - Signature Corporation Name (if corporation) Address: Z 1 :1 1.11! Title: Corporation Name (if corporation) . 0£ NIV PAW ress: , State Zip'' State Zip r c; Form GS -97 ' YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 32.209286 CLIENT #: 56189 NON STAT PROC PAGE RODRIGUES, JOSE A. DATE/TIME TAKEN: 12/10/02 09:05 11 ARBUTUS ST. DATE/TIME REC'D: 12/10/02 03:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/13/03 PHONE: (914)-320-7731 SAMPLING SITE: 11 ARBUTUS ST. SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10579 PRESERVATIVES: NONE COL'D BY: JOSE RODRIGUES TEMPERATURE..: < 4C NOTES...: KITCHEN TAP COLIFORM METH: Ml:-- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 12/10/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 ' COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN�~]l���HE NEW YORK STATE AND EPA-FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS - TESTED. AT THE TIME OF COLLECTION. SUBMITTED 80. Director ` ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 ' Albert H. Padovani, Director LAB #: 32.300109 CLIENT #: 56189 NON STAT PROC PAGE E RODRIGUES, JOSE A. DATE/TIME TAKEN: 01/07/03 04:00 11 ARBUTUS ST. DATE/TIME REC'D: 01/07/03 04:35 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/13/03 PHONE: (914)-320-7731 SAMPLING SITE: 11 ARBUTUS ST, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL`D BY4 JOSE RODRIGUES TEMPERATURE..: NOTES...: C[]LlFORM METH" N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEENSUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L I -MS/L-= MILLIGRAM-PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY.- H1bert M. pagovanz, m.!.mbm) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 32.300109 CLIENT #: 56189 NON STAT PROC PA[ RODRIGUES, JOSE A. DATE/TIME TAKEN: 01/07/03 04:00 11 ARBUTUS ST, DATE/TIME REC'D: 01/07/03 04:35 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/13/03 PHONE: (914)-320-773l SAMPLING SITE: 11 ARBUTUS ST, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSE RODRIGUES TEMPERATURE..: NOTES...: COLlFORM METH: N/A mm-- ------- ----- — ----- —m ------ m'' DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/07/03 LEAD (IMS) 1.1 ppU o-zn ppo 01/07/03 NITRATE NITROG 1.08 MG/L O - 10 9139 01/07/03 NITRITE NITROG <0.01 MG/L N/A 9146 01/07/03 IRON (Fe) 10.060 MG/L 0-0.3 mg/l 2037 01/07103 MANGANESE (Mn) 0.041 MG/L 0-0.3 mg/l 2037 01/07/03 SODIUM (Na) 94,7!1G/L -N/A -- ' 01/07/03 pH 6.6 UNITS 6.5-8.5 9043 01/07/03 HARDNESS,TOTAL 236 MG/L N/A ' 01/07/03 ALKALINITY (AS 94.0 MG/L N/A 01/07/03 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: Pb/Cu LEAD limits for public schools are set at 15 pph. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1_14. MEASUREMENT OF pH IS ONE OF THE IMRORTANT 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. YML ENVIRONMENTAL SERVICES 321 Kear Street -1Heightsv N~,N,'~ (914) 245-2800 Albert H. Padovani, Director LAB #: 32.209286 CLIENT #: 56189 NON STAT PROC PAGE RODRIGUES, JOSE A. DATE/TIME TAKEN: 12/10/02 0905 11 ARBUTUS ST. DATE/TIME REC-D: 12/10/02 03:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 12/14/02 PHONE: (914)-320-7731 SAMPLING SITE: 11 ARBUTUS ST. SAMPLE TYPE..; POTABLE : PUTNAM VALLEY, NY 10579 PRESERVATIVESt NONE COL'D BY: JOSE RODRIGUEG ' TEMPERATURE^.: < 4C NOTES...: KITCHEN TAP COLlFORM METH: Ml-' DATE FLAB PROCEDURE RESULT NORMAL - RANGE METHOD 12/10/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINE7���7HE NEW YORK STATE 'AND EPA FEDERAL DUNKING WATER STANDARDS, FOR THE PARAMETER- TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: H. Padovani, M.T.(ASCP) r ELAP# 10322 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Locaiion Street Address: T n/Village. Tax Grid # Map Block Lot(s) Well Owner: Nam Address: Use of Well: 1- primary 2- secondary Residerhial 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 a- / ft. Length below grade /gMft. Diameter G " in. Weight per foot _lb/ft. Materials: CL Steel _ Plastic _ Other Joints: _ Welded rc Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes 7c No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours F Yield _!!�_ gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 3�a r Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 67 A If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type ,�; /i4�2 Capacity —6- Depth 9A9 Model -�_f a Voltage .2-30 HP Tank Type 0Y9.1�o Volume �- Date Well Completed 10-too o Putnam County Certification No. q Date of Report //Z'/6 s Well Driller (signature) NO�E: Oxact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. 1. Well Driller's Name � � -� e' Address:` Signature:� ,�e�, Date: / a3 iUJ�7� z White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 J"K. JOHN KARELL, JR., P.E. - , 121 CUSHMAN ROAD 845-878-7$94 - P ATTERSON-, N] Iw YORK, 12563:.... ....:, January 30, 2003 Joe Paravati Attached plans revised per your letter dated january 29, 2003 I have n�eqprd of a trench plan. Adam did this in the field. jack 1111N� r ` IN BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI 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/Preschool (845) 278 - 6014 . Fax (845) 278 - 6648 January 29, 2003 John Karell, Jr., PE 120 Cushman Road Patterson, New York 12563 Dear Mr. Karell: V) Re: Construction Compliance - Rodriques 11 Arbutus Street, (T) Putnam Valley TM# 41.14 -1 -49, Permit # PV -1 -95 This office has received and reviewed the most recent set of plans for the above mentioned project.. We would like to offer the following comments for your review and consideration. 1. A note, making reference to the source of the survey needs to be provided (Bulletin ST- 19, Section 6.5 .. a). 2. Two (2) more copies with original signatures of the 2 year guarantee need to be provided (Bulletin ST -19, Section 6.2). 3. A column for point `C' should be provided on the as -built plans to avoid confusion with the measurements from point `A'. 4. According to our records, a trench plan was never submitted. Please provide a copy of the trench plan and permit for our records. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj r41 � ,, 13, _ LTMIOU , CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERIVHT # PV ' I Located at , F-F L)- ' �5 90A\72 Town or Village P,,TNnr✓, V,6 F,0402 I K46- S2.oak, Subdivision name C_n 4G. � Subd. Lot # Tax Map 41 - 14Block i Lot -1 Date Subdivision Approved -7 Renewal Revision Owner /Applicant Name J® 5F, f�D 16 U LSS Date of Previous Approval Mailing Address � G �n oZgo Ko U6+4 L� WA,jvP ,NGa2S Amount of Fee Enclosed Zip ) ZS''! 0 Building Type�5W-$-e FA-m + L-� Lot Areab- 57 P No. of Bedrooms 2 Design Flow GPD ©0 Fill Section Only - Depth 3 Volume G.� PCHID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of � ��> gallon septic tank and Other Requirements: �j (3 To be constructed by }3 t✓ VC- T • Address _ Water Supply: Public Supply From or' Private Supply Drilled by 7D 3e ��_j" . Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition , _ any part of said sewage treatment system during the period of two (2) years immediately following e ' o f e issuance -of the approval of the Certificate of Construction Compliance of the original system or anyXepair"s to. ;/ �) Signed: Address i o ate. 6 � P.E. ,.� KJVl 10 �l R.A. Date 41( to License # C� 1 ,11,� (o APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved ,for discharge of domestic sanitary sewage only. By; i��G�tf'1CCU�. ' Title: , Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - ,;iwner;( range copy - Design Professional Form CP -97 CeinpietianRcpoRsig�+ edbythaysrel�d €apes;incluftthe.resuhsofat.. least a 6 -hour pump test (See Appendix K). ll ' ld f 5 ire uired. For yields less than S gpm see M4)A Q /v A mnnunum we yne o gpm s q Appendix F for procedures on performing a 24 hour well pumping test. The results of the 24 hour pump test are to be submitted to the Department for review and a determination will be made regarding utilization of the well for supplying potable water to the dwelling. If the new well is found acceptable, then the procedures for determining the minimum potable water storage requirements, located in Appendix G. are to be utilized. 4. If the water supply is from a public water sa ' factory results of a coliform bacteriological analysis of a water sample tak from the service connection, performed by a laboratory approved by the NYS cal artment "Environmental Laboratory Approval Program.° S. Three (3) sets of "as bunt" plans, signed and sealed by 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 shall include: a.. Surveyed house location with respect to property lines. The plan shall make reference, by note, to the source of survey. b. Metes & bounds description of property lines. c. Actual locations of installed SSTS and water supply improvements. d. The distances necessary to locate the septic tank, distir'bntion boxes; junction boxes, ends of the SSTS and well from two fixed points, preferably the comers of the building. e. The plan must include a legend, which reads as follows: "This Is to ceHW that the sewage treatment system was constructed as Indicated on this plan and that the system was !respected by me before it was covered over. The system ivas construded in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health." E The "as- built" plans must also include a title box, giving the information required on the original design drawings. Minimum size of "as built' plans should be 11 inches by 17 inches with a minimum scale of 1 inch to 30 feet. g. Space for Putnam County Health Department approval stamp (minimum 3" x S" preferably at the lower right -hand portion of the plan. 6. Fee - See Appendix I. After the Certificate of Construction Compliance Permit is issued by the Department, a copy J� of the Certificate of Construction Compliance Pemnit, Well Completion Report and approved _ v "as- built" plans should be brought to the local Building Inspector for processing the Certificate of Occupancy. The local municipality should be contacted for their particular requirements for a Certificate of Occupancy. Z. :0 CFg FICATEOF CONSTRUCTION Ct`INIP"'A►"14. P-7-11)��_ . \\ Before a Certificate of Occupancy for dwelling is issued by the local Building Inspector, Certificate -of.- Construction Compliance for .the._SSTS rfiust first be issued by the 3epartment. the Department must be notified before the system is backfdled in order that an inspection of the completed system can be made. Open work inspections may be omitted tt11l1C at the discretion of the Director or his designated representative. - In order for the Department to issue a Certificate of Construction Compliance, the following must be submitted: (Note: All submitted Department application forms shall contain ariSbal signatures (no photo copies)). 1. Certificate of Construction Compliance. (See Appendix K) 1 � — a. The Construction Compliance Permit is to contain the assigned "E 911" a issued by the respective municipality. The "E 911" address is to be pro ded at the "Located at " section on the permit form. The f llowing telephone numbers are offered for the agency assigning the "E 911" es within the municipality: Carmel: Building Department Philipstown: Building Department 628 -1500 265 -3929 . Kent: Building Department Putnam Valley: Town Planning 225- 3900 326 -3740 Patterson: Town Planning Southeast: Building Department 878 -6319 279 -5698 A Construction Compliance permit will ad be issued without the current "E 911" address. 2. Three (3) copies of a two (2) year guarantee, signed by the installer, and/or general contractor, or the owner. (See Appendix K) 3. If the water supply is from a drilled well: a. Satisfactory results of a water analysis, for the parameters in Table Blow conducted and reported by a NYSDOH approved laboratory der the "Environmental Laboratory Approval Program (FLAP)." ' ,, W .. .'.1... .OtM CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/1(15 ug/1) Nitrates 10 mg/l as N Nitrites I mg/l as N ' Iron 0.3 mg4 Manganese 0.3 mg/1. Iron plus manganese 0.5 mg/l Sodium No designated limit (2) pH No designated limit Hardness No designated limit Alkalinity No designated limit NOTES: --66 LA-P,),c- - - 5-1 w'6 (1) Maximum contaminant level. (2) Water containing more thaw 20 mg4 of sodium should not be used for driuldng by people on severely restricted sodium diets. Water contaidmg more than 270 mgll of sodium should not be used b)• people on moderately restricted sodium diets. (3) NTU means Nephelometric Turbidity Units. (4) mg/l means milligram per liter. (5) ug/l means microgram per liter. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRMIEN" TAL HEALTH SERVICES FINAL SITE MPECTION o _ w..... _ Date:. Inspecte y: Street Lo 'o T �� -T Owner s Town Permit TM # Subdivision Lot— 1. Sewage Svstetn Area a. STS area located as per plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from «water course / wetlands ...... ............................... II. Sewage Svstem a. _ Septic tank size �Ievel 250 .........other ... ............. b. Septic tank inst........ ............................... 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 & trenches e. Junction Box - properly set .......... ..........................:.... f. Trenches : TUe—ng—th required -Z, ( o Length installed 2 t a 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ...` .................................... 4. Slope of trench acceptable 1116'- 1/32"Moot ............. 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' /z" diameter clean ............::.....:.: '9.'Depth of gravel"in tiench 12" minimum ....:............:. 10. Pipe ends capped ................................... :.................... g. PumD or Dosed Systems 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 1. Alarm, visual / audio .................... ............................... . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ : ................. .. 6.- Cycle witnessed by H.D.estimated flow /cycle. .... III. House/Building a. House located per approved plans ............................ b. Number of bedrooms ............ ............................... IV. Well a7—Well located as per approved plans ................... b. Distance .from STS area measured d D 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 plan.. f. Curtain drain outfall protected & dir.to exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate... .. ......................:....... / CDJ s • Sent By: LLL; 1234567 ; Oct -26 -01 13:24; Page 2/4 �' °r ? stale .•7''' +. 8A block r.9! r 1 d �' 1 concrete wall r- retainln9 � h c i ^► tr.. Ladd s. rel• wall o Q c t»• 4 mac- c + (D O• O C �A O dS •i. i , w ,� 0 a f. '77 7j G g a 1 AP n..: 1 V ''- h �� �♦ % � 3�• �V t o o a ON ♦ 4 C � D•w ♦ ` h� CL qT lb At 6b%H.9`dj a Q 6 V �� \ d 0lq W `\ ~� joau 1 . . •�Ch ! J � . JN !'.Y r -!YA'J t' :4��� ;.XryX� ^ Sent By' LLL; 1234567 ; Oct -26 -01 13:25; Page 3/4 93, IZ.I f r y r r..Ode X...�� SILT WQ Vj- _ � ��'1 � — _`.•.• � ;ter,~ • �' 1 y r . ` � fib fS� r•. ow -nrT%� f1f- oAOTMCAIT flC Q Z e � Sent By: LLL; 1234567 ; Oct -26 -01 13:25; Page 4/4 ` " ' _. -290 Ir.wi. .s .:.�.• r+.w� acs'. apn.....s...rv: ,•Cr...-. n. ��. �.. •'a �. ... -.. a.... -.r.,. .:F,�N. -` r.� ..� �. a ��..� _. �.. - �'.. r.. � ... 'xt. ,..• J a. r. .. t qq \ 1 • o,� e VV5L 'r i Also AQBU 1 U a� V� _ - -- - .._.._ ..- ..�...... ....r .. rte•, .- .�r•l.rrTnar�ir n[' M A r, Complaint Information Log # 387 -01 -19 Complaint Recieved July 25, 2001 -Complainant (Person Making Complaint) First: JOHN Last: ALLEN Address: PV BUILDING DEPT City: PV - -- Source of Complaint Source: RODRIQUES Address: 11 ARBUTERS RD Phone: - - Location: PUTNAM VALLEY Operation Type: Nuisance (Public Health) Category: Sewage Exposure Received By: Graap, Kathy Assigned To: Stiebeling, Adam Phone: 845 - 526 -2377 State: NY Zip: -- Complaint Nature of Complaint Complaint Septic systems(include se Status Needs Investigation Description: NEVV_ MOVED IN. o` t, 11 irvo Page 1 of 1 ActionTaken: TIC- Associated Facility/Operation Facility Address: Sub -LHU: Risk Level: Date Resolved Date Printed July 25, 2001 s N0.• �� I y TYPE: CODES: YES IlNFORIGIATI0 N FOR REQUEST FOR SERVICE Complainant: NAME: STREET: II� TOWN- T' V PHONE SL �' J3 % (No anonymous request) Violator (Name): i Violator Address: Telephone: Problem: cur �C Directions: Taken By: Referred to: Date: COWLFRM . :::45 s ... M C Sheef' ` of _ a ..e * - PUTNAM COUNTY "DEPARTMENT'OF HEALTH DT��IS1 N_ 1 �'IIr; YO : FIELD.ACTIVITY REPORT tvm (,F Street ~. To n State Zip PERSON IN CHARGE._ Name and -Title TYPE OF FACILITY .FINDINGS:. h.5 W _ G r" P Gt�t -hc �<SrcuC�c = Jul t4Y r 4 cSG� o A.— kE A � L1 Vey C.�,� XA TA_c� tv A IV �_. _ - Signature -and Title R FPQRT RPtRTtirFT) RV., =I acknowledge receipt of this report: SIGNATURE: _ :W/96 :Title; L-Rev—' _ PUTNAM COUNTY DEPARTMENT OF HEALTH CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 12V ' �S Located at M—tZ->0TU5 go R0,6 -R L -JS IS(Zoroy Subdivision name L.nKT-- Subd. Lot # (3� Date Subdivision Approved -7 f -'57 Owner/Applicant Name 6-O SS Town or Village VA LLB Tax Map 4 L ( Block . I Lot 4_ Renewal Revision X Date of Previous Approval I `� Mailing Address S,0- G P—t3n K cFU6+a LM WA-Pr iw6dMS Amount of Fee Enclosed `P 3©6>— W `If. zip) 2930 Building Type Lot Area(9, S% A No. of Bedrooms 2 Design Flow GPD 40 Fill Section Only Depth 3 Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of � gallon septic tank and Other Requirements: r l LL, (- +!5D GL To be constructed by ::R2 13 -P(!LT- Address Water Supply: Public Supply From or: _ Private Supply Drilled by Address _Address . I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following e o e issuanc f the approval of the Certificate of Construction Compliance of the original system or an y�p s t t Signed: FLrraa�-(,^ G,3� Address i o Z G La� t--- I N6 I PLLG, P.E. R.A. Date ((a (a S),i_ License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. Appr ve or discharge of domestic sanitary sewage only. By: �-� � Title: '�- • �` Date: White copy - HD F l e; ello copy - Building Inspector; Pink copy - wner; range copy - Design Professional Form CP -97 BRUCE °.,R.. FOLEY'.., Public Health Director JVne 12; -2000 LORETTA MOLINARI R.N., M.S.N. . Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (91 4) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 CO, CERTIFIED RETURN RECEIPT REQUESTED Irvine Sevelowitz Putnam Valley Building Inspector Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 Re: Rodrigues, Arbutus Road TM# 41.14 -1 -99, Town of Putnam Valley Dear. ';%-lr. Sevelowitz: You' are hereby notified that Non = compliance of the' Putnam County `Sariitary`H'ealth Code; Article III, Section 2, Paragraph C on the property of Rodrigues, Arbutus Road, Tax Map # 41.14 -1 -49, Lot # 135 (Roaring Brook Realty Subdivision), Town of Putnam Valley has been determined. "Such system shall be constructed in accordance with the standards, rules and regulations duly promulgated by the New York State Department of Health and the Putnam County Health Department with the terms and conditions of the permit issued therefore or approved amendment thereto." It is the determination of this office that the sanitary sewage treatment system is not being constructed in accordance with the approved plans of the Putnam County Health Department regulations. This notice is an official request to STOP `YORK, as required by PCHD Sanitary Health Code, Article III, Section 2, Paragraph D. I would ask that an immediate Stop `York Order be placed on the building permit until such time as the following, conditions have been met. .- ,..r.e...ry.rr. •aW_.o•>..or - . rc... nr>.:,.,. �r.::..,... e,:.= a ._..rr..:.�_.,...z..x :.:�•.,..: r..,�........ -��.s. ....:ss_ ..- �. -.�r� ..�.z_.,o -... -. _+.,,......+�.. _..o zr... .... -.., e.... r- .,�.�._,..�..._.c.n .,. Page's Rodrigues 6/12/00 A. Renewal of Construction Permit dated 11/1 9/96 which expired on 11/18/98. Renewal to include: - Submission of applicable plans and documents pursuant to PC14D Bulletin ST -19. - Witnessed perc tests in the area of the SSTS. - Witnessed deep tests in the area of the SSTS. - Approval by this office. Field testing to be conducted after the following items have been completed: B. Removal of all rock "fill" material from area of the proposed SSTS. C. Removal of all construction material and debris from the area of the SSTS. D. Protection, by way of roping off and delineating the area of the SSTS. E. Installation of appropriate erosion control measures on entire site. An inspection was made on Friday, Jane 9, 2000 of the above referenced project and the above stated violations were noted. I can be reached at this Department at ext. 2157 if any further questions arise. Very truly yours,. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj cc: Jose Rodrigues - Certified Mail Putnam Engineering File ' - ' ---�-----�T'-----'------- ------'--------------'--��--''----�---------------�--'-----'--' - » /.. / ------------- ` ------- ' - ----- ' '------'-----------''- - --- -- ---- -''- ' - - - '' ' / - ------- a_ __.: � � t� -�_ - -- - -� -s ,, �� �� O_ _ _ _ __ O- .. a_ ..�_ ...�. r - -- - - — _ � _ .._ . _ ... , .. ��_r _ .-Z�. _ .l._� -.. _SS7� __ _. _ .... __ _ _ .____ __ .___._ __ _._ -_ -- - __._.___. f___�.____----- .__.______ __ _.�._.__ _ -- .._ ._.. _ ., �.__ �. ;� .,L � � _ ._ ^ ��`: ,,, t �� __ ,a: �:., . - -- .� �, t _. --- .-- .-- __._ -- --- .---- - -._._ _.__._..- -_ -___ ___�. _ __.._�.- __.___ �.._ M__._.._._...._.__...___._.. -�. - -_ -_ -. -- - - ._._._._ ._ .__ __... -- - ��. 0 a0* kA BRUCE R.- • FOLEY ...... Public Health Director June 12, 2000 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLP4ARI, R.N., ,M:S.N: Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 CERTIFIED RETURN RECEIPT REQUESTED Irving Sevelowitz Putnam Valley Building Inspector Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 Re: Rodrigues, Arbutus Road TM# 41.14 -1 -99, Town of Putnam Valley Dear Mr. Sevelowitz: You are hereby notified that Non - compliance of the Putnam County Sanitary Health Code, _ - - Article 11I; Section 2; Para ra h C on the roe of Rodri -ues ' Arbutus Road Tax Ma- # g p property rty g� � P 41.14 -1 -49, Lot # 135 (Roaring Brook Realty Subdivision), Town of Putnam Valley has been determined. "Such system shall be constructed in accordance with the standards, rules and regulations duly promulgated by the New York State Department of Health and the Putnam County Health Department with the terms and conditions of the permit issued therefore or approved amendment thereto." It is the determination of this office that the sanitary sewage treatment system is not being constructed in accordance with the approved plans of the Putnam County Health Department regulations. This notice is an official request to STOP WORK, as required by PCHD Sanitary Health Code, Article III, Section 2, Paragraph D. I would ask that an immediate Stop Work Order be placed on the building permit until such time as the following conditions have been met. #­t "...b Rodrigues 6/12/00 A. Renewal of Construction Permit dated 11/19/96 which expired on' 11/18/98. Renewal to include: - Submission of applicable plans and documents pursuant to PCHD Bulletin ST -19. - Witnessed perc tests in the area of the SSTS. - Witnessed deep tests in the area of the SSTS. - Approval by this office. Field testing to be conducted after the following items have been completed: B. Removal of all rock "fill" material from area of the proposed SSTS. C. Removal of all construction material and debris from the area of the SSTS. D. Protection, by way of roping off and delineating the area of the SSTS. E. Installation of appropriate erosion control measures on entire site. An inspection was made on Friday, June 9, 2000 of the above referenced project and the above stated violations were noted. I.can be reached.at this Department at ext.,2157 if any further questions arise. ABS:cj cc: Jose Rodrigues - Certified Mail Putnam Engineering File Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer BRUCE°fit.-- ,FOLEY Public Health Director June 12, 2000 DEPARTMENT OF HEALTH 1 Geneva. Road Brewster, New. York 1o5o9 I IARETTA M0fINARI ` R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 R'IC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 CERTIFIED RETURN RECEIPT REQUESTED Irving Sevelowitz ': Putnam Valley Building Inspector Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 Re: Rodrigues, Arbutus Road TM'T't 41.14 -1 -99, Town of Putnam Valley Dear Mr. Sevelowitz: You .are hereby notifiedahat Nbn- corripliance of the Putnam County Sanitary Health. Code, Article III, Section 2, Paragraph C on the property of Rodrigues, Arbutus Road, Tax Map # 41.14 -1 -49, Lot # 135 (Roaring Brook Realty Subdivision), Town of Putnam Valley has been determined. "Such system shall be constructed in accordance with the standards, rules and regulations duly promulgated by the New York State Department of Health and the Putnam County Health Department with the terms and conditions of the permit issued therefore or approved amendment thereto:'.' . It is the determination of this office that the sanitary sewage treatment system is not being constructed in accordance with the approved plans of the Putnam County Health Department regulations. This notice is an official request to STOP `'YORK, as required by PCHD Sanitary Health Code, Article III, Section 2, Paragraph D. I would ask that ari immediate Stop `York Order be placed on the building permit until such time as the following conditions have been met. A. Renewal of Construction Permit dated 11/19/96 which expired on 11/18/98. Renewal to include: -Submission of applicable plans and documents pursuant to PCHD Bulletin ST -19. - Witnessed perc tests in the area of the SSTS. - Witnessed deep tests in the area of the SSTS. - Approval by this office. Field testing to be conducted after the following items have been completed: B. Removal of'all rock "fill' material from area of the proposed SSTS. C. Removal..of all construction material and debris from the area of the SSTS. D. Protection; by way of roping off and delineating the area of the SSTS. E. Installation of appropriate erosion control measures on entire site. An inspection was made on Friday, June 9, 2000 of the above referenced project and the above stated violations «,ere noted. I can be reached at this Department at ext. 2157 if any further questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj cc: Jose Rodrigues - Certified Mail Putnam Engineering File Joseph L. Peloso, Jr. Putnam County Clerk Public Information Officer Application for Public Access to Records To: Records Access Officer PUTNAM COUITTY Nam2't3fAte tits "'"' ' -''"a � °' Vh`1`�� eneva Road Rt. 312 Brewater Pf_Y., 10509 Addres9—y I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: Date Appli�nt`�S' natured> Applic,fnt Name (PRItf CLEARLY) Representing „ U J n Check one: ❑ I will hand deliver myself ❑ Please submit to the specified department forme FOR OFFICIAL USE ONLY: Date: JOSEPH L. PELOSO, -JR. Public Information Officer Mailing Address _ " S.— �..q.. _ ...... e _.. _ FOR AGENCY USE ONLY • • • I, DENIED Record of which this Agency is Legal Custodian cannot be found. Record is not maintained by this Agency. Signature Title Date NOTICE: YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE. Name Business Address WHO MUST.FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: Signature Date June 12, 2000 William & Agnes Fejes 9 Arbutus Street Putnam Valley, NY 10579 TO: Adam Stiebeling Public Health Engineer Putnam County Health Department # 1. Geneva Road Brewster, NY 10509 RE: Copy of Septic and Septic Field Plans as approved By the Putnam County Health Department. Also, Request copy of any violations per installation of a Septic System for a 2 bedroom house on Arbutus Street. As per our phone conversation I would like a copy of the Stop Work Order as it pertains to the several violations noted by Mr. Adam Stiebeling during his site visit on Friday; June 9, 2000. - As a concerned neighbor who borders Mr. Jose Rodriques property of the left side I am very concerned that he needs professional assistance in the installation of a Septic System. Any reports that indicate public health violations should be sent to my home at 9 Arbutus Street .Putnam .Valley New York, 10579 Att: William & Agnes Fejes. Thank you. a William I Fejes. JUN-26-2000 07:39 FROM PUTNAM COUNTY CLERK TO 2787921 P.01 dVR Lj VW Joseph L Poloso, It. Pub= cou* Cie& J 0 S rwic infaamdaft qtlqea hMillation for Pub& AECQSa to All 2 6 AM 8::4 3 To, Rwor& Aaaes OR%Br varnum load Rt. $22 Ad OW I HEREBY AMY TO INSPECT M r-OU-MNG RECORD: -L—• - a &. elk-- a Pease subrrdt>utlie sped depart 4M for -tee DOW Date. L DENIED ReWd CfWrgh 90 AgGM k U*W CUNWIM OMM bS fWAVL USS ONLY! M071M YOU HAVE A RIGHT TO APPIK A MNK OF -MIS APPUCATM TO BUW� AO&M "40muST PUNY 8WWj4HIS W W SUCH DEW—IN WWf IM SEVEN DAYS OF RWMPT OF AN APPEAL I 1,931W APPEAW i Ow TOTAL P.01 a June 12, 2000 William & Agnes Fejes 9 . Arbutus Street Putnam Valley, NY 10579 TO: Adam Stiebeling Public Health Engineer Putnam County Health Department #I Geneva Road Brewster, NY 10509 RE: Copy of Septic and Septic Field Plans as approved By the Putnam County Health Department. Also, Request copy of any violations per installation of a Septic System for a 2 bedroom house on Arbutus Street. As per our phone conversation I would like a copy of the Stop Work Order as it pertains to the several violations noted by Mr. Adam Stiebeling during his site visit on Friday, June 9, 2000. As a concerned neighbor who borders Mr, Jose Rodriques property of the left side I am very concerned that he needs professional assistance in the installation of a Septic System. Any reports that indicate public health violations should be sent to my home at 9 Arbutus Street Putnam Valley New York, 10579 Att: William & Agnes Fejes. Thank you. William I Fejes. I • - June 12, 2000 William & Agnes Fejes 9 Arbutus Street Putnam Valley, NY 10579 TO: Adam Stiebeling Public Health Engineer Putnam County Health Department #1 Geneva Road Brewster, NY 10509 RE: Copy of Septic and Septic Field Plans as approved By the Putnam County Health Department. Also, Request copy of any violations per installation of a Septic System for a 2 bedroom house on Arbutus Street. As per our phone conversation I would like a copy of the Stop Work Order as it pertains to the several violations noted by Mr. Adam Stiebeling 'during his site visit on Friday, June 9, 2000. As a concerned neighbor who borders Mr. Jose Rodriques property of the left side I am very concerned that he needs professional assistance in the installation of a Septic System. Any reports that indicate public health violations should be sent to my home at 9 Arbutus Street Putnam . Valley New York, .10579 Att: William & Agnes Fejes. Thank you. William I Fejes. d PUTNAM c DEPARTMENT f 1 Geneva .4 Brewster, New York .10509 i - S. e I el a i, PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Geneva Road -- Brewster, New York .10509 Date �° ! TO: ct 5 FROM: For your information For signature BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director' Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Z I ZOfc7 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 S to Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 CERTIFIED RETURN RECEIPT Jos %a712 Uv S REQUESTED 7O C Ja M0 -V�`f (,--L7, ork 10516 PLEASE REFER CORRESPONDENCE TO: Name: Adam Stiebeling Title: Assistant Public Health Engineer Phone: (914) 278 -6130 ext. 2157 Dear Mr. Delano: YOU ARE HEREBY NOTIFIED that non - compliance of the Putnam County. Sanitary .Code; Article III, Section 2, Paragraph C on the property of serr, located at Pamela 7 8, =+,u '" " ` 9, Town of town has been determined. Roo Q,�.v S A �; s fl/ L� r it- 13,�; Such system shall be constructed in accordance with the standards, rules and regulations duly promulgated by the New York State Department of Health and the Department with the:terrns-or. _._ .. _ _. _., _..:GOrad- .rtlorls =of.t e permi•� issued- tklerefortr or- �ppraved-amendments thel-eto ": ' ` �- " "" " '' A Notice of Attention was sent July 19, 1999; recommending the required erosion control measures installation, a follow up site inspection was made Tuesday, July 27, 1999. A subsequent site inspection was conducted Tuesday, August 3, 1.999 at which time erosion control "silt fence" was observed to be insufficient and installed incorrectly. Erosion control measures are not installed pursuant to the approved plan, PH- 35 -98, dated November 13, 1998. A request for a final inspection was made to this office on August 26, 1999, a final inspection was made on Monday August 30, 1999. This inspection resulted in the generation of a comment letter dated August 30, 1999. It is the determination of this office that the Sanitary Sewage Treatment System is not constructed in accordance with the approved plans or PCHD regulations.. Date: ! r� To: ff� S <. I.liA2�►'4. Cpv-rt.l -/G < T Re: CON-sre—no'd Town Dear . 7�O-r+rk prof --t «%P ;yould 4ikr to offer the foilw4ag rommantc for your concidczati n This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj --�s�d Orc- .� 2Co q `i ►i v _ _.i_l_tA ____ �t J�1 +. e �, ran �, y -„� j ice. u=�vr ► r _ 'S y S77" (*A- ax— Y,::o ( - �.Q N-� f fi _ '7j',,._ . C_ .v rc� i' i TIIL�a T? c�,Q •_ 76 Pudding Street Putnam Valley, NY 10579 July 26, 1999 A-DAM Mr. Dio rt Morris Board of Health Environmental Office Putnam County Office Building Carmel, NY 10512 Dear Mr. Morris: believe your office approves the location of septic fields for homeowners in Putnam County. I have a concern with new construction at 11 Arbutus Road, Putnam Valley. I own the property at 13 Arbutus Road. My concern is the location of the homeowners proposed septic fields. He has obtained large boulders from the parkway reconstruction and it appears they are located in the area where the fields will be located. My concern is that this is not a suitable material to locate septic fields in. I'm not experienced in the requirements of the board of health, but would appreciate _.._.:...yo.u_r. attentjop..to this ,mattes if indeed the homeowner is not proceeding according to the BOH regulations. Thank you. Sincerely, Karla M. Ruth :r J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Tti► -g�TUS R� Rod-a L -4.,5- Subdivision name L.nKT–_ Subd. Lot # (3� Date Subdivision Approved 711 Zed .--5- Owner /Applicant Name Jr � rogf!(!�ULS Mailing Address IAO G Town or Village R,'[ ',• I V& Tax Map 4 ( Block ( Lot Renewal Revision Date of Previous Approval I ( `� Co SGni21S0K0U6%+4 LM WA-PP Amount of Fee Enclosed `d 3c)6) — G Building TypeSiWA-�Fi�1 tM Lot Areal >- P No. of Bedrooms W K Zip 12930 Design Flow GPD 4 4)O Fill Section Only Y. Depth 3 Volume 4 `� PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of �� gallon septic tank and Other Requirements: -3 KV3 r l lam, (- +,!5D 4f�4 To be constructed by "rd j36 aD -T�- Address _ Water Supply: Public Supply From Address _ or:'��' Private Supply Drilled "7-E --1- - _ .__ . . PP Y Y'., . Addres`s- 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 teo o e issuanc f the approval of the Certificate of Construction Compliance of the original system or and s Signed: 4=E P.E. R.A. Date 41tto ' u't',.�-^^ E� cYL I r-J� —,,r "L L Address 10-2- 6 �.i �L A ly--- I`7� t a S YL- License # ^1 �� �o APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. Appr ve or discharge of domestic sanitary sewage only. By: Title: Date: 10 r/ `147 -'q4P White copy - HD F le; ello copy - Building Inspector; Pink copy - wner; range copy - Design Professional Form CP -97 PZJTNAM COUNTY (DEPARTMENT OF HEALTH a DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type. ]?CHD Permit # Well Location: Street Address: Town/Village Tax Grid # /� }� l�-U S K MrJ,d�M�/� Map 1, (Block l Lot(s) 4,9 Well Owner: Name: Address: cj05c 0007 R 1 coumS to C C.,J WA-PPIt-f'�QYL4 . 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 N I tJ 5gpm # People Served F*iv, Est. of Daily Usage 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 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 RP,&-R N-)6. bR6py- (44z1C,- 79 Lot No. 3 J Water Well Contractor: -TD 13-an Tc�E Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of con a prov- s crate sheet/pl t<u� Date:. 4 �f� Si ..... Applicant afore: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. I -N Date of Issue Permi Date of Expiration Title: Permit is Rion- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PC —: 1 P UT NAM C O UN TY D E PART MEN T O F H EA L TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name.and Address of Applicant: 0 tag( 4 2. Name of Project: Dsf:',o SS DS 3. Location T /V /C: _ 011_rlya� _/.Luray 4. Project Engineer: _9N,, LYkjcA S. Address: 1 ?y, R 37� License Number: U74 Phone: Z46 �4 6. lype.of. Project: Private /Residential Food Service Commercial Apartments Institutional Mobile.Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. K) o 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency K 11. Is this project in an area under the control of' lo ca1 planning,-zoni "nq;` 'J ' or other officials, ordinances? ......... ............................... 2. If so, have plans been submitted to such authorities? 3. Has preliminary approval been granted by such authorities? kJX Date Granted: 4. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ "Al 6. Waters index number (surface) ..... .... ............................... 7. Is project located near a public water supply system? .................. 8. If yes, name of water supply Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... D M 1. Name of.sewage system Date observed: S I. Jig 23. Distance to sewage system Name of Health Inspector: 4. Project design flow (gallons per day) ........ .............................. �L_ 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or haziai-dous waste disposal, �r landfilling, sludge application or industrial activity? ........ YES or NO rU 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or fV any other potential known source of contamination? ...............YES or NO 'y DESCRIBE: 33. Is there a local master plan or file with the Town or Village ?S 34. Are community water, sewer facilities planned to be developed within 15 years? '00 35. Are.any- sewage disposal areas in excess of 15% slope? U 36. Tax Map ID Number .......................... ..........:..........P........, y 37. Approved Plans are to be returned to: Applicant Engineer 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. Failure jo 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 Htsdsameanor pursdant to Section 210.45 0 the Penal Law. SIGNATURES & OFFICIAL TITLES: /k�- �� • Li �� Z 39 - MAILING ADDRESS: sli- F--A1Uea jt_ 10< br) 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. �J G 26. Has SPDES Application been submitted to local DEC Office? .:.......::.... �Lio 27. Is any portion of this project located within a designated Town or State wetland ?..... ...............:.:......... ............................... 28. Wetland ID Number ........................................................ hJi� 29. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? ................... Q' 30. Does project require a DEC Stream Disturbance Permit? .I. ................. YV 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or haziai-dous waste disposal, �r landfilling, sludge application or industrial activity? ........ YES or NO rU 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or fV any other potential known source of contamination? ...............YES or NO 'y DESCRIBE: 33. Is there a local master plan or file with the Town or Village ?S 34. Are community water, sewer facilities planned to be developed within 15 years? '00 35. Are.any- sewage disposal areas in excess of 15% slope? U 36. Tax Map ID Number .......................... ..........:..........P........, y 37. Approved Plans are to be returned to: Applicant Engineer 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. Failure jo 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 Htsdsameanor pursdant to Section 210.45 0 the Penal Law. SIGNATURES & OFFICIAL TITLES: /k�- �� • Li �� Z 39 - MAILING ADDRESS: sli- F--A1Uea jt_ 10< br) 14.18x4 (2187),—Text 12 R�ROJECT I.D. NUMBER 617$1 SEOR 1' Appendix C State Environmental quality Review -' SHORT .ENVIRONMEN'TAL ASSESSMENT` FORM _. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicanfor Project sponsor) 1. APPLICANT /SPONSOR iN N'cte 2. PROJECT NAME, 'DRteves - ,�!l3urL 3. PROJECT LOCATION: Municipality (V County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 'p j�l NG qT Tt) AKr3 vas 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. D SCRIBE PROJECT BRIEFLY: rj I tJGti� �/ks1M' 71m •�1n1 a�.�l -1 tv Z� O�1 s� r? /2�L�D � �.�13t'J J � S U� 7. AMOUNT OF LAND AFFECTED: Initially 40. acres Ultimately o, 57 acres 8. WILL PROPOSE ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? .'es No If No, describe briefly 'p VV j5_-LjL I N 6' iN 7 LA _ - i2j�—:Q V 7 f L� YA,ip -) -rgw ,,j -Z-r,3& 9. �T IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other D scribe: = - -- :,.__- • . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes 1;1p No it yes, list agency(s) and permll/approva13 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes If yes, list agency name and permlUapproval 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 Applicant/sponsor name: Z f 1�G I "� ' l ` Date: If the action is In the �)astal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use,the FULL EAF. ' ❑ Yes ❑ No V' 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. r ❑ Yes ❑ No - C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, ,existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced-by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other 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 THERE-LIKELY TO BE, CONTROVERSY. RELATED TO POTENTIAL ADVERSE- ENVIRONMENTAL IMPACTS? as LJ 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 or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a .positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on` attachments as necessary, the reasons supporting this determination: . Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsi e Officer Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . LETTER OF AUTHORIZATION RE: Property of Located at T!V JTc Vat. Tax Map # '`� 1 • 14 Block _�_ Lot Subdivision of ROAcgz l LA kfJ_'-_ Subdivision Lot # i 3S- Gentlemen: Filed Map #j ©g Date Filed This letter is to authorize �/�-t' 1, L_ N CA+ Porr')&0\1 a duly licensed Professional Engineer_ or Registered Architect to apply for the required wastewater treatment and/or water supply permits) 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 p cle 145 and/or 147 of the Education Law, the Public Health Law, and the Putna �`,' Very truly yours, Countersigned: ,?' A i I Signed % A*_ wner of Property) Mailing Address 0_rrrll l �.i&t l N6 Mailing Address: ;2p C_ S C*K_&XoLX'-,ln 1J �b2- kve1 State CA-6^C-�, 0 1� Zip 16571 -2- Telephone: Z,�2_5 So 6::,-0 State Iy Zip 12 179C.) Telephone: gel % 91 f q73 0 53"7 7 7 Pol Form LA -97 ;>4-•^ '2 �.Y..: .., r:....'3"'�X'T : "S' =� 'k^'st '.; —_ "S. .._�°p `T+' ; '�^, 'r'ix. SUM DElAlII1�dY' OF .1 Y , 3 PUTNAM ' q' DhMle� d Soevleea. Ceemel.1� ]C lt)B11 .w TB OF OOBH}'IJMi(S; ` XXX!!! HgRpCIION ! FO: SEWAGE DSH�AL STMMM Fea�tt / �unrra� /�n -,u�7• � !A'Rf51.i'1'l35 ,'IZUI,� , ewe er vie prMd/1SSitastN�r �s=�. 4 -A L-t 7�t7AC� Heoewal_ Bayieeea ❑ Dodo et Fraybae � ,' �'t' .• ,.s,► s .14�� -r�r rr . Tew>a t,l.E�t Plpc�) NY l I i7 CI? n Dad Subdivision pro ell Fee Enclosed Ammiir n � Y Hii`s Tj�m 1 CD3t1la L- 'Lot Ae O •.. 5 i- Fal, Seetk® oofy Dep& Vala®e �(J e 400 �• - llow 64"D D � - ... ' . ICBID Noll6eatloa b He�tlk+il W6ea FM b oot�p6ead NaaaMr d Hf�e�ee.e ' Sap�eaa Selo. a oeerlet d ►CryU CAWN Tack r. ea e....eaa by`Tv � i ctw nay` u 't Wster StOpb =' .Ssr;Fre® Adtae Dilabd by Ty (eft .. 1 reprefent ,that I am wholly anA'.compNtely rosporisible fOI {he desggend btatton of tna p►opofad systom(s) 1) that tM :�apaiat® sow di teL Astern above amfivibad will he oonstiueteo as shown on,tha app.ovee amendinenE thereto and `in'aceovdai ee with tAe standaids,-rum a rpu ns o m Cainty I4piitntent of_ Maeltlti; end tMf:on cornpation thereof a .CM4if�cata of Coisttuction,tompliince aitidatcto►y to the Commi'seWmr of NMKDwill"' M su0mltted' to 4M OapeAment, and o written .ywrantee will Oe furnished .tM owns his sucwxers, ,Mls or'asi�ns by the dweller, tMt said Ouilderwill Dad, N° goo0_' opMatinj condition ariy beet :ol. YW sear ditposl system.durino the paioa of two`.(2) years knnwdiatsly folgwle/ tMdate of the Imu• anq. of iM lapprosal' ,of tM,.CfilNkito: of Corist►uctbh;:Complianca of tAO:o►ginil system' ny 0 2) "that'tM drilled. welPdasailed allow will be loeated.es snoimrW n the iCprovod pion and that said will wU(M i n-esem f RandarAS;' uas"and rqu�nf of the Putnam COuMy, daiiinnnet Of �Mp Oet� � o l �8� 1 t CP A ddress P _ > S g� oal .. . P.E:J nn Y E'':A' 0 A U i* No S ' APPROVEOyROR CONSTRUCTION Tbifapprpvat,expkef:,two s, lr tiie date i od unless coestiuction Of the building ,Ms been undertaken and is 9". if a y ed ormodifis0 when eon er n ry by t ommissionmr of Meenh Any eAa�e or alteratbq of conftruetbn ApprOVed fOr AispoYl of domestk ®and/ everts water supphr only. evoea.N for . YwK 711 Rev. " 10/88 wa . ®v. Titer ` ^4 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 `�.- ARPLYCATION: 7T'Orw-CONSTRUCT:'A°...WATE'R-. WELL: PCHD PERMIT # F V H-S WELL LOCATION Street Address Town Villag City Tax Grid Number r3u9-u5 F-04D PvrmwK A 'L'my 41. 14 — 1 —49 WELL OWNER Name Mailing Address Private ��ruuewiZ. �GFp�o 5 Hsu l.p�a UESr W.Y. tlrl(o Public fE OF WELL primary secondary RESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED USINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED `T /EST. OF DAILY USAGE �t�Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 12. ADDITIONAL SUPPLY W SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING NZL-j S �PE,4jC.F_ WELL TYPE I DRILLED DRIVEN DDUG OGRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES V NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISI N: R.lwa4 o 4 (3 rL.vvk- L/xk� iNVP I $ �i0V 14 Lot No. 14q WATER WELL CONTRACTOR: Name '16 Bf QeTs ta4 41.r%4�1 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,_�0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM, NEAREST. _ WATER MAIN,- --- — - - LOCATION SKE H SOURCES OF CONTAMINATION PROVI SEPARATE SHEET �` �U (date) (si na u ) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days.of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2.1 Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril g operations be contained on this property and in such manner as not to degrade or of rwi a con at surface or groundwater. Date of Issue: Z-d 19 Date of Expiration Al 191: Pe it Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller -RECORD OF TELEPHONE CONVERSATION ..:: _.7.. .... - . PUTNAM COUNTY DEPARTMENT OF HEALED Division of Enpviroanmenal Health Services Facility: vv T®n: S Tithe: It Date: 3 A Telephone # Caller's Name: A 1W j. To:,,,z iq DISCUSSION: ,r � ray Cftc-q,L- (1/1 L �lzi3vivs �. •— V (4-t", co .. <-- ©. ez-a Signed: Date: I Rev. 6/97 PUTNAM COUNTY DEPARTMENT OF HEALTH ___..DIVISION OF, ENVIRONMENTAL.. HEALTH - SERVICES........ 0 _V, . Date -eoTS z 1?�� 199(o Re: Property of &70f .wiJS UI ]�1?-�pp Located at A913 u--i-yS 2AD (T) I�A6q VMArlllr Section 41-14 Block Lot 4q Subdivision of 2o/sga uG T� Z'-'Wk LA-1c� - ,&F `* 1 S EZziUU A. Subdv. Lot # 135 Filed Map # 30f> A Date -7 `Z1 4S Gentlemen: This letter is to authorize a duly licensed professional engineer 'Y�,--or registered architect (Indicate) to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf 1n ...c- onnec -t.ion with this matter- and..-to.. ;s.upervi.se the _. -construction. .of said system or systems in conformity with the provisions of Article 145" or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigned: P.E. , R.A. , # C� l 4 CP T> G. g Gx 3 ?1 Address w Y 1 cis b`j °! I q -Z-4b 45o� Telephone ess W1 (wry , Nj i r7(,o4 - Town i & 331 3Z�13 Telephone t t PUTn M QOURN DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENIAL HEALTH SERVICES \ 1 DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE N0._, Owner Address G U r,- 4 T W4 ti,Y tt Located at ( Street) ,(2(3 vrvs 2&rn� Sec. AI , t 4 Block 1 Lot 4.1 (indicate nearest cross street) Municipality ?'—', � +�-- V Watershed SOIL PERC0LAT-ION TEST DATA RDQUIRED TO BE SUBMITS WITH APPLICATIONS 3a- .._ Date of pre - Soaking ' Ll Date of Percolation Test t �4 —5 '3y HOLE E'o� 30 2.4 NUMBER CUXX TIME PERCOLATION Lk PERCOLATION Run Elapse Depth to Water From Water Level 3v No. Time Ground Surface In Inches Soil Rate Start Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 4! io 4'3o zo 14 -- - 2- 2 3z 5!07_ -3o q4 I /A -).-c S i 1...4,09 1 q,3 . 3a- .._ Z t �4 2 4"40 5tlo '3y 4 5 t 3 S E'o� 30 2.4 tip 1 ?,� �' Lk 1�S S i 1...4,09 1 q,3 . 3a- .._ Z t �4 2 4"40 5tlo '3y Z�.7Jy 7/ ZG 3 s (t styl 7v Z4- 4 5!4Z- !o'IZ 3v Z4��g 27 t�4 9� G _ 5 NOTES: ]. Tests to be repeated at same depth until approximately equal soil sates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. tee°, 0 /or, TEST PIT DATA REQUIRED TO BE SUBMITTED WITH I APPLICATION DESCRIPTION OF.SOILS ENCOUNTERED. IN TEST HOLES -DEPTH HOLE NO. HOLE NO. Z— HOLE NO. 3 G.*L. 21 31 41 51 (L-- S7> � –r 6vt-ve. 5/aLir-:> 61 71 81 91 10, 121 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED Do. 6r.Li. 1 2- INDICATE LEVEL To WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE* OBSERVATIONS MADE BY: DATE:" DESIGN 4- Soil Rate used p,­10 Min/1" Drop: S.D. Usable Area Provided. 2-400 54 No. of Bedrooms Z Septic Tank Capacity 00-v _gals. Type Cz)'-YC-- Ahs6r6tion:,Ai& Provided By Z-Z-7_ L.F. x 24" width trench Other ':3� f2. b, M`� 1-1 L,(- C.-r s`,Naar S-r C-fll-rZ44AC-,�- 011-T, t L) SPACE FOR USE BY HEALTH Soil Rate Approved ONLY: OF blEsf, Signature SEAL 66 6 7 4 4 6 sq-ft/gal. Checked by • Date SEWER' • Complete Items i and /er 2 for ditional services. t also wish to recelde the ,'Complete items 3 ands a & b..- ' <' = following services (for an extra r ' • No'n't your name -end address on the reverse of this form so :that we can ' retum'thia card to ynu., • Attach this form fo the front`of.the "•meilpiece, or on the back, if spabe' 1. ❑'Addressee's- Address does <not permtt : - • Wflie "Retum Receipt Requested" on the mailpiece below the article number. 2. ❑ Restricted Delivery n' The Return Recelpt_Fee will provide you the signature of the person delivers t0 and.the date of delivery. :: Consult postmaster forks; . '3'...-Article Addressed to. -'. 4a. Article Number •" 4f;- tJ iu 4b. Service Type 0 Registered Q Insured` `E Certified EYCOD 4 0 Express Mail [T Return Receipt for 1° Merchandise 7. Date of Deiivre�ry 1r 5 Slgilature (Addressee) 8 °. Addressee'sAFddress (Oniyifrequested and fee is. paid) 6. 3)gnature (Agenti s PS Fotr» ,"Nove; r.4 a..a. Gob '199, _9117;000 DOMESTIC RETURN RECEIPT . REGIPTEREpD MAIL RETURN RECEIPT REQUESTED Date ._., ......,�.__ _�... .B�ldnq` °Iiispect'or- ,... �: -. � . -..... �. __.,..� .-.•� ., ; .. �..,- . , ,;.,,,- �:._ . __, - .....-: _� ., F _.: .,�. -_... _ .. tw, evi -------------- - - - - -- I�ur ►...mac. -• ti'hsc.� y Iv��`( 1 � S'1 �j Dear Re: Construction Permit for single family residence Applicant -- ------ - - - - -- --- - - - - -- Street _� �T---------- - - - - -- Town - - - - - -- THt This Firm (I am) submitting an application to construct a sewage disposal system serving a single family residence on.the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from 'your office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for any variances? Yes -- - - - - -- NO --- - - - - -- B) Is any portion of the parcel located within a regulated wetland or its control area, and if so is a vetland permit required? Yes-- - - - - -- No --- - - - - -- C) Is any other local permit or approval necessary? Yes No Ii the' answer to any of the questions above is yes; please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence- If the answer is no, you need not respond to this correspondence. Name Eo5UeT ACW -94S Health Department Inspector JK /jp wetland bh Very tr o r , Engineer, A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMMM HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address S H, E2Y �_�u� l ), -q 1 Located at (Street) Aeg v-rvs 2aa�2 Sec— A4 Block i lot 4-Al (indicate nearest cross street) municipality Watershed I - 01,12405 PA-T `iAN D WITH APPLICATIONS Date of Pre- Soaking L!�> Date of Percolation Test S it HOLE NUMBER CLOCK TIME 2 4<<)v Silo PERCOLATION Z3 7ly PERCOLATION Run Elapse No. Time Start Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop 1 4.- iy 4.3c) Zo A q.G 2. % 3u zL4 27 1/ 4 ��� 9, G 3 5, L! S • 3,Lf 5 4 5 :3!� 6'0!r �:o 24 ��� 251�� `-� 7•S 5 NOTES: 1. Tests to be repeaters' zre obtainers at each for reviryw. 2. Depth measurements tc at same depth until approximately equal soil rates percolation test hole. All data to* be submitted be made fran top o! hole. 2 4<<)v Silo 30 Z3 7ly Z4 3 s It sly( 7v Z4 Ll 31 /b q.G 4 5! 42- G e tz 3u zL4 27 1/ 4 ��� 9, G 5 NOTES: 1. Tests to be repeaters' zre obtainers at each for reviryw. 2. Depth measurements tc at same depth until approximately equal soil rates percolation test hole. All data to* be submitted be made fran top o! hole. PC— i PUTNAM COUNTY DEPARTMENT OF HEALTI-3[ APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: Mre It 1((.1z; 01�_� I_ o S !-� ►.s �Y l._,� �...� r� �.1 r=te i 2. Name of Project: 3. Location T/-V -/s 4. Project Engineer: _L UL Y °� 1= � � 5. Address: 10.3 re-. ST License Number: (o9 44 Ce_ Phone: Zzs 6%�4 6. Type of Project: _ Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt _ Type II. Unlisted X_ 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ..:........ 10. Name of Lead Agency 11..Is. this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? y 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ P-A 16. Waters index.number (surface) ........... ............................... FJ 17. Is project located near a public water supply system? .................. 8. If yes, name of water supply U A, Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... �J C) 10. Name of sewage system A. Date observed: s1 s 19y Distance to sewage system // 23. Name of Health Inspector:T WVs 4. Project design flow (gallons per day) ....... . .............................. 4Q0 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local DEC Office? ............... y 27. Is any portion of this project located within a designated, Town or State wetland? .................................. ............................... iJ(� 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? .............. ............................... Has application been made to'Town;or Local DEC Office? ..................�- 30. Does project require a DEC Stream Disturbance Permit? ................... .00 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 or N0. 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, - .sludge disposal site or any other potential known source of contamination? ..............YES or N0 N Z� DESCRIBE: 33. Is there a local master plan or file with the Town or Village ?�� 34. Are community water, sewer facilities planned to be developed within 15 years? -35. Are: any. sewage disposal ..areas in excess of 1.5% slope ?, . ..... c 36. Tax Map ID Number ................. ....... ... ................41. °.�... 37. Approved Plans are to be returned.to: Applicant Engineer 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. 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 Hi �t nor p Olant to Section 210.45 of the Pena 1. Law. SIGNATURES &OFFICIAL TITLES: I &l i2-. S MAILING ADDRESS: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATI ®N TO CONSTRUCT''A' WATER _WELL ` Jam/ PCHD PERMIT WELL LOCATION Street Address Town Tax Grid Number � Re� Vm'Loy 41-11-1-41 WELL OWNER Name Mailing Address JZWrivate Ai vr-- D05FAO S i vst-e �� T 4- ,(,LL4F z RAcM public USE OF WELL RESIDENTIAL O PUBLIC SUPPLY '. AIR /1COND/ EAT PUMP O ABANDONED 6> primary t BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 2- secondary 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE gal REASON FOR 13 REPLACE EXISTING SUPPLY 13 TEST /OBSERVATION II ADDITIONAL SUPPLY DRILLING NEW SUPPLY NEW DWELLING UDEEPEN EXISTING WELD DETAILED j uTl�rvsl,F I:TI� -- iJ REASON FOR -t�- DRILLING WELL TYPE LED DRIVEN DDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �0 IF WEL�OCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: '-- 13ewy Se� :,L A Lot No. WATER WELL CONTRACTOR: Name 10 �3F_ � .+t "��(rtKlw "�✓�a'?.. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE T.0 PROPERTY FROM NEAREST WATER MAIN: } � LOCATION SKETCHe& SOURCES OF CONTAMINATION PROVIDED N-SEPARATE SHEET S 17 (date) (sign ture PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a.manner as not to degrade or Date of Issue• / 1 19/� 2 Date of Expiration 1 3 19 d 'T Permit is Non - Transferrable White shall take appropriate action to assure that drilling operations be contained on this othe wi. e cont TInate surface or groundwater. /64'/ ?ermit Issuing Official copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller � mps 4 mzN wi t fV NY 10511 q•(. t4 -1- 4o I'I s � �L LI�J DvNc� -117 BUDDING St' FV NY IoS79 jobi A6N�;-s FI=,'ES Cl r -F wTus Rte P V NY l os7 9 �g Gr-/RilAAr7Ni` 9�-,F-So 5 fhONp./y t -lgljF- Wld j w &46. (5t,,00? NY 11 -744 14 -1 - SO brit- wtu,►r� ��} �V NV 1 os71 41.14'1_ Sg LILLIA-iQ Cloy >&No 31W RDDV�,Ts WNX Ny 10 461 I2 M<k! TV S (Lb PV Ny Iomq 60 �"MOND j *YVA LOW 5A 6AII05 1c) N*oro s Two 7V NY lnr-7a TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF .SOUS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. Z. HOLE NO. 3 G.L. L f 1' 2' 3' 4' 5' 6' 7' 8' 1�ui(-- S /_'.Ir-:;)`r 9' 10' 11' 12 _.. _. 13' 14' - ° R - INDICATE LEVEL - AT WHICH- GROUNDWATER IS ENCOUNTERED 00. G. t J . itJ INDICATE LEVEE, TO WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: 1�iyv _ I� , t -`� i- DATE S S� y L( DESIGN -- Soil Rate Used A - • t o Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Z Septic Tank Capacity 1 C C,-w gals. Type Czxc - Absorption' Area Provided By ZZZ L.F. x 24" width trench Other -3, fL: c& fS : -R U_ {v L. JVEIy Y Name _ Signature " - .Ac'Cc3ress tv 3 mac ST. SEAL SPACE. FOR USE BY HEATITH DEPARTMENT ONLY:. Soil_ Rat-, Approved _ _ _ u.ffi __— Date -- APPENDIX 3 P(JTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS - REVIEW SHEET for _CONSTRUCTION PERMI� NAME OF OWN .., ' STREET ATI N BY DATE TAXMAP# nn TQ Y EM PERMIT APPLICATION m PC -1 = WELL PERMIT;M PWS LETTER = ENGINEERS AUTHORIZATION = DESIGN DATA SHEET(DDS) = DEEP HOLE LOG C= CONSISTENT PERC RESULTS (3) C= PERC HOLE DEPTH = CORPORATE RESOLUTION PLANS THREE SETS C= HOUSE PLANS - TWO SETS = VARIANCE REQUEST GENERAL = LEGAL SUBDIVISION C= SUBDIVISION APPROVAL CHECKED m PERC RATE C= FILL REQUIRED = CURTAIN DRAIN REQUIRED =STANDPIPES = EX- APPROVAL SSDS ADJ. LOTS = WETLAND (TOWN/DEC PERMIT R & D) DATA ON DDS PLANS & PERMIT SAME PRE- 1969 -NEIGHBOR NOTIFIFICATION = LETTER BVZBA m l OD YR. FLOOD ELEVATION REQUIRED `DETAILS ON PLANS = SEWAGE SYSTEM PLAN - (NORTH ARROW) S5DS HYDRAULIC PROFILE = GRAVITY FLOW D/J BOX= TRENCH/GALLEY= P- PIT DETAILS CIS SEPTIC TANK - SIZE, DETAIL = WELL DETAIL, SERVICE LINE IF OVER C= CONSTRUCTION NOTES (GRINDER RATE) = DISIGN DATA: PERC AND DEEP RESULTS T'WO -FOOT CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES CUT = FOOTING /GUTTER/CURTAIN DRAINS COMIVENTS: = DISCHARGE (OK) = PERC & DEEP HOLES LOCATED = REPRESENTATIVE OF PRIMARY AND EXPANSION = EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE M IF PUMPED PIT & D BOX SHOWN & DETAILED = HOUSE - NO. OF BEDROOMS C= WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM = PROPERTY METES & BOUNDS = HOUSE SETBACK NECESSARY (TIGHT LOT) m HOUSE SEWER - 1 /4 "/F-r. 4"0; TYPE PIPE M NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS =CLAYBARRIER C=10 FT HORIZONTAL: SLOPE 3:1 TO GRADE = FILL SPECS =DEPTH GAUGES CD FILL PROFILE & DIMENSIONS M VOLUME TRENCH MLF TRENCH PROVIDED =60 FT MAX = PARALLEL TO CONTOURS = 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FIELDS - . = 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL = 20' TO FOUNDATION WALLS = 100 TO WELL, 200' IN D.L.O.D., 150' PITS C= 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) = 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER = 10' TO WATER LINE (PITS -20') = 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS SEPTIC TANKS =10' FROM FOUNDATION; 50' TO WELL WELLS =15' WELL TO P.L. 1�1S 14'• 1� 13 L 12 SNORT x2 I�1 1.819 AG II�I�. 111 Y ►INS � l i 11 11� 1 i I Y `, OI21 A ewo 1 •'YI � � o 41 � A � 4q 4` o � _ W 15 6 / ' x �C 17 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of WIC, Located at AR-gulyc, (T) VALC Section 41.14 Block Lot Subdivision of 13m,-uiL_ LAKxz.. Subdv. Lot # l 3 S Filed Map # Date `1 Z614 r Gentlemen: This letter is to authorize '- j 'L' �A, L'-f1'j6a a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as prom-u- lagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Cod- Counters P.E. , R,. Address Telephone Very truly yours, Signec DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 6, 1994 Paul Lynch 103 Fair Street Carmel, NY 10512 Re: Proposed SSDS: DeFao Arbutus Road (T) Putnam Valley Dear Mr. Lynch: J%IN KARcLL -Jr., S.E. M.S. . Public Health Director Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wet .lands regulations. You should contact local wetlands officials in this regard." 1. Percolation tests must be witnessed by a representative of this Department. Please contact the office to arrange a mutually suitable time. .2.. _Trench design.: has. nqt been..submitted.:-:..: 3. Top and bottom slope of fill pad is to be delineated on proposed fill plan. 4. Title block for fill plan is to note "preliminary Design for fill section only ". Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Ver truly yours, Robert Morris Public Health Engineer RM /jp LOT 134 well casing ( M0P = S 7822'4o" E) e S %8 °Zf^j 'c?J ++ �, iron pipe found, V cut set in /edge 0.9' N. of line iron . /n, set "nen (Mop 1 _ ?57.-73' o / ) z7s.. 73' A 1 0.4' �e found ,,e�pa�k� , concrete block reP ` wall P• 0.8'E./ -- io ` o; a r o ve / d r i v e w a y \ met `` po% we// ,._.�y y stono \ c9ti iron pipe found �. � �� eln� - -- -�" r hing \ 0 X E. of line - - /i, ;, t, \ masonry stone steps !/ G (1 MANY /Q EA o \ W 04'00Y .. L 0T% 135 ,;,::;' ;,: l_ / o �.QQo10 MAX o z3 �� 140.1' MjV 0-0 All m p (rtLl. 'C� P ROV �Oli - o �� 0 za �', ; � _ __ - .. _ . ,•d``� ~ 6 l5 °�e SLOPti 1'� AND -- � tJ V Sa h W *1 11J -TWG ( ioo .l Gv Tv 2 u�i \41 ARAM£ O p N u o 1V %8 °53 5C 11' concrete block CO (;Mop, _ ?75.4.3•) v o . . -. - ••- �,_�.:__ r.- - � ng.�w.oll � ,:rorr ,. o...� • . sto>>es 7J�.4�:%' � ©. " V- cut'set in concrete' ( near toll iron pipe) concrete curb gro v / dr /ve way V -cut set in concrete O( near toll iron pipe ) `0 • j ' � 7 LOT 134 well casing ( M0P = S 7822'4o" E) e S %8 °Zf^j 'c?J ++ �, iron pipe found, V cut set in /edge 0.9' N. of line iron . /n, set "nen (Mop 1 _ ?57.-73' o / ) z7s.. 73' A 1 0.4' �e found ,,e�pa�k� , concrete block reP ` wall P• 0.8'E./ -- io ` o; a r o ve / d r i v e w a y \ met `` po% we// ,._.�y y stono \ c9ti iron pipe found �. � �� eln� - -- -�" r hing \ 0 X E. of line - - /i, ;, t, \ masonry stone steps !/ G (1 MANY /Q EA o \ W 04'00Y .. L 0T% 135 ,;,::;' ;,: l_ / o �.QQo10 MAX o z3 �� 140.1' MjV 0-0 All m p (rtLl. 'C� P ROV �Oli - o �� 0 za �', ; � _ __ - .. _ . ,•d``� ~ 6 l5 °�e SLOPti 1'� AND -- � tJ V Sa h W *1 11J -TWG ( ioo .l Gv Tv 2 u�i \41 ARAM£ O p N u o 1V %8 °53 5C 11' concrete block CO (;Mop, _ ?75.4.3•) v o . . -. - ••- �,_�.:__ r.- - � ng.�w.oll � ,:rorr ,. o...� • . sto>>es 7J�.4�:%' � ©. " V- cut'set in concrete' ( near toll iron pipe) concrete curb gro v / dr /ve way V -cut set in concrete O( near toll iron pipe ) `0 1'. 1, I DEPARTMENT"OF'HEAJH ONMgNTAL FjEALTH SERVICES. I ED FOR CONFORMANCE WITH C ,aAln orni II -Ammic r)C TUC -AS—BUILT MEASUREMENTS NO A A; B B R REMARKS 0 N ( . . lo t 14 ( � t ti9 . I I q S 3 + V V5.1 5 3 35. 1 1ti. G G E 1 13 3 34 9 z z(,o t tiL la ` `i 1 4 43 E ENO ..38 ..;.Q Il _ _ . Is 4 4 d b b1 2-Ft -ruwck ALTERATION Or THIS DRAWING EXCEPT BY A LICENSED P.E. OR . ARCHITECT OR LICENSED LAND SURVEYOR IS ILLEGAL. ANY ALTERATION BY A P.E. OR ARCHITECT no el iovcvno Ul lQT Rl: imnirATPn