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Home My WebLink About2370DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.14 -1 -57 BOX 20 1 I IF' 1 " ., ' ' � .I ts ''' IN tr ' ' 16 I I NN Ti r. IN I 1 . f rl I ., JA JIM 02370 LORETTA MOLINARI R.N., M.S.N. , Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 9, 2003 Mike Doebbler Ralph Mastromonaco Engineering 13 Dove Court Croton -on- Hudson, New York 10520 Dear Mr. Doebbler ROBERT J. BONDI County Executive Re: Waiver Determination — DeRiggi Arbutus Street, (T) Putnam Valley TMH 41.14 -1 -57 The Putnam County Health Department reviewed the waiver request for the above regarded project on 10/8/03. The following determination has been made: ❑' _ The'Waiver request was approved: -- X The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. * . The Waiver request was denied. An explanation has been noted below. ❑ The Waiver request was not voted on. Explanation noted below. 1. It is recommended that a smaller pump or smaller force main be used. 2. Distribution box detail should show two (2) inch separation dimension between inlet and outlet. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj r Puma Characteristics Pw*/)Aow Unit SabmwAle Maned Model, SHEF40MI 5111111401012 Aetoaertk Models SHEF40AI SNEF4OA2 Her ewer 410 Fall load Amt f 2 1 6.5 Molar Shaded Poi (4 Fate) R.PJtL 1550 Phase 19 Whop its 230 NWIX 60 Lnrmure 120' F Max, Ftoh! Te HEMIA body A Mtidalfoe Class A DWW She I I /r NPF sow 3. Not for cm*uc ion purpose W- .. •- - 41 - - 28 IbL Power Cord 19/3, SJTW, 20' std. (30' op*ftU Materials of Construction Handle SNWets Steal I' Oil PIREME� tm Houaft Celt Iron P Cost Iron Shaft 31ee1 Maiholdw Shah Soot Seal Fauns Carbon/Cetalk Seal Body; Anodi2ed Steal Spsi>� Steidess Sleet Be9ows: t eerod Th &Dore Skew Opaing Lower Wrino Row log lealm io P616 1 Yol ed Steel. WIN= Stoiotass Sleet Legs igbewW TheralMdulk Perfor rna ' cce•'-bat'a � :.' 1�MENMEMOMMON.� i Dimensonoi #?t PIREME� .—ells c+esrn 1_ All dk neon in inches. (Metric For 1 -1 ' NONE International use )_ _� I Component dimensions may vary t 1/8 inch. 3. Not for cm*uc ion purpose l (89.42) �' i -, N rte' unless cerl&d. �°" s •. ' j, pim0nsions and weights are approximate. ®aa ®e>®I e®t revisions to our product and their NEE spepFisoNoas without notice. ON®®®W®010 tl �o�s W?'M M.M.N®®MO■NNUM r (so.a) .e- :.. . MY®ROMATIC 1840 Bonet Road Ashland, Ohio 44805 Tel: 419.289.3042 For. 419.281.4081 Web She: wWw.penloirpinep.com SALES OFFICES IN ALL MAJOR CITIES AND COUNTRIES iN 1. •Pmnnt" in 16 rbl6w moat al veur n6fto 44PAwV for VMr lorel IliariAu - Your Authorised Local DislAbutor - 1sso �Trf l� n igh i Dimensonoi #?t .—ells c+esrn 1_ All dk neon in inches. (Metric For ? V nz» International use )_ _� I Component dimensions may vary t 1/8 inch. 3. Not for cm*uc ion purpose (89.42) �' i -, N rte' unless cerl&d. �°" s •. ' j, pim0nsions and weights are approximate. 11 S. We reserve the ri hl to make revisions to our product and their spepFisoNoas without notice. tl �o�s W?'M r (so.a) .e- :.. . MY®ROMATIC 1840 Bonet Road Ashland, Ohio 44805 Tel: 419.289.3042 For. 419.281.4081 Web She: wWw.penloirpinep.com SALES OFFICES IN ALL MAJOR CITIES AND COUNTRIES iN 1. •Pmnnt" in 16 rbl6w moat al veur n6fto 44PAwV for VMr lorel IliariAu - Your Authorised Local DislAbutor - 1sso �Trf l� n igh 7'- RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914).271 -2820 Fax- Mr. Joseph S. Paravati, Jr. Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Onofrio & Maria DeRiggi Arbustus Street, Putnam Valley, NY Section: 41.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: October 15, 2003 1. Five (5) signed and sealed copies of the drawing entitled Preliminary Design for Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, Town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003, last revised October 14, 2003. This plan shows the dimensions of the fill pad. 2. Two (2) signed and sealed copies of the drawing entitled "Preliminary Design for, Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, Town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003, last revised October 14, 2003. This plan shows the design of the absorption trenches. 3. One (1) copy of the pump performance curve and design data As per your memo dated October 9, 2003, we have made the following revisions to the drawing: 1. Revised the distribution box detail. 2. Changed the effluent pump to a SHEF40 and revised the pump detail At this time we are requesting your review and approval of the referenced project. Please call me if you have any questions. ly, Ral6h G. Mastromonaco RGM /jl Enclosures RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (.414) 271 -4752 - (914) 271 -21x20 Fax Mr. Joseph S. Paravati, Jr. September 29, 2003 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via Airborne Re: Proposed SSTS for Onofrio & Maria DeRiggi Arbustus Street, Putnam Valley, NY Section: 41.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: 1. Three (3) signed and sealed copies of the drawing entitled Preliminary Design for Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003, last revised September 29, 2003. This plan shows the dimensions of the fill pad. 2. Two (2) signed and sealed copies of the drawing entitled "Preliminary Design for Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, Town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003, last revised September 29, 2003. This plan shows the design of the absorption trenches. 3. , One (1) copy of the New York State Dept. of Health Waiver Application 4. --One (1) copy of the pump performance curve and design data _ Based upon your review -memo dated September 22, .?003, we have made the following revisions to the drawing: 1. Added construction note #9 2. Adjusted location of deep test holes 4, 5 and 6 3. Added the note "dust free" to the absorption trench detail 4. Show the location of the water - service connection 5. Revised the distribution box detail to include pea- gravel bedding 6. Reference pump chamber same as septic tank 7. Adjusted pump design calculations 8. Provided pump curve data At this time we are requesting your continued review and approval of the submitted materials. Please call me if you have any questions. rely, Iph G. Mastromonaco Enclosures d LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 22, 2003 Mike Doebbler c/o Ralph Mastromonaco Engineering 13 Dove Court Croton -on- Hudson, New York 10520 Dear Mr. Doebbler: ROBERT J. BONDI County Executive Re: Proposed SSTS — DeRiggi Arbutus Street, (T) Putnam Valley TM# 41.14 -1 -57 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. The following items do not meet current code: \,v %,e,� a. Less than 10 feet from toe of slope to property line. b. Impervious side slopes at 1:2. + - - 1 �. -. Less than -100 feet between welr and toe of slope d. Two (2) bedroom design. e. Well less than 15 feet from property line. �2 Construction notes are mis- numbered and one note is missing. Y. Date of drawing and revision block needs to be provided. It appears location of deep holes # 4,5 and 6 are not shown where holes were dug. It is recommended that the system be rotated 90° so trenches are parallel to the existing contours (north and south instead of east and west.) 6!' The washed gravel label in the absorption trench detail needs to include the words "dust free." Water service connection needs to be provided. Distribution box detail needs to show minimum/maximum cover and bedding/base material. Plan view of pump chamber needs to be provided. CIO. Pump chamber elevation calculations are in error. Please check gallon/foot calculation. L,�I. Provide lead loss /friction loss calculations and manufacturers chart. Show head loss /friction loss curve on the chart. pujilllto k66 U14 z lwiop- Y h ih.lt� o, 12. This office will continue its review upon consideration of the above" men-tiorie� comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP: cj Very truly yours, All Joseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM7 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT-SYSTEMS.,-;,.�..i..,.;:--. REV IEW SHEET FOR CONSTRUCTION PJKRNffT NAME OF OWNER: STREET LOCATION: Arig S REVMWED,BY: RK GIZ, SRDATE: TAX MAP#: (CONFIRIAED) DOCUMENTS DPERMIT APPLICATION WELL k.ERWr OR PWS LETTER PC-97 CV )C__yLETTEROF AUTHORIZATION CZL__>DESIGN DATA SHEET (DDS) ((__)CORPORATE RESOLUTION .LJSHORT EAF IC,,--)PLANS -THREE SETS HOUSE PLANS - TWO SETS C16LJVARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION (—:)SUBDrMION APPROV HEC`qD (-)LJPF,RC RATE LJCL_JFTLLREQVfiED DEPMO//y (—J_ TAEN DRAIN REQUIRED e--- GENERAL C-jz� CATEDINNYC WATERSHED PLANS SUBMITTED TO DEP ELEGATED TO PCHD EP APPROVAL, EFRFQ'D (�X_JPEEP TEST HOLES OBSERVED 'PERCS TO BE WITNESSED C-Jcv-JEX-APPROVAL SSDS ADJI LOTS (_)LE.2WETLANDS (TOWN/DEC PERMIT REQ'D?.) (v:j7C__JDATA ON DDS PLANS & PERMIT SAME ( --Y' )PRE 1969 NEIGHBOR NOTIFICATION • Y N (REQUIRED DETAILS ON PLANS CONT'D) C-' �L_)HOUSE SEWER -Vill FT. 4110'; TYPE PIPE.C&ST IRON CZ)L_)NO BENDS; MAX BENDS 45* W/CLEANOUT EE NWALS . FILL SYSTEMS . .1 0' HORIZONTAL; PAST TRENCH SLOPE (3:: 1:T:0:G:RjADE) �TLL SPECS/ FILL NOTES 1-5 'ILL PROFILE & DIMENSIONS ML IN EXPANSION AREA FILL GREATER TER THAIV2 FEE CLAY BARRIER ?'ILL CERTIFICATION NOTE )EPTH GAUGES L�ON PLAN-FOR-R.O.B.,-UNCLASSIEMD & IMPERVIOUS, 7RENC—H LF TRENCH PROVIDED Q50 60FT MAX ARALLEL 'TO CONTOURS C—)100% EXPANS I IONPROVIDED 12S HGEOTEXTILE D9TA6,10fSLT Fift (:;�USHED'STONE OR WASHED GRAVEL COVER -------,-<SEPARATTON-DT,qTXNrPR-ON-PY-.AAI--.FROM*SSTS f/ 10' IQP.L DRIVEWAY, LARGE TREES, TOP OF OWTO FOUNDATION WAL � 0! IN DLOD , 0-TO PITS P=T001 TO STREAM, WATERCOURSE, U2�nc. expan). 0!TQ-c-A-1!T 351 STORMDRAI�K,PIPED WATER aERL A -M bt& - 20 �jxum YR. X (L4C --JSO'- INTERMITTENT DRAINAGE. COURSE Q0 PIL TESTING LOTS>10 YEARS OLD (�)CJ200'/500'RESERVOIR, ETC._ 150' GALLEY SYSTEMS REQUIRED -DETAILS ON PLANS :(x(,_)10' MINTO LEDGE OUTCROP _)SEWAGE SYSTEM PLAN-(NORTH ARROW) SEPTIC TANK 6-z-(-)_) DS HYDRAULIC PROFILE C_J10'FROM FOUNDATION; 501 TO WELL VVIELL TRI a0N NOTES I-is -TO-PR ENSIONS opeaw-mus --VVDEEr1%ESUftS DESIGN DATA: PER ji �' " �--m 5 OCATION OF SERVICE CONNECTI 2'CONTOUIRS EXISTING & PROPOSED '��Ewp is, rapRoPERTYLINE RIVEWAY & SLOPES, CUT SLOPE FOOTING /GUTTER/CURTAIN DRAJUIS(�.�� . H&/�AJLOP't IN SSTS AREAZ'ZE(-,.20%) DA SOIL TYPE BOUNDARIES C_)CV, L_)TrrLE BLOCK; OWNERS NAM ADDRESS JREGRADED TO 15%, IF REQUIRED DOSE/PUMP SYSTEMS ONE JPUMP NOTES JDOSE 75% OF PIPE VOLUMMOSE VOLUME NOTED NAi S' PH # A OF D� GIREVIS: T iCO ES '.MAIN, (PIPE TYPE, ETC.) IL L-)DETAIL FOXF-ORCE DATUM EA F PONDS LO A .TION 0 1a4,LJBX.S1%f LAXESWETLANDSWITHIN` 200'OFP.L. PIT AND -O OWN & DETAILED OC - C1 Z� L40L_)PROPOSED FINISH FLOOR AND _J1 DAY STORAGE AB BASEMENT ELEVATIONS AIN D C-JC-JSTANDPIPES, 5' BO DETAM 1. �'IWELLS 94 SSDS'S W/IN 200' OF SSTS 0 00 1 _J15, m.1m t %,20'-4%,15'-3%,35'-1b/9, '*-<I% .(V—)PROPERTY METES & BOUNDS - f EROSION CONTROL FOR-HOUSE, WELL & to CD DISCHARGE/1001 with 182 cons day discharge SSTS, EROSION CONTROL NOTE 10' MIN to NON - PERFORATED PIPE 'OM BUMS: —�Iotv jure RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 .(914) 27,1. -4762. (914).271 -2820. Fax Mr. Joseph S. Paravati, Jr. Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Proposed SSDS for Onofrio & Maria DeRiggi Arbustus Street, Putnam Valley, NY Section: 41.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: August 6, 2003 Via Airborne 1. Three (3) signed and sealed copies of the drawing entitled Preliminary Design for Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003. This plan shows the dimensions of At this time we are requesting your review and approval of the submitted materials. Please call me if you have any questions. Sincerely, Ralph G. Mastromonaco RGM /jl Enclosures Cc: Onofrio & Maria DeRiggi w /copy of plan the fill pad. 2. One (1) signed and sealed copy of the drawing entitled "Preliminary Design for Fill Placement Only, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1, Lot 57) Of Roaring Brook Lake Located at Arbutus Street, town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003. This plan shows the design of the absorption trenches. 3. Four (4) signed and sealed copies of the Construction Permit Application . 4.. One. (1) signed and sealed copy of the Letter of Authorization - -- - - - - - -5. -0n-e- •(1) -signed--and sealed- copy of the - Application For Approval Of- Plans For A- Wastewater Treatment System 6. One (1) signed copy of the Short Environmental Assessment Form 7. One (1) signed and sealed copy of the Design Data Sheet 8. Certified check No. 0256204121 in the amount of $300, payable to the Putnam County Dept. of Health. 9. Two (2) sets of architectural plans for a two.- (2) bedroom house 10. One (1) copy of the New York State Dept. of Health Waiver Application 11. Copies of neighbor notification mailings for adjacent properties. At this time we are requesting your review and approval of the submitted materials. Please call me if you have any questions. Sincerely, Ralph G. Mastromonaco RGM /jl Enclosures Cc: Onofrio & Maria DeRiggi w /copy of plan -- -- . ..- ... -... .. _ - . Jul -31 -03 02:27P Ralph G. Mastromonaco PE 914 271 4762 PUTNAM COUNTY DEPARTMENT OF HEALTH f:�"Yp .:::....:: ..b-IDMW S, ION- OF�ENVIRONME.NT AL- REAJLTH-SERVI[[CES LETTER OF AUTHORIZATION RE: Property of _C,) io zjo � XAr-1A EDE R 16� Located at Ap-BUToS STp-EET' TN PAM VX BY Tax Map # _4-1.14 _ Block ( Lot 57 t Subdivision of T-Io J 5 Subdivision Lot # 14B Filed Map #308—B Date Filed -7/zal4s Gentlemen: This letter is to authorize R_ A L Pd L MAST -20 MQ ACC a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with- the -pry isions f .A;rticle- -11.4 5 746 nd/65'r 447.6f4he Education Law the, Public- Health-Law, and the Putnam tary Code. Very truly yours, Countersigned: _ Signed: P.E., R.A., # r ' (Owner of Pr perry) 4� oFj210 DE lG 1- Mailing Address L>6F' _ Mailing Address'. _ g -e-)IQ � D o C� UQ59 State �E��2p'wZip 1c)52.0 Telephone: (914) 2-11 -4%Z HOPEWELL TQ4 Tior State �EFp fd)q-K- Zip 10553 Telephone: to - f O(o Form LA -97 r Pump M6Uel SHEF50 Namepla.t Horsepower .50 Pump Mo'aIel Classification Submersible Service High Head EfflQent Phase Single Three Voltage 115 200 230 230 460 575 R.P.M. 3450 Starting/Locked Rotor Amps. 57.4 29.1 29.1 22 11 8.8 Full Load'Amps. 14.5 7.6 7.1 3.1 1.6 1.2 Winding Oesistance, - Range Start 7.8-7 7.8-7 7.8-7 Run .65-.69 2.56-2.32 2.56-2.32 4.91-4.45 20.5- 17.7 29.7 - 27 Locked Rotor Code H s F Class Insplation B B Noma Co4e Letter L D Maximum'Water Temp. 140° F. Power Col, d Size 14/3 16/3 16/4 Motor Mapufacturer Emerson Type of M' for Split phase with centrifugal switch and start capacitor Polyphase Motor Fes"tures, Automatic reset thermal overload protection Overload protection in control panel Pump Operation - Automatic Pressure Switch No No Float Switch ;f Yes No Pump Operation - Manual Yes Yes Yes Furnished as standard equipment. Optional NOT furnished as standard equipment but the manual pump model can b' e I HYDIROMATIC'm AURORA PUMP PUMPS r os- oe"en^c s.rN.%t. X- U-1 equipped with. z ELECTRICAL DATA SHEF60 PUMP MODEL Nameplate Horsepower Type of Service MATERIALS OF SERVICE Motor Housing Pump Housing Impeller Pump Shaft External Fasteners Lifting Handle O -Rings Mechanical Seal Upper Bearing - Radial Lower Bearing - Thrust Bottom Plate Legs APPLICATIONS Solid Size Type of Oil Oil Re -fill Quantity Power Cord Size Diameter Amp. Rating SHEF50 .50 High Head Effluent Cast Iron ASTM A - 48 Class 30 Cast Iron ASTM A - 48 Class 30 Thermoplastic Stainless Steel Stainless Steel Stainless Steel Buna N Carbon Ceramic Single Row Ball Single Row Ball Polyester Coated Steel Engineered Thermoplastic 3/4 Inch Dielectric SE40 Single Phase 70 Fluid Ounces Three Phase 63 Fluid Ounces Single Phase 14/3 16/3 .375 ± .01 .388±.005 15 13 SJTW STW -A Three Phase 16/4 .424 ±.005 10 STW -A 1 Separate Wires Black Power Power White Power Power Red — Power Green Ground Ground PAINT Painted after assembly before testing. Dark green, water reducible alkyd enamel, one coat, air dried. PUMA A UNIT OI CCNistZ..9.0 —L Gs TECHNICAL DATA SHEF50 10 -28 —.1998 11:03AM FROM SUPER — TURBINE SALES 914 769 6756 TOP' VIEW ... . _. �.3 :JA ,s 716 Nameplate H.P. :so 5 a Lb Boxed Weight 58 s. 31-1 p I is SIDE VIEW 14 7 nil I f1 2" NPT Discharge 1. AN dimensions in hr -bes. 2. Component dimensions may Vary us incn. 3. W tot Construction purposes urines certified. a. Dimensions and weld is am eppro)driuts. S. we reserve the right to- make revisions to our products and their spedAadorrs without Move. 6. Own ~ is adjustwe when Aged with a wide >Apts Ftoit SNrltch. I ( Discharge Neigh a,s If the pump is ordered for AUTOMATIC operation, a FLOAT SWITCH and TIE BAND are shipped loose with the pump. When installed as shown, the TURN ON and TURN OFF height is approximately the same as the float tether length. If this is 8 inches, the volume of water pumped out each time the pump runs is: 24 inch tank diameter 15.0 Gallons 30 inch tank diameter 23.8 Gallons 36 inch tank diameter 34.6 Gallons 48 inch tank diameter 62.0 Gallons P. 2 e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address. of applicant: Ot OE R.lo � MAR A F---)E R 164 t 3�i1?��K�Iq� �oA►D " }- }oP�w��:�Sv�rio�l ,1�•`f 0.513 2. Name of project: �� I GtG, 3. Location TN: P'rt�IAM VALLE'f 4. Design Professional: PAL pAU, Address: ��Po'ro►� -0t - H VPSo�.j �OS2O 6. Type. of Project: _ Private/Residential Food Service Apartments Institutional Office Building Realty Subidvision Commercial Mobile Home Park Other (specify) _ 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ......................... o 9. Has DEIS been completed and found acceptable by Lead Agency? ............... LA 107 _ Name of Lead Agency I L. If this project is an area under the control of local planning, zoning, or other . officials, ordinances? ......................................................... ............................... 12. If so, have plans been submitted to such authorities? ............ . ............................ 13. Has preliminary approval been granted by such authorities? 4 Date granted: 14. Type of Sewage Treatment System Discharge ................. surface water 15. If surface water discharge, what is the stream class designation? .................. 16. Waters index number (surface) ........................................ ............................... 17. Is project located near a public water supply system? .... ............................... YEs SVA 18. If yes, name of water supply Distance to water.supply 19. Is project site near a public sewage collection or treatment system? ................ NO 20. Name of sewage system Distance to sewage system 14 21. Date test holes observed 14103 22. Name of Health Inspector]�-, PA RAVATj Form PC -97 2 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... O 25. Has SPDES Application been submitted to local DEC office? ......................... A 26. Is any portion of this project located within a designated Town or State wetland? FJ O I 27. Wetlands ID Number ........................................................... ............................... f�! 28. Is Wetlands Permit required? ..................................... ...... ............................... tI a Has application been made to Town of Local DEC office? ............................... Nf H 29. Does project require a DEC Stream Disturbance Permit? .. ............................... 30. Is or was project site used for agricultural activity involving application of pesticides-to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application ,or industrial activity? ............................ Yes/No f�o .31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any I other potential known source of contamination? ... ............................... Yes/No ISO DESCRIBE: 32.. Is there a -local master plan on file with the Town or Village? ......................... _y'e 33. Are community water and/or sewer facilities planned to be developed within J.5. years in.or adjacent to project site? .... ..............w... .. :.. �o 34. Are any sewage treatment areas in excess of 15% slope? . ............................... �7 35. Tax Map ID Number .......................... ............................... Map4-1.14Block__ Lot S % 36. Approved-plans are to be returned to ..... Applicant X_ Design Professional If the application is signed by a.person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and bel a Class A misdemeasuant to SIGNATURES X190 Mailing Address: �, .... �o. 054 &9 � PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF (ENVIRONMENTAL HEALTH SERVICES. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner O. 0FPz1oiMAP_iADEEic:5,&,1 Address 3(f_y_P_P_r_, ce 1 a53 Located at (Street) A, ?_ suruwo �-rv_EET Tax Map Block I Lot (indicate.n cross street) Municipality 10 tL� PUT UT AJA �&LLE� Watershed Pe VLS 4 ILL PoLLo w SOIL PERCOLATION TEST DATA Date of Pre-soaking .. :Z I Date of Percolation Test �1130103 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each Percolation test hole. (i.e. & I min for 1-30 min/inch, & 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 "jar 1i th Mun.:.,n x R_mw .1 4-: 1 (o. - -PHA 20 Z3 2 4 :31 -4:41 18 20 23 3 Co 3 B 2-0 Z-3 3 4 5 . '33 _L _._ __. -Zo . _ 2 3- 3 - - 5 . 2 4:33 -4:54- 20 23 3 -7 3 +:54-5:15 Z I Zo Z3 3 -7 4. 5 P H c-, 1 + 2044'6 2 B 20 23 2 50 -5: ZZ' `3 Z 20 23 3 9:2.4-5-57 33 20 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each Percolation test hole. (i.e. & I min for 1-30 min/inch, & 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. Z HOLE NO. G.L. 1 -0 �2 ToPSoi LT 1 -ej LT Lo AM -LOAM W1 iff eQUL 1.5' 2.01 2.51 3.0' 3.51 4.00 Uj 461 10 To r-eo I L. --ropso I t, AA '5114"LOA, sl(-,r IDA": LO/BoutD 1.61 1 , , Wo 2.51 No. 0. C, r..Lu - Indicate level at which groundwater is encountered N ON F- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered t 04 Deep hole observations made by: �ALj)a6. MM-iTgQtdo, Aco. PE, PC,. _Date 7h4- 1 03 Design Professional Name: Address: 13 E)--,vF:—: IWXIAROQIW- -.q--WArm PrefeWonal's Seal .APPENDIX E Date Au�i usT Co, 2003 .26.. Porcelli RE: Dept of Health Review of Proposed 20 Arbutus Street SewagcTreatment System for Property Putnam Valley, NY 10579 Name:©t�OFRlo WAR.IA DE R1GG t Address: ARWTU5 ST'12.E ST- Town: R3T- 4 Alert \/ALLEN Tax Map 4:4-1-14-- Dear -Slrz/MADAM Please be advised that an application for a Construction Permit relative to the construction. of a sewage system and/or well proposed for the captioned properly has been made to the : oiv6ty.Depaithierit of Health.::Aftached please= find..a_copy;of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly Yours, By: �ALP��.. M��ToMeIAP�• Tide: 51G�N G I N Received By: Fo W�� L L j Address: 2 O Tu5 ,:�rf': u-tJAHVALLEY Tax Map #: J.-I - 1-- r25 i 660 Augm t 1997 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT 5 ; -,49 - 0 3 Well Location. . Street Address: At-balL ff wq f-er-.f Town/Villa ge; , Ut got h. C Tax Grid# Map fj./fB lock "/ Lo Well Owner: Name: Address: 0 Alf-14, CaCkojle )U. Use of Well: 1-primary 2-secondary Residential Public Supply Air cofid/heat pump y jrrigation Business Farm Test/monitoring Other(specify)' Industrial Institutional Standby Drilling Equipment Rotary _ Cable percussion 1x_ Compressed air percussion Other (specify) Well Type Screened _ Open end casing Open hole in bedrock Other Casing Details Total length _,jLft. Length below grade __p26 ft. Diameter —in. in. Weight per foot -j7lb/ft. Materials: _X Steel Plastic Other Joints: Welded _& Threaded Other Seal: _X Cement grout _ Bentonite Other Drive shoe: _XYes No ILiner: Yes _X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped _)( Compressed Air Hours Yield 0 gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) i, t4 iik Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available,- - - - - please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description ft. ft. Land Surface ) 2 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type Capacity —76 pM S 101 A;. Depth Z) 0 Model 6iDULDS745 1 Voltage 7_30Sl'J4LeHP Tank Type L. Volume 40A AL Date W9 Comp ated 7/0 /6L Putnam County Certification No. 007 Date of Report 7h 9 6- ' /6 Well Driller (signature) NWE: Hxact location of well with distances to at least two pennanenflandnlarkS to be provided on a separatolieet/plan. Well Driller's hs Signature: It'll Address: _ 311 tv'L' Date: V!17,4�1 v- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 7:1 )941Z ti •s l�ol b PUTNAM COUNTY DEPARTMENT OF HEALTH? DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #5W-26-03 Located at i &'A?- &U T us `j I R.EET Town or Village PuT SIAM VAL LE:- -( Owner /Applicant NameNOF21ot MAQA ItIZIC�► Tax Ma 1.14— Block: Lot 57 Formerly ►� Q _ Subdivision Name 20ARI �G► 5200 1L- HAP -C Subd. Lot # 145 Mailing Address �G (Z E e �l of I< D I I L? PEW f✓LL I J 1 Zip ls- 1 Date Construction Permit Issued by PCHD Separate Sewerage System built by O W N e Q- Address _ EZc y EE, r� ,f f I Consisting of 1 000 Gallon Septic Tank and 2 5 O L.F DF Z4 w I DE A 260 1Z FT'l0 J T2i✓ I 1 I Other Requirements: �J IZ R.O F3. F I LL PLAGF M E��I� PUMP EITI W/0V.EPPLOW STO� Water Supply: —�IA Public Supply From Address or: i< Private Supply Drilled by H.Y -AT JOt Address 1 DI RTE • 31 P E25oiJ 25 I:L::�2aI.<71� Number of Bedrooms _1W 0 2 Has garbage grinder been installed? IJ O I certify that the system(s), as listed, serving the built plans (copies of which are attached),' in ac plans and the standards, rules and, regulations o� Date: I I O Certified by Address ted essentially as shown on the as- Construction Permit and approved nt of Health. P.E. R.A. License # 015 4-49(?5 Any Pe rson occupying P remises served by the above system(s) ) shall promptly take such action as maY , be necessary to secure the correction of any unsanitary conditions resulting from such usage.. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By 67 Title: Date: l /cl W>fv copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' WELL COMPLETION REPORT Nell Location:,; -: Street Address: TowiT/Viliage: Tax Grid # Map */ /*Block Lots) Well Owner: Name: Address: n �j ,, c . r s � U C 11? d� Use of Well: 1- primary 2- secondary I Residential Public Supply Air co d /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 ft. Length below grade eft.. Diameter in. Weight per foot. lb /ft. Materials: _X Steel _ Plastic —Other Joints: _ Welded X Threaded _ Other Seal. Cement grout _ Bentonite Other Drive shoe: &Yes No _ Liner. Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed ?. First Yes. No Hours Second Well Yield Test _ Bailed _ Pumped, Compressed Air Hours Yield — gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Wei Log If more detailed. information descriptions or siege analyses are available, plefse attach. De th From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ' If geld was tested at dfferent depths durir<g drilling, list; Feet Gallons Per Minute. Pump /Storage Tank Information Pump Type �, Capacity �hNl. Depth Z.I O tnu IBodel G�eULDS %5 Voltage 7_305w4leHP Tank Type, l, Volume _40,A AL . DatevNel Comp ted Putnam County Certification No. Date of Report Well Driller (signature) )541 Z N "'h: coact location of well witn atstances to at Least two permanenrlanartfarKS to be proviaea on a SeparateAsneet(plan. Wei Driller's Name Al " ; �' s Address:. Signature: Date: IA 47A <_ Wlite copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 - �- ' (914> go. bert H- van "J. Director , � ~~ 9~~~E-- ~-- ~---7-4LAB#9.60153 NT#596- ~ NON STAT AS=: ~~~~~ � C&C MECHANICAL . DATE/TIME TAKEN: 09/10/06 0l :00 233 TOWN VIEW DRIVE' DATE/TIME WAPPINGERS FALLS, NY 12590 REPORT DATE: 09/18/06 SAMPLING SITE: 16 ARBUTS ROAD, : PRESSURE TANK- ' pi[TNAM VALiEY SAMP/F TvP� . nnjum� ` COL'D BY:�CRS CLERIC[ NOTES.,.� ` ~~~~~~~~~~ DATE FLAG pROCEDURE __ ET fl .`'..~^� PRESERVATlVES: NONE , TEMpERATURE..: < 4C COL1 FORM. METH: MF ~~~~ ( RESULT NORMAL- RANGF METHOD - ' PUTNAM CNTY FROFILE ` 09/11/06 MF T.' OLIFORM ABSENT T /.00 M. AB SENT 1'08 0q/l2/06 LEAD (lMS) 2,9 pph 0-15 ppb 9x)3 09/13/06 NITRATENITROG 2.78 MG/L 0 - 10 9�52 09/13/06 ' NITRITENITROG <7 ,0� MG7L - NyA 962 09/13/O6 IRON <Fe) 0 280 MG/L ^ . 0-0.3 mg/l 9002 09/l4/06 MANGANESE (Mn) 0.0=6 MG/L n-o.3 mg/l 9O02 O9/12 :15.2 MG /L N/A 90O2 09/!1/06 pH 5 . 8 UNlTS `6,5-8.5 9043 09/11/O6 HARDNESg TOTAL 128 MG/L ' ' N/A 09/l8/06 ALKALINITY (AS' 48.0 MG O0O1 � 09/18/(>6-.-c' TURBlDlTY.�TUR' . 1.9 NTU .5 ' COMMENTS: BACT THESE RE�ULTS INDICATE THAT THE WATE WAS NOT) OF A ' SATISFACTORYSANITARYQUAL[TY ACCORD I E NEW YORKSTATE AND EPA FEDERAL DR}NKINGWATER STANDARDS, FOR THE PARAMETERS TE9TED, AT THE' TIME OF COLLECTION. Pb/CuLEAD limits for p EPA Lead & Copper than 10% of 'their ' than 15 ppb and a treatment must bci PC) ten ia1. /blic schools are set at 15 ppb. Rule for Public Sys`ems requires that no more distribution points have a iEAD *alua of more COPP.ER value of 1.3mg/L, else water undertaken tn reduce the' water's corrosive Fe/Mn If both iron andma nganese are present, their total value combined not exceed 0,5 mg/L. , Na No limits for Sodium are pros cr. b/d. Suggested guidelines state that for people on a sodium restri c.-:ted dtet,the water sh�uld contain no more than 20mg/1- of So6jum. For those on a moderately restricted cIiet, a maximum of 270'mg/L of Sodium v vML EmVlRONMFmr^/ SERVlCES 321 K Kear Street _Yorkto*/n H H��o� N.Y. 1 � 16 ARBUTS ROAD, : PRESSURE TANK- ' pi[TNAM VALiEY SAMP/F TvP� . nnjum� ` COL'D BY:�CRS CLERIC[ NOTES.,.� ` ~~~~~~~~~~ DATE FLAG pROCEDURE __ ET fl .`'..~^� PRESERVATlVES: NONE , TEMpERATURE..: < 4C COL1 FORM. METH: MF ~~~~ ( RESULT NORMAL- RANGF METHOD - ' PUTNAM CNTY FROFILE ` 09/11/06 MF T.' OLIFORM ABSENT T /.00 M. AB SENT 1'08 0q/l2/06 LEAD (lMS) 2,9 pph 0-15 ppb 9x)3 09/13/06 NITRATENITROG 2.78 MG/L 0 - 10 9�52 09/13/06 ' NITRITENITROG <7 ,0� MG7L - NyA 962 09/13/O6 IRON <Fe) 0 280 MG/L ^ . 0-0.3 mg/l 9002 09/l4/06 MANGANESE (Mn) 0.0=6 MG/L n-o.3 mg/l 9O02 O9/12 :15.2 MG /L N/A 90O2 09/!1/06 pH 5 . 8 UNlTS `6,5-8.5 9043 09/11/O6 HARDNESg TOTAL 128 MG/L ' ' N/A 09/l8/06 ALKALINITY (AS' 48.0 MG O0O1 � 09/18/(>6-.-c' TURBlDlTY.�TUR' . 1.9 NTU .5 ' COMMENTS: BACT THESE RE�ULTS INDICATE THAT THE WATE WAS NOT) OF A ' SATISFACTORYSANITARYQUAL[TY ACCORD I E NEW YORKSTATE AND EPA FEDERAL DR}NKINGWATER STANDARDS, FOR THE PARAMETERS TE9TED, AT THE' TIME OF COLLECTION. Pb/CuLEAD limits for p EPA Lead & Copper than 10% of 'their ' than 15 ppb and a treatment must bci PC) ten ia1. /blic schools are set at 15 ppb. Rule for Public Sys`ems requires that no more distribution points have a iEAD *alua of more COPP.ER value of 1.3mg/L, else water undertaken tn reduce the' water's corrosive Fe/Mn If both iron andma nganese are present, their total value combined not exceed 0,5 mg/L. , Na No limits for Sodium are pros cr. b/d. Suggested guidelines state that for people on a sodium restri c.-:ted dtet,the water sh�uld contain no more than 20mg/1- of So6jum. For those on a moderately restricted cIiet, a maximum of 270'mg/L of Sodium YML ENVIRONMENTAL SERVlCES 321 Kear Stre�t Yorktown He 1/}598 ' Albert H. Padovan�, Dire�to� LAB #: 9,6O1539 CLlENT ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ C&C MECHANICAL ` 233 TOWN VIEW DRIVE ' WAPPINGERS FAL1.1,3, NY 12590 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ... ... ~~~~ ' DATE/TlME TAKEN: 09 Cl 0l:00 DATE/TlME REC`D: 09/11/06 12:50 REPORT DATE: 09/l8/06 PHONE: <914)-474-�184 ' SAMPLING S[TE: 16 -ARBUTS ROAD, PUTNAM VALLEY. SAMPLE TYPE..: PO L � : PRESSURE TANKT PRE Tl VF, S, NONE C0-'D BY: CHARLES CLERIC{ TEMPERATURE'.: <4C NOTES...: � COLlFORM METH, MF ~~... ~~~ ... ~~~~~~~~~~ ... ... ... .~ ... ... ... ... ... ~~~~~~ DATE FLAG P E RO[EDUR RESULT METHOD is suggested' H H SCALE lN WATER RANGES FRO ME p p M 1-14. ASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS [N WATER CHEMlSTRY, WATER TH A LOW pH MIGHT BE CORROSIVE TO METAL PlPE'S AND F[XTURES THE NORMAL RANGE OF H lS 6 5 TO G 5 . p . ,. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESlVM `CONCENTRATlON, BOTH EXPRESSF. .DAS CALCIUM CARBO � TE, {N MG/L^ THE HARDNESS MAy RANGE FROM 0 TO HUNDREDS OF MG/L, p�PENDS ON THE SOURCE AND TREATMENT TO WH[[H THE WATER HAS 8EEN SUBJECTED. _SOFTWATER 0-70 MG /L VERY HARD �4BO VE.380 M 'G/L HARD WATER: 140-300 MG /L (1 gr Iin/gallnn = 1`7.2 MG/L) �UBMITTED RY: Dir�ctor . ELAP# (/)323 ,N A777-7,7_7 u, 1!00' MIN. SETBACK TO SEPl1C q . ?OX. LOCATION nNG WELL i THIS IS TO CERTIFY THAT THE 'SEWAGE DISPOSAL j SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY THE DESIGN ENGINEER PRIOR TO BEING BACKFILLED.' THE. SYSTEM WAS CONSTRUCTED . IN ACCORDANCE. -WITH ALL RULES AND REGULATIONS OF THE PCDH . AND THE NEW YORK STATE- DEPARTMENT OF HEALTH. SURVEY AS —BUILT INFORMATION HAS BEEN PROVIDED ON PLAN PREPARED BY J. CHARLES BOOLUKOS P.L.S. :i i' TIE. DISTANCES TRENCHES REQUIRED = 250 L. TRENCHES PROVIDED 250 L. PUMP TEST PERFORMED 8/17/ DOSE VOLUME = 125 GAL. /CY( 4 1 /2" DR A B Ti 12.3' 41.5' T2 15.1' 33.5' T3 22.3' 37.3' T4 20.5' 44.6' DB1 110.4' 119.5' L1 78.3' 88.9' L2 80.2' 88.0' L3 85.0' 9 0.0' L4 88.3.' 90.8' L5 150.0' 150.9' L6 148.7' 151.0' L7 146.7' 150.5' L8 146.1 ' 151:5' TRENCHES REQUIRED = 250 L. TRENCHES PROVIDED 250 L. PUMP TEST PERFORMED 8/17/ DOSE VOLUME = 125 GAL. /CY( 4 1 /2" DR OCATED WITHIN 100' UPSLOPE IRECT LINE OF DRAINAGE LOCATION AS SHOWN. :)R PROPOSED WELLS ;LOPE OR 200' DOWNSLOPE 4GE OF EXISTING SSDA •30" E 340.65' N j F PORCELLI x-1.14 -1- 56 (VACANT LOT) 1� 1000 GAL CONC. SEPTIC TANK o. N 1000 GAL. CONC. PUMP PIT WITH OVERFLOW STORAGE T1 1.4 AND ACCESS MANHOLE 2" PVC SC 4" CIP T2 T3 FORCEMAIN PATIO 'B' in 0 N i :. _ LOCATION WELL APPROXIMATE LIMITS OF 3 1/2' R.O.B. FILL SECTION APPROXIMATE LOCATION OF IMPERVIOUS EARTH BERM N 87'06'30" W 361.21 100' MIN. SETBACK TO t z \ L1 4" SOLID PVC (TYP.) ` ", 1� , i. d6 --32' \ - -- 3 4, • !i \ 6' O.C. — -- - 32' - - - -- L8 CAPPED ENDS (TYP.) I— 3V AREA °' Ld L'J \ i SSDS (4.000 S.F.) n If (t S _ s V ; -- -- - -- AIL V , -- - - - -L6 1 — 31' tj O a' is jai I .' TIE DISTANy ES A , B \ L1 4" SOLID PVC (TYP.) ` ", 1� , i ALL LATERALS HAVE d6 --32' \ - -- 4, \ 6' O.C. — -- - 32' - - - -- L8 CAPPED ENDS (TYP.) I— 3V AREA °' Ld L'J \ _ 31' - -. - -- L7 SSDS (4.000 S.F.) n If (t \ L3 -- V ; -- -- - -- AIL I VI -- - - - -L6 1 — 31' tj O a' \ i\ jai \ 100% EXPANSIO N .AREA 1 0 N" ! W N cn i a .' TIE DISTANy ES A , B f' 1 THERE ARE NO SEPTICS LOCATED WITHIN 100' UPSLOPE 1 -OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE N/F PORC FROM THE EXISTING WELL LOCATION AS- SHOWN. 4- 1.14' - -1- I THERE ARE NO EXISTING OR PROPOSED WELLS (VACANT I LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE . IN DIRECT LINE OF DRAINAGE OF EXISTING SSDA: 'EXISTING WELL , 100' MIN. SETBACK S 86'20'30" E 340.65' I 110. S' iV N TIE POINT 'A' t z / + E�' � d � � y �"'�• Y 1 it i an' x U P *r' T�2 ` s EXISTING or a{ S DRIVEWAY .; j `'fir 11=t8 'EXISTING TWO (2) r F,x�� cK ytts rk'` ^�'r BEDROOM' HOUSE t . O s O .r 6 6 acres + A � r _ . 3d� TIE POINT BUILDING DRAIN DISCHARGE 7'_ _ _ _ _ _ S Y iE.. d r d'n x .,F� -•.^ r -;* r �'' r �' �'�fa3,�� ,�.,; � 3r { tip �h� � h�'��: '`S, ''' S. rn,'� �, riV h 0 N Ti ty /1000 GAL. CONC. SEPTIC TANK 1000 GAL. C6NC. PUMP PIT WWITH OVERFLOW STORAGE T4 AND ACCESS ',MANHOLE 4" CIP T2 T3 PATIO 2" PVC SCH40 FORCEMAIN .APPROXIMATE LIMITS OF 3 1/2' R.O.B. FILL SECTION hs�t''ir� G?st5. },� K '_ b r .•'tee "C"r . l 7-p /� ' tY is x h 0 N Ti ty /1000 GAL. CONC. SEPTIC TANK 1000 GAL. C6NC. PUMP PIT WWITH OVERFLOW STORAGE T4 AND ACCESS ',MANHOLE 4" CIP T2 T3 PATIO 2" PVC SCH40 FORCEMAIN .APPROXIMATE LIMITS OF 3 1/2' R.O.B. FILL SECTION MEMORY TRANSMISSION REPORT - - _..... - - - ....... .. _ _.... TIME :..APR,20.2009.01.: 1 3RM -- TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 443 DATE APR -20 01:10PM TO 9120912034132966 DOCUMENT PAGES 007 START TIME APR -20 01:10PM END TIME APR -20 01:13PM SENT PAGES 000 STATUS 50 FILE NUMBER 443 * ** TX FA I LURE NOTICE Q P'iTTNAM COUN'T`Y DEPARTMENT OF HEALTH DIVISION,OF ENViitON1VIENTAL HEALTH SERVICES CERTIFYCATE OF CONSTRTSCT20N COMY'LIANCE FOR SEWAGE TREATMENT SYSTEM PC�7Ja CONSTRUCTION PERMYT # S vv-,z 8 - 0.3 \ ):.Qr_ toa at I Ca �12F3U-Tt_: �, �T' R�1 =`T- Towa or Village PUTIJANT Owacr /Applicant Namc�hloF2ta� i�IA2W(��Ir�i Tax MataCi- i _ I�- , Hlocic I Lot �% Formerly_�A Subdivision Nome F<>0.4 R 1 rJG P� i2ooiL- %CIA P I; S� �1 s,xbd_ Trot # I' 4g Mailing Address 7- F-E-W F_7_w SST 1� Zip l 253 Date Cox .p ction Permit Issuod by PCI IIID --- - - - S�„garate Sewerage Svatewn built by W) r_1 F__— Q Address A Fi_.,p �/ . • n _ `• V Consisting o£ I OOC] o-alloa Septic Tank and z S O L-F o1= W 1 Other Requirements- �� 2 �. C?.�. F I L� PLAGp= t✓I e=>Jj` E-0" f2 Pi T �I L?V 12G LOW STO �- Water Suonly: " Public Supply Frarn Address or: ->< Private Supply Drilled by NYATT 4-e�rlTa a Address l f:�1 RTe� -'� I I PATTF1rSO� Building Typ F F; 1w^ I L'f 2E�1 been coxxipleted7 �'rG a, Y- l Z�G Number of $cdrooms Has garbage grinder been installed? O I certify that the systezn(s) as listed, sawing the I3;t onstructcd essentially as shown on the as- built plans Ccopies of wbich are aTTa=hed3. in r nth ids Cl-m Construction Permit and approved plans and the standards, rules and. regulations , r ` a` artznent Of i-Iealth. . Date: i O a Corti$ed, by ALP - Q�h� P_E__ RA Address 1 � U !�- , ` Licczisc # ©� Any person occupying promises served by r}.P above systemCs)i shall proaxptly take such action as may be necessary to secure the correction of any + +r+c:.r�tary conditions resulting �Om such usage. Approval of the separate sewage treatment system shall bccome null and void as soon as .m public saxtiuwy sower becomes availably and the approval of the private water supply shall bccome null and void when a public water supply becomes available. Sucb approvals are subject to modiflc Ozi or change when, iti tlae judgment of the Public Health Director, such revocation, moddiifiication or change is necessary. gy• 01 - ecc� Titlo: Date: WIS copy - i-m File: Yellow copy - .$uildiztg Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCH D CONSTRUCTION PERMIT # S w- 2 8 - 03 Located at I (_o Al?aU T US S I R-E'ET Town or Village Purl AM VALLE-( Owner /Applicant NameONoF -Vbo APJA Tax Ma Block (—Lot 57 Formerly j�UA Subdivision Name 2oARI N6 gRooiL -MAP I)- SEC- Subd. Lot # 14-5 Mailing Address ,�? G (Z E EK::;�I 0E RD, HO PEW ELL TC:r -1 Zip 153 Date Construction Permit Issued by PCHD i A-- Og5 Separate Sewerage System built by O W N e (Z Address _ A 2 o \/ EE, �� 14 99 Consisting of 1000 Gallon Septic Tank and 2 5 O L.F o)= Z4- w I OE A 1�o2 PTloJ TgeNGd Other Requirements: 112 I R.0,8. P I LL Water Supply: Public Supply From, Address or: ""X Private Supply Drilled by N1'AT r JOIE Address 101 P) RTE. 31 PATrEQ5c> J NY. I Z 5�3 Buildi. g T3�P -fir' 4 "IrL - I0E_- as ers' on- control been completed? _�._:: Number of Bedrooms -1AJ0�� Has garbage grinder been installed? t� O I certify that the system(s), as listed, serving the`rnise'� onstructed essentially as shown on the as- *rN yo built plans (copies of which are attached), in ac rvi rth� Ise CHD Construction Permit and approved Tans and the standards, rules and regulations e✓' $ ` ` "''" : ` ' Y5 " p g ��htq D artment of Health. Date: I 10 Certified by �' "' S. � �' P.E. R.A. RALPH . e.. of T2.0PV Address �7 l�Ca/ u G —oil- 0 License # OSJ� Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: �- Date: & > Whit copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT ,50 03 N E: &act location of well with distances to at least two perm menylandnfarks to be provided on a separat heet/plan. Well Driller's Name Able. / I A A, Signature: 541 Z Address: Date: i White copy: HD File; Yellow copy -Building Inspector; Pink copy -Owner; Orange copy- Well driller Form WC -97 �f T'own/Village :"-" P ��t Tax Grid #° .. ... .. _: Map fi, *Block Lots) c2 Well Owner: Name: Address: Co 1100e. AA s a ;� Use of Well: 1- primary 2- secondary Residential Public Supply Air co d/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 __,2_Lft. Length below grade _,�16 ft. Diameter _7 in. Weight per foot % lb /ft. Materials: _X Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped 'y Compressed Air Hours6l Yield A gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach.. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface Sod ° If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type I�eQsi6 Capacity -7C; F'pA Depth ZIO 'Model GOULDS745 Voltage 7-305w41.CHP Tank Type(, Volume —40-4 AL . Date WeY Comp pted 7/0/6:! Putnam County Certification No. 0 0 Date of Report - Well Driller (signature) &&r-, 3�&l N E: &act location of well with distances to at least two perm menylandnfarks to be provided on a separat heet/plan. Well Driller's Name Able. / I A A, Signature: 541 Z Address: Date: i White copy: HD File; Yellow copy -Building Inspector; Pink copy -Owner; Orange copy- Well driller Form WC -97 ` . YML ENVlRONM SERV{CES 321 Kear Street Yorkt 1 Albert H. Padovani, Director LAB #: 9.601539 CLlENT #: 59674 NON STAT PROC PAGE: 1 C&C MECHANICAL DATE/TIME TAKEN: 09110/06 01:00 233 TOWN VIEW DRIVE /T) v: REC'D: 09/11/06 12:50 WAPPINGERS FALLS, NY 12590 REPORT DATE: 09/18/06 PHONE: (9i4)-474-2l84 SAMPLING SITE: 16 ARBUTS ROAD, Pi[TNAM VALLEY SAMPL£ TYPE..: POTABLE ; PRESSURE TANK PRESERVAT}VES: NONE COL'D BY: CHARLES CLERIC[ TEMPERATURE..: < 4C NOTES...: ` COLIFORM M�TH: MF .....~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~r~~~ DATE FLAG.PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFlLE 09 COL. IFORM ABSENT /100 ML ABSENT 1008 09/12/06 LEAD (lM(S) 2.9 ppb 0-15 ppb 9003 09/13/06 NITRATE NITROG 2.78 MG/L 0 - 10 9052 09/13/06 N{TRITE NITROG <0.0J. MG /L N/A 9162 09/13/06 lRON (Fe > 0.280 MG/L O-0.3 mg/l 9002 O9/l4/06 MANGANESE (Mn) 0.056 MG /L 0-0,3 mg/1 9002 09/12/06 SODIUM (Na > t 5.2 MG/L N/A 9002 09/11/06 pH 5.8 UN[TS 6.5-8.5 9O43 09/11/O6 HARDNESS,TOTAL 128 MG/L N/A 09/18/06 ALKALINITY (AS 48.0 MG /L N. 01 09/18/O6_~- - TURBlDlTy (TUR - -1 -q�NTU�-. ' WTU_~, COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NO]) OF A SATlSFACTORY SANITARY QUALITY ACCORDIN�-f�~7HE NEW YORK STATE AND EPA FEDERAL'DRlNKING WATER-STANDARDS', FOR' THE PARAMETERS TESTED, D, A THE TIME OF COLLECTlON. Pb/Cu LEAD }imits for public schools are set at 15 pl.-A). EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD va}ue of more than 15 ppb and at 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 shail 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 Sod�um. For those on a moderately restricted diet, a maximum of 270 mg/L. of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown He-i-ghts,_N.Y. 10598 _ Albert H. Padovani, Director LAB #: 9.6O1539 CI lENT #: 59674 NON -13-FAT PROC PAGE: 2 C&C MECHANlCAL DATE/TIME' TAKEN: 09/i0/06 0J.:00 233 TOWN VIEW DRIVE". DATE/TlME REC^D: 09/11/06 12:50 WAPPINGERS FALLS, NY 1259O REPORT DATE: 09/l8/06 PHONE: (914)-474-2184 SAMPLING SITE: 16 ARBUTS ROAD, PUTNAM VALLEY SAMPLE TYPE..: POTABLE : PRESSURE TANKT.M.44/.14-1'5'f PRESERVATlVES� NONE COL'D BY: CHARLES CLERIC{ TEMPERATURE,.: < 4C NOTES...: COLlFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS lN WATER CHEMlSTRY. WATER WITH A LOW pfi MlGHT 8E CORROSIVE TO METAL P�PES AND F[XTURES. THE NORMAL RANGE OF pH YS' 6.5 TO 8,5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESlUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, lN MG/L. THE HAR�NESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WH[CH THE WATER HAS 8EEN SUBJECTED. SOFT WATER: 0-70 MG/1- VERY HARD WATER: ABOVE 300 MG /I AJz� ��-4AF/��WAT��R^� ��~`�4��-MG,�'--'-��4G41- ��-�� I�G ' l lW�� -----~ HARD WATER: 14O-300 17.2 SUBMITTED BY: ELAP# l/)323 r`t i. 411. 1,4, BRUCE R. FOLEY � � LORETTA MOLINARI. RN., M.S.N. Public Health Gi�etar =,: YOB ksociaie-- Public Health "'Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN O (Signature) DATE: 9L r? 12 C i i �/ y P. �,2e;l L/ FFICIAL: /()/ 6/a The Putnam County Department of Health will not issue .a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRINO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES * GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM NOFZ10 i MARiA DE R1GG 1 41,14 1 . `57 Owner or Purchaser of Building Tax Map Block Lot OwrJE PQTr AM VALL E'( Building Constructed by TownNillage 1 o Ap-&uT us IT rIzEET RoARli�l,&ooy_ LAKE MAP 1., SEc. B. Location - Street Subdivision Name Or-, EAm 1 L-r P_ es, 1 o Et1f ->1 148 Building Type 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. l Dated: Month 1 O Day 2 Year 2_006o Signature: Aie" ` Al-_ All ckopefo II Ei -164i Title: �E PT,C D STALL. 2 Gener Contractor (Owner) ignature C 41cr -aio DF_ Ric G t - P_�,UI LOEP— 0�oFR.to DE 1 6;r� 1 n) Address: 3 G REEK.51 pe RD. Address: 3 G(?.EE-IC51 C.- P_yA Q- State }-�op � -r, `�. Zip I ZS33 State ]c< Zip { Z 's33 Form GS -97 RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914).271-2820 Fax Mr. Joseph S. Paravati, Jr. Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Construction Compliance for DeRiggi 16 Arbutus Street, Putnam Valley, NY T.M. #41.14 - Block 1 - Lot 57 Dear Joe: November 3, 2006 Please find enclosed five (5) signed and sealed copies of the drawing entitled SSTS As -built Lot 148 On Map 1, Section 8 (Sec. 41.14, Block 1, Lot 57) of Roaring Brook Lake Located At Arbutus Street, Town of Putnam Valley, NY, Prepared For Onofrio & Maria DeRiggi, dated October 10, 2006. As per your review memo dated November 1, we provide the following revisions: • The drawing scale is noted on the plan • Three (3) original guarantees have been provided • The as -built house location is referenced to the property line We are requesting your continued review and approval of the submitted matreials. __......_.._ —Please-call-me-if-you have -any- questions :___.-- .__..__..__.._........� Sincerely, vz��& Ralph G. Mastromonaco RGM /il Enclosures SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health Mike Doebbler DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr.. Doebbler: ROBERT I BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health November 1, 2006 Re: Construction Compliance — DeRiggi 16 Arbutus Street (T) Putnam Valley, TM# 41.14 -1 -57 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. Please provide, a scale for the .drawing. 2. Please provide 3 original guarantee forms. 3. The as -built house location with respect to the property line is to be provided. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise: JSP/kly Very truly yours, doseph S. Paravati, Jr.- Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fu (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914) 271 -2820 Fax Mr. Joseph S. Paravati, Jr. October 10, 2006 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: SSTS As -built for DeRiggi 16 Arbutus Street, Putnam Valley, NY T.M. 941.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: 1. Five (5) signed and sealed copies of the drawing entitled SSTS As -built Lot 148 On Map 1, Section B (Sec. 41.14, Block 1, Lot 57) of Roaring Brook Lake Located At Arbutus Street, Town of Putnam Valley, NY, Prepared For Onofrio & Maria DeRiggi, dated October 10, 2006 2. Four (4) signed and sealed copies of the Certificate of Construction Compliance dated October 10, 2006 3. Four (4) signed copies of the Well Completion Report dated July 29, 2005 4. One 91) signed copy of the Well Water Analysis dated July_ 29, 2005 — - . -> �— - -- --� r - - --.-- it ' 5. Thee. X131 _conies:of,�the�Guarantee of��.Subsurface��Sewaae Tceatm'erit,, Svstern zdated 6. One (1) signed copy of the E911 Address Verification Form dated October 6, 2006 7. One (1) copy of the New York Board of fire Underwriters Certificate -- .8. Check-#4443 payable to the PCDHI in she amount of -$300 We are requesting your review and approval of the completed works. Please call me if you have any questions. Sincerely, IFIph G. Mastromonaco RGWJI Enclosures RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914L271 -2820 Fax Mr. Joseph S. Paravati, Jr. October 10, 2006 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: SSTS As -built for DeRiggi 16 Arbutus Street, Putnam Valley, NY T.M. #41.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: 1. Five (5) signed and sealed copies of the drawing entitled SSTS As -built Lot 148 On Map 1, Section B (Sec. 41.14, Block 1, Lot 57) of Roaring Brook Lake Located At Arbutus Street, Town of Putnam Valley, NY, Prepared For Onofrio & Maria DeRiggi, dated October 10, 2006 2. Four (4) signed and sealed copies of the Certificate of Construction Compliance dated October 10, 2006 3. Four (4) signed copies of the Well Completion Report dated July 29, 2005 4. One 91) signed copy of the Well Water Analysis dated July 29, 2005 5. Three (3) copies of the Guarantee of Subsurface Sewage Treatment System dated October 2, 2006 6. One (1) signed copy of the E911 Address Verification Form dated October 6, 2006 7. One (1) copy of the New York Board of fire Underwriters Certificate .8.-• .nick -#44-43- payabie °to °ire-PCDH in the amour of $300_ We are requesting your review and approval of the completed works. Please call me.if you have any questions. Sincerely, R Iph G. Mastromonaco RGM /jl Enclosures Joe_ FROM (FR I) JUL 21 2006 15 :21 /ST. 15: 20 /10. 6310615644 P 2 ri BY THIS CERTIFICATE OF COMPLIANCE THE ::.. APP-OF T_1i E.__UNDERWR�.T.�.F7S.. BUREAU OF ELECTRICITY 5 40 FULTON STREET NEW YORK, NY 10038 CERTIFIES THAT Upon the application of AMPUL ELEC., INC. 62 FULTON STREET WHITE PLAINS, NY 10606, Located at 69 ARBUTUS ST PUTNAM VALLEY, NY 10579 Application Number: Section: 41.14 Block 2103847 1 upon premises owned by MARIA ONOFRIO & DeRIGGI 69 ARBUTUS ST PUTNAM VALLEY, NY 10579 Certificate Number: 2103847 Lot: 57 Building Permit: BP2005 -169 BDC: W106 Described as a Residential 0 -599 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: First Floor, Outside, I A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the stn Day of July, 2006, 5r Name (YrY Rate Ratin Circuit Miscellaneous a.: 781766 _ SEPTIC PUMP & ALARM SAlarm and Emergency Equipment Panel Board l 0 sElyllic Alarm Appliances and Accessories Pump Motor 1 0 SEPTIC F.H,P. Wiring aid Devices Motor Control Center 1 0 SEPTIC Special An as built inspection, of the delineated electrical installation, determined that nn obvious hazard is not present and the installation is believed to 211 be in comformance with the applicublc reference standard for the estimated period of construction or the premises wiring system, seal 1 of This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated, 0 PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVFSION,�OI ENVIR,0NMEN:TAu HEAT -1,11[ SE'RUICES- FIELD ACTIVITY REPORT MAM'F zTC 6-: :.A ngFS4: geB07-0S S r" R)T N o� d!✓�_`_V,4LC.E>,l .Street . :Tov.,m State.... Zip PERSON IN CHARGE Q / nR INTER VIE M ` • 7/o (� - - — - -. . r-- F� - �q-T3 `r `� ' ° - ':: 'PEST OAL SiDia re , id T' to IMP S'E.Ii1FT� RY: : • now le of this report: SIGN.4I iJ sz: Aug -08 -06 04:36P Ralph G. Mastromonaco PE 914 271 4762 P.01 " . SHERLITA AMLE2, MD,_1NiS, FAAP Commissioner oj'Hea'! ?'" LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH i Geneva Road, Brewster, New York 10s09 REQUEST FOR FIELD TESTING ROBERT J. BOND[ All inforMation below must be fully completed prior to any scheduling. DATE: 8 a Olo ENGINECRING FIRM:RALPd 1 - :M;' TQQM PHONE #:q14 Z-71- 4762. PERSON TO CONTACT: N W C'(INS'I`ItCICTION 0 EPAIR PROGRAM L ADDITION PROGRAM PIF_ASE S(-dEOVLF -TEST Fop- REASON: DEEPS:'O' ", TERCS: ❑ PUMP TESP FiP-$ropL.AST IdsPE�roti RoAD/s�t REE r : OF TIDE �A.`�.T�- i,an��Yo�, KiVTi6 e✓TGr-ET.__ TOWN: QTt A V � LLB'( TAX MAP #: 1. SUBD.R';ISION: P, oAP -WA B (1G101 LA lam- LOT #: 146 12�GG1 OVVNF.R:_ - -��_ . NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO _:.- ... _.._ __ . -.Propos :d US'E'S -vvft sin A;he drain nge basin- of.West.Hrareh or Doysls..Corher & ...�......._ _ Croton Falls Reservoirs. 0 -9f, Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ 14 Proposed SSTS _within 200 feet of a watercourse or a DEC wetland. F1 `jjr- Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑( Proposed -SSTS for. a. Commercial' Project. It is thit responsibility of.the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to,any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined,.to be..Delegated based on the above response and then subsequent information indicates NYCDEP is, .,required to witness the soil tests, it will be the sole responsibility of the de4iun professional to schedule re- witnessing of the.soil testing with NYCDEP. I�OIt O(jNTY, USE ONLY y DATE: /� �;.-.J �t TIME._ -- - COMM SNTS: NLC. Fop :.i! -.W1 Environmental Health (845) 278 -6138 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 FO (845) 225 -5418 !Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278-6678 Nrrsiing Home Care Fax (945)279-608'5 Early lntervendomTreschool (845) 278 -6014 Fax (845) 278 -6648 ALti; -O -Et [r, ?UL i.`•: `- } FEL:845 -278 -7921 NAME: PUTNAM COUNTY DEPARTMENT OF P. 1 Aug -08 -06 04 :32P Ralph G. Mastromonaco PE 914 271 4762 P.01 > "G le,5 -79 Z I -- _ _SHERL1TA AMLER, MD, -MS, FAAP Commissionet• gj'Nealth LORETTA MOL*ARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI .... , _ .. .� :. County Executive _ DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10,509 REQUEST FOR FIELD TESTING All information below must be fully completed prior to any scheduling. DATE: 8 a O(o ENGIN9ERINC FIRM:RALP9 �1.Iq.4 PHONE #:914 Z71- 47&Z PERSON TO CONTACT: ::Tp5r, E t�P.i4VAT1 ANEW CONSTRUCTION 0 REPAIR PROGRAM, REASON: ROAW/ - r'REET: TOWN: DEEPS: ❑ PERCS: O PUMP TES El ADDITION PROGRAM PLEASE 5c�r-0ul.E7EST Fop- TX Fipsr op L AsT I szrio>.I F TAR MAP #:_41-14-1- 57 SUBDIVISION: P C)ARI'&A b'Roov-- L/Ai�E .. COT #: 46 - OWNEA: P� 21GtGl NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO _ - Proposed`SS1'S wi"tkiin' "the diainage- fiasin of:PVest�iii=auch or �oytis'CoriteY`8i _ "' ' - `"" ' Croton Falls.Reservoirs.. 0 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 IW_ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. D Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. F] Proposed SSTS.for a Commercial Project. It is tht responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you 6swered.Zs to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated based on the above response and then subsequent info rmiation indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule: re- witnessing of the soil testing with NYCDEP. FOR COUNTY -USE ONLY. DATE:: _ .TIME:. `COMry ,N'TS: ee� n,e Environmental Health ($45) 279 -6130 Fax (845) 278.7921 water supply Section (845)' 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278-6026 WIC (845) 278 -6678 Nursing Howie Care Fax 043j278-6085' Eariv Intervention/Preschooi (845) 278 -6014 Fax(845)278-6648 AUG -8 -2006 TUE I 5 4:1 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Aug -08 -06 04:37P Ralph G. Mastvonnonaco PE 914 271 4762 P.O2 rR0M (FRI) AL 21.2006 15.21 IS T. 15.2V0.6310615644 P M ;'. '"Nt�..:0" w'T,,p�t��TG OF �t?!Nf�laA1VOE' THE - . NEW YORK BOARD OF FIRE. UNDERWRITERS BUREAU. OF ELECTRICITY 40 FULTON - STREET - NEW YORK, NY 10038 CERTIFIES THAT 1 Upon the application of upon premises owned by AMPUL ELEC., INC. MARIA ONOFRIO & CeRIGGI j tit FULTON STREET 19 ARBUTUS ST J WHITE PLAINS, NY 10806, PIyTNAM VALLEY, NY 10579 Located at 89 ARBUTUS ST. PUiNAM VALLEY; NY 10579 Application Number: 2103847 CertHicate Number: 2103847 Section: 41 14 Block: 1 . Lot: 67 Building Permit: SP2005.169 BDC: W1o6 Described as a Residential 0-599 square ft, occupancy, wherein the premises electrical system consisting of { electrical devices and wiring; described below, located inion the prprnisps at. First Floor, Outside, A visual inspettion of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordpnce._. with the require►nents . of, the applicable code and/or standard promulgated �y the State of New York; Cepartmertt of State `Code Enforcement and Administration. or other authority hawiAg ,Wisdiction, and fcund "to be in cam' pliance therewith"on the 5th .Day of July,2006. Miscellaneous SEPTIC PUMP & ALARM . Alarm and Emergency Eaulpment PAMI Board I . U $EN1 IG Alarm Appliances And Accessories Pump Motor l 0 SEPTIC F.H,P, Wiring and A4vica Motor Control Center l 0 SEP'T.IC _ Special An as built impCvion, of chc delineated tiectrieal ins :611mion, deieenincd thitan obvious Usrd is not presatt aid the itutallatioo is Wicved to be in comform4oir will+ the applicuble reference standard for the estimated period bfb045truc6an of the promises wiring Sol=, seal • I of I ' This certificate may not be altered in anyway: and is validated only bY, the presence of a raised seal at the•location indicated. N Emil I, Lvalmigill HUG -9 -2006 TI_IE TEL:845- 278 -7921 NAME:PUTNAI4 COUNTY DEPARTMENT OF P. 2 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FILIAL SITE INSPECTION . Date: Inspected by: NSF' Street Locations S Owner /�� Town: �'v n.. �. Subdivision Lot # 16f 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. _ Width . Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15 from STS area...:::... e. 100' from water course / wetlands..... ................ !' M. Sewage System i. a. Septic tank size - 1,000 .......... 1, 250 ......... other ................ b. �Septic'tankinstalled level ......................... . ....................... c. 10' minimum from foundation .......... .......:....................... d. Distribution Box 1. Ail outlets at same elevation -water tested ....... ........ .. 2. Protected below frost ................... ............................... 3 �in ft.Original box & tr e. Junction o Box properly e ........... 6. renc es 1. Length required Length installed 2. Distance to watercourse measured Ft..�- 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1116 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. -Room allowed for expansion, 100 % ......................:.. 8. Size of gravel 3/4 - 1112" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends capped ...:..................... ............................... g ..Puma or .-Dosecf Systems i. S'ize` . pump chamber....... 2. Overflow tank ................... ............................... x,1.1- -. 3. Alarm, visual/ audio ........:. ............................... .. 4. Pump easily accessible, manhole to grade.......: . 5. First box baffled ........................... ........................I. -•F�c 6. C�yycle witnessed by H.D.estimated flow /cycle..,.D..;11 k_ M:House/Buil din' � a. House located per approved plans............ I.............. ..... . b. Number of bedrooms ............ ..............................��;�� IV: Well ; Well located as per approved plans . ......:........................ b. Distance from STS area measured ft ........... c. Casing. 18" above grade ...................: d. Surface drainage around well acceptable ....................... V. Overall Worlananshin . 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 & dinto exist watercourse t g. .Footing drains discharge away from_ STS_ area h: Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 YNSPL+'CT`i X FOR 1FiL'L PAD :. Date: L,-2e,/ ° Inspected by: J S Fill pad located perthe a P, P roved plan / Fill Pad Length Required Length_ Fill Pad Width Required Width Fill Pad Depth ` % Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed F-rosion Control Installed ,S Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mike Doebbler Ralph Mastromonaco Engineering 13 Dove Court Croton -on- Hudson, New York 10520 Dear MR. Doebbler: December 12, 2005 ROBERT J. BONDI County Executive V' Re: Field Inspectior. — DeRiggi Arbutus Street, (T) Putnam Valley TM# 41.14 -1 -57 A site inspection was made for the above referenced project on December 8, 2005. The following comments must be corrected in the field. I. A pump test needs to be witnessed by a representative of this Department. 2. The force main needs to be 3.5 feet below grade. 3. The pump chamber needs to have a riser and manhole to grade and a vent pipe. 4. The well casing needs to be raised to 18 inches above grade. 5. System can be backfilled except for the pump chamber cover and distribution box. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 Dec -06 -05 04:20P Ralph G. Mastromonaco•PE 914 271 4762 P.01 845 278 - PUTNAM COUNTY DEPARTMM OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENT ON JOSEPH ❑ GENE RE UES FOINAL INSPECTION ' For: Fill . All info ation must be fully completed prior to any Trenches X inspectio s being made. PCHD C instruction- Permit. #. :PV- ZI -.D.3; -31N28 -D3 V Located: U , 'f- {� (V) Tt�AM ALLEY Owner /A plic Name: D E tG•G I Block _I Lot S Formerly} Subdivision Name: M i Subdivision Lot # i Is system' fill completed? Yt="S Date:, 1 O l ps Is syste �: complete?: Y Date: L 2 (� f35 Is syste constructed as. per plans? Is well d 'lied? do Date: Is well located as per plans? Are ero0on control..measures in place ?, I certify tat the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion ' in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and. R tions of the Putnam 'County Department of Health. Date: i 2� �o� D`-� Certified by: PE �_ RA Professional Addressi o�- ti #, , . Lic. # 05449j5 Comme�s:. TA r. -KS F1 E11.75 A> Q ALL P f PES 1r S-TA LIEC� Form F #R -99 r DEC -6 -2005 TUE 03:29 TEL: 845- 278 -7921 NAME:PUTNAM COUNTY DFPAPTMFNT nF P 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVI( CONSTRii UCTI N PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #1 Located at _ P_ pjy"j" lY57 2 E Ej- Town or Village R)1 't A M 1 A L L E1' Subdivision name RQAQJt (2 &2cbL Subd. Lot # Tax Map , Block I Lot �] Date Subdivision Approved 71 Z g 14-'s Renewal Revision Owner /Applicant Name(:Ao F QC2Ij MA 21A D � j Date of Previous Approval Mailing Address -3 G 2 F a K.S I c,>E Rr1)• H OPI= h/ E:L__1t LT aj, � - I • Zip 2 Amount of Fee Enclosed Building Type I FAM. 2ES1PE4CFLot Area *,No. of Bedrooms 2- Design Flow GPDLC� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I (:)oQ gallon septic tank and 7, 50 LF of Z4" vv i n _ A a!!�?Qp_ E 'r-ioij T2E dcd Other Requirements: To be constructed by To B G C)ETE RN I d FD Address Water Suualy: Public Supply From Address _ .._ ..._, or: X Private -Supply Drilled by To 6r; �GTE�P'I1 r.�l✓D Address ell 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 sv= 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, V-1V uance of the approval of the Certificate of Construction Compliance of the original system or any reps _ er Signed:` P .E. R.A. Date (O Z Orj a Address ii `f 1 pSZp License # O 1 All APPROVED FOTRYJ : This approval expires two years from the date issued unless construction of the J1'U - �iivS� sewage treatment syste mpleted 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 or di arge of domestic sanitary sewage only. B z Title: A-Pfi-e Date: j it opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 RALPH G. MASTROMONACOI P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271,4762 M (914) 271 -2820 Fox..--. Mr. Joseph S. Paravati, Jr. Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Proposed SSDS for Onofrio & Maria DeRiggi Arbutus Street, Putnam Valley, NY Section: 41.14 - Block 1 - Lot 57 Dear Joe: Please find enclosed the following materials: October 12, 2005 Via Airborne 1. Three (3) signed and sealed copies of the drawing entitled, SSDS Plan Lot 148 on Map 1, Section B (Sec. 41.14, Block 1,. Lot 57) Of Roaring Brook Lake Located at Arbutus Street, town of Putnam Valley, NY, Prepared for Onofrio & Maria DeRiggi, dated August 6, 2003. 2. Four (4) signed and sealed copies of the Construction Permit Application for Sewage Treatment System. 3. One (1) signed and sealed copy of the Design Data Sheet for the percolation tests performed in the stabilized fill. 4. One (1) copy of the request for field testing for the fill placement. 5. One (1) copy request for field inspection. At this time, we are requesting your review and approval to construct the proposed septic system. Please call me if you have any questions. l y, G. Mastromonaco Enclosures Cc: Onofrio & Maria DeRiggi w /copy of plan PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM OwnerOj or-gio iMARIA DE RI GG►I Address GR EK.SI E Ro 0 ud GTIOj Y 1253? Located at (Street) A BUTUS �°T'REEn- Tax Map4�, C Block I Lot 57 (indicate near st cross street) Municipality 11TI M LLE`�' Watershed LEE�csK-ILL of low6pmeI!. SOIL PERCOLATION TEST DATA Date of Pre - soaking 9 1 ZS 105 Date of Percolation Test 91Z(.1015 Hole Na R;un No tme Mart StopNLn) eta se Time 1 1 V"A V I V YIiU Surface (Inches) Start Stop LG V Il dropp In Inches Date MrnfIncfl 1 �lo -I:IC� (a Zo Z3 -3 z 2 I.JG-1 :25 9 Zo Z:?> 3 3 1.25 +a4 9 Zo 23 3 4 5 1_ I�14 -1 :23 3 1 =32 -I 4 5 1 2 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST ]PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES -_ DEPTH--,.. HOLF�rIQ._ _ HOLE NO. -HOLE NO. 4.0' 4.5' 5.0' 5.5' =: 7.5' 8.0' 8.5' 9.0' 10.0' , Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level -rises after being encountered Deep hole observations made by: Date Design Professional Name: p co :y Address:,�c %u �'T of NEw . Signature Design Professional's Seal I a !BRUCE R. FOLEY-. Public Health Director LORETTA MOLINARI RN., M.S.N, Associate Public Health Director Director of Patient. Services DEPARTMENT OF HEALTH. 1 Geneva Road .-Brewster, : New York 10509 REQUEST FOR FIELD TESTING. ATTENTION: >(,JOSEPH PARAVATI ❑ GENE REED Allinformation below must be fully completed prior to any scheduling. DATE: ENGINEER OR FIRM: RALDiJ (2, H& TOQH"CO PHONE O A - 2-71- 47&2, REASON: FILL PlAc s MEN DEEPS: ❑ PERCS: ❑ PUMP TEST: o ROAD /STREET: TOWN:. PRAM A LLP.'f TAX MAP #:41.14.1 -57. SUBDIVISION: PQAIZI N G Pi por_ L.frk:F_ MAP IS LOT #: OWNER: CAN OF RI O t' MARIA pE R1 -r NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING -.YES NO.' _...:. . ❑ '� Proposed SSTS within the drainage basin of West Branch orBoyds Corner Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ 21� Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. o Lk' Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Les.to any of the questions, NYCDEP must witness the soil tests. This .Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE: COMMENTS: (FIELDTEST) FOR COUNTY USE ONLY 11KE: Mar -22 -04 11:55A Ral h G. Mastromonaco PE 914 271 4762 • Complete items 1, 2, and 3. Also complete A. SI Item 4 N Restricted Delivery is desired. O Agent • Print your name and address on the x ❑Addrese _.._.._ _... e r se_ 1 _ so that ive can return the card to you. e. C. cafe of �eiive►y O Attach this card to the back of the maifpiece, _ s or on the front if space parinits. ff from dem 1? ❑ Yes 1. Arilde Addressod to: . eriher dei� - bsim: ❑ No Mr. Ruth 13 Arbutus Street. Putnam Vallev. NY 1.0579 Vr7� K'rbN 11 3. Service Type cartnied IaAaO E3 express Mai: Regwered Cl Rearm Recelpt for Merchandise 0 Insured Mail Q C,O.D; 4. Restricted Delivery? Pam Fee) El Yes W 2. Mide Number v rtrrn' service febel) fm' 7002 2410 0000 7406 5404 (f'ransror Ps Form 3811, August 2oo1 DornestioReairn Reoelpt aaWw- M -ZIMS • Complete items 1, 2, and 3. Also Complete Item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. . • Attach this card to the back of the mailpiece, or on tho front It Space permits. 1. ArucloAddresredto: A. signature O Add►esa„ge B. Received by f?ri Nams1 % G. -Gate of Delivery L °r�r� t G••P�C 1. D, le diliirery address dnferent from item 1? 13 Yes M YES, a tmdarvary aderess 0 No Miceli 15 Arbutus Street Putnam Vallev. NY 10579 sem"coYype V cerdw Map 0 Dgxess Mau 0 Registered 0 Return Receipt for Merchandise i O Insured Mel - . • 0 _C.O.D.. - 4. Restricted Oellvery? IExrra Feel {� YeS 2. Arilcle Number (Trvrsler rron► scrvtco raDer) 71302 2 410 0000 7 4 0 6 5381 PS Form 3811, August 2oo1 Domestic Return Redetpt sACPRr-0azees • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the tmallplece, or on the front if space permits. 1. Article Addressed to: Mulqueen 14 Arbutus Street I Putnam Valley, NY 1P579 A 0 Agent D. Is deliveiy adds diflfyrent from Rem 1 ?/ Lr Yet ff YES, enter delivery address below: a No s.. seMce TM ® Certffiod ail 0 Express Mail ❑ Regieieied b Return Receipt for Merchandise E3 Insured Malt 13 C.O.D. C Restricted Delivery? (Extras Fee). 0 Yes 2. Article rfr Number rservice label) (Transfer Iran 70U2 2410 .n000 7406 5374 _., ,- . PS Form 3811, August 2001 Don osk Holum Receipt 2ACPRKOZ-0B55 P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI SEWAGE TREATMENT SYSTEM PERMIT # Located at Ai2eqL6 T U Town or Village �U -j'dAM VALLEY '�""Q II Subdivision name ROA21 h A Vp� U,Subd. Lot # Tax Map4�4_- Block I Lotl 51 Date Subdivision Approved � I 2 S l 45 Renewal ��A Revision N� Owner /Applicant Name Mailing Address Gy_E :er_s i PE PP OPE Amount of Fee Enclosed -ion j Date of Previous Approval 41A LL _TV NGr'IDN , 4-� Zip 21 533 Building Type I FAMI LY - Lot Area- 66Aallo. of Bedrooms Z Design Flow GPD��'9 Fill Section Only >- Depth 3. S Volume 8 20 c.Y. PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 000 gallon septic tank and ZSO L.F. Other Requirements: To be constructed by To l�, QETEpM LAED Address Water Supply: Public Supply From _ Address P"rfvate'Supply"I &h5d -by - Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sum described above will be constructed as shown on the approved amendment thereto and in saccordance 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 -Pepartment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operat' tion any part of said sewage treatment system during the period of two (2) years immediately following -the d k!' f the approval of the Certificate of Construction Compliance of the original system or MVepairs ther Signed: Address P.E. - g R.A. Date b15103 License # 5169b APPROVED FOR CONS s approval expires two years from the date issued unless construction of the sewage treatment system has been comp eted and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. pproved discharge of domestic sanitary sewage nly. B ` �- Title: C C.� / Date: �'- y' White copy - HD Fi ; Yel ow opy - Building Inspector; Pink copy - Owne ran opy - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELLT PCHD Permit # Well Location: Street Address: TownNillage Tax Grid # AP- e�-lJTUS S- rV-EET PDT1 AMVALLEY MaP41.14- Block Lot(s) 57 Well Owner: Name: oPP-lo j "AP-IA DE R.' � Address: 3C2EEK5I0E PD. H0P T0JCrioJ 0TI25 WELL Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- rima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 3 Est. of Daily Usage 4c� gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason W Co 0C o for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ......... ....................... Yes No _ Is well located in a realty subdivision? ....................................... ......................II........ Yes No Name of subdivision RO I �G L I: S lore Lot Vo. 142) Water Well Contractor: FF DEA L Address: s .l! Is Public Water Supply available to i e? .................................. ............................... �A s No Name of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to on separate sheet/plan. 4vided Date:..g 5 03 Applicant Signature: -- -- _ .. �L M o AGO . S . 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 wat r well driller certified by Putnam County. Date of Issue -0 � Permit Is s ' g Official• / Date of Expirati b r Title: Permit is Non -Train ferry le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Oar; Orange copy - Well driller Form WP -97 14.16-4 (9!951 —Text 12 PROJECT LDX NUMBER 617M State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsor] 1. APPLICANT NSOR 0d0f= _ lam. W '&IZ 1 2. P wr NAME. , oQft 9-J C> PA D R 3. PROJECT LOCAMON: Mtmfaiailty li 1 jJ Y�1 L L� County► U N m 4. PREMSE LOCATION (Sliest addn>ss and road Intersections, pfandnent landmada, eta, or provide 1/4 MILS SovT' Of Ir.1T'��s>✓c�"(oj� r . S. Is ROP09® ACTION: ❑ emanalon ❑ Modi11040mv Reratwn G. DESCRIBE PROJECT BRIEFLY: I PF.-GEO I4rrW oIlE t06 WAS 5vg3fc-X pFAG1✓ sEvVAGE D Kf t>54LJ DJ21 LL. E D W F L.L., FA\*,O PWE5WA% 7. AMOUNT OF LAND Initially t7 • �� acres m1matey O �O�O acres 8. WI PROPOSED ACTION COMPLY WITH SUS11NG ZONING OR OTHER DUSTINGIAND USE RESTRICTIONS? XYes a No If No, dmorihe briefly S. IS PRESENT LAND USE IN VICINITY OF PROJEL" _ �._ aldentlal 13cw wciat•: -° .'._.El _Agrio*ra _ _..-Q.ParidF=msVOp= hrat° -- _0induatdai 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR Ut_TIMATEI.Y FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAAI., STATELACAL)? Yea O Na If yes, list agency(s) and pennlU Pravda Rbri4AMGo0Lk P6rr 07 }- IE,d,L�.� : BC4R00� NEALT� A�pr �AL' PV TI-AH vA�'f'. 1LnIr1G I DE F I ,: bl-)l L.plrl4 11. DOES ANY OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? []Yes No If yea, list agency name and permWapproval 12. As A RESULT OF PROPOSED ACTION WILL EXISTING PEWIT/APPROVAL REQUIRE MODIFICATION? ❑ Yea o I COMFY THAT THE INFORMATION PROVIDED ABOVE 18 TRUE 70 THE BET OF MY %mow msE Applicamlan L �% 1`'Io�+H�,O t P Date: lo-3 r Stgnatura: If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II--- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A DOES ACTION E PEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 817.47 If'yes, coordinate the review prozess and am the FULL EAF. ❑ Yea y o EL„WIlL:A 10M.fli =CEfYE C00FfBINATEpiiEviEw_ APjwVlDED FOR uNusm ACTIONS IN:�;RL1!{riif±, PART,817.t3? . ..If No, a negatltredactaratlon may be supersede another Involved agency. ❑ Yes Zwo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C7. Existing air quality, surface or groundwa sr quality or quantity, noise levels, existing traffic pattenut solid waste production or disposal, potential /for � erosion, drainage.or flooding problems? Explain briefly: C2 Aesthetic,, aggricultural, archaeoicgtcal, historic, or other natural or cultural resources or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfleh or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C.0. A commualWa existing plans or goals ae ofrlciady adopted, or a change In use or Intensity of use of land or other natural resources? Ecplaln briefly, Aloe C8. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C& tong term, short term, cumulative; of other effects not Identified In C1.= Explain briefly. C7. Other Impacts (including changes In use of either quantity of type of enero? Explain briefly. D. WILL THE PROD HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CFA? Cl Yes E:` IS 1141 9 , °OR IS ! p UK_Y TO eE CONTR OV E.R_i..Y .._ RELATED. TO POTEM_W_. L . ADVERSE ENVIRONMENTAL IMPACTS? ...Oyes &O � It yes. explain briefly PART ill — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUC71ONS: For each adverse effect identified above, determine whether it Is substandai, large, Important or otherwise significant Each effect should be assessed In connection with its (a) setting p.a, urban or Wasik (b) probability of occurring; (c) duration; (c) irreversibility, (e) geographic scope; and (f) magnitude. if necessary, add attachments or reference. supporting inateriaie. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts-have been identified -and adequately addressed. If question 0 of Part 11 was checked yes, the determination and significance must evaluate the poteMlal Impact of the proposed action on the environmental characteristics of the CEA. ❑ 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 andfor 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: Name of Lead. Agency t o Type N of F."pom e O ker in Lead Ardency T7wo of R/ O cor f tore o 7T I e Officer in Lead Agency SignaWre of Preparer (it diffemnt timn 1600nSibie Data N BRUCE R. FOLEY Ai8lia- -.r 4 A,� S� -A.N. M. N.' Associate Public Health Director Director of Patient Services DEPARTMENT' OF HEALTH 1 • Geneva Road )Brewster, New York. 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 279 - 6558 WIC (845) 278 - 6678 Fax (845) 278 .'6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (94.5) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER oe NAME: ADDRESS: (V 9 �zf SITE LOCATION: DATE: �d /' l r� 3 Toe p STAFF PRESENT: .4kW., Rob M., Mike B., Adegrg., Gene R., Shawn R., SPECIFIC WAVIER. REQUEST: -DOES -.-THE--* PROPOSED' VARIANCE .'_REQ ST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? NO DISCUSSION. REQUEST APPROVAL QR.DENIED, -DENIED REASON ZOR DAMAL -1 %__ I A 141% DATE: -7o DIRECTOR (SPECWAIVER) VEIN YORK STATE WARTMEW OF HEALTH Specific Waiver 3urealta. of Camnsmity Sanitation and rood Protection from Requirements of Pat! 75 and Appendix 754, jaMyCAR forIndlvidusl Hwaeh*WSew%e Tredni tKSysiem9 Name of Applueant C R i C-*ii i _ 0146F IZ10 MARIA _ Address 3 GtzEEKS1OF- RoAl7 HoP8W LL -U T1o� 1J.'t' (Z'S33 span ARBUTUS STREET PUT>JAM VALL:Ef JDS -1`� p� APPLICANT • . iL i. Reason why site does not meet 1bNYCRR_Append1x 7" (check appropriate box(sew. �] Separatlon disimm cannot be achieved. . �] Exeesshre•elope. High groundwater• lnadaquate depth to bedrock or lovermeabia layer. SSA unsuitable. m_ Other texpiaiN A LA'S` "t�A ll (®FEET FR.o of O F SLQ F!E TO PIZoPE Ri'')' LIt . vloos s l E 51-o ES � 2 G. LESS �I IOOr BETWE EIS W ELL A DoE, 5 O e D. • ocz) BE 5 6t� E. ,Y.�t LtLLZ m" F L14 2. Proposed design or conditions of waWer. 3. The Moosed design may- have >the:f llowti petdtatlans.(C1st gtrdPrtate b s4es� - - _ _.._ _. w- - - Increased risk of well or spring contaminatlam increased risk of surface water rontamtrtatiion: (� Pxpecxed design Ile of tha system will be d minisamd. } Operation of sewage system Is subject to 'rmechanhcat pr+oblerrd. J (C3 Other (explain) Additional information attached ConsWction pursuant to this waver request should not pose any foreseeable health or emdronrnental problems. In ac=r+dwcs with Now York State Osparhttent of Health Aci tnistradve Rules and Regulations. Pact 75.6 (b), a waiver Is hereby granted This waives nay be revoked by the Issuing official for ji change In conditlarts for which Zhis waiver was granted. iii ' • ORIGINAL • Local Health POW p COPY - AppilcantlDeslgn Professlonat 1 \ 4 . THERE ARE NO SEPTICS LOCATED WITHIN 100' UPSL.OPE OR 200' DOWNSLOPE IN DIRECT LINE OF DRAINAGE N/F PORCELLI 1 FROM THE EXISTING WELL LOCATION AS SHOWN. 41,14 -1 -56 THERE ARE NO EXISTING OR PROPOSED WELLS (VACANT LOT) I LOCATED WITHIN 100' UPSLOPE OR 200' DOWNSLOPE I IN DIRECT LINE OF DRAINAGE OF EXISTING SSDA ' fi EXISTING WELL tjI 100' MIN. SETBACK S 8820'30' E 340.61V 110.3• 1000 GAL CONC. SEPTIC TANK n' u 1000 GAL CONC. PUMP PIT — — — - -- 71 Td WITH OVERFLOW STORAGE — -- AND ACCESS MANHOLE DB1 PVC �1 17 If TIE POINT 'A' i 7 / 1 L1 -- 32' -� - -- 11 8. O.C. 4' SOLID (TYP.) — — — — J2- •` lB ALL LATERALS HAVE CAPPED ENDS (TYP.) U.P. ? O L2 -- — — ; DRIVEWAY 4' dP T2 .� — 31— — — I" PVC SCH40 11'\ — 31• - -- L7 SSDS AREA SSDS S.F.) — - -- fit_ LOT 14 EXISTING TWO p BEDROOM -- - - -- (4 1 . 1 4 - 1 - 5 7) HOUSE, e 1�\ ---- 31 - - -- - Ls _ r. 8 0. 6 6 acres o APPROXIMATE UNITS OF 1 \ 3 1/2' R.O.B. FILL BECTON ` 1` p 2 1 28,552 s.f. 1: PATIO APPROXIMATE LOCATION OF 1 �• C • I TIE 'B' IMPERVIOUS EARTH BERM 1 '�3 EXPANSION AREA ry POINT BUILDING DRAIN DISCHARGE ;• ------------------------y----------- 11 H 1 y / m ----- - - - - -- — / N 87108'30' W 387.21' I / tt 100• MIN. SETBACK TO SEPTIC APPROX LOCATION N/F MULOUEEN EXISTING WELL- 41.14-1-58 (DEVELOPED) TIE= DISTANCI t T1 12.3' 41. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL i SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS T2 «� 15.1' 33. PLAN AND THAT THE SYSTEM WAS INSPECTED BY 37. THE DESIGN ENGINEER PRIOR TO BEING BACKFILLED. T3 {s 22.3' T4 +i 20.5' 44. 1 THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE DB1 7 110.4' 119 n WITH ALL RULES AND REGULATIONS OF THE PCDH L1 88• AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 78.3' L2 80.2' 88. SURVEY AS —BUILT INFORMATION HAS BEEN PROVIDED L3 !' 85.0' 90. ON PLAN PREPARED BY J. CHARLES BOOLUKOS P.L.S. 90. L4 i 88.3 L5 150.0' 1 15C is i L i 1 1 THAT THE SEWAGE DISPOSAL RUCTED AS INDICATED ON THIS SYSTEM WAS INSPECTED BY R PRIOR TO BEING BACKFILLED. ,NSTRUCTED IN ACCORDANCE ► REGULATIONS OF THE PCDH STATE DEPARTMENT OF HEALTH. FORMATION HAS BEEN PROVIDED BY J. CHARLES BOOLUKOS P.L.S. w TIE DISTANCES TRENCHES REQUIRED = 250 L.I TRENCHES PROVIDED = 250 L.I PUMP TEST PERFORMED 8/17/ DOSE VOLUME = 125 GAL./Cy( 4 1/2" DR A B T1 12.3' 41.5' T2 15.1' 33.5' T3 22.3' 37.3' T4 20.5' 44.6' D131 110.4' 119.5' L1 78.3' 88.9' L2 80.2' 88.0' L3 85.0" 9 0.0' L4 8 8.3' 90.8' L5 150.0' 150.9_ L6 148.7' 151.0' L7 ,x- 5..0.5' ... L8 146.1' 151.5' TRENCHES REQUIRED = 250 L.I TRENCHES PROVIDED = 250 L.I PUMP TEST PERFORMED 8/17/ DOSE VOLUME = 125 GAL./Cy( 4 1/2" DR