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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 50.16 -1 -5 BOX 21 02416 I L : * 6 ko! J '. 'T Xo T . of 1.6; - ` 02416 PUTNAM COUNTY DEPARTMENT OF HEALTH II DIVISION OF ENVIRONMENTAL HEALTH SERVICES��: WELL COMPLETION REPORT �R/�:ILL- osation .... Street-Address:." rail 'of the Hemlocks Town/'d iil~d .:.:.....� "' Putnan Valley Tax Grid # 50.16 1 5'. Map = Block Lot(s) Well Owner: Name: Heino Bastys Address: 25 Scenic Drive Croton —on- udson, 1N Use of Well: 1- primary )t 2- secondary _x Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby. Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing l;: Open hole in bedrock Other Casing Details Total length Length below grade 39 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel Plastic Other Joints:' _ Welded __X_ Threaded _ Other Seal: Cement grout X Bentonite Other Drive shoe: X Yes No Liner: 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 Y. Pumped Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 20 During yield test(ft) 400 Depth of completed well in feet 1000 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 4 Clay 4 ; 1000 Hard Granite Quartz -' : 2 J� 6 co -vjrii If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Info5 atioit r =, 1000 5 Pump Type sj &pacity - Depth 903ft Model 1 2 Voltage 230 HP 3hp Tank Type djadgm Volume 120 al n Date Well Completed 11/4/04 Putnam County CtIgcoion1lo. 02 Date of Report 2 Well r er (s atu / NOTE: Exact location of well with distances to at least two permanent landmarks to be pfckided on a keparate sheet/plan. Well Drillers : ' e Address: 75 Putnam Ave. Brewster NY Signature: 114 111 Date: 3 q f&b White copy: HD File; Yellow copy -Building Inspector; Pink copy; - Owner; Orange copy- Well driller Form WC -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. March 24, 2006 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Final Survey for Heino Bastys 61 Trail Of The Hemlocks Town of Putnam Valley, NY (TM #50.16 -1 -5) Dear Joe: As requested, enclosed please find one (1) copy of the final Survey of Property for Heino Bastys, Town of Putnam Valley, NY, dated June 24, 2003, last revised October 5, 2005. Please call me if you have any questions. Sincerely, QL Ralph G. Mastromonaco RGM /jl Enclosures I RALPH G. MMTROMONACO, PE, P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914)1271 -4762 (914) 271 -2820 Fax Mr. Joseph S. Paravati, Jr. March 22, 2006 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: SSDS As -Built for Bastys 61 Trail Of The Hemlocks Putnam Valley, NY (TM #50.16 -1 -5) Dear Joe: Please find enclosed four (4) signed and sealed copies of drawing entitled SSDS As -Built Plan Lot 3, Property Located At Trail Of The Hemlocks, Town of Putnam Valley, NY, Prepared For Heino Bastys, dated March 22, 2006. As per your review!memo dated March 21, 2006, we have added tie distances from the house to the property lines. We are requesting your continued review and approval of the completed works. -7 .,P-you haue.anyquestions. -.. __ .. . _ .._......_._._. .�..�_^__:.:...._._.:..::'._... _..__....:_.__._._......_.... Sincerely, Ralph G. Mastromonaco I RGM /jI Enclosures SHERLIT'A AMLER, MD, MS, FAAP Commissioner of Health LORET'T'A MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mike Doebbler Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Doebbler: ROBERT J. BON ®I County Executive ROBERT MORRIS, PE Director of Environmental Health March 21, 2006 Re: Construction Compliance — Bastys 61 Trail of the Hemlocks, (T) Putnam Valley TM # 50.16 -1 -5 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. The surveyed house location with respect to the property lines needs to be provided. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -60.14 Fax (845) 278 -6648 Feb 21 06 01:55p' BUILDING DEPT Feb-21-06 01:,412P Ralph G. Mastromonaco PE Public health Dincier 9145268806 914 271 4762 P.2 P.02 Asscedwe Public Health nbwar Dirftlar of Pataw Serwker I DEPART NEW OF, HEALTH I Geneva Raid Bmwdw New York 10509 Radreasestal Health (914)273-6130 ft (9.14) 278.7921 NwdvgSvmkn(914)278-GSS$ WIC(914)i78-6M FM(914)278-GM Early hknnt1jaa(914)279-6014 P."Kbool(9i,4)27UM Fax(914)2784649 E911 ADDRESS YERULCATION FO OWNM NAME: --HEidC) BA:5T-TS TAX M" E911 ADDRESS: TOWN: -PVT� AM VA AUTHORIZED -aOY,& t10 D TOWN OFFICIAL: (Signi,ture) DATE: T The Putnam County Department of Health will notissue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is' a, e4 by an authorized town official. This form is to be submitted with the a� 'pp. ficati6a for a Certificate of Construction Compliance. 1=� I 1, Z r/A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT -. - Welt I.ocatioo�,.:;, - _ _� -. _....:_.. - tt3��;,Addi ess _ rail of the hemlocks. Town/Village: utnam Valley Taxi irid ##µ5O.16 1 5 Map = Block Lot(s) Well Owner: Name: Address: Heino Bastys 25 Scenic Drive uroton— on- 1-ludson, WY Use of Well: ,I-primary 1( 2- second2ry x_ Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling )Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 39 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel Plastic Other Joints: Welded ___I Threaded Other Seal: Cement grout Y. Bentonite Other Drive shoe: .X Yes No Liner: 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 6 Yield L gpm Depth Data Measure from land surface - static (specify ft) 20 During yield test(ft) Depth of completed well in feet 400 1000 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 4 Clay 4 1000 hard Granite Quartz . . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 1000 5 Pump Type rs j &Pacity — Depth 903ft Model _2M 12 Voltage 230 HP 3hp ,Tank Type diaphragm Volume 12Qgal Date Well Completed 11/4/04 Putnam County Certification No. 02 Date of Report 2/28/06 Well r er (s to ` NQD rx: txact location of well with distances to at least two permanent landmarks to be provided on a separate sneevplan. Well Drillers N e Address: 75 Putnam .Ave. Brewster QTY Signature: '� G Date: 3 /� White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 CONNECTICUT. NVVV YIOAK AND NELAC'CERTIFIED Toll Free 866- JMS -5091 I Corporate Fax 203 -798 -2408 1 Lob Fax 203 -798 -2107 I wwajmsenvironn-ental.cam Page 1 of 1 � En vlro ent�l Services, Inc. 41 Kenosia Avenue AAiD Danbury. Connecticut 1 Telephone 203 4111I tvATa;A, SOIL Am ANALYsis 06810 -798 -2229 Mailing Information: Collector's Information: JMS ID: 011436 Name: Mill Drilling Co Name: Robbie.Mill Address: 75 Putnam Avenue Address of site: Heino Bastys Trail of the Hemlocks City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone:, Sample's Information: Site: Tank Hose Bib Date Collected:. 2/28/2006 Date Received: 2/28/2006 . Preservative: HNO3 - -Time-Collected: -10 :00:00 AM, - - -- - -Time Received : -- 12:15:00 PM Temperature: <4 Lab No.: J0601724 Matrix: Water Date Analyzed Test Name Result MCL Method. . 03/08/06 Chlorine Free Residual . <0.1 mg /L N/A SMWW 4500CIG 03/08/06 4:05 PM E! C,oli Absent Absent SMWW 9223 B 03/08/06 4:05 PM Total Coliform Absent Absent SMWW 9223 B 02/28/06 Color <1 Units 15 Units SMWW 2120 B 02/28/06 Turbidity 0.11 ntu 5 ntu SMWW 2130 B 02/28/06 Odor <1 TON 3 TON SMWW 2150 B . 03/06/06 Hardness 182 mg /L N/A SMWW 2340 C 03/06/06 Iron 0.022 ppm 0.3 ppm SMWW 3111 B 03/06/06 Mangpnese 0.013 ppm 0.05 ppm SMWW 3111 B 03/06/06 Sodium 10.5 ppm 28 ppm SMWW 31116 <3 mg /L- . -._, -. -.250 mg /L SMWW 41:10 B - .......10 mg%L - SMWW 4110 B...... , _._ ..... -._ ... 03/01/06 Nitrite <0.1 mg /L 1 mg /L SMWW 4110 B 03/04/06 Sulfate 51 mg/L, 250 mg /L SMWW 4110 B 02/28/06 pH 7.75 S.U. 6.4 -10 S.U. SMWW 4500 H B -CT Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll Ref Lab#11301 - Total Coliform Sampled 3/7/06 @3:3pm - Received 318/06 @9:00 CFU = Coliform Forming Units; MCL = Maximum Contaminant, Level mg /L = milligrams per Liter N/A = Not Applicable ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit TON = Threshold Odor Number Units = Units ?_ j���[PG I Signature: -; _ Reviewed ey: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 CONNECTICUT. NVVV YIOAK AND NELAC'CERTIFIED Toll Free 866- JMS -5091 I Corporate Fax 203 -798 -2408 1 Lob Fax 203 -798 -2107 I wwajmsenvironn-ental.cam rAl ,✓ III Y { F .i °/ i \�� f G��1 I N,uY�l 1...} h 7 3 M1'�V III CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT s PCHIID CONSTRUCTION PERMIT # FV- 30 -0 1 W Located at L OF Id E H E H LQ,- Owner /Applicant Name E I IJ O �A ~( Formerly I<O &EIZT" W I-� I AN Mailing Address 2 Date Construction Permit Issued by PCHD Separate Sewerage &stem built by DAM pi 14 0 Consisting of Gallon Septic Tank and �iR O.P. FILL 71DC —E Other Requirements: 0VMPC o A A E7aR; E C Wyatea• Supply: /A Public Supply From o>re_)<_ Private Supply Drilled by Town or Tillage PV Tt A P1 VAL LF--( Tax Map 50, 1 (o Block I Lot S Subdivision Name RODE9:*A\ lAt dITHA� Subd. Lot # �. Zip t 05Zo 2Z-% sTIZIbu- iod Address Address - B�,rildingType I Fi�M�L�(QCV� E ...Has erosior .control- been.conpleted2 Number of Bedrooms tt Has garbage rinder been i� stalled? D I certify that the system(s), as listed, serving the built plans (copies of which are attached), in acc plans and the standards, rules and regulationsoi Date:_ Certified by Address ted essentially as shown on the as- Construction Permit and approved nt of Health. P.E. R.A. License # 01�AA`11�r,5 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. By: . �� Title: 14-PW Date: O copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 14—U .� � `Kei..::1.•�'1 P " "t7 r �ca•a cr 'v...v. •�,..:. v:.. .. _._ ... .� _...._.. —_.._ ,.j��, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES OUARA,NTZE OF SUBSURFACE SEWAGE TREATMENT SYSTEM J 5 Owner or Purchaser of Building Tax Map Block Lot (9w, deZ- Building Constructed by A 11•. `,© F I dE, HEMLOC,95. Location - Street Building Type Town/Village �B��iVlAr� � r� i7°MAf� Subdivision Name 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 pxoperly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health . Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful' or negligent act of the occupant of the building utilizing the system. : Dated: Month Day __1__ Year corporation Name (it corporation) Address; State _ Zip D� �� Arn - h 1(1U l Ji7�r8�• � �GN� Corporation Name (if corporation) Address: �-WgRA, ��71.ii 1Sf`i ►4xcYZ T State N-11�, Zip/ Form GS -97 IN �U `' _ 4jILL � | | | mal 'N, EM K:T prl=905 h7r 77' remj;ise�j at Tj 11=11= al f_ paw 44- 6OU LDS "F.,*4M !P' . COMPONENTS W is' Submersible Effluent Pump 6. Vv t 4* 8 3° h. ...... ...... '2 ......... IPM018 jq.tf.. PS,,(gallons per minute) y. E MOD MA M1 .. . ....... J wliaW,iii 3M WE614 2 Casing M(IK) -4 Motor-Shaft," _T Motor - 6 Ball-Bearing'. 7 Power Cab la 8 Casing O-Ring Submersible Effluent Pump 6. Vv t 4* 8 3° h. ...... ...... '2 ......... IPM018 jq.tf.. PS,,(gallons per minute) y. E MOD MA M1 .. . ....... Or de'! J wliaW,iii 3M WE614 M ax Amp. '11PRT'lolids M(IK) WE0311 L 1WE20H :115 1 AOX 1750, . -16. WEOI181' 6-8 WE03121 0, 4.9 WE031 I M 115,... :;1.7:50. WE0318M ;208.: 6;8 WE03:12M 77M , 4.9 ROTT I'm gg 7141 5 14.5 3500 ..... WE0518H. "208:i iz' 8.1 WE0512H:: 3 7.3 WE0538H .10 .70 . 4.9 WE0532H. 230 3.3 _WE65144.s. 4 0. 1.7 WE0537H. .1.4 WE05TI14-K WE051 8HH�,* 115. 710:!, 'go - - 5EER, WE0538FfH 20 2Y . WE0532H-H . _23 .3-6 WE0534HW _WE_0537Hfr 123 49 90 r 1 WEO?fO 0.' ;':' .) w23'0: P Hot 70 . 7WE-57417w. WE0738W 45 3: WE0732H 230 - WE0734H6,. .`460 2.7 WE0737H 5751 F 2.2 wtiofsk 13C 248 , t M.0 WE1012H: 230.,-.-_,,1 . 12.5 WE1038H 103 8.1 Wfl'032H. :.:230":� 7.0 WEI034H-. 460 3T WOOPH! 74 717-2.8 7 WE1518H I 1h - .,. ..,..46Q: LAM: 80 PE1511H: 23p. 15.7; WEMEIH.;: 771'gT -T 25 10.6 WE1532H WE1534H WEI 537H 575. 53 WE1518HH 208 � .. x''17.5 WEI.512HH, 2 0_. W0538HH' .'200.. 10:6 WE1532HH:,. 210 .�.697 WEI 534AH', taw. WE1531NNi WE2012H .230. 1 18.0 83 WE2038H 3 12'.V WE2032H =3Q 11.6 WE2034W 460 5.8 575 41 Or de'! J wliaW,iii 3M WE614 W6*' H: MON Ep 1w I *E� SMH 1WE20H sipm :1750 - :;1.7:50. 350.0 3500 3500 3500 .:3500 5 86 .10 .70 . 631- 78 58 15 , 52 SO 710:!, 'go - - 53 20 2Y . .35 10. 83:: 98 123 49 90 r 1 48: -.76 94 10 45 87 30 - 351.1- .67 ----- 88 .110 40 .83-' 13C : 3 ; 35 2- 0 - 57 �2 103 80 i*s 40 45' 74 95 .3001 45 .3 5 -64 86 25 74 116 50 351 53 77 40 j .�.697 -TOT taw. 3 0 .:56 . 25 8W 90i 100 28:- 30.:t') DIMENSIONS',`'' (All dimensions are in1khes-Do not use for construct ion. py!Ptisesj 2' NPT,,: 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. March 17, 2006 Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: SSDS As -Built for Bastys 61 Trail.Of The Hemlocks Putnam Valley, NY (TM #50.16 -1 -5) Dear Joe: Please find enclosed the following materials: Five (5) signed and sealed copies of drawing entitled SSDS As -Built Plan Lot 3, Property Located At Trail Of The Hemlocks, Town of Putnam Valley, NY, Prepared For Heino Bastys, dated February 22, 2006 ® Four (4) signed and sealed copies of the Certificate of Construction Compliance dated 12/16/05 o Four (4) signed copies of the Well Completion Report o Three (3) signed copies of the Guarantee of Subsurface Sewage Treatment System _...:....'r'�..: o...One (1). copy .ofthe.Well Wdf_rAnalysis- One (1) copy of the E911 address verification form m One (1) copy of the Electrical Underwriter's Certificate One (1) check payable to the Putnam County Dept. of Health in the amount of $300.00 One (1) copy of the pump specification We are requesting your review and approval of the completed works. Please call me if you have any questions. cerely, Ralph G. Mastromonaco RGM /jl Enclosures SHERLITA AMLER, MD,'MS, FAAP Commissioner of Health r - .----- L®RETT'A- M0LINARI, RN; MSN- Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 December 12, 2005 Mike Doebbler Ralph Mastromonaco Engineering 13 Dove Court Croton -on- Hudson, New York 10520 ROBERT I BONDI County Executive Re: Field Inspection — Bustys Trail of the Hemlocks, (T) Putnam Valley TM# 50.16 -1 -5 Dear MR. Doebbler: A site inspection was made for the above referenced project on December 8, 2005. The following comments must be corrected in the field. AtX A manhole cover needs to be provided for the pump chamber. Speed levelers need to be provided in the distribution box. jowvS If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:cj Si rely,. 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 L XL - DIV'ISION OF ENVIRONMENTAL HEALTH SERVICES 1,2A /e s jcm FINAL SITE INSPECTION Date: Inspected by: :TS p Street Location ��` Gf flt N� ;wf�c.l� Owner Town ��:'4 -�,_w 6'�,y Permit# _ • pJ -3v rr� TIM Subdivision Lot # 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 /wetland IL Sewage System ; ........ ................ a. Septic tank size - 1,000 ... :.....1, 250 ....... ..other ................ b. * S eptic'tank installed level ................:....... c. 10' minimum from foundation .................:... a................... d. Distribution Box 1. All outlets at same elevation -water tested.......:......... 2. Protected below frost ......... . ....................................... . 3 Minimum 2 ft.Original soil between box & trengh,�s_ e. Junction Box properly set ............................ � .`.. ... 6, renc es 1. Length required d0 Length installed Oa 2. Distance to watercourse measured Ft.. . "t ico 3. Installed according to plan ........................ 4. Slope of trench acceptable 1116 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. -Room allowed for expansion, 100 % ......................:.. 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends ca ed ...:................... ................I.............. g. Pump or Dosed z5ystems _ ..1 ::...Size of pump - chamber .....:.:.....::? ®:C'.' 2. Overflow tank ............... ............................... 3. Alarm, visual/audio........:. ........... 4. Pump easily accessible, anhole to grade) .............. 5. First box baffled ..... ............................................. :...... 6. Cycle witnessed by H.D.estimated flow /cycle........... III.:House/Building . A. house located per approved plans' ................ ......... b. .Number of bedrooms ... ............................... ?.............. IV: Well 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 Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. .Footing drains discharge away from.. STS... area .................::.__.. hi -- Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. 12102 R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Or! ENVIRONMENTAL HEATER SERVICES Street Town State Dates Zip I 4. PUMP TEST 0. DOSE TEST go REQUIRED GALLONS 0 -3 -Z EL START 1 EL. STOP - . ........... TM4PF.rT0R! TRT! Signature and Title Rpp()RI JjPr AMT) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Nov-29-05 03-16P Ralph G. Mastromonaco PE 914 271 4762 P.01 .FAX i RALPH G, MASTROMONACO, P.E., P.C. Consulting Engines 13 court, croton-on-Huclson. New.York 10520 (914) 2714762 T": � o PA RA VA fl FaxPhoile ; cc, -276--792 Date .11 1291os li*mdwof par$ kooft cover sheet (2) FROM VIICdAE LDbEF>5LEp- Re: PP- ol F%-TSTATLr=- Phone (914) 2714762 -REJWARK�: C]Re,*AW []Please Comment CIUMent OAS roqt"ed .Fl �A�,E ET Nl E Kdow Tdc- s TATOs"OF T E;Fo L*LC>WIJ6 ppojEr-rp: i"V, -5U9H ITTED5EFT 25. E( A- E A LTY H o L)SF- pl A 12 EQV.560 �0 R F- F L-T v T Ne (9p C-� WALL AIJP� 6>14 C2 SC DoE Lp0 l P TEST &A, NOS.1-29-20'05 1 IL 2 TEL: 845-278-7921. NAME:PUTNHP: (11UNTY DEPARTMENT OF P. 1 Oct -26 -05 04:350 Ralph G. 2 �8 -7121 Mastromonaco PE BRUCE R. Public Health ATTENT1 All inform ENGINTI REASON ROAD /S7 TOWN: _ SUBDINI 914 271 4762 P.O1 LORETTA MOLINARI R.N.. M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York '10509 REQUEST FOR EEL D TESTING 1: XJOSEPH PARAVATI - p GENE REED on below must be u11v completed prior to any sebedutis,g. DATE: 42e 71. 005 OR MUM: o PHONE #� 14- Zl I- 607, Gib M � Aet_ poElaaLE R: . DEEPS: a PERCS: ❑ PUMP TEST: X L of THE HEMLQ.c 15DM ` TAX MAP#A� E T LOW: L)N: o I' LI=1 tin BASTYS , • ..� -. � ... YES —NQ N Pro osed�SSTS within the drainage o - ...-::.-. .. . - ... '.... . o ~� p - ages of West Branch orBoyds Corner f2.esei irars.'- - - 0: ❑ Proposed SSTS within 500 feet of a reservoir, reservoir. stem or control lake. o ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallonsiday or SPDES Permit required. ❑. Proposed SSTS for a Commercial Project It is the sponsibility, of the design professional to provide the above information prior to soil testing. This De oartment 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 Departo entwill coordinate a mutually suitable time for field testingwith the Design Professional and� NYCDE . ' 1 If a prof ect has been determined to be Delegated based on the above response and then subsequent inform& ion indicates NYCDEP is required to witness the sod tests, it will bi the sole responsibility of the design professional to schedule re- wktnessing of the soil,testing with NYCDEP. FOR COUNTY USE ONLY DATE• TIl": JAN -5 -2000 WED 18:.1c,, TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Nov-04-05 11:36A Ralph G. Mastromonaco PE 914 271 4762 ?P.01 FAXtRANSMITTAL SHEET RALPH G. MASTROMONACO, P.E.., P.C, Date: I I `�� Consulting Engineers 13 DovO Court, Croton-on-Hudson, New York 10520 Number of pages (914) 271-4762 (914) 271-2820 Fax (including cover sheet) TO: Tic-) sP-eg PAR.A4.1ATi From: RWph G. Mastromonaco Re: Fax Pho'ne: 54°5- Phone (914) 271-2820 . Vo6c® Phone: (914) 271 4762 Remarks: ❑ Urgent ❑ For your review ❑ P99ase comment ❑ Reply ASAP Messa e BAS-�ys JAN-14-2000 FRT TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Nov -04 -05 11:36A Ralph G. Mastrotnonaco PE 914 271 4762 P.02 SBY THIS CERTIFICATE OF COMPLIANCE THE I °, _ �O�R� -= OF FIRE .UNDER-WRITERS -°�'� BUREAU OF ELECTRICITY 40 FULTON STREET NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by C� 5 , OHN STAGNO ELEC CONTR. HEINO BASTYS �O. BOX 715 01 TRAIL OF THE HEMLOCKS UTNAM VALLEY, NY 10579, PUTNAM VALLEY, NY 10579 c 5 Located at 61 TRAIL OF THEAEMLOCKS PUTNAM VALLEY, NY 10578 S S Application Nurrrber: 2074822 Certificate Number: 2074822 Section:. Block: Lot: Building Permit: 1398-05 BDC: W106 5 Described as a Residential 0 -599 square ft. occupancy, wherein the premises electrical system consisting of Cj electrical device/ and wiring, described below, located in /on the premises-at: Basement, dutside, 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring o the extent detailed g 'in 5 herein, was c nducl:4 accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department State Code Enforcement 5 of and Administration, or other 5 authority avin g ; j urisdict ion and found to be in compliance therewith on the, 13th Day of October, 2005. Name -QTR'_ $;Ilg tin Cif _TYYL - Miiscelianeotfs ° ... .. _ ..., WIRING FOR SE61C PUMP,& ALAFM Alarm and Emeriency Equipment S Signaling Device 1 0 SEPTIC Alarm 5 Wiring and Uevioes Receptacle i 1 0 SEPTIC Motor Control S seal I of I SThis certificate m$y not be altered in anyway and is validated only by the presence of a raised seal at the location indicated. t�j O r� t l�nro I NIP P 11,11111 r n�.l���nts e ill o JAN -14 -2000 FRI t :1_ TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 i i I SHERLITA AMLER, MID, MS, FAAP Commissioner of Health - L®RETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mike Doebbler Ralph Mastromonaco Consulting Engineers 13 Dove Court Croton -on- Hudson Dear Mr. Doebbler: R ®BERT J. B®NDI County Executive September 29, 2005 Re: Field Inspection — Bastys Trail of the Hemlock's (T) Putnam Valley, TM # 50.16 -1 -5 A site inspection was made for the above referenced project on September 28, 2005. The following comments must be corrected in the field: 1. A pump test needs to be witnessed by a representative of this Department. The test can _.. _....... notb�s�heduled.unti] the Electricall .Underucrit6rs...Certificate is issued and a.copy provided to this office. 2. System can be backfilled. Please leave open the pump chamber and the distribution box. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Sep -27 -05 11 :23A'Ralph G. Mastromonaco PE 914 271 4762. P.01 B+S -2 78- '1912f , T..r ........ .: �f x 71TM04 COUINMYDUARTUM `ii Ti.AL`Y'1 ' i DMSION OF ENVMONMNTAL HEALTH SERVICES ATTENTION JOSEPH G' ENE RROTTF4 FOR FINAL INSPECTION ' For: Fill Z I Q . � •� . All bon must be fully completed prior to any being made. (T) c� s T? Subdivision Name: Subdivision Lot # Dater C&s� P lans? `{ � i Date: P Trenches (o 00 LF ;T 6M val_LE -f Block Lot Qr4TV -1AJ ITMAI� Date: Tt7� Zcx:> 5 Is well 1&ated as per plans? *(CS Are erosion control ;measures in place? Yft!____— Icer"tifyi at the system(s), as listed, at the above premises has been constructed and I have inspected and ve ' red their completion in accordance with the' issued PCHD Construction Permit and approve plans arid! the Standards, Rules and Regulations of the Putnam County Department of Health. Date: " i'� 21 '1 d 'Certified by: _........ pE_ PLA Design Professional Address !> QW FE 12'l'. C(bTa l -04- HQQJQ �D Lic. # 1) �I 14- 27 1 . . Form F R -99 PS• C- ARC, M TC, itl t• v �'o,Y1 ?'1 twu AT I 1 M M RLIIO 'T95 A"r 1 , (+A td WE ALSO i NISI` e cT . P1 SEP -27 -2005 TUE`11:24' TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 i RALPH G, MASTROMONACO, P,E,, P,C, Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (9 14) 271 -2820 Fax Mr. Joseph S. Paravati, Jr. Asst. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Bastys Residence SSDS Permit #PV -30 -01 Sec. 50.16; Block 1; Lot 5 Dear Joe: August 19, 2004 Please find enclosed two (2) signed and sealed copies of the architectural plans for the proposed three - bedroom house. The following revisions have been made to these drawings: 1. Study has been revised to provide two openings into room 2. Upstairs bonus room egress windows have been added. This room is now proposed as the third bedroom. At this time we are requesting your review and approval of the revised architectural plans.. Please call me if you have any questions. Ralph G. Mastromonaco RGM /jl Enclosures a•�p PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :..- k.r °- ,.,.,.seo .:- ,.e.ar.... - ....,.... ::r.'r.s.-- ..r,rn,c- .r.-::n<. -. aw-::: r..t......•.. .,� ;'.:';, c .,:_xr- n...�....— _..,..� >:.c,a, i�..c�..r•:.a ^n: -e:. s.' •.0 .er..r.l. -r. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM. PERMIT # _Ai' 5 e' o / LTa Located at ✓,a it v�, 7/1d jilyl�i /�� own or Village,�r�'1 Subdivision name Subd. Lot # 3 Tax Map -a' A, Block _ Lot j"' Date Subdivision Approved %pc-e Owner /Applicant Name ! ✓�G %� l> Mailing Addresss'��� Renewal ?"0* Revision Date of Previous Approval O'er 111f 60el'v /V,9 zip ,/e --lw Amount of Fee Enclosed i gle � N,C Building Type /�s��c i ce Lot Area ;"t'1 o. of Bedrooms 3 Design Flow GPD ee?,o Fill Section Only Depth Volume PCHD iNOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of )0'A0 gallon septic tank and Other Requirements: 2-1 ! ,oV & A? 7 G, % ��ia, 0 .; 4 To be constructed by — Address Water Suonly: Public Supply From Address �Private-Supply'Drilled_tiy. • %�/'�' ���� •...- _..__Address c�j/' /�Y� -_.::�._ _. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ss§darate sewage treatment s sY tem described above will be constructed as shown on the approved amendment thereto and in .a6 ordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address APPROVED FOR"CONS1`11ICe -TION' This. ro al lkq sewage treatment system has been completed and inspecteq modified when considered necessary by the Public Health Di R.A. Date of �ijd-n License # :; � y92 s ' '' i the date issued unless construction of the revocable for cause or may be amended or or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sew- MiFgtily'. By: Title: Date: J' 13 /03 Whk copy -'HD File; Yellow.'copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM (COUNTY DEPARTMENT ®IF HEALTH D)IVIISRON ®IF ENVIRONMENTAL HEALTH SERWCIES CONSTRUCT A WATER WELL _ please print or type~.....- PCHD V—; 0— Well Wellll Location: Street Address: Town/Village Tax Grid # lleir"hg /,� ,le Map drg- j6Block ® Lot(s)_:5- Wen Owner: Name: Address: ,d AU Use of Weill: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __, r gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well IIDetailled Reason for IlDrifling Wen Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 1,e_ Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision 4 o Z—,� a7 Lot No. ,a Water Well Contractor: i�° 09��',,��r� Address: ,IP70'e d6 Is Public Water Supply available to site? .................................. ............................... Yes No �- Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: �� 'r .- App.�c;�-:t SignaVare:.. ' —. ° /i`orr✓� f3 , PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue I/ ( 3 c . Permit Issuing Official: Date of Expiration 13 vim— Title: S"i rk, Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I� b ' 14•16412re71l—Teat It PROJECT LD, NUMBER ' . ,» - r �ii.Z1 1 V . ." ... SE ®01 • .r .. $tat* Entrltrarimntnl Quality Redew SHORT ENVIRONMENTAL ASSESSMENT FORM F�w UNUSTED ACTIONS Only FART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT )SPONSOR 1, 2. PROJECT NAME, 1 3. PROJECT LOCATION: _ T t PRECISE LOCATION {Street address and road Inters _� County ` " %`—n , c na, prominent landmarks. etc.. or provide map) d /- /� e A,? /o �s S. IS 3ED ACTION• Xew 0 Expansion 0 Modlficatlonlatterstlon G. DESCRIBE PROJECT BRIEFLY' 4v A4 dal /1e_ �v� /l �• w 7. AMOUNT OF infdally- S. WILL PROPC Ayes ►np a.rFL•cTED: / acres UIIlmetely . D ACTION COMPLY WITH EXISTING ZONI C.1 NO It No, describe briefly 9i H IT IS PNESENT LA rNO USE IN V ��-'�j IT L..,J Induatrlal Owcrlbe: 10. DOES ACTION INVOLVE A STATE OR LOCAL)? AYes 0 No acre's ..... OR OTHER EXISTING LAND USE RESTRICTIONS? IOOF PROJECT? 0 Commarclal [] Agriculture park/FoteaUOpen apace 0 Other RMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROF ANY OTHER GOVEstweNTAL AGENCY (FEDERAL. !f yea, list ageney(m) and permlUapprovals /cL� • ¢ /� >� �yjp/yyj �iG 111 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PEPWIT OR APPAOVA' 9Yes ❑ No It yes, list agency name and permlVapproval (,A/ xp 12 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? 0 Yea^ �No • -- —_ -• _ _M..r,..�_.._._ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS 'RUE. TO THE %EST OF MY KNOWLEDGE E AppllcanVSPorssor na+sra:.._J :>C?J�� _ . __— ........ .— .... Vale: Signature: it the motion is in the Coastal Area, and YOU are a ante agency, complete the Constsl Aseilissmefnt Farm before proaseding With this assessment e) VER LORETTA MOLINARI R.N., M.S.N. Public Health Director October 29, 2003 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 Frank Sullivan, PE 2092 Femerest Drive Yorktown Heights, New York 10598 Re: Proposed SSTS Renewal — Bastys Trail of the Hemlocks, (T) Putnam Valley TM# 50.16 -1 -5 Dear Mr. Sullivan: rROBERT J. BONDI County Executive 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 short EAF form-:- /2...-o Please show any existing SSTS'+s within 200 feet of the.proposed well. If there are none, provide a note stating -such. = - V' 3. o�- Please provide datum reference. 4. Please clarify storage calculation on the detail sheet. V15. Please provide a note stating that the proposed SSTS is to be staked by a licensed land surveyor before construction begins. 1/6. Please provide area to show revisions description and date of revisions. It should be in a block near the title block in the lower right corner. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, r ! � oseph S. Para" vati, Jr. Assistant Public Health Engineer JSP:cj LORETTA MOLINARI R.N., M.S.N. Public Health Director I October 29, 2003 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 Frank Sullivan, PE 2092 Ferncrest Drive Yorktown Heights, New York 10598 Re: Proposed, SSTS Renewal — Bastys Trail of the Hemlocks, (T) Putnam Valley TM# 50.16-1-5 Dear Mr. Sullivan: County Executive 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. Please i pr o de a short EAF form. , vi V� Please show any existing SSTS's within 200 f6et of the.propQsed well. If there are none, provide note stating such-.:-: Please provide datum reference. Please clarify storage calculation on the detail sheet. Please provide a note stating that the proposed SSTS is to be staked by a licensed land surveyor before construction begins. 4,b Please provide area to show revisions description and date of revisions. It should be in a block near the title block in the lower right comer. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext.. 2157 if any questions arise. Very truly yours, aoseph S.'Paravati, Jr. Assistant Public Health Engineer JSP:cJ PUTNA ' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH _ _ — _ WATER•SUPPI,X Rc STJE{SLTRF+r�:sE 5EWi GE TItEATlY1EN`T SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: Ax S STREET LOCATION:- C k5 OJ 1 � 271.3 REVMWED.BY: RM, GR, �, SRDATE: TAX MAP#: (CONRIRIvIED) Y/ N DOCUMENTS (�(JPERMIT APPLICATION j�(�WELL PERM[T OR PWS LETTER (,, l )PC =97 a (�✓ LETTER OF AUTHORIZATION (dDESIGN DATA SHEET (DDS) ORATE RESOLUTION (PLANS -THREE SETS HOUSE PLANS -TWO SETS (_JL,::�VARiANCE REQUEST SUBDIVISION A (,j LJLEGAL SUBDIVISION SUBDrMION APPROVAL CHECKED Y (_)PERC RATE & L REQUIRED. 27 DEM (�(ZURTAIN DRAIN REQUIRED e GENERAL (_}C!�)I.00ATED -IN NYC WATERSHED ((_-) PLANS SUBMITTED TO DEP DELEGATED TO PCHD ��DEP APPROVAL, IF REQ'D (_DEEP TEST HOLES OBSERVED UUPERCS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS (�v /�/ WETLANDS (TOWN/DEC PERMIT Q'D (�(� TA ON DDS PLANS & PERMIT S kw��9 (� ✓PARE 1969 NEIGHBOR PIOTIFICATION. I. C—)C,f %00 YR. FLOOD ELEVATION W1I 200' (_} SOIL TESTING LOTS ?10 YEARS OLD REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN- (NORTB[ ARROW) ().SSDS HYDRAULIC PROFILE (GRAVITY FLOW Unf, )CONSTRUCTION NOTES 145 (� DESIGN DATA: PERC & DEEP RESULTS .Lt. 2V CONTOURS EXISTING & PROPOSED &J( Z- r DRIVEWAY & SLOPES, CUT (FOOTING(GUTTER/CURTAIN DRAINS �UUSDA SOIL TYPE BOUNDARIES (r,::j(jT.ITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; Nr1tiNZ ADDRESS, PHONE# RAWTiYG/REVIS �N�� DA (LOCATION OF WATERCOURSES, PONDS / LAKES,WETLANDS WYTHIN 200' OF P. cr U/ (___)PROPOSED FINISH FLOOR AND I C -BAJSlWWELE-`VA-T-lONS_____ WELLS & SSDS'S WAN. 2qtQEM PROPERTY METES & ROUNDS EROSION CONTROL FOR - HOUSE, SSTS, EROSION CONTROL NOTE /Z„ k .?.�''yW Y N (REQUIRED DETAILS ON PLANS CONT'Dl - (0�OUSE SEWER - %l' FT- 4 1101; TYPE PIPE, CAST IRON (___)(.!:2)NO BENDS; MAX BENDS 45' W /CLEANOUT WALS (__)(�:10'. TE NOTE (NN) CHANGE) HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE j l )FILL SPECS / FII.L NOTES 1 -5 (� FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA ct[.l, v.q[� tntur rc '(J(�_j CLAY BARRIER T TE C--)C G RE UL _)V PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS EPARATION DISTANCE FROM'TOE OF SLOPE TRENCH* ULF TRENCH PROVIDED 60FT MAX. 0PARALLEL TO CONTOURS 100% EXPANSION PROVIDED �3HGEOTEXTILE DETA0JDUST FREE CRUSHED STONE OR WASHED GRAVEL COVER / SEPARATION DISTANCES ON PLAN - FROM -SST (� 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL TO FOUNDATION WALLS 5-0 ` �r h� ���� 1''[l "'``� - 100' TO WELL, 200' IN DLOD,150' TO PITS ;� a a �' rs.s7s 0100' TO STREAM, W.ATERCOUF.SE, IAUK (inc. ezpan).. _ _ 1(•�_ 50! T�?.?;?'TCu y�:5�; 3S' STL�RiY1�RAIN, P1PEDWATER _J10' TO WATER LINE (pits - 201) SO'- INTERMITTENT DRAINAGE COURSE ( ✓�� )200500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (__�10' MIN TO LEDGE OUTCROP SEPTIC TANK CZ:JL 10'FROM FOUNDATION; 50' TO WELL WELL (�� IDYMEI+TSIONS TO PROPERTY LINES ` /LOCATION OF SERVICE COMmiECTION („_„)UM%N 15' TOPROPERTY (LINE SLOPE KLJ�eSREGRADED opt IN SSTS AREA TO 15 %, IF REQUIRED • . DOSE/PUMP SYSTEMS PUMP NOTES . . (_✓f DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED L:DODETAII, FOR FORCKMAIN, (PIPE TYPE, ETC.) D -BOX S�OWN� D AY S RAGE ABOVE ALARM (—iS'TANDPIPES, T BOTH SIDES, DE �%A- C—JIS'KWtoCDS=>S% o, 5'-3 %, 35' -1 %,100 % -<1% (_)20' MIN to CHARGE/100, with 182 cons day discharge (_ j to NON- PERFORATED PIPE Ll a k i UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of` Located at A-411 T/V � /`Ier4�, " w �//V_ Tax Map # Block �_ Lot r Subdivision of Subdivision Lot # —5 Filed Map # Date Filed Gentlemen: This letter is to authorize d` t�.�%j 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 Ipapers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam= County. Sanitary Code. - - ,..._ _ ,. ..._... .... _......._... -. _ _ .- .__.,_a_ .... _.__...._... Very truly yours, Countersi * �� Signe FE., R.A., (Owner of Property) Nailing Add '" � Mailing Address:75- Sc�ir✓ /C 7�T� Slate % Zip /��`�� State Zip -lelephone:��, a y `� Telephone: Form LA -97 Friction PLASTIC ` PIPE.- �TECHNLCAL DATA �� v�' . • • . . ".. .. 777, 1 y r 4 O Y2n 3�4n 1" 1Y4 1Y2n GP GPH R. Lbs. Ft. Lbs. Ft. Lbs. R. Lbs. Ft. Lbs. Ft. Lbs. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 2 120 15.13 6.58 4.83 2.10 1.21 .526 .38 .164 .10 .044 . 3 180 31.97 13.9 9.96 4.33 2.51 1.09 .77 .336 .21 .090 .10 .043 4 240 54.97 23.9 17.07 7.42 4.21 1.83 1.30 .565 .35 .150 .16 .071 5 300 1 84.41 36.7 25.76 11.2 6.33 2.75 1.92 .835 .51 .223 .24 .104 6 360 36.34 15.8 8.83 3.84 2.69 1.17 .71 .309 1 .33 .145 8 480 63.71 27.7 15.18 6.60 4.58 1.99 1.19 .518 .55 .241 10 600 97.52 42.4 25.98 11.27 6.88 2.99 1,78 .774 .83 .361 15 900 49.68 21.6 14.63 6.36 3.75 1.63 1.74 .755 20 1,200 86.94 37.8 25.07 10.9 6.39 2.78 1 2.94 1.28 25 1,500 38.41 16.7 9.71 4.22 4.44 1.93 30 1,800 1162 5.92 6.26 2.72 35 2,100 18.17 7.90 8.37 1 3.64 40 2,400 23.55 10.24 10.70 4.65 45 2,766' - ` " 29.4 42.80 13.46 " -5.85'' 50 3,000 16.45 7.15 60 3,600 23.48 10.21 a 1 y r 4 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: SSDS Permit #PV -30 -01 Sec. 50.16; Block 1; Lot 5 Dear Joe: June 23, 2003 Via Airborne Please find enclosed two (2) signed and sealed copies of the architectural plans for the proposed three- (3) bedroom house. We are requesting Putnam County Dept. of Health sign off on these plans for submission to the Town Building Department.. Please call me if you have any questions. SVcerely, 5bIph G. Mastromonaco RGM /jl Enclosures FROM : U I RMNT POMAR i Cb, JR INC FAX NO. .:.845-236-4821 ..,11ar. 19 20M 12:14PM P1 P 1',, COUNTY DEPARTMENT OF HE DIM, ION -NV V S UOYE -,HtG ALTILSERVICES C0NSTRUCM0NPERWT FOR SEWAGE TnATMNT SYSTEM Located Subdivision naive d Subii Lot # 3 Date Subdivision ApFoved —,/Rrd Mailing Address Town or Vill Tax 1444a.24 Block Lot. Renewal Revision Date of Previous Approval Zin-)J47-!7f Amount of Fee Enclosed gee Building Type & K: Lot Area, NO- of.Bedrooms _i3 Design Flow QPD 61-00 FJR1 Section only. Depth i Valn'me. PCHD OTI1 TiON is L _M OWL D Sep&Mg Sewerage ftdki to consist of gallon septic. CkherRequirements: .Tob,econstrv;tedby__ e� Ad Miff SM13U. Public Supply From ,--.,.— Address A Private .Supply Drilled by d&css I senfthatlaxnwholly d completely responsible-for the desip and location of sy.' tein(s) Od.tW the mpre In 'I I., _a A9=9Q9=ent__ M dc=*W above will be consimcW as on the amitiagent S id' * . accordance with the standards, rules and regulations of the Putnarn &*y be at on Department cut of He" and that o4toplefion' thereof a "Cerdficate'oKonstrilction Compliance?, satisfactory to. the Public Health Director will be s'ubmittid to the Department, and a written pua�nfte will be furni3he&the owner, his . successors, -heirs or assigns by the builder, that said builder will place in good opetstinS condition any part of said sewage treatment systm during the period of two (2) yeaks immediately following the 4at� of the isamce oi the approval of the cartirwite of construction compliance of thc..oftinA system or any repairs thereto. Signed: >Ikezel P.E. Date Address FO A Val R CONSTRUCTION sewage treatment has been completedtnd inspected by C for cause or maybe amended or mbdified'when considered b PublicHeafthl)i on of the ap ved lan'requires ythe anew Ap o domestic sanitary scvmvonk, Title A;; 7Lom5F -AV &k, Date: ItIZ11, White copy - RD File; Yellow copy - Suit I cc ng Inspector Pink copy;-Owner; Orange copy - Design fens nil FOrM CP-97 Shipment Label Airbill #: 1$'176'137055 To (Company): Putnan) County Department of Health 'I Geneva Road Brewster, 11Y '10509 UNITED STATES Attention To: Mr. Joseph S. Paravati, Jr. Phone A 914- 225$130 IR g�SOR From (Company): RALPH GEORGE d1 PRES , MAS ROMONACO PE PC 13 DOVE COURT M airbome.com CROTON ON HUDSON, NY 10520 UNITED STATES Sent by: R. htstromonaeo Phone N: 914. 271.4762 Page 1 of 1 Origin: DBY Date Printed: 6f23r2003 UU.f3 tU41LUU'11 H � '� F, 41} Description: Trans wr2 S &S architectural Plans Weight (Ibs.): Letter Dims: 0 x 0 x 0 Pieces: 1 of 1 Pratection: Not Required Bill Shipment To: Sender Ship Ref: Bastys- Putnam Residence ------ - - - - -- Please fold or cut in half --- - - - - -- DO NOT PHOTOCOPY Using a photocopy could delay the delivery of your package and will result in additional shipping charge - _.___.._ .......:..:...::._:� Fir- Tracking, please go to www.airbonre.corii or call"! - 800- i�IRBORNE Thank you for shipping with Airbome Express Create New Shipment View Pending Shipments https:Hshipexchange. airborne. com /shipmentdocuments /labeldoc.asp 6/23/03 PUTN 'AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN AL HEALTH SERVICES `C STRi C'IYONVERMTI' E171��S XOE T ! REATMENT SYSTEM PERMIT # ' O/ Located a0�1111' ��> l j� Ile 4�J' i . Town or Village Subdivision name Subd. Lot # 3 i Tax Map;.�'o. /?, Block / Lot Date Subdivision Approved /� 1� i Renewal Revision Owner /Applicant .Name S'ar /i/i6 ' Date of Previous Approval i - ,p . Mailing Address Amount of Fee Enclosed; .i 345"a j} c Building Type ji / a y e Lot Area�5,S- No of Bedrooms 3 Design Flow GPD /ow Section Only Depth Volume Separate %Sewerage System to consist of jG' fj gallon septic tank and LI r %' / / /l/% ���i.��il�'� !� // ii // �/T L-• �� �. � �� /�'yJ� j d C %'%" ���Y....y+ Other Requirements: 1 To be constructed by '62 /y"'7 �✓- Address `,•'' arr, Water Supply: !Public Supply From Address or: d% : ,Priya+e. Supply Drilled -by-- . /,1'�•`/a5.C�% -- - ?, � ; ,.' - Address~ �= g L5i I represent that I am wholly; and completely responsible for the design and location of the proposed system(s) and that the separate sewagg treatment sysiem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, 'rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original ! system or any repairs thereto. , NEW Signed: Signed: �'i „�'''L^ —� P "�` a s A. Date �v G" Address�7 �'1' /` G� icense # APPRO D FOR CONSTRUCTION: This approval ex VMS a date issued unless construction of the sewage treatment system has$een completed and inspected by tl � evocable for cause or may be amended or modified when considered necess by the Public Health Director. ion or alteration of the approved plan requires a new . Ap o e of domestic sanitary sews e'only. By: Title: Date: �( Z White copy - HD File; Yellow, copy - Building Inspector; Pink copy Owner; Orange copy - Design P fessi )nal Form CP -97 IF>IJTNAM (COUNT Y DEPARTMENT OIF HEALTH IIDIIWSRON 07 IEN RONMIENTAL HEALTH SIERWCIES APPLICATION TO CONSTRUCT A WATER WELL Y _ f' # " f' V.. 8 6"*- 61 r Well Location: Street Address: Town/VillaV,,�r���� . Tax Grid # /t,k I`v // e / � �'.f�t- Map sa; it Block % Lot(s) Well Owner: Name: Address: / Use of Well: /Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �� gpm # People Served _,!jLr— Est. of Daily Usage , e al. Reason for Replace Existing Supply Test/Observation Additional . Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed ]reason for Drilling Well Type i'Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No e' Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. 3 Water Well Contractor: Al Address: I'' Is Public Water Supply available to site? .................................. ............................... Yes No e/' Name of Public Water Supply: °— Town/Village -- Distance to property from nearest water main:] Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant. Signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise 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 wate well driller certi ed by Putnam County. Date of Issue V1 Permit Issuing Q fficial: Date of Expiration i I L(- © Title: Permit is Non- Transfferra Ile White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM! COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVA OF PLANS "FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: ark r 2. Name of project: 4. Design Professional: 6. Drainage Basin: 3. Location TN: P_ 5. Address: /j�+7�'rc� l`"U.�!',✓7 y .. ype o ro�ect. —z'Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision ` Other (specify) 8. Is this project subject to, State Environmental Quality Review (SEQR)? 111"v Type Status (check one) ........ ........... .................................... Type I Exempt Type II . Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... U 10. Has DEIS been completed and found acceptable by Lead Agency? .........:..... 11. Name of Lead Agency _-- 1-2hia-}�ro' } e -'ct in�an� ark a "uu er the- control=of local lann i g_ ; z_ o r.. i_n_ _ g . 'or-other-.-..– :... _ . officials, ordinances? ................................ ................. ....... .. ............... ................ ye-S-4 13. If so have plans been p submitted to such authorities? ...::....... ............................ --f� 14. Has preliminary approval been granted by such authorities ?)/` Date granted:. I " 15. Type of Sewage Treatment System Discharge ................ .surface water A_**� groundwater 16. If surface water discharge, what is the stream class designation? ............. .:..... 17. Waters index number '(surface) ............ .:. 18. Is project located near a public water supply system? .:...... ..............................y 19. If yes, name of water supply Distance to water supply 2tL;/mss 20. Is project site near a public sewage collection or treatment system? ................ Ale 21. Name of sewage system Distance to sewag system 22. Date test holes observed ! pyl 2 3. Name of Health Inspector24. Project design flow (gallons pe da ..................`...,.... ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.:. 26. Has SPDES Application been submitted to local DEC office? ......................... "• I is Form PC -97 2 27. Is any portion of this project located within a designated Town. or State wetland? 28. wetlands ID Number ... ............................... .... ,29. " Is Wetlands Permit required? ............................................. ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? ................ 31. Is or was project site used for agricultural activity involving application of Pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No Alel 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... /V --1 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent. to protect site? ................................ ............................... Al"O 35. Are any sewage, treatment areas in excess of 15% slope? . ............................... �(/p 36. Tax Map ID Number p ° _� .......................... ............................... Ma � •.16 Block Lot S 37. Approved plans are to be returned to ..... Applicant 1/ Design Professional NOTE:.AlI applications for review and approval of a new - SSTS tabe located -vritthir� die C �ilafershed shall isenito the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the.watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for, such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision . may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a G'lassA misdemeanor pursuant to Section 210.45 of the Penal Law. SIGIVA7'1111ES & OFFICIAL TITLESo Mailing Address: ................................... 6-11 < ,� .P JT.NAM,.COUNTY DEPARTMENT OF HEALTH DIVISION 011 EN871 ONMENTAL HEALTH SERVICES DI SIGN DATA SHEET. -,St: BSlU1U. ACE.SEWA:GE TREAT- MENT- SYSTEM . Owner`_M ��!/> /��' -� Address Located at ;S' tree t)- ;y^Gi o Tax Map Block / Lot � (indica 'e nearest cross street) Municipality _ 11�2 /�—� -� _ Watershed e::5?3 SOIL PERCOLATION TEST DATA Date of re- soaking _ i C// Date of'Percolation Test -� percolation test hole, (i.e, s 1 inin for 1 -30 min/inch, s; 2 min for 31.60 min/ineh) All data to be stibrnitted for r'avfew, Depth measurements to he made from top of hole, Form DD -97 Ruu :10.::``;:?'> N... r.: 011Water '. a r from Ground :Level Surface ('inches) Start Sta l ds' 3s'° 3e 4 ` I S ?, 4 2 4 NOTES: 1. 'Fests to be reueated at same deoth until ammroximately equal percolation rates are obtained at each percolation test hole, (i.e, s 1 inin for 1 -30 min/inch, s; 2 min for 31.60 min/ineh) All data to be stibrnitted for r'avfew, Depth measurements to he made from top of hole, Form DD -97 11ST PIT DATA DESCIUM. 1, IONOF SOILS ENCOUNTERED IN TEST HOLES 1111 �-JAOLENC G.L. 0.51 1.01 1.5' 2.0' 25 3.0' 3.51 4.01 5.01 5.51 6.01 .6.5' 7.0' 7.5: 8,0! 8.5' 9.01 9. 10+.0'. 2 1nd1.(;w.::.,. level at which jouLinclivater is encountered Indic, ,C,iL(.,'L(.,,vc,latwlilch mottling; isobserved Indj.uu elevd to -which water level rises a-ff.e, being enc.ou ri I erect. Dee,.pfiolc; observation s made by: j Date I't-of'ssionat Name: j-) ve ............ .Des igull-rofessio na I's Seal 10/10/2001° 08:22 9149624248 JOSEPH SULLIVAN PAGE 01 P.4 NiX"N Of EM >{ UTE Ga X K. It 914? "t -37K l � BRUCE K. FOLE:Y LORETTA NIK -P4AfU it.N., tvS..5.N. Pt.bla- tignith DireCtor 'tnwiam Pubfle A�atrk Dtrocto► �W Dlrrcror of P404M Setwtrr, I)EFARTNi NT OF HBO -L,TH 1 ( teneva Road Bpswver, New York 10509 A'rfE:N710N, GeADA1M STIERELING 0 GENE REED .W lnfox•rnstion bclovi rAust too fAU completed prior to any scheduling. DATE. _- EN(il:NEEK OU FIRM: ^ � �- L i Y aY1 F1 OKL fig fli.�SON: DEEPS: X// FFRCS: L7 Pff1YlP TEST: A Z12 ltUP►DIJ'rliJ:;E't': r ; e-ra? A0 c,//..f TAX KAN: LOT0. : ,,,SIUBI i'VISIOI'�i: ...�- ._.-.- . r • F.3.�3..�'. Y'. OiZ ti111V1' RFV�F�it NO W11NrESS11YSi' ]y SQ11, 1ESfi1111I9 i YES N0 u propased SS'1S withIA the drainage basin of West Branch or Boyds Corner 1p+sse wix l7 Proposed BS'rs within $00 fret of a rt"rvou',- eovervoir stem or control lake. W h000sed 59l' within 7A4 Peet of. wotercour�e or a DLC wetland. � I''ropoaaii SS`TS tlesigts ilaw greuta�r.than T.010:ga119nslda7 -ar ES Permit required. l'rGtabsed It is the .responsibility of the design prufessional to provide the .above information prior to roil testing. This Department will detertnine the.. KUDEP project status (Joint or Delegated) based on the revpouse. If you "Swered W to any of the questions, NYCDEP smut witness the soil testing. '1b& I)cpartmc;,t will coordinate a tnutually Suitable tintt• for field testing with the PC'DOH, the ieAgn Professional and NYCDEP. If a project has been dettrlttined to be DelegUrd based on, the above response And theft eubsequrnt Wormatio +ti indicates NYCDEP b required to witness the soli testing, it will be tiro sale responsibilitl+ of thc desigis professional to schedule re- wit,tessing of the soil tcstingwith NYCDEF. Fait coulTrY USE ONLY o lixr& ,.,r. 11• 0 `Y "Cllr.: _ ..._,r a iFL;1.lYffiS'fj I j OCT -10 -2001 WED 09:40 TEL:845- 278 -7921 � �; NA,ME:PUTNAM COUNTY DEPARTMENT OF P. 1 P S ''v. � �� S • COUNTY DEPARTMENT (�) C ! •� ^�% e,�x �,, (�� a ENVIRONMENTAL i HEALTH SERVICES LETTER OF AUTHORIZATION 1I] ORIZATION RE: Property of 1✓ r1 12 Located at /Tee /GC�7 -5 T/V io t,-y Tax Map # .S`0 . I � Block _� Lot I ij Subdivision of �o�Y� r��Oi /"m «✓� Subdivision Lot # Filed Map # % 7 Y Date Filed dVael �d Gentlemen: r This letter is to authorize e ' v�2 �� j // �j a duly licensed Professional Engineer _L,---' or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health -Law, and the Putnam CounVf Sanitary.Code:- Very trul rs, aNCIS yo Countersigned�� ���' s� 9� Signed: E d � P.E., R.A., # — (Owner of Property) Mailing Addre 4 5 �,;-, ,r��J� Mailing Address:`{ c►�bJ �. T Pun" COUNTY HEALTH DEBT. 02.2426 State 1.Geneva Road (845) 278 -6130 Bre"tor, nor 10509 Date Telept ��� Received of �„a.� The Sum Of Z Dollars $ Dd, oU For - � THANK YOU! � X13 3 ❑ Cash '�?tineck 0 M.O. I] Credit Card By rn /1 1111 11 1 � 1 _ 1-1773 1 1 11 1 1 1 1 1 1 1 1 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FO - z: SECTTIONNA: GEN )<tAL INFORMATION Name o Project, �` f Prod . ct, -nn� tH+� (T)(V) County Site Location Building construction begun �a Extent �� Is property within NYC Watershed ? ................. F7 Yes 10 SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. a Hill y � Rolling �t�rOp'we g4_ ntle slope F� Flat 2. F7 Evidence of N etlands Low area subject to flooding F_� Bodies of water J Drainage ditches F_� Rock outcrops S 3. Property lines" or corners evident ....................... ............................... Yes o ............. 4. Do water courses exist on or adjoin the property? Yes 0 No 5.. Will these affect th ' e ' design of the sewage system facilities Yes F_� No 6. Do watershed regulations apply in this development? ........ i .............. F_� Yes No 7 Will extensive grading be necessary? ................. ............................... F Yes No 8. Will extensive fill be necessary for SSTS ? ......................................... F_J Yes r3 No 9. Do filled areas exist within the SSTS area ?........ _ Yes No. . If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: and Dgavel oam F� Clay F_� Hardpan Kixture 11. Observed from: a Borings ' 0 Bank cut ackhoe excavations 12. Soil borings /excavations, observed by ? -V_6 w ttlwe 13. Depth to groundwater M- . i on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas.......'! 16. Soil percolation tests made by U 17. Soil percolation tests witnessed by SECTION D (on back) [2-`fes E] No [am on 1. Form ST -1 1) SECTION D. DRAINAGE .. � . 19. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑Yes 19. Will groundwater or surface drainage require special consideration? ..................... e No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ?. .* ....................... Yes ] No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? .............................. ............................... F-1 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... F;� Yes 0 No 23. Additional comments 24. Site observer /inspector. and title -Vz 25. Date(s) of oliservation(s)inspection(s) t V I Z( 196 TEST PIT PROFILES Hole # i Lot # Hole # 2 Lot - Hole # Lot r Depth to water Depth to water Depth to water Depth to mottling '� U& Depth to mottling Depth to mottling -.� _. Depth to rocVirrtp G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 G.L. 0.5 G.L. 0.5 1.0 1.0 2.0 SiAi 1� 2.0 3.0 3.0 4.0 4.0 Z 5.0 5.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 10.0 9.0 10.0 I ERLTCE R. a,. EOLEY. :: � 1:.:.;..:., .......::...: . Public Health Director .. LORETTA-: - MOLINAR.I. R.N:, .:I\,L.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road i Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 November .15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heigh lts New York 10598 Re: Whitman, Trail to the Hemlocks Whitman, Lot # 3, (T) Putnam:.Vallaey TM# 50.16 -1 -5 Dear Mr. Sullivan:, This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. Plan: ),,"1. The SSTS area as shown on approved subdivision map differs from the submitted plans. Please clarify. V2. The plan states 100 gallon septic tank. It should read 1000 gallon septic tank. -•• �/-3: Please- clarify size of -pump force -nain..Plan- states -2" 0,-detail- states'1' %z'�o.= -. -= :• -. • - -- t -.•• k000'4. Pump effluent line to exit out of side of pump chamber, not the top of tank as shown. Pump specifications and performance curve required. Plan title block to state "proposed sewage treatment system." This office will continue its review upon consideration .of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. ABS:cj Very truly; yours, Adam B. Stiebeling Assistant Public Health Engineer OLL'Y'•..:. .. s. ...,.i �•� :�::...�e .:.n•.w.a ... Public Health Director IvIOLINARI R.NM, M.SN. 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 I Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 November 15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Whitman, Trail to the. Hemlocks Whitman, Lot # 3, (T) Putnam Vallaey TM# 50.16 -1 -5 Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would, like to offer the following comments, for.your review and consideration. Plan: 1. The SSTS area as shown on approved subdivision map differs from the submitted plans. Please clarify. 2.' The plan states 100 gallon septic tank. It should read 1000 gallon septic tank. - - w 3-.---, Please-eliarify size of puitrili force main: Praii states.2 0, detail states 1 '%2" o. 4. Pump effluent line to exit out of side of pump chamber, not the top of tank as shown. 5. Pump specifications and performance curve required. 6. Plan title block to state "proposed sewage treatment system." This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, i Adam B. Stiebeling Assistant Public Health Engineer ABS:cj O� - O 10 N GOV ID .N o-n -sa�clo a n o •o n 9 n •7b,� _ � �n C n ...A O Vn10 K . v� n 0. :3� O N 1 N 1 A � � 1 o �(41 krl c + ^�1� d 350 co .... _ _ .... _. _ .... ....... ;_.;. _..360 _. _. . Ile h 370 380' O \y�y 380 b� f); Vf ry 4b p� Reoch Trai/ / � 4 p0 b n � ' � y 31 °53'W. 262.62' c o � ol�'S o f \ - C Qj o �0 s' !7 �p ? o o? 09s \ �V Iz c O a � n P Q 0 ti� C 3 OS£ 0 CD of + �, of k G' 0� 0 �. �. oc v oti� ti i �D AO p� 2 m a, v L N i W C N C C O. 0 r- G .O . W C A 7 ..0.. ty g L A 6 V o O V W C O. W N I I L O N N a+ ^ L O. m W O D• c c 4 � ii I h tii ?{ a r, t , ...i � �.,`a r•;L ytt�i*: r;', r� � :.1�'.. r! -..C. 1� YC .ass -.. �:. .r .•....- .. ..r..r.. nrr n ..h., J'�' ..,...., .. Rte.•..... -m u .. «... r. •,.,� -.- • ....• t� I .,1�. .... a. wr -. �, C iVMW'. } ° ; 't Y�d� J.(,� 1rV�n'C'�k. ;.'k t �, -.. , •hri . ��� x'11 y� rl • '1 ;a L• Y asap .�s•n�Imw.....VNlplgp>�l11Y1� .. * y 1 T '>t !i Y + ' r; • r �,r , r , 1 n � ,, „. , Y'. 1 .111 AP'3IL1G.it1 it N i vpriAa., p, J,CC�ioit rte i•�t :,.° ?a #3; +�r. �iti,�l,. „Illc,cr.. Call �, �,�I� .atci: uoritinutYUSi '� <° �Igne:i fr' the t b� provNed 0', s: ".i ter Ur !it, l :�J "1; E, !Il','j:'iiiif �'i'11l bid a a without; riarnage fi>1ilOwlr,�: r 11is, blrait: threaders 4Ct!' +o.:>r;. an orati�lr.. 15 Gearfitgs:.Upp6r and „ Gtain!e�.5 stool. ran ,• n , r`. +a, y 1' t:y ball racarrng ii 1'li i� �i L 3 {ftl�. Tl E I.r YF�l� [i" 1`Y Vr li,• f l �.i f I�hiilrir1gv i ctil sF'9E'(.gJ fr, , a;11'i:• :;',.F. ;.r ,.,r,h'�u1,1 B'111 �f,liL ;'. L€.rl�::iUC�IOr'1. u•1,•er and lower, ,�- fluty �laiit:i t,iFUftS "" + itF ter ,d ciiliF• BY 1�IIWe9t CAbte' Sd'J9rt1. " flower ;ofw': 21) fc,; t 'rr �{fC@ r I' ' t6rt1 l)t' ;15 4 ; ra ?art f;?.l and water resistant I, SchoF:! , s ".;, a ,. r rtlLt li �,`., b , !� a � +'f61; ►'E!litf? +i � � �+• 1 811:1Ct?i"f C.t;1Xy :eai l��f ti10tbf eilt� " riospil, +. larlgtPrs availaNe). CAH�P s "� ;, SILj.:�DP prorides secondary iE1ot;;turo Single Irif,ll yl`f'y' a , f r CARBIDE ',turd faces ban I�lr in Cits� of oUtBr jA4�iCt a e ' s•-t S drld HP /;3 0� i.0 I n 1 s rfatnage and to prevrrnt,oil xA±''! =' } , irlilu�rl, stf.rn,. vrrth 115 V or 230,.V three Starn,a�.: ^.cl E tr1. a 1�., • �rrJr?q uiu�. BUN'A -i�'4 st<1�taYterA wicking, SPECIFICATIONS 1 . a; �, with �3 "tiaPi: t li;ilC'i +bSiSta(i' im 0 -Hit AssUrBS ?USItIVA q 1 it HP i 3 STG with g' t i pump — bare leads. E tainlee�; ;IF,,I E hredded sealing against Cantamint�nts y ca, haUi t •�. Thros phase: E:ieslg�r i.ijarlE+t':'n throe and oil leaktipa. r ,° S;,Iid ' d: in p i- .. i4" rtaxi-irum. °'1`2,1% HP —14/4 GTa � rllase I ;io;tE -'::•. to guard N Cischargt: size: 2" NPT. w1tt bar'p leadti, On CSA rgnkltt rl,, iponen? dama!,E; AG'ENCt LISTINGS. e s' 2 lisied models '- 20 foil *. q -Ir. tFj ?r''' t� � 9Vt:rS° !'ctati I Capacitie'': ll� to 1�3 GriV1, Total 1t�`ai.IS: JG to i23 feet ' +ang ; t,l•1�N and STV4 51Mutter, Foi;r wuUrriulge� in � Cam !:ej�stnr�nrasa>�arEaltun TUH, are tandard. high- grad, :'urbine N1 for ��11:'.t'tiJ�iF ;11 SO; silicon i ;tbricatici,l (igftlClFiilli °c';(� U:;.lylNtstq►aI.21RI0rdt0rf @S, 'ri ' {,y, t w carbide -rotary seat/silicon' FEATURES transfer carbide ,, ±atiorlary seat, 300 itpelJer:J, t1 @Si;,�iisl par C1l�ttiruuuts r`ast iron serni= _• - - --- - _ SLr1�f�.S!<rinlEti5� Steel- n181'Ai • _._. ,. ...1tt74rAtiC!?; f il1.. +J•i.�lril�5 �riy ... _ ._......,... .: 'f ,'�fi... - - ::pan, non_c!,�a with paint;- -. , part;;, BljNA -N elastornurs. ',vithin the rr %xor martufsciurer s a out vanes for irreehanieal soar' rl; �•' 7F rnperaturo: recut` ;ended working limits, iO4`F t40 °G) continuous prctsctian. Balanced for 140`F (GO °C) intermittent. hiLTTEiib rer T r� f1 ti * Fasteners: 300 series _ -',- - -- _._ ...,..,•, ..• ` sWnle�5 ;steel. �1 1 ..r � ., I 1• r Ga able r.? rEUtnin dt .sr t._....... z `tt R g Y >,, i wis, t i > i t M vaaEO�s *< i; without I:Lrrage to I � L . t ..r. ,- ...... o ` carEponants. I 7G( �1fE1 w motor 4 �U1• 1 ��.._ I "'a.._.i ._i ,t. ^r ' i � t i .!... r t..a.... i, it 4;t • Single phgse: r i �.. "WED t,,. � HP, 11 V, 'r_00 V, 2 0 �! 60 dz t r4>0 RPM; /j HP, 1 5 V, � :az, 350E RP1n; i "►— ca +A . r. _i. ` ' i /��t__/'•� yam( pr 41...E - ( ' `�. ••�_ „y., 60 Rx , 6(4 RHO, i il�r• it r��rc� '. 1 _ s � '�� � 1 ,� F_ r 1 � � >f a Built -in overload wits! aulonr 3til 1`S`t 1G YY,E.• .....i ; ..sue':;- �•'� -.a. ",�` �i �.,` ,....,..,.+ _. 1 Class B Iris ;ulatiun. Three phase: I i. � i 1 t i i t..- `'`"'�. ,. ' , � J......_.. a ?; HP, 1 ii NiW '00 /2301 i I �4!�0 V 6ti biz, 3500 FtpPJI, ' t�.. c.. tin too :,o ca;:' 1110 120 460 130t31� 1 "+ r Class E imiulation, 10 20 ibihilh �' g �G APACITY. �p 1 + 1a J�µl 3� 1995 COuIdE Pumf"e, iilC. J �h7® YY iii �7� ! E!rsntive M3�+,1895 �T 7.,, . " i SHEIRLI'' f AMLER, MID, MS, FAAP Cc41 Inissioner of Health ROBERT J. BONIDI County Executive 1GISN` � t ®B✓tT MORtIS,'PE Y�LORETTA MO LINARI'N,'` Associate Commissioner of Health ire of Environmental Health DEPARTMENT OF HEALTH . 1 Geneva Road..Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREETG'! 1ie4 /4 cvr--liY//" &&'tco,�T OW NpC=&A tZ1V TAX MAP #_SQc NAME h'� /,V P &9sxS/S PIIONE9/y/8�� /Z PCHD# = vZ2 MAILING ADDRESS /4 DOLL. (�2v,27� C& DESCRIPTION OF ADDITION F-1,01,Y7 ` NUMBER OF EXISTING BEDROOMS ? _PROPOSEID #9F BEDROOMS_ (FROM-CERT. OF OCCUPANCY M. OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition. which is considered a bedroom requires formal approval of plans.(Construction,permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278-6130. 1. 2: 3. El 5. Certified check or money order. for $100.00. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and - dimensioned, and-use of each-= roorri= -specified): - (See'Section 3.c.- of Bulletin=-- HA -1) Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) Copy of survey showing all well and. septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. .Copy of Certificate of.Occupancy from the Town or Certification from the Building . Department with legal bedroom count of dwelling: OFFICE USE . COMMENTS 5. Environmental. He alth (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 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 =1580 SHERLIT" "AMLER, MD; MS, FAAP - CoMV.issioner-of Health Associate Commissioner of Health DEPARTMENT OF HEAL] H -1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive Director of Environmental Health Town Legal Bedroom Count & Proposed Addition Status Re: -4LC-,.W6 (Owner's Name)' Tax Map # Le, ,kddress: L Town:, PL'A I- N- VAvL_LQj Year Built:. According to records maintained by the Town, the a.bove'noted dwelling, is in compliance with Town Code. Is . not I in compliance with Tow n Code. The Legal Bedroom 'Count is: This information has been -obtained from:' Certificate of'.Occupandy. Other:, The plans for the proposed addition are considered: NewConstruction V/ Addition to existing house only Teardown and/or re -build allowed under Town Regulations �-. ► 9 Building inspeptor Date 6.. 'Environmental Health (845) 278-6130; Fax (845) 278-7921 Water Supply Section (845) 225-5186 Fax (845) 225-5418 Nursing.Services (845) 218-6558 Fax (845) 278-6026 Nursing Home Care Fax (845) 278-6085 WIC - (845) 278-6678 EaHy Intervention Preschool (845).228-2,847 Fax (845) 225.-1580 SUBJECT RES I DEN f iAl SilrE lNQuil-.\,y DATE : U1 /Zb/2UIU 372800 PUTNAM VALLEY 50.16-1-5 ROLL SEC TAXABLE PARCEL PRCLS 311 RES VAC LAND 13ASTYS HEINO TOTAL RES SITES 1 LAND $183,700 DENNYTOWN RD TOTAL COPT SITES 0 TOTAL $183,700 SALES RES SITE R01 RESIDENCE PRICE $180,000 TIAL I D I EXTWALL MAT STORIES GRADE, - - -,'.REAS PROPERTY CLASS RES VAC LAND I HEAT TYPE 1ST STORY: ZONIING R3 I NO. OF FIREPLACES 2ND STORY: SEWER. NONE NO. OF' BATHROOMS I / 2 STORY: WATER NONE i NO. OF BEDROOMS 3/4 STORY: UTILITIES ELECTRIC I ATT. GAR. CAPACITY FIN BASMT: NEIGHBORHOOD 28140 1 BAS. GAR. CAPACITY TOTAL SFLA: ===TOTAL IMPROVEMENT ITEMS 0 'TOTAL LAND ITEMS- 2 TYPE SIZE] SIZE2 QUAL\J I 'TYPE FRNT DPTH ACRES SQR FT 1 UNDEVELOPED 3.00 2 RESIDUAL 2.88 Fl-=MORE ITEMS I F6=ASMNT INQUIRY F10=GO TO MENU 75.20 03-050 F4=NEXT RES SITE 014 FILE Fc-/'=GO 'TO XREF Fll=PREV ITEMS CERTIFICATE OF OCCUPANCY CERTIFICATE NO 2006 -198 DATE: 8/30/2006 FI�RMI7 "i�TO'2004= '1fi8•�.�.. �...�_. �r .r. �,.��,r -� _..�.. �_�. .r�u.... �„ �, z _a.�.....�..__a ,_..: - ...- •.:..���:,: ;.,�,�_,�... TAX MAP # : 00/50164-5 LOCATION: 61 TRAIL OF THE HEMLOCKS ISSUED TO : BASTYS HEINO 14 DOVE CT CROTON) NY 10520 This certificate covers the construction of: ONE FAMILY RESIDENCE WITH TWO CAR GARAGE; THREE BEDROOMS; FRONT PORCH (136 SF); REAR PORCH (8' X 15.5% UNFINISHED BASEMENT. The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary Code,. the Uniform Building & Fire Code and the Laws in effect intheTown:of Putnam Valley, Putnam County, NY, having paid the required fee therefor and the undersigned having by personal inspection ascertained that improvement of the proposed structure -m- incompliance. with the requirements of the,-laws, as• aforementioned; -that the said work 'and materials meet every requirement of the laws as aforementioned and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law. Now, therefore, the Certificate of Occupancy is hereby issued ugder the seal of the Town of Putnam Valley. TOWN OF PUTNAM VALLEY,. NY By Code. Enforcement Wicer it 4 P ! : A COUNTY DEPARTMENT OP HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM[ J IPCHD CONSTRUCTION PERMIT # Located at i ' -._. I �- w 1�4I t=1 ` ty =':� Town or Tillage Owner /Applicant Name =;, `;� °` `� <. Tax Map "'` A Flock f Lot " Formerly i ` _ ;.. �� ; ! T i1 Subdivision Name .. fi 4?' i �' { r t° : y E 7 Subd. Lot # j Mailing Address ; g ; `R #.F! Zip �.,.,.. Date Construction Permit Issued by PCHD Segnau'ate Sewer age System built by . } _ ,Address. t""e,.�� „' ~F Consisting f F g �. �.;� Gallon Septic Tank and �..____ �, � � . � ��:.' � Other Requirements: U .fl 1 Water SurD®Yv: WI ” Public Supply From or:— Private Supply Drilled by ' e' /AL !':, TQ i P, U T" i C. Address Address ". Has -erosiorf co.ntrof been- completed!-- Number of Bedrooms" r ! M ` _'; Has garbage grinder been installed ?,; `certify that the system(s), as listed, serving the above s® JOKe constructed essentially as shown on the as- built plans (copies of which are attached), in accor CHD C onstruction Permit and approved plans and the standards, rules and regulations of ih p ent of Health. a QA .. Date: It j,' -:. Certified �y Address Any person occupying premises served by the above P.E..". R.A. i., ,: License # ,�, ',( = a .1 R 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 treatrent'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 cha%et-,wh niybf,� dgment of the Public Health Director, such: . revocation, modification or change is necessary. By: Date: - -' .- . ;: ., ' "� Title: .. White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIiON OF'ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT �V•ell L'ocation - . "..;, • S'tr�'tri= AiilPess: .` . ° .' ". ' . -, rail. of the Hemlocks Tow.n/V i9lage: ° - .. ° Putnam Valley. TaxGrid �"'3 i7. 6 „' � ...,...� ., . Map I= Block Lot(s) Well:Owner: Name: Addr ss: Hein Bastys 25, Scenic Drive , Qroaon –on- Hudson, NY Use,of Well: I- prim ary• >; 2- secondary Y 'Residential Public Supply Air cond/heat pump Irrigation ' .Business` Farm Test/monitoring Other(specify) Industrial Institutional Standby . Drilling Equipment.. Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details t Total` length. __ j_ft. Lengzth below grade-• 39 ft. Diameter o in. Weight per foot 171b/ft. Materials: x Steel Plastic Other Joints: ; . _ Welded__g Threaded � Oilier. Seal; Cement grout X . Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First-!.: •Yes No Hours Second Well Yield Test _' Railed..:' X Pumped . — Compressed Air Hours 6 Yield .5 gpm Depth Data-. Measure frowland surface- static, (specify ft) 20 During yield test(ft) 400. Depth of completed well in feet 1000 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. A. Land Surface 4 Clay 14 1000 Hard. Granite Quartz If yield was tested at different depths during drilling, list: Feet Ghllons Per Minute Pump /Storage Tank Information 1000 5 Pump Types i&pacity Depth _3= Model 412 Voltage HP Tank Type disdtuagn Volume l a'i Date Well Completed .11/4/04 Mnam,County Certification No. 02 Date of 7 Well r ler (s a , % NUTS: Exact location ot.well with distances to at least two permanent ianamarxs to De proviaeo on a separate snecupian. Well Drillers e,(. tJd l n tciic. r Address: 75 Putnam Ave. , Brewster. NY Signature: �.. ; Date �:3. f. ':4 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 mbLr- 14- XXqq99 1��1���7TT7/I (���j/'�� ®J (1�a�['�( �j ([']App �J _.. . -.. ... ._ .._.... ...e 6'P`= '.LA'N�r -, �..-'r T"�a�:.: 1— GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building _ e9w, ee2- Building Constructed by _rRA I1_' E 1" E HEMLG<11_ 75 Location - Street ! �5 . Tax Map Block Lot TownNillage �1dMA4 1 *rrMA Subdrvision Name AMILfr_ E151 o�� 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 whicl , 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 ptoperly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director bf the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month j Day Year (Owner) = Si Corporation Name (if corporation) Address; State __ t�gW Zip Signature Title: Corporation Name (if corporation) Address: State �j Zip L.6 Form GS -97 Sherlita Amler, MD,;MS, FAAP Commissioner of Health Robert'Morris; PE Directo:�, of. EmYrenntental ildw /i April 1, 2010 Heino Bastys 14 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Bastys Department of Health 1 Geneva Road, Brewster, NY 10509 Robert J. Bondi County Executive Re: Addition- A- 043 -10 No Increase in Number of Bedrooms 61 Trail of the Hemlock (T) Putnam Valley, T.M. # 50.16 -1 -5 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated March 31, 2010. The addition is approved with the following conditions: 1. The total 'number of bedrooms must remain at three without prior approval by this Department. 2. The area 61the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low.flush toilets; r str etors for shower .heads-and faucets- etc ; .. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, � . 62 Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845).225 75418 Nursing Services (845) 278 -6558 Fax (845)178 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 i . A B T2 16.2 44.2' T3 14.4 47.8' T4 12.5' 55.7' DB1 112.6' 121.1' L1 114.3 122.3' L2 109.1' 116.9' L3 103.3' 112.2' L4 97.4' 108.0' L5 91.9' 103.8' L6 85.8' 99.5 L7 135.4' 99.1' L8 142.3' 106.4' L9 146.6' 111.9' L10 151.4' 117.6' L11 157.7' 124.4' L12 162.1' 129.7' 90 TRENCHES REQUIRED = 600 L. F. TRENCHES PROVIDED = 600 L. F. _ -.PUMP TEST. PERFORMED 12/8/05 .....__..:.._..__........t... ...._. _�. __ �.. � DOSE VOLUME_ DROP = 15 1/4" i / CYCLE 1 � I fO \\ IS 7 U' \ BUILDING DRAIN \\ J, IDISCHARGE \ 4 O 1000 GAL CONC. PUMP CHAMBER n0 ' „ C ' gb \ W/ ACCESSS MANHOLE TO GRADE 1000 GAL CONC. SEPTIC TANK, { \ !- T4 \\ 1 1/2- PVC SC3+40 FORCEMAIN - EXISTNG.'r „y�Y ORI VEWAY T3 \ - T2 \ 7' DEEP CURTAIN DRAIN EXISTING POND —Ti 4' CIP SOLID 4- PVC (TYPICAL) TIE POINT Xy \ ?• �=!`,Z - b \ CONC. DISTRIBUTION BOX W/ SPEED LEVELERS INSTALLED U.P. \0s N 7919'10' E 2.13' / DOI CURTAIN DRAIN HIGH POINT N 3058'50 - E 2.51' DR INS IN BOTH DIRECTIONS loox EXPANSION OF TRAIL 7' DEEP CURTAIN DRAIN M/ \ SSDA 10.000 a.f. ' / , / \ THERE ARE NO EXISTING PROPOSED WELLS '64ts' LOCATED WITHIN 400' UPSL OPE OR 200' DOWN D.I. d \ APPROXIMATE LIMITS OF IN DIRECT LINE OF DRAINAGE OF EXISTING SS7 \`'• 2' R.O.B. GRAVEL FILL �( \ \\ IMPERVIOUS EARTH BERM �, INSTALLED AROUND SSDA 00 �� 4 10 \\ ALL 4- PERFORATED PVC LATERALS HAVE CAPPED ENDS (TYP.) / k d — l . S 31'58'05- W - 2.1S' �d PUTNAM CC JP DIVISION 0� 10. 1s APPROVED. t '� _ nDw heal r 1 l .I . a c yi 0 k a Y• k.