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Home My WebLink About2429DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 50.20 -1 -9 BOX 21 11 M or rm r T �` '1 t r LL { 6 '' . ,_ 02429 COUNTY MENT OF HEALTH ;:'ATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM `l -. INSTRUCTION PERMIT # 3 -' G% Located at e's,1 n /act d Town or Village Owner /Applicant Name �9 `' �4y Tax Maps ` Block /—Lot � Formerly /�/ ,jX, Subdivision Name u�y Mailing Address / �` Subd. Lot # ;_7 Date Construction Permit Issued by PCHD 0/� Zip % s' V Separate Sewerage System built by6'%/'i rrr� cr Address Go 1/L4 dy �1 �/ Consisting of z)d6' J Gallon Septic Tank and 3- oa d,/:� Other Requirements: i �% � 4 x"-a ate° -� -, -i�/ Water Supply: Public Supply From Address, r: Private Supply Drilled by 1-3,7 d/ Address earw e,11 . - ....M - . -._ . Has erosion control been-completed? Number of Bedrooms _ Has garbage grinder been installed? ,/old I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Vii' 2--r-, v v Certified by De n Address �Any person upymg premises served b " e above s to secure the correction of any unsanitary conditions rest treatment system shall become null and void as soon as a P.E. R.A. 2L License' # -X 41 l �tly take such action as may be necessary i usage. Approval of the separate sewage 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 modific tion or change when, in the judgment of the Public Health Director, such revoca n, modi atio o c g necessary. By: Title: Date: White 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 Well Location Street Address: to W n f CCJt Town/Village: PU1"rL_, (n Lk l ICL ) Tax Grid # Map 6� r-]—Block ' I ot(s) Well Owner: Name: Address: 3h a,r/ Ili_ Z 2 w 5 AN / zs6 L Use of Well: I- primary ,2-secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby )[Drilling ]Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing � Open hole in bedrock Other Casing Details Total length Z 1 ft. Length below grade ZD ft. Diameter _� in. Weight per foot J_lb /ft. Materials: _ Steel _ Plastic _ Other Joints: _ Welded .5<Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped _- Compressed Air Hours Yield _,0 gpm Depth Data Measure from land surface - static (specify ft) Al During yield test(ft) /6�l /i%�/%!ll[Y iI 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 3 P>ivn s Qc� !,jbi�Y,/J Chi ,,. 6r If yield was tested at different depths . during drilling, list:; Feet Gallons Per Minute Pump /Storage Tank Information Pump Type-,'/— Capacity, 42Lj2 ;.,ey Depth 11L' Model 2ji 2 Voltage Tank Type Volume�- r- . o iA Date Well Completed Putnam County Certification No. Date of Report Well Driller 'ignature) NQDTIK: Exact location of well with distances to at least two permanent ianamarKs to oe proviaL"n a separate sneetipian. Well Driller's Na mp f S i Gi n c . Address: 2f- Z Signature: Date: White copy: File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 .. a BRUCE R. FOLEY . DEPARTMENT 1 Geneva Brewster, New OF HEALTH Road York 10509 LORETTA MOLINARI R.N., M.S.N. "Aisocidte ' Pub7ic- "Niafthi m Direc or Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278.6678 Fax (914) 278 .6085 May 17, 2000 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Application of Certificate of Construction Compliance - 320 Dennytown Road, Bellatto Town of Putnam Valley, TM# 50.2 -1 -9 Dear Mr. Sullivan: ::. Al" ,, ,at - ,.. This office has determined that the above referenced Certific , Constr,,ul Compliance application, received by the Department on May 15, 2000 is u &omple't.. Please be advised that the following information is required before the Department m Lommence its review. Documents: 1. Application Form CC -97 "Has erosion control been completed" f Answer must be `yes' 2. Form WC -97 Tax Map Number is incorrect b Pump /storage tank information must be completed. c. Date of report must be completed. This office will continue its review upon receipt of the above mentioned comments. Please feel free to contact this office if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc: CC -97 WC -97 .4 s _- BRUCF R.. Public Health Director _ ... _.._. _. _ .. LORETTA - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York, 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 Cr' L4 May 17, 2000 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 Mr. Frank Sullivan, PE 2972 Femerest Drive Yorktown Heights, New York 10598 Re: Application of Certificate of Construction Compliance - 320 Dennytown Road, Bellatto Town of Putnam Valley, TM# 50.2 -1 -9 Dear Mr. Sullivan: This office has determined that the above referenced Certificate of Construction Compliance application, received by the Department on May 15, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. Documents: 1. Application Form CC -97 "Has erosion control been completed" Answer must be `yes' 2:. Fon- n -WC -97 a. Tax Map Number is incorrect. b. Pump /storage tank information must be completed. c. Date of report must be completed. This office will continue its review upon receipt of the above mentioned comments. Please feel free to contact this office if any questions arise. Very truly yours, . Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc: CC -97 WC -97 PUTNAM COUNNTY DEPARTMENT OF HEALTH DIVISION OF E\'VIROINMENTAL HEALTH SERVICES • FINAL SITE INSPECTION Date: % 6 Street ns cted by: +• a..... eet Location cc t ,� (�? O�r-n Permit r _-4.3 Z-91�? TM M Subdivision Lot r 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lath. Width Avg.Dpth c. \aural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area ......... e. 100' from water course/ wetlands ...... ............................... Il. Sewagge System a. beptic tank siz - 1......... 1,250 ......... other ................ b. Septic tank insta evel ....... ............................... c. 10' minimurn from foundation ..... ............................... �2 d. Distribtuion Box outlets at same elevation -Water tested ................. 2. Protected below frost .................. .............:................. 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set.......... ..... ............................... f .. . —�T Le�-gt.�i t required 3cqa Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ..................? ..................... A . Slope of trench acceptable 1/16 - 1/32" /foot .:........... 5. 10 f. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1 %z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ .............................. _...._......_ - I - Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. house located per approved plans ... ................................ b. Number of bedrooms ....................... ............................... IV. Well dell Tocated as per approved plans..., .......................... b. Distance from STS area measured 2 ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 wig -- NE NORTHEAST LABORATORY OF DAIVI1 URY 391*1M1 1;--F :iJ R,f Rwo (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: G.M. TAYLOR & SON 31 MEMORIAL AVENUE PAWLING, N.Y. 12564 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL:5 /9/2000 DATE SAMPLE COLLECTED: 5/2/2000 & 5/8/2000 TIl4E COLLECTED: 11:30 A.M. & 4:00 P.M. COLLECTED BY: JAY & HENRY DATE RECEIVED @ LAB: 5/2/2000 & 5/9/2000 TESTED BY: LAB #11471 REPORT DATE: 5/11 /2000 BELLOF'ATTO, 320 IDEN NYTOWNl ROAD, PUTNIAM VALLEY, N.Y. I(ITCHENi FAUCET WELL NONE 1•/l 3� \ Irrl NA M Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS:5 /2/2000 Color 2 15 Odor ND 3 Units pH 7.71 no designated limit Turbidity 1.5 NTUs 5 NTUs CHEMISTRY:5 /2/2000 Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N <0.05 mg/L as N 10 mg/L as N Alkalinity 73.0 mg/L no designated limits Hardness 92.0 mg/L no designated limits Iron 0.070 mg/L 0.30 mg/L Manganese 0.018 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 5.7 mg/L 20 mg/L ** Lead 0.002 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 5/2/2000 & 5/9/2000 SAMPLE, AS TESTED ABOVE: MOTABLE or �OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) nr Laboratory Direct- - oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 .tr ' BRUCE R. FOLEY _ "Hek1Fh'!Xrector" ... e.......,..,.,_.:..-.:: . is. 1. �1�- ia+- i. �:. Ll?.:; ly: �. 1. �1L` II' J. i�1 :.i�:.1F.ya:,FY1��r1M�•. ».;: n.,...:. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (Q14) 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 DDRESS VERIFICATION FO OWNERS NAME: TAX MAP NUMBER: :50. 2— ' E911 ADDRESS: 2,0 ,b ,L H)-?h TOWN: PL/, D AUTHORIZED TOWN OFFICIAL: V 'T/if��,� (Signature) DAVE: 0 � 000 . The Putnam County Department of Health will not issue a Certificate of C onstruciion 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. (F.911 VERFRIv17 ....aF cv. .:f.Y "^(.1.:_t'.Oe` -.0 l VJ ��L 1>j�� 11 Y ��J1J S[J 31 1 Ji�y'1 JY��' �'��- L:JC•l.l�I'Ji.,.n :':.�. ::..a. ..'.~� t r,. ..... m._,....�..K.., � DRVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �iti��A ��1 DMA -7TH 5"0 Owner or Purchaser of Building Tax Map Block Lot /X)C- 7y7' Building Constructed by TownNillage DFi��ti'�u�iy Location - Street 1110 lk)I-AA' Building Type 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 - --- - -sewa� t- re4at:�ent'system;; or �ariy= repairs .made by .rne. 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. r��tori . ARnnth_ . .V na.v Year 4n-T), _ Signature:,,. -, ation) _��d, �y dip Form OS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH �..x.....;>..r. .. .•f.�a.a:.•.:.e•. , �:. �u. .�- .'i:•.r.:l.'4- ,..f "e:�•.yrt: �. ._ .. .. .. .:...... .. ... .. .• r _. . :'-e :.. d..;•.....a...m:':.+%:r. :.:..w. wn .. .. =. tr.r- ..'a.. ••rt.i'a:.�ua •fig.. ;.. y.... t .l. ... •. DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM AAA )Aq Owner or Purchaser of Building .5 ' Eec`►c'r0Q 6-42srr . Building Constructed by DAN& � y'[9t,LIA) &ice l� Location - Street InO DDI -8 Building Type so 1 a -/- 10 Tax Map Block Lot Town/Village tLgM /q;,g&_ C 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 opera ji�o eriy�i� eau �� 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. w <(11w-`ri. Dated: Month Z�yY Day Year Signature: , � f i Title: 6cc�/UL: ne Contractor (OwnGr) - Signature 22 l.Lh Z`Z� Z �9� . Corporation Name (if corporation) Address: DP geX At 171-1� State Zip Corporation Name (cif. corporation) Address: /Z� ^7l l State G _Zip Form GS -97 .' — P tiJ'T AM- COU— ,NT, -Iii " -DEPAR—T,- D`llE Y ti F./F. HEALT H DffVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Eelc,`�' 6T) 6iT&r5 . Building Constructed by Du F_AW �` '',9t, Location - Street Building Type TownNillage tors lop 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 Sewa& A ealrhenf 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. cI I d46 Y;9/ V �i►vsr�uc�, Dated: Month _�� Day Year Signature:. Title: 66.6 _ 9frievig Contractor () - Signature Corporation Name (if corporation) Address: State' Zip /A5-/" --T Corporation Name (cif. corporation) Address: hK& / ym, State Zip Form GS -97 ..' JAN -13 -00 09:57 AM SHERWOOD 914855 5977 P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH ENVIRONiMEl\ .l A HEAL 1 99RV!t IJ.,,.,.....,,,.<. LETTER OF AUTHORIZATION J RE: Property of L.—� - ' � - � 1 V\ , Located at Den n cI Own o et T/V pu Va 11 Tax Map g Y'1V ,2- Block ! Lot Subdivision of ; 1 ; a wo law v se: Subdivision Lot # Gentlemen: Filed Map # Date Filed This letter is to authorize d of c� �q q <�, V \ � %, ua ✓1 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 SYMMS in conformity with the provisions of Article 145_ and/or 147 of the E4ucation1aw,.th blic Health:.... ealth:...a..-• . -- - i;aw; and the " Putnam County Sanitary Coda. ^� n ` TIT Countersigned: Mailing Address State . ,____,Zip )OS-15— Telephone: 9 i Z— 4 ), Very truly yours, l t PeMailing Address: / Aj I ti 1� State Zip i f�1 Telephone: Form LA -97 4' . _ % zCE *-.P Public Health Director DEPARTMENT 1 Geneva Brewster, New ��_,LORIrTTA; MOLINARI.�R�N...M.S.N.q a Associate Public Health Directors - Director of Patient Services OF BEALTH Road 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 March 17, 2000 Mr. Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown I-Igts, NY 10598 RE: William Burge, Dennytown Rd. TM # 50.24-10 (T) PV Dear Mr. Sullivan : This office has conducted a final site inspection of the Sanitary Sewer Treatment System for the abo 'e referenced project. I offer the following comments for your review and consideration. Trenches are covered with "rosin paper ", trenches must be protected with Geo -tec fabric as specified on approved plans. *Paper to remain, with fabric to be installed to best ability, after removing dirt cover. 2 100 % expansion area to be shown on as -built with accurate dimensions. 3. Well head to be raised to a min. 18" above grade. Currently 14 ". Representative of trench to be left uncovered for inspection, most to all covered over. Bedroom as -built inspection of house required, house was locked at time of inspection. A re- inspection of this project is required. Please contact this office by way of request for final inspection form upon completion of all above stated items. Feel free to contact this office if any questions arise, or if I can be of any assistance. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj MAR-21-2000 09:48 FROM:PLEASANTVILLE REC 741-5157 TO:19142787921 P. 002/003 TOWN of PuTNAM VALLEY DEC IS 1999 PERNaT WAWER CHAPTER 144: Frahwater Wetlands, Wattrmrm and Waterbodies Ordinance of the Town of Patagn VQw-yj New York. The Town Wetlands lope'dor, in AMMval AuftM. ha determined that the puposW a=n is an Unhawl Action undler SBQ" and will not have a siaffikag cwbvnm=LW kg=L Them(ore,aPElt?4TrWAPrERisgr,,&-.0 DAIT. PERMIT 0SURD; December 9, 1999 DATE PERMIT EXPIRES: December 9, 210 APPLICANTISPON90R.- Linda Bellotittio, & Janice Pierguca I Mayflower Drive Putnam Valley, NY 10579 PROPERTY LOCATION: 320 Dennytown Road ' TAX M"#.' 50.20-1-9 SIZE OFPARCEL: 2.001 aercs ZONING: R-3 PROPOSED ACTION: filling In and grading of large bole from previou cKcavation within watemurse bufrer MATERTAU REVIEWED: 1. Site AfteradniPtrindApprwationfiim*66.#W.T-330,.d,-,412="- CONDITIONS OF PERMIT: I Erosion co*w1s cow of a sit fence" be idled along the strem in the location 2. No grading or t;rtbraeft w&Wm pv*tIcd within 25 6:9 ofoem r-wd sOc to be graded, =W mW mulched with bay.. Sat fin;c to mnidm =W sitc stabilized in the mm% of 2000. If accessm►, am should be msocdcd and hayed in the spd* 3. The Buildiog Inspector be notiW once erosion control meamm are in place and at kat 49 hour* prior to the initiation of any site work, Pie I di - A- . MAR -21 -2000 09:49 FROM:PLEASANTVILLE REC 741 -5157 TO:19142787921 P. 003'003 _ a....yo.4. Whm Emm *ouconuels m comwedon pmcm and mmdn in Ph= unto f *C Odom for a®ap "'Ji* COMP . S. lim PNOWDS Bow& Wets 11 08, MWOT 00ft Ingmur, Sfe U lmvc & ng8 Y® to show W. cej�ww Ir®E'988 wan& bspwtof cc: �ppAic�uB ins b2paace �. laili, -cia �_ _ _ ......_._... ........ _ p4pacm WWOR MAR -21' -2000 09:48 FROM:PLEASANTVILLE REC 741 -5157 y �p TO:19142787921 roUh 7f P. 0 �enn�_ .fin �S�lo�S ol v ...,O 'm+ r ��.a -.�. •+v�•. -:y•r � r n /•s ^. l..:c :.. -. a- •- ^'•_f. -.tea :m+4txiYee++M "��R. +.m .a :T,a..c .... .•.. -:... :q..•a ... C -.• ... � C... - vY a- .q �xwcrM afa R..+v ../s+n,.• . PUTNAM COUNTY DEPARTMENT OF HEALTH T DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION X ADAM 0 GENE REQUEST FOR FINAL INSPECTION For All information must be fully completed prior to any inspections being made. Fill f/ Trenches PCHD Construction Permit # - Located: 10C__4 /7 V Z u c� :--A� (T) Owner /Applicant Name: 1 "n Z' Gfe%J:�e TM -521.47 Block Lot It' Formerly: l 'rl1f` V ,�P Subdivision Name: i? yll"`a-*j Subdivision Lot # Is system fill completed? Date: Is system complete? Klk � Date: _ Is system constructed as per plans? Is well drilled? -V 1%-3 Date: Is well located as per plans? 1/� Are erosion control measures in place? i/el I certify that 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 appfoved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: F 5;rZ � Certified by: Design Professional Address: Z— ✓f� ��'� %� /;;�_ , Lic. # Comments: yl'% /y /' Zy�4" �— Form FIR -99 03/15/2000 13:51 9149624248 JOSEPH SLLLIVAN PAGE 01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM, 13 GENE MQUEST EQR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit pew,7 q (T) (Y) Located. Owner/Applicant Name:'. TM 50-1 A Block Lot Formerly: W11 PP-4Y Subdivision Name: W"y//WfPj, Subdivision Lot Is system fill completed? M." Date- Is system complete? Date: Is system constructed as per plans? )te±' Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? I certify that the systern(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 Regulations of the Putnam County Department of Health. .Date: -Certifir, Design Professional Address: 7-- Lic. # Comments.- Form FIR -99 _014/A, PVTN,'� M COUNTY DEPARTMENT OIF HEAL I I I II)IVf'f(1 }N 0f f Wf'(1NMf N f AI. HEALTH I f I Sf.f'W(I a I`JS'll'IIBNeC'll'II�I�T I�IE AGE 'IrRIEA'iTPViIIEi\T7[' S�YS'IrIEIYit IFIERI�iIIIT # � � ° Located at ,gin I—elw Town or Village Subdivision name %lei / �r rr ��,nr e, Subd. Lot Tax Map ,!50. 2- Block % Lot le U— Date Subdivision Approved % I Renewal Revision Owner /Applicant Name c /W s � j e Date of Previous Approval Mailing Address � � � c �' J, g � e; A,- x Zip /'r j 2 Amount of Fee Enclosed 30 n Building Type 1,Z� �f r,�r �' Lot Area :2 No. of Bedrooms 3 Design Flow GPD y e IFM Secdom Only ^ Depth Volume M P CHD NOTEFI CATIION IS III UIRiEIlD VTHEN FALL IS COMPLETED Sepairate Seweira- a &stem to consist of gallon septic tank and 3 O y Other Requirements: To be constructed by Address Public Supply From Address - -- _ dt Private Supply Drilled by ,el,a,�r -� c� Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the serrate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of royal of the Certificate of Construction Compliance of the original system or any repairs thereto. of NEW y NCis Signed: * �` d� R.A. Date ` 9- Address 2- r ,-- . License # 9 _ APPROVED R CONSTRUCTION: This expi es two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Appro ed r discharge of domestic sanitary sewage only. By: &' Title: Date: White copy - HD Fil ; Xel w opy - Building Inspector; Pink copy - er; Oroa copy - Design Professional Form CP -97 • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPIc►TiQN:T ....CQNSTRi1GT. A► W . TTIt� please print or type PCHD Permit # Well Location: Street Address: / Town/Village Tax Grid # 1'9e"h /7 )V lr-ell!y!aM yMap Jd, 2 Block % Lot(s) / 0 Well Owner: Name: Address:" Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage o n gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 1, "New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ✓' Is well located in a realty subdivision? ...................................... ............................... Yes i'.' No Name of subdivision 1/iJ /� �r� 5'�'r% or�r�' !' S Lot No. 2 Water Well Contractor: 4e", cv" Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: /4;1.`��f 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 water well driller certified by Putnam County. r 4 _ 111-7 Date of Issue 9 V Permi Date of Expiration 1A Title: Permit is IN ins erralfie White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �--' - .r.•.r IPUTNAM COUNTY DEPARTMENT ENT O HEALTH H ]DIVISION OF ENVIRONMENTAL HEAIL'II"IHI SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT ENT SYSTEM 1. Name and address of applicant: Ae / C A/y /x/257 2. Name of project: ,�� -5 _ 3. 4. Design Professional: & L i //a 5. 6. Drainage Basin: `�'• 7. Typed of Project: Private/Residential Apartments Office Building .- ocatidn TN: f Address: ;� y/ a Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? .Type Status (check one) ....................... ............................... Type I Exempt `Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Al c,? 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other _ ..�. ... off gals- ordinances? -.:......:�::; ................... : ......................... .....,........,:..,.....:�- 13. If so, have plans been submitted to such authorities? ........ ............................... y e-.1 14. Has preliminary approval been granted by such authoritiesr Date granted: 1,!�ZX_ 15. Type of Sewage Treatment System Discharge ................. surface water `groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Maters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... /Iv 19. If yes, name'.bf water supply Distance to water supply r—$, 20. Is project site near a public sewage collection or treatment system? ................ A42) 21. Name of sewage system °"` Distance to sewage system 22. Date test holes obscrved 23. Name of Health Inspector 24. Project design flow (gallons per day) ................... d .!n. :. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... _ A�, 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 z 27. is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... - -29': - �IsFW'etlands Permit- required? .........::..:.:.......... ::......................... r :. wAl� . _....- . Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /I /e 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? � 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? . Yes/No ��' DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ...:..................... 34.. Are community water and/or sewer facilities planned to be developed within 1.5 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /1//6 36. Tax Map ID Number .......................... ............................... Map v Z Blocky Lot le, 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall b:eaent:to the..Department,-and need not be sent'in:duplicate'to the nEP., although,.th!: pL�J�ct m !�' rCLluire QF I? approval of the SSTS prior to final approval by the Department. Projects within the watershed mad- also require DEP review and approval of other aspects of a project, such as storilmater plauis or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms tiu such act1%'i11es 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 ltcn" I .J11c application ntu�t be accompanied by a Letter of Authorization (Form LA -97). failure to comply- with this pro%'isiuti may be grounds for the rejection of any submission. I Hereby affirm, under penalty of perjury, that information provided oil this Jana is trite to the best of my knowledge and belief. False statements made herein tire Ininishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Z-,C Mailing Address: ........ ........................... TNAM (COUNTY DEPARTMENT 0IF HEALTH DIWSION OF ENVIRONMENTAL HEALTH SERVICES � ...:..::::....... _:.....- DESIGN DAITA SHEET - SUBSURFACE StWAGE TREATMENT SYSTEM[ Owner ! �! i Q 1, �' � Address � � �h AI Located at (Street) VA kj1,4- cx Tax Map � 2Block Lot—la (indicate n crest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking �� f �� Date of Percolation Test Zz& :Fr Hole No. Run No. Time Start - Stop Ela 1dli se Time �U.) IIDe th to Water lErorn Ground Surfface (Inches) Start Stop Water ]Level IIDro IIn IInc�es Percolation hate Min/Inch Ax 2 3d / �� 4 5 3 �7 4 5 1 2 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. 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 DEPTH 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' d.0' . 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. l HOLE; NO...:..�., 7 411 Indicate level at which groundwater is encountered Akieze Indicate level at which mottling is observed Indicate level to which water level rises after being encountered `T Deep hole observations made by: d� 7 ,6- - Date � J� Design Professional Name: 4--,VY-Jazz it rl Address: Z 9'1 t4�,r�.'IG�5 ,4 Signature: Design Professional's Seal r ofN0 r� �o i PUTNAM COUNTY DEPARTMENT OF HEALTH DI VISRON OF ENWRONMENTA1L HEALTH SERVICES RE: Property of Located at LETTER OF AUTH®R ZAT)1®ll .:..,- - ._. ,- . ,. :ll 'I 4 W 77/ W, A T/V�'��j�,� Y�% Tax Map # j7d?- 20 Block l Lot Subdivision of Subdivision Lot # —Filed map # 164 Date Flied _ /f 7f Gentlemen: This, letter is to authorize 7V � a duly licensed Professional Engineer Ao" or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on:my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 1-45 and/or 147 of the Education Law, the Public Health Law and the Putnam -Coup - tyani Code. . ....._...� ..,.. v -- �-..._.�.. ., Star}' . C7` A/A Counte signed. P.E.,)/A., # Mailing Addressi��d�Cd -d�� State o'L' r' Zip /d_4�- Telephone: 7b- y Very truly yours, Signed: «� `l+ (Owner of Properly) Mailing Address: State 'i/. —Lip Telephone: �� °' & Form LA -97 &1-1° 'Pt JTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 4y Located at (Street) �6tj L4ra 4C,t.j Tax Map 0 2- Block Lot la (indicate n (rest cross street) Municipality J�lalle_ Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking � A? Date of Percolation Test z z r Hole No. Run No. Time Start - Stop Ela se Time (pMin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 4 5 1 ��f ✓.3 �/ Zf 2 . _ _... _. 3 4 5 1 2 3" 4 5 NUTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' . 6.0' . 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' TEST PTT DATA IDESCRIPTION OF SOILS ENC0UNTEREID IN TEST HOLES HOLE NO. % HOLE NO. HOLE NO. 7, �%--a % >- I ✓a'. 6 � P -o Indicate level at which groundwater is encountered dvd rr�G° Indicate level at which mottling is observed Indicate level to which water level rises after being encountered '4 Deep hole observations made by: c 6� -�� %�i ✓OZY� Date g 7 �� Design Professional Name: rq Address: -z- / z �r�.'I,��✓''i Signature: Design Proffessionafl's Seal of NEW yo O PUTNAM COUNTY DEPARTMENT OF HEALTH a DIVISION OF ENVIRONMENTAL HEALTH SERVICES Y - DEIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner d l,i ��u'�5 "G Address Located at (Street) Tax Map • - zo $lock _ j Lot ! v (indicate ne rest cross street) Municipality_ ps%W—'w Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre- soaking /fc -7 4� Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Dro In Inles Percolation Rate Min/Inch � 1 2 3 4 5 •, ,� J�G%rJ 3 4 5 l� 2 3" 4 5 NUThb: 1. Tests to be repeated at same deptn unto approximately equal percolation races are ootaineu an cacn 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 9 DEPTH HOLE N0. HOLE NO. HOLE NO. G.L. d % I ,�� S� 0.5' 1.0' 1.5' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 6.0' , 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' Indicate level at which groundwater is encountered ,��G" xy e Indicate level at which mottling is observed 2 Indicate level to which water level rises after being encountered Deep hole observations made by: jE��f 4�e� Date Design Professional Name: _ 1 f r—a 0 Address: A - ; ye Signature: Design Professional's Seal of N C1 e o z 14 -16 -4' (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Quality Review r ,�...,__- .•,•.......,.r :. - �. WORT ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT. INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT //SPONSOR l l l ;r� -t-0 Z6 O .. 2. PROJECT NAME /) ,J` 3.. PROJECT LOCATION: Municipality 11�:::/r / /r/ �Iw eG ` County 4. PRECISE LOCATION (Street address and road Intersectitions rominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: eW ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: j Initially acres Ultimately acres 8. WILL PROPOSED kTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ briefly as No If No, describe 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Oesidential ❑ Industrial 11 Commercial C1 Agriculture ❑ Park/ForesUOpen space ❑ Other ibe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE R LOCAL) ? Yes ❑ No If yes, list agency(s) and permlUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMI OR APPROVAL? ./ Ayes - ❑ No If yes, list agency name and permlvapproval j�, ��`�✓'� S It0/7 ��if%f�a�/ �/ 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes XNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: `�� Date: " "? 'z. Signature: If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 V !mss llkg PART II— ENVIRONMENTAL ASSESSMENT (ro be completed by 4gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL.ACTION RECEIVE COORDINATED REVIEW AS PROVIDED. FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? � If No ,,a nggative declaration, r.,.: ..,... . , .f �, :.... ,....,,.. .....: Tmeyrbe superseded by anotheF Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible O icer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 2 • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET E " Q12 ONSTEtUGTIO.I>LPERIVIIT_ ... .STREET LO ATION .:�.jrT,� ., .,�... -... - .:..... <_- - :.......... ....- - - .- -,..,, 1 , - ,. .,,t,.,.. • ..�_ ... C 1t �jTOu -)t�� NAME OF OWNER REVIEWED BY � DATE 7 9 g TAX MAP # saz -I Y DOCUMENTS Y 6PERMIT APPLICATION PC -1 WELL PERMIT — PWS LETTER LETTER OF AUTHORIZATION ��D PRIGN DATA SHEET (DDS) . i yj' CORPORATE RESOLUTION V, S ORT EAF PLANS - THREE SETS FUSE PLANS - TWO SETS VARIANCE REQUEST FEE 6ul AIL 1►_ LEGAL SUBDIVISION 3�0p &"- SUBDIVISION APP�OVAL CHECKED PERC RATE fj''" FILL REQUIRED Z . DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED NS SUBMITTED TO DEP aLEGA D T C AP V o �rr v nn vrn n AL SSDS ADJ. LOTS ETLANDS (TOWNIDEC PERMIT REQ'D ?) kTA ON DDS PLANS & PERMIT SAME LE 1969 NEIGHBOR NOTIFICATION KIER BI/ZBA P'YR. FLOOD ELEVATION FHER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS ;WAGE SYSTEM PLAN - (NORTH ARROW) ;DS HYDRAULIC PROFILE_ GRAVITY FLOW )NSTRUCTION NOTES ESIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED iJVEWAY & SLOPES, CUT )OTING /GUTTER/CURTAIN DRAINS COMMENTS: VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 300 60 FT MAX. PARALEEL'TO CONTOURS ' 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS —15' WELL TO PL 00' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 0' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _I50' GALLEY SYSTEMS min to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35'- 1%,100' - <I% 20'min to CD discharge /100'with 182 cons day discharge SEPTIC TANK E-: ; 10' FROM FOUNDATION; 50' TO WELL FORM ST-2 EROSION CONTROL:HOUSE,WELL, SSDS L�j aJ rG� PERC & DEEP HOLES LOCATED 6PRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE iF PUMPED, PIT & D BOX SHO ETAILED toot) HOUSE - NO.OF BEDROOMS �(ELLS & SSDS'S W/IN 200' OF OSED SYS. PI OPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) H6uSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER I T. HORIZONTAL; 3:1 TO GRADE FILL S S FILL NOTES FILL CE TION NOTE DEP GUAGES L PROFILE & DIMENSION VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 300 60 FT MAX. PARALEEL'TO CONTOURS ' 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS —15' WELL TO PL 00' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 0' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _I50' GALLEY SYSTEMS min to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35'- 1%,100' - <I% 20'min to CD discharge /100'with 182 cons day discharge SEPTIC TANK E-: ; 10' FROM FOUNDATION; 50' TO WELL FORM ST-2 4 / p. BRUCE R. FOLEY Public. .- Health DEPARTMENT OF BEALTH Division of Environmental Health Services � 4 Geneva Rbad Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 July 22, 1998 ' Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Hgts, NY 10598 Re: William Burge, Dennytown Rd. TM# 50.2 -1 -10 (T) Putnam Valley Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans and application for the above mentioned project. We would like to offer the following comments for your consideration. 1. Record of Deep tests are from a 1978 subdivision. It is the determination of this office to re- witness Deep tests and request additional Perc testing. One Deep and one Perc are required in area of.a. primary system and one of each is required in area of proposed expansion. Please contact this office to schedule an appointment. This office reserves its right and will continue review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, QL' r') - Adam B. Stiebeling ASB:dk Assistant Public Health Engineer A Z\ 0 . & Date:— To: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road' Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 VIAD I LvG From: Adam B. Stiebeling Asst. Public Health Engineer Fax #: BRUCE R. FOLEY RuNk.. Health.; Direc t 741 - -51-5-7 No. Pages (Including cover sheet) For your information .--.Please respond For your review Attached as requested As discussed NotesfMessages — �', I C04tr'c Please call Z YLAt4 @,/7, x 01. KA-ly- In the event of trans mission/reception difficulties, please contact this office at (914) 278-6130 ext. 157. P EltA IT i Located at PON Subdivision name 9var Subd. Lot Date Subdivision Approved Owner /Applicant Name ._'i��i �J� r1 G Mailing Address �% J�ZA/ Amount of Fee Enclosed 3e7 y kGE TREATMENT SYSTEM Town or Village Ile-yy Tax Map Se'l-2 Block Lot le Renewal Revision Date of Previous Approval `% AI X Zip /e % z Building Type Y,, ,/ c� Lot Area No. of Bedrooms 3 Design Flow GPD U Fill Section Only ]Depth Volume ?CHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 3a v � >i M Other Requirements: To be constructed by - Address Watvr-SunnRy- Public Supply*From. Address or: Y" Private Supply Drilled by AOJJ v o Address ¢ 1 Ile- If I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of roval of the Certificate of Construction Compliance of the original system or any repairs thereto. , of NEyy y Signed: d" R.A. Date Address 9 7 2- z License # 9 APPROVED F6R CONSTRUCTION: This expi es two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit: Appro ed r discharge of domestic sanitary sewage only. By: �' Title: Date: � White copy - HD Fil ; Yel w opy - Building Inspector; Pink copy - O er; Or n copy - Design Professional Form CP -97 A r .,. •;3+':: i,t ,�1{I,;Y{�,. v. •ua'''.';'SrJ ?;„ ,crq +x•a.7.',dt:t;,.,; ,,.. Uilk ;{s'R ! ✓'aM H r ✓( ?'P' §a 1 44Sr 4 AMA' %irT A1y r r y r r1'r2o,r, tit r,}• .rasY•w'yiy G: iS'Ji`�`.� L,.4 .t �I ,Sis,yvsy.�•,{lt Jr S + s t'41,r'. � ., per I..•� ; � � , ' .4 v ?C ✓�(. ,}' �, hi ♦- .a.y. r' 1 >" tr a.:4. ,•.'i ''l.: J t c �:�:.: .. .. fir r •� i t` 1; <t ! � v y r tii �S1t �•� � � .S r., Y •�4 ,R � v4 ,{ l�a�;ri• .:.� •4'�SE., yt � t t � 1 :+ S�; yy • ��VVV 1�, :�. L 'i 0 ' \• 0 , •; '� i �' .' ;:. Wit.., (., ir;, •' •.. e`,: '�.�• � ::. ✓! t yr \. 1 a L ctrl\ }Jr Fit .lip ra 0 o .. t�{ i .y Acl 1s 1( {r - .i�,1,y'j%r •jat•Y"��l(Rr. l�MS. ,. � e{ yl 1' k l�N,r� �'ii� d "t•ligfZ r�� h `Ar' Ve.. -•;,w� ;.rwrM Y y r r -• ,r y,:., -tar ;, .,, zrl r �$ r .s ti /i b {r:aui QP 5 R ti t. 'rwa �LV a ti% islet 1�:: PIr r0 W''�!Ir_`•1 ..�'�!` .i,�! `,!'w'y_i �i _ .. _ ., .r ..- FEB-17 99 09:02 FROM: PLE�ASANTVILLE REC 741-5157 70:19142787921 PAGE: 02 QUIT CLAIM DRED XWOW YE, THAT Nilliam H. Burge and warianne suxq® his U !both 09 43 890t 09th ftrast, Now York, Now yowk %0120 Cth�! "Releasors"), for Tan Dollars 010) and other val"abla c ®noid ®eat to the rGesipt Of which is hereby acknowledged, do by'tha 00 reldise, release and forever Nit-Claim unto William H. East 80th Street, New York, New York 10128 (the "Rmleames") and to. 991G69000s heirs, mucCOSSOrs and assigns forever, all the rights title, interest, claim and demand whatsoever as the said'ROISMOOM have or ought to have in or to: .570s 2— 0 ALL that certain plot, piece or paFcal of Band, eLth'�d4f•��i� W., buildings improvements thereon erected, situate, 4 1 in the T of n m1laxp, Putnam County, Noty York, ma e particularly boumqi And described as follows: BEGINHUG at a point in the center of the Dennytown Road,,N;4 the southwest corner og the parcel heraby.conveyed and northwest cornez of the right of way leading Into I" ftap' annnybra6k knOwn a3 Gilbert Lane#, running thence' along the norther1r,mift 0.9 right off uay North so UO East 211.52, feet and •outh 70 Elie tas - !4 .65-37 feet to croso on rock in the center of ;Q broq'9;. the center . of said brook'North 0 '54 Emot 23999g. g sst,;tpid! worth .45-0 Vast. IL(67 z -an a:.TocU t,hence &.long tho line dividing the premIgBas har(iln gahvb_ IV& -; Moar. now or formerly og Gould Worth 690 36o t1ast, 569 d 13 IQGC. the middle of gaid-Aannytown Road; thened"aldh§Mhe cenZdk4-!O sa� T., Dennytown road the gollowing courses and. di-O"tQUICOdi so'ni 3 J-1 t 05.93 foat 0 so Tast 21I.90 2(rotj Sou 30 a +':9 "9 .feet, Soutkx 7 421 Sast 224.22 fast to %bo -point or. boginning. LESS the paycal conveyed to John Caruso and ArlanplCaruso' the Releasers bounded and described as follows: f. DF, Wb .?V%V N� Fit FEB -17 99 09:02 FROM:PLFASANTVILLE REC 74 TO:19142787921 PAGE: 01 VILLAGE OF PUWANTVMLE Recreation & Fwks Department 359 Beed[ord Road Plea wtvilie,. New. York. IOS70 _ ... . FncsuWItE coven spa 7'IGINSM1777NG FROM FAX MO. (914) 741 -5137 qF PAGES INCLUDING COVER SHEET OP (X . �n A �- FAX NO.a:]1�( -7q a DATA: TIME SUBMITTED: FROM: sx 3UWrT- v,r�)A-(�- kn - I-e) '16 5 -79Sn IF YOU SHOULD ENCOUNTER ANY PROBLEMS WITH THIS FACSIMILE TRANSMISSION, PLEASE CALL (914) 769 -7950. NOTICE: The facsimile menage accompanying this transmittal form contains privileged and confidential information intended solely for the use of the individual or entity to whom it is addressed. If the reader of this notice is not the intended addressee, or the employee or agent responsible to deliver it to the intended addressee, you are hereby notWied that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this facsimile in error, please immediately notify us by telephone and return the original message to us at the above address by mail. Thank you. .I` ..._.:..�..:�......- _.r 13RUCE R FOLEi' A,- ig PuMc Hcit.S DEPARTMENT OF HEALTH l M13 1 GNisior. of Environmental Health Services TRANS M I T T A L It G =vz Road B::•.sr•:r, N.-w Yor'.< 10509 Te!. (914) 278-6130 FG (914) 278-7921 to: Nancy Smith fax �: 278 -4865 re: Records Retriev -1 date: pages: 1 , including &-;s cover sheet This is to request that t,-. following records be retrieved from storage: Record: Our Box r Your Box' Q Q c Circle one: Conunercial ,ddition Repair Realty Subdivisio Ind. SSDS Other ( } Na.m.- of Original Ov,her if available): kJ . 0 e &J� Street: Tax Map Other identifying information: 1 cV fS� �L V%rt i 5 Special Instructions: 6�� T 1 c Z SSA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a o- ADAM B. STIEBELING ASST. PUBLIC HEALTH ENGINEER 4 GENEVA ROAD PHONE (914) 278.6130 Ext.157 BREWSTER, NEW YORK 10509 FAX (914) 278 -7921 From the desk of... Kathy Graap / Account Clerk am County Health Department 4 Geneva Road Brewster, New Yore 10509 914 - 27"130, ext 153 v Fax: 914- 272 -7921 b , ' p. C k.. ! • 0 Q .( ) I WILL HAND DELIVER MYSELF LEASE SUBMIT TO THE SPECIFIE D PARTMENT FOR ME' SIGNATURE. APPLICATION.FOR PUBLIC ACCESS TO RECORDS TO: RECORDS ACCESS OFFICER DATE: 1 f Name of Agency JOSEPH L. PELOSO, JR., PUBLIC /, � INFORMATION OFFICER Address I HEREBY APPLY TO INSP 5 S -I-t--- — ,._'1 — Signafure Representing THE FOLLOWING RECORD: Ue(NS L T �.� �T rz'}TIO-r C. j &-Gz, T ��ti�y qu.�hC IiZo� Date ��'�a`2• Gha�d �OvAcouos--e .. . _.._...� _ :: nailing .Address../��'3.G.= ...G:. FOR AGENCY USE ONLY APPROVED. DENIED Record of which this agency is Legal Custodian cannot be found. Record is not maintained by this Agency Signature U Title Dat NOTICE: YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUTIVE. Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS OF RECEIPT OF AN' APPEAL. I HEREBY APPEAL: Signature Date • Fy - • 3 Ott �� a o vag �q'� `��.,�'�,,+,�,,�� fez •� � � � .. Y � 7V.. P i � d ?a'i}•.,'er�'rK"� a�'ik x � i'1� r.". clel°tify. @ieab UO @eWMa dip., wFia .ggte1A t ..._ /3 � ►... i iFf. < do inn, ed !9 mo 80t0tfl �9 t4$q: ao o{'�tc�' Qt�� .. i w i y scnstrueted, JA, MOOD OO t O)l A4 .41{��, ;u1,at10ra.Of Bii9' he Now Yort State. AapqvGSnsmt of goall, IF G �}• +..,,y 1C7 `, �ViI, �// p'�}�. � ~�(4J��'1 ir'k 4-s �m P� -'• 1 r �.JyIC I p h J'.p. fi� - > I A 4 13�f1iyy y c. . , . .,,T , n.:. a.e. '�::. .. , ..- .. ». �:F�. _ ,..w...... ., ...., ._? � •,.,,. +ia� ?,v�,R"ar.,`�e.... 4 -. -wx � .r_ .a d.c