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BOX 21
02451
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02451
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health services, Carmel, N. Y. 10512
RTIFICATE.DF CONSTR •UCTION•= 4COMP�L- E- At4CE,FOR. SEWAGE DISPOSAL-SYSTEM _Putnam. Val le.y,._,(T) ..;
Town or Village
Located at Bell Hollow Road Tax Map 4 . 4 2
Block ,
Owner Claudio Crescenzo Lot Job
Separate Sewerage System bunt by Manuel Portes Address_ Mohegan Lake, N.Y.
Consisting of 1200 Gal. Septic Tank and 500 1. f . x 24" tile fie 1 ds
K
Other requirements
aGi r5 el A • ..
Water Supply: Public Supply From
X Private Supply Drilled By Anderson
Address Putnam Valley; "Y'New' +aYo'
Building Type Sri n g l e — Family No, of Bedrooms 4
Has Erosion Control Been Completed? yes y W
•�',�P� p,ZpitE V
I certify that the system(s) as listed serving the above premises were constructed �y vn
attached), and in accordance with the standards, rules and regulations, plans p it .J
Date --June 15, 1987 Certified
Address 186 Katona
Date Permit Issued
Of the completed work (copies of which are
the Putnam County Department of Health.
P. E. X R.A.
.10536 License No. 51251
Any person occupying premises served by the above system(s) s sewerage shall promptly to
conditions resulting from such usage. Approval of the separate arate t` scary to secure the correction of any unsanitary
ste Y void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void supply becomes available. Such approvals are
subject to - modification or change when, in the judgment of the Commission' of H evocation, modification or change is necessary.
Date �y (/ / B Title
i
—
S�� PUTNAM COUNTY DEPARTMENT OF HEALTH Permit a
Division' of Environmental•'Health- Services, - Carmel; =N.-Y..,,f051,2_
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley (T)
Town or Village
22
,l
�(
Located at Bell Hollow Road . Tax Map Block 2 Lot 4 �4- j, 1
Subd. Lot # - Renewal __❑ Revision _❑ . +' > +�
Subdivision ,
owner/Address Ll aud i n r rP t r enzo s 3029 Xing-tan Aveaa ;J4 kAiA4 %Q
Builtling Type Single-Family n� N.Y. 10547
.j -
Lot Area 11.5 acres Fill Section only ❑
4 Design Flow G /P /D P.C. H. D. Notification Required
Number of Bedrooms gn
Separate Sewerage System to consist of 1200 Gal. Septic Tank and 500 1 , f . X 24 11 tile fie 1 ds
To be constructed by Frebar Construction Address Lincolndale- N Y
Water Supply: Public Supply From
�trr Torlish
_p.. Private Supply to be drilled by -
Address Maple —Ave.-, Armonk, N.Y.
Other Requirements I DEep Cui" "Ik Z)?, Y i f\ '
"•N em(s); 1) that the separate sewage disposal system
I represent that I am wholly and completely responsible for the design and locati he standards, rules an regu a ons o e u nam
above described will be constructed as shown on the approved amendment ther i
County Department of Health, and that on completion thereof a " Certifiea c9 i A Ila " satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnis 't ner„ cc s, s or assigns by the builder, that said builder will, :
place in good operating condition any part of said sewage disposal sy a- f ears immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of- rtgih y r r hereto; 2) that the drilled well described, above_-::,
will be located as shown on the approved plan and that said well will be Insf n a" j the sta ards, rules and regu a ons of the Putnam
County Department not Health. ' t
Date --Jul 1985 Signed P.EX R.A.
Address 186 Katonah Ave -h 0536 51251
6
License No.
APPROVED FOR CONSTRUCTION: This approval expires one year from the da PAeairm.% ° struction of the building has been undertaken and {s
'
revocable for cause or may be amended or modified when considered necessa by t lflXf► ner of Health. Any change or alteration of construction,: ;'i
requires a new permit. Approved for disposal of
l •� t � _ Q L. domestic sanitary sewag and / �. to water . supply only.
�
�P I�
Title
r;,F.�.-
WELL UUMrLb'11UV ]!MrUml Office Use Only
DEPARTMENT OF HEALTH
..Health -Se rvices._ _
PUTNAM COUNTY DEPARTMENT OF HEALTH'
R 'T ADDRESS: TOWN-11TILACALICHY TAi'GRIO NUMBER: "uur,r�" o
WELL LOCATION
WELL OWNER '
ME: ADDRESS:
—TPBIVATE
OKPUBLIC
USE OF WELL
1 plimary
secondary
"ORESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL. 0 STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT gpm./NO.,PEOPLE SERVED rEST. OF DAILY USAGE gal.
REASON FOR
DRILLING
C
NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPT H DA. TA
WELL DEPTH 40 —ft.
STATIC WATER LEVEL o_-cL_Lj 14DATE
MEASURED
DRILLING
EQUIPMENT
ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION 0.OTHER (specify):
WELL TYPE
❑ SCREENED' ❑ OPEN END CASING. *OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
. TOTAL LENGTH ft.
MATERIALS: aSTEEL ❑ PLASTIC 0 OTHER
_LENGTH.BELOW GRADE ft.
JOINTS: 0 WELDED ;THREADED ❑ OTHER •
DIAMETER in.
SEAL: ❑ CEMENT GROUT 0 BENTONITE _121*7HER
WEIGHT PER FOOT W_ Ib./ft.
PRIVE SHOIYES 0 NO
LINER:-OYE 0
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST -
0 YES. ONO -
SECOND
GRAVEL PACK
0 YES
0 NO
GRAVEL
SIZE:
DIAMETER
OF PACK In. I
TOP
DEPTH ft.
BOTTOM
OEM — It.
. I
WELL YIELD TEST It detailed pum'ing
p
METHOD: 0 PUMPED 1 tests were done is in-
If COMPRESSED AIR formation attached?
0 BAILED 0 OTHER 0 YES 0 NO
It more detailed formation descriptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM
SURFACE
'Water
Bear-
ing
well
Dia-
meter
In
FORMATION DESCRIPTION
CODE
ft .
I
WELL OEM
ft.
DURATION
hr. min.
DRAWDOWN
It..
YIELD
gpm.
Land
Surface
WATER—/-d-CLEAR TEMP:
QUALITY 0 CLOUDY HARDNESS.
0 COLORED ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK: TYPE
CAPACITY GAL.-
PUMP INFORMATION
' *
TYPE CAPACITY
MAKER 3,11L DEPTH
OOEC jj- VOLTAGELL HP
WELL DRILLER NAME , V� OATS
SIG? RE
v
rrMr•.tr cln':cK SlErT • DATE -
/ IMc'ets std.( Rem arks C FIELD CIMCK, I; CST.
` ¢
C3 NO Date:
DOrN ^LI�,rA �l inl �� \- n)Gr T ✓ p Y:
'
R Ins .b
0 `KR'F?? r a; I .
House plans, .K.
Yen N
No C
Couvuonts
Prolror�.y lines or corner3 fow-id . . . . . . . _
DssiCn data beet ✓
+ Peres presoa ed? ,
✓
1
✓
r -tn. 30" per test dept
r,(
Const. resins for 3 runs 1
✓
/
D. Hole log; .K.
- -
Corporate A i.davit for other than individual
k
I
1Jat06 elevation.. �- _..._.--- . - -_: -- __ -- -- .
Authorizati6h for engineer
�
I
.
-�
Ietter fromllater Supply if applicao e
I
If variancer$equested -such noted on plans & apps.
A
T s'
Ilouse. kocated A:ihere shown on approved plan —
-'IC�IJATtiRE E j�F�L OIJ PEA
•
DETAILS
SM _located where approved • • • . • . • • •
.FALL DE P1M FAA' 'Nn :� CY) NOTE' PLAtj To 156 PRAJ .a_
E,,Zng contours shown (show new contours)
Slopes for djriveway cuts, etc. shown
o.
titter servidm line location
Footing drai, etc. location I
•
✓
I
^o
Tp slops, b ttom slope of fill
i •I
t
Percolatior ¢ests and deep test pit locailon
✓
1
Septic tanize and conformance to std.
_O
!
I 1
3 3. R. hous6e minin gum
i
!
House setback shown
ITstributionbox ftg. below frost
I
All water within 5Q:Tt. of. PL shown .•
r
�/
' WEIL-CAG1KG';j I2" s)e3GVE- GPADC
Plan and :profile SDS ' • '
'•,� - (' '
All other¢wells and SUS closer 200'
s I
shown o� reference made
!ox-
Property I4oundaries (metes_ and bounds- clearly
wn
;
C6G64L. su DIU,SIOn�
I ✓
GtALTV ET`�P D,J i�,fav
fib
Were f,)b, -, M I t-S
y
ji
�SEFARATION DMANCES SPECIFIED ON PLAN
m
I10, to P.L.
20 ; to Fox ndation wails
io0 to Nearest well
100' to strea3, march, lake, etc. incl.expansion
15' to Curtain drain
�0' to water.iline (pits -2O
5' to stont0drain
j01 to lar;-Y trees
10' 1'110tn i* ' dation Lo septic tank
5' to
i
pike !1'r0ut ler_dcr dt•ain &.i'ooE-1-11 ; c i•aiti
/
15 To CRT-_4 6RS11J
IJ" WELL JD It
Eo .6evnc. 'RRIJK c0 • wEl L
is
I . � - 9
IN. r, .5 1T: 711• Y
Yen N
No C
Couvuonts
Prolror�.y lines or corner3 fow-id . . . . . . . _
_
A
_
/
- -
--- —._
1Jat06 elevation.. �- _..._.--- . - -_: -- __ -- -- .
• 1
-�
FINAL 6
11AUe: _
–
Ilouse. kocated A:ihere shown on approved plan —
— --
SM _located where approved • • • . • . • • •
0 }
J
Y
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Mr. Sal Riina, P.E.
Valley Pond Road
Katonah, New York 10536
Dear Mr. Riina:
October 8, 1985
JOHN, - JIIIIId10N5 'V.D'^........ :I
Deputy Commissioner
RE :. Crescenzo SDS Construction
Permit Application - Bell
Hollow Road (T) Putnam Valley
TM 22 -2 -4:4
Following receipt of.two sets of house plans that indicate
a four bedroom house, or a design revision to accommodate a five
bedroom house as the existing enclosed house plans. show; and a
copy of the D.E.C. stream crossing permit, this Department will
be able to issue the above referenced permit.
V1ery. truly ..yours:i;� _�._....._�
t
James S. Ho gens
\ Asst. Public Health Engineer
JSH:mk
enc:
cc: Claudio Crescenzo w/o enc.
jsh
file
TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641
a ,a PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date July 25, 1985
Re: Property of Claudio Crescenzo
Located at Bell Hollow Road
(T) Putnam Valley Section Shto 22 Block 2 Lot 4.4
Subdivision of
Subdvo Lot # Filed Map #
Gentlemen:
Date
This letter is to authorize Salvatore No Riina, P.E.
a duly licensed professional engineer X or registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department.of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system "or'" systems -ri conformity wiii� the provisions of °Ar'tic e��4` "or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code,
Very truly yours,
Si g ned
Countersigned: Owner of PropertyjY
P,E, ]Kxxxl # 51251 3029 Lexington Avenue
Address
186 katonah Avenue
Address
katonah, New Yor
232 - 7408
Telephone
Lake Hohegan, New York 10547
Town
Telephone
y_4
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KE
lyt
.
2
3. AC 26 AA AC CAL
CALyp
MrRAL SO4
--' 4L
r$?iCT No
3
!,67,.0 CAL 4
12,67 .1 :
\1.65AC.
-J32ACCAUt a-
MAP 2-1-2 07
AO 66715 AC
27.01 AC.
,46.92 AC.CAL
N.T.l FAm491TOCK V.PN
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16805 AC.0 AL. 4- ac 6w i.
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MOONDEA : Cu, X AC
4-11
4.6
5.87AC
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21
9.52 Ar. dAl
CERTIFICATE OF CONSTRUCTION COMPLIANCE
Before a Certificate of Occupancy for a dwelling is issued by the local Building
Ynspector, ii. C ficxt5'°6FConstrueti-6n ewage. .-.:.w..::::......_.._ ...
disposal system must first be issued by this Department.
The Department must be notified before the system is backfilled in order that an
inspection of the completed system can be made. Open work inspections may be.
omitted only at the discretion of the Director or his designated representative.
In order for the Department to issue a Certification of Construction Compliance,
the following must be submitted:
1. Certificate of Construction Compliance.
2. Three (3) copies of a two (2) year Guarantee, signed by the installer,
general contractor, and/or the owner.
3. If the water supply is from a drilled well:
a. Satisfactory results of a bacteriological analysis of the water,
performed by a State Health Department approved laboratory.
b. A Well Completion Report (PCHD form) signed by the well driller,
including the results of at least a six -hour pump test.
4. Three (3) sets of "as- built" plans, signed and sealed, etc., showing
house location with respect to property lines, the actual layout of.the
SSDS and water supply facilities as they have been installed. The
distances necessary to locate the septic tank, distribution boxes,
junction box° .,- ,4nd_e-ilds :of tt„he.,,,.tren.ch:es -f,rom two�.f;ixed.�- points;,
preferably the corners of the building must be provided. These plans
must include a legend, which reads as follows: "This is to certify that
r - _- ......... y..... :- �...�_:_•►�...L..� �.;.,au .��' ...- ...ewY� �-=' ....••�.
_ :Fhat —the`;sysE as= insnected- bv.me- •- hef- ore'=- it.-wrma, ss:i- - fi•bc+ yevsaer-:6.�•.adr_over..s w �,:1•a5Ja5 ^:>
-.The
sstemx was constructed in accordance with all s.ta
SSIrtSY.' e"^' �e�- "4"•R' >y,b7:- SSinw.,�,7ti= 'rfxx. etc .- «;uucfesa »s ..•.,.�.. d y,••,ven���V:v �u,r.., -.^.3
recrulations of . the Putnam Countv..DenartTment of_.Healt
State Debarttrment of`14 th " "As- built" plans must also include a title
Box, giving the information required on the original design drawings.
Minimum size of "as- built" plans should be 8P by ill'.
5. A Certif ied Check or Bank Money Order in the amount of $25.00 payable to
the Putnam County Department of Health.
After the Certificate of Construction Compliance is issued by the Department, a
copy of the Certificate of Construction Compliance, Well Completion Report and
approved "as- built" plans should be brought to the Town Building Inspector so
that he may process the Certificate of Occupancy.
4
L
Claudio Crescenzo
Owner.or iurchaser of Building Section
Claudio Crescenzo 2
_.. "'': Building Construet•ed•- by;--_`--
Bell Hollow Road
Location - Street
Putnam Valley (T)
Municipality
Single- Family
Building Type
4.4
Lot
Subdivision Name
Subdv. Lot_ ##
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it 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 success-
ors, 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 initial use of the sewage disposal
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 occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
ation.of the Director of the Division of Environmental Health Services
"� "' ox "Cfi� F '�riarn County Department of- Health -,a-s -t&--- zhether or not . the._ fait-
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this % J day of s 19�L2 Signature
Title owner'
Corporation N me 'f corp._
Address
THREE (3) COPIES ARE REQUII<tED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
LAB
Yorktown Medical Laboratory, Ina
� .:- . ' Colle.ction S,tation-, Used:,
Yorktown Heights, N. Y. 10598 Carmel Peekskill
Mt. Kisco New City
(914) 245-3203
Director: Albert H. Padovani JW. T. (ASCP) Date Take'n:
Date Received:
Date Reported:
y:
Collected B
Z-2
A)-,Lo it) R e f e r r e d B y
2,S e--, 7, Sample Source: ie,7_
—7/0"
/4 A/ Id lei
L &
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER-
.-GENERAL BACTERIA
_Standard Plate Count per 1.0 ml
(Agar plate @ 35 °C)
M-7'• BRANE FILTRATION TECF,"IIQUE (1• IFT)
Total Coliform Der 100 ml
Fecal Coliform ner 100 ml
Fecal Strentococcus Der 100 r.1
"T DRORABLE NU!-!BF.P, TECIINTOUP (11P'1)
T 6_t .'C6*1' i7ffb r`m Index -'per 10'0_'E17_
— Fecal Coliform: VPN Index per 100 ml
C7 FR ANALYSES
THESE RESULTS- INDICATE THAT THE WATER SAMPLE (WAS)
0.7 A SATISFA-CTO .. R 1. Y* .. SANITARY QUALITY ACCORDING TO THE
WATER STANDARDS, FOR::THE PARAMETERS TESTED,
rel.
Albert
.H. Padovani, AM.T. (ASCP), Director
)(WAS NOT) (NOT APPLICABLE)
NEW YORK STATE DRINKING
TIME OF COLLECTION.
LEGEND
RDS = Recommend Disinfect-
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
-PERMIT
'PERMIT NO.
3085 -0939
UNDER THE ENVIRONMENTAL CONSERVATION LAW
ARTICLE 15, (Protection of Water) ARTICLE 25, (Tidal Wetlands)
ARTICLE 24, (Freshwater Wetlands) ARTICLE 36, (Construction in Flood Hazard Areas)
PERMIT ISSUED TO
Claudio Crescenzo
ADDRESS OF PERMITTEE
3029 Lexington Avenue, Mohegan Lake, NY 10547
LOCATION OF PROJECT (Section of stream, tidal wetland, dam, building) Canopus Creek approximately 4,000
south of the intersection of.Sunken Mine and Bell Hollow Roads.
DESCRIPTION OF PROJECT
Construct a concrete bridge in accordance with the.plans dated
September, 1985
(revised October, 1985) as prepared by John Whalen, Architect,
and the special
conditions contained in this permit..
COMMUNITY NAME (City, Town, Village)
TOWN
Putnam Valley
COUNTY
A COMMUNITY NO..
DAM NO.
PERMIT EXPIRATION DATE
Putnam
December 31, 198
GENERAL CONDITIONS
1. The permittee shall file in the office of the appropriate Regional
Permit Administrator, a notice of intention to commence work at least 48
hours in advance of the time of commencement and shall also notify, him
promptly in writing of the completion of the work:
2. The permitted work shall be subject to inspection by an authorized
representative of the Department of Environmental Conservation who may
order the work suspended if the public interest so requires.
3. As a condition of the issuance of this permit, the applicant has ac-
8. That the State of New York shall in no case be liable for any damage
or injury to the structure or work herein authorized which may be caused by or
result from future operations undertaken by the State for the conservation or
improvement of navigation, or :for other purposes, and no claim or right to
compensation shall accrue from any such damage.
9. That if the display of lights and signals on any work hereby authorized
is not otherwise provided for by law, such lights and signals as may be pre-
scribed by the United States Coast Guard shall be installed and maintained
cepted expressly, by. the execution of the application, the full legal respon- by and at the expense of the owner.
-- sibility for all damages, direct or indirect, of whatever nature;•and • by- whom -10. All work carried out under this permit shall be .performed in•accor --
- ,.
_. ever' su'ffeied;`arisinjs out o1 "the project tlescntied herein and has agreed 'to - ":` 'dance wiiFi established is "ngineeflnj; practice and id a "workmanlike ms'nnef:"
indemnify and save harmless the State from suits, actions, damages and
costs of every name and description resulting from the said project.
4. Any material dredged in the prosecution of the work herein permitted
shall be removed evenly, without leaving large refuse piles, ridges across the
bed of the waterway or flood plain or deep holes that may have a tendency to
cause injury to navigable channels or to the banks of the waterway.
S. Any material to be deposited or dumped under this permit, either in
the waterway or on shore above high -water mark, shall be deposited or dumped
at the locality shown on the drawing hereto attached, and, if so prescribed
thereon, within or behind a good and substantial bulkhead or bulkheads, such
as will prevent escape of the material into the waterway.
6. There shall be' no unreasonable interference with navigation. by the
work herein authorized.
7. That if future operations by the State of New York require an alteration
in the position of the structure or work herein authorized, or if,,in the opinion
of the Department of Environmental Conservation it shall cause unreasonable
obstruction to the free navigation of said waters or flood flows or endanger
the health, safety or welfare of the people of the State, or loss or destruction
of the natural resources of the State, the owner may be ordered by the Depart.
ment to remove or alter the structural work, obstructions, or hazards caused
thereby without expense to the State; and if, upon the expiration or revocation
of this permit, the structure, fill, excavation, or other modification of the
watercourse hereby authorized shall not be completed, the owners shall,
without expense to the State, and to such extent and in such time and manner
as the Department of Environmental Conservation may require, remove all or
any portion of the uncompleted structure or fill and restore to its former
condition the navigable and flood capacity of the watercourse. No claim shall
be made against the State of New York on account of any such removal or
alteration.
11. If granted under Articles 24 or 25, the Department reserves the right
to reconsider this approval at any time and after due notice and hearing to
continue, rescind or modify this permit in such a manner as may be found to
be just and equitable. If upon the expiration or revocation of this permit, the
modification of the wetland hereby authorized has not been completed, the
applicant shall, without expense to the State, and to such extent and in such
time and manner as the Department of Environmental Conservation may require,
remove all or any portion of the uncompleted structure or fill and restore the
site to its former condition. No claim shall be made against the State of New
York on account of any such removal or alteration.
12. This permit shall not be construed as conveying to the applicant any
right to trespass upon the lands or interfere with the riparian rights of others
to perform the permitted work or as authorizing the impairment of any rights,
title or interest in real or personal property held or vested in a person not a
party to the permit.
13. The permittee is responsible for obtaining any other permits, ap-
provals, lands, easements and rights -of -way which may be required for this
project.
14: If granted under Article 36, this permit is granted solely on the basis
of the requirements of Article 36 of the Environmental Conservation Law and '
Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood
Hazards — Building Permits) and in no way signifies that the project will be
free from flooding.
15. By acceptance of this permit the permittee agrees that the permit
is contingent upon strict compliance with the special conditions on the
reverse side.
95 -20 -4 (9/75) (SEE REVERSE SIDE)
IAL CONDITIONS
16. To satisfy the requirement of General Condition No. 1, the permittee or a
._. re�prsentati.vP- aha_l.l. contact, _by telephone,__ the._ Division,_ of. Law*_Enforcement
in New Paltz (914/255 - 5453) 48 hours prior to the commencement of any
portion of the project authorized herein°
17. The perm ittee shall require that any,contractor, project engineer, or other
person responsible for the overall supervision of this project reads and
understands this permit and all special conditions.
18. Abutment footing treches shall be dewatered to settling basins to avoid
contamination of the Canopus Creek.
19. A row of staked haybales shall be placed- between the abutment excavation
sites and the Creek. Immediately upon the completion of construction,
trapped sediment shall be removed from behind the haybales, following which
the.haybales.themselves shall be removed.
20. There shall be no modification, excavation, or disturbance to the main.
stream channel.
21. All, necessary precautions shall be taken to prevent contamination of the
waters.of the Canopus Creek by silt, sediment, fuels, solvents, lubricants,
epoxy coatings, concrete leachate, or any other pollutant associated with
construction and construction procedures.
22. All areas of-soil disturbance -resu.lting from this project shall be seeded
with an appropriate perennial .grass seed and mulched with hay or straw
within one week of final grading. Mulch shall be maintained until a
suitable vegetative cover is established.
23. Rock rip -rap shall be used as necessary to stabilize the stream bank in
order to prevent erosion and stream siltation.
SEQR NOTE:
Under the State Environmental,Quality Review Act (SEQR), the project
associated with this permit is classified as an Unlisted Action and the
Department of Environmental Conservation (DEC) has determined that it will
not have a significant effect on the environment. Other involved agencies
may reach an independent determination of environmental significance for
this project.
DISTRIBUTION:
P. Keller
Law Enforcement
J. Isaacs
PERMIT ISSUE DATE
la /9 / �s
PERMIT ADMINISTRA OR
10. W . �.
ADDRESS 21 South Putt Corners Rd.
New Paltz, New York 12561 -1696
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, ...:..=CARMEL, N.Y. Y. 10512
,
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Claudio Crescenzo Address 3029 Lexington Ave., Mohegan Lake, N.Y.
Located at (Street Bell Hollow Road Sec.Sht.22 Block 2 Lot 4.4
Indicate-nearest cross street)
Municipality Putnam Valley (T) Watershed New York 'City
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTID WITH APPLICATIONS
.. ALL TEST HOLES WERE PRESOAKED PRIOR TO RUNNING TESTS ..
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run apse Depth to Water a er ve
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1 11:20/1:50
30
16
18.7' 2.7 11
21.51/2.21
30
18
20-L 2.7 11
3 2.22/2.52 30 16 18.7 2.7 11
4
5
2 11:00/1:30 30 17 19 2 15
2 1 � 11'12'.. O 1 . - - - -30 1-6
2:01/2:31. 30
4
YN
3 11.45/,'11r5'r' .30 18 20 2 15
2 2.' Ifi - 30 18 20 2 15
32':47Z3-:417- 17 19 2 15
4
5
Notes: 1) Tests to..be repeated at same depth until approximately equal soil
rates are obtained.`a,t each percolation test hole. All data to be submitted
for review.
2) Depth_:measurements to be made from top of hole.
18fl. w /.boulders
2411
3011
3611
4211
48'!
54"
6oll
66"
72
78"
84"
w/ boulders
!w/ boulders
DIH
Blk. organ°
topsoil
sandy loam
w/ boulders
{gyp �R�u�y
INDICATE LEVEE, AT WHICH DGR�U R W ATE R 0 SKNCOUNENCOUNTERED o
IE ENCOUNTERED O H <<
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NON
TESTS MADE BY Salvatore N. Riinde P.E. Date July 230 1985
- DESIGN
Soil Rate Used 11- 15Min/1 'Drop: S.D. Usable Area Provided 5.000 sgeft.+
No. of Bedrooms 4 Septic Tank Capacity ' 1200 Gals Masonry
Absorption Area Prov de By 500 L.F.x24" X -3 o nc .
_,ORE -f none
ure
Address 185 Katonah Avenue SEAL
K tonah Now York 10536
THIS SPACE FOR USE BY HEALTH DEPARTIMT ONLY: ��pROFESSI��P`
Soil Rate Approved Sq. Ft /Cal. Checked by Date
TEST PIT DATA REQUIRED
TO-BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN
TEST HOLES
DEPTH
HOLE NO. y
HOLE NO. 2
HOLE NO.3
_ G"
Bt k." organic
Blk. organic
Blke organ.
61'
topsoil
topsoil
topsoil
12"
sandy loam
sandy, loam
sandy loam
18fl. w /.boulders
2411
3011
3611
4211
48'!
54"
6oll
66"
72
78"
84"
w/ boulders
!w/ boulders
DIH
Blk. organ°
topsoil
sandy loam
w/ boulders
{gyp �R�u�y
INDICATE LEVEE, AT WHICH DGR�U R W ATE R 0 SKNCOUNENCOUNTERED o
IE ENCOUNTERED O H <<
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NON
TESTS MADE BY Salvatore N. Riinde P.E. Date July 230 1985
- DESIGN
Soil Rate Used 11- 15Min/1 'Drop: S.D. Usable Area Provided 5.000 sgeft.+
No. of Bedrooms 4 Septic Tank Capacity ' 1200 Gals Masonry
Absorption Area Prov de By 500 L.F.x24" X -3 o nc .
_,ORE -f none
ure
Address 185 Katonah Avenue SEAL
K tonah Now York 10536
THIS SPACE FOR USE BY HEALTH DEPARTIMT ONLY: ��pROFESSI��P`
Soil Rate Approved Sq. Ft /Cal. Checked by Date
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENIML HEAI,T" SERVI(ES
JMIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS .
FIELD INSPECTION REPORT
DATE:
�p BY:
:(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES I NO COPTS
Wetlands on /or proximate to property..
Property liries or - corners found........... :: .....
can estimate house location...; ...................
Willdriveway need cut .........:..................
Must trees be re=moved - note these.................
Deep holes representative of entire SDS area......
Additional deep holes needed ........... ':..........
Sufficient•SDS area available considering driveway
cut, house location, separation distances, etc....
Adjacentwells/septics ..........................
Access to orocosed well location for drilling.....
D.H. 1 Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.'
6 ft.
9 ft.�
12 ft.
FINAL SITE INSPECTION
D.H. 2 Lot
Depth to G.W.
Depth to rock
Soil DescriT)tion
Mzw�
House SSDS located per approved plan.. ........:.
Length .of trench measured .,:;4>C> i
Width of trench average
Slope of tile line and trench acceptable...,......
Roan allowed for expansion trenches ....... ........
Over 100 ft. fran watercourse ....................
Natural soil 'not stripped or SDS area
unnecessarlygraded.............................
10 ft. maintained from property line and
20 ft. fran house.. .....
Distance well to SSDS (ft.)....... UL..........
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench:.... .... .. .
15 ft. of peripheral soil horizontally
frantrench....... ........... ............ .
Boxes properly set.......... .
Could surface runoff from driveway, roads,,.
ground surface, etc., channel near SDS area....
Does lot drainage, appear ' OK in ' area ' of SDS.*.'....*.; : :
-n-m-m r e-n T r%vu- ^rs --rmm T rv+c•rrnr nr
D.H. - Deep Eole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
.Depth to rock
z)oz.i vescrinuon
0 ft.
E W
MEWYm"
Sou
_ ?
:5—
is ..
l
1
S
Mzw�
House SSDS located per approved plan.. ........:.
Length .of trench measured .,:;4>C> i
Width of trench average
Slope of tile line and trench acceptable...,......
Roan allowed for expansion trenches ....... ........
Over 100 ft. fran watercourse ....................
Natural soil 'not stripped or SDS area
unnecessarlygraded.............................
10 ft. maintained from property line and
20 ft. fran house.. .....
Distance well to SSDS (ft.)....... UL..........
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench:.... .... .. .
15 ft. of peripheral soil horizontally
frantrench....... ........... ............ .
Boxes properly set.......... .
Could surface runoff from driveway, roads,,.
ground surface, etc., channel near SDS area....
Does lot drainage, appear ' OK in ' area ' of SDS.*.'....*.; : :
-n-m-m r e-n T r%vu- ^rs --rmm T rv+c•rrnr nr
D.H. - Deep Eole
G.W.- Groundwater
D.H. 3 Lot
Depth to G.W.
.Depth to rock
z)oz.i vescrinuon
0 ft.
E W
MEWYm"
Sou
_ ?
:5—
is ..
l
1
C4
�/Il .
- )dut
h� ��� red
A 6
O
Yy
Vi
VR
a
yr
-- 9
-3n
O
71
r Z:
A-4
4pt
a
yr
-- 9
-3n
O
71
a
yr
-- 9
-3n
O
3EC77101V A-A
J U I<_ P a {}?><
5ECT70"
SCALE V--)V 7_/CA
TAI_
7' !'-r 7
�¢' 'Soto P1P� -
-�' � I{
I I rte,.
��R.Fot�.o.�-� -D Qrt °ems-•
Ic
100 4qAL
e- P T I c- -rd
4t-Yv4,r
F
5EC7 - 101V A -A
j
� SCALE /'� /O'O" ✓ER Y /CAL
' 20-0'•"oxivz0NTq[-
t
�i
i
SEC "T " " /UN B-B
f.
f
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
.. >. ,. � -... >. ,.v, .-.... ease-pnncortype__
Well Location:
Street Address: Town/Village Tax Grid #
/3 fGL hW44 J Map �. Blocky Lot(s)l b'' 4
Well Owner:
Name:
Address:
Gz7 ri-ol is '
S -,�� 15- 'Iz-
Use of Well:
A- Residential Public Supply Air /Cond/Heat Pump Irrigation
1 rimary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm eop a gerved Est. of Daily Usage —gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
, ;4*- "C? i=
for Drilling
Well Type
_� Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ....................................... ............................... Yes X No
Name of subdivision G'11 % i j'J°' Lot No. /
Water Well Contractor: T-0D Address:
Is Public Water Supply available to site? .................................. ........................ ........ Yes No
Name of Public Water Supply: /V 14 Town/Village
Distance to property from nearest water'main: ///-
Proposed well location & sources of contamination to be rovided on separate sheet/plan.
C
Date: _ % �.f L'�� --) _A pplicant 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.
Date of Issue 2 ` Permit Issuing Off —�-
Date of Expiratio L Title:
Permit is Non- Traniffer"ra
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
IA ?UTNAM COUNTY DEPARTMENT OF HEALTH
IDWESION OF ENVIRONMENTAL HEALTH SERWCES
C N9TP,1JCTffON PERM1IT ]FOR SEWAGE TREATOENT T1EM _ ..
PER �'v -�� e1
Located at ,ALL /lzi LG6 w �@d Yf /) OEODr Village /0047/V4,-1
Subdivision name C' T F 5'' TTY r Subd. Lot # Tax Map,,)-, Block o2 Lot Z714 tq-
Date Subdivision AppRwed 16Z7ZA� Renewal V Revision
Owner /Applicant Name G %� J %� / -f ` Date of Previous Approval
Mailing Address P Fl- Z &.4 j) ��' /��h ��l ��f' � `� Zip
Amount of Fee Enclosed
'Vo41h'
Building Type rnaii c- y Lot Are�� No. of Bedrooms J Design Flow GPD �6y
1Fifl Section Only Depth V®Rume
PCH D NOTIFICATION IS REQUIRED WHEN ]FIILL IS COMPLETED
Segau°itte Sewen°age ftstem, to consist of /1� 6 & gallon septic tank and 4"'M �"' 41
S?r' Z, 6, ' 0`2 % ij�GH MPW G /Y'
Other Requirements: C it 12 i al y 9,41i-,,y
To be constructed by 'Tr ?/ � Address
Wztez Sapp ly Public Supply From
-. -,(_- ._ Priuhte- Supply Drilled -by-
Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage 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 the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed:' P.E. Z---- R.A. Date
Address /-J-0 �C/� .�� .cu �Zi i� �' /!�!�' License #
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. A� ge of domestic sanitary sewage only.
B Title: _� Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr ession 1
Form CP -97
BRUCE R. FOLEY
Public Health. Director. s.... ,, ....:.:..
July 6, 2000
LORETTA MOLINARI R.N., M.S.N.
Asscciate Public Health Director'
Director of Patient Services
DEPARTMENT. OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 218 - 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
Dan Donahue, PE
120 Breckenridge Rd.
Mahopac, NY 10541
.. _. .,:DearMr.Donahue:
Re: C & T Estates, Lot #I
TM# 51 -1 -13, Town Of Putnam Valley
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 consideration.
Field testing required to be witnessed.
0 * Soil data record is greater than 10 years old (10.0) current requirements require field
168ting (deeps and peres) to-be valid / current -within -thelast•40:0years. '
* Please submit request for field testing form, requesting appointment.
2. Re- submit plan in a legible condition.
* Plan submitted is not legible, it can not be reviewed.
3. Submit copy of wetlands permit on the Permit Waiver Form for any /all activities within
100.0 foot buffer of wetlands.
This office will continue its review upon consideration of the above mentioned comments.
Please feel free to contact us if any questions arise:
Ve truly yours,
dam B. Stiebeling
Asst.. Public Health Engineer
ABS:mc
PUT NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OIL ENVIRONMENTAL HEALTH SERVICES
APPILI<CATI(ON TO CONSTRUCT A WATER WELL
please print or type. PCHD Permit-#:! ••— -
dY�Illl IL ®cafe ®>m:
Street Address: To illage Tax Grid #
�ffya�d� RP mi-e a Map / Block Lot(s) f"
Well Owner:
Name:
AdL� dress:
/�
6/ t- f /T-j el'
�d/�� fi r✓ d =s �.S�s�
se of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
p>rimalry
Business Farm Test/Monitoring Other (specify)
2-secondary
Industrial Institutional Standby
Amount of Use
Yield Sought �� gpm e Est. of Daily Usage.;kal.
]reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
dDefiiIled Reason
A •`. j 0fi 4n,' -L
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes /-° No
Name of subdivision �` %:1''`� Lot No. /
Water Well Contractor: Address:
Is Public Water Supply available to site? ........ d ........... Yes No
Name of Public Water Supply: 14111 Town/Village
Distance to property from nearest water main: Alf%.*f
Proposed well location & sources of contamination t e , arate sheet/plan.
Date: 4 "11 Applicant Signature: P..
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 COI`NSTRUCT11ON: 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 chiller certified b Putnam
County.
Date of Issue Si-3. 10 Permit Issuing Official: 9-4�, K
Date of Expiration Title:
Permit is Ikon- T>ransffe>rra Ile
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
PUTNAMCOUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
REVIEW SHEETS 'QR,QUNST'RL•ICx'IANPER -NIIT
.. _ .....
..
NAME OF OWNER: STREET LOCATION:
REVIEWED BY: RM, GR, AS, @DATE: V I)-- TAX MAP #: (CONFIRMED) 5 � l�
Y N DOCUMENTS
(ZUPERMIT APPLICATION
L__4(= � L PERMIT OR PWS LETTER
C_4,: 'r )LETTER OF AUTHORIZATION
(,[)(DESIGN DATA SHEET (DDS)
(,_- :::y BORATE RESOLUTION
C�PLANS -THREE SETS
J,,4 6iiSE PLANS - TWO SETS
CE REQUEST
(_)ULEGAL SUBDIVISI
UUSUBDIVLSIO ROVAL CHECKED
(____)UPERC
UU QUIRED DEPTH,
(_JLJVATAIN DRAIN REQUIRED
GENERAL
C_JC_JLOCATED IN NYC W D
((_,)PLANS SU D TO DEP
U�r)D ATED TO PCHD
EP APPROVAL, IF REQ'D
( e!:J )DEEP TEST HOLES OBSERVED
(,<: iPERCS TO BE WITNESSED
WLJ - APPROVAL SSDS ADJ, LOTS
ETLANDS (TOWN/DEC PERMIT REQ'D ?)
TA ON DDS PLANS & PERMIT SAME
(�( 1969 NEIGHBOR NOTIFICATION
(__)( TTER BI/ZBA
, -FLOOD ELEVATION W/I 200'
( SOII: TASTING LOTS >10 YEARS OLD
OUIRED DETAILS ON PLANS
(SEWAGE SYSTEM PLAN - (NORTH ARROW)
(, Ji' )SSDS HYDRAULIC PROFILE
C_)(_f:5GRAVITY FLOW
3C__)CONSTRUCTION NOTES 1 -15
DESIGN DATA: PERC & DEEP RESULTS
2' CONTOURS EXISTING & PROPOSED
DRIVEWAY & SLOPES, CUT
FOOTING /GUTTER/CURTAIN DRAINS
USDA SOIL TYPE BOUNDARIES
( TITLE BLOCK; OWNERS NAME ADDRESS
TM #, PE/RA; NAME, ADDRESS, PHONE#
DATE OF DRAWING/REVISION
DATUM REFERENCE
LOCATION OF WATERCOURSES, PONDS
LAKES,WETLANDS WITHIN 200' OF P.L.
(�J-C_)PROPOSED FINISH FLOOR AND
BASEMENT ELEVATIONS
UC__)WELLS & SSDS'S W/IN 2 ' OF SSTS
U ) PROPERTY= METES = &�
( ,t!jr �EROSION CONTROL FO HOUSE, WELL &
SSTS, EROSION CONTROL NOTE
COMMENTS:
,REVSHEET)09 /01/00
Y N (REQUIRED DETAILS ON PLANS CONT'D)
(=:t�HOUSE SEWER -' /," FT. 4 "0'; TYPE PIPE CAST IRON
(en+___)NO BENDS; MAX BENDS 45' W /CLEANOUT
RENEWALS
(( )STTE NOTE (NO CHANGE)
� / FILL SYSTEMS
UU10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE
(==!J(" JFILL SPECS/ FILL NOTES 1 -5
L---)t--)FILL PROFILE & DIMENSIONS
(� 1FI LL IN EXPANSION AREA
FLLL GREATER THAN 2 FEET
(UCU CLAY B
UUFIDL C ICATIO OTE
C--)L A ES
(__)(�VOL. N P R R.O.B., UNCLASSIFIED & IMPERVIOUS
U(__)SEPA TION DISTANCE FROM TOE OF SLOPE
TRENCH
LF TRENCH PROVIDED _r VV 60FT MAX.
PARALLEL TO CONTOURS
( fn 000% EXPANSION PROVIDED
(i ( DETAIIJDUST FREE CRUSHED STONE OR WASHED GRAVEL
( -GEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FROM SSTS
10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
20' TO FOUNDATION WALLS
(rC, _)100' TO WELL, 200' IN DLOD,150' TO PITS
(—)(_ V TO STREAM, WATERCOURSE, LAKE (inc. ezpan),
(_JCS ' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
C'j(^J10' TO WATER
(;L�450' INTERIVIITTENT DRAINAGE COURSE
L_)('jp0' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS
(_J 10' MIN TO LEDGE OUTCROP
SEPTIC TANK
(;�10' FROM FOUNDATION; 50' TO WELL
? WELL
(�(DIII�ENSION5- . a $f]�ER`TY$L-INES1c
l�(-JLOCATION O VICE CONNECTION
(�(_JMIN 15' TO PROPERTY LINE
SLOPE
(_)LJSLOPE IN SSTS AREA (S20 %)
(_)(JREGRADED TO 15 %, IF REQUIRED
DOSE/PUMP SYSTEMS
UUPUMP NOTES
(__)(DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED
(_)C__)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.)
C—J(—JPIT AND D -BOX SHOWN & DETAILED
UC—)1 DAY ST GE ABOVE ALARM
CURTAIN DRAIN
(,)( e S �TANDP: , 5'?BO,TH-SIDES, DETAIL -t,.
MIN to CDSt >5% 20' -4 -4 %, 25' -3 %, 35' -1" /0,100 % - <1%
C—)(— with 182 cons day discharge
L-) MIN to PERFORATED PIPE
)�y A47-4.
91 •6 NV S2 8JV ZO
AN3
AiNno'l W"'Nirld
Po 03M333d
Erosion control measures for house, well and SSTS.
r. When a pump pit is proposed due to insufficient elevation for gravity flow
or for dosing purposes, the pump pit design/detail. shall include,, as a
minimum, the following:
- Make and model of pump to be used and operational characteristics.
One -day's storage past the high -level alarmwithin the pump chamber.
Check valve.
Gate valve. d S
Unions
Operating and alarm levels for pump.
Means for pump removal for maintenance.
All weather junction box with an outlet and screwed cover at or above
grade at the pump chamber to allow for a plug in connection for the
pump(s),
Pump curve should be supplied with the engineering report.
The pump operating range should be indicated on the pump curve.
- Pump dose volume to be equal to 75% of the volume available in the
SSTS pipe network.
Minimum velocity of 2 feet per second to be provided in force main.
- Baffled distribution box to be utilized for SSTS.
Trench detail for force main, specify pipe type and rating, bedding and
cover. - _ :..._....._..�.:
stating, "All electrical work and material for pump installation
shall comply with the National Electrical Code." ..
Note stating, "An electrical Underwriter's Certificate for the pump
chamber must be provided to the Department prior to the
Department conducting a final inspection on the pump chamber.
Note stating, "The pump control panel and alarms shall be located
inside the house"
s. Delineation of United States Department of Agriculture Soil Conservation
Service soil type boundaries..
8. Two (2) sets of house plans with title block as specified in 7(k) above, one of
which must accompany copy of approved Construction Permit to the Building
Inspector of the local municipality. Upon approval of the Construction Permit,
the house plans will be signed and stamped: "Approved For Bedroom Count
Only ,
9. If water service is from a public supply or community supply, a letter from the
water supplier will be required stating that they will be able to supply the
property with water at adequate pressure.
10. Well Permit Application, if required. (Appendix K).
v:
i
• a
a
DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROCEDS & POLgCI[ES
SUBSURFACE SEWAGE TREATMENT
WATER SUPPLY FACIb,ITIES PROGRAM
FOR
- _
SINGLE-FAMILY RESIDENCES
BULLETIN ST -19
WP /SSTS(M l Edition 1
August 1997
Rev. August 2001
BRUCE R. FOLEY
4 .,, , . Publi rfi'ilt{iN 13irzCtor" .. ; ...... ,,...,,... z <
W11
>... _..- ;.L4RETrA -Ma - 117AR�'�t.Ai.,`Iv .S N: ;
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
a
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 Nvic (845) 278.6678 Fax (845) 278 - 6085
Early Intervention (S45)278-6014 Fax (845) 278.6648
rs Preschool (845) 228 - 5912 Fax (845) 228 - 6113
M M
e
e
To: Design Professionals Submitting Plans to Putnam County Health Department
From: Bruce Foley, Public Health Directo
Date: August 10, 2001
Subject: Revisions to Putnam County Health Department Bulletins ST -19 and CS -31
As a result of a recent meeting held with the Putnam County Electrical Board, the following
items were agreed upon with respect to the design and construction of wastewater pump
chambers:
1. An all weather junction box with an outlet and screwed cover will be provided at or
above grade at the pump chamber to allow for a plug -in connection -for the pum ,P(s)..v__
:2....._:. ::Prior to conductaing a=final-inspection-on tlie-pu�rip che&ibdr; an electrical Underwriter's
Certificate for the pump chamber must be provided to the Putnam County Health
Department. The Putnam County Health Department will not schedule a final inspection
of the pump chamber until an electrical Underwriter's Certificate is provided.
3. The Putnam County Health Department will only inspect the pump pit construction_,
pump dose and alarm operation.
4. The note "All pump power and control wiring shall be made directly to the control panel
without any outside splices," is to be deleted from Bulletin ST -19, Section 4.A.7.r and .
from Bulletin CS -31, Section 4.C.15.h.
5. The following note from Bulletin ST -19, Section 4.A.7.' r and Bulletin CS -31, Section
4.C.15.h has been revised and shall now read as, "The ump control panel and alarms
shall be located inside the house or building."
The following revised sheets from the above referenced Putnam County Health Department
Bulletins are included for inclusion into your existing Bulletin documents:
- Page 12 - Bulletin ST -19
- Page 13 - Bulletin CS -31
Should you have any questions concerning the above; please contact this office.
Cc: William Picarella, Electrical Board
b'
R. " FOLEY .. _ .....
Public Health Director
_ .,..,. Z.
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF BEALTH
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 (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113 May 1, 2002
Donald Knapp
2 Dale Avenue
Somers, NY 10589
Re: Proposed SSTS - Link
Bell Hollow Road
(T)Putnam Valley, TM #51 -1 -13
Dear Mr. Knapp:
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. Comments are offered as follows:
S
Provide property metes and bounds.
L2-'--
Provide the dimensions of the proposed well to two (2) property line.
L3'
Standpipes are required at 5' offsets uphill and downhill of the proposed curtain drain
Provide standpipe detail.
- -•- -• - ��-
Show a° minimum- 20'-separatio u'between -tlie `curtain -drain discharge and the closest
expansion area trench.
Provide the updated pump notes (see attached).
Lfie"'
Current codes do not allow construction of a SSTS on slopes greater than 15 %, therefore
1
this project can not be approved as submitted. You may request a waiver from'this
requirement in writing. You should revise plans to show the SSTS area regraded to
I
<15% slope with ROB fill.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
Sincerely,
Shawn Rogan
Public Health Technician
SR/jp
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRQNMENTAL HEALTH SERVICES
31YST :RUC.TION:,EERMIT --FOR;SEWAGE TREAT1Vi "� -SYSTElY�
PERMIT # py -
Located at Bell Hollow Road � `M Town2Rffl" p„tnam ya11Qajr
Subdivision name C & T Estates Subd. Lot # I— Tax Map _ Block Lot i3
Date Subdivision Approved lo/7/,9,9 Renewal Revision
Owner /Applicant Name David Link Date of Previous Approval 12/4 %9 7
Mailing Address 79 Main Street - Alit- _ 21 , nss;Lning Ny Zip n56
Amount of Fee Enclosed $300.00
Building Type Single F a m i 1 p Lot Area 3.018 No. of Bedrooms I Design Flow GPD 600
Fill Section Only —1,+ Depth Al .+ Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of i59 gallon septic tank and -Sef-a 1 f_
of 24" trench
Other Requirements: 10 0 0 gallon „m pc h a m b e r
To be constructed by
Water Supply:
Address
Public Supply From Not d e t e r m i n e H Address
or: X^ Private.. Supply Drilled by Not determined Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed:
P.E. 97277() l.AXXXX Date 4./15/2GL02
License # ��? 7 0 Address 2 1i � TP A v e n u e . S o m e ry L5 ga
914 - 248 -7726
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. Approved for discharge of domestic sanitary sewage only.
Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
DICK CONSULTING ENGINEERS
2..RALE.AVEi�UE SOWl ,R.S,,N6�1! YQRK.IQS. $.9: (91:4),248.177 _0.. .y....aa n_.. __ _: ,_� s,_.,, .
I•.J ,r w ... a— ai�.�.1C^!��.a', _ .Y.,..._ ..wa ewfY -.. .�� -
April 6, 2002
Mr. Bruce Foley,
Director of the Putnam County Department of Health
Ptltnatn County Healttt Departmprd
1 Geneva Road, Route 312
Brewster, ,NY 10509
Re: Renewal of Construction Permit #: PV-30-87
Tax Map No. 5519 -1 -1$
Two -Lot Subdivision of Meadow Road, Carmel NY
Property Owner: Mr. David Link
79.. Main Street —Apt. 21 ,Ossining, t9Y 10562
Dear W.
�— -- --- On,behalf of-nTy clie it•Mr:,Davidtink,- rregiiest a grade and 11 variance, the topography varies
botween 21 °Lo and 20% acron.the area-designated for the SSTS and have not been altered
sense the lots approval in 1988 grade. It will be necessary to construct a retaining wall and re-
grade the SSTS area with approximately 4'-6" of fill.to achieve a 15 %Vragle.
Thank your assistance in this matter. If you should have any questions, please me at (914)
248 -7726.
Sincerely,
Donald R. Knapp, P.E.
t
F'
i
�
'
-
��C�/�� 71
-~
~ �
= BRUCE—R. FOLEY
Public Health Director
May 9, 2002
r..:.L�ORETIt� .AQOLINARh iRa+�:; - tti153N ==
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
Don Knapp, PE
DRK Consulting Engineers
2 Dale Avenue
Somers, New York 10589
Re: Proposed SSTS - Link, Bell Hollow Road
TM# 51 -1 -13, Lot # 1, (T) Putnam Valley
Dear Mr. Knapp:
Review of plans and other supporting documents submitted at this time relative to the above
regarded project has been completed. Comments are offered as follows:
1. Provide the design detail for the proposed retaining wall.
2. Provide fill volumes on the plan for R.O.B., impervious and unclassified.
...Uponxeceipt of a submissidri Tevised'io- reflect- the,aliove comments; this application will be
considered further.
Sincerely,
Shawn Rogan
Public Health Technician
SR:cj
BRUCE,..,,.-_R -F-
Public Health Director
NAME:
: ^L'ORETTA'" 1VIOi:INARi '1i N:, M.KN.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New Ybrk 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 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
SPECIFIC WAVIER
ADDRESS: 414-IA,
SITE LOCATION:
DATE:,
STAFF PRESENT: Bruce F. Rob M. Mike B. Adam S. Gene R. Shawn R. Bill H.
SPECIFIC WAVIER Q
REQUEST:
S% Jr
DOES--- THE PROPOSED- VARIANCE REQUEST POSE A HEALTH HAZARD OR
ENVIRONMENTAL CONTAMINATION PROBLEM?
+ -- -+ +
YES NO
WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP?
S NO
DISCUSSION
REQUEST APPROVAL OR DENIED
APPROVED
REASON FOR DENIAL
DIRECTOR OF PUBLIC HEALTH
(SPEC WAIVER)
DATE:
DENIED
NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver
Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and. Appendix:75- A,10NYCRRs.
- _ - �•- - ''for (ndivlduaf f- lous'ehold Sewage Treatment Systems
Ml
Name of Applicant /lla,� /��j
No. Street City/Town State Lp .
Address jcii� S�� o7f �S:S/ 6A-I
��C.No.�/� Street City/Town State Tip
Site-Location
%�.�,�1,,� /�+` , �v�'( t�1 /ii
1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)):
Separation distance cannot be achieved.
Excessive. slope.
J High groundwater.
Inadequate depth to bedrock or impermeable layer.
Soil unsuitable.
Other (explain) ... ............................ & !�
........................... .. ............ t ........................
4- f
. ....... ...............................
2. Proposed design or conditions of waiver:
.. FC,............:.. p .............. Q......... �, � ...............�..1,�......... �.:.,
.................................. .... .. r..............................................................................................................................
`s.... ice' . t u � .
.., ...�� ...... ......... .............................. .. ....... ......... ...........
...
3. The proposed design may have the following limitations (check appropriate box(es)):
J Increased risk of well or spring contamination.
Increased risk of surface water contamination..
J Expected design life of the system will be diminished.
Operation of sewage system is subject to mechanical problems.
Other(explain) ........................................................................................................................................................................ ...............................
................................................................................................................................................................................................................. ...............................
Additional information attached
Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with
New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver
may be revoked by the. issuing official fora change in conditions for which this waiver was granted.
.......................................................... ...............................
REPRESENTATIVE OF COMMISSIONER OF HEALTH
.................................... ...............................
GATE
ORIGINAL - Local Health Agency
COPY - Applicant/Design Professional
DOH -1326 (7/921 (GFN -1591
soi .. .. T. set ea•.. .. .r � :�R ^. l...i'ia... ..p'
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI. R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845)278-6130 Fax(845)278-7921
Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
June 6, 2002
Don Knapp, P.E.
2 Dale Avenue
Somers, NY 10589
Re: Waiver Determination
Link
Bell Hollow Road
(T) Putnam Valley, TM# 51.4-13
Dear Mr. Knapp:
The Putnam County Health Department reviewed the waiver request for the above regarded project
on June 4, 2002. The following determination has been made:
-The Waiver request was approved:
❑ The Waiver request was conditionally approved. However, the revision(s) noted
below must be completed prior to the issuance of a permit.
® The Waiver. request was denied. An explanation has been noted below.
❑ The Waiver request was not voted on. Explanation noted below.
This Department can not approve a side slope at 1:1.33..A 1:2 slope would be the greatest slope
considered approvable by waiver.
If there are any questions regarding this matter, please contact me at (845) 278 -6130 ext. 2159.
Very truly yours,
Shawn Rogan
SR:tn Public Health Technician
e�
-
BRUCE fit. 1 OLEY .
. .• `t�c�tic Yfii�dtia ,b�eea+s�.. = .- �. :_....�...- t : _s._,. �. , ... .
DEPARTMENT OF HEALTH
I Gneva Road
ISaewetar, New York 10509
l,®UMA MOLWAEI P.N., M-S.W.
1
A'Il°II'f�l�'D'Il ®h`i: �RIIB.�9 SYIlEIlt�1�Il�Y� 6 �i�T� 1�1�®
All enfauranatioao bdow must be hft cootapleted p6or to Dray 2ftdaftg. ®Ally
PIZRCS: o IPA 7,2s7:13
W� -
II LSr.7� i V
® Proposed SS73 within Me deaainage basin of bleat Sreaach or Soyds Comex Pkservofiin.
ei PJ Proposed SM within Sw feet of P reservoir, re€to "Oup MM or e"ol !sabre.
o Proposed SST S within 200 feet of a wastercouroe or a DISC Wetl=d
a
Proposed SSTS design Sow greater twee IM golloeev/dny or MRS llerr»it r,2q*ed.
.... _ �. ®.. _ Proposed SS'flS for a Commerical Project. :., .. _..._. _: _._... ;.. _a� :......._ ::..-..:.:..._
It is the mza►ponsibilitq of the design professional to provide dw' above Wormetiost prior to soil tating.
This Department will determine dw NYCHDEP project sttatu (Joittt or ted) based an the
response. Hff you amwered go to any of *2 quesdow, MYCD111P annot witmo dw sail gating. Thin
lDepsartsont wN coordinate n mutually suitable fine f ®P 4aeld tee wih the N, (the Design
t?ro*atsiOnw and 1YCDEP.
Ilf a project isms beeaa deterata d to be Dekgaate4 based da aboya yespaim Wd tba oubsequeat
ieaformaation indicates NYCDEP Is rw.gaalred to witness the Goa gating, it wffl be fie vole ragponsiboila'ty
ogtl
"In psrofeesaond to , ule re witnes$ing of the 'soil apt wn4h WYCIDSF.
omr
60& C0tNTV t-SJ& ®. iB.V!
`8'i 12; O @ o
OrMp 1ES ?j
0
BRUCE R. FOLEY _
Public °ff itkliiret4r _ ..... _......_ < .
C
.= LORETTA,, ;MOL'INARI -R:N., M:S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF 'HEALTH
1 Geneva Road
Brewster, New .:York .10509 -
Environmental Health (845) 278 - 6130 . Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 -6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
May 30, 2001
- Effective July l,'2001 , all separate-sewage treatment systems are to be installed only by a
certified septic system installer, as certified by the Putnam County Health Department.
The construction of new separate sewage treatments systems, replacement of existing
components including-septic, tank, junction and distribution boxes as well as leaching structures,'-
and expansion .of- existing septic system can be installed only by a' certified installer or by the
individual owner. _
All installations and repairs require permits approved by this Department prior to construction.
Certification will be issued upon receipt of the enclosed application and after on site approval of
a minimum of three (3) septic system installations. Certification will be valid for two (2) years.
Please complete the enclosed application and return to Putnam County Health Department, 1
Geneva Road, Brewster; New York 10509, Att: William Hedges, prior to June 15, 2001. .
Should you have any questions, please contact me at 278 -6130 ext. 2168.
Very truly yours _
�-- William Hedges
Sr. Public Health Sanitarian
WwjP
SENDING CONFIRMATION
DATE
NAME :
DEC -16 -2002 MON 16:25
PUTNAM COUNTY DEPARTMENT OF HEALTH
/
: 1/1
`�> —_6 L"/(
TEL
845 - 278 -7921
: 00'38"
(�
: ECM
RESULTS
PHONE
: 92654428
PAGES
: 1/1
START TIME
: DEC -16 16:24
ELAPSED TIME
: 00'38"
MODE
: ECM
RESULTS
: OK
FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
} e
PUT1�1AliI �O[JNTY DIEPARTMIENT OH! HEALTH$
,HDIVISION OE ENVIRONMENTAL E[EALTHI SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
P1r�t1Yf1'TgPy'.3u'f�% `.f:�i
Looted at 9?EbL h6A C s u A-OA D ) ow r Village par*f Af
Subdivision tame -A Subd. Lot p Tax Map ,rl Block / Lot
Date Subdivision Approved LA Amt Renewal Revision
Ow dfApplicmtNamc4:�-a Date of Previous Approval ��j g rq
_ Mailing Address ��G4 %/s�,4ew. ,e," R � %HAH rMt � Fi i� `.t Ztp ---+�/
Amount of ee Endloacd -A-50 .00
Buildigg7ype.s /Ml �✓L�•jlot U No: 6fBed(ooras- 3''Lk�ignFkiw0PDG" -
.- _
FIB 8e*n Only Vadhsne
FIL
O D
.. $@pg u5g to consist of /006 gallon septic fink and
Other Raquirem ets: jet/vsAa.- �Batp
To be conanucted by' Tp d Address
Water Public Supply Fain Address
yD &_ Private Supply Drilled by ? w Address
I represdat dut I am wholly and completely responsible for the design and.bWatt4n of the'proposed syrtm*) and that drd
described above will be conegtacped as ahown on'*a approved ant thereto and in
aocotdmm with dw otsndnrda M. ks and regulatlans of the Potraut Cgdety DpparanentrofHealtW that on �anptatibn
thereof s "Certificate of Construction Compliance" satisteotory� tokh 110 Heath Diiexor writ be sulitt0tted. the
Depoi'unetrc, and a written guarantee will be furnished tho owner; "4cssore, helm or assigns by the b'uifdta,:that .aid
Wilder Will piece in good operating coadltlon any part of said sewage treatment system Quring tbo period oft" (2) years
immedigely following the dote oftho ismance ofthe approval of rho Cetl6cate of Construction Compliance of rho original
system 9r any rwfm the W. .
• r'
Signed: if.}:. 1 � R.A. _„ Date G ® c
Alp
Addmsa % �rk�is mF[ r�sc
APPROVED FOR CQN &MUCTION: approval expim two yeas from the deft issued unless oosbuction of the i
fewage troatr r)t,syjrtani'ha5'pbsit =4 inspected by the PCIiD and is revocable for cause or may be amended of
modified wlipobcantider`bd the Public Health Director. Any revision or alteration of the approved plan req irio9 i
anew pea App for domestic sanitary age only. ..
��
By: 0- f Title: I)abo:
White copy - HD Pile; Yellow copy - Building Inspector: Pink copy - Owner; Or copy - Dd�'mf Prothssional
T. Form CP -97
M
w.xnac.rt. ri
_ - - - i'�VC_+1'nt rvx,.avS. an+K. ••,a.aWru. —. -' a.n.x M=•w. ... T .4]YM
.. •.nrf 'a M �
y�wr1-- •.L.n �.y!•Yra.,..... •r +n.. :y:.mmv4.v11A.:T •may c+'rnM .vl_ +.I.:Yr -. _ s° -•r -
q. Erosion control measures for house, well and SSTS.
When a pump pit is proposed due to insufficient elevation for gravity flow 1
or for dosing purposes, the pump pit design/detail. shall include,, as a
minimum, the following:
040" - Make and model of pump to be used and operational characteristics.
-r °One; da` 's stora a ast a '°
high- lev_��e �alarmwrthin'thepump chainber., .... . _ . -..
Check yaive.
�- - Gate valve. ._�_.
Unions
Operating and alarm levels for pump . -
Means =for puinpr me oval forFnauntenance
.�xs�
- f All weatierjunctlopox cth an outlet and;screwed cover a or
above
um
J
gradeat theppeh�am %ertoaowforaplug�'�ncannechon for the' .
PP.tS)
_ . _...........__._... Pump pled « - plied report curve - should be up i u
The pump operating range should be indicated on the numn.curve.
P%mmP doserolnmeo-�b�=equato73`% of�the volume available ui ; e
ire• Minimum velocity of 2 feet per second to be proyide.d, in force main.
�- /.��B� led- distribution box to be utmzedffor�SSTS: .
Trench detail for force m_ ain, specify pipe type and rating, bedding and_ ,.:._..
Note stating,: 'All electrical work and material for pump installation .
krv-shall comply with th:e National ElectricalCod�."
Note stating "An- electrical .6 V&W- terrirs � ertif cat forbthe pump,
k a ,
chamberYt�rtiust be � provided ..to the Department .prior... o he...':
_ + epartment conducting a final inspection on the pump chamber.
Note statue , " 'fie pump condo anel andralarmsxshall be locatted
Inside "the�3��us' - ; .: .. ....._
s. Delineation of'Umted State0epattnient of Agriculture Soil Conservation
Service soil type boundaries.
8. Two (2) sets of house plans with title block as specified in 7(k),above, one of
which must accompany copy of approved Construction Permit to the Building
Inspector of the local municipality. Upon approval of the Construction Permit,
the house plans will be signed and stamped: "Approved For Bedroom Count
only'
9. If water service is from a public supply or community supply, a letter from the
water supplier will be. required stating thaf they will be able to supply the
property with water at adequate pressure.
10. Well Permit Application, if required. (Appendix K)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISI ®N OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date ��' ••."� _
Owner
Street f ccation P �` /G�i1 t lNk
Town Permit
TM 4 /. — 'l Subdivision Lot #. ,
1. Sewage System area
a. STS area located as per approved plans ...........................
b. Fill sectis - date t
3:.1 b gt . idth Avg.Dpth
c. Natural soil not stripped.
.................. ...............................
d. Stone, brush, etc., greater than IS' from STS area..........
e. 100' from water course / wetlands ...... ...............................
II. Sewage S ste
a. Septic t c siz�eevel .......1, 250 ......... other ................
b. Septic tank ins ............. ... ...............................
c..10' minimum from foundation ........... ..........................
d. Distribution Box
1. All out ets at same elevation -water tested .................
2. Protected below frost .................. ............:.................:
3.. Minimum 2 ft.Original soil between box & trenches
e. Junction Box - properly set ........... ...............................
£ 'I rent ems
T. ngth required Length installed
2. Distance to watercourse measuredt.,,lC7,'
�3. Installed according to plan ..............>
4; Slope of trench acceptable 1/16 - 1/32" /foot .............
10 ft. from property line - 20 ft.- foundations..........
6? Depth of trench <30 inches from surface ..................
. 7/ Room allowed for expansion, 100 % : ........................
�C 8. Size of gravel 3/4 - .l Yz" diameter clean ....................
9. Depth of gravel in trench 1-2.7. minimum .................:.
i 0. Pipe ends capped ...... ....:..........................
Pump or Dosed Systems
g Size ot pump chamber..��....
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. House/Buildin
a. House located per approved pins ... .......... .I....................
b. Number of bedrooms ............ ..............................
IV. Well
47-Well located as per approved plans . ...............................
b. Distance from STS area measured __rft.40
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 waters ur:
g. Footing drains discharge away from STS area .... ar, .-k
h. Surface water protection adequate ... ...............................
i. Erosion control provided .......:......... ...............................
COINMI ENTS
MIS
Sheet- � of
PUTNAM- COUNTY DEPARTMENT OF HEALTH.
:.: DIVISION OF ENVIRONMENTAL HEATLH 'SERV'ICES
FIELD ACTIVITY REPORT.
Street
Zip
a;
MAR -19 -2003 11:04 BADEY & WATSON, PC
P.02/02
PUTNAM COUNTY DEPARTMENT OF HEALTH _
- aN:.c. v. .! xam.. a.�.. -..-.. ... ..�:r�a :...:vasrx- - ..,y- .r,-n. a.4•.tin,_c ylv.:a.• ..a*.a u�ny
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
REQUEST FOR FINAL - INSPECTION For: Fill — _...,_�_...._
Date: 3MM003 _ Trenches
PCUD Construction Permit # PV-30 -87
Located: Isell Hollow Road MM Putnam Valley
Owner /Applicant Dame: David Link TM 51 Block t Lot 13
Formerly: C Ili T Estates Subdivision Name: ,__. C & I Estates
Subdivision Lot #
Is system fill completed? No
Is system complete? Yes (exaw pump)
Is system constructed as per plans? No
Is well drilled? Yes
Is well located as per plans? generally
Are erosion control measures in place? Yes
Date:
Date:
U
301812065
- - -- 12/2312002
Date: (130)
I certify that the system(s), as listed, at the above premises has been constructed and 1 have inspected
and verified their completion in accordance with the issued PCED Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Nealth.
Date: 3/1812063 Certified by: PE _ RA
Address:
®adey & Watson, P.C. 3063 Route 9, Cold Spring, NY
Lic. # —_
Comments: 1) Runoff from road roust be diverted around 8SYS; - 2) Northa rlymost run of curtain
drain do discharge appear to be installed on neighbor's pro ; this location must be confirmed
by your surveyor (please coordinate surveyor's field work with this office); 3) Some lateral ends
appear to be less than 10' from your northerly property line; 4) An adequate expansion area
remains to be provided; additional system and expansion area fill samples will be needed
accordingly; 5) provide an Electrical Underwriter's Certificate for the pump installation; 6) make
arrangements for pump test with this office (after our receipt of Underwriter's Certificate).
FOIL: ® ADAM ® GENE . ® David Link
(NAME)
Form FIR -99
TOTAL P.02
P. P
2003 11:04 BADEY & WATSON, PC P.01i02
. t\
B.ADEY & WATSON .` Surveying and Engineering P.C.
Y 3063 Route 9, Cold Spring, New York 10316 (845) 265.9217 Glcnnon J. lyatson, L.S. -
(845) 225.3312 John P. Delano, P.E.
FAX: (845) 265 -4428 (914) 62 6-1800 Peter Meisltr, L.S.
atslcN
(914) 739.3577 Stephen R. Miller, L.S.
(877) 314.1593 Jennifer W. Reap, L.S.
FAX TRANSAUTTAL George A. Badey, LS., Senior Consultant
James W. Irish, Jr., P.E., LS., Senior Consultant
Mary Rice, R.L.A., Consultant
DATE: O-P> 14i
TO: U A J I D Lk N
FAX #
FROM: - D
WSSAGFANSTRUCtONS:
12. . .V& 00 ;T�F�tS : MbS 1 �Jla
r
NUMBER OF PAGES INCLUDING THIS ONE �
RADEY & WATSON FILE # '9444.1
PLEASE CALL IF ALL PAGES DO NOT GO THROUGH
GCr : C4+VS M Emv A F--.L A- f5 -et,U LD94Z5
5 �.oG�Ati} �i Pc�iN .
Owners of the rds and es of•T'aeonic Surveying & Engineering, P.C., Burgess & Behr,
Roy Burgess, J. Wdb.pr Irish, Joseph S. Agaoli, Vincent Btrruano, Hudson Valley Engineering Company, Inc.,
Douglas, A. Merrit; •E. B. Moeb.as and Reynolds 8t Chase
' J
-- --
. ,
... , .
-:
w .. � _ � ,_ �. �,. _,. ...; _ � ,, ,. � w=
k
PUTNAM. COUNTY DEPARTMENT Off" HE LTH
DIVISION ®1F ENVIRONMENTAL HEALTH SERVICES
. _ . - ._ �.c -.: '4;. •�' +.ya'_'Xrv.. r. >.i:..e- ...r... -. t -, v ^ +' mot:•'. ,r.^v.:4 -:: a ^-- .--a. -�-.: .- . _.: 1�. - :F:�.. _. ._ _ --t -'•r:, - ..r -b.y . A - . .. .. Y. l
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM '
61
Located at QEGL YOAZ 16 tj ; og D r Village AJ >9•A9 4 '
Subdivision name A Subd. Lot # Tax map ,� I Block L_ Lot 1.3
Date Subdivision Approved Lo Renewal Revision
Owner /Applicant Name, 91' WIWT Date'of Preyious Approval /ot
. .
Mailing Address f4L 11&440 w k ZIA P 4 11-14�w il4z -z- ` y Zip 0
Amount of Fee Enclosed 46yzf977 ® 0.00
Building Type: Sl AL 4 0, jq ! �jL,ot Are 0 No of Bedrooms Design Flow GPD e
Fill Section Only . Den Vof4me
P.cCHD NO'T'IFICA'T'ION IS RE UIRED VM— 1'FILL`Is COMPLETED
:.: Seq�arate4Syewerag ' Svstem' to consist of, /�U )1d. gallon septic tank and -
Other Requirements`.
To be constructed by ..: e -7 Address
WA I r: Sat lv:. Public Supply From . Address
- oa�: Private Supply Drilled by Address -
I represent.that I am wholly and completely responsible for the design and,`19catign of the'proposed systems) °and that the..
separate sewage s s�tetn described above will be constucted as shown on the. approved amendment;thereto and _in' .
accordance with the standards, rules. and regulations of th e Putnam Cout►tyD,ppartment`of:Health',tand that on,dompletion. .
thereof a "Certificate of Construction Compliance" satisfactory: to'the'p�blic Health Director v�ll be sufmitted to the
Department, and a written guarantee will be furnished the owner his successors, heirs or assigns by the buil'd"er .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 the eto.
Signed: P E. R.A. Date
Address ., . /r� .'.el � � /� /lc'� �� License #
G�
APlfB ®ViEID, FOitN57['RBJCTI< ®1�: T approval expires two years. from the date issued unless construction of the
sewage treatment ,ys er lias;b n m , and inspected by the PCHD 'and'is revocable for cause or may be amended or. . .
modified wh�n'constdered necessa the Public Health Director. Any revision or alteratiorrofthe approved plan requires
a new perm' Appro d for arg of domestic sanitary se age only. 4
_- g 3
By: _ Trtle: Date: ""
Oc
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
4 '
BADEY & WATSON
LETTER of TRANSMITTAL
- ��•r�veyi�g & ...Enganee�ng; F.C.
- ....._ . _ ._ ,.. t...� �.. _.....
_
3063 Route 9, Cold Spring, New York 10516 Date:
10 Jun 2003
File No.
84 -147
W. O. #
15547
RE:
Certificate of Construction Compliance
Link
TO:
205 Bell Hollow Road
Shawn Rogan
C & T Estates Subd. Lot No.
Putnam County Department of Health
Tax Map 51.4-13
1 Geneva Road
Perautffidet?0 # PV -30 -87
Brewster, NY 10509
Sent via:
US MAIL. 0 UPS -NIGHT
El
MESSENGER UPS -2 DAY
PICK -UP UPS -3 DAY
FAX El UPS -GRND
F
We are sending :
e
UPS -COD
copies date description of document
❑1 1 Fire Underwriters
F-41 I 10- Jun -03 SSTS "As- Built"
❑ I
❑ �� —�
. ...... _ ..... - .__...... _
REMARKS:
Pursuant toyour request; underwriters certificate for pump, as provided by builder; As -built drawing revised to include a fill certification note.
Copies to: File
Yours truly:
John P. Delano, PE
Tel: (845) 265 -9217 ext 12
Fax: (845) 265 -4428
Email: jdelano @badey - watson.com
40 40-05 514823 630746 21615
JUN 16 2003 1:10PM HP LRSERJET 3200 p.1
W.NERWOMESaFOk4NGECOUNTY. com
845.294.8242 / FAX.• 84 ; .294.7486
E 1TALL: FERRANTE@ WAR WICK, NET
Memo
DATE :; -Zpa 3
TO: su--Od r'Ojmtr
PAGES. (Includes Dover)
t11,14
FROM.-
P14:
27 13 Rt 17 M New Hampton, NY 10958
01988 GOES 4520
CERTIFICATE NO. 121 FEE:
LIC. PLATE NO.
COUNTY OF PUTNAM
2 0 2
PLUMBER'S LICENSE
................
.................................................................. ......... ........ .......... ......... ... ... I ..... .......................................
..............................................................
maintaining a place of business at ........... .... .. . . .......... ...................
in the ...... 6 --- ....... PJ� ..... 0- - - - t� U. r,-, C .............................. . is hereby granted a LICENSE pursuant
to the provision oVPutnam County Plumbing License Law - Local Law 4 of the year 1988, to
engage in the plumbing trade in the County of Putnam, State of New York.
This LICENSE expires December 31,12002, is not transferable, and must be renewed annually.
I hereby certify that the foregoing is a true copy. PLUMBING BOARD OF PUTNAM COUNTY
Z 6f the
.......................... ............... 1� .... ... ... - .......................
Dated: .................... ...................... ................ -2�
Art. Chairman
pM C 'I
A 40-0--r� "I
........... ............................ 4i'c.� -Attested: ... ---------
Fw Yom
NOT TRANSFERABLE Secretary
I
1^
ABAR PLUMBING & HEATING Fax 9142945314 Jan 24 10:45
ABAR PLUMBING & BEATING
i, > . ' -2 S GREEN ST. � _ .. ..... • ; _ , .. ,.�. � ..� .r ,
GOSHE N, NY 1 0924
February 19, 2003
E 'Builders
2713 ltte. 17 M
New Hampton, NY 10958
Att: Chris Memmelaar
Re: 205 Bell Hollow.Rd.
Dear .Mr. Menunelaar:
in regard to the above job site, the following have been installed:
One Jacuzzi Hurricane submersible well pump, model N T5141JR5 -82, %z HP, 5 Spm, 220 volt,
220' depth.
One WX205 34.gallon well tank in. basement.
If you should need further information regarding the above, please do not hesitate to call 'me.
Sincerely,
Samuel LaMontanaro
President .
SL /pc
FMON1<: 64*294 -7782
FAR: $4589445314
SAMARAINnwrmmmi r.Mwr
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVIfCES
WELL COMPLETION REPORT
Well Location
Street Address: *2a -
Town�Vilrage:
V10 IMap
Si Block Lot(s)
Well Owner:
Name: A dress:
w a
Residential Public Supply Air cond /heat pu p Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Use of Well:
I- primary
P- secondary
Drilling Equipment
Rotary Cable percussion Compressed air percussion Other (specify)
i
Well Type
Screened Open end casing >�' Open hole in bedrock Other
Casing Details
Total lengthft.
Length below grade ft.
Diameter 6 in.
Weight per foot lb /ft.
Materials: Steel _ Plastic _ Other
Joints: _ Welded Threaded _ Other
Seal: Cement grout _ Bentonite - Other
Drive shoe: Yes No
Liner: Yes -V No
Screen Details ..
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes—No
Hours
Second
Well Yield, .Test r�
_ Bailed _ Pumped Y Compressed Air
Hours
Yield gpm
Depth )(Data.
Measure from Iand surface- static (specify ft)
During yield test(ft)
Depth of completed well in feet
WORD 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
®,Q `
6e
III/
�.
—
f
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
g `
2da
Pump TypeS_ Capacity �AA ,p
Depth gip' Model jys- 4Q S S
Voltage � HP
Tank Type AJKaCL' ` Volume � �
Date Well Completed
Putnam County Certification No.
Date of Report
Well Driller SAgnature
100 Z-,-
q
NU'ii'IE: Exact location of well with atstances to at least two permanent lanamarxs to oe provi n a sCgara`ys,locul„c►l.
Well Driller's Napie Address:
Signature: Date:��1
White copy:
-Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
OCL Analytical Services Analytical Results
35 Goshen Turnpike
Bloomingburg, New York 12721
OCL Sample No: 145064
Method: EPA 200.7
Analyte
Result
Units MCL
DL By Notes
Iron
ND
mg/1
0.050 CD
Lead220
ND
mg/l
0.010 CD
Manganese
ND
mg/I
0.0050 CID
Sodium
6.2
mg/I
1.0 CD
Page I of I
Prepared Analyzed
05113/2003 00:00 05/13/2003 10:12
05/13/2003 00:00 05/13/2003 10:12
05/13/2003 00:00 05/13/2003 10:12
05/09/2003 00:00 05/0912003 02:26
GT = greater than MCL = maximum contaminant level PID = Photoionization Detector (QC) Printed on: 5/14/2003
LT = less than DL = detection level Analysis by Eastern Lab Services #11216
ND = not detected ELCD = Electrolytic Conductivity Detector (QC)
Iro
"'ICL Anal ical Services Phone: 845 - 733 -1557
:.: a.._35 Goshen- Turnpike...:.:_:.:_,
Fax: 845 - 733 -1944
Bloomingburg, IVY 12721
Serving The Hudson Valley For Over Sixty Years Printed: 5/13/2003
Al Ferrante
Client Code: 8FERRAN
Ferrante Homes
2713 Route 17 M Fed ID
New Hampton NY 10958
OCL Sample No: 145064
_ System Name: Al Ferrante
Exact Location : Bell Hollow Rd, Putnum Valley - Pressure Tank
Date/time Collected: 5/7/2003 13:30
Date Received: 5/7/2003
Submit By: C. Ferrante
Ana ytics9 Results
Analysis Result
Units mclldl Method Lab Date Time By Remarks
Alkalinity as CaCO3
72
mg /L
23208
10510
05/12/03
LM
Hardness as CaCO3, Total
86
mg /L
2340C
10510
05/08/03
11:45
KG
Nitrate as N
LT 0.20
mg /L 10
MCL Lachat
10510
05/13/03
LM
Nitrite as N
LT 0.01
mg /L " ' -
MCL EPA354.1
10510
05/08/03
10:00
KG
pH
7.51
4500H +B
10510
05/07/03
16:00
KG
Turbidity
0.501
ntu
21308
10510
05/07/03
16:00
KG
Remarks: RUSH METALS
Copies to: 914- 978 -6031 - Chrisfax: 294 -7486
GT = greater than MCL = maximum contaminant level
LT = less than DL = detection level
ND = not detected
l� L t NAj� C (k 01
Inorganic Chemistry Department
Page: 1 of 1 ELAP #10510
-L:ft
OCL Analy(jpql,Services Phone: 845-733-1557
35 -z: R&f z,7;845y-3-3-1444,;
Bloomingburg, NY 12721
Serving The Hudson Valley For Over Sixty Years Printed: 5/9/2003
Al Ferrante Client Code: 8FERRAN
Ferrante Homes
2713 Route 17 M Fed ID:
New Hampton NY 10958
OCL Sample No: 145064
System Name Al Ferrante
Exact Location Bell Hollow Rd, Putnum Valley - Pressure Tank
Dateltime Collected: 5/7/2003 13:30
Date Received: 5/7/2003
Submit By: . . C. Ferrante
Microbiological Results
Analysis Result Units Method Lab Date Time By Remarks
-f6t-aI)f6FiFoFrF(OIqP6 - -abseh6d' - C100 922313' '10510-'-05/07iO3--i6:60 'HH PASS
E.coli(ONPG) absence C1100 9223B 10510 05/07/03 16:00 HH PASS
Remarks: RUSH METALS
Copies to: 914-978-6031 - Chris
fax: 294-7486
PASS = Passes NYSDOH and EPA Drinking Water Standards
FAIL = Fails NYSDOH and EPA Drinking Water Standards
GT = Greater Than
LT = Less Than
C1 = Colonies per milliliter
C100 = Colonies per 100 milliliters
Page: 1 of 1
IrIL 4 'L&
Microbiology Department
ELAP#1 0510
0
OCL Analytical Services
......---.P-hone..8.45�733.1.557
35 Goshen Turnpike Fax: 845-733-1944
Bloomingburg, NY 12721
Serving The Hudson Valley For Over Sixty Years Printed. 5/14/2003
Al Ferrante
Ferrante Homes
2713 Route 17 M
New Hampton NY 10958
OCL Sample No: 145064
System Name,: Al Ferrante
Exact Location Bell Hollow Rd, Putnum Valley - Pressure Tank
Date/Time Collected: 5/7/2003 13:30
Date Received: 5/712003
Submitted By: C. Ferrante
Analytical results are shown on the pages following this cover page
Notes
Client Code: 8FERRAN
Fed ID:
Cover Page Reviewed by David M. Kennedy - Director
ELAP#1 0510
MAY -06 -2003 09:48
BADEY & WATSONo PC
PUTNAM COUNTY DEPARTMENT OF HEALTH
-DIVISION 0F, ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
P. 03/03
David Link_ 51 _ 1 13
Owner or Purchaser of Building _..._._...._....__ "� - Tax Map Block Lot
E- Builders
Building Constructed by
20SBell Hollow Road
Location_ Street
Residential
Building Type.
Putnam Valley
Town/Village
C & T Estates
Subdivision Name
10566
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship,. material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period. of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system:
The undersigned further agrees. to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Rated nth Ma Day 6 Year 2003. Signature:
f,,
on—
C
_._-...._._..___ �� ......_u....._...............: _.._...
eneral ntrac (Owner) - Signature
E- Builders N/A
Corporation Name (if corporation) Corporation Name (if corporation) -
Address: 2713 Route 17M Address: 20SBell Hollow Road
State _ New Hampton, NY Zip 10958 State Putnam Valley, NY Zip 10579
Form OS -9T
TOTAL P.03
��ANI C G
J tia
rL ,�
:BRUCE R:- FOLFYZ ::: _...�. <._.. _ _.. ..� .. -. � ,... � .., . � ,; • :� � .. �...�a�,
Public Health Director �c�k, Yo�`� 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
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: ` A\tl o L jo c
TAX MAP NUMBER: 51. l - 1-2j
E911 ADDRESS: zoos- �vt t &��} \�q�
TOWN: �,1AV%A QA
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
The Putnam County Department of Health will not issue a Certificate of Construction Compliance
unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town
official. This form is to be submitted with the application for a Certificate of Construction
Compliance.
(E911 verfrm)
JUN 16 2003 1:10PM HP LRSERJET 3200
55099 Fax Into
• i
j New Yb& Board of Fite Undeewdtem
Ban= of Eledddty i
is in ex Proms of issuing t oettililra�e cf
covois ce,.far the clectdW instillation
� provided, far in the eppli� dim (a i
an !
�L
P•2
®001
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Now York Board of Fine Undawdtm
1 Ruman of ElecWdty hwpw oe adk*
f p6ewmt fe Application
-tie,
I � I
hay beret completed and a cwdfiea% of
cmeli ee fw(h Se detail of the
elecfai i i being npuv&
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,.w• _a.+v e.-r �._w.w .. .. -. -w ..... r- • .� ... �.�. ....�..+. � ..w .� a +_ s..... t .. _ �.. _. .�..... .a+.. -r..v -. .� �w.w .L _�. ....•w -. • ... .�. .r. ...... ti. � .+. .. ...... �.�... P .. .. ....
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`IT . � ♦, :� ti '� �,,� � ��� e '� �' If � ,� 3 Tai � ., �� � l/� � � � � ,1 �
a i V. Bi t ~ L L " _ o i {
.
C1ERTffFIICAT E OF CONSTRUCTION COMPLLANCIE IF A'ICIiENT SYSTEM
?CHID CONSTRUCTION PERMIT # Q -313 8
Located at ZO'5 Town or Village
Owner /Applicant Name \)A J, (-� Lim �
Formerly L`S �A`►- -5
Flailing Address
Tax Map SA' Block k Lot i3
Subdivision Name
Subd. Lot # t
I q MAW S W 2EE. 0-,S1tiI I A1C.i i 9\4
Date Construction Permit Issued by PCHD Oa I L✓3 I 00
Zip VbZ6
Separate Sewerage ftstem built by � - 3�-'t L� �-S Address 0&-J OAM �J �
Iv14xII
Consisting of �� Gallon Septic Tank and
3S�j ie- 02 2�l" w��z
Other Requirements: CL- -- e��U/v\,,P 0'A" `^3e-(Z. , `1AM0 2oL5
Yager Supply:
Public Supply From.
Address
or: K Private Supply Drilled by �5wn AL" 10SV " &`,� X-Address
Building Type
Has erosion control been'completed ?"
.q. r.,.5-
Number of Bedrooms Has garbage grinder been installed? mo
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 Pu o ty Department of Health.
Date: cli °G' °3 Certified by i P.E. )6 R.A.
Address 3`a Sw �•.C� (De ign Professional
'Z Z i r, l V I & License # Z5 0 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
revocati Iln, modificati n or change is necessary.
r
By: e r Title: Date:
White copy - IID ile; Ll copy - Building Inspector; Pink copy - Owne Oran copy - Design Professional
Form CC -97
SECTION D. DRAINAGE
19. • Will�proposed`g * ing matenally alter the natural drainage in this or adjacent areas? ❑Yes to
19. �ViII groundwater or surface drainage require special consideration? .................... ❑ Yes o
20. Will gullies, ditches, etc., be. filled and watercourses be relocated ? .......................... ❑ Yes -5446 /.
SECTION E. REMARKS
21. If a common water supply is proposed, has an inspection been made of the
existing or proposed source and facilities ? ........... . ............ ............................... Flyes 1 0
Inspection data
•� 4
22. Do adjacent wells and/or sewage systems exist? ....................... ............................... Yes o
23. Additional comments
4 rti _
24. Site observer /inspector and title C
25.' Date(s) of b'bservation(s)inspection(s) illoa
TEST PIT PROFILES
Hole € Lot Hole r Lot - �` Hole r Lot r
Depth to water Depth to water Depth to water
Depth to mottling Depth to mottling Depth to mottling
De2th to rockhmp, _ : 77. Depth to-rocWimp. _ ~ % --'d" " Uepth to rock/imp.
G.L. G.L. G.L.
0.5 d Ifr g «_ 0.5 CO Q ci 0.5
1.0 1.0 1.0
2.0 �r�- << 45�5L 2.0 ��� �' 2.0.
3.0
4.0 -(-
5.0
M
7.0
M11
KMWMM.
3.0
4.0
5.(
6.(
7.1
3.0
4.0 -
5.0
6.0
7.0
8.0 8.0-
9.0 9.0
10.0 10.0
r r'lUTNAM ®UN'I'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONM ENTAL HEALTH SERVICES
INITIAL INDIVIDUAL/COMMERCIAL SITE INSPECTION FORM
SECTION A. GENERAL INFORMATION
Name of Project �5T-- (T)(V) County
Site Location < tV tA' i�t�-J P&--� LV T
Building construction begun Extent
Is property within NYC `Vatershed ? ................. F_� Ye`�o
SECTIOitT B. TOPOGRAPHY (Please check all appropriate boxes)
1. Hilly Rolling Steep slope Gentle slope Flat
2. 'dente of wetlands w area subject to flooding Bodies of eater
Drainage ditches Rock outcrops
3. Property lines or comers evident ....................................................... F_� Yes 140
I
4. Do water courses exist on or adjoin the property? ............................ E2<es F No
5. Will these affect the design of the sewage system facilities ?............ F�es F-1 No
6. Do watershed regulations apply in this development ? ....................... F-1 Yes io
7 Will extensive grading be necessary'?...: ............ ............................... F Yes Zo,
8. Will extensive fill be necessary for SSTS? :........ .............. .................. � Yes
Do-- filled area -exist iithinthe SSTS area ?:..:::. °.:..:: . _ -Yes No
If yes, what is the condition of the fill?
SECTION C. SOIL OBSERVATIONS
10. Appearance of soil: a d Gravel;oam Clay F__] Hardpan Mixture
11. Observed from: F__] Borings ' F__J Bank cut Backhoe excavations
P
12. Soil borings /excavations observed by on 411cr
13. Depth to groundwater on
14. Depth to mottling
15. Are test holes representative of primary & reserve areas ...... .....................:.::.:....
16. Soil percolation tests made by 1-1)
17. Soil percolation tests witnessed by
SECTION D (on back)
on
E2es 1:1 No
on
on
Form ST -1
r
—�;r.ij.JjEPTH'
G.L.
0.5'
1.01
1.5'
2.0'
2.5'
3.01
3.5'
4.01
4.51
5.01
5.5'
6.01
6.51
7.0'
7.5'
8.01
8.5'
9.01
10.01
TEST PIT DATA 2
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE N0. HOLE NO-. HOLE NO.—
Indicate level at which groundwater is encountered /A 41d
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: _Date
Design Professional Name: 41,6f&.,,txe- J. Aa�,�
Address: /--1-6
Signature:
Design Professional's Seal
0 VSS101V4,4.-
IQ a. Do
��1T1`�1A1�� COUNTY DEPARTMENT OF tCHiA�eT
DIVISION OF ENVIRONMENTAL MENTAIL HEAILTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner �tAtele 2 eL' Address ,2%� %e: a e, en*
Located at (Street) Tax Map -1 Block Lot
(indicate nearest cross street)
Municipality je(I Watershed a�&--VJ' R &Ce r
SOIL PERCOLATION TEST DATA
Date of Pre- soaking � Date of Percolation Test
5
1
2
3
4
5
Kn7TFR! 1- Teets to he reneated at same denth until approximately edual nercolation 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
1
6
I r
3
3
rdr
? 0
xI, J- 7
4
5
�6
at
;�
f/
r
2
j�
a
3�
4
5
1
2
3
4
5
Kn7TFR! 1- Teets to he reneated at same denth until approximately edual nercolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
::.,_DEPTH ::., , .:..::. HOLE-NO.. .;.. HOLE-NO.- NO.- 4-1 L.;-; ; HOLE- NO: -- ,_:. .
G.L.
0.5'i�
1.0'
1.5'
2.0'
/k,-f
2.5'
3.0'
/I
3.5'
4.0'
4.5'
5.0'
5.5'.
0 ��
6.0'
6.5' ,
!lam
7.0'
7.5'
8.0'
8.5'
9.0'
10.0'
2
Indicate level at which groundwater is encountered M 41A
Indicate level at which mottling is observed �,�,or
Indicate level to which water level rises after being encountered
�°._
Deep hole observations made by: �. �id.�'r?%'�r�; � /,o`'- Date
Design Professional Name:.`
Address: /�-G i�����C.�ii�li✓c� .
Signature;
11
(/49Q F,�
4
��,q� �0. 49a 1 � f •'.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
~ DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Ifni y1D e,-Ae r co x1?— ej Address d /gam vim. oea�,0
Located at (Street) MF44 �leie, eOW7 Tax Map _r/ Block �_ Lot
(indicate nearest cross street)
Municipality I Watershed xKaN°-J Eoce--,,4"
SOIL PERCOLATION TEST DATA
Date of Pre - soaking ��- �� Date of Percolation Test�� e'ei
/r
2'�'
IM IY .70
,9-,f
NOTES: 1. Tests to be repeated at same depth
Q
ely equal percolation rates are obtained, at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s ZIn' in 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
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth
Q
ely equal percolation rates are obtained, at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s ZIn' in 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
T r PIT DATA REr, MM TO Hz SUBM= ?+TI'T'S APPLICATION
DESCRIF"ION OP SOILS �VCOUMMED IN TEST 'aOLc,.
'3 EOLE NO. � HOLE NO. Z- EOLE NO. � HOLz NO.
J"
�n
�" CD -7 s''
s
ii
I
1,
M
;ern
AT waCS GIOM WAM is mcomt=
:CATS L.= FOR WMCR WAT2R Lr"VEL RISES AFM BEING
3 MADE BY L� ?_ DAIT'V.
DFSIM
Rate Used Min/1" Drop:. S.D. Usable Area Provided�{�_ �
of Bedrooms
Septic 'rank Capacit•,I--z�y_Gal3. Masonry_ Metal______
:-motion Area Provided by .P.x 2h " 36 Width trench. Others
Do Sisnatur
-0 z sEaL
-J TN441 Caunt7 Health Department
late Approved Sq.F t. /Gal.
�n 1 •4
Checked by
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL•HCALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
`.bESIGN DATA SHEET- SEPARATE §SWAGE DISPOSAL SYSTEM FILE NO.
Owner ti 4o G'rejc .ems 2 e, Addre s s 3D7_-j LEX t Nc:mM fi yE m oi�A y LAI(E N y 1as4 7
Located at (Street Rt L HOLLDVi ZD �T ZZ Block 2- Lot
ica a neares cross street)
Municipality PUTN A M VA LL Y (T) . Watershed
SOIL PERCOLATION TEST DATA RE4UIRED TO BE SUBMITTED WITH APPLICATIONS.
4,2
Cz
Oe
Number CLOCK TIME
PERCOLATION
21
PERCOLATION
apse
p
o Water
water ve
No. Time
From Ground Surface
in Inches
Soil Rate
Start-Stop Min.
p
Start
Sto p
Drop in
Min. /in drop
I._..
Inches
Inches
Inches
//'
2/5����
.2�
3,.2' y 3
vZ
�f
4,2
Cz
5,2
V
21
42 J
IS
5
Notes:. 1) Tests to be repeated at same depth until approximatelyy equal soil
rates are obtained at each.percolation test hole. All data to be submitted
for review. r
2) Depth measurements to be made from top of hole.
DEPTH
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
AT WdIal QZa NCfA=r- IS ENMUN= .j. h �l s �g• .,
INDICATE LEVEL TO WHICfi WAUM IZV7EL RISF n A BEING ENM ED O
Nefk �NSPPcT /e ^f Df DffPNolfS /N /aft fa/ ofc FTr�R G�i•�d- A"f
DEED ROLE OBSERVATIONS MADE BY: 17gni e IJ, Da n DATE: not {d o P
DESIM1
Soil Rate Used /b Min/l" Drop: S.D. Usable Area Provided 0,0
No. of Bedrooms 3 Septic Tank Capacity Z0,00 gals - Type /" I Asa n
Absorption Area Provided By 333 L.F. x 24" width trench
Other
Nampa Dan / -cI J &4PXGI
Address
nq n6bl, e )V• 1.
THIS SPACE FOR USE BY HEALTH DEPARD= ONLY:
Signature
SEAL J P
�o. 484a�
Soil Rate Approved sa.ft /gal. Checked by Pate
DMSICN OF MWMRC HEALTH SAC
APPENDIX I
DESIGN DATA SIi=- SUBSUFAC E
SEW. DISPO.AL S
Cwme_r S.._. -� a (3' / D (f rZ tC e !7 Z d Address d. 490 )( l!/ S
/ SNT
Located at (Street) 9411 fia`G a w lPoaal Sees. J oZ Hlock Lot
(indicate nearest cross stre-et)
municipality
Pc.l n Pm
14 /1e ,x (T)
Watershe3Pee.�.s,�,
SOLI MERMLATIEW TEST DATA REQiT= TO BE SUF9= TWITS APPLIC ATIOS
Date of Pre - =Soaking r%
Date of Percolation Test.
Ap%
HOLE
NT-A= 'r=
TIME
PERCQLP.T' CN
P5RC O=CN
Run
Elapse
Depth to Water FYCm
beater Lure?
No.
Time
Ground
Surface
In Inches
Soil Rate
Start -Stop
Min.
Start
Stop
Drop In
Min/In Drcp
Inches
Inches
Inches
°j li OV
2 // if 11 "
/oZ
/
02 /
:n
Cd
4
5
Y(Q
3//'
4
5
C 1 A f Aloi-
2
3
4
5
N =: 1.
2
Tests to be re,-t--tea' at s--ma der',-% until aporcx2:j ate,7y emml soil rates
are cbtaine3 at each pe=crlaticn test hole. All data to be s•, �-tted
for review.
Depth tre3s=e rents to be ma. e f.ar, tea of hole.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
RE: Property of
Located at Z O
LETTER OF AUTHORIZATION
-t-
U
T
T/X/X Putnam Valley Tax Map # 22 -2 -4.4 Block I Lot 1
Subdivision of
Subdivision Lot # 1
Gentlemen:
C & T Estates
Filed Map # 2 3 5 2 Date Filed 1 o/ 7/ g g
This letter is to authorize Donald R. Knapp
a duly licensed Professional Engineer New York - 072770 apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with.the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam County Sanitary Code: _..... .
Form LA -97
F N E
Very truly yours,
Countersign
�~
R
Signed: `
P.E.
o�
CO 7
er of Property)
Mailing Add
2 D
w
e ven ers
Mailing Address: Q �cr n • . 2-�-
AR�FES SIONP�
oelslly i
State New York
Zip 10589
State yo Zip �-
Telephone:
(914)
z Ts
248 -7726
Telephone: %/ ]► . %�_ �%
Form LA -97
le for t
County Department "of, Health , " "and ;that -on completion thereo
be submitted to the Department, °and'a written guarantee Cwi
place'' ;n. gooe operating 'condition any •part o/ ;said sewage; d
once of the;_approval +of "the Certificate of. Co`n "stiuction" Co
m
will'be.located asshorvn_on - the' -a proved plan antl -the tsald well
Couhty:D;epar men of Health:
Date :':' •� .. S
Address
APPROVED FOR CONSTRUCTION.' This approval.;expires
revocablecfor' cause or' may -6e,anle6ded *or- rl6dlfied'when' con
requires b new permit proved for disposal'of� domesti
iesign 'and location of the! proposed systems) 1) ,that• the separate sewage disposal system
entlment there to antl �n accordsnco with therstantlards rules an regu a „pns o e- u Ram
f a Cartificate'�of Construction'Compliance' satisfactory to she Comini'sslonor ci Health will
11 be "furnished the owner, his successors; begs or assigns by, the buildai, that said builder will
isposal system_ during thaperiotl'.of two (2); -years immedlately"foI lowing' the date pf the issu-
pllance,,of the o ginal.tisystem or:any repair$ thereto; 2) that the drilled well described above
�,. ,....
will be install accordanee ' h' the stantlards, .rules ,antl regu a –T•%ns of the Putnam
19ned,. P.E. R.A.
License No-481-91
year from A ed unle f',construction of the building has. been undertaken and is
d nec slry t Commissioner of. Health Any' change or 'alteration of construction
tary: age d r rival water pply only
Title
in
O
O
.........
w - ' I
.03,
04UCO'W- Z-33
..............
411
%J
.000,
bA,
-A VIS sa-v?q lkvl.4
0:3 i 1
lu
%J
UO
June 5, 2000
DANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
120 Breckenridge Road
Mahopac, N.Y. 10541
914- 628 -7576
Putnam County Department of Health
Geneva Road
Brewster N.Y. 10509
Att: Mr. Adam Steibling.
RE: Application fora:Renewal -of a-SST-S and Weil
Permit Well
Bell Hollow Read
Putnam Valley
Dear Mr. Steibling:
Enclosed herewith please find-the following:
1. SSTS application -
2. Well permit application
3. Fep in the amount of.$ 34b.
4. Wee copies the construction pJan.
-Sincer
aniel J. Donahue, P.E.
n
Site • Sanitary • Environmental
R,
0
_M
I
I
in
I
m
m
0
z
lz
m
a
0
ofa
m
0
w
U
U
w
x
U
. •.AS- BUILT.,: -v. .. a
RELOCATION - DIMENSIONS
1A
18.5'
DROP BOX
1B
n
DROP BOX
N
21.4'
DROP BOX
2B
L0
DROP BOX
x
27.5'
w
3B
0
DROP BOX
z
33.6'
U_
4B
74.3'
DROP BOX
a
39.5'
a
5B
75.3'
DROP BOX
0
45.3'
0
68
w
DROP BOX
C7
_M
I
I
in
I
m
m
0
z
lz
m
a
0
ofa
m
0
w
U
U
w
x
U
. •.AS- BUILT.,: -v. .. a
RELOCATION - DIMENSIONS
1A
18.5'
DROP BOX
1B
76.4'
DROP BOX
2A
21.4'
DROP BOX
2B
75.4'
DROP BOX
3A
27.5'
DROP BOX
3B
74.4'
DROP BOX
4A
33.6'
DROP BOX
4B
74.3'
DROP BOX
5A
39.5'
DROP BOX
5B
75.3'
DROP BOX
6A
45.3'
DROP BOX
68
77.3'
DROP BOX
7A
53.1'
END LATERAL
7B
29.7'
END LATERAL
8A 1
57.7'
END LATERAL
8B
26.8'
END LATERAL
9A
61.7'
END LATERAL
9B
23.4'
END LATERAL
10A
61.8'
END LATERAL
10B
31.2'
END LATERAL
11A
64.7'
END LATERAL
11B
30.5'
END LATERAL
12A
35.7'
END LATERAL
12B
96.9'
END LATERAL
13A
54.3'
END LATERAL
136
117.6'
END LATERAL
"14A'
65.5'
END +LATERAL
14B
127.3'
END LATERAL
15C
23.4'
SEPTIC TANK
15D
28.3'
SEPTIC TANK
16C
29.2'
SEPTIC TANK
16D
22.5'
SEPTIC TANK
17C
37.1'
PUMP TANK
17D
17.5'
PUMP TANK
18C
1 44.6'
PUMP TANK
18D
15.0'
PUMP TANK
WE
46.6'
WELL
WF
50.9'
WELL
19A
93.6'
CURTAIN DRAIN
198
31.0'
CURTAIN DRAIN
20A
52.7'
CURTAIN DRAIN
208
30.8'
CURTAIN DRAIN
21A
37.2'
CURTAIN DRAIN
21B
46.2'
CURTAIN DRAIN
22A
11.7'
CURTAIN DRAIN
22B
71.6'
CURTAIN DRAIN
23A
92.9'
CURTAIN DRAIN
23B
162.4'
1 CURTAIN DRAIN
2
O
Sol
�D
r
C
O
Q
r-
(;o O
"-I
N
2
a
N
O
I
i
i
i
i
i
I
- .,....._. - . _ POLE .......... ......
AREA = 3°01 S ACRES
i D'AQUINO and DONAHUE
CONSULTING ENGINEERS
TO
NY 1 os- I
❑ zt-
John V. D'Aquino
RD 2 Box 17
Put. Valley, N.Y. 10579
526 -2039
Daniel J. Donahue
Breckenridge Road
Mahopac, N.Y. 10541
628 -7576
DATE 311? �7
Joe NO.
ATTENTION - -. .. - .,v - _.. -.... ..._. tt _.,, .... ... ..
RE:
SS
C[tWdAa Cr&S(_10
btu Awao
1
WE ARE SENDING YOU Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
THESE ARE TRANSMITTED: -as- .decked w - :_ ... .. ........ ._ - ..,.... .
For approval wvi
d For your use :.
❑ As requested
❑ For review and comment
90
�❑ Approved, as submitted
❑ Approved as noted
❑ Returned for corrections
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
SIGNED:-
It enclosures are not as noted. kindly notify us at once.
DESCRIPTION
r
THESE ARE TRANSMITTED: -as- .decked w - :_ ... .. ........ ._ - ..,.... .
For approval wvi
d For your use :.
❑ As requested
❑ For review and comment
90
�❑ Approved, as submitted
❑ Approved as noted
❑ Returned for corrections
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
SIGNED:-
It enclosures are not as noted. kindly notify us at once.
]isDANIEL J. D ONAHUE, P.E.
CONSULTING ENGINEERS
' 120 Breckenridge Road. .
Mahopac, N.Y. 10541
914 -628 -7576
October 30, 1997
Putnam County Department of Health
9 Geneva Road
Brewster, N.Y.
Att: Wm. Hedges
RE: Renewal of a Sewage Disposal System
Property of Claudio Grescenzo
Bell Hollow Road
Putnam Valley
Dear Mr. Hedges:
Enclosed herewith for your review and appr,6val are four sets
of plans along with a renewal application land a letter of
authorization of the above captioned project. Your review and
approval would be appreciated.
Sincerely,
l
tia::ean . e, v, E.
Site a Sanitary a Environmental
IST�A A ell d S (A��
'
,
DAQUINO and DONAHUE
CONSULTING ENGINEERS
'
TO
B znxn V o, in� NMI, oauiel � '
' w'�^ ore��eoc� Donahue
ou � op� 27
` iege goad
Put. Valley, N.Y. 10579 ma*q N.Y. 10541
52e-2039 $28-7576
DATZ
WE ARE 'ENDING YOU O Attached O Under separate cover via the following items
O Shop drawings Prints O Plans O Samples O
El Copy of letter 0 Change order 0
�
COPIES
DATE
NO.
DESCRIPTION
WE ARE 'ENDING YOU O Attached O Under separate cover via the following items
O Shop drawings Prints O Plans O Samples O
El Copy of letter 0 Change order 0
�
COPIES
DATE
NO.
DESCRIPTION
arri
rr
THESE ARE TRANSMITTED as checked below: -
For approval O Approved as submitted O Resubmd-_____copies for approval
w^�
O For your use [] Approved as noted O Swbmit_--__cmpies for distribution
-- O As requested O Returned for corrections O Retum___comected prints
O Yor review and comment O
.
O FOR BIDS DUE lg-__--_O PRINTS RETURNED AFTER LOAN TO US
| R[KARK3
Ofol
go C
yZe
^��,re'«w 1:?,6 vc
or
COPY To_
SIGNED:_;O���
�a F
1�
�1
� 51'
T
,
7�
r�
1( _:
�J J
0;
w BREAKFAST
D INING �— KITCHEN 92 12U
IIS.12U
10i 12U
LIVING RM FOYER
• ' 23rD. l34 74 x 134 .
;1`-`�
BED RM a 1
Q
(�
.. Isual2U
BATH
6IIa541
• 2 '
6
��
1
y '1a ,
..4
i
I
0
;n
X--� U -L
V
BATHfI' i
l
HALL
\ 94x54.
j S
rav v
-41
BED RMII 2
BED RMII3
• 12UaI0W
134.12]
LINCOLN 27'x59'
PUTNAM.COUHTYC DZPARUjFj,TilQa &gM
I10USE' PLANC, 4P . ROV= F
$EDROW" ImIi r Qua;;
S3�riatur*
;■ r' PENN LYON HOMES INC." f
d _ ' Ofd Trail Road. Selinsgrove Pa. 17670
;�; Telephone (717) 743 -0111 i #�
APPENDIX L
PUTNAM COUNTY DEPARnaM OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICFS�
DATE:
RE: Property of Y-,7 .z y
Located at
(T) f o -/A/, 114 //.e y . Section Block Lot
Subdivision of Z %�r �i a cd'I /n Cpl tG-pn 2 d
Subdvo Lot # Filed Map # Date
Gentlemen:
This letter is to authorize IDAh l -f/ J, �-
a duly licensed professional engineer. ) or registered architect
(indicate)
to apply for a Construction Permit for a separate sewage system, to serve the
above noted property in accordance with the standards, rules or regulations as
promulagated by the Commissioner of the Putnam County Department of Health, and to
sign all necessary papers on my behalf in connection with this matter and to
supervise the construction of said system or..systems in conformity- with-the
provisions -of*- Article 145 or 147, Education Law, the Public Health Law, and the
Putnam County Sanitary Code.
Telephone
Very truly yours,
Signed:
�lt'a'W
Owner of Property
0,
Address
Town
Telephone
19
h
CL
s-
ON
Countersigned:,-
P >Ee, R.A., #
X00
w
Address
r lie ✓�,,� �9'� efl
lif'e' 4pkc
Telephone
Very truly yours,
Signed:
�lt'a'W
Owner of Property
0,
Address
Town
Telephone
19
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
a.,. ......... � Date ®L,�J
Re: Property of (24Av0_14 _ �2 .�cC-AiZ
Located at/3z;U, gottow A'0 /h, t -j'O P) yA6tZ I /Ul.
(T) Section Block _Lot
Subdivision of �d�� S7 -j74e S
Subdv. Lot #-. Filed Map # y35;1, Date IO Z% 69
Gentlemen:
�AJ,s u�
This letter is to authorize �3/�% /�
a duly licensed professional engineer or registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
. connection with this matter and to supervise the construction of said
�,. _...
_�._.__,_. _.sys•t.em. or•• spy- s•tems� n c-an�formrty- •with-. ttre--•provi'sioris 'of':•Article - TV5 --or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned el
P . E . , R.A., # 74 F>-e ��
`off-® x�6� l/� 0��0 40e- "�y
Address
Telephone
Very truly yours,
Si g ned C_ Aa 4016� Owner of Pr perty
316,?,"W
Address
A%tahi0/w ®S % T
Town
6'x601
Telephone
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT i
WELL LOCATION
Street Address
Town /Village City Tax
III
Grid Numb r
WELL OWNER
Name
��i�AQ P l &n'
30-2-9
Address rivate
d3 OKO- 6o LC O Public
SE OF WELL
- primary
2 - secondary
C
tARESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP
0 BUSINESS O FARM 0 TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
❑ ABANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
NEW SUPPLY
OREPLACE EXISTING
SUPPLY
❑PROVIDE ADDITIONAL SUPPLY
0DEEPEN EXISTING WELL
®TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
1 Awdellna,
Ij
WELL TYPE
&JDRILLED
DRIVEN
®DUG
®GRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODING? YES �'NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION-
4 &1 J1 o 47 .net Gyts4enL4, Lot No.
WATER WELL CONTRACTOR: Name d be, Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: —YES0
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM --NEAREST WATER_ MAIN:: n46 e e
LOCATION'SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION ON ARAT
( ate U-1 (si g nat e)
� c` :: N
o - - -
> ON PERMIT
�! TO CONSTRUCT A WATER WELL
This permit to construct Are water well as set forth above is granted under the
provisions of Subpa t,:�5 -2 f Part 5 of the New York State Sanitary Code, and
provided that withiwr ,hirt; *(30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health De rtment.
Date of Issue: 19 YJ 4 "°
Date of Expiration: 1( 19 e> Permit Issuiry§ Of Hal
Permit is Non - Transferrable