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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -50.3 BOX 21 �L MUM di,Ir 16 1 r , r� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE: Exact location of well with distances to at least two permanent landmarKs to be provided on a separate sneetiptan. Well Driller's N e / D2, � d vL. 0A/_ Address: 47A/Okk Signature: �^-� Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 .wn ! iVC C —mvA_wl V r llage:1 � Map ;�/ Block Lot(a� Well Owner: Name: Address: Use of Well: -prima 2- secondary Re tdential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion _ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length tl- I ft. Length below grade _Lj _L- Oft. Diameter _ in. Weight per foot V_lb /ft. Materials: Steel Plastic _ Other Joints: _ Welded _X Threaded _ Other Seal: _X Cement grout _ Bentonite _ Other Drive shoe: Yes No I Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _Bailed _Pumped _X Compressed Air Hours Yield c9d gpm Depth Data Measure from land surface- static specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or U ieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface : O ► A r PAN/ O z3 G—RAlf arAtilrt _ IS If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth egad Modelziasl0 Voltages HP Tank TypewKrm -Volume Date Well Comple d fios- Putnam County Certification No. Date of Report Well Dr' er (s nature) NOTE: Exact location of well with distances to at least two permanent landmarKs to be provided on a separate sneetiptan. Well Driller's N e / D2, � d vL. 0A/_ Address: 47A/Okk Signature: �^-� Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 22, 2009 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Charles Ralston 19 Timberline Court Putnam Valley, NY 10579 Re: Dear Mr. Ralston: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Addition- A- 168 -09 No Increase in Number of Bedrooms 19 Timberline Court (T) Putnam Valley, T.M. # 51.4-50.2 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated October 22, 2009. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be "maintained." 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower head; and faucets etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, rO� . Gene D. Reed Senior Engineering Ai e GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 . �_ _ _ e ..R +w.Yaa..aa...>aru_v. . t♦ f �• v arr. .. .. �. a� a..1 .a....w OC�i•af'SP.a�: wJ�wIO- .�T.�•.....f ...�Or October 18, 2009 Putnam County Board of Health 1 Geneva Road Brewster, New York 10509 Putnam County Board of Health, Enclosed please find all the necessary submission material as per the memo dated May 14, 2009 from Robert Morris, PE, Director of .Environmental Health. The sole purpose of this submission is to insulate the basement walls of my house and not to increase the number of existing bedrooms or the square footage of the structure. However in the course of this work I thought it would be prudent to install a full bathroom, as the rough in plumbing was installed when the house was built, as well as a slop sink. Should there be any questions regarding this matter please contact me in any manor as described below. Thank you for your review _and -- consideration. of this: ma.tter.... Sincerely, 19 Timberline Court Putnam Valley, New York 10579 Phone: 845- 284 -2241 Fax: 845 -528 -0114 Email: csr4 @optimum.net SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Lei E'�' I:IIVARI; RN' MSN' . M Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ADDITION APPLICATION ROBERT J. BONDI County Executive ROBE (ORRIS, PE Director of o Health RESIDENTIAL, ONLY STREET 9 f 10K1 i \C Ct TOWN NNAPN y MAP- # NAME'. W' PHONE �i�- -��.41 PCHD# - MAILING ADDRESS (DESCRIPTION OF , ADDITION /v O. A)EW NUMBER OF EXISTING BEDROOMS' PROPOSED # OF BEDROOMS L (FROM-CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans .(Construction permit): prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278-6130. /1!! Certified check or money order for $100.00.t/ tel: Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown.and dimens. oed--arrd-use of each room specified): .(See Section 3.c of Bulletin HA -1) /3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3:d of Bulletin HA -1) /4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any ` questions. 5. .Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling: OFFICE USE COMMENTS " S Environmental. Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 . Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2841 Fax (845) 225 =1580 e SHERLITA AMLER, MD; MS, FAAP Commissioner. of Health r= LORETTA MOLINAR.' RN,-MSN• Associate Commissioner of Health ROBERT J. BONDI County Executive Pitts, PE Director of Environmental'Health DEPARTMENT OF HEALTH l Geneva Road. Brewster, New York 10509 Town Legal Bedroom Count & Proposed Addition Status Re: i l L S Tc) 'IQ (Owner's Name) Tax Map # — Address: L I Nis Year Built:. 200 According to records maintained by the Town, the above.noted dwelling, is_ in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtain d from: Certificate of .Occupancy: Other: The plans for the proposed addition are considered: New Construction Addition to existing ouse onl 6, h I S 11 Q �� S� .f, g Y ht' Teardown and/or re -build allowed under Town Regulations Building Inspector .Date 6. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing.Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax ($45) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 CE.b 2 0 Sys .Q5 07: 077 �° • c CERTIFICATE NO: 2005 -233 PERMIT NO: 2005 -30 TAX MAP # : 00/51. -1 -50.3 LOCATION: 19 TIMBERLINE COURT ISSUED TO : TMERLINE ASSOCIATES ATTN: BLITMAN DEVELOPMENT 118 N BEDFORD RD STE 102 MOUNT KISCO, NY 10549 DATE: 10/20/2005 This certificate cowers the construction of: ONE FAMILY RESIDENCE, 2 CAR GARAGE, 4BEDROOMS,2 1/2 BATHS,REAR DECK 12'X 12', FRONT PORCH,LAUNDRY ROOM, FIREPLACE,UNFINISBED BASEMENT,UNFINISHED ATTIC The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary Code, the Uniform Building & Fire Code and the Laws in effect in the Town of Putnam Valley, Putnam County, N .,_.�aving.paid the required fee therefor and the undersigned.haviii by. . _.._ personal inspection ascertained that improvement W tie proposed structure - is in compliance with the requirements of the laws as aforementioned; that the said work and materials meet every requirement of the laws as aforementioned and that the premises have now been fully completed' and are ready for occupancy pursuant to the provisions of law. Now, therefore, the Certificate of Occupancy is hereby issued under the seal of the Town of Putnam Malley. TOWN OF PUTNAM VALLEY9 NY V Alf, By v �D Code Enforcement ® ecer TNAM COUNTY DEPARTMENT OF HEAL'rt DIVISION OF ENVIRONMENTAL HEALTH SERVI �I CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # S 4) - /.S � O 2 Located atl�rl"-00 Z-I� "/ Owner /Applicant Name A -, A.r'a Tax Map �_ Block C Lot Formerly Subdivision Name Subd. Lot # .� Mailing Address % �i f9 4e/), C��✓' /y Zip Date Construction Permit Issued by PCHD — 11,6 9 Separate Sewerage System built by Address 1047 114 llw Consisting of Gallon Septic Tank and - 4 Other Requirements: 494 J'/ ,u 4C Water Supply: Public Supply From, Address or: Private Supply Drilled b}f%l� Gl� /� Address yn,.,' „ - 'e� Building Type... D AJ4.4.9 � � Has erosion control been completed? .,rr,8 1-1 Number of Bedrooms Has garbage grinder been installed? 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 Putnam Co ty Department of Health. Date: C! "Certified by P. E. (Design Professional Address moo( License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, odification or c ange is necessary. By Title: G fg►'t2 Date: q13 fl copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ES WELL COMPLETION REPORT WeII'Loegtion : = Sheet Address: -- - d ft1 r t',n'rtH V#11,t4 ITax Grid # IMap J7 Block Lot( Well owner: Name: Address: Use of Well: -prima 2- secondary Re idential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby ]!Drilling ]Equipment Rotary Cable percussion _>� Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade _ o ft. Diameter in. Weight per foot alb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded __K Threaded _ Other Seal: _X Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped -X Compressed Air Hours Yield Ad gpm Depth I<Dats 7 Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 13 7- Well Log If more detailed information descriptions or sieve analyses are available, please attach. IIDe th From Surface Water Bearing Well Diameteron) ]Formation Description fft. ft. Land Surface A q 4 A rl paw (J 3:¢ 2.3, e n4mi , /J• - .. -:_- = :: - :.:::_ - . iZry If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type6tb Capacity 7 Depth 4aeB Model GS 1 iq Voltage ll' HP Tank Typ rmLVolume 1p Date Well Comple d Putnam County Certification No. Date of Report L-P 6 �, Well Dr er (s' nature) NOTE: Exact location of well with distances to at least two permanent Iandmatks to be provided on a separate sheet/plan. Well Driller's N e I t7/�.�/S �� /VJ' Address: 7Z ti/�- Signature:. = Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 - " "�' ' ` ' `BRUCE 'R. ��FOLEY � � • Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)•278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278.6085 Early Intervention/Preschool (845) 278.6014 Fax (845) 278 .6648. E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: JD —5 E911 ADDRESS: �� /f ?L� tom.• �?� (;C�T2CQ/Yl Y� y TOWN: AUTHORIZED TOWN OFFICIAL: DATE: `I VaLu 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. (1391 Iverfnn) NMI WWT DIVISION O ENVIRONMENTAL EA f i SERVICES GUARANTEE OF SUBSURFACE SEWAGE Y AGE TR EATMENT..SYSTEM .. N'T 1 / w2m • ;. uildin �., l (ko& / Building Constructed by fi OAS Location - Street " jz—XA Building Upe 4-/ l JD•3 Tax Flap Block Lot fim 0Ccm V Town/Village Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director 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. Dat *'month Day 6 Year 7 Ge eral Contraz(0wner) - Signature a )&Xt- M0 Corporation Name (f corporation) Address:Ir'® State / 6O L Zip Li 79 I . r Corporation Name (if corporation) Address: //& Ali) State fQGy VOVC- Zip .1� Form GS -97 , YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (91./t) 2z�5-28O0 Albert H. Padovani, Director LAB #: 3.500599 CLIENT #: 114 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TORLISH & SONS BOX 271, 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY 10504 DATE/TIME TAKEN: 08/10/05 02:00 DATE/TIME REC'D: 08/1=5 REPORT DATE: 08/1B/05 PHONE: (914)-273-3448 SAMPLING SITE: TIMBERLINE ESTATES LOT 3 SAMPLE TYPE..: POTABLE : TANK PRESERVATIVES: NONE COL'D BY: D TORLISH TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD .1 PUTNAM CNTY PROFILE 08/11/05 MF T. COLIFORM ABSENT /100 ML ABSENT 08/12/05 LEAD (INS) <1 ppb 0-15 ppb 08/11/05 NITRATE NITROG <0.2 MG /L 0 - 10 08112105 NITRITE NITROG <0.01 MG/1... N/A 08/15/05 IRON (Fe) <0.060 MG/1 0-0.3 mg/l 08/15/05 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 08/16/05 SODIUM (Na) 2.03 MG/1 N/A 08/11/05 pH 7.3 UNlTS 6.5-8.5 08/15/05 HARDNESS,TOTAL 90.0 MG/1 N/A 08/15/05 ALKALINITY (AS 86.0 MG /L N/A 08/12/05 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE W S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETER!.; TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ub}ic schools are set at 15 ppb. . Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium 10013 9003 1052 9162 9002 9002 9002 9043 9001 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 '-' , �,.z�+=0914) 2&5=2800oaa v; =~`.` .^ : "—, � Albert H. Padovani, Director LAB #: 3.500599 CLIENT #: 114 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TORLISH & SONS BOX 271, 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY 10504 SAMPLING SITE: TIMBERLINE ESTATES LOT 3 : /Amx COL'D BY: D TORLISH NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is suggested. DATE/TIMETAKEN: 08/10/05 02:00 DATE/TIME REC'D: 08/�1/05 REPORT DATE: 08/18/05 PHONE: 014>-273-3448 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: Ml::' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14.� MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS [N WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/Lr DEPENDS ON THE' SOURCE AND TREATMENT TOWHICH THE WATER HASBEEN SUBJECTED. ' SOFT WATER: 0-70 MG/| � VERY HA �''ATER: ABOVE 300 MG/L � '� M��ERATE[.Y �iARD'WATEB��7U���8�MG/�������-M��L'=MIl-LIGRAN PERi�I� �----��-� SUBMITTED BY: Albert 1-4 :'adovani, D i rec tc-.�r/ -� M.T.(ASCP) ELAP# 10323 DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 September 21, 2005 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Joseph Pavarotti RE: As Built Plans Timberline Estates Lot #3 Timberline Ct, Putnam Valley Enclosed please find: 1. Certification of Construction Compliance 2. Well Log and Bacti Results 3. Guarantee and two copies 4. Three copies of the as built plan 5. Filing fee of $300.00 6. E911 Verification Letter Your prompt attention would be appreciated. Sincere y, eel Donahue, P.E. Site - Sanitary • Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL' SITE . INSPECTION Date: /7 �0 Inspected by: -j3ja Str.eet.Location Town Permit 4 54Af rc S :a TM# —,I Subdivision Lot 4 ejAIe.�. 6-f 1. Sewage System Area YES NO a. STS area located as per approved plans .......... : * ................. 1 b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth- c. Natural soil not stripped ................................... ................ d. Stone, brush, etc., greater than 15'fro'm STS area. : ...... 6. -100' from water course / wetlands ..... ............................... C/ 11, Sewage System a. Septic tank size - 1,000 ........... 1,250..V ... other ................ b. * S eptic'tk ifistaled level ..... : ......................................... :.c. 10' minimum from foundation .......... ; ................................... d. Distribution Box 1. All outlets at same elevatio n-water tested ..... ...... 2. Protected below frost .................................................. 3. .. Minimum 2 ft.Original soil between box & treqches e. Junction Box properly set ..................... N4. I/V ........ 7' 6. 1'renches 1. Length required Length installed 2. Distance to watercourse measured 3. Installed according to plan ............ I 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6.. Depth of trench <30 inches from surfice .................. 7. Room allowed for expansion, 100 % " " ................ S. Size of gravel 3/4 - VA" diameter clean ..................... 9. Depth of gravel in trench 12" minimum .................... - 10., Pipe.ends ca ...:............. .I............................. . .......... cap ...-..g-:----Dumn-or-Dosea-;�iystems 1. Size of pump chamber ...... V1 i .2. Overflow tank ......................... ....... .3. Alarm, visual/audio ..................................................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........... I ................................................ 6. Cycle witnessed by H.D.estimated flow /cycle........... 1011.. House/]3uUdin'g A. House located per approved plans .......... bocllNumber of bedrooms .............. 6 ........................... ... a isp per _ippp �pr o v �e �dp plans...... n �s ... .. ......... 0/ 5 b. bistEct6_r_fi_ fiSTSiE_ii measured kl,9 d ft........... c. Casing. 18" above grade .............................. . . . . . . . . . . 6 . . . . . . . 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 pla f. Curtain drain outfall. -protected & dir.to exist waterc g.. Footing drains discharge away from STS area ............... h. Surface water protection adequate ............................... 6 ...... i. Erosion ontrol provided ................................................ Rev. 12/02 2 COND1ENTS 5P 6(e"e (I 'dj SITE INSPECTION FOR FML ?AD Date:' Inspected by: `T Fill pad located per the approved pl a o ✓ Fill Pad Length Required Hit '-, Fill Pad Width fo Required Width Fill Pad Depth' ` 3 - 6 fi,` Required Depth s/. zr % cv a°•' �F�� >l.� Run -of -Bank Fill Quality�''Qt' \ Slope from Top to Toe�°'� Impervious Layer Installed LipS J 4— 5�^ �'z✓ / ✓�L�" ` "'7 �'^ trosion Control Installed s� j,, j,�� ;, ,� G e 14, ?r Sieve Test Results (if applicable) �`'` �� •� . � Additional Comments: Reserved for Field Sketch if Applicable SHERLITA AMLER, MD, -MS, FAAP `'`'° Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Dar! Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 18, 2005 ROBERT J. BONDI County Executive - :.... c� Re: Field Inspection — Timberline Associates Timberline Court, (T) Putnam Valley TM# 51 -1 -50.3 A site inspection was made for the above referenced project on August 17, 2005. The following comments must be corrected in the field. The septic tank and the siphon tank need to be installed and completely exposed for - �inspection. V ' r- d'osing-siphon test needs'to-be witnessed -by a representative, of this Department.- The cast iron pipe needs to be installed and completely exposed for inspection. The side slope at the end of the system is still not completely finished. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 1Y LB1®U TY DEPARTMENT OF HEALT BMSI®N O TEY RO AL jK AEll H SER V UCES ATTIENnON AJOSEPH ® GENE MUES'T E09 E21AL INSPEOON For: Fill All information must be #'u11y completed prior to any 'Trenches inspections being made. PCHD Conn Permit # . Located: T14AW dA(aik C.Or- 'o "0 Owner/Applicant Name: T eW fifL Lot& & C & C '� M , Y Block ® Lot ",�'� � Formerly: Subdivision Nam• l Subdivision Lot # .� Is system fill completed? r, Daft: Is system comphte? - Is system constructed as per plans? Is well drilled? Is well located as per plow? Are erosion contml measures in place? Date: Date: I certify that the system(s), as listed, at the above premises hm been constructed and I have inspected and verified their completion in accordance with the issued. PCHD ' Construction Permit and approved plans and the Standards, Mules and Ragulatiou.of the Putnam County Department of Date: Certified by: � 1 PE BRA Design PAessiozal Address: C.4- '4 ft. � � � Lic. Comments- Form FIR -99 TM . enCZ_a7P-7gp1 NAME PIJTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVIC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEI PERMIT # �-- f,- Located at.� ,d r Subdivision nam`��''`" ��'' Subd. Lot # 3 �r Village Tax Map rZ Block _/ Lot .-e Date Subdivision Approved L l—t& � Renewal Revision Owner /Applicant Name'/ l 'o? powL/lile, 4ST 0 C Date of Previous Approval tI., !yam Mailing Address A -a ,� e rf e Cj rj,1 .�f �y/ Gy `��' r� Zip /oyy Amount of Fee Enclosed Building Type S dry &% Lot Area No of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: L /� C� To be constructed by Addre s Water Supply: Public Supply From 'Fnvate'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 treatments s� 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 Address R.A. Date 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 pe Approved for discharge of domestic sanitary sewage only. l / By- Title: l��' Date: /g/, -�-- ite py - HD File; Yellow copy - Building nspector; Pink copy - Owner; Orange copy - Design Pr essional Form CP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 10, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re:. Field Inspection — Timberline Associates, Inc. Timberline Court, (T) Putnam Valley TM# 51 -1 -50.3 Dear Mr. Donahue: A site inspection was made for the above referenced project on June 7, 2005. The following comments must be corrected in the field. 1. The fill pad side slopes below the primary area needs to be completed and all trees in the side slopes removed. 2. Please provide more silt fence to cover the entire S_STS area. 3. It appears either the house or the SSTS area was relocated. Please verify. 4. Please verify the well location and make sure it is a minimum of 15 feet from the property line. If you have any further questions, please contact me at (845) 278 -6130 JSP:cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 CONSIXTI NG INGINl ItIS d Dwol 1. Doraws. P.E. MWI oW, N.Y. 10341 14.bZ1•�578 ro gig . ...a.,.r_.... IL WE ARE SlFNIDING VOU C« Aftehod Ll Unft Marais arar via tho lieorbwirl,8 ftma: G ftP drowino O Pf4ft C7 Piono 0 SWAOM IM S®"Cvftft Cow of Mw ❑ Chomp crow � AMM'TUD chocked ..�.. _ ...TasESE bow"— -ea -below: , _ .. ! ►OV�d..Ed8.sd01l+itlaS: G I +rbrn;a.,,,,,.,..aa -. , for ayProwl .. _ -. C3 for ynf un t.' Aw olred as notao to? d1aRrOl olon ... 0 G As roNaW D Rotuanod for ewrationa G Rewffl � offn ew ! D For roview and oafflao n C.: ,... _ 0 FOR NOS OUR 18� C PRIM RETURNW AFM LCM TO US REMARKS -- -- amm"; ►7 All F Is Is Is Is Is an PUTIqAM COUNTY DEPARTMENT OF HEALTH DIVISION ()F ENVIRONMENTAL HEALTH SI P-W CES ,JOSEPH 13 G ENF, For: lion must be fully completed prior to any being made. ]Fill Trenches ID Construction Permit # ier /Applicant Name. And 'G a X � M -f� Block _(� Lot nerly: _ Subdivision Name: Q3 �_ +�' Subdivision Lot # 3 stem fill completed? �Z e® - Date: -� 4' stem complete? - Tate: stem constructed as, per plans? ell drilled? Date: ell located as per plans ?. erosion control measures in place? I c rtify that the system(s), as listed, at the above premises has been constructed and I haveinspected an veri£ed their completion in accordgmee with the issued PCIM Construction Pcmlit and ap roved plans and the Standards, RWes and Regulations of the Putnam Cotinty Department of th. Certified .by. ,...__. .,.___�.......... _ PE.._.. __.. Design Professional oft 0 FIR -99 JUN -6 -2005 MON 16:49 TEL:845- 278 -7921 OPME:PUTNAM COUNTY DEPARTMENT OF P. 1 I '34b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES liDESIGN,DATA SHEET - SUBSURFACE -SEWAGE TREATMENT :SYSTEM ownei 41 N tf 6',Pr d e- Addresi-23� ,''C"R,O-�0'ew,-/ee/v', S 'r Locatid it (Street) 7-/ t 0 &o? Z / Alf C 1' Tax Map V Block Lot -(indicate nearest cro s street)'." Muni ipality rz., A'a ,&r A-, 71Z z Watershed ��4c- .0 4u SOIL PERCOLATION TEST DATA A 'Date of Percolation Test Date 4f Pre-soakinjg �/10 41/-f' 4 5 S: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I 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 h t . IN A" K .... 2 o ya � a 3 3 4 0z 9 2 C23 a J 3 34) 01) 4 3b 0? 5 2 3 4 5 S: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I 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 PIS` DATA 2 DES ION OF SOILS ENCOUNTERED IN 'TES's HOLES i DIrP'il= DOLE NO. HOLE NO. HOLE NO. G.L. 0.5' 2.0' 2.5' i 3.0' ; 3.5' 4.0' --- 4.5' I 5.0' c 5.5' 6.0' F 7.0 cis T. �.Ot. ON 9.0' 9.5' 10.0' -; Indicate level at which groundwater is encountered Indicato level at which mottling is observed Indica4 level to which water level rises alter being encountered Deep h( le observations made by: Date Design; Professional Nance: D,& 1y sg/ AFF Address: !�- V��E'k?��c �• i ®� oe Signature: 1 Design Professional's Seal �P bt( PUTNAM COUNTY DEPARTMENT OF HEALTH It DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ CONSTRUCTION PE�tMIT FOR SEWAGE TR�ATMEN'� S'YS'i�EM PERMIT # �-,�' �d' �- zEy,;- ',,'''j1�n_I Located at / t`t 5W L1A1 r 67_ ,_ " r Village �► ��� Subdivision name O's -j Subd. Lot # J Tax Map Block/ LoP%3 Date Subdivision Approved �t�j f� Renewal y Revision ''Tl•'tQ @RG�� fL �� 3 G Owner /Applicant Name Date of Previous Approval % d Mailing Address G'lf?L�Z GdfyiE'� d"r �y/��TG'`�' ,GYM`% Zip Amount of Fee Enclosed �O G Building Type A`�Pfti 1-7 Lot Areaa /'� No. of Bedrooms Design Flow GPD 8 -ow Fill Section Only X_ Dept ±'4 `' Volume A PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by Address Water Supply: Public Supply From 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. A--"' R.A. Date 6 Address 1016 QrQ,c .z /-I oly4 GPd A4` wlwl�W ec A-7 License # IT Z/0 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 modifi d when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. App r for disch4rge of domestic - sanitary wage only B Y: l� Title: '_—Date: White copy - HD 4 e; el w copy - Building Inspector; Pink copy Own , range copy - Design Professional Form CP -97 EUTNAM COUNTY DEPARTMENT 0E HEALTH DffVRSION OF ENVIRONMENTAL HEALTH SERWCES APPLICATION TO CONSTRUCT A WATER WELL. _.. _ please print or type PCHD Permit a# ~ ^ ��f ® 2.- Well Location: Street Address: o illage Tax Grid &--i Map Block Lot(s) • Well Caner: I,am�e* Addre�'� _ �o Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm ed Est. of Daily Usage 22Egal . Reason for Replace Existing Supply Test/Observation Additional Supply IlD>riffing New Supply (new dwelling) Deepen Existing Well Detailed Reason SPA sr . A- 4.0-4 Rwkolwe� for )IDrifling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes L"', No Name of subdivision'/"'—/ Lot No. _ Water Well Contractor: Address: Is Public Water Supply available to site? .................................. .............6................. Yes No 4/ Name of Public Water Supply: Ajl4L TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to b rovided on s arate sheet/plan. Date:A. -.. ...pplic ant. 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 CONSTRUC')1'ION: 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 w ter well drille certified by Putnam County. n Date of Issue V Perm ffic' Date of Expiration' Title: Permit As Non -Tra® fe> rzble White copy -1 D file; Yellow copy -Building Inspector; Pink copy - O *er; Orange copy -Well driller Form WP -97 CONSUMING ENGINEERS 0 Dani cl 1. Donahue, P. E::: - 200 Breckenridge Road Mahopac, N.Y. 10541 914 - 628-7755776 LZU4CO @F 4°MMED1 &L WE ARE SENDING YOU O Attached is Under separate Cover vita. the following Items: G Shop drawings O Prints Q Plans O Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ , ..� THESE ARE TRANSMITTED as checked below: 73 For approval J Approved as submitted C Resubmit copies for approval n For your use 0 Approved as noted ; J Submit copies for distribution — G As requested 0 Ratumed for corrections G Return_ corrected prints p For review and comment [~i a FOR BIDS DUE I9 ❑ PRINTS RETURNED AMR LOAN TO US RCW�OKC COPY - SIGNED. KERLITA AMLER, MD, MS, FAAP Commissioner of Health ,0RErr MOMNAW, RN, ISN - =y Associate Commissioner of Health January 6, 2005 DEPARTMENT OF - HEALTH 1 Geneva Road, Brewster, New York i 0509 Dan Donahue, PE 120 Breckenridge Road Mahepac, New Yor1c.10541 Dear Mr. Donahue: ROBERT J. EONDI Cou" BlecuuVe Re. Proposed SSTS Renewal — Timberline Associates Timberline Court, (T) Putnam Valley TM# 51. -1 -50.3 - This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1 Tax map is 51 not 51.1 as shown on the trench plan. The septic tmik and pump tank should be shown on the fill plan. Th, -ere is o'ne expansion area trench that is not 10 feet from the edge of the top of h11. 4. The trenches are not scaling SO feet. Also, check the expansion trench lengths and .. labels.. 5. The invert for the distribution box in the profile is incorrect. 6. The pump selection is correct, but the calculations for static and total head are incorrect. 7. 1 oroeixiain &dfibh detailVi0ald "shciw -a minin-iurti -tover feet -overtlre-faxcema'in. --- This office. will continue its review upon consideration of the above mentioned comments. Please feel free to contact meat ext. 215'9 if any questions arise. JSp:cj .Very truly yours, Joseph S. Paravati, Jr: Assistant Public Health Engineer Environmental Kcaltb (W)M-6130 Fax(845)218-Ml Ntusiu Serviae$,(845) 278-6558 WIC(845)278-6678 Fax(845)278-6085 Early lntervantlon/Prekhool (845) 2784014 Pax (845) 278.6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 6, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 .Dan Donahue, PE 120 Breckenridge Road Mahopac, New York. 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Timberline Associates Timberline Court, (T) Putnam Valley TM# 51. -1 -50.3 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. Tax map is 51 not 51.1 as shown on the trench plan. 2. The septic tank and pump tank should be shown on the fill plan. 3. There is one expansion area trench that is not 10 feet from the edge of the top. of fill. 4. The trenches are not scaling 80 feet. Also, check the expansion trench lengths and labels. The invert for the distribution box in-the profile is incorrect:. 6. The pump selection is correct, but the calculations for static and total head are incorrect. 7. Forcemain trench detail should show a minimum cover of 3.5 feet over the forcemain. This office. will continue its review upon consideration of I the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 20 V va 0 V" 10 U.S. GPM 0 10 20 30 m3 /h FLOW RATE I[QGOULDS PUMPS, INC. WATER TECHNOLOGIES GROUP SENECA FALLS, NEW YOF70C 13148 METERS FEET _ ...- -. >% 20 --/ � 4 e� as 1 OR 1 Cn-993 Goulds Pumps, Inc. w S. U.S. GPM 0 10 20 30 m3/h CAPACITY Effective July, 1993 SPECIFICATIONS ARE SUBJECT TO CHANGE WM40UT NOTICE. PRINTED IN U.S.A. 038853450 PUTNAM COUNTY DE'PARTMENT. OFHEALTH T11 S DESIGN DATA SHEET.- SUBSURFACE. SEWAGE 'T ENT SYSTEM TREA M Owner.. Ad e- A, Located at (Street) C 7 _ -- VV tf. Tax Map Block lot (Wicate nearest.cross street) i. Municipality Watershed 46�0 SOIL. PERCOLATION TEST DATA. Date of Pre-soaking Date' of Percolation test gm- NOTES: 1- Tests to Ve rOPOR00 at 3am%; urlyug Percolation test hole. (i.e. zc I Min fbr 1-30 min/inch, t 2 min for 31-60 mintinch) All data to be submitted for review. 2. Depth measurementsto-be made from top of hole. Form DD-97 N'y xR :9") �z h A - 7 Rto , 3o 2 3 0 J AW' .4 5 4 2, rr 3 2 A! 3 3 /7 .4 5 3 4 5 �•l it eA6 NOTES: 1- Tests to Ve rOPOR00 at 3am%; urlyug Percolation test hole. (i.e. zc I Min fbr 1-30 min/inch, t 2 min for 31-60 mintinch) All data to be submitted for review. 2. Depth measurementsto-be made from top of hole. Form DD-97 TEST PIT DATA 2 , ] ESC RIPTION. OF SOILS ENCOUNTERED IN -TEST AOLES �DEPTH',. p�yQ pq.�1 ANp �7pgg Y Qpi� �ryy .. b/i :. ' 8 A ®�b/ i Y • �: �_ ' 1 , 8 ®b/bJ b '1 ®. .Y pry�� HOLt 8.'. ® . O.L.- VV - 0.5' } ,; r , 15 2.5':. 3:0' 4 0'�' 5' 7 10.0' a Indicate level at which grouadwater is. encountered . . Indicate level it which.mottling is observed �e ; Indicate level. to which waterievel ryes after being encount ered Deep hole observations made by:,� .d.c AM g-f? ZI k . Design Professional l me: P OOP Al 040 N 44V AM '� 6Ei (. oe4I s � !iODQ06 ..tlV 0!'�. Q?,, o, Z w -Design Professional's Seal �'�)�� °f 4 ,o�; FEATURES 1. Impeller, 2;Caiin1g, -3. Mechanical Seal 5.'Motor 6. Bearings — Upper & Lower 11. Power cable 8. O-Ring MOMLS! a. A It b W �V Aft RFFL 9 z VOW* 2 Goulds, mmmmft-- Submersible Z --- nuent 3 fro" F �9.. jl;.. At : - v, . Z 0 4 3, J7 a is 5 " W.' so 41-4-14 Ar ��. 49 t o, &1 -7 it to, .15- i t' �40 JW ;4 :r T. t '05 60 F �9.. jl;.. At : - v, . 4 C" POP! Z Z': �1 0* A* 0.. IOU- 4 CO ry M, 141 Pu ly AS At j I L WIS 054 *for r orex pt vaad.f HP .06 "JI *L Owe IT g _2 or I:* WEV12H • 18%; L,: PRINTED A. Z 0 4 Yo. Im MR VON J7 a is 5 " W.' so 41-4-14 Ar ��. 49 t o, &1 -7 it to, .15- i t' �40 JW ;4 :r T. t 60 -4 $5 4�1 N X rz 14 IYI� IVA-- 4, 1 4 C" POP! Z Z': �1 0* A* 0.. IOU- 4 CO ry M, 141 Pu ly AS At j I L WIS 054 *for r orex pt vaad.f HP .06 "JI *L Owe IT g _2 or I:* WEV12H • 18%; L,: PRINTED A. Pin DANIELS. DONAHUE, RE. CONSULTING ENGINEERS . ,.. .r.r _; .. ... dge Br .. e , c : nn ,.. _ •.. Ro . m ad r. _.:... a.rwr..aw,,::a.. rn.,ev: a.+.4r. ^va. �.� rw:•+ :�:y - .rse. 120 ke Mahopac, N.Y. 10541 October 7, 2004. 845- 628 -7576 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Aft: Mr. Joseph Pavarotti RE: SSTS Permit & Well Permit Timberline Estates Lot #3 Timberline Ct. Putnam Valley Reference is made your letter of comment dated May 24th regarding the above captioned project. My responses are the same order as your comments. 1. The new owner and correct tax map number is shown on the plan. 2. The response is the same as above. 3. The property line is noted on both plans. 4. A new design data sheet is enclosed with the new deep hole test results. 5. All the field testing locations are now shown on the plan. 6. This matter was discussed with you. 7. This matter was discussed with you. 8. A separation distance of 45 feet is between catch basin number nine and the toe of slope. The catch basin is located above the sewage disposal system. 9. The fill pad dimensions are shown on the plan. 10. The dimensioning of the trenches has been revised to maintain a ten foot distance to the end -of trenches.. T11. This information has been provided. 12. This information has been provided. 13. This information is provided. 14. This information is provided. 15. This information is provided 16 The silt fences are all labeled. 17. An inspection of the property indicated that there is no septic system or well on the Schmidt property within 200 feet of the septic system on this lot. 18. This matter has been addressed. I hope the above answers all your concerns. Enclosed are revised plans and pump data Regards an' Donahue, P.E. Site o Sanitary o Environmental 1ei0ef2e04 1s,:0 91493'7324© �L ITMiW P" 811 4P ••:i C=EN w COLEMAN I�rtAL cols MTINQ Uc September 28; 2004 Mr. Irij; TiWduuw Timberline AssocWcs, ILC 1 -11 Wirth Bodslbrd Ro%4 Wto 102 MOUttt 1 JWG, New york 10549 bwvworw at IrawmM a sea Anima wo*Ww AleIWIII 6 + eleve"M Py/M WORW 060WA R • AUSUMN t At: . Riwiew of Eat 02 Scoc .System and sQueat wetland Ores LOMM-1-3 "• Ldw ftill � 0- !� • fta 4wwp ad uwwp As per Ivor requesk I coaducwd a site inspection on 09-26.04 to da wias why the s Mtic symcm ocwvaed for Im s2 is within the regulated wstlaW bufft as depicted vet the "nai approved wWivisigwj rasps. 5asa4 upon my bold revi«w, lhero den MA 11ppW m be nay fiwti*4 WOWrd arts prowl in the vicinity g( lot 0 2. his vary kely that wht► e cite detelntion basin'wts conitruc;" tho rernnnnt wetland area thet wu remift ft was permanently altered. I Observed no evidence o(wttlsnd characteristics to remain in tW Windy *(lot 02. Thsrasbv, the wus of wtwba the locatioe ofthe s ptk- system awst:nesad fbe lot 4 2 is within the r4ui ked wt tlW buft'er is no ioW rolsv", and should therefore, trot be an *we lwhh the Nealtly AaegaCtttrent. ukase advise whaher you require Additional Wbrmation of have my quetltiOns. kAK 5ept+m W. Coleman �etialladit Inspector . '1•awri of P ran Valley SWC /thh a •'IORM f.QtJRt. OYSNpp,j, my resit • 414414- 'l9*wAX M OCT -7 -2004 THU 17:25 TEL: X345 -278- 7 921. riAMF: PI ITNOM r n IKITV nconoTMCK17 �- d . '119 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085. Early Intervention/Preschool (845)278-6014 Fax (845) 278 - 6648 May 24, 2004 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Timberline Associates Timberline Court, (T) Putnam Valley TM# 51.4-50.3 This office has received and reviewed the most recent set of plans for the above - mentioned �:►, ., project. We would like to offer the following comments for your review and consideration. -Please- provide.a..new trench plan showing new owner -and correct -tax map'number: ` Q7 Tax map number on fill plan is incorrect. v3: Please clarify property line on both the fill plan and the trench plan for the 30 -scale site plan. Deep hole test results are greater than 10 years old. 5. Please show all field testing on 30 -scale site plan (subdivision testing, any recent �( testing including new perc tests, etc.) The wetland buffer needs to be shown. It is possible the toe -of -slope might be in the Co+ LL wetland buffer. Fill layout should run parallel along the fill pad, not irregular as shown. aasc� v1f . The toe -of -slope appears to be less than 50 feet from CB -9. , Please provide fill pad dimensions. 10. Fill should be 10 feet past the end of all trenches and 10 feet past the last trenches before 1:3 regrading. The PVC pipe between the septic tank and the pump tank and between the pump tank and the distribution box needs to be labeled. Please provide size, type, and minimum 1Z pitch. the pump detail, please provide minimum/maximum cover and bedding material. k In the section view in the pump detail, please provide overall height dimension for pump chamber. i 4 _ Please provide calculations for pump concerning. head loss, friction. loss, etc. Also provide all manufacturer cut sheets that were used, including pumpi performance curve. 5. In the distribution box detail, please show the minimum and maximum cover. Please label all silt fence. Please provide the septic and well location for the Schmidt property. Depending on wetland boundary location, SSTS may have to be staked by a licensed land surveyor prior to construction. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:cj Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY &SUBSURFACE SEWA,CE TREATMEN SYSTEMS ,. • REVIEW SHEET FOR CONS iRbli Y01�1 PER1V1iT NAME OF OWNER. j�U�► %-G' e A Svc . STREET LOCATION:'' 0 _ REVIEwED.BY: RM, GR, .40, SRDATE: TAX MAP#: (CONIM MED) Y DOCUMENTS PERMIT APPLICATION LtfY WELL PERMIT OR PWS LETTER PC-97 0 (___)'LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF < (_)PLANS -THREE SETS (-,J HOUSE PLANS - TWO SETS C RE UE �l .�rL•*fe= SUBDIVISION s4'' LEGAL SUBDIVISION ' SUBDIVISION APPROVA�' CHECKED ( )PERC RATE 30 {'''`e J-Lj) :ELL REQUIRED '`Y" DEPTX3 U CURTAIN DRAIN < -5 REQUIRED GENERAL U::5LOCATED.W NYC WATERSHED U(fPLANS SUBMITTED TO DEP C— IL- JDELEGATED TO PCHD U(_ bEP APPROVAL, EF REQ'D (•(___)DEEP TEST HOLES OBSERVED (_)L---)PERCS TO BE WITNESSED 1 - APPROVAL SSDS ADJ, LOTS (__-)U ETLAIYDS (TOWN/DEC PERMIT REQ'D ?) (;,ATA ON DDS PLANS & PERMIT SAME - C l(_ PRE 1969 NEIGHBOR NOTIFICATION Y N 1REOUIRED DETAILS ON PLANS CONT'D) (.6'(_)POUSE SEWER - YV FT. 4 "0'; TYPE PIPE. CAST IRON C--)U /NO BENDS; MAX BENDS 45' W /CLEANOUT RENEWALS L--TUSTI'E NOTE.(NO--CHA:NGE) - - --� FILL SYSTEMS ' -- HORIZONTAL; PAST TRENCH SLOPES• 3:1 TO FILL GREATER THAN 2 FEET CLAY BARRIER CzjLj. FILL"CERTIFICATION NOTE , (_ L_)DEPTH GAUGES VOL• ON PLAN FQRlLO.B.,A -WCL" D & IMPERVIOUS L-)(�1SEPARATION DYSTA NCE PROM'TOE OFI.Z3PE� a�-Q eaC TRENCH �.,.d, --'- (✓� LF TRENCH PROVIDED 90-., 6 60FT MAX.�� • 8 G � �� u,�Y`es.� (JPARALLEL TO CONTOURS L✓ - 100% EXPANSION PROVIDED DETAdL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL (:�0()GEOTEXTILE COVER- o P Y8a PCC SEPARATION DISTANCES ON PLAN - FROM CiLy 4)(01 TY, LARGE TREES, TOP OF FILL WALLS DLOD 150' TQ PATS ' Inc. a -1 ! nun�RAIN, "EI:EVATION W11200" 50'• �ERMTTENT DRAINAGE COURSE L j . SOIL TESTING LOTS >10 YEARS OLD w ` i_ � S REQUIRED DETAILS ON PLANS U�200 /500 RESERVOIR, ETC. 150 GALLEY SYSTEM (JU10' MIN TO LEDGE OUTCROP (Z . SEWAGE SYSTEM PLAN (NORTH ARROW) SEPTrCAIVK S HYDRAULIC PROFILE Y SOW U(_)10' FROM FOUNDATION; 50' TO WELL ►CONSTRUCTION NOTES 1 -15 ►DESIGN DATA: PERC & DEEP RESULTS W CONTOURS EXISTING & PROPOSED (DRIVEWAY & SLOPES, CUT ►FOOTING /GUTTER/CURTAIN DR�1S (USDA SOIL TYPE BOUNDARIES NITLE BLOCK; OWNERS NAME ADDRESS TM #, PEIRA; NAM, ADDRESS, PHONE# (DATE OF DRAWING/REVISION (DATUM REFERENCE . (LOCATION OF WATERCOURSES, PONDS LARES,WETLANDS WITHIN 200' OF P.L. IPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS IrR�PERTi� 11ETES �c EO ' — �L (EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE )MM NTS: :VSHEET)09/01/00 MUBi SIGNS TO PROPERTY LINES UUKIN IS' TO'PROPERTY ]DINE SLOPE U SLOPE IN SSTS AREA _ (S20 %) LLJREGRADED TO 15 %, LP REQUMED DOSE/PUMP SYS3:EliY5 (� P.UMP NOTES . (DOSE 75% OF PIPE VOLUIV7MOSE VOLUME NOTED ETAM FOR FORCKMAIN, (PIPE TYPE, ETC.) ffIT AND D -BOX SHOWN & DETAILED -jl DAY STORAGE ABOVE ALARM ' ( —)(—JSTA NDP ESBRTAIlV tv 2 0 S, DETAL P C JLJ15' MN t K, 20'- 4 %,15' -3 %, 35' -1 %,100 % -<1% C—)(--)201 CD DISCHARGE/100' with 182 cons day discharge 0' MIN to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: hp„ lie,,&&Jh r,% Sfrf f VC-ki- GoTS '4%,? 1 represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: LL(, Having offices at: 222-- C�+� r Whose Officers Are: President - Name': L� Address: I bro � Mew okwe �lof) �-r�a�� Vice President - Name: A' ON LOU, Address: - �Sb Secretary -Name: Address: Treasurer - Name: r' Address: V% CkAVN I A4 7 and that I am and will be individually responsible for any and all acts to the approval requested and all subsequent acts relating thereto: Sworn to before me this 13 day of (month) 2_00 (year) Notary Pic r— racey A. Bo t. LIC, State of NewYC No. 01805081711 . .Aualified in Westchester County - Commission EVIM July 079 20 6 Form CA -97 Signed: Title: Corporate Seal l ISi S with respect .u..L. �• s U tow i - 7�j/ � . /�N.}1/pp�.... .. .... -r P�n",1 : ®T T11I'�7��] / / /�I� �/�\ I'I� IRI I� \yr lYE 1l A E� ®A A li HORH . ATRON R& Property of 11 MtZU 'Akt� � uu� Located at Ov Pv'i Jg4AVW -ko fax Map # S Block [� Lot So Subdivision of 7 / 'M OR kid 6 -ro " 'O's Subdivision Lot # Filed Map # ZfAqA - Date Filed Gentlemen: This letter is to authorize DAD d e L J. j2 10 Al A *10 a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on. my behalf in connection with this matter and to supervise the construction of said wastewater 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.- Very truly your Countersigne • Signed: P.E., R.A., # � ��� (owner of Property) '°(I AJF Mailing Address Mailing Address: &Lnmpwj D ou- UZ 6PACC, s State At y Zip 20,14 ® State Zip 0�7� Telephone: ��� -� �� 7.�'7� Telephone: 6Z6 Form LA -97 April 6, 2004 DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120 BreckenridgeRoada ._ Mahopac, N.Y. 10541 845 -628 -7576 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Joseph Pavarotti RE: SSTS Permit & Well Permit Timberline Estates Lot #3 Timberline Ct. Putnam Valley Dear Mr. Pavarotti: Enclosed herewith please find: 1. Application for permit to construct an SSTS 2. Application for a permit to construct a well 3. Letter of authorization 4. Three copies of constructiori drawings Comments: Application is for a renewal and name change fee filed under separate cover. . Your prompt consideration would be greatly appreciated. Sincerely, Daniel J. Donahue, P.E. Site - Sanitary - Environmental BRUCE R. Public Health Director - 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 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: aS y SITE LOCATION: <4`� s &af 4t�' DATE: a q10 1;�-- STAFF PRESENT: c F. ob e Xd= S. G ne R1 9ha BI SPECIFIC WAVIER. REQUEST: W. 1 DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENIED �APPROVWD DENIED REASO POR DENIAL DIRE OR IF PUBLIC HEALTH (SPECWAIVER) DATE: (U V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner an'z l Address ab 3-7 Located at (Street)"/ PiftFA*Ai-vf el' Tax Map Block Lot (indicate nearest cross street) Municipality &71444 Ord" 0 4f Watershed C#A*'%oj *W-C•ft, A?A-OdA- SOIL PERCOLATION TEST DATA Date ofPre-sbaking 3////6210 Date of Percolation Test' NOTES: 1: Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I 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 De tbt Lep From Gi6ii ater v #* .No R .. *W T - - Ti" 9 me a. Start Stop ir aches .3o r�%�- l ��- a a 2 D 3 3b n /f 3 3&r lik y1v 4 -2- 3o 2 a 31 3 3 3 4 5 2 3 4 5 NOTES: 1: Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, !s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' . 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0'. 9.5' 10.0' VEST PIT DATA 2 DESC IOIV ®F SOIL$ ENCOUNTERED IN TEST HOLES HOLE NO. _�� HOLE NO. —2.- HOLE NO. 'I Indicate level at which groundwater is encountered JV o /t r=° Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep. hole observations made by:, kg�g g'® & ®j-jV!S QW _ Date Design Professional Name: D4 &,A z, Address: /.�d ,,®(����r�-v Zd 4 Signature: Design Professional's Seal 13.15.1(2187) —Text 12 PROJECT I.O. NUMBER 617.21 SEAR Appendix C _._. State Environmental Ouallty Review _ �..._....... , .. w es.,_..... _,.... SKORt"ENVIRONMENTAL ASSESSMENT TORNt_.�..,,..�,.�..,:,�.•.:,�..... For UNLISTED ACTIONS Only PART t_PRQ.IECT INFORMATION (To be ComDleted by Applicant or Prolect sponsor) 1. AP (CANT /SPONSOR 2. PSOJECTAIAME 3. PROJECT LOCATIO : �, ./ y �V IN4wi Municipality / �`40 / County 1. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) v4j ,q P,4C `/ tLle S. IS PROPOSED ACTION: ipl New ❑ Expansion ❑ ModiticationJalteration e. DESCRIBE PROJECT BRIEFLY: o C,7f 0/V 0 F 7. AMOUNT OF LAND AFFECTED: i Initially __Q1 r acres Ultimately r acres e. Ytll PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 0 No It No, describe brietly S. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential CI Industrial ❑ Commercial ❑ Agriculture ParklFOrest(Open space ❑ Other Describe: 1C, DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE R LOCAL)? t Yes ❑ No It yes, list agency(,) end permit/approvals 1t. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? [3 r1 Yes [ No It yes, list agency name and pem+itlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE'MOOIFICATION7 ❑ Yes fEJ No I;CERT THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE ^IFY Applicantlsponsor name: 17AN� �- J• Date: C Signature• _ , ro•. It the action is In the'Coestal Area;.and you are a state agency, ipomplete'tho,",\. Coastal Assessment Form bel6re proceeding with this assessment nVFR 1 DAD4 (1_gllvtans,ao�n,on, n....e�o. a..a _ .. �......�•�vr,a,ryb vw.mcaarvrcr�r try Qe c;umplevea Dy Fgency) - - -A -DOES- A- eftaN'Exc£EO ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 817;727 t! yes, coordinate the review process and use the FULL EAF. ❑ Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED l►CTIONS iN 6 NYCRR, PART 817.6? It No, o negative declaration may be �upersedr�eed by another involved agency. 13 YS: Nb C. COULD,ACTION. RESULT IN ANY A,OVERSE'EFFECTS ASSOCIATED,WITH.THE FOLLOWING: (Answers may be handwritten. If legible) Cl. Existing' et'r quality, surface or groundwater quality or quanlfly, noise levels, existing traffic patterns, solid waste production or disposal," potential for erosion, drainage or flooding problems? Explain briefiy: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cutlurai resources; or community or neighborhood charact er? Explain briefly: Ne /V /17 C3. Vegetation or fauna, fish, shellfish or wlidiife species, significant habitats, or threatened or endangered species? Explain briefly: /11 a NZ— C4. A community.'s existing plans or goals as officially adopted, or a change In use or Intensity of usoof land or other natural resources? Explain briefly N .a tV Ie, �-* CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly, 0/V&F Cb. Long term, short term, cumulative, or other effects not Identified in C1C87 Explain briefly. /s/ o /V,—: C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO 6E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes No If Yes, explain briefly PART Ill— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or.ruraq;.(b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. if necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have identified one or more potentially large or elgnificant adverse impacts which MAY occur. Then proceed directly to the FULL E4F and/or prepare a positive declaration. �Check,,this box . if you have determined, based on the information and analysis above and any supporting documentatibn; that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on aftachfnents as necessary, the reasons supporting,thii.,determination: PIP UJI f V k. Print or Y esp si a ic er in lea Agency Title o esponsr a cer �- Qn cure o Responsi icer Signature of reparer resent turn responsible officer) Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # CONSTRITCTI01 SEWAGE TREATMENT SYSTEM Located at 1 /- yJPK&IA&P G'% T/nISAW" Subdivision name Subd. Lot # Date Subdivision Approved n1opb A11194 Owner /Applicant Name J. a/ZZ4 o r Village _111jfj14Lf7! Tax Map_ Block —L Lot Renewal Revision Date of Previous Approval Mailing Address .141 144/Irt /44 if llpe* a /PQ 4/10 ow ol" Zip Amount of Fee Enclosed C?d o rsrrt4 41A)her�. Building Type Lot Area S /�No. of Bedrooms Design Flow GPD� Fill Section Only `'' Depth J —IV L " Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /o1110d gallon septic tank and Other Requirements: L d, 4 F 40--V�i 0) /5-D e) AV To be constructed by T"�l� Address Water Supply: Public Supply From Address pp Y Y�� -- Address oar: _; :Frigate. -Sii 1 ..Drilled�b . 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. Address PrAale"� AMY* e/ R.A. Date �'*, e. 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 p Approved for discharge of domestic sanitary sewage only. By: Title CAC AC Date: 6 White c py - ile; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT OF HEALTH DIVIKON OIL ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER, WELL please print or type ..._..,�. _._ _ -.. -. ,... ,._ ,., . • "PC�IID"PerIiilt'�# .v :rj W "`'"r�"�.�.:.�,, Well Location: Street Address: o illage Tax Grid # 0 ,� Map Vllp' Block / Lot(s) O Well Owner: Ram e: d ° Address: Use of Well: &Residential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought °'- gpm 6rved Est. of Daily Usage 919'gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling V New Supply (new dwelling) Deepen Existing Well Detailed Reason '0'-&V Aelrp , d&-F 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 subdivisions OWE' Lot No. Water Well Contractor: �'/ f Address: ° Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /d Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be pjqvided on separate sheet/plan. Date: 0.. p`�,Applicant,Sigpature: 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 L Permit Issuin fficial: Date of Expiration 9111 6t Title: Permit is Non- Transferra Ile White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements-of P.art.75 and Appendlx75- A,10NYCRR Treatment Systems Name of Applicant Address Site'Location _- - &. eat . No. Street No. Street 46 ! v im" i%! .It 3 i ? (/_ 1. Reason why site does not meet t ONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. xcessive slope. 1 High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ..................................................................................... ............................... _S z`7 State ZP 2. Proposed design or conditions of waiver: ............. ........... .... .`.:- .............'...... — .................... ............................... .... y........, i .......... ............................... ......... ............k..�............... r.......... ..... .................................. .� 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. increased risk of surface water contamination.. 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 is /g/ official fora change in conditions for which this waiver was granted. i n J A AEPRE$�fGTXTI�IE`'0 C061MISSiONEFi'OF FIEAITH �� " ""������� "���� " " "� " "' ORIGINAL - Local Health Agency J COPY - Applicant/Design Professional DATE...... ....!' ..................................... ............................... . .. -1 me &t 4cn% 01N. Rm. LrV ft ej,j fee I it F1001, 8111"s 922120 "t 2 15611126 2"d fuor WED. I 804 BAT► HALL Om To 69uw FAA RK J WHO% D GROI STU Fu AM COUNTY DEPARTMENT j HEALTH L OR B ROOM COUNT ONLY, BEDROOMS 3 ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE .HOUSE LANE MUST BE SUBMITTED TO THE P'CDOH FOR APPROVAL �_ SIGN Up'. & -4m 901m pigp4pi LYON NOWAS INC. Old Trall Road. Selinsgrove Pa. 17870 Telephone (717) 743-0111 LLL AV CoNgUITING, "ENGINE , ERS 0 Daniel J. Dcnahue. P.E. LV BreckraKdp Road Mahorac. N.Y. 105411 414-6218-7576 TO METTIM OF MU CAt 0 t 00, WE ARE SENDING YOU ["" Attached [3 Under separate cover via --the following Items: Shop drawings (j Copy of letter 0 Prints . C Plans - "Ej Samples 0 specifications 0 Change order - - 113-- copi No. _T THESE OCTRANSMITTED as- -checked b&Iow:. approval 0 Approved as subm'itted -coples for approval 0 For your use Approved as noted ubm copies for distribution L correctsd prints As requested --Lj Returned for corrections m 0 For review and comment [I, FOR BIDS DUE 19 C) PRINTS RETURNED AFTER LOAN TO US REMARKS- 1%A TO_ SIGNED: .. --# -- noted, kiRdlY ""Ity Us J A. BRUCE ' R. " FOLEY Public Health Director DEPARTMENT OF BEALTH 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 June 3, 2002 . Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Dear Mr. Donahue: Proposed SSTS - Gizzi, Timberline Court (T) Putnam Valley, TM# 34 -1 -3 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 depth gauges for the fill pad with appropriate depth gauge detail on plans. 2. Show a minimum 50 foot separation between the toe of the slopes and the existing catch basin. 3. Provide the force main detail. A.::...:':Plans..incor.redtly show a siphon tank—when a pump pins needed =Also; provide the volume of the tank on the plans. 5. Putnam County Health Department codes do not allow the construction of a SSTS on slopes greater then 15 %. You may request a waiver for this code requirement. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, 416--1 &_ Shawn Rogan Public Health Technician SR:cj PUTNAM' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMEN.T..SYSTEMS -• - ° :;.,. - - REVIEW SHEET FbR•CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, (!'pkTE: 3� a TAX MAP #: (CONFIRMED) Y N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) C�3PERMIT APPLICATION � HOUSE SEWER - I/," FT. 4 "0'; TYPE PIPE CAST IRON V)CJWELL PERMIT OR PWS LETTER (NO BENDS; MAX BENDS 45' W /CLEANOUT (DC_--)PC -97 RENEWALS �,6(�LETTER OF AUTHORIZATION C�C�SffE NOT\O CHANGE) C,, UDESIGN DATA SHEET (DDS) FILL SYSTEMS CSC CORPORATE RESOLUTION kf!!n X10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (QC_JSHORT EAF /r : FILL SPECS/ FILL NOTES 1 -5 C�(�PLANS -THREE SETS (FILL PROFILE & DIMENSIONS (__)(__)HOUSE PLANS - TWO SETS (FILL IN EXPANSION AREA C_)( )VARIANCE REQUEST FILL GREATER TH4N2 FEET SUBDMSION CLAY C )LEGAL SUBDIVISION F�_CERR TION NOTE (r)(�SUBDIVLSION APPROVAL CHECKED (�U:DEBTH= GAUGE (_/��PERC RATE w (,�,VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS C�(JFILL REQUIRED --Z -S't DEPT QQ� r f ,C�SEPARATION DISTANCE FROM TOE OF SLOPE CSC OCURTAIN DRAIN REQUIRED) t`lp ��`� TRENCH GENERAL � )LF TRENCH PROVIDED 60FT MAX. C�C�LOCATED IN NYC JPARALLEL TO CONTOURS C)(�PLANS S ED TO DEP (� )100% EXPANSION PROVIDED (� ATED TO PCHD C!DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL DEP APPROVAL, IF REQ'D(�` GEOTEXTILE COVER DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM'SSTS (.i �PERCS TO BE WITNESSED L---TCL)I0' TO P.L: )RIVEWAY, LARGE TREES, TOP OF FILL (,!:n�EX- APPROVAL SSDS ADJ, LOTS (.=4t��20' TO FOUNDATION WALLS C___)C,�J,WETLANDS (TOWNIDEC PERMIT REQ'D ?) 0,100' TO WELL, 200' IN DLOD,150' TO PITS (,��DATA ON DDS PLANS & PERMIT SAME (=�100' TO STREAM, WATERCOURSE, LAKE (Inc. expan). ( ( PRE 1969 NEIGHBOR NOTIFICATION C r 50!7TQ,CATCHBASIN-Zi5' STORMDRAIN, PIPED WATER C�(�ETTER BI/ZBA . 1�� TO WAT.EIt- L`�INE.(pits �•20')- -.._:: ...._..�........::__..._.....:. ....._._: •- -' --•- - { 100- YR-+LO6D ELEVATION-W1I-200' "-- "` (_�(_J50' INTERMITTENT DRAINAGE COURSE C--)C_::::JSOIL TESTING LOTS >10 YEARS OLD E:nU200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (=:J(_)10' MIN TO LEDGE OUTCROP (,C�SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK (_,:fj(__)SSDS HYDRAULIC PROFILE Cif (-)10' FROM FOUNDATION; 50' TO WELL (,GRAVITY FLOW WELL C,/�JC_)CONSTRUCTION NOTES 1 -15 (y/� DIMENSIONS TO PROPERTY LINES (z=:::)T�DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION (-,�U2' CONTOURS EXISTING & PROPOSED MIN 15' TO PROPERTY LINE (�( )DRIVEWAY & SLOPES, CUT SLOPE ((_)FOOTING /GUTTER/CURTAIN DRAINS ((SLOPE IN SSTS AREA 1- o�`(S20 %) �- (----lvUSDA SOIL TYPE BOUNDARIES (' 1 REGRADED TO 15 %, IF REQUIRED (,/ C�TITLE BLOCK; OWNERS NAME ADDRESS �`� DOSE/PUMP SYSTEMS ✓.� TM#, PE/RA; NAME, ADDRESS, PHONE# (%�C_) PUMP NOTES DATE OF DRAWING/REVISION U (./')DATUM REFERENCE (_)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS U DE� TAIIrEUR FYORCE'1VIAI1Ys_(P�I TYPES ;ETC) LAKES,WETLANDS WITHIN 200' OF P.L. Cam- --)PIT AND D -BOX SHOWN & DETAILED C—)PROPOSED FINISH FLOOR AND ( )1 DAY STORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN DRAIN C,:�CJWELLS & SSDS'S W/IN 200' OF SSTS (--JC__.)STANDPIP , 5' B S ES, DETAIL („�C — OPER- TY -IMT -E &S BOUND C--)( --) 15' 4 N to S- %, 20' 4 %, 15'-3%,351-1%, 100 % - <1% C�vEROSION CONTROL FOR HOUSE, WELL & C- -)U20' MIN to C GE /100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE UC )10' MIN to ON- PERFORATED PIPE COMMENTS: (REVSHEET)09 /01/00 a. DANIEL, Jo DONAHUIE, F.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 May 28, 2002 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Shawn Rogan RE: SSTS Permit & Well Permit Property of Gizzi Timberline Estates R.S. Lot #3 Putnam Valley Dear Mr. Rogan: Enclosed herewith please find the following: 1. Form PC -1 2. S STS, application 3. Well permit application 4. Design data sheet 5. Letter of authorization 6. Fee in the amount of $300.00 7. Short EAF Thzee .copies of fill construction plans.and.twocopies:of the_trench.p an_ 9. Two sets of house plans By: Daniel J. Donahue, P.E. Site o Sanitary o Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at (D_c_<Pt U) d\M A L t-S c (2v ��K max Map # Block Lot Subdivision of <7_!ftW ,44"A $ Subdivision Lot #, Filed Map # Date Filed / 3 Gentlemen: This letter is to authorize Z)4 vsoL J. Z)046 l a duly licensed Professional Engineer &,-,* or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity. with. the, provisions of:Article 145 and/or 147. of the Education Law - the.Public Health °Law; arid'the Pu'triam bounty unitary Code. `~ Countersigned P.E., R.A., # Mailing Address/ Very truly yours, Signed (Owner of operty) Mailing Address: Z.o S�W vv1 jkl 91 V-u U State Zip - 4Q N / _ Telephone: f4 4, 'State Zip Telephone: r[Q) 3 G OQ Form LA -97 PUTNAM COUNTY .,DEPAKfMEN'I'. Uk'.ki.LALI*H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR .,:-,--.,---A,.WASTEW-ATEkTRFAT-MENT SUN[ 1. Name and address of applicant: dazl 2. Name of project: Sp 3 y,&,e rxvIt- r 1,�r- r Locatic& 4. Design Professional:A&t /EL. J. Dom.4,iorg 5. Address: IP.b 6. Drainage Basin: �_A &,,r P.4e_.:A-, 7. Inc of -Pr_oiW: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (S.EQR)? Ty .pe Status (check one) ....................................... I .............. Type I Exempt Type II Unlisted Y 9. Is a. Draft Environmental Impact Statement (DEIS) required? ................ I ......... R14- 10. Has. 150 S been completed and found acceptable by Lead Agency? ............... 11. Name of LeacfAgency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....... I .................................................................................. 13. If so, have plans been s bmite such ii th6rties?..-.'.-.-..*.--..-.�.--.- .......... .... 14. 'Has preliminary approval been granted by such authorities? Date gdmted: 15. Type of Sewage Treatment System Discharge .................. surface water k_groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................................................... 18. Is project located near a public water supply system? ...................................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection,or treatment. system? ................. NO 21. Name of sewage system Distance to sewage system JV Z407 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day), ................................................. ................ 061 V 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... /1 /1! Form PC-97 K) 27. Is any portion of this project located within a designated Town or State wetland? A/e 28. Wetlands ID Number.................................................. ... "Is'i�Vetlands Permit required? .............. .................................................................. — .. _..�.; A/0 Has application been made to Town or Local'DEC 6"' ffce? ............................... 30. Does project require a DEC Streaii" I it urb ance ermit .............. ............I...... 1(rJ 31. Is or was project site used for agricultural activiy "involving application of 'pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes 32. Is project located within 1,000 feet of existing or—abandoned—landfill,,'.:. hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Ye DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .. .. ............... ............................... A 0 35. Are any sewage treatment areas in excess ,of 15% slope? . ............................... '. 3 36. Tax Map ID Number .......................... ............................... Map 8 Block 0 Lot 3 37. Approved plans are to be returned to ..... — Applicant Design Professional NOTE: All applications for review and approval of a new SETS to be located within the NYC Watershed shall be sent.to the Department and need not-be sent in duplicate to the DEP,;altho_vgh the.p pjeot;may approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is tare to the best of my knowledge and belief. False. statements arcade herein are punishable as a Class A misdemeanor pursuant to Section 210. 43 of the Penal Law. SIGNA.TURES & ®FFICUL TITLES: 414, e Ho '6 R_ ��1 �9 •� fi �: �i Mailing Address :..... ..............................� 4 t N s\ \ \ Y 0 CO I f u . : c o Owu 0 3 v\ `6�q Ol 5 'O QiA� p s2g. — _ N .� 2�8 S "lrJi �tia iVOrae'2i:E (1 ` p i X536 TO M cn OZ Z— CO ' � am CD CIO. -� ' SS[S TIE - INS (MEASURED BY TAPE) .. h M��� O (!1 SSTS TIE - IIVS.(M]EASURED BY TAPE) UNIT A n 0 41 57 DOSING TANK 62 70 DIST. BOX 80 r 1 58. 58 2 n m 3 m 64 4 73 68 5 ; 78 0 - a 78 o 90 cn 8 0 84 9 102 88 10 107 95 11 82 40 12 m 44 13 -91 C7 14 96 54 W; 101 60 16 106 66 17 111 72 18 116. 78 19 112 -84 20 0 90 O (!1 SSTS TIE - IIVS.(M]EASURED BY TAPE) UNIT A B SEPTIC TANK 41 57 DOSING TANK 62 70 DIST. BOX 80 75 1 58. 58 2 64 62 3 67 64 4 73 68 5 ; 78 72 6 :. 85 78 7 is 90 80 8 96 84 9 102 88 10 107 95 11 82 40 12 86 44 13 -91 49 14 96 54 15 ? 101 60 16 106 66 17 111 72 18 116. 78 19 112 -84 20 128 90 i LENGTH OF TRENCH E.. 82 82 82 82 82 82 82 82 82 82 �, -�I�. EXISTING SECOND FLOOR PLAN Irk Charles Ralston 19 Timberline Court Putnam Valley; New York 10579 ! Tax Map #: 51. -1 -50.3 1 I � 1 1 I 1 I i I M�ST�R MASTER BNEDR O - �j ji , , 1 , 1 1 1 1 i l Q I -- 1 r 1 1 1 1 + 1 � 1 I 1 n i , 1 1 1 � aTT' BE/1� , s4 I , I r 1 I - - - - -- -- - - - - - -, L-- --- -- - - -- -- -- __------ __: - - -__i , 1 + 1 1 1 1 , ---------------- - - - - -- ----------------=-- _ 1 1 SECOND FLOOR PLAN Mirror Image "o - ui " i. VW2b 11 aou .36w WN .. a. -f if 9 -v:j1 :I • 1 1 1 1 1 1 1 1 1 1 i 1 1 1 1 1 1 1 1 1 1 1 i EXISTING FIRST FLOOR PLAN 't Charles Ralston 19 Timberline Court Putnam Valley, New York 10579 . Tax Map #: 51. -1 -50.3 room - t1 1 I 1 1 I I Oil 7N'7— •. I 1 1 I FAMLY I I LA 1 . t '1 1 O 1 I ssyy CAR p pRpW1 I � - t -- - ---- -- ---- _ 1 1 I _ • 1 1 ' 1 FI R5T FLOOR PLAN Mirror Image of "As Biiilt" 141 . . . . . . . . . . ELL Ic IPO M P F- _T • � I _� I � I I F it R Ic • A T _T In it L It *P5. I . . ..... S-31, J.- --PLA- tie s I F. T11 I co A. 'AUT-1 E P,,'Tl, G* WELL MY RU'll, \-Y, -0. R A ... _10 r \...r r r• : r•rr � r : r•rr / , I ba..ut �,._ r., ,..tf.y� �' �+.wfW�� -- .rr••N.cr� - -....L... .•ra�r.n•..tur• 11 \ it • ul; Il II l! L,. i PUTNAM COUNTY DEPARTMENT OEALTH.; VOUSE PLANS APPROVED FOR BEDROOM COLFNT ONLY .41_ BEDROOMS���� r— �-- -- ,-- --- --- - ---- ALL SUBSEQUENT REVISION /AL ERAT10NS TO THESE HOUSE - - - - -- - - _ _ _ _ _ _ _ _ _ _ _ _} _`_ P_ PLANS MUST'BE SUBMITTED TO THE PCDOH FOR APPROVAL J ' SIGNATURE & TAE DA 3 � - - - -- n ' O I I r- 1' u W. U ED ii ;—W& WAIN MIA It r u V bE3 E3 (Dz H- r-J tai .1 - 0 �. �z Uri o £ r* Lo ri' b 0 O In v &. S II; I. I I 1 Z I I Q I lu In I � lu i lu I h ti I II t 0 lu I S r- 1' u W. U ED ii ;—W& WAIN MIA It r u V bE3 E3 (Dz H- r-J tai .1 - 0 �. �z Uri o £ r* Lo ri' b 0 O In v &. S II; I. +41 L L14 F-1 ------ --- F A J A 1,11-1 lit 6 Lr - (01 ..... .. . ... --wR-1— -J- w ----- -- -- ---- T Ttl It- sl J. D, R TJ Ell ISHI ETRqCK�--- --j --4 -T-5 Lt-C7 Vtf�FAK 1; IMA L, T-11 -PLONAf- �T, HOUSE Fo BEDROOM C L A-t A IV, I J 1 ALL SU SE&E Wb J,U 111,ne;HoOSE i J PLANS U--- NL 4-15- V1 ST OTuWAl 0 BITTED LO THE P 00" FO 'SHOWER-: ..... .. L--4 MOT -5-TALL $ AT.43 IGN RE;&TlTLF!-,':. Z 15L RS R T. To�.5 PTjr- IAX.-'.MAP SL -1� -5 D. j! --IS -CALE OF ut—To AJ cl.