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51. -1 -50.4
BOX 21
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02487
AM COUNTY'DEPARTMENT OF HEALTH
.!..DIVISI -O-N OF- ENVIRONMENTAL. HEALTR-SERVIC
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT
PCHD O STRUCTION PERMIT #
Located at G)rVillage
1
Owner /Applicant Name`—�V13 Pie g l,,y e AS� c.Tax Map Block Lot
Formerly
Subdivision Name
Subd. Lot #
Mailing Address �J ., r4 c-c Lr "c/Gc f. f-' ��✓ ���f x ��% Zip ld s2-2
Date Construction Permit Issued by PCHD
Separate Sewerage S s> tem built by 44 ilA-g-
Address ,t, 4&.^ �� -1`fy If
Consisting of ,.2 j`D Gallon Septic Tank and J;'% 1 4 / OL 4e-%h&--�r
Other Requirements: 3- y rf ryz
Water Suonly: Public Supply From.
Address
Private Supply Drilled by Address kni lk A
Has.erosion:control. beon..compldted ?. _:_._. ...._
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 of the Putnam County Department of Health.
Date: Certified by
Address
License #
P.E. Z.A.
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation, modification or change is necessary.
y: Title: Date: C/
rte copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional
Form CC -97
2
PUTNAM COUNTY (DEPARTMENT OF HEALTH[
(DIVISION( OF .ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address: pp
D C-S &-n
TO illage:
&- -'Cv��l .11t4
Tax Grid #
Ma lock Lot( )
Well Owner:
=E�5
Name: Address:
Use of Well:
fl- priiana
2- secoIIndM
Resi ntial Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion Compressed air percussion Other (specify)
Well Type
Screened Open end casing Open hole in bedrock Other
Casing Details
Total length ft.
Length below grade ® ft.
Diameter in.
Weight per foot lb /ft.
Materials: Steel _ Plastic _ Other
Joints: _ Welded X Threaded _ Other
Seal: Cement grout _ Bentonite Other
Drive shoe: Yes No
Liner: Yes No
Screen Details
Diameter (in)
Slot Size
Length(ft) Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
WeH Yield Test
_ Bailed _ Pumped A Compressed Air Hours
Yield gpm
Depth Date
Measure from land su ice- static (specify ft)
During yield test(ft) Depth of completed well in feet
6_4SL
Well Log
If more detailed
information
descriptions or.
le ve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
(Formation
Description
ft.
ft.
Land Surfaced
®
w ITt
If yield was tested .
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type S kkb Capacity _S
Depth CA40 Model .5-GS 10
Voltage cW HP 1
Tank TypeUkil IW- Volume
Date vrell Comp ete
3 ate' ®S
Putnam County Certification No.
� ®.� • . �
Date of Re iWeirDriller (signature
`7: � �„��
rvurk;: hxact location of wen with distances to at Least two permanent tanamartcs to oe proviaea on a separate sneeupian.
Well Driller's ®0� t- d �- ®�.� Address:
Signature: Date: d9�
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller
Form WC -97
l
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: JV-)J0eL6tA-k, OWt-ec��o,C
TAX MAP NUMBER: — / —'50-4
E911 ADDRESS.
� jnJOA &�
TOWN:
AUTHORIZED TOWN OFFICIAL:
DATE:
(- d . E.c., c� *
(Signature)
ICX
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 Certificatc of Construction
Compliance.
(E911 verfrm)
CONSUL ENGINEERS
CC3 Uanici 1, Donahu e . P.E.
_._. 2rjo.BrwVenridge Road
914-629-7576
TO
W.E ARE SENDING YOU
-/: ° separate cover via
r Attached er sep
❑ Shop drawings. ❑ Prints
p Plans
the folloviing items:
C]
Samples ❑ Specificatiorns
THESE- -ARE- TR-AN6MVT -TED- 83- checke±t_ ow _.... _ ....__. -- -..... _ -- _ -._.. _,.._ _ . ...._. ......
C3 Approved as submitted ❑ Resubmit _�.¢copiis for �pprova'sl
r ' approval • ..:
use
❑' Approved as noted ❑ Submit copies for distribution
[3 For yo
❑ As requested ❑ Returned for corrections ❑ e ts
rn oaeTected .prin
For review and comment L -_—
❑ FOR BIDS DUE 19 L-1 PRINTS RETURNED.''AFTER I-GAN. TO US�
REMARKS
COPY TO - — --
SIGNED:
if oneiosuros oro not as notod, kindly notity us -at *"Co.
MAY -31 -2012 03 :44 FROM:PUTNPPI COUNTY DEPART 845 -276 -7921
BRUCE R FoiieY Q, ._
Public Health Director
May 29, 2002
T'0:9E287576 P:1!1
LORMA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient ServWx
DEPARTMEINTT OF HEALTH
1 Geneva Road
Brewster, Now York 10509
Eavl ronetental Health (845) 278 - 6130 Fex (841) 278.7921
Nursing Services (845) 278 - 6558 WIC (845) 278.66 ?8 Fax (845) 278 - 6085
B4riy Intervention (845) 278.6014 Fax (845) 278.6648
Premhml (843) 228 - 5912 F'ax (845) 222 - 6113
Dan Donahue, PF
120 Breckenridge Road
Mahopac, New York 10541
Re: proposed SSTS - Gizzi, Timberline Court
(T) Putnam, Valley, TM# 34 -1-4, Lot # 4
Dear Mr. Donahue:
Review of plans and other supporting docuructits submitted at this time relative to the above
regarded project has beets completed. CommPats are offered as follows:
1. Basic note # 16, and fill note # 3 are incomplete.
2. Show the expansion area trenches with their lengths.
3. Putnam County Health, Departmm. t codes do not allow the construction of a SSTS on
slopes greater than 15 %. A waiver may be requested from this requirement.
4. Side slopes arc shown steeper than 1:3. If it is your intention to use 1 :2 horizontal slopes
than you should request a waiver for this and revise your rill section detail to reflect this.
Upon.re-ceipt of a.submimion rev sed•to- retkct -the above- cormnents'- this applicatidii *i.11'be'.
considered further.
Sincercly,
Shawn Rogan
Public Health. Tecbniciau
SR:cj
PI.TTNAM COUNTY DEPARTMENT OE..HEAETTT
DIVISION OF ENVIRONMENTAL HEA LT SERVICES
......w•o.ry -.. .;.. -.�., z .. ..._..- -_._. .� _.. - .. .vm > ., w .. --.. ,. •. s [� v �... ..... n Fran......,. .c
.. . •r..�Y.... , .tY- .�... -.m .[ -: . �..- rc - a ;..rJ . F .�C>4... -...�v .... ........ . _.. v . >:.r« t n:Y.� Y.. :! u:V
RE: Property of
Located at
LETTER OF AUTHORIZATION
74
Tax Map # Block Lot 4-
Subdivision of
Subdivision Lot # Filed Map # Date Filed
Gentlemen:
This letter is to authorize &wee
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 nromolgated by the Public Health Director.-of the Putnam
County Health Department, and to sign all necessary papers on my behalf m connection:with this
matter and to supervise the construction of said wastewater .tretment and%or. waver supply, systemsin
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
--`----Law -add, the " Putnam -County -S —d tart' Code.
Very
cr
Countersigned: Signc
# --
MailingAddress f
State Zip State Zip
Telephone: '4 sW� Telephone:
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE - TREATMENT SYSTEMS
°:REVIEW'SHEET FOR CONSTRUCTION'PERNIff
� . _.> ,... _._..._ .... _.
NAME OF OWNER: y STREET LOCATION:!�/���
ATE: S 9 �%� TAX MAP #: (CONFIRMED)
REVIEWED BY: RM, GR, AS,� ,
Y N DOCUMENTS
S.e!J(�PERMIT APPLICATION
iAC__)WELL PERMIT OR PWS LETTER
(,ojl(_JPC -97
(,e!n(__)LETTER OF AUTHORIZATION
(,Gj(_)DESIGN DATA SHEET (DDS)
C_J(/�CORPORATE RESOLUTION
((_)SHORT EAF
(�L_)PLANS -THREE SETS
(.L)UHOUSE PLANS - TWO SETS
(_JUVARIANCE REQUEST
SUBDIVISION
(_�(�LEGAL SUBDIVISION
Y(__)SUBDIVISION APPROVAL CHECKED
U(�PERC RATE �_ ",
(_)(FILL REQUIRED DEPTH
-)(---)CURTAIN DRAIN REQUIRED
GENERAL
C_)( )LOCATED IN NYC W ERSHED
UUPLANS S D TO DEP
UUD TED TO PCHD
DEP APPROVAL, IF REQ'D
DEEP TEST HOLES OBSERVED
UPERCS TO BE WITNESSED
(,-)C" )EX- APPROVAL SSDS ADJ, LOTS
C_JC -_- LAND /DEC PERMIT REQ'D ?)
i_ L _ .. .�- ....,_. _...,__
�jUD TA -ON S; &_� RMITM MEN
(_)(PRE 1969 NEIGHBOR NOTIFICATION
U(z:::ftETTER BI/ZBA
'✓�U100 YR.- LGDD- ELEVATION W/I 200' __....�
(___)(_SOIL TESTING LOTS >10 YEARS OLD
REQUIRED DETAILS ON PLANS
SEWAGE SYSTEM PLAN - (NORTH ARROW)
)SEWAGE
HYDRAULIC PROFILE
GRAVITY FLOW
CONSTRUCTION NOTES 1 -15
UUDESIGN DATA PERC &,DEEP,RESULTS
Uet-)2' CONMA&EXISTING & PROPOSED
(Q(___)DRIVEWAY & SLOPES, CUT
(=::!5UFOOTING /GUTTER/CURTAIN DRAINS
C_AC__)USDA SOIL TYPE BOUNDARIES
t1}(__)TITLE BLOCK; OWNERS NAME ADDRESS
TM #, PE/RA; NAME, ADDRESS, PHONE#
(QUDATE OF DRAWING/REVISION
(ZUDATUM REFERENCE
(,,,oJ,(__)LOCATION OF WATERCOURSES, PONDS
LAKES,WETLANDS WITHIN 200' OF P.L.
(,,OJ" (PROPOSED FINISH FLOOR AND
BASEMENT ELEVATIONS
(f�(—JWELLS & SSDS'S W/IN 200' OF SSTS
( �)L—)PROPERTY METES & BOUNDS
(,,e(__)EROSION CONTROL FOR HOUSE, WELL &
SSTS, EROSION CONTROL NOTE
COMMENTS: i^ 1 C
(REVSHEET)09 /01/00
Y . N . (REQUIRED DETAILS ON PLANS CONT'D)
(�HOUSE SEWER - %4" FT. 4 "0'; TYPE PIPE CAST IRON
NO BENDS; MAX BENDS 45' W /CLEANOUT
RENEWALS
40S ITE NOTE (NO CHANGE)
FILL SYSTEMS
U(_J10' HORIZONTAL; PAST TRENCH SLOPE". - TO "G�AD�
�( JFILL SPECS/ F�L NO' bT 55
JUFILL PROFILE & DIMENSIONS
(_)FILL IN EXPANSION AREA
FILL GREATER THAN 2 FEET
(Z(_) CLAY BARRIER
(f)C_JFILL CERTIFICATION NOTE
C_,6C__)DEPTH GAUGES
(�UVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS
(_JSEPARATION DISTANCE FROM TOE OF SLOPE
TRENCH
(�LF TRENCH PROVIDED 60FT MAX.
C-n(_JPARALLEL TO CONTOURS
C_ _) L J100 - °'o ~E N- PROVIDED
(.tt )DETAEUDUST FREE CRUSHED STONE OR WASHED GRAVEL
C:nUGEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FAOM SSTS
2H10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
20' TO FOUNDATION WALLS
0)100' TO WELL, 200' IN DLOD,150' TO PITS
(� 100' TO STREAM, WATERCOURSE, LAKE (inc. expan).
C_J50'TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
x,50' INTERMITTENT DRAINAGE COURSE
(,,,)t,200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS
(¢)(J10' MIN TO LEDGE OUTCROP
SEPTIC TANK
C-1)(! )10' FROM FOUNDATION; 50' TO WELL
WELL
DIMMNSIONS TO PROPERTY LINES
LOCATION OF SERVICE CONNECTION
(, ,41!:� )MIN 15' TO PROPERTY LINE
SLOPE
UUSLO SSTS AREA,'e (S20 %)
jf GRAD D 15 %, IF REQUIRED
D E/P EM
OS UMP SYST S
UUPUMP N
T
_)DOSE 75
O PIPE VOLUME/DOSE VOLUME NOTED
(�UDETAIL
FORCE MAIN, (PIPE TYPE, ETC.)
UUPIT A
D -BOX SHOWN & DETAILED
(�(�1 DAY TORAGE
ABOVE ALARM
CURTAIN DRAIN
UUSTA
ES, 5' BOTH SIDES, DETAIL
x)(_)15' to CDS =>5 %, 20'- 4 %,15' -3 %, 35' -1 %,100 % - <1%
U(�20' to
CD DISCHARGE /100' with 182 cons day discharge
C-_)(_)10' MIN to NON - PERFORATED PIPE
A k # a
Fill 11A � �k
DANIEL J. ONC91lL E, P.E.
CONSULTING G ENGIN EIERS
120 Breckenridge Road
Mahopac, N.Y 10541
845 -628 -7576
May 10, 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 #4
Putnam Valley
Dear Mr. Rogan: 4
Enclosed herewith, please find the following:
1. Form PC -1
2. ' SSTS application
3. Well permit application
4. Design data sheet
5. Letter of authorization
6. Fee in the amount of $300.00
7. Short EAF
8. Three�copies of construction- plans
9. Two sets of house plans
By:
Daniel J. Donahue, P.E.
Site o Sanitary ° Environmental
PiTTNAM COUNTY DEPARTMENT OF HEALTH[
DIVISION OF ENVIRONMENTAL ALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
.. ...�::,.....n........,v , . n , _ ..k..�
;7 t �A`STgWA'I'E'R TRFATME11 T— SYSi`EM"
1. Name and address of applicant: L-7 —t
2. Name of project: Mydlet }`Avlt., Y d F r 3. Locatigov: og/& W710 gy1e. 9'
4. Design Professional: &6L/1
6. Drainage Basin:
7. lyre o f Wiect:
� X Private/Residential
Apartments
�Office Building
DoM ,44ur-- 5. Address: /a1 o SEE .y R /.O ae o
Food Service Commercial
_ Institutional Mobile Home Park
Realty Subdivision Other (specify)
8.. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ..................... ............................... Type I Exempt
Type I1 Unlisted
9. Is a Draft Environmental Impact Statement (DEIS)'required? ......................... N14-
10. Has DEIS been completed and found acceptable by Lead Agency? ................ All et —�
11. Name of Lead Agency
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? .. ............... .........: ............................... -j"
13. If so, have plans been submitted to such authorities? ..... :................................. No
14. Has preliminary approval been granted by such authorities? Date grhnted:
15. Type of Sewage Treatment System Discharge ................. surface water ygroundwater
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? ................
21. Name of sewage system_ Distance to sewage system
22. Date test holes observed 23. Name of Health Inspector Af• A41 yam,
24. Project design flow (gallons per day) ....................... ............................... . .....
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... �Alo -=
26. Has SPDES
Application been submitted to local DEC office? ......................... ze
F01SX-P
2
27. Is any portion of this project located within a designated Town or State wetland ?__ Aa
V.
28. Wetlands ID Number ................................... ............................... I .......................
— -�� -
29. Is Wetlands Permit required? .............................................. ............................... .�
Has application been made to Town or Local DEC office?
30. Does project require a DEC Stream Disturbance Permit? .. ............................... .�
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal, ;
landfilling, sludge application or industrial activity? ............................ YeSAV
32. Is project located within 1,000 feet of existing or abandoned landfill, ca':.��•.
hazardous waste site, salt stockpile, landfill, sludge disposal site or any V
other potentially known source of contamination? ............................... Yes(
DESCRIBE::
33. Is there a local master plan on file with the Town or Village? ..........................t'
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ............................... A V
35. Are any sewage treatment areas:in excess °of 15% slope? . ............................... �
36. Tax Map ID Number Map Block Lot
.
37. Approved plans are to be returned to ..... Applicant - Design Professional
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the. Department. Projects within the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater lans 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 1.,the application must
be accompanied by a Letter- of Authorization_ (Form ),A -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby afran, under penalty of per,pury, that information provided on this forays is trine
to the best of easy knowledge and belief' False statements made herein.,are punishable as,,
a Class A misdemeanor pursuant to Secti ®n 210.45 of the,Fenal Law.
SIGNATURES & OFFICIAL TITLES Z)Aus "V4ofaF
. ,. A
DANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
,....•., : m ..:.., ..:.., w . ; ... _:, . �, ........ <120`B eckcruidge7 Road � ....
Mahopac, N.Y. 10541
845- 628 -7576
September 19, 2005
Putnam County Department of Health
Geneva Road
Brewster N.Y. 10509
Att: Mr. Joseph Pavarotti
RE: As Built Plans
Timberline Estates Lot #4
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.
2l, rel J. Donahue, P.E.
Site • Sanitary • Environmental
Y11-1L ENVIRUNMENTAL SE:RVlCES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2B0O
... F-
T
F`���l����z--�I�i�����
LAB #: 3.500448 CLIENT #: 114 NON STAT PROC PAGE: 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TORLlSH & SONS
BOX 271, 45 MAPLE AVE.
ATTENTION: DWAYNE TORLlSH
ARMONK, NY 10504
.
SAMPLING SITE: TIMBER LINE ESTATES
: LOT #4, PUTNAM VALLEY
COL'D BY: D.TORLISH
NOTES...: TANK
DATE FLAG PROCEDURE
DATE/T}ME TAKEN: 06/20/05 03:30
DATE/TIME REC'D: 06121/05 1l:50
REPORT DATE: 06/29/05
PHONE: (914)-273-3448
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..:
COLIFORM METH: N/A
~~~~~~~~~~~~~~~~~~~~~~~~
RESULT NORMAL - RANGE
PUTNAM CNTY PROFILE
06/21/05 MF T. COLIFORM ABSENT 1100 ML ABSENT
06/27/05 LEAD (IMS) 1.1 ppb 0-15 ppb
06/24/05 NITRATE NlTROG <0.2 MG/L O - 10
06/22/05 NITRITE N[TROG <0.01 MG/L N/A
06/23/05 IRON (Fe) <0.060 MG/L 0-0.3 mg/l
06/28/05 MANGANESE (Mn) <O.OlO MG/L 0-0.3 mg/l
06/28/05 SODIUM (Na) 2.65 MG/L N/A
06/22/05 pH 7.3 UNITS 6.5-8.5
06/28/05 HARDNESS, TOTAL 100 MG/L N/A
06/27/05 ALKALINITY (AS 86.0 MG/L N/A
06/24/05 TURBIDITY (TUR <1 NTU 0-5 NTU
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORD; HE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
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.
ublic 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
METHOD
1008
9003
9052
9162
9002
90012
9002
90413
9001
�
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
_ 914) 5-280O
LAB #: 3.500448 CLIENT #: 114 NON STAT PROC PAGE: 2
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TORLlSH & SONS
BOX 271, 45 MAPLE AVE.
ATTENTION: DWAYNE TORLISH
ARMONK, NY 10504
DATE/TIME TAKEN: 06/20/05 03430
DATE/TIME REC'D: 06/21/05 Al:50
REPORT DATE: 06/29/05
PHONE: (914)-273-3448
SAMPLING SITE: TIMBER LINE ESTATES - SAMPLE TYPE..: POTABB
: LOT #4, PUTNAM VALLEY PRESERVATIVES: NONE
COL'D BY: D.TORLISH TEMPERATURE..:
NOTES..": TANK COLIFORM HEW N/A
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
is suggested.
pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY,,
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO G.S.
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 O TO HUNDREDS OF MG/L, DEPENDS ON THE
SOURCE AND TREATMENT TO WHICH THE WATER HAS BEENSUBJECTED.,
SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L
MODERATELY HARD WATER: 70-140 MG/L _ MG/L = MILLIGRAM PER LITER
-_.'-- .HARKWARK 140-300-'MG/L'—'- - (1-grain/gallon T7.2'MG1L)`------
SUBMITTED BY:
| Uzrecycr , ELAP# 10323
� .
OF E.NYIRONM.ENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TR EATMENT..SYSTEM
jin,bob,it Ou s kt(!.� l a./_
Owner or Purchaser of Building Tax Map Block Lot
jtt a,& A-Z OWOCZaUj�
Building Constructed by
ab
Location - Street
Building Type
TownNillage
Subdivision Name
'T-
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
A
General Contractor (Owner) - Signature
ko
A_)� &C4 vct�_L e>L
Corporation Name (if corporation)
Addri
State
Corporation Name (if corpo ation))
Address: /9 Alb
Statol O Zip /0o
0 Form GS -97
CONSULTING-ENGINEERS
ir-I L Donahue P. E.
200 Breckenridge Road
Mahopac, N.Y. 10541
914-628• ?576
TO
I WE ARE SENDING YOU 2 Attached ❑ Under separate cover via
the following items-
• Shop,drawings 0 Prints 0 Plans 0 Samples 0 Specifications
❑ Copy Of letter ❑ Change order 0
COPIES DATE NO. DESCRIPTION
THESE ARE TRANSMITTED as checked below:
L-1 For approval ❑ Approved as submitted
0 For your use FJ Approved as noted
C As requested 0 Returned for corrections
0 For review and comment F1
❑ FOR BIDS DUE 19
REMARKS
❑ Resubmit copies for approval
CJ Submit -copies for distribution
0 Return- corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
COPY TO -
SIGNED:
If anclosurss or* not as nat*d, kindly nolty us at once.
_ U)✓RLATA AMLER,1l D,.MS, FAAE._ __:...._.
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Dan Donahue, PE
120 Breckenridge Road
Mahopac, New York 10541
Dear Mr. Donahue:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
September 28, 2005
ROBERT J. BONDL.. __ .._....._. -._...
County Executive
Re: Construction Compliance — Timberline Assoc.
23 Timberline Court, (T) Putnam Valley
TM# 51 -1 -50.4
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.
� One well dimension is incorrect.
SSTS tie -in measurement # 4 is not provided.
'3.
According o the field inspection report, the well casing has not et been raised to 18"
g p P g Y
Q�
above grade.
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
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
v.A A JL "xx I ujb• JjLA,.LU:L
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date:
Inspected by:
Street Location Owner
TM# _s-1 -6/ Subdivision Lot #
1. Sewage Svstem Area
a. STS area located as per approved plans .................... I .......
b.. Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth
c. Natural soil not stripped ..................................................
d. Stone, brush, etc., greater than 15' from STS area....:.:...
6. 100' from water course /wetlands..............
II, Sewage System
Septic tank size -.1,000 ........... 1,250 ......... other ................
.:�.'b. 'Septic* tank installed level .................. ' ............................
c. 10' minimum from foundation ...........................................
d. Distribution Box
1. All outlets at same elevation'-water tested...
........
2. Protected below frost ..................... . . .
.3. Minimum 2 ft.0riginal soil between box & trenches
e' Junction Box properly set .........................................
6. 1'renche
1. Length required Length installed
2. Distance to watercourse measured Ft..........
- 3. Installed according to plan ............. * ...........................
4. Slope of trench* acceptable 1/16 - 1/32,,/foot .............
5. 10 ft. from property line - 20 ft.- foundations..........
6.. Depth of trench <30 inches from surfice ..................
7. Room allowed for expansion, 100% .....................
8. Size of gravel 3/4 - 1112" diameter clean ...................
9. Depth of gravel in trench 12" minimum ....................
10. Pipe ends caTped ........................................................
g. -Pumv -or Dosed -Svsterns 7
I . Size'of pump chamber ..................... . ............
2. Overflow tank ......................... : ........ j . ..................
3. Alarm, visual/audio ... ...................................
4. Pump easily accessible, manhole to grade ......
5. First box baffled .......................... ............................... .
6. I Cy c e witnessed 1. T-T y D.est r. 0 Cyc e ...........
III.: HouseBuilding
a. House
located per approved plans ...................
,.b. Number of bedrooms ........................... I .......
IV.` Well
Well located as per approved plans ......................................
b. Distance from STS area measured ft...........
c. Casing. l$" above grade ................................................
V. d. Surface drainage around well acceptable: ,....... .............
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 plant.
f. Curtain drain outfall -protected & dir.to exist watercolUeIA
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ........ : ...........................
i. Erosion control provided ................................................
Rev. 12/02
ZA,A-f
ykvY
L
01'
Form=_.
ZA,A-f
.. .. .— • +•a.e.s....,.M -.. ...- ... .. .. ..-.. .. M .._� .s....i..- itx,c.wr. ..�.. s. _ t._ _ z r t
•Ir..� 'Y�'y�Yy�•j�yy' �/'�) ¢N,� ...w .. y�/e Aq �1t1�1,' a. _ : � -. .. • _
/yyVpe'�ft�KY,✓i�CTiVY' ®LYLl1JW
Date: c,
Inspected by: is,
Fill pad located per the approved plan
Fill Pad Length �� �'�`� a Required Length
Fill Pad Width 3 Required Width
Fill Pad Depth �� J Required Depth
q
Run -of -Bank Fill Quality
Slope from Top to Toe
Impervious Layer Installed
Erosion Control Installed
Sieve Test Results (if applicable)
Additional Comments:
Reserved for Field Sketch if Applicable
u.. _..:: PUTNAM COUNTY DEPARTMENT OF HEALTH 1
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
REQUEST FOR �FINAL INSPECTION For: Fill
Date: /(/ b r Trenches Z--'
PCHD Construction Permit # _, F4) -/ -(>Z—
Located: !. K & Irk G f- am At
Owner /Applicant Name: * fr wZ64 43 s41- C 4 TM r/ Block/ Lot
Formerly: Subdivision Name:
Is system fill completed? W
Is system complete?
Is system constructed as per plans? T
Is well drilled?
Is well located as per plans?
Are erosion control measures in place?
Subdivision Lot #
Date:
Date:
Date:
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
�,- approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Health,
Date: ` ..Ce ifted.br -PE �.RA
- . ., ..... . _.. __ ._.._ - Design Professional
Address: Iro �r� A /,45'. A"(4 K20( f'r1 Lic. # rY %/
Comments:
FOR; ❑ ADAM 11 GENE ' ❑
(NAME)
Form FIR -99
SEP -1 -2895 THU 17*49 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1
I F . j COUNTY DEPAWt
CONSTRUCTION PERMIT FOR SEWA
PERMIT # � �0 - / V - 62-
Located at ` t'16.1 j9 Ae t `Aj fS G .Y
Subdivision nam 7 e r49r' Subd. Lot #--!!E- Tax Map S— Block Lot
Date Subdivision Approved f A-12 Renewal Revision
Owner /Applicant NwKe-rl--10 L1,�ag 4rre4e-Z e C- Date of Previous Approval
Mailing Address 6a `' r c 'e G'u� -c�j ��r �/� i� Zip
Amount of Fee Enclosed 04,41
mf,c Z in
Building Type /--' *t E- `i Lot Area3. I No. of Bedrooms 4- Design Flow GPD__�
Fill Section Only Depth Volume
]PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
/J- Jr6
gallon septic tank and
Other Requirements: 3 � o t---r-
To be constructed by RIP Address
Water SU ly: Public Supply From Address
or:- _ ffPrivate-Supply Driiied`by
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 ereto.
r
Signed: P.E. R.A. Date Zzmzej
Address /d - IS-ee4 =gin 174 � 4 C. 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 it. Approved for discharge o omestic sanitary sewage only.
Bye�- ���� Title: 'P�"l Date:
it opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
U =Daniel 1. Donahue. P.E.
200 sreci cnjiijg-c Road*
Mahopac. N.Y. 1054I
9 14 - KS • 7576 __._ __._ �_�� To _. _
WE ARE SENDING YOU C Attached :: Under separate cover via
C-3 Shop drawings
Qj Copy of letter
. P4xd
the following items-
0 Prints, r.- Plans 0 Samples 0 Specifications
11 Change order 10
COPIES DATE
No.
'THESE' ARE' TRANSMITTED as checked below;
approval D Approved as submitted Q Resubmit copies for. approval
CJ For your use, '] Approved as noted E; Submit ......_copies for distribution
C As requested U Returned for corrections Q Return, corrected prints
0 For review end comment 1:
2 FOR BIDS DUE-- 0 PRINTS RETURNED AFTER LOAN TO US
REMARKS----.--
COPY SIGNED:
are not *0 ftatod. rift roet"y us of anti.
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health "
LORE'T'TA MOLINARI, RN, MSN
Associate Commissioner of Health
Dan Donahue, PE
120 Breckenridge Road
Mahopac, New York 10541
Dear Mr. Donahue:
_. ROBERT 9. BONDI
- County yEsecufive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
August 23, 2005
Re: . Proposed Trench Plan
Timberline Court, (T) Putnam Valley
TM# 50. -1 -50.4
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
Plan view shows a five bedroom residence. Approval is-, for four bedrooms. Please
revise the trench plans to show a four bedroom residence.
This -office..
will continue its - review upon_ consideration of the above - mentioned comments. Please - s .. _ -._.._ _ ......_.. _. _..._._._ ...__-
feel free to. contact me at ext. 2157 if any questions arise.
JSP:cj
Sincerely,
oseph 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
ie
0
P"UTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL,,HEALTH
_FRVICES
DESIGN DATA SHEET - SUBSURFACE S6 ACS 'T�i kENT SYSTEM
05 Au��8 cyJ 2:'t1.,! 0
44 4- .4 1( S!, �01'e
Owmer 1,,v(A!! Address 2-
Located at (StreetrL'L-f'2 Tax Map,5'b' Block Lot
(indicate nearest cross street)
Municipality 4-4', Ile 7 watershed _,�1'gp
SOIL PERCOLATION TEST DATA
Date of Pre-soak-We /rte r" Date of Percolation Test
-V) e
NOTES.- 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. i I min for 1-30 minlinch, !g 2 min for 31-60 mirdinch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
vo
•
r
cw
2
3
4
2
3
30
d 17 4
4
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. i I min for 1-30 minlinch, !g 2 min for 31-60 mirdinch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
TEST PIT DATA 2
DEPTH -HOLE NO. HOLE NO. HOLE N0.
G.L.
0.51
1.01
2.01
2.51
3.00
3.51
4.01
4.5
5.0'
5.5
6.01
6.51
7.0'
7.5'
8.01
8.51
q 30
9.5
10.00
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: Date
Tnael Professional ID a WAAQ I XT 0AJ1JA—.e J&L Xf &_- � _ t L. )Y/r/�'V�
Address:/dr) Vlg,-. cc /< _,on i � L_14 �
Signature:
Desip Professional's Seal
0, SSSIO/Nv_
S. Do
00
................
A/0. 4
TF F
__ _ ..__ ,o.r�i a�a
CONSUMING ENGINEERS .: �-
• Cl:: Daniel,h_D_gnahue.: P.E.- > _ - - _.- �, . .
200 Breckenridge Road �wrc :.lG/ �o. No
Mahopac, N.Y. 10541 ff
_ 914 -628 -7576 ✓ j Y G' ke
TO
WE ARE SENDING YOU C Attached ❑ Under separate cover via -- ._,._the following items:
❑ Shop drawings O Prints ❑ Plans O Samples ❑ Specifications
Cl Copy of letter ❑ Change order ❑ —,+ _
COPIES
DATE
NO.
DESCRIPTION
elk
I
THESE ARE TRANSMITTED as checked below:
C��For approval ❑ Approved as submitted
0 For your use ❑ Approved as noted
-- C As requested O Returned for corrections
❑ For review and comment C'
O FOR SIDS DUE
REMARKS
COPY TO
n Resubmit copies for approval
❑ Submit ____ copies for distribution
O Return corrected prints
O PRINTS RETURNED AFTER LOAN TO US
SIGNS .
It .nelowris are not of noted. kindly notKy s .t onc.. _
PUTNAM COUNTY DEPAR17AtBAPI' OF HEALTH
DMSION OF ENVIRONMMAL REALTIE SERVICES
ATTENTION P'JOSEPH ® O
RE
All information must be fully completed prior to any
inspections being made. .
For ]Fill
Trenches
PCHD Consti►on Permit #
Located: iV4 ®�
Owner /,Applicwt Naer'O" ' hA"A-&-s Aditia Block �_ Lot
Formerly: Subdivision N : P
Subdivision Lot #
is system fill completed? --
Is system complete? Ewe:
Is system.conaftcted as per plans?
Is well drilled? Date: .
Is well located as per plans?
Are erosion control measures in place? _^
1 certify that the system(s), as listed, at the above prises b4 been �nstattcted and I have Inspected
and verified their completion in accordance with the issued PCHD Constnwtion Pernut and
approved plans and the Standards, Rules and RwWr iow of the Pub= County Department of
Health.
Date: j� i �' Certified by: PE RA
DeAp Professional
Address: '�' ® Lic. #
Comments:
OF
Form FIZZ -99
AUG -10 -2005 WED 14:22 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1
PUTNAM COUNTY DEPARTMENT OF HEAL
VISION OF ENVIRONMENTAL HEALTH SERVI
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # S k-' % 4 D 2—
41�%`
Located at Al 13 1,-1 Al �E G"%" own r Village _,pi?�G� l/!, /�-e5/
i-
Subdivision name I �/7! &/-//.-kASubd. Lot # !!�- Tax Map tW Block Lot Q
Date Subdivision Approved %� Renewal Revision
Owner /Applicant Nam e-72iyJ li /�t��al Date of Previous Approval Q
Mailing Address��- �s GQlI�i� G�� /� :S T /��� %G/,P�ne Zip %15,V
Amount of Fee Enclosed S -dy
Building Type �`/i Lot Area3��No. of Bedrooms Design Flow GPD.d ?!v
Fill Section OnlyZ,,,, 11'16epth.�3 - 4;K Volume /1
PCHD NOTIFICATION IS RE UIRE�D WHEN FILL IS COMPLETED
Separate Sewerage System to consist of gallon septic tank and
Other Requirements: yl' 3G- !f. d f%l or /ego? 00c/_
To be constructed by Address
Water Supply: Public Supply From
Address
or: _ Frovate Supply-Dnlled-by
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.
c
Signed: - P.E. 4-- R. A. Date
Address i3re�� -,f 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 rmit. Approve for discharge of domestic sanitary s wage only.
By: / Title: — Date: ", Alt,
White copy - HD le; I �ejllocopy - Building Inspector; Pink copy - O er; Or ge copy - Design P ofessional
Form CP -97
t - -: - - , - . ..
P it 1VAM COUNTY DEPARTMENT OF HEALTH
DIVIRON OF ENVIRONMENTAL HEALTH S ERW CES
APPLICA'II'IION TO CONS'II'IIBUCT A WATER WELL
please print or type PCHD Permit #
Well Location:
Street Address: o illage Tax Grid #
e , Map Block / Lot(s)
Well Owner:
e:
Address:
s 4.-
r � r
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
- >rflnmiry
Business Farm Test/Monitoring Other (specify)
2-secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm erved Est. of Daily Usage 2 __7"_9 •
Reason ffoir
Replace Existing Supply Test/Observation Additional Supply
D>rIlflflnng
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for IID>rilling
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 'Ff371!' Lot No.
Water Well Contractor: '%� It? 4D Address:
Is Public Water Supply available to site? .................................. ............................... Yes No !/
Name of Public Water Supply: /y /,I- Town/Village
Distance to property from nearest water main: Al r
Proposed well location & sources of contamination to be vided on separate sheet/plan.
Date:. - /Applicant.Signabire:*: 0
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. „ I
Date of Issue D Permi
Date of Expiration Title:
Permit As Non -Trans elrkb e
White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller
Form WP -97
t
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FOR am on PRINT$ RRURNia Aim" U" To us
4&MARltS
e -gl&
t�f�1KR:
SHERLIITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA M OLINARI, RN9' MSN'
Associate Commissioner of Health
February 28, 2005
Dan Donahue, PE
120 Breckenridge Road
Mahopac, New York 1b541
Dear Mr. Donahue:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDII
County Executive
Re: Proposed S &TS Revision —Timberline Associates
Timberline Court, (T) Putnam Valley
TM# 51. -1 -50.4
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.
i. Due to excessive depth of fill (8 feet in some areas) the proposed application will
have to be brought back to waiver or redesigned so less fill is proposed.
,2' Please provide a ne\y well permit and a new construction perm.it with correct tax map
number. ( *A- "/ ® .r' �—
Please show all topography for 30 -scale plot plan. D �.
Expansion area is short by one (1) foot. �-
�! Please show and clearly label all catch basins on Timberline Court. 0411-
:e The regrading. for he.f ll: pad - has
7% Please clearly show the two (2) feet of solid pipe before the trenches begin (primary
and expansion).
-8' Please remove all excess lines, dimension arrows, etc.
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.
Sincerely,
d svr�t'
b .
oseph 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 InterventioNPreschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA M6LINARI, R1V, MSN
Associate Commissioner of Health
February 28, 2005
Dan Donahue „PE
120 Breckenridge Road
Mahopac, New York 10541
Dear Mr. Donahue:
ROBERT I BONDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
i
Re: Proposed SSTS Revision —Timberline Associates
Timberline Court, (T) Putnam Valley
TM# 51. -1 -50.4
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. Due to excessive depth of -fill (8 feet in some areas) the proposed application will
have to be brought back to waiver or redesigned so less-fill is proposed.
2. Please provide a new well permit and a new construction permit with correct tax map
number.
1�kt- Please show all topography for 30 -scale plot plan.
4. Expansion area is short by. one (1) foot.
5. Please show and clearly label all catch basins on -Timberline Court_
6. The regrading for the fill pad has not been completed.
Please clearly show the two (2) feet of solid pipe before the trenches begin (primary
�nIP ply and expansion).
8. Please remove all excess lines, dimension arrows, etc.
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
Sincerely,
oseph S. Paravati, Jr.
Assistant Public Health Engineer
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
Daniel ]'. Donahue, P.E.' ' � - :, .-�- ..- � °..._�• .,,
200 Breckenridge Road
Mahopac, N.Y. 10541
__ ......___ __ .........__._ 914- 628 -7576
TO
DATE
JOQ M0.
ATTENTI N
r �/� / ,,�.
aE ! AO !/ /�/� i'
If
® WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
• Shop drawings ❑ Prints
• Copy of letter ❑ Change order
❑ Plans
❑ Samples ❑ Specifications
COPIES DATE NO. DESCRIPTION
� 1/- 4 `hG rim
G�2lr�i Z /I7c1
Q�1®
THESE ARE TRANSMITTED as checked below:
[-or approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:
iQ an619"rt® are not as noted, kandty +waft us of ones.
CONSULT! NGENGIA-Iff R9
❑ Daniell. Donahue. Pl,..-
200 Brackenridge Road
Mah"c, N.Y. 10541
914-628-'7576
r
TO -Z
LIEUTER TI VMR6519TT&I
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ew
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— WE ARE SENDING YOU Li Attached D Under separate cover via —the following Items:
C5 Shop drawings
❑ Copy of letter
C3 Prints 0 Plans 0 samples ❑ Specifications
El Change order 0
COJIIIS
DATE
NO.
01SCRIPTION
Tx
THESE
ARE TRANSMITTED as chocked berovie;
51or approval 0 Approved as submitted C. Resubmit— . copies for approval
6-11
C1 For your use 101 Approved as noted J Submit—c"las for distribution
C As requested LM Returned for corrections 0 Return —corrected prints
El For review and oomment [.i
Cl FOR BIDS DUE —19— ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY
PUTNAM COUNTY DEPARTMENT OF HEALTH
IDH`ISHON OF ENWRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREAT SYSTEM
Located at -7DPv R o RL4 &y p �/� To. Vill
Subdivision name O -F— Subd. Lot # Tax Map Block Lot
Date Subdivision Approved Renewal _� Revision
Owner /Applicant Name �Wea & tIdl e- Date of Previous Approval
Mailing AddressA 4 6t efie.-P, 0 ( f&lflcwf & p4A 0 e.,,4e 4-T N j Zip s
Amount of Fee Enclosed qi� 4d 6
d' ,f N& & OQ
Building Type 6�Od `� Lot Area,?. 6 No. of Bedrooms 41-�- Design Flow GPD(_v
Fill Section Only Depth �_ Volume E—a-
Seinarate Seweirage System to consist of
Other Requirements:
gallon septic tank and
r0 eg�_ poy' eAn 17
To be constructed by APP Address
watg SUALRY: Public Supply From
Address
®r _ g-•-Private Supply Drilled-by-__ Add (
ss
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. R.A. Date
p
Address �� a�tr �� s n J,9-Z k d 06�� a � License # ASP Q fy
APPROVED YOR 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 it. A prove or discharge of domestic sanitary se ge only.
By: Title: Date: ' 10 Z1 e -
White copy - HD Fi e; Y llo copy - Building Inspector; Pink copy - Owne Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT_A WATER WELL
_.?� .,,.. ...�,,- .r..,.�:. �..,_ ,....fir' ease prii►�o`r'type -- ._...�_ ..�_ . , _ _, ,,..a .,rio .. _. - .. T...,:. �= T"�HD "Perm`if � #: (1 :���:%�y.Q '•�.� �,
Well Location:
Street Address: o illage Tax Gri
�,�
A'�RG tP%N AM !/�j`d,io y Map Block Lot(s)
Well Owner:
Name:
„Saw? 10*
Address:
d?
a a&Q-e1a c4w4ew rr Arie= 74!-,V047"
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
621- rimary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm erved Est. of Daily Usage d�gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
crkwvle 4 4 0*/ A"I bAtwe'A
for Drilling
Well Type
rilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes Ao"'No
Name of subdivision ']" / j�p R 'L /ems /a g C 7— Lot No.
Water Well Contractor: Address:
Is Public Water Supply available to site? .................................: ............................... Yes No A---
Name of Public Water Supply: A l Of Town/Village
Distance to property from nearest water main: Allj fL
Proposed well location & sources of contamination to provide on arate sheetl/plan.
Date: !f,46 Applicant Signature:
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a w er well driller certified by Putnam
County. , f
Date of Issue Permit Is ing Offi 'al:
Date of Expiration Title:
Permit is Non- Transfei rabl _
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
,�..
-TIMBERLINE ASS0CIlA:l V%- t.L --L- C
118 North Bedford Road
Mount Kisco, NY 10505
Phone: (914) 244 -8600
Fax: (914) 844 -8606
October 22 2004
Mr. Joseph D. Paravotti
Putnam County Department of Health
1 Geneva Road
Brewster, New York 10509
RE: Lot 4 Timberline Estates, Putnam Valley, NY
Dear Mr. Paravotti
Please find attached two architectural plans for Lot 4 at Timberline Estates.
These plans are being submitted to you for a bedroom count so that we can
subsequently submit them to the Putnam Valley building department for a building
permit.
Please do not hesitate to call my office or Daniel J. Donahue, P.E. if you should
have any further questions.
Sincerely,
M
TimberlinelAssogiates. LLC
CM/cm
Cc: Daniel J. Donahue, P.E.
Enc.
-.t y 0 z
Ed .,;
NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver
Bureau of Community Sanitation and Food Protection - from Requirements of Part 75 and,Ap
pendlx.75- A,10NYCRR„
.,_ - �- .- _�.- .r•....- ��:.:a� _•:- .w >.�.,• �' �" forindiv (dualHousetioldSewage7reatmen #Systems
Name of Applicant
No. Street City/Town State ZP .
Address a'-'o/ S&V /U
No. Street ityer n State ZZP
Site location C+1
APPLICANT - D• NOT WRITE BELOW
1. Reason why site does not meet 1ONYCRR Appendix 75 -A (check appropriate box(es)):
Separation distance cannot be achieved.
Excessive slope.
`] High groundwater.
Inadequate depth to bedrock or impermeable layer.
Soil unsuitable.
Other(explain) . ............................... .......... ............................................. ...............................
2. Proposed design or conditions of waiver: L /�
........................................................... ............. " "1 " " "' ".......... ......... ................... i
? ...-..........43 ................ a... .................. S_: l. ...................
, - y..... ..d.. ...�..
_ _ ..............:._:..._.. �:. ':': ..... ... . - ........._ ... _ __• -__
_...._......._ .... ............ .......... .......... ........__... _._........... _..........._.._.
...................................................................................................................................................................................................................................... ............................_.:
3. The proposed design may have the following limitations (check appropriate box(es)):
LJ 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
f,
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 ' ing official for .a change in conditions for which this waiver was granted.
........ issi :........................... ...............................
fiEFfiESENTATIVE OF CO MIS §TONER OF HEALTH ORIGINAL - Local Health Agency
COPY - Applicant/Design Professional
.....
DATE
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF BEALTH
I Geneva Road
Brewster, New * York. 10509
Environmental Health (845) 278 - 6130, Fax (845) 278 - 7921
Nursing Services (845) 218 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6 085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
PUTNAM COUNTY DEPARTMENT OF HEALTH
SPECIFIC WAVIER
NAME:
ADDRESS:
SITE LOCATION:
DATE:
STAFF PRESENT:
SPECIFIC WAVIER
REQUEST:
DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR
ENVIRONMENTAL CONTAMINATION PROBLEM?
RE UEST APPROVAL OR DENIED ---�P PROVED DENIED
REASON-FOR DENIAL
(OVI
L -
DIRECI-OR OF PT)BLIC HEALTH
(SPECWAIVER)
DATE:
YES
NO
WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP?
YES
NO
DISCUSSION.
RE UEST APPROVAL OR DENIED ---�P PROVED DENIED
REASON-FOR DENIAL
(OVI
L -
DIRECI-OR OF PT)BLIC HEALTH
(SPECWAIVER)
DATE:
11.16•4 (117)—Text 12
PROJECT I.D. NUMBER s� %.zi SEOR
Appendix C
State Environmental Gtiali Rsvisw 7--
SHORT" ENVIROWWAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Appiicant or Project sponsor)
1. APPLICANT JSPONSOR
2. PROJECT NA E
Pyle
&&t
yoxesd odo
3. PROJECT LOCATION:
P!/��iL/�
Municipailly County
1. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, ate., or provide map)
5: IS PROPOSED ACTION:
IV New . 0 Expansion 0 Modificallonialteration
6. DESCRIBE PROJECT.,BRIEFLY: Cv�1,r % 0 CV 0 D tf �y SS'• /.T
7. AMOUNT OF LAND AFFECTED:
i
Initially acres Ultimately dr acras
IL
a. W 'PROFOSEO ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
1Yes ❑ No if No, descrlbe briefly
9.. WHAT It PRESENT LAND, USE IN VICINITY OF PROJECT?
IResidenital G Industrial Cl Commercial ❑ Agriculture P80,0aresUOpen apace
Cl Other
Describe:
1;. DOES ACTiOWINVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
STATE R LOCAW?
WY OS ❑ No If yes. 11st agentcy(s) end pe►mltlapprovals
it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
Yes 19No It Yes, Ilat agency name and perntiUspproval
12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMITJAPPROVAL REQUIRE MODIFICATION?
xOFF
C3 . It:.J No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
ApplicanUsponsor no �, � d N:�. Date:
G
Signature:
ff•the -e` ilon'is in the �Coastal;Atea, and you are a state agency, compiete'the
Coastal Assessment Form before proceeding with this assessment' '
WPM
a
E'er 1 4.31
PART 11-- ENVIRONMENTAL ASSESSMENT (To be completed hV AnanAu%
A` DdESACTiCiN ON! SF OLD1141 NYCRR, PART e1T.la? if yes, coordinate the review process mnd use the FULL EAF,
Yes
s. WILL ACTION RECEIVE COORDINATED REVIEW AS iaROVIDED FOR UNLISTED"CTIONS IN a NYCRR. PART as7.a? If No, a negative declaration
may be superseded by another Involved agency. .
❑ Yes Nb
C. COULD ACTION. RESULT IN ANY ADVERSE EFFECTSIASSOCiATED WITH THE FOLLOWING: (Answers may be handwrftlen,-lf iegibio) •"
Ct. Exlsti,ng qtr 4quality, surface q. groundwatar quality or quantity; noise levels, existing traffic patterns, solid waste production or disposal,
potential foi erosion, drainage or flooding problamsi Explain bristly:
l:a, ;
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
)v 0 iv IS
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, cr threatened or endangered species? Explain brtet!y:
/V o n/'JE"
04. 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
/aIV�
CS. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly.
C8. Long term, short term, cumulative, or other effects not identified In C1-057 Explain briefly.
�_.
N m
/V o fvl� x __X
S.
07. Other impacts (including changes It% use of either quantity or Type of energy)? Explain briefly. t,7
W
D. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? C')
❑ Yes ®No If Yes, explain briefly CGJ W " <
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS- For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant.
Each effect should be assessed In connection with Its (a) setting (i.e. urban or rurat);.(b) probability of occurring; (c) duration; (d)
Irreversibility; (e) geographic scope; and (t) magnitude. if necessary, add attachments or ref9mnce supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately ad, dressed:
C3 Check this box If you have identified one or" more potentially large or significant adverse Impacts which MAY
occur. Then proceed directly to the FULL EAF and /or prepare a'posltive declaration.
Check this box if you have determined, batted on the Information.snd analysis above' and any supporting-
I documentation, that the proposed action WILL NOT result In idly significant adverse environmental•impacts
AND provide on attachments as necessary, the reasons supporting this deterrrtfnatlon:
&A6
Name o Lea Agency mor I)rirt�_Vpe name o Responsible 0 icer rn lead Agency
it ¢ o espns a icer
� asu po a �icei,i Agency � haw►¢ o r¢par¢r i ¢rent rom r¢sponsi ¢ o.ri<erl
�� �7
;t
PUTNAM COUNTY DEPARTMENT OF, HEALTH
-DWISION OF -ENVIRONMENTAL -HEAL-TH- SEER' IC E'S
DESIGN DATA. SHEET - SU . BSVRFACE SEWAGE TREATMENT SYSTEM
Own is 0j&1,F*s0, 920-Awoed'e40 �PVAOC;►e.* •
Located at (Street.) --rP79,0,e".Yg-- e, T Tax Map 3';! B'
Lo . t 'i�-
(indicate nearest cross street)
Municipality ��j LIA44 R'gip' Watershed
'SOIL PERCOLATION TEST DATA
Date of Pre-soaking Date of Percolation Test 4 7//: Z,6
NOTES: 1- Tests to be repeated at same depth until approximately equal ptrcolition rates are obtained at each
percolation test-hole. (i.e. :5 1 min for 1-30 min/inch, s2 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
7
�]D th'tO Ater
_p;
M
0 GM'n &
Role .W��
t.. Oft 1W ......
Time
S dace
a 0
h,
414
010
40
2
41?
L6
3
mom
06
4
L
34)
-2
2
3
30
4
5
2
3
4
5'
NOTES: 1- Tests to be repeated at same depth until approximately equal ptrcolition rates are obtained at each
percolation test-hole. (i.e. :5 1 min for 1-30 min/inch, s2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
DEPTH
G.L.
0.5'
1.0'
1.5'
2.0'
2.5'
3.0'.
3.5'
4.0'
4.5'
5.0'
5.5'
6.5'
7.0'
7.5'
8.0'
8.5'
9.0'
9.5'
10.0'
TEST KT DATA,
DESCRIPTION OF SOILS ENG®UNTE D �c` 'HOLES
HOLE NO.
HOLE NOOCT —8 PYi 2: 2ROLE NO.
EV
L
to
Indicate level at which groundwater is encountered a AJ
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered N z
Deep hole observations made by: %j.P4 r1*r,o1 i P', //1V D. ,Q6AJ - #JY ff Date
Design Professional Name: -- ---- -- - --� --
Address: o�o� q;
Design Professional's Seal
PiloDANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
c .•*.o. :+..a -.. �. .K'.w- .+ -K -.• .ry..-�re•:'r: n:v w�a •:rt )... n.�.0 "ws. - ...Y.. w -. .4 v. �•..• vetC +�wra- .f)uiM:.•:•'r.aty wvu.�.
" °" 1211)Brec�enndge Road'
Mahopac, N.Y. 10541
845- 628 -7576
October 7, 2004
Putnam County Department of Health
Geneva Road
Brewster N.Y. 10509
Att: Mr. Joseph Pavarotti
RE: SSTS Permit & Well Permit
Timberline Estates Lot' #4
Timberline Ct.
Putnam Valley
Dear Mr. Pavarotti:
Reference is made to letter dated September 30th 2004. My responses are in the same
order as your comments.
1. The field testing locations are further delineated on the plan.
2. The design data sheet showing the requested - information -is enclosed.
3.. The well is now shown on the 30 scale on both plans.
4. This item has been addressed.
5. The roof and footing leader drain discharge is shown on the 30 scale.
6. This item has been addressed.
7. The profile is now shown on the trench plan.
8. The current tax numbers are shown on the plan.
Enclosed are three plans for the fill.section and two plans for the trench plan. I hope this
submittal meets with your approval.
Regar --- °`--
el J. Donahue, P.E.
Site - Sanitary • Environmental
Public Health Director
September 30, 2004
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) 279 - 6648
Mr. Dan Donahue
120 Breckinridge Road
Mahopac, NY 10541
Re: Proposed SSTS Renewal = Timberline Associates
Timberline Court (T) Putnam Valley
T.M. #51 -1 -50.4
Dear Mr. Donahue:
County Executive
This office has received and reviewed the most recent set of plans for the above mentioned project. We would
like to offer the following comments for your review and consideration.
L . The field testing locations are still not clear. Please show all field testing (original subdivision testing,
new perc tests, new deeps from May 27, 2004 etc ... ) on both plans (fill and _trench). Also, please
clarify the labels or the -deeps and peres
Please provide dates for presoak and perc tests (recent perc tests). e
s� 3' Please show the well on the 30 scale site plan (both sheets).
CL It appears that the side slope regrading is greater than 1:3.
tas Please show footing/roof leader drain discharge on the 30 -scale site plan.
%f. The absorption trench detail is crossed out on the trench plan.
0' Please provide a profile•of the SSTS trenches on the trench plan.
%9'.' Please correct the tax map number on the plans.
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.
Gwti vr. h^
PkO'"` , �`-AA Very truly yours,
� - 2
Joseph S. Paravati, Jr. .
Assistant Public Health Engineer
JSP:cw
-.w v. �..r v .F.uva "wR�:�.an }-- ..v.ar�., nr �.rs. .aaT �oaa aC•v..�+�]/.. �. - ' ^. ..
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF 'HEALTH.
1 Geneva Road, Brewster, New. York .10509 •
Environmental Health (845) 278.- 61'30 Fait (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
August 13, 2004
ROBERT J. BONDI
'County Executive
�I
Dan Donahue, PE
120 Breckenridge Road
Mahopac, New York 10541
Re: Proposed SSTS Renewal —Timberline Associates
Timberline Court, (T) Putnam Valley
TM# 51.4-50.4
Dear Mr. Donahue:
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.
T Fill being provided :is less than 3 feet.
The field testing locations are not shown on the fill plan.
It appears the fill is not extending 10 feet horizontally past the expansion trench ends.
,•
= .:'frerlch.pl4A.sho.uld_ Show .the_actuaLdesign,.4ncli3ding all =t�k; boxes;- pipes; -and
..._.._..._- _- ..�....._. ._..._.._..• trenchlayout.
,i/ Please show septic tank location on the fill plan.
Please show footing/roof leader drain discharge on the 30 -scale site plan.
�l The absorption trench detail is crossed out on the trench plan.
Please provide profile of SSTS trenches on the trench plan.
.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.
a Sincerely,
4 5( ' -e_ j
e : 3 Joseph S. Paravati, Jr.
Assistant Public Health Engineer
JSP:cj
Correll �µx r"�ip
Cu"NSULTING"'ENGINCER-S -
200 Breckenridge Road
Mahopac, N.Y. 10541
914-629.7576
TO
L]EUTER TIF
pit
- WE ARE SEND114G YOU C Aftechad .13 Under separate cover via. '--the following Items:
C; Shop drawings C1 Pritift 0 Pismo 0 sarnplos 0 spacificatims
0 Copy of jeftar [3 Change order
Copies
VATIC
I
L
l .............. j
THESE ARE TRANSMITTED e$ checked bal ow.
For approval r-1 Approved as submitted [2, R@8UbrMit_C4*pl68 fOl 6ppMV@I
(73 For your UN 0 Approved ss Wed Submit-a*lao 1w distribution
C As requested 0 Returned for corrections M Return.--correcW prints
0 For mview and comment Ei
C) FOR BIDS DUE D, PRINTS RETURNED AMA LOAN TO US
REMARKS
DOPY TO---.-
SIONED:
Dallol I DonaAua PE
500 Brackenridge Road
Mah", N.Y. IouI
. 914.628.7576
TO
WE ARE SENDING YOU C Attached C11 Under separate cover ria ...._the knoiwft tea:
0 Shop drawinp Cl Prints O. Plans O Samples O SpeelAoetiens
0 Copy of letter O ChallSe ordor ❑
_ THESE ,ARE- IMANSMITT10 at- checW...Wgw:..__
C For approval 0 Approved as subm tted 0. Resubmit- ooplaa for approval
C for your uM 0 Approasd as noted rJ' Slomii collies for did"MID ►
C As rsoiw isa C Raturned for corrections O Return competed p►irots
C for ravhiw and oofr nw t C'
0 FOR BIOS DUE 19 0 PRINTS RETIIRNEO AMR LOAN TO US
REMARKS
COPY TO.--
St®NED:
_. w..� M.rh...OWN ro __
j
LORETTA MOLINARI
Public Health Director
May 19, 2004
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
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# 51.4-50.4
This office has received and reviewed the most recent set of plans for the above mentioned
s Gi project. We would like to offer the following comments for your review and consideration.
C °'r�t v**'l : Please provide new trench plan with current owner and correct tax map number.
- o, .g ! ✓l -= -- -Deep test results are greater than 10 years old. Retesting is required.'
,-3. Provide a north arrow for 30 -scale site plan.
Please provide more topography for well location and to the left of the primary
system.
Please show the well location on the 30 -scale site plan.
V6. Please provide fill pad dimensions.
Please provide stationing for the horizontal scale in the profile. (Fill profile and trench
profile).
08. Please show all field test locations including subdivision testing, recent perc tests, etc.
on the 30 -scale site plan.
It appears the location of the field - testing does not match the subdivision plat.
5 Q� lam° Fill is to extend 10 feet past the ends of the trenches and the last trench before 1:3
regrading takes place.
11. The last two primary trenches are not 6 feet from the previous two trenches.
It appears that the toe of fill slope is less than 10 feet from the driveway.
The trench plan profile does not show any trenches.
'A06t1JV'4 PVC pipe between tank and first junction box needs to be labeled. Please provide
/ , size, material, and minimum pitch.
0� Please provide a corporate resolution.
'his ,office., will.- continue, _.its..review..,u on .consideration ..of theta over mentioned. co e t
Please feel free to- contact me at ext. 2157 if any questions arise.
JSP:cj
Very truly yours,
Joseph S. Paravati, Jr.
Assistant Public Health Engineer
V� .b
LORETTA MOLINARI
Public Health Director
May 19, 2004
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 IIntervention/Preschool (845)Z78-6014 Fax(845)278-6648,
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# 51.4-50.4
This office has received and reviewed the most recent set of plans for the above mentioned
project. We would like to offer the following comments for your review and consideration.
1. Please provide new trench plan with current owner and correct tax map number.
are.great&than.10 years�old. - R- etesting- is- requir- id.. -:- _ _...._....._.:..,...:.._�..._.
3.
Provide a north arrow for 30 -scale site plan,
4.
Please provide more topography for well location and to the left of the primary
system.
5.
Please show the well location on the 30 -scale site plan.
6.
Please provide fill pad dimensions.
7.
Please provide stationing for the horizontal scale in the profile. (Fill profile and trench
profile).
8.
Please show all field test locations including subdivision testing, recent perc tests, etc.
on the 30 -scale site plan.
9.
It appears the location of the field - testing does not match the subdivision plat.
10.
Fill is to extend 10 feet past the ends of the trenches and the last trench before 1:3
regrading takes place.
11.
The last two primary trenches are not 6 feet from the previous two trenches.
12.
It appears that the toe of fill slope is less than 10 feet from the driveway.
13.
The trench plan profile does not show any trenches.
14.
PVC pipe between tank and first junction box needs to be. labeled. Please provide
size, material, and minimum pitch.
15.
Please provide a corporate resolution.
w/1 b
k ♦ .
I.ORETTA MOIDIABI ROBERT 1. BONDI
Po6ao HN&A Anne.. Coup• a
DEPARTNMNf OF HEALTEI
1 Gan va Road, 13rowt6x, New York 10909 .
Zw anmbl ROM (045)278-6130 Ea(SO)17a -7911
nartlo8 srelco (015)170.6a5e
WIC(345)270-6M Fu(145)178.6085
amtr Iabneaeml reldmd (005) 278.6014 FU(S15)278-664&
May 19, 2004
Dan Donahue, PIS /
120 Breckenridge Road ✓
Mahopac, New York 10541
Re: Proposed SSTB Renewal -- Timberline Associates
Timberline Corot, (T) Putnam Valley
i TM4 51. 4-50.4
Dear Mr. Donahue:
This office has receivod and reviewed the most recent eat of plans for the above mentioned
project We would like to offer the following comments for your review and considasti .
I. Please provide new treoah plan with current owner and correct tax map number.
2. Deep teat results ate grater than 10 years old. Retesting is required.
3. Provide a north arrow fur 30 -scale site plea
4. Please provide more topography for well location and to the loft of the primary
S. Please show the well location on the 30-scale site plea.
6. Please provide fill pad dimensions.
7. Please provide stationing for the horizontal scale in the profile, (Fill profile and trench
I
prof"),
8. Please show all field test locations including subdivision testing, recent peen tests, etc.
on the 304rale site plan.
j 9. It eppeam the location of the field - testing does not thatch the subdivision plat
10. Fill is to extm4 10 feet past the ends of the trenches and the last stench before 1:3
regrading takes plane.
11. The'last two primary trenches am not 6 feet from rho previous two trenches.
12. It appears that the We of fill elope 13 less then 10 foot from the driveway.
13. no trench plan profile does not show any trenches.
L4, PVC pipe between tank and Bret jrmction box needs to be, labeled Please provide
size, material, and mini— pitch
15. Pleas* provide a corporate resolution.
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PUTNAM' COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMEI'fiT}l�ffi -
-.. -- - .REVIEW ST3EET FOR CONSTRUCHION PERMIT
~ _ + NAME OF OWNER: f;� /iS o� �Ls G( STREET LOCATION:
REVIEWED.BY: RM, GR, , SRDATE: TAX MAK (CONRIRIvM)
Y N DOCUMENTS
DPERMIT APPLICATION
(�WELL PERMIT OR PWS LETTER
(PC =97
LETTER OF AUTHORIZATION
(/ (___)DESIGN DATA SHEET (DDS)
Lj )CORPORATE RESOLUTION
SHORT EAF
PLANS -THREE SETS
E PLANS - TWO SETS
U JVARIAXCEREQUEST ���
LEGAL SUBDIVISION '
SUBDIVISION ROV,kL CHECKED
5L_)PERC RATE `5
(e!:)(�FILL REQUIRED -:5 . DEPTH
U 77(UCURTAIN DRAIN REQUIRED
GENERAL
C__)CLaOCkTED.IN NYC WATEI�SHED
UUPLANS SUBMITTED TO DEP
( �- )DELEGATED TO PCBD
LAPPROVAL, IF REQD EEP TFST HOLES OBSERVED
L_)( P:JERCS TO BE WITNESSED
C_JC X- APPROVAL SSDS ADJ, LOTS
Y N (REQUIRED DETAILS ON PLANS CONT'D)
isLSC�HOUSE SEWER -V," FT. 4 "0'; TYPE PIPE. CAST IRON
U(e/ jNQ BENDS; MAX BENDS 45- W /CLEANOtJT
RENEWALS
(✓(JSITE NOTE (NO CHANGE)
TEMS
HORIZONTAL; PAST TRENC LOPES-3:1 TO GRADE
(� FILL SPE 1 -5
(c�FILL IN MANSION AREA
FILL GREATER THAN2 FEET
( CLAY BARRIER
(FILL CERTIFICATION NOTE
DEPTH GAUGES
- �0_N_. PLAN FOR R.O.B., tJNCLASSBFIED & IMPERVIOUS
(_;)SEPARATION DISTANCE FROM'TOE OF '
(! )F )LF TRENCH PROVIDED !O 60FT MAX.
e(� PARALLEL 'TQ CONTOURS
100% EXPANSION PROVIDED
DETMLDUST FREE CRUSHED'STONE OR WASHED GRAVEL
(--)GEOTEXTIL9 COVER
TO T DRIVEWAY, LARGE TREES, TOP OFF �' ~
(� ETLANDS (TOWNIDEC PERMIT REQ'D ?) 1001 TO WELL, 2061 IN DLa, 50' TQ Pi
LJ_DATA ON DDS PLANS &PERMIT SAME 10?,Tor O STREAM, WATERCOURSE, LAFE(inc: ezpan),
(� 1969 NEIGHBOR NOTIFICATION 50 T ATCH DASIN,35'- ST0RMDRAIl�i,_$I
T=BI/ZBA
( --•)_ _,:_... _... .- : <:....: .•. -. •• -. 1,.: :::.- ...._.._ 10 ,..TO'WATER- I:iIVI:'(pits -20')' ..�
'7')1/50', INTERMITTENT DRAIl'•SAGE COURSE
SOIL TESTING LOTS ?10 YEARS' OLD ' ' S'. ((,2001/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS
u6 __)10' MIN TO LEDGE QUTCROP
SEWAGE SYSTEM P - ORTH /ILA• SEPTIC TANK
HYYVRAU 10' FROM FOUNDATION; 50' TO WELL
WELL
ONSTPOICTION NOTES 1 -15 (_)DIMENSIONS TO PROPERTY LINES
ESIGN DA:TERG & UL'TS�;,,,� DUI, ®CATION OF'SERVICE CONNECTION
(__,)2' C NTOUR5 EXISTING & PROPO , c (��__)MIN 15' TO'PROPERTY LINE
Altt—'iUSDA D WAI' �i SLOPES, i-�� SLOPE
FOOTING/GTJT"TER/CURTAINDRAIN3 (� s/SI,OPE%NSS'TSAREA(520 %) SOIL TYPE BOUNDARIES (REGRADED TO 15 %, IF REQUIRED
BLOCK; OWNERS NAME ADD.
DDRESS v,nc�rorrnry c x4c
TM #, PEMA; NAME, ADDRESS, PHONE#
C_JDATE OF DRAWNG/REVISION
(_ j�` DATUM REFERENCE .
'LOCATION OF WATERCOURSES, PONDS
'LAKES,WETLANDS WITHIN 200' OF P.L.
(PROPOSED FINISH FLOOR AND
/ BASEMENT ELEVATIONS
i/ WELLS 8c SSDS'S W/IlN 200' OF SSTS
PROPERTY METES & BOUNDS
(,,JEROSION CONTROL FOR-HOUSE, WELL &
SSTS, EROSION CONTROL NOTE
)MMENI'S:
EVSHEET)09 101/00 '
UUPUMP NOTES
/"
(_„)UDOSE 75% OF VOLUME/DOSE VOLUME NOTED
UUDET FORCKMAIN, (PIPE TYPE, ETC.)
D -BOX SHOWN & DETAILED
1 DAY STORAGE ABOVE ALARM
CURT
U(—JSTANDPIPES, 5' BO ES, DETAIL
(•�—)U1S' MIN to %, 20' -4 %, $5' -3 %, 35' -lb /o, 100%-<I%
CD DISCHARGE/1001 with 182 cons day discharge
U 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: An„ �ja� f7Jn rK r rrr f U&I'L /.,Ors �/- �' i,,, 4•1 At c'rt.
I,
represent that I am an officer or employee. of the corporation and am authorized to act for:
Name of Corporation: �
Having offices at: 222. CaR CA4v'" S�
c KAI 15
Whose Officers Are:
President - Name: - K. -E�LA44-
Address: l bo +IAa MOCO &A I O kW19 Xnrl t1vabQ#
Vice President - Name: TbN 'IO'�,,
Address: - �Sb tly_-4L 'e- eAePVa_
Secretary -Name:
.Address:
Treasurer Name: WRl
Address: �. 4
and that I am and will be individually responsible for any and all acts
to the approval requested and all subsequent acts relating thereta�
Signed:
Title: MY4W- -
Sworn to before me this 13 day of
_(month) 2� ® ® (year)
'"— I racey A. Boi
�LIC, State of New y01k
ft'. 01805081711 Corporate Seal
."Jalified in Westchester County
- Commission Expka July 07,
Form CA -97
t ISl S
with respect
.UA_
LETTER OF AUTH®R1IZATffON
r,
RE: Property
Located at _''►': /opy� Aild�.� ��-�
T PaT 9 ,4m VW k0fax Map # Block Lot So
Subdivision of `r / .M OR k o yj 6d -"Avy-'O's
Subdivision Lot # Filed Map #� Date Filed
Gentlemen:
This letter is to authorize 'Dka ` 6.4
a duly licensed Professional Engineer V 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 you ,
Countersigned: Signed:
P.E., R.A., # (Owner of Property) �/
'f rw6&1jNF_ 'ASSPCIMIL7b ° �R p
Mailing Address Mailing Address: Q'i ptf\j pvM"
ZZ Z C-9ALC
State Zip 40474 ®r State. Zip
Telephone: 9 *,_ -4e -19 � V74 Telephone: �'4 - 6Zb' '�55S.
Form LA -97
DANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
.. A20 Breckenridge. Road -
Mahopac, NX 10541
845 - 628 -7576
April 6, 2004
Putnam County Department of Health
Geneva Road
Brewster N.Y. 10509
Att: Mr. Joseph Pavarotti
RE: SSTS Permit & Well Permit
Timberline Estates Lot #4
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.' Thiee copiei of cofikhicfion drawings
Comments: Application is for a renewal and name change fee filed under separate cover.
Your prompt consideration would be greatly appreciated.
Sincer
aniel J. Donahue, P.E.
Site • Sanitary • Environmental
._....... -..... . -:. _A
P i I i °a a zCOUNTY D ;PA I I I OF HEALTH
A I
DWESION OF Id r I'1N ' I N I A I HEALTH A I I 16 S I I't ' t
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
Located own r Village
Subdivision name Subd. Lot # Tax Map J* Block Lot
Date Subdivision Approved� Renewal Revision
Owner /Applicant Name J.- , V Date of Previous Approval
Mailing Address Zip
Amount of Fee Enclosed
Building Type p Lot Area IN—o. of Bedrooms — !�EDesign Flow GPD d)
Fill Section Only Depth , G VoRume
PCIID NOTIFICATION IS REQUIRED WhEN FILL IS COMPLETED
Separate Sewerage/ ft stem to consist of J. 2� gallon septic tank and
Other Requirements: 2 0 �OOy
To be constructed by 6P Address
Wak Sannnfla: Public Supply From Address _
or: Private`Supply Drilled by 27 � 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 o
Signed:
Address
License #
f�
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 whe considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe t. p roved for discharge of domestic sanitary sewage only.
By' Title: �(��l A Date:(® 4) �--
White 1py - HD File; Y llow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
_ ....._ W pease print or-type ~ - - - - , - - -..3 - PCHD Permit #
Well Location:
Street Address: o illage Tax Grid #
7-/A99 l.4K to er P ap v �. Block ` Lot(s)
Well Owner:
Name:
Address:
a6t T,gW,06r1Le. f V iprD ego
Use of Well:
esidential Public Supply Air /Cond/Heat Pump Irrigation
1 rimary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institution4 Standby
Yield Sought gpm Est. of Daily Usage gal.
Amount of Use
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
dNew Supply (new dwelling) Deepen Existing Well
Detailed Reason
X69AV& *- Aiew koxtOA, C o
for Drilling
Well Type
Tilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes !/ No
Name of subdivision fT1 a JwA1 & r4= Lot No.
Water Well Contractor: -!775R--P Address:
Is Public Water Supply available to site? .................................. ......... ....................... Yes No y
Name of Public Water Supply: A�& Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to b F provided on separate sheet/plan.
Date: V Z Applicant Signature:
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue 1 6/-7/102- Permit Issuing Official:
Date of Expiration Title: A 6t f-
Permit is Non- Transferfalil
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
ON. Rm,
ftnata�
� 6Q�
�
n
Tat Moor
Dili /!I
LAUK , .
�fiKtAB
PAM. RM.
Isoaf>P®
IN
OvEw vo' ®Ra 0
ULOW a l49
Is IL fa I?
STS ]UT M COUNTY DEPARTMENT O HEALTH
fi;ta9Q
ROUSE P1,
UNT ONLY,
Ind Boor q— BEDROOMs 3 — /- Ii
ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE
AGNATU' T BE SUBMITTED TO THE PCDOH FOR APPROVAL
.& ITL DATE
pQLm Lyme Noun$ INC.
L Old Trail Road, Selinsgrove Pa. 17670
Telephone (717) 743 -0111
L.
r•
PVTNAM
� COUrNTy I)�p
DIVISION OF Elul' AUNT OF HEALTH
.... ...,..a'VIJ2®NMENTA�;��.HE�A]LT : r
H`SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner adds 010, w t
Located at (Street)1 /r?,�F,Q c �- Tax Map Bl �r Lot -
(indicate nearest cross street)
Municipality PIL%/1lA ,44 R `1 Watershed G��e��tl
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Date of Percolation Test
percolation test hole. (i.e. s t min mr r - .)v &- ist11--, ,
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'
3.01
TEST PIS' DATA 2
DESCRIPTION OF SOILS ENCO NT.ERED IN TEST H®LES
HOLE NO. HOLE NO. HOLE NO.
NAS - -- y •� h .
APANY AND
ICATION SHALL
/ � •-•.. i6tONUMENT
/ FOUNO�� n
C
LOT ur/
Q/
AZ/
cd
/ LOT 4
/ AREA.= 3.0518 ACRES �\
/
/
iJct. Box
620' .4; d
-- _ -�_�0- 7'%
Septic Tank - -
0
6P i •' � �00
.A
. _....... . R.... ., .. _ .. ,_ ...��0 nom. .. .. `�. j.A /. ..._......__. ,.... .. .. .......
d f0
6
a
P1tiM4M COUNTY DEPARTMENT
DIVISION OF ENVIIR O ENso
APPROVED Aq OTED FOR CONFI
/ APPLICABLE RULES AND REGUIJ
/ PUTNAM COUNTY HEALTH DEPAF
/
O T ITLE �,
WE
® / LL �,sl LOT 5
0 (P
SSTS TIE -INS (MEASURED BY TAPE)
/ UNIT A B . C
/ SEPTIC TANK 22 24
/ 1 39 22
2 444 22j4'
22
/ ES610ry 154 3
�� i. DO�y � Fi $¢
1 / 0 Q 6 76 40
7 70 67
\ / o " :• 1 8 73 73
75 79
10 77 82
V t'o, 464S% pc' 11 71 71
q�f OF NE N y 12 64 69
13 60 65
14 52 64
i v
LOT 5
SYMBOLS
CATCH 8AS:N
CABLE T.V.
r-ILF;CTRIC TRANSFORMER
PMAM COUNT( DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES:
M Q vi if •�-
APPROVED AS NOTED FOR CONFORMANCE WITH
APPLICABLE RULES AND REGULATIONS -OF THE
PUTNAM COUNTY HEALTH DEPARTMENT.
GNATURE & TITLE TE
SSTS TIE - INS (MEASURED BY TAPE)
UNIT
YA
B
C
LENGTH OF TRENCH
SEPTIC TANK
22
24
1
39
22
51
2
44
22
44
3
62
5¢
62
_..
-.70
8
73
73
62
9
75
79
62
10
77
82
62
11
71
71
62
12
64
69
.62
13
60
65
62
14
52
64
62
15
47
63
16
54
74
DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT
FORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE
GULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW
YORK STATE DEPARTMENT OF HEALTH
ASBUILT PLAN
SEWAGE TREATMENT SYSTEM
Property of TIMBERLINE ASSOC
TIMBERLINE CT. .
TM# 50 -1 -50.4 PUTNAM VALLEY
DANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
120 BRECKENRIDGE ROAD
MAHOPAC, N.Y. 10541
628-7576
MAHOPAC, N.Y. 10541
DATE: SEPTEMBER 19, 2005
i SCALE 1"= 30'
SURVEY BY: ROLAND LINK.