Loading...
HomeMy WebLinkAbout2488DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -50.5 BOX 21 0 ru, T - � L 16 1 i �` ,` ,' -� s - i r ;1 9 �` CL PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES WELL COMPLETION REPORT Well - Location ... Street Address :..... _ _ _... ____ _ _ _ ..._ _ ._..._..�c 67sra 'QJ TownN_illage:. - rr %Ile ., Tax Grid, #_. _.._..__. .. ....... _ . :... Map !�/ Block^T� y Lot(*) , Well Owner: N e: Address: • Ci � � C.s7" Use of Well: -prima 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion __X Compressed air percussion Other (specify) Well Type Screened Open end casing _X_ Open hole in bedrock Other Casing Details Total length 44ft. Length below grade . t D ft. Diameter in. Weight per foot 1b /ft. Materials: X 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 Well Yield Test Bailed Pumped Compressed Air Hours Yield 15� 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 sieve analyses am-available,. _ _.. please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface I ArZA4 QfANj7'e Q ®S` 1 _ _.:..,•. _ ... _ _..: .... - .... _. _ ..._ ._. . _.�_ ... -- - _...... _ ....I\ `— Fri If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank InformIt G r, Pump Type-Sq Capacity �; Depth 664 d Mod GSl.S* a Voltage HP Tank Typ e(,&T Volume Date Well Co pleted Putnam County Certification No. Date o Report Well Driller (signature) NOTE: Exact location of well with distances to at least two permandht landmarks to be provide n separate sheet/plan. Well Driller's N e 61 dl� Address: Signature: Date: / //I op ( White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 1 1,31 Y a GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 1. Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Town/Village Location - Street Subdivision Name Buil ' g Type P 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 n gligent-act _of the occu ant of the building utilizing the - _. Y .. p _ g system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dat Mo �ti ,.. ��; Day >> ear eneral ContrMtor (Owner) - Tignature Signature: Title: k v--` A Fti S -r Corporation Name (if corporation) Corporation Name (if corporation) Address: s , ' �- .Zip `) State ' C uj ' 7 1 i ' Address: Staten ►`- Zip r Form GS -97 BRUCE K 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: 5) 1 — S E911 ADDRESS: l iM b- e, -11oye CiT TOWN:ilsy� AUTHORIZED TOWN OFFICIAL: DATE: 0(0' 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. (E9I i verfcm) r g i p CERTIFICATE E OF CONS ll RaJCTI[ON COMPLgL'91V C1E FOR SEWAGE TREATMENT SYST PCINIM ®wc! ToIIJCTIfnw ]P1Eni&xyr # - dk- -A2 . Locat at ` AJe�-- dC-7— own o Village Owner /Applicant Name 1"- 1A0 <'�i / ,1,e 47'e<— Tax Map Block _� Lot Formerly Subdivision Name Subd. Lot # Mailing Address -�'�- ��� C��� X-rye, 7li41l Zip _22 -� Date Construction Permit Issued by PCHD� Selpairate Sewerage System built by Z R OAf Address � Consist' g of Gallon Septic Tank and �1� �2- -T Other Requirements: 3. 6 4 Water San�n ®Id: Public Supply From Address ®� Private Supply Drilled by J , Id® IJ 7 Address __....__— Building -Type 1 i`3 / `!` 'Ias-erosion contiol begin completed? C' -' y 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 09Wt Putnam Counj popartment of Health. Date: Address P.E. - -R.A. 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, modification or change is necessary. By- �-� Title: Date: O 0 �p White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location. _ . Street ,p dress: n/& ES773TP1 Town N_illage;_ / -4/If Tax Grid: iMap'�/ Block Lot( *) j Well Owner: N e: Address: Ci #4#v e, mir Use of Well: -prima 2- secondary Res dential I Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion _x Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total lengthj_ft. Length below grade D ft. Diameter in. Weight per foot lb /ft. Materials: X Steel Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: )L 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 _)( Compressed Air Hours _ Yield . 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 sieve analyses are•avaiiable, - •-:.. please attach. Depth From Surface Water Bearing Well . Diameter(in) Formation Description ft. ft. Land Surface 14 jFY4 /& L 171! _._ __ _ _ ._... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type-qq Capacity ! Depth tod ® ModelPG Z/,Z Voltage 02-509 HP Tank TypeWe_&_Trt1'( Volume Date Well Co pleted 7 Putnam County Certification No. �O� Date o Report ,7 Q& We 1 Dnl er (signature NO I E: Exact location of well with distances to at least two permandht landmarks to be provide n separate sheet/plan. Well Drillers N e Q/1LS Address:. -ems Signature: - Date: / White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVlRONMENTAL SBRVlCES 321 Kear Street | Albert H. Padovani, Director | 1.600092 CLIENT #: 114 NON STAT PROC PAGE: TORLISH & SONS BOX 271, 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY 10504 SAMPLING SITE: TIMBERLINE : PUTNAM VAL COL'D BY: D. TORL{SH NOTES...: TANK ~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: O1/06/06 10�00 DATE /TIME REC'D: 0l /O6/06 10:55 REPORT DATE: 01/13/O6 PHONE: (914)-273-3448 ESTATES LOT #5 SAMPLE TYPE..: POTABLE -EY PRESERVATIVES: NONE TEMFERATURE..: < 4C COLIFDRM METH: MF ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PUTNAM CNTY PROFILE are proscribed. 01/O6/06 MI-— T. COLlFORM ABSENT /1O0 ML ABSENT 01/10/O6 LEAD (IMS) 1.3 ppb O-15 ppb 01/12/O6 NlTRATIE NlTROG ' 01/O6/O6 NITRITE NITROG <O.O1 MG/L N/A 01/09' . IRON (Fe) <0.)60 Ivi G/L O-0.3 mg/} 01/06/O6 MANGANESE (M n> <0.010 MG/L 0 -O.3 mg/l 01/06/06 SODIUM (Na) 2.65 116 /L N/A 01/06/06 pH 7.9 UNITS 6.5-8.5 0J /09/i6 HARDNESS,T OTAL 94.0 110 /L N/A --~--�'�-0 KALI4#TTY 76.O_4 J.�-,�-=.-� --�O1fBIDfT'\/^(�Df(---'-`-7TNT\Y---------'7)�5rTD--- COMMENTS: ' BACT THESE RESULTS INDlCATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY THE NEW. yORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Ru�e for Public Systems requires that no more than 1O% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. 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 shouJ.d contain no more than 20 mg/L of Sodium. For those on a METHOD 1008 9003 9052 9l62 9002 9002 90O2 9043 '- 0� 90 � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 C9144�=-2881* Albert H. Padovani, Director LAB #: 1.600092 CLIENT #: 114 NON STAT PROC PAGE: 2 TORLISH & SONS DATE/TIME TAKEN: 01/06/06 10:00 BOX 271, 45 MAPLE AVE. DATE/TINE REC'Dx 01/06/06 10:55 ATTENTION: DWAYNE TORLISH REPORT DATE: 01113106 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITE: TIMBERLINE ESTATES LOT 05 SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: TANK COLIFORM METH: Ml-' ~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~..~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD moderately restricted diet, a maximum of 270 mg/L of Sodium 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 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/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. ----~-SOFT 'WAWE / - MG/L �-�� .: '': 7 ' VAW MAR DWATER � G/L�-'��'�^�-� MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/!allon = 17.2 MG/L) SUBMITTED BY Director ELAP* 1032-3 b CONSULTING IENGEq EIERS 120 Breckenridge "Road Mahopac, N.Y. 10541 845 -628 -9596 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 AT Mr. Joseph Pavarotti RE: As Built Plans Timberline Estates Lot #5 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. Sincerely D el J. Donahue, P.E. Site o Sanitary o Environmental _. .:'•.1 SHERLITA AMLER, MD, MS, FAAP _ " " ' " ";. C6,;nmissioner '— fHealth 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 October 11, 2005 ROBERT J. BONDI County Executive, Re: Field Inspection — Timberline Associates Timberline Court, (T) Putnam Valley,. TM# 51 -1 -50.5 A site inspection was made for the above referenced project on October 6, 2005. The following omments must be corrected in the field. 0� Z The well casing needs to be raised to a minimum of 18" above grade. A well cap needs to be provided. An inspection of the house for bedroom count needs to be done when the house is completed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157 JSP:cj Sincerely, a � 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 All information must be fully completed prior to any Trenches inspections being mace. PCHD Construc. ton Permit # Located: _ '® A Owner /Applicant Name" f7:tt Formerly: Is system ti,U completed? Ir'°� a.tre& �' i'ie o 'I'�q tlock�tLot Subdivision Nme: P Subdivision Lot # Date: is system complete? Is system constructed as per plans? Is well drilled? Is well located as per plans? Are erosion. control measures in place? Date: I certify that the system(s), as listed, at the above pramim has been constructed and I have.inspected and verified their completion in accordance wi* the issues PCHD construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Date: _ // 1 Certified by rrokssional, Address: I tic. # Comments: Form FIR-99 DIVISION OF ENVIRON_YIENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: j2sp Street Location Owner. r;,� �k AS , .. Town it y► : - (/ .1 - Permit #" s�:� : o � : n A TM # -/ — v. Subdivision Lot # C� •�?� s: �...�s fir` j� 1. Sewage System Area a. STS area located as per approved plans .......... ............... b.. Fill section -date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area. e. - 100' from water course/wetlands .............. ......... '4� II, Sewage System a. 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 ..........................: .......1. 3. .. Minimum 2 ft. Original soil between box & trenche e. Junction Box - properly set ....... ............................... 6. Trenches 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 surface ................ 7. Room allowed for expansion, 100 % ...................... 8. Size of gravel 3/4 - 1'/2" diameter clean ................. 9. Depth of gravel in trench 12" minimum .......:......... 10. Pipe ends capped ...:................ ............................... g.. Puma or, Dose(f Systems _ _ L--Size ofpurnp *clfamber..' ............. .... 2. Overflow tank ......................... :........ .......... 3. Alarm, visual/audio. .......:...... .. :..........................., 4. Pump easily accessible, manhole to grade ............. 5. First box baffled ..................... ..............................: 6. Cycle witnessed by H.D.estimated flow /cycle....... Eq.:House/Building a. douse located per approved plans....:....... G .ccr►�! b. Number of bedrooms ................. .............:..........:...... IV:: Well Well located as per approved plans . ......:........................ b. Distance from STS area measured ft....... C. Casing. 18" above grade ............ ................. ............... d. Surface drainage around well acceptable ................... V. Overall Workmanshin . 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 & dinto exist watercl g. .Footing drains discharge away from STS area.......... h. Surface water protection adequate ........:................... i. Erosion control provided .......... ... ............................. Rev. ?2102 SITE INSPECTION FOR FILL, Pte: Date: Inspected by: Fill pad located per the approved plan C f Fill Pad Length %'© Required Length Fill Pad Width -71 Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope. from Top to Toe ccv,�( Impervious. Layer Installed1 Erosion Control Installed S Sieve Test Results (if applicable) Additional Comments: ��— s•t h Reserved for Field Sketch if Applicable _ w_.r _ ..�... - .�.r,.•. ,_ _ _ K b� , r_.+%i i CO^r OWNION OF ENVIRON1tOWAL MLTS SSRVICES REQUEST p©L1!iA>� , 2IRMTION For: Fill Date: ,_ /�d► 1� Trenches PCHD Construction Permit # ,,. - '� �•• // Located: ff l ,lil✓I� t %'� On �ir 4/a i/r .� Owner /Applicant Name' .�"'t��' /�1/�NL- 'I'M.� Block Lot Formerly: Subdiviaion.Nm n, Subdivision Lbt # Is system fill 0040 w? ,....,.,�._„ Is system 0090"? Is systOM ca>ss RMod 1Y pa plans? Ae Is well Wide ovo Is well located a per &,s? Are erosion coWW rnoasures iD lace? Date. Date: Date: r I certify that the *Wool a , at,fb4SW6lftdM bsu beat constructed =6.1 have inspected and verified th comple ion in Ili =dance with the ipuid PCHD -Construction Permit and approved plans and the Standards, Rules and ReplsSiM f the Putnam. County Department of Health. Date: ft Certified.by: PE RA Address: - Lic. # FOR: 13 GENE 0 (- • ME) Form FM -99 •f OCT -4 -2005 TUE 12:58 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 e j IL f.. elo� eP !^ -... l Ian t F, 4,L- Re 8) i s pa A rio A rn o d f.#Af rt � 0 0*-Sl— Af 6 al C / 0 46 1 '404 `d& i �X�p*+iio41 OCT -3 -2005 MON 16:38 TEL:845 -278 -7921 $ rip NAME:PUTNAM COUNTY DEPARTMENT OF PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH .SERVI( CONSTRUCTION PERMIT FOR SEWAGE TREATMENTi,SYSTEM PERMIT # �5.O , o 8 -b Z AUG f a Pt"' 2: 1 l,. Located at —% /ur Or--,Q Z-i (V e To r Village 60-4�j < .-r �4 Subdivision name � ,?-- Subd. Lot # Tax Mapes / Block / Lot ,S"7), Date Subdivision Approved /'!Z' Z�6 Renewal Revision Owner /Applicant Name 7 -/rj Oi5;f z-/A.> r OS See, e,4 e- Date of Previous Approval Mailing Address a<,2j C,14,eg 6"C11 -97- Zip /o,r) -' Amount of Fee Enclosed _ P4 /v Building Type /� y Lot Area ` o. of Bedrooms g yp �� .� Design Flow GPD & Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /00 b gallon septic tank and Other Requirements: .? 13 r= % .,?(/ 47 To be constructed by 1-009 Address Water Supply: Public Supply From Address "or:rivate Supply Drilled by T 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 s,, stem 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/ R.A. Date Q Address -A%/,9y ee License # C Yl� j 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. f By: Title: /�'��r� Date: A7 a,-/ O Wh a py - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES )�4 1 - I 0 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner rr/vA 6Cvfz4'/yAA 4ss ge­,44 C-.' Address �ggtz:.e it '4 r Located at (Street) '7—/,vr ?4 eov ra: e-7- Tax Map 11 Block Lot (indicate nearest cross street) mullicipa,ifty jpo: ' llet Watershed 4 Se X A, SOIL PERCOLATION TEST DATA Date of Pre-soaking 1a o Date of Percolation Test 2 Ze 11dY 0 �i� at d atei� ct►iatia . ]Elate loottt�t :l!P 7Wi' AA o'� /P /i 34 2 /to .30 .2 ZZ 30 ) v 4 5 2 3 4 5 3 2 3 4 5 OTES: i. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < I min for 1-30 min/inch, < 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 P'I'P DATA DESCRIPTION OF SOILS ENCOUNTERED IN MST HOLES 2 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 Design Professional Narne.—iE Address: /9-r) 46-,� Slgnaturg Design Professional's Seal 0 04- \`rT9 �f�o. 4 C( NSI�'LTIIVG EI�iGINE]ERS L IETI'TIER OGF VIUMMURI IML 200 Breckenridge Road Mahopac, N.Y. 10541 TO _ ... _..._. _ 914.628.7576 — WE ARE SENDING YOU C Attached ❑ Under separate cover via • Shop drawings ❑ Prints • Copy of letter ❑ Change order ❑ Plans �ATTCNTI N PE the following items: ❑ Samples ❑ Specifications COPIES OATS NO. _ _ DESCRIPTION r THESE ARE TRANSMITTED as checked below: cQ-Vor approval Cl For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections 19 -1 Resubmit copies for approval ❑ Submit copies for distribution O, Return corrected prints D PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: natifr us ono.. CONSULTING " EN G1NEERS - 2W Br iterwidge Road Mahopae, N.Y. 10341 TO r,- n WE ARE SENDING 1►IKU 0 Aftctted i3 Under Mards cover via ft wowli Iteens. G mop drawlaa O Drifts Plans &nwfes sowficatws 0 coy of Iry O Chanp order D,,,,. THESE -ARE TRAMMITT9.0 ce cbockW Bairn: ar appmoal 0 Approved as subrnittw G eQ�ssPlsa Par approval n For your un ; ; Apprewed os note submit copier for dilift tlon C As vuoalal D R*UfMd for CWTO kma G I� Prwe ® For wiew and 0ornment C:i — — 0 FOR SI®S GUE 19— C PRINTS RETURNED AMR LOAN TO US REMARKS OOPv p® - --- - -- OWED. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SY 5R MI � a 2 oq, PERT # S` W �v rq16 Located at ? /-"zf�e� -isf �'%~ �r Villag 41' /fie _ Subdivision name"//" 8; Subd. Lot # Tax Map c�` =Block Lot Date Subdivision Approved /zl�,,' Renewal �_ Revision Owner /Applicant Name LL-e Date of Previous Approval 1;4000 MailinR Address 01 C4i,4T4,o ST POW 7 -e­1A* J1 % Zip /°J'v Amount of Fee Enclosed ',fa D Building Type /,, `"7 Lot Area,?. /f No. of Bedrooms Design Flow GPD Jd Fill Section Only Y Depth a Volume -9 f? 1 d('' 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 - or:_.Fri�'upplBrilled�;...: 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. , n 1 f�- ` l ��- Signed: P.E. �— R.A. Date Address � f ° /'�� 'E License # — 4! APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w n c nsider necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe ppro for discharge of domestic sanitary sewage. ; y. � By: Title: Date: 41- )14116's White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional, Form CP -97 PUS NAM COUNTY DEPARTMENT OF HEALTH IIDWIlSI ON OF ENVIRONMENTAL HEALTH SERVICES APP)LIICAT I_ON. TO— CONSTRUCT- A k,AT ER WELL please print or type ~ � PCHD Permit #�'� Well Location: Street Address: o illage Tax Grid #si 1A1,p�Ak /,rsP �¢ d4 "',� %¢lam Map Block / Lot(s)-J' Well Owner: Name!-// Address: 4or CO C- Use of Well: � Residential Public Supply Air /Cond/Heat Pump Irrigation arimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # erved Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply D>riHing Z!' New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. .......... .I.................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision Ofd" Lot No. a^ Water Well Contractor: Address: Is Public Water Supply available to site? ......./ .......................... ............................... Yes No -Y Name of Public Water Supply: /V ///- Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be pro ided on separate sheet/plan. Date; " _- Applicant- Signaturo. 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. AP?ROV ED. 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 waP4,J . 1 driller certified by Putnam County. ff)ox Date of Issue �� •' Permit Iss Official: Date of Expiration Title: Permit is Non- Tlransff >rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH -,:....;�,-;.""DIVISION-OF-E-NVIRONMENTAI;-HEALTH-SERVICES�'-.�t . w- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner AIM glow A i ov * 00,r rd 0 Address P"G wr!g6geyvo9eo, r-r P.Womw/'Ok Located at (Street) -7/ Al VAW 4 4iAr g;.I,, Tax MapZ / Block Lot J"b"X' indicate nearest cross street) Municipality if 4r4 oftv v 4d, A., Aw Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking-----. Date of Percolation Test rows Wi ve 71 $ top ZL 2 L e 3 2 J6 Y-j 3 IVA ve LA oil 0 re 17 1 0 /l A0 3 /# Y;- -2 4 approximately equal percolation rates are obtained at each NOTES: Tests to be repeated at same depth until 2 min for 31-60 min/inch) All data to be I for 1.30 min/inch,!; percolation test hole. (i.e. s min submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 FAI DEPTH G.L. 0.51 1.01 1.5' 2.01 2.5' 3.0' 3.51 4. . 0' 4.51 5.0' .0 5.5' 6.51. 7.01 7.59 8.00 8.50 9.00 0.51 10.09 TEST fIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. S°- HOLE NO. HOLE NO. t� Indicate level at which groundwater is encountered go it Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: DJ J)d . rg M00,ZA 41?1).ate Design Profe-ssiojmalNwne:* 4-04141e4- J. Address: 01, Design Profissional's Seal 3 -D iX A� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. LETTER OF AUTHORIZATION Property i9 Located at _ �T, / 40 IM id 11,. (om/ .Pt.)?,q.t•H V0k0 ax Map # —Block _/ Lot �� S Subdivision of T / M OR L 14 6 04- rolr49s Subdivision Lot # ` J Filed Map #q Date Filed Gentlemen: 12) i3) 96 This letter is to authorize D&AI / 6 L J ; `o At a duly licensed Professional Engineer � per or Registered Architect to apply for the required wastewater treatment and/or water supply mits) 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 Countersigne P.E., R.A., # Mailing Address Very truly y Signed: ftx- 14 RD A14W*4. State 9 `J Zip OS Q / Telephone: g4s--�r 1 � ,r94 (Owner of Property) C-/ 'Tirw6b�- &JZ ASS(XIMEb Mailing Address: PLnMPtry D9VBZPM� Ck(/ -p ZZZ GRALC- S State 11A Zip l05'7� Telephone: 914 - 6Z8' �,.2>5S Form LA -97 DIVISION OF ENVIRONMENTAL HEALTH SERVICES . - -_. _- �,.;.a::.,;.:.;ww� - «.•,r ..,ia.,. __..s�.a1,..,,:. .. .. .. - ,-V. .. r - -.o. r., -•.a: .wwa v...,. r..�. _ .. _ ...zc.. a.. _:'�.. AFFIDAVIT - CORPORATE OWNER APPLIICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: ho. lta,& Afdix P7, rf% v U &sue 4®7',t °41` I T represent that I am an officer. or employee of the corporation and am authorized to act for: Axe- Name of Corporation: �& uy Having offices at:2— r Whose Officers Are: . President - Name: - az K_ —Tvi � Address: — 11111 s v � • CIS _ �!► 's �_� Vice President -Name: L Address: Secretary -Name: _ ....._Address:.. Treasurer - Name: Address: ;W4 ;es • - • I Wiwi and that I am and will be individually responsible for any and all acts o to the approval requested and all subsequent acts relating thereta:l,4 Sworn to before me this 13 day of (month) 2� 00 ' (year) Notary P is racey A. B® " "LIC, State of Now YC 1�o. 01805081711 .a:ualified in Westchester CountV .Commission ftim July 070 ZO Form CA -97 Signed: Title: M - Corporate Seal with respect DANIEL I DONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road «��..� Y r Mahopac, N.Y. 10541 February 8, 2005 845 - 628 =7576 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Joseph Pavarotti RE: Revised Plans Timberline Estates Lot #5 Timberline Ct. Putnam Valley Dear Mr. Pavarotti: Enclosed are copies a revised plans for both the fill section and the trench plan for the above captioned project. I responded to your comments in the same order as they were presented in your Feb. 1 st letter: 1. The plans have been revised to show a slope of less than 15 percent across the sewage area. Please note that the difference in the horizontal is approximately two feet measuring across two foot contour intervals on a 30 scale would produce a slope grater than 15 percent. 2. The item has been discussed with you. 3. The location of the SSTS and well locations for lots 6 and 7 are shown on the trench plan. "he drairi•discharge -has -been labeled: 5. The rear on the property has, been regraded and a retaining wall is proposed across the rear of the property. 6. This note has been provided. 7. The minimum pitch for the PVC pipe between the tank and the first junction box has been provided. 8. Enclosed is a design data sheet. 9. This item has been discussed. 10. The proposed swale has been eliminated. 11. I have indicated lengths of trench which provides for the two feet of solid pipe on the plan. 12. A construction permit is enclosed. 13. The basement elevation is shown in the profiles. Regards, Dani . Donahue, P.E. Site • Sanitary • Environmental SHERLITA AMLER, MD, NIS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Daniel Donahue, P.E. 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: February 1, 2005 ROBERT J. BONDI County Executive Proposed SSTS renewal: Timberline Associates Timberline court (T) Putnam Valley, TM # 51.4-50.5 U� yiThis 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. 4" Slope of fill being proposed is greater than 15 %. The regrading of the fill pad on the eastern side appears to return to grade and then goes into cut �"ti k t'^ right after the top of slope edge. The required depth is not being provided over this area. Please show the proposed SSTS and well for lots 6 and 7 on the trench plan. lease label the footing drain discharge on the trench plan. cS! The basement elevation of 776 is proposed over elevations 10 -16 feet higher. The approved floor plans only show an 8 foot high basement. Regrading around the house needs to be shown and/or the basement elevation needs to be adjusted. • - -Please provide a note -in both the plan and profile view-that ROB -fill is -for depth -and grading: - �Please provide the minimum pitch for the PVC pipe between the tank and the first junction box in the plan view. Also, label the PVC pipe in the profile view (same as plan view). _91� Provide an updated design data sheet showing testing from 5/27/04. There is no field testing on the western side of the system. The proposed swale above the house is no longer being shown. Dr"'The trench lengths provided are not scaling to the labels provided and it appears the 2 feet of solid pipe is not being shown in the primary and the expansion area. Z.� A completed construction permit needs to be provided. 13r!Please show the basement floor elevation in the profiles. 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:ky Very truly yours, Joseph 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 LORETTA MOLINARI ROBERT L BOND( ' P.M. Hank! 0lmuor EYa aw DEPAlt'1'MHNT OF HEALTH ' t 0em- vaRoai; Bn:witer,New York10509 E2"M -ft1 B-11L (W) 276.6130 Yu(34S)278-7921 Nenay Sm Am (64?)276.65S6 WIC (667):76.6676 F6t(M*2764065 June 25, 2004 "Hy latm thafflrurbM (647)276.6014 Fm(667js7a -e666 Mr. Dan Donahue 120 Brockioridge Road Mahopac,h'Y 10541 It v.: 1'mpusuI SS1 S Renewal — Timberline Associates Timberline Court ('I') PuWala 4'a11cy,1'.Ai. 151- 1 -5(?.5 Dear W. Dopshue: . This office has received and reviewed B10 most 47cent sal of plans for the above mentioned project: We would ilike to offer the following comments for your review tied consideration. I. Fill plan has not been provided. i2. Fill needs to extend 10 feet horizontally past aiI trench eruls. 3. Side slopes are not 6hown at 1:3. 4. The wall is lees than 100 feat flour the propose, SSTS.. , 5. The. fill too of alope Is less than 50 feet from th,: catch basins. Alsu, catch basins should be labeled. 6. Ploaee show the proposed SSTS locullons fir ]ot,6 and 7. i 7. The roof leader dmin is running uphill co ttu LywcU. 8. Please provide basement elovati9n in both views. 9. The KOA being provided is tier depth and grading. Please note this in both the plan and the profilo view. 10. Please provide correct tax" number on the• ph —. 11. Please label the plastic pipe betwucu the tank auri first junction box. Provide size, type and minimum pitch. 12. Construction permit is not complutu (enclosed). ' i This office will oorl:7iuo Its rcvirw upon consideration of thu abovo rr mrioned comment .4 Please feel free to contact meat ext. 2157 if any ouestions miser Very tru t,' yvu,S. 06eph S. Pinvati, Sr. Assistant Public 14C01111 FWSIUar t C.. :i.... 1SP;0w • • *C1H1J,IWSNVHJ, INHWIDOQ IM0U dO HOVd ISHIId x0 : ss'znssx Wad : dQOW „8£,00 : dHls QBscivrld 9f7:£T 90-A1vf awil surss T/T SdOfid 9LSL8Z96. MOM TML- 8LZ -SVS rml H17VHH dO INHKJHdddQ AIMO0 WVNJfld M4VN Lt?:£T QdM SOOZ -S -Wr HIVQ NOINWN M00 ONIGMS SHERLITA AMLER, MD, NIS, FAAP Commissioner of Health LORETTA MOLINAIPI, RN, MAN Associate Commissioner of Health . Daniel Donahue, P.E. 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: February 1, 2005 ROBERT J. BONDI County Executive . Proposed SSTS renewal: Timberline Associates Timberline court (T) Putnam Valley, TM # 51. -1 -50.5 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. Slope of fill being proposed is greater than 15 %. 2. The regrading of the fill pad on the eastern side appears to return to grade and then goes into cut right after the top of slope edge. The required depth is not being provided over this area. 3. Please show the proposed SSTS and well for lots 6 and 7 on the trench plan. 4. Please label the footing drain discharge on the trench plan. 5. The basement elevation of 776 is proposed over elevations 10 -16 feet higher. The approved floor plans only show an 8 foot high basement. Regrading around the house needs to be shown and/or the basement elevation needs to be adjusted. •- - -. -. . =- -L-6.• Please- provi&a -no in both. the. plan. and - .prof ?e vie�%.that.ROB.fi11_ is.£or depth.and grading. _. 7. Please provide the minimum pitch for the PVC pipe between the tank and the first junction box in the plan view. Also, label the PVC pipe in the profile view (same as plan view). 8. Provide an updated design data sheet showing testing from 5/27/04. 9. There is no field testing on the western side of the system. 10. The proposed swale above the house is no longer being shown. 11. The trench lengths provided are not scaling to the labels provided and it appears the 2 feet of solid pipe is not being shown in the primary and the expansion area. 12. A completed construction permit needs to be provided. 13. Please show the basement floor elevation in the profiles. 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:ky Very truly yours, Joseph 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 CON If LTI N G'­!ENG1'N'E'--E-R-'9 Donahue. P.E. 200 Breckenridge Road Mahopac, N.Y. 10541 914-628.1576 TO . LZUTER 0)(F 7MRSUMM&R. - WE ARE SENDING YOU ❑ Attschsd L"J' Under separate over via the. following Items: G Shop drawings 0 Prints 0 Plans ,"J Samples ❑ Specifications I ❑ Copy of letter ❑ Change order THESE ARE TRANSMITTED as chocked below: 0 For approval 0 Approved as submitted C Resubmit __—.,-copies for approval M For your use 0 Approved as noted J Submilt—coplas for distribution C As requested 0 Returned for corrections 0 Raturn_corr*CW prints 0 For review and oomment 0 0 FOR BIDS DUE —19-- 0 PRINTS RETURNED AFTER LOAN TO Us REMARKS COPY TO --------- -------- 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 June 25, 2004 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Mr. Dan Donahue 120 Breckenridge Road Mahopac, NY 10541 Re: Proposed SSTS Renewal – Timberline Associates Timberline Court (T) Putnam Valley, T.M. #51 -1 -50.5 Dear Mr. Donahue: ROBERT J. BONDI County Executive 1� 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. f 1 Fill plan has not been provided: 2. Fill needs to extend 10 feet horizontally past all trench ends. �3. Side slopes are not shown at 1:3. �, t, ok . he well is less than 100 -feet from the proposed SSTS. The fill toe of slope is Jess than 50 feet from the catch basins. Also, catch basins should be labeled. Please show the proposed SSTS locations for lot 6 and 7. y 4— 6417 The roof leader drain is running uphill to the drywell. Or oi`h'ti Please provide basement elevation in both views. 9. The R.O.B. being provided. is for depth and grading. Please note this in both the plan and the profile view. lease provide correct tax map number on the plans. 11 ` lease label the plastic pipe between the tank and first junction box. Provide size, type and minimum pitch. Construction permit is not complete (enclosed). 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:cw Very truly yours, 2 oseph S. Paravati, Jr. Assistant Public Health Engineer _6 2. i PUTNAIVI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS 12E Pi' SHET:FOR CONSTRUCTZON`PEIt1121*1 NAME OF OWNER: ✓ i f{ re_ ' 11550C STREET LOCATION: r rl REVIEWED.BY: RM, OR, . SRDATE: f ay _ TAX M`AP#: (CONFIRNSD) 7 - ' - S� • S" Y /N DOCUMENTS Y N fREOUIRED DETAILS ON PLAN5 CONT'D? PERMIT APPLICATION LUL OUSE SEWER -'/t' FT. 4 "0'; TYPE PIPE. CAST IRON j CWELL PERMIT OR PWS LETTER (� ✓ ( NO BENDS; MAX BENDS 45' W /CLEANOUT PC=97 , 3 RENEWALS 4 aC LETTER OF AUTHORIZATION UU SITE NOTE (NO CHANGE)__--___._ --- . �_, DESIGN DATA SHEET (DDS) —"� FILL SYSTEMS �. �� CORPORATE RESOLUTION ( 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRAD SHORT EAF . (FILL SPECS / FILL NOTES 1 -5 PLANS -THREE SETS ( FILL PROMS & DZIENSIONS rT.SF, Pr aNS _ ?'WQ SETS (FILL IN EXPANSION AREA ( �VARIANCf: REQUES ✓' FILL GREATEI�,T9ANl FEET N 'U�'=-) CLAY BARRIER L LEGAL SUBDIVISION ( UFILL'CERTIFICATION NOTE ( SUBDIVISION APPROVAL CHECKED (�� DEPTH GAUGES ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOU PERC RATE VOL. L REQUIRED J o S `It DEPTH U(�CURTAIN DRAIN REQUIRED SEPARATION DISTANCE FROM'TOE OF SLOPE G NERAL THE �-- P�.,:.�:✓- y —•--- 3•�S � � FF TRENCH PRO_ED mss' �cn60FT MAX. (�(�LOCATED.IN NYC WATE 2SHED ;9L PARALLEL TO CONTOURS U(�LANS SUBN11TED TO DEP 0100% EXPANSION PROVIDED C�ELEGATED TO PCHD (�DETM0UDUST FREE CRUSHED•STONE OR WASHED GRAVEL b�6DEEP EP APPROVAL, IF REQ'D L2(_JGEOTEXTII'E COVER TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - ER- ON'SSTS (r jC�RCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. - APPROVAL SSDS ADJ, LOTS ' O FQUNDATION WALLS_,.____ (__) - TLANDS (TOWNIDEC PERMIT REQ'D ?) f 200' IN DLOD,150' D A ON DDS PLANS & PERMTT SAME TO-- ---O,E awn _ (� 1969 NEIGHBOR NOTIFICATION , . 0' O TCS BASIN, 35'. STORMDRAIN, PIPED WATEi ; UU ., BLZBA, = 200` 10 ' T ®CATER LIKE its - 0') 7ETTER YR. no ELEVATION W/I ( gp . INTERNmrrENT DRAINAGE COURSE �j ✓ SOIGTESTING LOTS >10 YEARS OLD 00'1500' RESERyOW, ETC. 150' GAIJ, Y SYSTEMS REQUIRED DETAILS ON PLAINS X10' M1N TO LEDGE OUTCROP SEWAGE SYSTEM PLAPi- (NORTH ARROW) SEPTIC TANK SSDS HYDRAULIC PROFILE LJ(J10' FROM FOUNDATION; 50' TO WELL (JGRAVTTY FLOW (t:D(,JCONSTRUCTION NOTES 1 -1S " C::JL I MENSIONS TO PROPERTY LINES gk�/l 4DESIGN DATA: PERC & DEEP RESULTS (�DOCATION OF SERVICE CONNECTION CONTOURS EXISTIlYG &PROPOSED (✓f (�LMIN IT TO'PROPERTY LINE Rmm4x& SLOPES, C,uT /�, I&I- SLOPE OOTING /GUTTERICURTAINDRAMS , *p "K) Lloh4(� �/ SLOPL IN SSTS AREA f 8�%SZO %) 5 REGRADED TO 15 %, IF REQUIRED TITLE BLOCK; OWNERS NAME ADDRESS S S N/f - TM, PE/RA; NAME, ADDRESS, PHONE# . DATE OF DRAWING/REVLSION L— )t- -.JPUN P NOTES . DATUM REFERENCE U(_JDOSE 75% OF PIP .V0 UME/DOSE VOLUME' NOTED (___)LOCATION OF WATERCOURSES, PONDS Ut-- )DE�AAGI CE:MAIN, (PIPE TYPE, ETC.) LAKE3,WETI MS_w_I rw 200' OF P.L. UL-- )PYT SHOWN &DETAILED PROPOSED FINISH FLOOR A ��x U Y STOR ABOVE S & SSDS'S W/IN 200' OF SST s (_ , L_ TANDPIPES, S' SIDES, DETAIL 1.� -564-7 15' ° 20'-4% 25' -3 %, 35' -1 %,100 % -<1% PROPERTY METE UU M 5�5 /o, , ��/,_/- ,)(,,- )EROSION CONTROL FOIt:HOUSE WELL U�--�2 to CD DISCHARGE/100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE 10' MIN to NON - PERFORATED PIPE ►MMENTS: .. • 'VSMET)0910vo0 WI k i dll April 6, 2004 DANIEL J. DO YL YJ111 Y / E9 I.E. CONSULTING ENGINEERS 120 Breckenridge Road 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 #5 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 construction drawings Comments: Application is for a renewal and name change fee filed under separate cover. Your prompt consideration would be greatly appreciated. Sincerel Daniel J. Don ue, P.E. Site o Sanitary o Environmental 5 \ °\ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - ", ., a .C€3NST- 'R- UC'FION-PERMITfFOR °S �'�E`T- tEA -TMENT S.YSTtM..h:....,.:; , ��PERMIT # 0 Located at '7�i,�',�� /°. / Town r Village Subdivision namer Subd. Lot # Tax Ma �— p Block _� Lot Date Subdivision Approved 11111q6 Renewal Revision Owner /Applicant Name 1 v kn 6 t:;,- z- Date of Previous Approval Mailing Address J- 6 Tof 4" '/`Z/G e- zip lei.. e Amount of Fee Enclosed '4; G3 d P'recff Building Type Lot Area 3, No. of Bedrooms _3 Design Flow GPD 660 Fill Section Only 1 Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by Water Supply: Public Supply From gallon septic tank and Address Address _or• _ Private. Supply Drilled b 'T 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 treatmentsystem 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. i Signed: P.E. R.A. Date lj Address �-v %�r�G •� .,-,� .P �'e� /�'lC,��,� ��. �y 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 permiy1pproved for discharge of domestic sanitary sewage only. By: 1W5Zd Title:PA6 l is IL-4-OJ-4�ate: --- - � -E-� -� White co y - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 -BRUCE Public Health Director S W 0 2- � ,, ." ° . - LOR'�'I'�` IvIOI;INARI�RN., M.S.N. -• . Associate Public Health Director Director of Patient Services DEPARTMENT OF BEA]LTH I 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: SITELO`=ON: DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: /.0 ;76 / /.:piP -2 9 f4eAAe 3, r' s e-4 /%44z-0 DOES THE PROPOSED 4ARIANCE REQUEST POSE A HEALTH IdARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? + - - -+ YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? e--S+ NO DISCUSSION REQUEST APPROVAL OR DENIE APPROVED R OF (SPECWAIVER) C HEALTH DENIED DATE: V u-16 -4 (=) —Text 12 PROJECT I.O. NUMBER . , :k... - .- Y,.. -. .s_ 81 %..ziv. »� .;.: ; ,:..:4 a . „� SEAR­,- . Appendix C State Envlrontilental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPL! NT ISPONSOR CA r Z �. / 2. PROJECT NAME r p L0 %� L'r � f� 3. PROJECT LOCATION: Municipality !r lid- County 4. PRECISE LOCATION (Streit address and road Intersections, prominent landmarks, etc., or provide map) S. IS PROPOSED ACTION: 0 Now ❑ Expension ❑ Modificationlelterseon 6. DESCR18S PROJECT BRIEFLY: C 0,qrj if 0 G ?l6 is Tr 7. AMOUNT OF LAND AFFECTED: D d �� Initially • acres Ultimately c acres 8. WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? XYes C No If No, describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? -••. •..- ! �•�- -- [— .�Industriat�-- �- �} Commercla !•'��'-`�Apncultur�" "� "`D Pirk7ForestlOpin a @ice ❑Other Residentla - Describe: 1C. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATkE ,,IR LOCAQ? t f1 1'1 Yes ❑ No If yes, Ilat agency(s) and permlVapprovals O !✓�`� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes [WNo if yea, list agency name and permlUapprovai 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes VJ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor �' d NI� a Date: name: Signature: v If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ®1 PART 11—ENVIRONMENTAL ASSESSMENT (To be completed by 4aencv) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN i NYCRR, PART 017.12? If yes, coordinate the review process and use the FULL EAF. n Yes RI No 0, WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.87 If No, a negative declaration may be superseded by another Involved-ageney. ❑ Yes >D.I Na C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING. (Answers may be handwrilten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for eroalon, drainage or flooding probiema? Explain briefly: CZ. Aesthitic, agricultural, archaeological, historic, or other natural or cultural resources; or community or nelghbonccbd character? Explain briefly: Na x IS C3. Vegetation or fauna, fish, sheilfish or wildlife species, significant habitats, or threatened or endangered species? (Explain briefly: / 0M� C4. A community's existing plans or goats as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly /V ,B /V C9. Growth, subsequent development, or related activities likely to be Induced..by the proposed action? Explain briefly. Cb. Long term, short term, cumulative, or other offects not idontllled in CI�M? Explain briefly. f /V C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. • 6 D. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? (] Yes ®No If Yes, explain briefly PART III-- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS; For each adverse effect Identified above, determine whether It Is substantial, large, importmnt or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or.rural);.(b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. It necessary, add attachments or reference supporting materials. Ensure that explanations cohtaln suff Went detail to show; that all,relovant adverse impacts have been Identified and adequately addressed. ❑ Check this box If. you have,14entifie_d one or more potentially large or slgnlficant adverse impacts which MAY occur. Then proceed directly to tit® FULL E49 ind/or prepare a'posltivadecliratlon. Check this box _if you have determined, based on the information and, analysts abgv #- and, 4ny s#p�gi ing documentailon, 4'hat 'the proposed action .WILL NOT result In any significant ad`versi environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of lead Agen � Print or TL ;p me of esponsi 0 icer`in in toad I It le of esponsi a Officer SiStature of es nit e Officer in Lead Agency Signature of repa r (If aifferent tr&t responst e o ice: 0) ._. -- W —C) 9 —0:?, NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and.Appendlx 75- A,1ONYCRR for Individual Household Sewage Treatment Systems rust M.I. i Name of Applicant / X, J . No. Street City/Town State ZP Address ZS/ JGll�J.y1 �T i� /erg d%,i -S 'u /O No. Street Cityfrown State LP t Site tocation 4-19, i lod 1. Reason why site does not meet t ONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance annot be achieved.. 1 ., Excessive. slope. J High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ... . ......... ...................... : ................................................ ............................. .... 2. Proposed design or conditions of waiver: ................... .............. .....,r."................. ..... ............... ......................,;......r ......... ................... ........... .. ..'............................ . ...........�................... �..........^...' ".... '...........T..�.��......... `,............._._... ....... r:.!°� ...... %!^ :E..,.�..�t................. �. �.. op 3. The proposed design may have the following limitations (check appropriate box(es)): J Increased risk of well or spring contamination. Increased risk of surface water contamination. - Expected design life of the system will be diminished. I Operation of sewage system is subject to mechanical problems. Other(explain) ................................................................................................................................ .................:............. .............................. :................................................................................................................................................................................................................. Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiver was granted. ..................:.................................................... ............................... iiEPRESEN ATI OF CO ISSIONER OF HEALTH ORIGINAL - Local Health Agency G COPY - Applicant/Design Professional DATE............ .......2. � ....................... ............................... DOH -1326 (7/92) (GEN -152) . PUTNAM COUNTY DEPARTMENT ®P HEALTH DIVISION OF ENVIRONMENTAL TAIL HEAILTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permrt # (� 1 ` 67. WeH Location: Str et Address: 607 illage Tax Grid # A� Map Block Lot(s)Q WeIR Owner: Name: Address: 41 Use of Weh: _residential Public Supply Air /Cond/Heat Pump Irrigation alrimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm `'°kd Est. of Daily Usage „. e d1 gal. Reason ffor Replace Existing Supply Test/Observation Additional Supply IDrill➢ing l,/New Supply (new dwelling) Deepen Existing Well Detailed Reason v -yak/ i' 011-11416,A for Driflfling Web& Type 1/brilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision / -t J�� �' Lot No. Water Well Contractor: 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: Ala- Proposed well location & sources of contamination to be vided on s arate sheet/plan. Date: /a-' �/ _ 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 4 Permit Issui Qfficial: Date of Expiration r "i Title: tai I ;c Permit is Non- Transffe rabde White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BATH" 3 DINING KITCHEN 101 101AI20 L 1V1fjG RM FOYER r L r WHEATLAND 27'x28' �, lea ist Floor L L BATH'C 2 k K89 RM 141 k K! I PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PT AlVQ ADDDAICTV A ju FOR BEDROOM COUNT ONLY, -3_BEDROOMS 3 Y. - /- S- /ay- 3--- ALL SUBSEQUENT REVISIONI ALTERATIONS TO THESE HOUSE .PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL )714, QTdlr,T m-- - ---- - st , r , (zed, HALL BED RM' 3 BED RK4. 0 2 1(tv 2nd Floor PENN LYON HOMES INC. Telephone (.717) 743-0111 Old Trail Road, Selinsgrove Pa. 17870 (L33HSA3) I :SIN3I4I'lOO Salaa3lYUomi o� mi ,oit ,�y� _ - -- a3=e�asrp ��p saoa Z8I :jLj �+a .O OT/3O OSI of t�I1I ,OZ�n 0� " � S 0 £SZ ` %tA ' %S< Q o; SQNilO$'II3a `sams .5'S dIdQrINISnn SI SS 30.00Z Wa smiss v sa lamc —) ) 0 Sl,IOLLYA3'I3I93I43SYa IAi?IM 3AORY 0 OIs xya imn atdY HOO'I3 HSIt�3 Q3SOd0Tid7)i� Q3'IIY1.3Q,P S a-Q Ql�IY ZidC�n . "I'd 30100Z NM M& SQ11Y'II31h`S33IY'I ('0I3 `3dxL 3dId) ` 30 3 O3'IIYI3QC�C� SQl1Oa'S3S2inooa3IYM 30 h0IIY0o'I(—)� • 3J)132i3332i I411IYa�)(T) (3dAAI 3IAWIOA 3SOQ/3uIl1'I A d a %SL 3sOQMn )dOISIA3Zi/9t.TIA1Y2iQ 30 3Z�'Qi —) s3 ON aluamC--) ;3uoHa'ss32iQaY `3I4IYld Yu/3a'rTNI s As so smaaY 3Iti m su3alAlo �xooaa 3m.L( —)C17) a321Il bau AI %si 01 aaard 32I�P� LSS �,y.� sm -ayam. Oa 3 Ai ii0S Yasilmc;"-) ( %OZS�'�S/- h /Y32iY S. AI ao ist J(�'' . ° :. S3. II' �IiQl SI�i .L�illJRi31.Li1J /92�.L003C�� oZS _ im 'saaoZS ,0xwAiuu Q( —)( mu'i AI23aoIa O.L.51)mnc - - -- Q3s ao V OhS' Oa'Oo ,zC� uOL VKOO IDIA2i3S 30 NOIIYOOI s17sax -d33 ouaa :YIYQ!aisaam 7) 0LSxl0ISH314TIQn� - 51-1S3.LOmNOi.3fl S'OOnG-7-) TIM moo mAY2ioMC7) 'T' as 01:.0S `•)1OLLYQldl1O3 wo'd3.0IC�� HgHO2id 0I'IllY2iQM S(jSSMC]) d 3OQ3T o L t�IT1,oiC.�, (/� (MO2RTY EZ2iON)-AIY'Id I13ISXS 3�JYA13SC�� SI�I�ISxS x3'I'I�'0 ASI '0I3 `2IIOA2I3S32i AOS /,00Zt )n sylviaRo suvlaq Q331!] 3SUf1OO 30Yl.'IYUQ Iu3IIiI�'2i311.'I _ .. - _ -- - - - - .. .._.. _ ...._ ... _�....(.OZ•° 7Id'}Si�' I fi'2�3�.Y/�1Oi �0i�' - �.,i :0-- Z IM3 hOZ_ - 3.dQg0ZOQua �- .i!3AI.I,.3Q;'iP�- Id'SuSS '.S£'�Sa HIYORR i3IYAi Q3�( - - �OIL�J _ O3H9I3N 696T 32id�C� (umdza •Zmq) 3�M RnMOOUa.LYlA I lYTalS 0.L ,001 `�° - , - • _ - _3itiI'YS- - 1,: ; ��.-'. � - 7d- SQQL ?:0 dZYCii —i� Slid OZ .OST `QO'I( t.�I ,OOZ `Z'I3M OI ,OOi �7) (LQ�a32I ZII ,KMOI) SQ?�in.Lah�l- )C� 3'I'IYa NoiIYQmoa OZ ,0Z(_ M SIO'I `faY SQSS TYAOuaav xa(�) . Tlu 30 dO.L's332Li a!),ay I `xvmaARia'Ta OZ ,OTt �C� aaSS3.gnm 38 01 Souaam- S S Wou - Ryla No MRvisia AO 3S a3Aaasa0 S3'I0H LS3.L d33Q UaAO3 3'II.LX3.LO39Mn Q,a3Zi `'IYAO2iddY d3QC- _. . 3 Q3iYO0 I ) -'I3AYU0 Q3HSVIA 1 0 AOIS Q3HSIliO 3313 LSaarHYI'la -y Q Y5, 31 (laMAOid !,oisNvaxa %OOII� 1 d3Q Oi Q SOIKIOO OI Z3'I'�dyat QH�3 !I 3210.9 a3QAO2d ROOM .111 �� PIYU3211130 -� Q32II lIa3'd!.'IY2iQl.'IYI2IlIJ�/ C� 3dO'IS 30 3OI I1IO2id 3OldYISIQ l:0IIY2iYd3SC-7 HId3a Q3231abra'I M Sf1O 33 �z"�"Q3T�ssY~IJl�t[1`S'.OZi 2io�.t3`�isi \o= 70;�(�(� 3IYZi O2i3d Q33IO31�'IYAO2iddY \OISIAIQai1SC�Cl3 �'' � pe, f�,ry °� �S►.��"� 3I ICI l�OII�3I�2iY� � �J n� \OISIAIQfit1S'ItO3T�� AO Q S ell Y32IY l;Olsgyaxa ,Q ,i II3i�n IS3Aa3?i 3O1�zuYAC7�C� i S�'8 aliao2id'I II3C� SI3S 0 411. - S \T�' Id 3SAOHc7( SE`S _ . IR /SO3dS'TI Jmc;;;) SI3S 332 L-S!��TdC�n 3Y3 I2i0HSn� 3Qt'2I0 OI i £ 53dO'IS H0N32i� - - : I S�d'd IYi2.OZRiOH ,Ot( momiZOS32i 3.Lyu0auOO�C� Sly • S Z (SQQ) .L33HS YIYQ \OIS3QC -X;/-) (3011tH0 OlJ 3I0 \ 3 IS KOUNMOEIJAY 30 21311 IC -(%i S M l/ L6-Odn(7) .I.fl0ISY3'lo /A10Sb Sa.'13a X'YI1I SQ_kl3a daii 'I SAid210 IIIkma i iakk C7'1 AOM ISYO 3dla 3aXI'.O..t- 'Ld /, -2i3A13S 3SlI0H(�C� !�OIIYJI IddY ZIII'2i3d(��i 00 S. Z 1�0 S I 3 Q32IlIl 3 \ X. S I L JOQ \ A 3IdC S `sd ',do !\Tu :XH Q3.U3 Ta .1\OLLY0O'I I33uls -. / •2I RIAO 30 3l%7vl1 _ -- -- - .. .. .. - 1IIt2i3d l:OII�f12iIS \OJ 2IO3 I33HS ri13IA32i ,y SI43ISXS L!`3I�1IY32iI 3OYA13S 3OYd2illSaaS T x'Iddl1S 2I3IYA1'IYl1QI UQ. a. S HI'IY3H'IY.L \3IC\OUM3 30 l.OISIAIQ May 3H 30 .L. \3I4I2IYd3Q XIKfIO, IIIYAIIRa J'' I Public Health Director .. .... -- `:- •LORI;T"fA M0i;I1QAf�i`1t.N',, °M:S.1�: .. Associate Public Health Director Director of Patient Services DEPARTME NT OF HEALTH 1 Geneva. Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax(845)278-6648 March 22, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Proposed SSTS '- Gizzi, Timberline Court, Lot # 5 (T) Putnam Valley, TM# 34.4-5 Dear Mr. Donahue: 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: The deep test hole data listed on note # 16 does not correspond to the data provided. Provide erosion control for the well. 07 Fill note # 3 is incomplete. Provide depth gauge detail. _._Provide fill. volumes for R.O.B. fill, unclassified, and-impervious. . . 67. w.. °The dkistirig s16pe approaches -19 %. Curl eiit'cod`e`s al'l'ow for tie constiucfi6n of a SSTS­ n slopes less than or equal to 15 %. The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, 5� e P '— Shawn Rogan Public Health Technician SR:cj Q 6 *C ODNNSUL M' ENGINEERS itr Daniel J. Donahue, P.E. 200 Breckenridge Road oATE ,00 No.. Mahopac, N.Y. 10541 914- 628 -7576 ATTEN ION TO WE ARE SENDING YOU Attached ❑ Under separate cover via .the following items: • Shop drawings Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ THESE ARE TRPNSMITTED as checked below: IV UejQr approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ _.._ ❑ FOR BIDS DUB, _ i r IMM ❑ Resubmit copies for approval ❑ Submit' ' copies for distribution ❑ Return corrected prints 19 _ ❑ PRINTS RETURNED AFTER LOAN TO US Pte+' f ® , aqe� ILI COPY TO SIGNED: L_ DESCRIPTION - i f b' ��� `�✓v ,f y � I er t THESE ARE TRPNSMITTED as checked below: IV UejQr approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ _.._ ❑ FOR BIDS DUB, _ i r IMM ❑ Resubmit copies for approval ❑ Submit' ' copies for distribution ❑ Return corrected prints 19 _ ❑ PRINTS RETURNED AFTER LOAN TO US Pte+' f ® , aqe� ILI COPY TO SIGNED: L_ Public Health Director G _ .�. LORE'tT1 1GIOI.INA� Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva. Road Brewster, New York 10509 Environmental Health (843) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (84S) 278.6678 Fax (845) 278.6085 Early Intervention (845) 278 -'6014 Fax (845) 278.6648 March 22, 2002 Presebool (845) 228 - 5912 Fax (845) 228 - 6113 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Proposed SSTS - Gizzi, Timberline Court, Lot # 5 (T) Putnam Valley, TM# 34. -1 -5 Dear Mr. Donahue: 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: The deep test hole data listed on note # 16 does not correspond to the data provided. Provide erosion control for the well. Fill note #B 3 is incomplete. Provide depth gauge detail. Provide fill volumes for R.O.B. fill, unclassified, and impervious. .. _ . ....,.... . eieiistitig.slope.approaches 19 %o..Current codes. allowfor- the construction- of- a- S-STS" on slopes less than or equal to 15 %. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission revised to reflect the above comments, this application will be considered hirther. Sincerely, 'P Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF-ENV ._R 0-NMENTALBEA-LT-RSERRVU DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) 0,r -k�4 "'Ier lle� 24 Tax Map Block' f LoL5�- indicate nearest cross street) Municipality, A, t", 414 Ile Watershed /IVA- SOIL PERCOLATION TEST DATA Dat . e of Pre - soaking 31 /2h Date of Percolation Test 311-21,10 ..... . . . I e 0-- Na ro . ..... . e ki BoU.N6. 1111. 0.: ;-Timv OD Apse. illie: u agace c S op: nc 33 VY. 2 .3 j. 0 Olt 02-1 5 2 6yZ 140 '2.r 3 1P /0 -3 4 k lb /0 r 9 5 • 2... % �� i� 3 ��i� /� /z "3 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. :5 1 min for 1-30 mWinch, :5 2 min for 31-60 mWinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. TEST PIT DATA � DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES 2 3.0' ' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' rn 6.5' 7.0' - -- - - -- 7.5 r 8.0' c1> W Indicate level at which groundwater is encountered Indicate level at whicl.mottling.is.observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name:,)-- w",C',/ I Da j!5trr Address: Signature:- Design Professional's Seal Q�oFESS�o; %q OF- nI E \� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISI OF-LN -ON. YTRON. MENTAL -HEAL TH-SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM ONN,ner J&1A z r Addressao/ ,'e Located at (Street) '//Jj 80Xk11*X?. Tax Map ,)-f Block Lot indicate nearest cross street) Municipality indicate AIA,14-10Z Watershed 1i4e-e 04-c-"r SOIL PERCOLATION TEST. DATA Date of Pre-soaking ZdZI&2 Date of Percolation Test rom roun d P"" a e r .,eye B616. ix: .... .. .........5 T AJM t! .. . ... ... . �to .. e. 'me': n u ace . . . . . . . . . . . . . . . . . . . . . IP 1,6 2 or Oil- 3 We 740 2- 4 5 2 3 .2 ./J0117 4 o2f) 5 3 4 5 NOTES: I Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. -5 .1, min for 1-30 min/inch, < 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. TEST PIT DATA. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH -HOLE NO. HQLEN9 0.51 1.0' 1.51 2.01 2.5' .5. 3,01 Design Professional Name:,0XWtez Address: Signature:.- Design Pirofessional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR ,. mA WAST-EW;ATEl TREAD'- EMYS-YSTEM- .:. 1. Name and address of applicant: J AWIV 6t 2 ->— , 2. Name of project: SIW,4 ,f ri "/t, r d F t 3. Locatigov: C Aii!Al 8c. 4. Design Professional:11Ay /eG Z)o*4 v6 5. Address: /.lo ,tftP c•��•v,t��paliv� 6. Drainage Basin: d e— wlfAl-:,e A74, 000^ AW y 7. Type of Project: _ Private/Residential Food Service —.Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? .. Type Status check one )......... '' .. ........ Type I Exempt Type II Unlisted _.y 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10.. Has DEIS been completed and found acceptable by Lead Agency? .............:. Allef. 11. Name' of Lead Agency a! /� 2.- 'Ys this eject in an area under the, control of local planning, zoning, or other officials, ordinances? ...... ............................... r 13-..I�_ _ ..� ....................................... _ _... so, have plans been submitted to such authorities? N o 14. Has preliminary approval been granted by such authorities? Date grinnted:' 15. Type of Sewage Treatment System Discharge ................. surface water _groundwater 16. If surface water discharge, what is the stream class designation? .................... iil /�► 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ..................... If yes, name of water supply ,- Distance to water supply 20. Is project site near a public sewage cbllection or treatment'system'� ......::....:,.: Ald 21.. Name of sewage system,- ' ' 'R', , ' /��` Distance 't "o, §ew,4ge 'system 22. Date test holes observed 01- _ 23. Name of Health Inspector H 24. Project design flow (gallons per day) .......... ...................................................... OfJ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... �o 26. Has SPDES Application been submitted to local DEC office? ......................... ig /.�► Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? n/6 -:2S: Wetetlatidi -I•D Nuinber� ::...................:....... .......::............... ...:...:........::- �::aw...:.., 29. Is Wetlands Permit required? .:...............:............................ ............................... /V e) Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream-Disturbance Permit? .. ............................... &(2 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? ............................ YesM 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes 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? .........................:...... ............................... /y 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 11N6 36. Tax leap ID Number ...... Reap Elock_J_ Lot )'2, 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE_: Affapplications for reviee� and approval of ngw SETS to-he located with the NYC Wat d;*U _.__.__ 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 farms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application trust be accompanied by a Leiter 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 9his form is true to the best of my knowledge and belief. False statements made herein ape punishable as a Class A misdemeanor pursuant to Section 210.45 of Flag Fend Law. SION TURES & OFFICUL TITL'ESe Z) 4mIe c- a4,Pf y ' Railing Address :.... ............................... ri CM BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva. Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 March 22, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Proposed SSTS - Gizzi, Timberline Court, Lot # 5 (T) Putnam Valley, TM# 34. -1 -5 Dear Mr. Donahue: 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. The deep test hole data listed on note # 16 does not correspond to the data provided. 2. Provide erosion control for the well. 3. Fill note # 3 is incomplete. 4. Provide depth gauge detail. -5_._ Provide fill volumes - for- R:O -.B:•fill; unolassified; andimpervious: - _ - .._,_.... _.__....:._.._........._....... 6. The existing slope approaches 19 %. Current codes allow for the construction of a SSTS on slopes less than or equal to 15 %. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. �y Sincerely, Shawn Rogan Public Health Technician SR:cj _.._ ... _ SENDING CONFIRMAiT �.a :a.' .y. >� r' � � _ . �-r. .s.•r .., -.� S --Y .uv .,, >'•- e....w ...a >_1 = ..a-.r »v+rv.y rs«. .,y.. ..::'..sY: �V^ -'C K'.v. ,- .�..7 .. -_,n DATE : MAR -25 -2002 MON 02 :25 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96287576 PAGES : 1/1 START TIME : MAR -25 02 :24 ELAPSED TIME : 0013411 MODE ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... , O BRUCE R POM k Lola PuMk N6aMr Dbvdw M DEPARTMENT OF HEALTH eneva Ro ] U ad Hr,,'W, New York 10509 RsWr.s.rsb 11.1/, (WS)276.6130 Fa(MS)276.7921 M.rd.aarr.ka(s15)27s_6S56 WW(M)Y)1.6676 F.(NS)27s -t Zarb1aaner§m.(6r5)279•6014 nn(MS)2784648 March 22,2002 9re+ea.1 (945)2n -5912 9.(913)220.6113 Dan Donahue, PE 120 Breckenridge Road - Mahapac, New York 10540 ; Re: Proposed SSTS - Gi72i, Twnto M Putnam Valley, T.f# 34.-1 Dear Mr. Donahue; Review ofplm and other supporting documents submitted at this time rel regarded project has been completed. Comments am offered ed as follows: 1. The deep test hole data listed on note # 16 does not correspond to d 2. Provide erosion control for the well. 3. Fill note # 3 is incomplete. 4. Provide depth gaugo detail. 5, Provide fill voltmmes for R.09, fill, unclassifrod, and impervious. 6, The existing slope approaches 19%. Current codes allow for the cc on slopes less than or equal to- 151A The construction of this sewage disposal sysrem may be subject to local wt You should contact local wcWmds officials in this regard. Upon receipt of a submission revised to reflect the above comments, this considered flndter. sincerely, Shawa Ragan Public Health Toclmie• SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at A� %� S �r�' f� ��.� �;r� �' T" T/V &CS ni //� /IlTax Map # Block Lot Subdivision of AeOv. C Ly, A/fz' ,J"/I'/' Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize ' .0AV..e -,9 e c/ Dv a duly licensed Professional Engineer l-'-or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity ..with- ft: provtsions.of Article:.4.5._.and /.or 147- Ah�e.Education.Lawy'the -Public Health Law, and the Putnam County Sanitary Code. Countersigned40*e� P.E., R.A., # C Mailing Address �yo'ot/'50e. State ! y �7 Zip _ e Telephone:, % Very Signed: (Owner 2-01, I AAw VAIII yir U NY_ r2S State Zip_ �i[ - o Telephone: - 3 G O0 Form LA -97 �D DANIEL Jo DONAHUE9 RE. o tezI CONSULTING ENG MEEK 420 BreckenridgeyR 62d 4i. _ v . Mahopac, N.Y 10541 845 - 628 -9596 December 4, 2001 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Adam Steibling RE.: SSTS Permit & Well Permit Property of Gizzi Timberline Estates R. S. Lot #5 Putnam Valley Site o Sanitary o Environmental BRUCE R. FOLEY Public Health Director January 28, 2002 DEPARTMENT 1 Geneva Brewster, New OF HEALTH Road York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: Re: Proposed SSTS - Gizzi, Timberline Court TM# 34.4-5, (T) Putnam Valley 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot,.percolation tests must be witnessed by a representative of tlus*Departinent. _ -- ._,.__ _..,_....._._... 1. The design data submitted relevant to the above referenced project is fourteen years old. Please contact Gene Reed at ext. 2261 to schedule the witnessing of percolation tests on this lot. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely; Shawn Rogan Public Health Technician . SR:cj ❑ Daniel J. Donahue, P.E. 200 Breckenridge Road Mahopac, N.Y. 10541 - _..... - _ .. 914 -628 -7576 TO S WE ARE SENDING YOU I Attached G Under separate cover via ._..._the lollowing items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples C Specifications ❑ Copy of letter ❑ Change order ❑ once JOB No. '---i1 ATTENTION PE 1 COPIES DATE NO. DESCRIPTION ve .I THESE ARE I MARfSARITTED as checked below. ❑ For approval' ❑ Approved as submitted V Tor your use ❑ Approved as noted ❑ As requested C Returned for corrections ❑ For review and comment Cl _ ❑ FOR BIDS DUE 19 REMARKS 14 • Resubmit copies for approval • Submit 'copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US �9Pj t® S%Q%ED-. f M C3�R L� / Oc t � oso� 3D v� Cap)' f z � L4 , C o � o � cl V R¢. c r�,3 5 &off v L I ris 3 r SSTS TIE - INS (MEASURED BY TAPE) / UNIT A B LENGTH OF TRENCH SEPTIC TANK 15 i , 56 JUNC. BOX 1 33;:. 47 2 37; 51 3 42 54 4 47r: 58 5 43 102 58 6 47'- 104 59 7 52 t 108 60 8 59 112 60 9 83 ; . 27 55 10 85 33 55 11 87 ; 38 55 y: is ASBUILT PLAN +. SEWAGE TREATMENT SYSTEM' Property of TRABERLINE ASSOCIATES PUTNAM COUNTY DEPARTMENT OF HEALTH j TIMBERLINE CT�.1 DIVISION .'F Eid RONMENTAL HEALTjH SERVICES. TM# 51 -1 -50.5 PUTNAM VALLEY � 501 -OS —019- APPROVED AS NOTED FOR CONFORMANGE WITH DANIEL J. DONAHUE, P.E. tei ��' 1' APPLICABLE RULES AND REGULATIONS OF THE CONSULTING ENGINEERS PUT A��1 COUNTY HEALTH DEPARTMENT. 120 BRECKENRIDGE ROAD MAHOPAC, N.Y. 10541 ( o D 628-7576 �T No. 4�a�� ! IATURE & TITLE ,�j� DATE MAHOPAC, N.Y. 10541 q�� OF /`ice t DATE: JANUARY 16, 2006 —� SCALE 1"= 30 ' S'ff Z SURVEY BY: ROLAND LINK. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE Tr WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WTTH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW.' YORK STATE DEPARTMENT OF HEALTH