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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -50.8 BOX 21 a I 1 -1 - or, -it-No, � IM 1 L 1'L rd UL 02491 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • --- ...... ._..•,i :.rv.- �- -r.... -. v., a. ...__r .-.n �.y.c. _.= v^,..,.e ..- ....- � -. r.. • -. . ,: r _. -__�.. ... �. ,..,w -� n..,.... -:.. e-a.: a o-eq�•yv -sw.. n•.,: ., -. q:. �.. rrn -. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # - Z2 G /�/ I vQ //. Located at `�%f/�,Q`� G� Town o Village �y,���i -�� Subdivision namerjr �7B �jP L /i[/,�`o "d. Lot # Tax Map ,f'-% Block Lot Date Subdivision Approved ��� Renewal Revision Owner /Applicant Name "7//7,QM liZA,( � ^L Date of Previous Approval Mailing Address e�-t Q �'�e� G��i c�T �r/�f ��-��' /% Zip Amount of Fee Enclosed Building Type v_ Lot Area J No. of Bedrooms -9/— Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System , to consist of Z_j gallon septic tank and Other Requirements: To be constructed by % %� Address Water Supply: Public Supply From Address or. Private Supply Drilled by -1 � Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address ®r. - .� �r • 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/rmj. Approved for discharge of dom tic sanitary sewage only. By: Q 6'1�� Title: '�� Date: I v Wh' opy - HD File; Yellow copy - Buil ding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PgJTNAM COUNTY DEPARTMENT ®lE HEALTH DIVISION OF ENVIRONMENTAL HEALTH H S1ERVICES A 1PL){CA7C��l�i. 7[ _ CONSTR>I, C'� ?,�:�?Y.,�'II ER W._.�-ILLI _- please print or type PCHD Permit # � Well Location: Street Address: To Tax Grid G-�' gyp //.I Map Block / Lot(s) Well Owner: Name: Address: 6 '�`T d�dRTGs� Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation Primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �gpm rved Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply gDiriWmg New Supply (new dwelling) Deepen Existing Well Detailed Reason ems &T / ®O N e—Ile for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .............................. :.............. ............................... Yes_ -No Yes N Is well located in a realty subdivision? ...................................... ............................... C� Name of subdivision :rj ae 4,11g tf Lot No. Water Well Contractor: X73 D Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Al 14 TownNillage Distance to property from nearest water main: � 14 Proposed well location & sources of contamination to be pro ' ed on separate et/ Ian. Date. --Applicant Signature:-- - . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED' FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issuing Official: - Date of Expiration "7 o Title: S,S ��_Pu b ke: f e_,,1 Hn itW i.'u�4,r- Peirnmit is Ikon- Tiransffer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 C0N19-UtT-1NG-- 'E'N- GINME49 200 BreckcrtAdse Road Mahopec, N.Y, 10541 914-629.7576 . TO 14--i2t--44--f�o�j -[LF'GTTf[ER (D[F Aft ATT11"Y' A WE ARE SENDING YOU 0 Attached 0 Under separate cover via. the following Items: r - Shop drawings 0 prints 0 Plans .0 Samples ❑ Specifications 0 Copy of letter 0 Change order 0— THESE ARE TRANSMITTED 'as chocked beiow- ..... .. ❑ For approval ❑ For your use E; As requested 0 For review and oomment 0 FOR 61011 DUE REMARKS COPY ED Approved as submitted * Approved as rioted * Returned for corrections C. Resubmit . copies for approval ,J Submit copies for distiWicim 0 Return --corrftted prints C PRINTS RETURNED AFTER LOAN TO US SIGNED. PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -;APPLIC;ATION --Tn CONS'I'ISILT-C-T'-.;,,�- WA -T-ER please print or type PCHD Permit # -Pt� Well Location: Street Address: o illage Tax Grid # //e Map r� Block Lot(s)4 -6.1P Well Owner: Name: Address: �l7i3r'�1'vr,✓! �, $:-r �-J ("."t t-c. C � .-�% Sf ,�s /�'��J' i'� �t% U off Well: esidential Public Supply Air /Cond/Heat Pump Irrigation - irim' sir y Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Anaou ®t of Use Yield Sought gpm ` e Est. of Daily, Usage , 94 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 'r f1Lr,w tyrirD i� -,'✓'( r- ffo>r Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ......... ............................... Is well located in a realty subdivision? ............................ ............................. Yes No .� Name of subdivision '" j � '"� -�� Li '/ 1 ` 1� ' 1'' Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No/--' Name of Public Water Supply: /4///- . Town/Village Distance to property from nearest water main: NZ—/Z Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: ��' �° .Applieant-gignature: 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 Permit Issuing Offici Date of Expiration Title: !� Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . H ._..,�.__ :.:.+.•li+csJw..,v.. .�..orq.T.r c, au.>r v.- , -. .. - :.rF.rR. ..;W......o.?..;.....w - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 14, 2005 ROBERT J. BONDI County Executive �.... _a..:�ea:w...�.r..r.> +.T...en,� �..r�- ca•w....:'.... -� t, ;. ?R.^n...:Opy:, :. -i..� a .. ..< r. .. - DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mr. Dan Donahue P.E. 120 Breckinridge Road Mahopac, NY 10541 Re: Dear Mr. Donahue: Proposed SSTS Revision — Timberline Associates Timberline Court (T) Putnam Valley T.M. #51 -1 -50.8 This office has received and reviewed the most recent set of plans for the above mentioned n pfroject. We would like to offer the following comments for your review and consideration. Please clarify all field testing locations. Locations shown do not match locations shown on renewal. Include testing from subdivision, new peres, new deeps, etc . . All trench lengths should scale exactly to what the trenches are labeled. Also, all trench lengths shown need to include the 2 foot solid pipe after the junction box. This includes the expansion area. --3"If the length of the jnnction_box and the 2 foot solid.pipe are added, the expansion _,_ - trenches may not -fit -.-• Aiso, part of the primary may not fit once the scaling is corrected. -lease rotate the septic tank 90 °. There is no outlet on the side of the tank. ease label the plastic pipe between the tank and first junction box (plan and profile). .ff . Show the house and the house elevations in the profile. yThe ground elevation over the septic tank is 664 feet. The profile has the invert elevation /into the tank at the same elevation. Please verify. ,.8". Please provide design data sheet with deep hole descriptions from field testing on May 27, 2004. 4. The Two o sets of floor plans need to be provided for review. . P fill requirement in note 17 and the fill section detail should be removed. 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. Ve truly yours, ,e-1 Joseph S. Paravati, Assistant Public Health Engineer JSP:cw 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 � 1VINGx� mss. va r 200 Srocksnsiagc Romd ®° - Mac, N.Y. 10341 TO 4TfHCaflbd WE. ARE WADIM ,YW C Aftchad 0 Unor sopersto cow pia �� tees: ® ffi9oo Jdn* Ci Prp� ® Polls C Boss p cm, !o Imov O Change ®rdtsr O n4fig ; off T S1a6TTFa as chac :... � . _ . _. ...... Co" To � Ido: � 1 -. ,. T.,.,..,.�..„,,..;a - . . ,:._:_... Q.,..a?ia�tdl•1;14on�uo, P;L;' .:�,r. <:� .x - .�:•' 200 Brsckcntidro Rood Mitwna, N.Y. 14541 91a.61!•�376 TO OVA G Av `L has W. T . WE ARE SENDING YOU C Atfatho C Under soparete comer via ,....ths fW wft items: 0, 4h" 01"Arlp . C1 Prints O Flan$ C Samples O tpec"10"i ." D Cady of wn4w O Change or"r O TPIESE ARE TRANSMITTfO as chec8 bsiou►: _ -- -..� _ ._._.._..._,.__._._..._..._ _........_..._ _..._.._.... -. _,. _._._ ..__.._;..___:: 61 or approval Q Approved as submthed C) Resubmit _..._.,oaples for approves N C) For your use Approved as noted O it ._......=on fbr d C b rap04" C For wow* and Comment 0 Returmol W corrections Q Rrtun+ aoraeted Priem C D FOR BIDS DUE t9 _ C PRI14TS RETURNED AMR LOAN TO US REMARKS I COPY TO SiflNED: A ".y.. wrab goo d *a". . 0 PUTNAAJ COUNTY DE DMSjqW0F PAR N -OF TME . I ENVM HEALT14- NTAL.REALT S P %Vj DESIGN DATA SR HT . C]ES -OUBINURFACES& GlITUA . WA Owner I.. TMEN'T SYSTEM Addre'ss 0/ Located at (sireet)- Tax Map �— Block -Y— Lot (indicate nearest cross street) Municipality P6-jV.4-* Watershed. - C-f w4,,oax hb ge46e SOIL RUMT A-rT Date. r% ON TEST I DATA Date of Percolation Test d -2— 7" Z t t e 71 U O M U. ta 30 Ap— 13"2 2 01 34) 02 3 C� 3 0 4 5- 61 d /YA- f 01 3 V& 3& Al -2 4 3 4 5 NOTES: 1. to be retreated at same depth until aDDr0XJMatelV Mal percolation rates are obtained at each percolation test hole. (i.e. & I min for 1-30 min/inch, s 2 min for-31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Prr DATA oUNTERED I.N TEST HOLES DESCRIPTION OF SOILS ENC DEPTH 110LENO. / HOLENO- U.Lj- 0.51 2.0' 2.5' 3.0' 3.51 4.0' 4.51 5.01 5.51 6.01 7.51 8.01 9.01 9.5 10.0 T& FS 6 A Lbw HOLY NO. 2 Indicate level at which groundwater is encountered Indicate level at which mottling is. observed Indicate level to which water level rises after being en'c'ountered Deep hole observations made by:, PAM P,4 V& Date Design Professional —Name: --- Do A1,4 A —jF Add„e IX & felv ow to �,PK 0 P13 0 ,is: 0,�F-s -i- F 0 Design Professional's Seal rn ,14 op signs ttup-r- CO 0 Design Professional's Seal rn ,14 op PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a. �... -w., .. o.: •; r.�. .: •a.� -. ..,,, -. .. .. .._ .... ....... .. a . - -. .-...a .r..._... ... s....�... .a..._ ... ..... .. ..< Nefy��.. ......., ... <. ._.M_ -. .ac. .w .m�u' ^.:.F.a �'— C�•_Or - ._.- �...�:�..at�A'c•��v: rx_ -.an �._. ... .. .- ... .. .. .. AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: ftp„ 114AfYJh P70% r rrr r (;&k4. 40TS 41-f i represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: -J 1&nLb LL(, Having offices at: 222-- r Whose Officers Are: President -Name: - 1aLLK_ �N � Address: 1bk0 40ka Mow Ckwe 010^1 t�",3t1VMbQj W4 Vice President - Name: 7bfV Address: 152D 4?L t� � b46,6 CAe�l_ Secretary -Name: _.. _. � _ ...... � tiddress: ....... ............ .....w. - ...... _. �... , • _ . _ __....:_..:. __�.y_:.:�.: � ......._.. .......... ,.. ....:.:._ ... _. PC Treasurer - Name: l ISl S and that I am and will be individually responsible for any and all Wthe ation wit h respect to the approval requested and all subsequent acts relating theret Signed: Title: M0 4W- "f LL(- Sworn to before me this 13 day of RJAI' i_(month) 2-001f (year) Notary P is r- racey A. 80 �LIC, State of NewYC iqo. 01805081711 ..«,alified in Westchester Cou - Commission Expires July 07, 20, Form CA -97 Corporate Seal A IN �°u,. ♦9 aY r i '4/t% C `�' t tr � ;' �'< *�,, # � � e ��/ � l,� k � �,� 3 i CERTffFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM � PCHD CONSTRZJCTI ®N REItMaT # _ -/ Located ST /me ���i� � G'�" own r Village 4.1'A4. 1141,110z Owner /Applicant Name` //"?R Z i/i1����f � c Tax Map � Block Lot Formerly Subdivision. Name'% //7Rar? b11V I gS'j% ' Subd. Lot # Mailing Address ,--J- d- 0�g S' /- & 1Y 44 -J Ai:, Zip I Date Construction Permit Issued by PCHD - 1jew Separate Sewera,a System built bylA'2�- Address —ev, Consisting of Gallon Septic Tank and -2y , /G D I' Other Requirements: Water Su Nly: Public Supply From. Address ore Private Supply Drilled by Address ,�,�� % //% ... - Bui -T Type - i k � Has�eroston�eontrol been completed? ° � • "� Number of Bedrooms !!f' Has garbage grinder been installed ?. /`lei` 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 th am County Department of Health. Date: Certified by P.E. !/ R.A. (Design Pr fessional) Address �� �� e � � c °�f ''1U'a_± (- 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 chan s necessary. By: Title: /�'�t Date: 5� t py - 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 �oeatian--' Stfeet A dress: ' " ` '' ° ` I f r .� Ttiwn/Village: Tax Grid # Map Block Lot($) Well Owner: N e: n - Address: OoffS71 Use of Well: -prima 2- secondary Res dential 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 I ft. Length below grade ft. Diameter in. Weight per foot �Ib /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded A Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) I Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed _ Pumped ) Compressed Air Hours Yield 1 gpm Depth Data Measure from Ian surface- static (specify ft) During yield test(ft) Depth of completed well in feet 3dsJ Well Log If more detailed information descriptions or sieve analyses_.... -. .... are available, please attach, Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface V 14 jkJVA A/ _� '' mad- ivi-r'� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type . Capacity Depth tad Model -`S/d Voltage c93d I-lP / Tank Type; fo Volume Date Well Comp to Putnam County Certification No. Date of Report Well Eller signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. WellDriller's ame a1ZLrs -.SONS Address: hi/C N.,,- . Signature: Date: LAble 5-- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH[ 1 Geneva Road, Brewster, New York 10509 LORET"TA 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 a 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278.6014 Fax (845) 278 - 6648 1E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: ,ltie 50 1 50 E911 ADDRESS: TOWN: r� AUTHORIZED TOWN OFFICIAL: DATE: / 24 / The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verfrm) � yML ENVIRONMENTAL SERVICE"-, 32L Kear Street Yorktown Heights, N�Y. 10598 (914) 45-28 � 00 �- --����`'��'--��- ' -| �i, Di�ector ' LAB #: 1.508047 CLIENT #: 1 J.4 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TORLlSH & SONS E)OX 271, 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY 10504 DATE/TIME TAKEN: 11/28/05 ll:00 DATE/T}ME REC'D: 11/28/O5 12:3() REPORT DATE: 12/06/05 PHONE: (914>-273-3448 SAMPLING SITE: TIMBERLlNE ESTATES LOT #8 TYPE..: POTABLE : PUTNAM VALLEY P1ESERVAT]VE8: NONE COL'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES...: TANK COL}FORH METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~=~~~~~~~~~~~~~~~~~~~~~~~ DA'rl-:. 1::*I.-AG PROCEDURE RESULT' NORMAL. -- RANGE Ill:-*"Vl--I(:)D 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 CHEM{STRY. WATER WITH A LDW pH MlGHT BE CORROSIVE TO METAL PlPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. H TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALClUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON T.E SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/I-. VERY HARD WATER: ABOVE 300 MG/I.. MODERATELY.HARD.WATER: 70-140 MG/L. MG/L. = MlLLlGRAM PER LlJER' - . SUBMITTED BY Albert -1. Paclovani, 11 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 1059B - ( l4) - =_��a���' '-`-+_'' ��. '��� | Albert H. padovanz, Director | � ' ,:.,-,' .* " A LAB #: 1.508047 CLIENT #: 114 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TORLISH & SONS BOX 271 , 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY .1O504 DATE/TIME TAKEN: IL/28/0�5 11:O0 DATE/TIME REC'D, 11/28/05 12:30 REPORT DATE: 12/06/05 PHONE: (914)-273-3448 SAMPLING SITE: TIMBERLINE ESTATES LOT 48 SAMPLE TYPE..: POTABLE : PUTNAM VALLEY PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: < 4C NOTES"..: TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~=~~~~~-~~,"~,~~~,'''"~~ COLlFORM METH: MI-7 DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/28/05 MF T. COLlFORM ABSENT /100 ML ABSENT 1008 11/29/05 LEAD (INS) <1 ppb 0-15 ppb 9003 12/05/05 NITRATE NlTROG <0.2 MG/L 0 - 10 9052 11/30/05 NITRITE NITROG <0.01 MG/L N/A 9162 11/30/05 IRON (Fe) 0.190 MG/L 0-0.3 mg/l 9002 12/01/05 MANGANESE (Nn) 0.038 MG/L 0-00 mg/1 9002 12/01/05 SODIUM (Na) 8.16 MG/L N/A 9002 11/28/05 pH 5.7 UNITS 6.5-8^5 9043 11 /30 /05 HARDNESS ,TOTAL 106 MG/L N/A 11/30/O5 ALKALINITY (AS J.12 MG/L N/A 9001 12105105 TURBIDITY (TUR 1.1 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. ablic 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 O�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 PUTNAM COUNTY DEPARTMENT OF HEALTH _ 11MSIGN O NVIRONMF.,NTALHEALTH SERVICES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM &,- ///-v �P kswo s Owner or Purchaser of Building Building Constructed by 8 l , r4�_:,*1 1r,ve GT Location - Street Ski Buildirt Type Tax Map Block Lot Jrj-k1q TownfVillage j T,46./Wc- Subdivision Name no Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the _ - _..._ _.�.. _ ...................._.- - _._........ __......._ . ^.___... system. .... __.... . _.�._.._...._..........__.._ _.......� The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Date onth 12— D Year 5 General Contractor (Owner) - Signk6rr Corporation Name (if corporation) Address: Signati Title: Corporation Name (if corporation) Address: State Zip State Zip Form GS -97 DANIEL J. DONAHUE, P.E. k 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: As Built Plans Timberline Estates Lot #8 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. _ . M........ Daniel J. Donahue, P.E. Site o Sanitary o Environmental SHERLITA AMLER, MD, MS, FAAP ,....... ..._.. Commissioner�ofFlealth= .:..:�,.- ,.�..:.A -..� _ _•- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Daniel Donahue, P.E. 120 Breckinridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI Coufity•Executive- ., ;...- . <:.... ::,AZ September 29, 2005 Re: Field Inspection — Timberline Associates Timberline Court (T) Putnam Valley, TM # 51 -1 -50.8 A site inspection was made for the above referenced project on September 28, 2005. follo2ing comments must be corrected in the field: The -'� The well casing needs to be raised to a level of 18" above finished grade. Bedroom -count needs to. be performed by.a representative of this Department•.when..tbe house is completed. .. ,:.... It appears that some trench ends are less than 10 feet from the property line. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Sincerely, � oseph S. Par favati, 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 DIVISION OF ENVIROIiFNIENTAL HEALTH SERVICES FINAL SITE IlgSPECTION Date:. d b ,i y. pecte � . r' Street Location j _- : .. _Owner - .l <�- •k =1�1 °� /-�sS ll Permit # PL/ -�q -a �•- TM # J-1 - l - S'v y Subdivision Lot 4 �,1 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section date of placement 3: er L Width .Avg.Dpth atural soil no stripped.. ��Iha.�^- ................. d. Stone, Ms a c., greater than 15 from STS area... :.:... e`. 100' from water course /wetlands ..... ........ .... .... 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 ......................... . 3 Minimum 2 ft. Original soil between box :ches e. Junction Box - properly set .......... ............................... 6. ren c es 1. Length required . 5,60 Length installed 2. Distance to watercourse measured Ft .... &,).. /A- 3. Installed according to plan ......................................... l Flo= cLttench acceptable 1/16 -- 1/32" /foot ............. 6..DeptHo trenc <30 inches from surface. ................. 7. -Room allowed for expansion, 100 % .................. .....:.. 8. Size of gravel 3/4 - 1'A" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends cap eel...:....:.:: : - g Pugnp .or °Dosedlystertis� 1. Size of pump chamber .. .....:...... ... 2. Overflow tank .:. ........................... ........................ 3. Alarm, vis udio ........:................ 4. ?um y accessible, manhole to grade ................. 5. ' st box baffled .......................... ............................... . Cycle witnessed by H.D.estimated flow /cycle........... IYL:: ouse/Building a. house located per approved plans ........ b. .Number of bedrooms .................... .. f : Aei IV.: Well Well located as per approved plans . ......:........................ b. Distance from STS area measured .v ft ........... c. Casing. 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Worlumanshiu . a. Boxes properly grouted ................... ............................... b. All pipes partially back lied ........... ............................... . c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plaaj�..�1 `j f. Curtain drain outfall protected & dir.to exist watercdtl°r� g. .Footing drains discharge away,_from_.$TS_ area. .:.__.... ii: -- Suffice water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 a 1rIrM/COW11'DEI W11I01I'WELU.A o1%UM4PMY RONMgRAL SLUM �1CRi ATCLN'tiQX des 0 gm All imfto mo►t*#* owo*Ad po br to a w 1ulmho .. _..� ia�pretio� b� ari► . . pow CambughoftWOM Loiaw b�1ApPO m WNMNe- Lot l PME Ssrii Lot #- - Xs via= fill ONOW L coy' is wa m aomlrmnMi/ r love ds�d't 4h& o1M Ars: wodon coal 6�0010 000 t o lydrt �s �►,!M X41 lrriil�M�rM� M�1 soil hew *sow sad veld � w�a i� ao�rdsm�a wM i MrM1 !C� � Pmt �d Op.. _ ... v _ _ ............._� . . _ .. , _ .....: _.. _ .. Haft, SEP -7 -2005 TUE 13:04 TEL: 845- 278 -7921 I : PI_ITNAM cnI INTV nPPORTMCMT nr o /SIVUSNGN GIF IENWRONMENTAL IHIIEAILT CONSTRUCTION PERMIT FOR SEWAGE TR EATME Located at-- 4�0 �a-� `i -� r Subdivision name/'P4 A�i/, A-T-T- Subd. Lot # Date Subdivision Approved %,jo� Owner /Applicant Name i..J* ���d lbw® < Mailing Address re c-, �.`� �''°r Village Tax Map � Renewal Revision_ Date of Previous Approval - ! ' 7 IF 10 Amount of Fee Enclosed J� eu'— Building Type 4e1-;Ao7 Lot Area _No. of Bedrooms Design Flow GPD Zip Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Se��na>Ye Se�e�adstte�m to consist of gallon septic tank and Other Requirements: ee�� To be constructed by Address Water Sugpl Public Supply From Address OT*- _ rivate Supply Drilled by � /�,� - Address I repr (sent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sear sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accoriance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thered a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Depa=ent, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builde will place in good operating condition any part of said sewage treatment system during the period of two (2) years irnmdately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original systeg or any repairs thereto. Signet: P.E. �/� R.A. Date Addrss /d r g—,, Oe- ZF-e— License # Z� f_ AIP PIOVIE1iD FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewar treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modried when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a nevpe t. Approved ' harge of dome sanitary sewage only. ley - Title: 0 Date: copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 LORETTA MOLINARI � ROBERT J. BONDI Public Health Director L�'� Wor, County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 .Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 May 14, 2004 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re: Proposed SSTS Renewal — Timberline Associates Timberline Court, (T) Pttnam Valley TM# 51.4-50.8 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. `� Corporate resolution is required. Deep hole testing is greater than 10 year old. Retesting is required. Based on measurements, the slope over the SSTS is approximately 14 %. Therefore, fill for grading to 15 % -is not required.. Please show existing SSTS on`lake property (property to the north). Please show existing well and existing SSTS on the Horton property (property to the east). Primary and expansion trench labels are hard to read. Please clarify. Please label the silt fence below proposed SSTS. Please show minimum labels for property line and foundation to SSTS. Please label C1P i~, plan view and provide pipe length, size and minim'. :1 pitch requirement. Please provide minimum pitch for 4" PVC pipe between tang: and first junction box. Show in both views. Provide large and conspicuous note stating SSTS to be staked by a Licensed Land Surveyor prior to construction. Please correct tax map number on plan. This office will continue its review upon consideration of the abo.ye- mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer' e JSP:cj LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 May 14, 2004 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Timberline Associates Timberline Court, (T) Putnam Valley TM# 51.4-50.8 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. Corporate resolution is required. 2. Deep hole testing is greater than 10 year old. Retesting is required. - I. Based on measurements; thc- slope over 'the - SSTS: is approximately 1.4%0. Therefore; fi1TT6r _ grading to 15% is not required. 4. Please show. existing SSTS on lake property (property to the north). 5. Please show existing well and existing SSTS on the Horton property (property to the east). 6. Primary and expansion trench labels are hard to read. Please clarify. 7. Please label the silt fence below proposed SSTS. 8. Please show minimum labels for property line and foundation to SSTS. 9. Please label CIP in plan view and provide pipe length, size and minimum pitch requirement. 10. Please provide minimum pitch for 4" PVC pipe between tank and first junction box. Show in both views. 11. Provide large and conspicuous note stating SSTS to be staked by a Licensed Land Surveyor prior to construction. 12. Please correct tax map number on 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. Very truly yours, oseph S. Paravati, Jr. _Assistant Public-Realth Engineer -. - - --- -- - -- - - -... _ .._. JSP:cj i PUTNAIVI' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWADE;TRF�A:TMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: V A1W -4y4k /h 50„ ' STREET LOCATION: ' / �v►b,./,AIC © ✓/� REVIEWED.BY: RM, GR, . SRDATE:J' l` vy ' TAX MAP#: (CONFIRMED) �� 5D Yf N DOCUMENTS ___ 1 PERMIT APPLICATION vf(. 1WELLPERMIT OR£WS LETTER 14 OF AUTHORIZATION TE RESOLUTION LANS -THREE SETS .OUSE PLANS -TWO SETS ARJANCE REQUEST SUBDIVISION LEGAL SUBDIVLSION ' L jSUBDIVISION APPROVAL CHECKED «(_jPERC RATE G� ��,,// L REQUIRED _n DEPTH URTAIN DRAIN REQUIRED GENERAL U(� OCATED IN NYC WATERSHED LLANS SUBMITTED TO DEP ( )( )DELEGATED TO PCHD Y IN fREQUIItED DETAILS ON PLANS CONT'D1 UHOUSE SEWER - V," FT. 4 "0'; TYPE PIPE.CAST IRON L_)UJJ NO BEND,, MAX REXD5 45• W /CLEANOUT (__)(!!!�:)STTE NOTE (NO ' - f: Lill.! VA 1711 t (�U10' HORIZONTAL; PAST (__)(FILL SPECS/ ga, TES 1 -5 (- L___)FILL E & DIMENSIONS (_-)(,„JF� IN EXPANSION AREA U(_-) CLAY BARRIER L___)(jFILL `CERTII�C NOTE UUDEPTH G SLOPES 3kQ }G E �tSJ 1r11C, N �Y"lD C--)C-_)VOL PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS U PARATION DISTANCE FROMTOE OF SLOPE TRENCH ' (CH 6(1FT MAX 00% EXPANSION PROVIDED 6 (,�L_)DETAaJDUST FREE CRUSHED'STONE OR WASHED GRAVEL (✓, (__)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN : FROM'SSTS RCS TO BE WITNE SSED (�� 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL �( - APPROVAL SSDS ADJ, LOTS (es 20t TO FOUNDATION WALLS WETLANDS (TOWN/DEC PERMIT REQ D ?) 0100' TO WELL, 200' IN DLOD,150' TQ PITS' ` L- PA ON DDS PLANS &PERMIT SAME'w L PRE 1969 NEIGHBOR NOTIFICATION • 0100 TO STREAM, WATERCOURSE, LAKE• (iac. ezpam) •, , ., („*ffC_J50' TO CATCH BASIN, 351. STOTkKDP AIN, PIPED WATT r !. ✓� TTER:BI/ZBA (�ji�10' TO WATER LINE (pits - 201) l 100 YR: FLO�B F,%Eiz V ' 00' 50'• INTERMITTENT DRAINAGE COURSE �(�SOIL TE TRIG LOTS >10 YEARS' ���200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS S (10' MIN TO LI';DGE OUTCROP 9��c < EWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK SDS HYDRAULIC PROFILE (�U10' FROM FOUNDATION; 50' TO WELL RAV ITY FLOW WELL CONSTRUCTION NOTES 1 -15 (DIMENSIONS TO PROPERTY LINES DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION ()2' CONTOURS EXISTIlYG &PROPOSED 15' TO PROPERTY LINE TO )L jDRIVEWAY & SLOPES, CUT SLOPE (��FOOTING /GUTTER/CURTAINDRAINS (ZUSLOPE IN SSTS AREA / (520 /o USDA SOIL TYPE BOUNDARIES ° ) (TxIZE �— BLOCK; OvVNERS NAME ADDRESS -)E;�Y 'GRADED TO 15 %, IF REQUIRED TM #, PE/RA; NAME, ADDRESS, PHONE# ( 1�DATE OF DRAWING/REVISION Ji ll/ )DATUM REFERENCE - � (_-_„ )LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (-JPROPOSED FINISH FLOOR AND / BASEMENT ELEVATIONS (___)WELLS & SSDS'S WAN. 200' OF SSTS V PROPERTY METES & BOUNDS - ffC_JEROSIONCONMOLFOP..HOUSE ; WELL & SSTS, EROSION CONTROL NOTE )A'MNTS: 3vS�Tln9in� mn • UUPUMP NOTES Ajr� (_)(_JDOSE 75% OF PIPE 1 DOSE VOLUME NOTED ((___)DETAIL FqJLWICK MAIN, (PIPE TYPE, ETC.) (_J(__)P -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM J (__,)(__)STANDPIPES, 5' BO ,DETAIL (_j(_)15' �iCD %, 20'4%,251-3%,35'-l%*, 100 % -<1% L c-j20'. CHARGE/100' wi th 182 cons day discharge C_ 7N to NON - PERFORATED PIPE April 6, 2004 DANIEL J. DONAHUE, P.E. CONSULT LL V G E V GR V 11JJJ.:J11 S 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 #8 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 Letter- of aulhorizatian- 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. Sincer , Daniel J. Donahue, P.E. Site o Sanitary o Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES T T µ LETTER OF AUTHORIZATION RE: Property of Located at OV P1) -r a 4m VA(4.0 nax Map #_ 15.1 Block L_ Lot Subdivision of T /'M OR `1 Kj a 04Tl4'r49`S Subdivision Lot # 43 Gentlemen: Filed Map # 2-(Aq A • Date Filed 12--1 016 This letter is to authorize DA-At ! e L J. DO Al .4 *0 JF 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:Putna'm'Co,,� ity S : anitary•Uodc.._ _. - .._..A_.._ ... _ .._ .... , .... _ . _. Very truly Countersigned: Signed: _ rialy�' APO, 77� � P.E., R.A., # / (Owner of Property) / Mailing Address Mailing Address: State tj y Zip J04-41 State �� Zip 10is-75 Telephone: . 91 ,-- te" 19 ' -r O Telephone: 9 4- 628.4 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # V-1 Located at 01 IW, aj, 1_� Eon Village PdI � i Subdivision nameT �r Subd. Lot # Tax Map ,I& Block L_ Lot Date Subdivision Approved All 11 Renewal Revision Owner /Applicant Name J, cI ZZw Date of Previous Approval Mailing Address e).0 j9*4/pt/4,4- IPIyoR R D 9Ow/ret'x X A4:1r+ Zip Amount of Fee Enclosed A D rl&4`R Building Type Lot Area No. of Bedrooms Design Flow GPD t� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of A IV gallon septic tank and f'1a L or- a1= 2'', Other Requirements: O` 110" be constructed by fW Address Water Supply: Public Supply From Address or _ Private Supply Drilled-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 s, s� tem 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. t Signed: P.E. R.A. Date tt Address Ari grte,4 +a r; .t, /e a[ /i'l���'`r 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 perm . Approved for ischarge of domestic sanitary se age only. By: Title: - Date: Z White copy - HD File; 4110woo y - Building Inspector; Pink co - O Orange copy - Design Professional Form CP -97 PU NAM (COUNTY DEPARTMENT OF HEALTH DffVffSffON OF ENVIRONMENTAL HEALTH H S ERVICIES APPLICATION ION TO CONSTRUCT A WATE][ W EILL _ .____,. j ..:. ; please print or type y . PCHD Weill Location: Street Address: o illage Tax Grid # D�7l bDCJ� aij q . (� Map Sy Block / Lot(s) o WeRlOwner: Name: Address: Jdzepae Jzalx -,zx& 416 Q® se of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm erve Est. of Daily Usage gal. Reason ffor Replace Existing Supply Test/Observation Additional Supply Drifflag P1vew Supply (new dwelling) Deepen Existing Well Detailed ]reason oe.� Apr wwc ap for Drn➢ling Weill Type Trilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes (..., No Name of subdivision v7TY M60a 6 w 0, Lot No. _ Water Well Contractor: Teg P Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: eeo- Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be vided on s ate sheet/plan. Date:__ :,.: �_ = ,..' °Applicaut.Signat=: PEST 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 .IFOR 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 z Date of Issue v Z Permit Issuin O1"icial: /+ Date of Expiratio --0 Title: Permit is lion White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SATH . 01N. SAM. KITCHEN NORNP4 RX s''Ktt lIU.12O '1o9r1Z� Ilsrl2n .. IN ' RK .. FAM. RM. 16QtIZB Itt�IQ� FOYER lit Floor BATA Q z 0-- ®RQ4 BATH WW.It•IN • ......mow KALL PTO... OR 4z <1 19iriQN STUDY PUT .AIM COUNTY DEPARTMEN HEALTH C 6y PLANS APPROVED FOR DEDROOlb1 COUNT ONLY, 2nd boor r.7 ___ BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST .BE SUBMITTID TO THE PCDOH FOR AI >PI.t.OVA:L, 5 G.NA'1'URE II' LE DATE PNli1N Lyojo 1400 SS INC. ® 1 Old Trail Road. Selinsgrove Pa. 17870 er' "" Telephone (717) 743 -0111 14.164 (7187) —Text 122 PROJECT I.D. NUMBER 81T.21 i SEOR Appendix C .. .. State Environmental �0_ ue�ty•AorletV ASHgRT ENVIRONMENTAL ASSESSMENT FORM Foy ONLtSTEO ACTIONS Only PART I— PROJECT INFORMATION (To be completed.by Applicant or Project sponsor) 1. APPLICA !SPONSOR 2. PROJECT NAME A r 3. PROJECT LOCATION: �1 Municipality County A. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: IN New ❑ Expansion ❑ Modification/alteration S. DESCRIBE PROJECT BRIEFLY: Cp^/ U G7l (}s1r O/C /f Jy S"s" 7' r 7. AMOUNT OF LAND AFFECTED: Of C d �� Initially Sere$ ultimately f acres S. VIIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 2Yes ❑ No It No, describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Ae$Idenlia! CJ Industrial ❑ Commercial ❑ Agriculture ❑ ParklForesUOpen space ❑ Other Describe: 1C. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE PR LOCAL)? (1 9 Yes ❑ No If yes, list sgency(a) and permillapprovals A v 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? O Yes L9 No It yes, list agency name and P miNapproval 12. AS A RESULT O�oy+F�, PROPOSED ACTION WILL EXISTING PEAMMAPPROVAL REQUIRE MODIFICATION? ❑ Yes - I�:J No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWL *DGE I— v' d W 4 ,4 lJ r y D � ApplicanGsponsor name: Date: Signature: �a• It the action Is In the Coastal Area, and you are a state agency, complete'the Coastal Aaseaament Form before proceeding with this assessmeAt OVER 1 PART Il— ENVIRONMENTAL ASSESSMENT, (To be. compteted'by Agency) - - A. DOES ACTION -PART 417.1127_ -it yes, =ordinate the rvvl ®w pros 9"er+Q use'tAe FUCt°E°AF; `� Dyes No B.. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6?, It No, a negative declaration may be superseded by another Imgalved agency. ❑ Yes , M Nd C. COULD ACTION, RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, II legible) Cl. Existing air quality, surface or groundwater.quallty or quantity, noise levels, existing traffic patterns, solid, wal;Wprodudtion,,or disposal, potential for erosion, dralna®e, br flooding problems? Explaln bdefiy: NO N C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or• community or`neighborhooQ.ehsracte,r? ;Explain briefly: �o/V CJ. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or ondangered species? Explain briefly: /V o n/F C4. A community's existing plans or goals as officially adopted, or a change In use or intensity of use of land or other natural resources? Explain briefly /1/.0 N& CS. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. /v C6. Long term, short term, cumulative, or other effects not Identified In C1-CS? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ONO it Yes, explain briefly PART 111 — DETERMINATION OF SIGNIFICANCE (Po 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 pr.rural);.(b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materiats. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been. identified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a* positive declaration. WCheck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result Many significant adverse, environmental Impacts AND provide on' °attachments as necessary, the reasons supporting this determination: ta Name of ea Agency r ype Name o Res onsi @ icer in Lea Agency Title o esponsi a Officer ignatvre o Res nsi tr i� ea Agency �) lure reporef t erent from respons e' a icer) ate PUTNAM' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER. SUPPLY & SUBSURFACKSEWAGETREATMENT SYSTEM. PERMIT L NAME OF OWNER: STREET LOCATION: 4 1.�yA4;y REVIEWED BY: RM, GR, AS, SATE: TAX MAP #: (CONFIRMED) " Y N DOCUMENTS C,t,jUPERMIT APPLICATION j ,e)L-)WELL PERMIT OR PWS LETTER (UPC -97 n (�L_)LETTER OF AUTHORIZATION (/)UDESIGN DATA SHEET (DDS) U(f)CORPORATE RESOLUTION (j USHORT EAF (�UPLANS -THREE SETS C�' ) HOUSE PLANS - TWO SETS (�(VJVARIANCE REQUEST / SUBDIVISION (��LEGAL SUBDIVISION UUSUBDIVISION AIVROVAL CHECKED. UUPERC RATE ( (--)(ijFILL REQUIRED 0 DEPTH U(eJ-CURTAIN DRAIN REQUIRED GENERAL )(___)LOCATED IN TERSHED UUPLANS TTED TO DEP C--) GATED TO PCHD DEP APPROVAL, IF REQ'D (,fit )DEEP TEST HOLES OBSERVED C,,-3UPERCS TO BE WITNESSED ( fn SEX- APPROVAL SSDS ADJ, LOTS L)(_,:!)WETLANDS (TOWN/DEC PERMIT REQ'D ?) (L)C_)DATA ON DDS PLANS & PERMIT SAME (_)C :JRE 1969 NEIGHBOR NOTIFICATION (� (! jLETTER BUZBA _. ._. 100 )k FLOOD ELEVATION W/I 200' (_)(_.SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS (_)SEWAGE SYSTEM PLAN - (NORTH ARROW) C,, (_)SSDS HYDRAULIC PROFILE (Gf(�GRAVITY FLOW (e!!:5UCONSTRUCTION NOTES 1 -15 (x!:::jUDESIGN DATA: PERC & DEEP RESULTS (.,,l _)2' CONTOURS EXISTING PROPOSED (zi j�DRIVEWAY & SLO , U(_ --)I! 00'IjNGLquJ T j S3 )USDA SOIL TYPO NDARIES (=f!5UTITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# ( /R' )DATE OF DRAWING/REVISION (- Ir )DATUM REFERENCE C,fULOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. t_/f PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (�(�)WELLS & SSDS'S W/IN 200' OF SSTS .PROPERTY METES & BOUNDS EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 r(REQUIRED DETAILS ON PLANS CONT'D) (�HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (t-=fj()NO BENDS; MAX BENDS 45' W /CLEANOUT RENEWALS (--)USITE N((NO CHANGE) // �v FILL SYSTEMS C()10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE C:nT- )FILL SPECS/ FILL NOTES 1 -5 (,f:!J�FILL PROFILE & DIMENSIONS OFILL IN EXPANSION AREA FILL GREATER THAN 2 FEET UU CLAIlFBARRIER UUFI,L R ON NOTE (--)(-_)DEPTH UGES (__ )( )VOL. N PL R.O.B., UNCLASSIFIED & IMPERVIOUS (�( )SEP IO ISTANCE FROM TOE OF SLOPE TRENCH ZC__)LF TRENCH PROVIDED C-C� 60FT MAX. �ZUPARALLEL TO CONTOURS (/')0100% EXPANSION PROVIDED (J' _)DETAII/DUST FREE CRUSHED STONE OR WASHED GRAVEL �4C _)GEOTEXTI.E COVER SEPARATION DISTANCES ON PLAN - FROM SSTS a )10'TO P.L. DRIV LARGE TREES, TOP OF FILL U20_. -TO FOUNDA - O - °S 100' TO WELL IN DLOD,150' TO PITS (_ )r )100' TO STREAM, WATERCOURSE, LAKE (inc. expan), (,fY_j50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER. �-�10' TO WATER LINE•(pits --261) . -- ..... .. . <... x___)50' INTERMITTENT DRAINAGE COURSE j,=::JC_)200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS L-J(--J10' MIN TO LED E OUTCROP TIC TANK UU10' =FROM F.= *AONWELL R DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (,,jC—)MIN 15' TO PROPERTY LINE SLOPE (n(___)SLOPE IN SSTS AREA f-/J (520 %) U(_)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS L-)(—)PUMP NOTES U(_)DOSE 75% OF LU OSE VOLUME NOTED U(�DETAIL FOR FO , (PIPE TYPE, ETC.) UUPTT AND D -BO SHOWN &DETAILED UUl DAY STORA ABOVE ALARM rN-PERrFORATED IN DRAIN UUSTANDP ES, DETAIL (_)t_)15' MIN -4-%,25'-3%,35'-l%, 100 % - <1% (�U20' MIN /100' with 182 cons day discharge PIPE UUNSULIENILY L1N`kj11_Nrrfta 200 -Breckenridge Road Mahopac, N.Y. 10541 914-628-7576 TO doe, ATE .._ ._vv'cs�?+�.__ - -� ..�.w....;,.,...... ATTENTI RE WE ARE SENDING YOU C: Attached ❑ Under separate cover via --the following items; ❑ Shop drawings 0 Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter El Change order 0 COPIES DATE ND. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted I ❑ As requested ❑ Returned for correir, ❑ For review and comment F" ❑ FOR BIDS DUE 19* REMARKS COPY ❑ Resubmit copies foe approval 'mi'_ copies for distribution ,sS_ rn-corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: It enclosures are not as noted, kindly notify ut at ones. DANIEL, J. DONAHUE, RE. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 May 2, 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 #8 Putnam Valley Dear Mr. Rogan: 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. Thrte -copies of construction plans 9. Two sets of house plans By: Darnel J. Donahue, P.E. L ZO Site Sanitary o Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALLTH' SERVICES .. .. ._ .. . -. ......vrw .. .t . t4.. _ _ ._«. R ..v .�... sc... —...s • 1 , Y.f....t.... e.tei.. w•. ....« - �y`i wT .w i'i.w.,.+..n _ :: .. ra....�•. « -.7j. ..rvt. S tTV` t. n.14.3•'nr,.i; Y .•Sti. t.... . - �r'.A:Attir:.. •„4'•vST ? K'wA . -� •.` T'rv,^ �:.'+s 'Yltl•.'C:.'.i1Kl.'*J+4...0 LETTER OF AUTHORIZATION op. of !.. '171r.t4j9M /i .JI .. Located at QV J44AW t iWX%i#7 Tax Map # Ot Block _�_ Lot, Subdivision, of / Ainfiez -i.,y 0 A8T' Subdivision Lot # _Filed Map # Date Filed Gentlemen: This letter is to authorize 04*10C a duly licensed Professional Engineer C-►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 supeMse 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;. -an' the Putnam County..Sanitary Code: Very truly our; Countersigned: Signed: P. E., R. A., �# � � (owner of Mailing Address Maili�g- Address: 0?0/ nlce Zd '1140)°A-1 State / Zip Na fL/, Telephone:.�Zf �f G State A) .Y _Zip /d 7o/ Telephone: 9/y W-3600 Form LA =97 w ,4 t _. ._....:F-IJTNA - .,CGUNTYDEPARTMENT" OF HEALTH* DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM . i O%Nmer. Jo /�� �, �z i ' Address 0 / 14 u/ 1114 C Ifw "- 4°40 ya,VAro00f . Located at (Street) T1tj8fiw1,1m r c,- ! Tax Map ,?L/_ Block- Z Lot __j (indicate nearest cross street) Municipality P147N4h V,� 4of y -- Watershed C•l.rtsw.r lloozow 84464- SOIL PERCOLATION TEST DATA Date of Pre - soaking 3 /?•� z- Date of Percolation Test 3 /3 D z- v . ~~ percolation test bole. (i.e. s 1 min for 1 -30 minrnch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. 3 4 5 ATn•R -SC. S 'r ..6.. I'A vanaa}Pd of camp denth until anoroximately equal percolation rates are obtained at each v . ~~ percolation test bole. (i.e. s 1 min for 1 -30 minrnch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. TEST T'I'C' DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES DEPTH HOLE N®.: HOLE NO.' HOLE NO. G.L. 0:5' , l .5' 2.0' 2.5' 3,0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 7.5' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Alm' Indicate level to which water level rises after being encountered ®' Deep hole observations made by: ,td Arm& Date Id Design Professional Name: , DAmin J, D4 N,4 IN-4or Address: /)-,o RA AA Signature: • Design Rrofessional's Seal FESSd iL 0. fifi4` 2 Y U TINAM UU U N T Y DEFAK1'ME N'1' Uk 1EALTk1 ]DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR 1 A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: mly c,( yL i �-a� J'itkifr��.c. iP /dam ie.0 . ya�ir�r� s 2. Name of project: siy gg g f aili- r �o F r 3. Locati : &kr* 41�r lei "OL 4. Design Professional: 44 v ieL J. .5. Address: 140 6. Drainage Basin: GA'X -'Pwl hlrk`aw 0#41C Mils >d!>ee-' � y 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 (SEAR)? Type Status (check one) ................... .............................. Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? .................:....... All* 10. Has DEIS been completed and found acceptable by Lead Agency? ............... All 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....................................................... .................................. 13 = =If so; have - plans - hen - submitted- to�such- authorities ::-- 14. Has preliminary approval been granted by such authorities? Date grimted: /VV 15. Type of Sewage Treatment System Discharge ..............:.. surface water groundwater 16. If surface water discharge, what is the stream class designation? ...........:........ N /il 17. Waters index number ( surface) ....... ............................... . ....................... 18. Is project located near a public water supply system? ....... ............................... /Y/J 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ...... ............ All 21. Name of sewage system Distance to sewage system 22. Date test holes observed 7/ %: . 23. Name of Health Inspector Aw_ max, • 24. Project design flow (gallons per day) ................................. ............................... �!J 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... /d z�f Form PC -97 ti. i 2 7. Is any portion of this project located within a designated Town or State wetland? A16 �S. Wetlands ID Numb er ::.:..::......::....:.,..........:.:....:::.::.,.:::::.. ..:..::::::..::: :: :............ 29. Is Wetlands Permit required? ............ .... .. .... ............................... N d Has application been made to Town or ;ocal-DEC office? ............................... 30. Does project require a DEC Stream Disiurh' 6e Permit? .. ............................... �U 31. Is or wag 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? ...........1. ................ Yes 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination'? . ............................... 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? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax leap, ID Number .......................... ............................... Mapt �E Elock_f _I.oIL_ 37. Approved plans are to be returned to ..... Applicant �� Design Professional . - I�t�1'E: 1 applacati ®n fat = vies =:� gr i- approval. of a new_SSTS to be:located wiWnn the_NYC N4Atershad.sball..:. . 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 inay also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate, forms for such activities from. DEP and, submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 1, hereby affirm; wader penalty of perjury, that information provided on this form Is true. 80 the best of knowledge and belief. False statements made herein are punishable as a Claris A.misdemeanor pursuant to Section 210.45 of She Penal Law. S1 GNA TURES & OFFICUL T'ITLE'S. Z) 4N s f c- J • �i��1M rlv Mailing Address: ................................... W 10 0 a q�l W SSTS TIE - INS (MEASURED BY TAPE) UNIT A B LENGTH OF TRENCH SEPTIC TANK 46 F 16 JUNCTION BOX 1 61 26 2 63 33 3 62 :7 38 4 62 44 5 64 52 6 109 66 60 z' 7 112 65 60 8 114 65 60 9 118 66 60 10 102 1 58 40 11 33 72 60 12 39 S" 76 60 13 47 84 60 14 50 78 40 ASBUILT PLAN i SEWAGE. TREATMENT SYSTEM Property of TIMBERLINE ASSOCIATES PUTNAM COUNTY DEPARTMENT OF HEALTH TIMBERLINE COURT Q 0¢ESS1y \ DIVISION OF�F(NVIR,O��IMENTAL HEEIALTH SERVICES. TM# 51- 1 -50.8 PUTaM VALLEY. APPROVED ^,S NOTED FOR CONFORMANCE WITH DANIEL J. DONAHUE P.E. APPLICABLE RULE-S AND. REGULATIONS OF THE CONSULTING ENGINEERS v ,:�: r. „ DEPARTMENT. 120 BRECKENRIDGE ROAD ' PUTNAM COJI�f71 HEALTH i IiE MAHOPAC, N.Y.] 0541 628 - 7576 NATURE & 7lTLE A MAHOPAC, N.Y. 10541 �y� 4'0, 45481: o /f. DATE: DECEMBER 27, 2005 F 0 FEV�1 SCALE 1" = 30' SURVEY BY: ROLAND LINK. 7 / THIS IS TO CERTIFY THATI THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH i f f