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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 51. -1 -59 BOX 21 1 ru IN f, la, j,. ti��'� �- T v 1. ` 4 _ �.; r .r iIN 1 No ,i, , 02495 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location reAt Aodres Tax.Gridl Map ock / Lot(s)-V? Well Owner: e: Address: Use of Well: 1-primary 2-secondary Xesidential Public Supply Air cond/heoump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary — Cable percussion Compressed air percussion Other (specify) Well Type Screened _ Open end casing X Open hole in bedrock Other Casing Details Total length 95 ft. Length below grade 23 Diameter L/I t 1, in. Weight, per foot 16 lb/ft. Materials: 2C Steel Plastic — Other Joints: Welded Threaded Other Seal:-/-,. Cement grout Bentonite Other Driveshoe: XYes No ILiner: 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 —2Compressed Air 7 Hours? - Yield L gpm Depth Data Measure from land surface-static (specify. ft) During yield test(ft) Depth of completed well in feet 0 Well Log If more detailed information descriptions or s . i.ev.e analyses,.-... are available,:- please attach. Depth From Surface Water Bearing Well Diameter (in) Formation Description ft. ft. Land Surface I X/ 13 W,0 ht If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type I ,6L,v-, Capacity S' Depth � Mode rv�--� SITJ�41 Voltage 2,36 WX Hp Tank Typ� 3o Volume 7-0 Date Well Co eted 211'3077,1 Putnam County Certification No. Date of Report Driller (sigoture) �xact location ot well witn distances to at least two permanent lanCIfnarKS to be provided on a separate sneev tan. Well Driller's Name Address:/ V �i Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 1 u: 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John and Susan Crawford 10 East 23rd.'Street New York, New York 10010 Dear Mr. & Mrs. Crawford: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 12, 2006 ROBERT .I. BONDI County Executive "ROBERT MORRIS, PE Director of Environmental Health Re: .Addition — Crawford, A- 132 -06 196 North Shore Road (T) Putnam Valley, TM# 51.4-59 I have received and reviewed the plans for the proposed addition at the above, mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: o This Departments records indicate the original proposed dwelling has a bedroom count of five, as noted on the Putnam County Health Department Certificate of Construction Compliance, (see copy enclosed). The Putnam Valley Building Department indicates the dwelling to have a legal bedroom count of three and also has no Certificate of _.. _._.Occupancy:, These obvious issues would..eecL to be reQtified_.priQr to tius_,Department's. further review of the above referenced addition. If you have any questions, please contact me at your convenience. GDR:cj Enc. Sincerely, Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Gene D: Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 MCHAEL A. GEYER 20 West 20th Street, New Fork, New Fork 10011 -4213 ...,..._,.. ,... - (i9Y =4 22 Voices >. 1VIGeyerS'0' @aol:` coin.":._.- .;:...;.2$'2= G91= 1156'_' o r. r.....;,..,.. .. _ 24 April 2006 Joe Paravotti Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Crawford Residence 196 North Shore Road Putnam Valley, New York Our Reference 66711.1 [667Letter7] Dear Inspector Paravotti, Per our recent conversation and your request, we enclose the following for your approval: Two sets of stamped and signed drawings, showing the plan of the house as originally approved, and the house as altered. The only change is the addition of a finished basement; A money order, drawn in the amount of $100.00 and payable to the Putnam County Health Department; An application form for a residential addition; and A form indicating the Legal Bedroom Count, signed by Iry Sevelowitz, the-Building.. _.. ow .. Inspector in Putnam Valley. y There is no change to the existing waste disposal system, previously filed and approved, and no existing Certificate of Occupancy. Please call if you require additional information. Sincerely, Michael A. Geyer Enclosures cc: S. Crawford A R C H I T IE C' T BRUCE R. FOLEY »�i'�ae Health Director - ,:_........ _...... .,._. Date: LORETTA MOLINARI R.N., M.S.N. '- Associate °iz'irDiic" i eailth `'`Dire'ct -or Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 To: AirXAk L 645 YOX lFax #: ;2-1-1- -6011- at�f No. ]Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health ]For your information - - -- ]Please respond - - _ XAs lFor your review discussed Notes/Messages Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. rA AlOLER, MD, MS, F'AAP Cnmmissioner of Health WF.ETTA.MOLINARI, RN, MSN _ .ti ✓:+at .lam..; -v... .. ..r� - associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ' ADDITION APPLICATION RESIDENTIAL ONLY STREET I% N OfZV-1 6'f02F O. TOWN RMAM VA EYTA'" MAP# 51 59 NAME GRAWFC90 PHONE ZIZ •253 • 93$b PCHD# I MAILING ADDRESS 10 eksr Z3zo �5vw�T New ftK NY 100r0 DESCRIPTION OF ADDITION . F0415ff'p (8A-6jr:5;%AG"_1 NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 275 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Eariy Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Apr 24 06 10:31a BUILDING DEPT Apr 17 06 02:37p Michael Geyer SHrOtLITA, 4MLM M% MS, FAAP Commissioner of Health LORETTA MOLUNAW, RN, FdSN Associate Commissioner of Health 9145268806 212-691-0564 DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Town Ugal Bedroom Count ROBERT J. a 0 Como; Erecuiive Re- CRAWFORD .(Owner's Name) Tax YvIap #: 51.-l-59 Address: 196--North Shore Road Town: Mal 1 e* Year Built: original permit 2002 - not complete no Certificate of Occupancy issued to date. According to records maintained by the Town, the above noted dwcllin,,,,, P-2 is 7 in compliance with Town Code. House under construction. is not in compliance with Town Code. The Legal Bedroom Count is: 3 This information has been obtained from; Certificate of Occupancy: tmder e%7rrp-.-r-ueti_n Dher. —Finished basement 'Awilding Inspect I ur Date Environmental Ifealth (945) YM-6130 Fax (94S) -,79-7921 Nursing Services (845) 2784538 Fax (945)27&6D26 WIC (&45)_-7&66")8 Nursing Dam Care PAx (84S)27"095 Emiy Interventloallirachool (845) 278-6014 Fax (845) 278-6638 P.1 V /+ P+, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION-' OF ENVIRONMENTAL HEALTH SERVII - .<- J .' ✓... .. V:: � >R n .. O ,p �. t. . .. _. u.� _ x y,. .. . ...qr Cny:iv n,'T�iwt.':: .•T.. CERTIFICATE OF CONSTRUCTION COMPLIANC E FOR SEWAGE TREATMEN' PCHD CONSTRUCTION PERMIT #�✓ Located at 4Z4yf� S%ivre ,/rtff�.' Town or Village %2z >ZZe7 Owner /Applicant CrUw�ITax Map S/ Block _ / Lot J'l Formerly Subdivision Name X Z / & -6r /f e 4 �/e:. Subd. Lot # 9 Mailing Address c r ,, ; A)ez� ��d�- f , /�� Zip %lilt Date Construction Permit Issued by PCHD 1_9/ /,zOO 1- Separate Sewerage System built by CLigrf 4f -7 Address Consisting of 151' 'a Gallon Septic Tank and S'aas�Jf ve7 7' ;n-,Pc-,4 Other Requirements: G�►� -f �d,��� / 3 /�� d �. /�' l / Water Sup Qly: Public Supply From Address or: Private Supply Drilled by . h44_7 � Ac,. Address /'0A J�e rte, Building.T..ype . --Has erosion control.been complet ;d? Number of Bedrooms Has garbage grinder been installed? /71-:7 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: `/_ ;S °Certified by r %-Z � ' P.E. P/ R.A. Design Professional) Address ,0; /Vk A5.�e-S; LL10 ,293 fur Ae. /go, 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: g OS copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Dec 28 04 10 :51a Planning Board (914) 526 -3307 P.1 12/8/04 TUE 10:18 TEL 814 277 8210 BIBBO ASSOCIATES LLP 1Q002 BRUCE' R -FOLEY LORETTA `MOLIN'jkR:1°R: PUTNAM COUNTY DEPARTMENT OF HEALTH r DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location, . _. ._ .,.. . Street Address: Tax Grid # Map 17 Block I Lot(s)S9 Well Owner: JY4�me: Address: Use of Well: 1- primary 2- secondary -7f-, Xesidential Business Industrial Public Supply Air cond/he ump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _,X Open hole in bedrock _ Other Casing Details Total length o2:�_ ft. Length below grade 23 ' Diameter in. Weight, per foot alb /ft. Materials: K Steel _ Plastic _ Other Joints: — Welded -/, Threaded _ Other Seal: Cement grout_ Bentoriite —Other Drive shoe: X Yes No Liner Yes x 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 HoursJ- Yield 1L gpm Depth Data Measure from land surface - static (specify. ft) During yield test(ft) Depth of completed well in feet O� Well Log If more detailed information descriptions or sieve an alyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface j3 QO If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity S' Depth 47-0- Mode SS�S -3� Voltage Lao W� HP j , '✓ Tank Typ 3o 7 ` Volume / Z� Date Well Co pleted Putnam County Certification No. Date of Report I Driller (si ture nv q exact Location or weu wire instances to at least two permanent IancifnarKs to be proviaea on a separate sheet/ lan. / t Well Driller's Name . Address:/ .y Signature: `�„ /J ,� Date: i has i White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNA.M COUNTY DEPARTMENT OF HEALTH DIVISION OF IENVI RONMEN GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Q5-1 i 1-57-17 Tax Map Block Lot l�Aa"or 14F //e- t' Building Constructed by TownfVillage Location - Street Subdivisio ame Building Type 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. Dated: Month Jcr "e Day 226 Year ��.�" Signature: -;F General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Ea-va I of �L wL5 C®�, Corporation Name (if corporation) Address : 1 Z Vaal, tO yl State Yy130n C ` Zip QSi-Q%q Form GS -91 .` iML ENVIRONMENTAL GRVlC0.) 32l Kear Strdet Ynrktuwn Heighti, N.Y. 10�598 ` Albert H . a uv n P d a i Di tor ,.�.r�� _ '` . LAB #: 1.502776 CLIENT #: 2173 ~~~~~~~~~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~ / NORMAN ANDERSON INC. 152 BARGER 9T PUTNAM VALLEY. NY 1057� ' SAMPLING SITQ LAKE OSCAWANA � B}G HO]SE COL'D BY: SARAH NOTES...x KITCHEN TAP ~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE NON STAT FROC PAGE: | ~~~~~~~~~~~~~~~~~~~~~~~~~ ' DATE/TIME TAKEN: 05/03/05 {i:45 ` DATE/TIME REC'D, 05/03/05 0100 REPORT DATE:. 06/21/05 PHONE: 014>-520-1491 SAMPLE TYPE..A POTABLE RRESERVATIVE& NONE TEMPERATURE.,: COLIFDRM METH: N/A ,,..~...�------------- °,,.,,,,.,,..,,,, 1:"" E�3 U[ T NORMAL - RANGE M|�THOD PUTNAM CNTY PROFILE are proscribed. Suggested guidelines state Vol. � that for people (�5/03/V5 MIT T. COLIFORM ABSENT /100 ML ABSENT l008 /)5/06/05 LEAD (INS) 1.0 ppb 0-15 ppb 9oq3 05/06/05 NITRATE NlTROG {0"2 MG/L 0 - 10 9052 05/06/05 NITRITE NlTROG 01 MG/L N/A 9162 ` 05/0005 IRON (Fe) 0.166 MG/L 0-0.3 mg/l 9002 05/04/05 MANGANESE (Mn) 0.021 MG/L 0-0.3 mg/k 9002 05/04/05 SODIUM (Na) 2.65 MG/L m/A 05/)4/05 / pH 6 , 3 UNITS 6 , 5-8,5 / 0500/05 HARDNESS,[OTAL 28.0 MG/L N/� 05/10/05 ALKALINITY (AS 34.0 MG/L N/(*.'-, 900). 05/05/05 TURBIDITY (TUR 2.9 NTU 0-5 NIU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT AS NOT) OF A SATISFACTORY 8AN[TARY.QUALITY ACCORD THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECT[ON. Pb/Cu LEAD limits for public schools are set at it ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 30% 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 potentiaj., ^' Fe/Mn If both iron and manga|n*se are present, their total value combined shail not exceed 0.5 mg/L, Na NV limits for Sodium are proscribed. Suggested guidelines state Vol. � that for people on a sodium restricted the water should diet ,the , ' contain no �^ more than 20 mg/L of Sodium. For those on a .` mmderateiy restricted diet, a maximum of 270 mg/L of Sodium YML EWVlRQHMONTAL SERVICES 3R1 Kear Street Yurktown�Heights, N.y. 10598 - --^�~`-� ' --� Albert H. Padovani, Director | LAB #4 1.50776 CLIENT #: 2173 ~~~~~~~~I~&~~~~~~~~~~~~~~.~~~~~~~~~~~~~ N[�MAN ANDERSON INC, 152 BARGER ST PUqTAM VALLEY, NY 10579 SAMPLING SlTE4 LAKE OSCAWANA a BIG HOUSE COL'D BY,.:,SHRAH NOTES...: KITCHEN Tf � ~~~~~~~~~~~~~°=~~~~' DATE FLAG PROCEDURE NON STAT PR�C PAGE: 2 ~.~~~~~~~~.~-~~~�~.~~.~~~~~~�~ DATE/TIME TAKENi 05/83/05 1105 DATE/TIME REC'D: 05/03/05 01120, REPORT DATE/ 06/2L/05 PHONE: (914)-520~1491 SAMPLE TYPE..: PYJTABi'E PRESERVATIVES; NONE TEMPERATURE..: COLlFOBM METHk N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~^~~~ is suggested. ` H H SCALE AN WATER RANGES FROM 1-14 MEASUREMENT OF pH IS ONE OF p p . THE lMPQRTANT AND FREQUENTLY UGED TESTS IN WATER CH011117TY. WATER WIT C0�RgSIVE TO METAL PIPES AND '' ` - ` ' ' ' ' ~ � ���T'6 5 ll} 8 5 FIXTURES. . . . Hd TOTAL HARDNESS IS 'DEFINED ' At T|{E`S\}M OF THE CALCIUM & MAGNESIUM � CONCENTRATION, 'BOTH EAPAOSED AS CALCIUM CARBONATE, IN MG/L. THE lNDREDS 0- MG/� DEPENDS ON THE HARDNESS MAY RANGE FROM 0T Hi ' -, SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. ' ' ...SOFT, WATER 0770 �k M G/�FL � �n) . _ -M' G�L Y 'Y =A�1 BO�E 3(( MG/L � � �P� HARD WATER: 140-300 MG/l- (l grain/gallun = 17.2 MG/L> SUBMITTED BY` Albert~/H, yaMovanz, r1.�.(*ilr) Director ELAP* 1030" BIBBO ASSOCIATES, LLP TO: G. DATE: / RE: �' S -1 Ile W rp� WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION THESE ARE TRANSMITTED AS CHECKED BELOW: FOR YOUR APPROVAL ( Pl' AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: e-loicf'/O-V7 J." w e COPY TO: SIGNED: 293 ROUTE 100 — SUITE 203 SOMERS, NY 10589 (914) 277 -5805 — (914) 277 -8210 FAX — bibbo @optonline.net IFENCLOSURES ARE NOTAS NOTED, IQNDL Y NOTIFY USA T ONCEAT(914)277-5805 131660 ASSOCIATES LLP 293 ROUTE 100 -SUITE 203 SOMERS; NY 10589 . _. (914) 2Ti5805 >: - bibbor�ogtonline.net -- -- �� TO r WE ARE'.SENDING YOU ❑ Attached ❑ .Under. :separate cover-via.- O Shop drawings ❑ Prints p ❑ Plans ❑ Copy of letter ❑Change order ❑ DATE JAB No. .. �. ATTENTION RE: _._._ .. ❑ 417J. z92�_Wpvr ❑- Approved as submitted .❑ Resubmit copies for approval the following items: :❑ Samples .❑ Specifications THESE ARE TRANSMITTED as checked below: ❑ For approval ❑- Approved as submitted .❑ Resubmit copies for approval ❑ For your use ❑:-Approved as noted ❑ Submit copies for distribution ❑ As requested ❑: Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑. O FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO' US REMARKS �y l COPY TO SIGNED: 1316130 ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 • (91 4) 27..1 -5805 r .... .'::...(91,4) 277-8210 FAX_. -. bib bo(a)optonline.net To ,1147�A-, Co 0216 /ice, /f'h WE ARE SENDING YOU O Attached ❑ Under separate cover via O Shop drawings. ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ FURUU121 ,n @1P V ° ° H@WDCTV1L° DATE^ .[ JOB.NO. ATTENTION � �,s RE: ❑ For your use A 4 Grate oro! g // tt ❑ As requested ❑ Returned for corrections ,Cay./r' the following items: O Samples O Specifications COPIES DATE NO. DESCRIPTION ❑ For your use O Approved as noted a71" CONS `. All 1W ❑ As requested ❑ Returned for corrections ,Cay./r' ❑ For review and comment ❑ • Gt/G' � Cdr ��0� -i � o/ • O FORBIDS DUE CI d ar7� 19 ❑ PRINTS RETURNED AFTER LOAN To US THESE ARE TRANSMITTED as checked below: or approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use O Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ O FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN To US REMARKS COPY TO SIGNED: If enclosurds are not as noted, kindly notIfy1i of once. Jan 04 05 12:05p Planning Board (914) 526 -3307 12128;04 TUE 10:18 TEL 811 277 6210 BIBBO ASSOCIATES LLP BRUCE R. FOLEY Public Health Dircclor Art C�� LORETTA . MOLINARI RN.. M.S.N. �t►w • Y Qom. Assoeiartc Public Iicakh Director Director of Paarrd services DEPARTMENT OF; ' REALTH 1 Geneva Road* Brewster, New York 10509 Environmental 11te114 (714) 278 - 6130 Fu (914) 278.7921 N ursiog 5kMCa (714) 275.6550 WIC(914)218-6679 Fax (914) 2711 - 6085 Early to ervention (914 278.6014 Prachool (914) 278 -6082 Fax(914)278 -6649 b 911 AD[Dtt `:A DUFOIR OWNERS NAN[E: L r ._.Z - TAX ivlAP NUM) BER: _ E911 ADDRESS: LQ A. TONV iq; AU"17MUZED TONY-N ®r1FICL4,U (Sigma wrc) DATE: P. 19002 The Putna>ni County )[Department of Health. will not issue a Certificate of Construction Compliance unless the above foray is completed, i.e., a legal E911 :address. is assigned .by an.authorized town official. This for n is to be submitted with the .lip )lication for a Certificate of Constructioa Compliance- (E911 �C1tt�liM) Tnk I-A -orVac 'rl it ., �. o-o 04/22/05 FRI 11:18 TEL 914 277 8210 BIBBO :ASSOCIATES LLP PCHD PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENV1R0NIV1ENTAL HEALTH SERVICES ATTENTION XJOSEPH 0 GENE REQUEST FQR FINAL INSPECTION. For: Fill All information must be fully completed prior to avy Trenches c- S %•, inspections.being made. PCI-ID Construction Permit Located: r.�r c:S' art (T) (�V). -_ / !'!'i 1►r 49r'Il�i Owner /Applicant Name:'si'rd TM� Block / Lod Formerly: _ Subdivision Name: 5 ,;.a Subdivision Lot # Is system fill, completed? �' . _ Date: Is system complete? :5 Date: !off -,3 -a l`` Is'system constructed as per ans ?� Is well drilled? e s Date: Is well located as per plams? a j _ Are. erosion control measures in ace? . s I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and. verified their completion in accordance. with the issued PC14D Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Date`. - ,Z.2 -y Certified by: � PE RA esiga Professional Address: c�ylso�s, GG�°� d2'9�3�1aop_r1_ ` 1 ©� Lic. # Comm_ ents: �. n y '1� j..i r e : h5�1c . �i ✓t�, v{ �, .41 1/hr u L ���• �+•e• form FIR -99 A , All yineers - Planners December 22, 2004 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATTN: Joseph S. Paravati, Jr. RE: Crawford SSTS North -Shore Rd., M Putnam Valley Dear Mr. Paravati: Joseph). Buschynski, P.E. Timothy S. Allen, P.E. Sabri Barisser, P.E. John P. McNamara. P.E. Robert A. B. Howe, B.S., Phys. We are writing in regard to your letter of December 10, 2004 on the above matter and offer the following: 1. The risers provide access to electric and telephone junction boxes and should have no effect on the integrity of the clay barrier. 2. The septic tank was supplied by Mid - Hudson Concrete Products. A cut sheet for the 1500 gallon tank is enclosed herewith. 3. We will advise you when the cast iron pipe is ready for inspection. 4. The SDR35 pipe out of the tank drops down behind and under the retaining wall. A 12" CMP sleeve was provided for the PVC pipe under the wall. 5. The junction box #8 cover was replaced. 6. Pipes in junction boxes #8 and #9 were trimmed. 7. Inlet and outlet ends of abandoned culverts have been plugged. JJB /bs Enclosures Very truly yours, Joseph J. Buschynski, P.E. Planning o Site Design o Environmental Mill Pond Offices 293 Route 100. Suite 203 • Somers. NY 10589 Phone: 914 - 277 -5805 Fax: 914- 277 -8210 • E -Mail: bibbo@optonline.net T001n ITL96 011 XH/x,L]. 9B:ZT Moil bo/OZ/ZT r o.. add 4" +o 4r1514 i- FOa H�7 I --IN I '--\ Notes: 1) Standard inlet baffle, 2) Two compartment 3) Reinforced with 6x6x1 4) Joints sealed with asp 5) Concrete strength 40( 6) Equipped with poiylok SEPTIC TANK a r- - - - - -- r ---- - - - - -- � I 1 1 1 1 I 1 1 TOP VIEW D A Ie K TANK SPECIFICATIONS =16=vsa19vn v1ay. 1 GALLONS A B C D E F G H I J K L -- 1500 67" 126" 68" 56" 48" 12" 3" 5" 4" 18" 10x14 18" 1250 60" 120" 68" 56" 48" 12" 3" 5" 4" 6x9 18" 10x14 1500 LOW BOY 78" 144" 60" 47" 44" 12" 3" 5" 4" 6x9 18" 10x14 2000 78" 144" 68" 56" 48" 12" 3" 5" 4" 6x9 18" 10x14 Note: Add 4" to H for H -20 Loading MlDwHUDSON CONCRETE PRODUCTS, INCORPORATED Route 9 . Cold Spring, New York 10516 845- 265 -3265 r, 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 December 10, 2004 Joe Buschynski, PE Bibbo Associates 293 Route 100, Suite 203 Mill Pond Offices Somers, New York 10587 Re Dear Mr. Buschynski: Field Inspection — Crawford North Shore Road, (T) Putnam Valley TM# 51 -1 -59 ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on December 9, 2004. The following comments must be corrected in the field. 1. What is the purpose of the two HDPE risers in the clay barrier? /l. .Please .provide manufacturer's specs on the septic tank and confirm size. T_ he cast iron pipe needs to be inspected when installed. Please be advised that it appears that 45° turns may be needed in the pipe, which, would require a cleanout for each bend. 4. The. route for the SDR35 pipe between the tank and the first junction box appears to go through or under the retaining wall by the house. Please confirm route and provide how pipe was protected in or under -the wall. The cover on junction box # 8 is cracked and should be replaced. X The pipes injunction boxes 8 and 9 need to be trimmed back. ZI All culverts remaining need to be plugged on both ends or removed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:cj Sincerely, goseph S. Paravati, Jr. Assistant Public Health Engineer T ' d d0 1N3Wi8 d30 AiNnoD WUNind :3WUN ATTENTION T26L- 8L2-GV8 :131 ZZ:9Z INN V002 -2 -930 PUTNA.M COUNTY bEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RJOSEI'W..... d.GENE REO[TEST FOIL FINAL INSPECTTniy For: Fill All information must be fully completed prior to any Trenches inspections being made_ PCHD Construction Permit #. Located: ALOr�h .flee- - (T) (V) Owner/Applicant Name:J,Wmft �.. 929,&�, 7 TM vr Block / Lot Formerly: Subdivision Name: Subd vision lot # 6 Is system fill completed? 4r&: ,9 Date: f f- 5 -- O f- Is system complete? .p Date: -l2 - D - 4 ►, Is system constructed as per pl ? e s Is well drilled? _ &1T Date: _ Is well located as per plans? e- 'y Are erosion control measures in p ace? I certify that the system(s), as listed, at the above prami�ses has been constructed and I have inspected and verified their completion in accordance with. the issued PCHD Construction Permit and approved plans and the Standards, Mules and Regulations of the Putnam County Department of Health. Date: l --'3 D ¢- Certi5ed by: ,w PE �'' RA esign professional Address: &2/lore7 /mp Lic. # �S�•.y �.,�s, by '11"e9l Comments: / ..,c �G! � rD Cd'vr. ss e.. �f- 7'�!�+•s ro H. /l ®�s toy- ZFo %i'.s A►�' Form FIR-99 Tooin axaa FFf d'I'i S3,I,[�i:: >i1SS4 t)HiiIB OTN LLZ M 131 £0 :9T Iad to /£o /ZT =21011 I •� ((�) I\ I ti II) I @" •� I'� I I I\ I (1) I III •� I I I I IIDIIVRS1(DN .CIF IENWRONMIEN7AIL HIEAIL'II'IHI SIERWCES CONSTRUCTION CTION ]PERMIT FOR SEWAGE V AGE TREATMENT SYSTEM PERMIT # Located at Town or Village, Subdivision name Va �� �i3 ,aa , e Subd. Lot # Tax Map S-1 Block / Lot Date Subdivision Approved 20, Renewal Revision Owner /Applicant Name e, /- _7awdt 00 iW Date of Previous Approval Mailing Address /pr s�� S L arJ ,,� Zip Amount of Fee Enclosed — Building Type ge-- r° Lot AreaW, ;.- No. of Bedrooms S-- Design Flow GPD_/e-Vt:7 Fill Section Only )(Depth Volume PCH D I`1OTIFI CATRON IS RE URREl(D WHEN FIDLL IS COMPLETED Sejparzte Sewerage ftstem to consist of gallon septic tank and ,5�. re Zl!�" Other Requirements: /. 5"_ To be constructed by %,E Address - &-Z Wztg SUUPR : Public.. Supply From..... Address or: Private Supply Drilled by Az,-, ��p,����'�� 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.A. Date //- /,0 -a f- License # a �$--PYz f- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage �only. By 1� Title: /�� Date: 8 ✓ L Whi opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ]C1 VISION OF ENVIRONMENTAL HEALTH SERVICES SHEET- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner,,�W„ ,&Zxjsr .-, Cy�4— >'a Address Located at (Street) Tax Map , —1 Block / Lot S9 indicate nearest cross street) Municipal Drainage Basin Z_417-e o,9Crwg� g J. SOIL PERCOL TION TEST DATA Date of Pre- soaking s - -o/ Date of Percolation Test. Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 4 5 3 3 3- �/ -3 =�s l IS a , 7 4 5 1 2 3. 4 NUTES: 1. .r bests to be repeated at same depth until approximately equal percolation rates are obtainea at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s '2 min for 31 -60 min/inch) All data to be submitted for review. 2.' Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' .5 1.01 .1.51 2.0' 2.5.' 3.0' 3.51 4.01 4.5' 5.01 5.51 :6.0' 6.51 7.0' .7.5' 8.01 8.51 9.51 10.01 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED Ili TEST' .HOLES HOLE NO. HOLE NO. HOLE NO. Indicate level at which groundwater is encountered tered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name:,2�—, iz 6 Address: Signature: Design Professional's Seal Date : BIBBO ASSOCIATES LLP 589 Route 22 — Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277 -8210 T WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter 11R4CITIK2 o9? CT a a1@Wa�Ci?zR,1� DATE // ` /D .. A `- + Joe NO. ATTENTION T� �+ • .• Y ��� .y RE: Craw Orar Cf'cS S ❑ Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: For approval' " ❑ Approved as submitted ❑Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify sat once. . . 1 DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval' " ❑ Approved as submitted ❑Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify sat once. . . 1 LORETTA MOLINARI Public Health Director May 10, 2004 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 -7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Joseph Buschynski, PE Bibbo Associates 589 Route 22 PO Box 403 Croton Falls, New York 10519 t�57g 'Dear Mr. Busch Yn ski: Re: Field Inspection — Crawford North Shore Road, (T) Putnam Valley TM# 51.4-59 ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on May 7, 2004. The following comments must be corrected in the field. . Fill pad for primary_and;expansion areas7is not complete. 2. It appears the length to to bottom of the rim system is correct, however, since the .pad Pp � (top ) primary Ys �Lk. wasn't completed, a determination can't be made as to what the actual length is. The area between the two fill pads needs to be completed. 3. The width (side to side) of the primary fill pad is short by 20 -30 feet. 4. The width (side to side) of the expansion fill pad is short by 30 -50 feet. CIV 5. In order to confirm depth, deep holes in each pad need to be dug. 6. Fill material looks marginal. Please provide a sieve analysis for both fill pads. T. It appears the impervious layer for the primary fill pad is not an impervious material. U 8. There are two culvert pipes for the driveway that are too close to the proposed SSTS. One is near the primary fill pad and the other is near the expansion fill pad. These_ culverts need to be removed. 9. There is a tree in the expansion area impervious layer that needs to be removed. If you have any further questions, please contact me at (845) 278 -6130. ext. 2157. Sincerely, �.00,0if.�. Joseph S. Paravati, Jr. Assistant Public Health Engineer Street PERSON IN CHARGE Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH -"'--]3lNrfSION OF'ENVIRONMENTAE-HEATLYf SEWVTCES-`-"--- FIELD ACTIVITY REPORT Name and Title �o TYPE OF FACELITY: a FINDINGS: a Town /�, b4"D mi State L/ Zip j f�'t . . .......... x9y� O&A C,)(va Alf'-11101,1Z54La cpa"Is f.n fi I I rl k-S I dyzzej 0 -. - - -- {ems: -� �� Gloms �-��,�►�� — �o,�.e.�..�.- ��...�_-��..._. _s_�J1.�.���� S_�_�..� •... ... . (W ( a 112J - TW.';PF,CT0R• TFT Signature and Title RF,PnRT'RF.r.F-T I acknowledge receipt of this report: SIGNATURE: .11/06/04 SAT 10:47 TEL 914 277 8210 BIBBO ASSOCIATES LLP PCHD 001 n PUTNAM COUNTY DEPARTMENT MENT Off' IDIVISIO1. OF ENVIRONMENTAL HEALTZ SERVICES AT11ENI'ION XJOSEPH O CEN1E REOUEST FOR FINAL INSPECTION For: Fill X All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit #,fit✓ a20/4.- Located: (V) rn Ila Ile- Owner /Applicant Name: eL.&KYW —ja � TM 3'_1 Bloch I Lot .d__T Formerly: — Subdivision Naxne: Subdivision Lot # Is system Ml, completed? *5 Date: 0I Is system complete? Date: Is system constructed.as per plans? We Is well drilled? (9e5 Date: Is well located as per plans? Are. erosion control measures. place? I certify that the system(s), as listed, at the above preaui.ses has-been constructed and I haveinspected and verified their completion in accordance wish the issued PCHD Construction Permit and approved plans and the Standards, Rules and-Regulations of the Fumam County Department of Healdhi Date: Certified by: L PE . RA esign Professional Address: sly %d�a/�rf�S'�c� �G%�, .S"8����/ce Lie. # Comments: Form. FIR -99 . : . SENDING CONFIRMATION DATE : NOV-1-2004 MON 17:50 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 919144552103 PAGES 1/1 START TIME NOV-01 17:49 ELAPSED TIME 00'36" MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 'LSIZ'IK'+O£17 --um:r.7nb impinj Xm n.,vq noi(•17 Mt of pj9n 9lnnpm mg.j• lmd III g uojllll! 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(-1?!' 01 RIO 'I'llm Qqt. pjl;j,iu,.,q juruonniptn4mois Aprw:iq unj,%nujjumppv pUd nqj .:IU!.q 'laA9ffi0lj'0=Q3 61 'IT911(s Luanid q: p (tzmliq .) del) t&Jtil nqj smoddl 11 niildmuz, oti F! vlW 'mmllfl jlg pud Wd ul oq j!,Iuvrvll cam utlpWbut Nts V :r .jsvXjlnnq -IjAj ma (I;- , ;.Ilq,(. pyjTmm�) tioppd,ul I N, Eop YOU oll zz pl".0 685 smc oosW oqqq.1 t,rK)z '0I 4E 2►99.SIZ(►A)"A 1109 UZ(GrO M4—Aivni),w -11M 6JJV3 "09*9tz(c*9).",l 909'41113t0) .11m :-F-N of -gulml 4imsir *0A TGROU I lWillom RIVVCIUW VLLMO'l ro UTNAM COUNTY DEPARTMENT ®IF HEALTH ENVIRONMENTAL EN'ITAIL IF EAIL'Ir'IHI SIERVIC CONSTRUCTION CTI ON PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 0 / Located at luke J$',4 S" �e, gl;/, Town or Village ?`tea/, ;4� 10btrl—OW Subdivision name P ���� Subd. Lot # Tax Map �r_/ Block % Lot Sg' Date Subdivision Approved ®c/Y% .2f8, /` ?ll° Renewal Poo' Revision Owner /Applicant Name fA4, 4 J4,jwo1 yZAAW Date of Previous Approval Mailing Address { © &-,F " o2,3 o2,3 �'�'; ,� /%� �� r, �,in Zip ©Ga . Amount of Fee Enclosed '`� faa Building Type Lot Area*-47 , c5- No. of Bedrooms L!r- Design Flow GPD �O49 MIR Section Only Depth S Vollume � PCIHD 1? O TIIFICA'g'llQN IS REQUIRED WHEN FILL IS COMPLETED Seroarate Sewerage System to consist of Ac a gallon septic tank and Other Requirements: /. �' -,� &, _�J,a,,�- 6 o, 7 22e ao Cevd/51;A-. S5 A%P// To be constructed by A`he.4-7 &C .S Address Water SunnI Public Supply From Address O Supply Drilled by 4/ A iG', 'r"P 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. Date 45 a27 04 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 mew permit. Approv d for discharge of domestic sanitary se age o�nll _ By: Title: t ate: Wlite copy - HD ile; el ow copy - Building Inspector; Pink copy - Owne Orange copy - Design Professional Form CP -97 qEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver „.. •., a • 7UP£ ��t •Of- tiWt?�P'Nlnit�uanit2tiGn �nc'�•�CCd r°rvt3Gtion: �' ° .¢ ^�- -. .� ° - -- - _ -. "- - PP • _ r "ffor3i- 'R @quiremerlts of'I?art'7� and A- ena{z 75 -A `10tVYC'HR• "` for Individual Household Sewage Treatment Systems Name of Applicant (-rr� ���� slz.& N No. st"eet CilyRown Stats ZP . } Address IC9 6,,,c-94 01-d !� .. ' { (t7� C c� No. sueet City/Town Stab Zip 1 Site'Location /vc>� SAore Pt l/G� ( /V � (4> -7q t. Reason why site does. not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): separation distance cannot be achieved. Excessive slope. High groundwater: Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other(explain) ..................................................................................... ............................... ...................................................................................................................................................... ............................... ......... ............................... .................................................................................................................................................................. .._..............._....._....._ 2. Proposed design 99..rr1ponditions of waiver: - - ----------- - . ------------• .................................. ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): J Increased risk of well or spring contamination. Increased risk of surface water contamination. J Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. 4. 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 thq issuing official fora change in conditions for which this waiver was granted. ORIGINAL - Local Health Agency .0 - COPY - Applicant/Design Professional ........... ........... ............................... oaTE " 1� V Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I - Geneva Road Brewster; New York. 10509- Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 219 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (945) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: V"� e, DOES. THE PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? 1+ YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION. REQUEST APPROVAL OR DENIED FOR (SPECWAIVER)— (r DATE: I LORETTA MOLINARI R.N., M.S.N. Public health Director .:.,.:.w•ro. ..,raw.w.........,K �•:i: :.._;.,��•i. •a_,.i. •7:. ., -., ., a. w.ri�ow...,.o. ...... -:...a DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921- Nursing Services (945)279-6559 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 ' FACSDULL TRANSMITTAL ROBERT J. BON•DI County Executive To: Fax• - C1 (q - 7 7 - 8l O From: foe Pamydi Sr. AP Date: cisgl�`� Re: Cry (�d C�fesK Pages: CC: ❑ Urgent k--For Review ❑ Please Comment ❑ Please Reply .:••wz-_s "1;. . ,'J4,54Z J OP f �� e�, Ur% � � ��p� no��ced/ t,., � �1L,.�• s •>��_•st'. ��. �,�� C� "�.lr�f� XJ7 % sJ d 1i. ,S O..fq l �' S li GILs ✓L /.L�. i"5 To e— CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CON MENTIAL and legally protected information intended only. for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissension, distribution, or copying of this telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone (845 -278 -6130) and destroy all documents associated with this facsimile. .b LORETTA MOLINARI Public .Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 n ROBERT J. BONDI County Executive 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 Joseph Buschynski, P.E. Bibbo Associates 589 Route 82 Croton Falls, NY 10519 Dear Mr. Buschynski: 20, 2004 Re: Proposed SSTS Renewal— Crawford North Shore Road, (T) Putnam Valley TM# 51.4-59 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=: The -last - expansion,= trench is-less than-10 feet fzoir the_.tap ofalope _Also , layout does not match what was measured in the field on 5/•17/04. Please verify whether the layoutR p shown on current plans actually fits. 2. Please provide plans for the separate one story garage. This office will continue its review upon consideration of the above- mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP/km r ' .v..•.. .._ . . _.. .J. .ur.✓t rw- aY. r -. _ �. w- 'n4...'q .a^, n r tr .._n . .. vs • w ..-.. .. .. ..'_... • . }.... .. .r.. rr..y'r 1u .. ..T A .ry q •!. fe l•.w •r •.f. ._ -nT •a LORMA MOLINARI•R.N., M.9 N. ROBERT 1. nONDI . P blk H.4h D/rcpar G+antY 8ra,arve DEPARTNI ENT OF IMALTH L Geneva Rdad, Hrewemr, New York 10509 Fav1 —=DWl Health (a45)278.6150 Fax(045)278.79,21 NurshV Swvlen (845)278.6553 WIC (845)278.6671 rU(845)278.6083 aadr 1-- tiat4prrsc800l (845)276.6014 Fu(145)278 -6648' FACSII)MELE TRANSMITTAL To: (lr �? %3;bfuo Bar.... _. l -' 91Y - &77- 1,21'o From: ae. +rtu/nfi 7�. !1E' Date: ail °Y 126: �w..ifFirni [c %tt%���1^_:_•_f_.._Ynges:....:— 02 , ( CC; Cl Urgent $For keview ❑ Please Commen4 ❑ Please Reply 2aN . It°i�:+r w.. •: 1. rr .y djeov'.ah 129:" in a'(r d eF S1e17. f -Lxr QLS}7' T Lu rn•1.�f4t ii'_e..: fry DCn wt A'-(!s v T 21,,,s �Aty pifa »6 :a.t„! .•(.'i r.'! . � rs Toe- u CONMEN TIAIM STATEMM: '11n: iL&ruunion cu=bled In this lLe dine WAY ..dl. CONFR)MMAL and 169agy protected &=Lidoa inteoded one for the on of the iodivldml or 62tiV named zbrn Irdw reader or th4 mange Is no[ tie Wvmdedreolpient. 70u an bet y nodded the( eW 6waz3oa.6ar.n.ullou w oon4 of this . .. X lec py Ls s �utrA If avoaeetdadthis a wW In cn • pt� immedia* mein w by telepnow "'Ga1.LI ISNVHJ1 ,LNW130Q ZNHOSH ,30 HOEId ZSHI,d xO : SLUM w0a : SCON .,6C,00 : HWI,L QHSdK'IH 80:TT 8Z -dHS :. aKil JIHV.LS Z/Z :. SHJEId OTZ8LLZt7T6T6 : HNOHd I TZ6L- 8LZ -St,8 rIHs H.L'IVHH 30 LN81^ IHVdZG ILMOO WVNZnd aKVN 60:TT HIIZ 600Z- 8Z -dHS H1VC1 NOINWER03 ONIMS Public Health Director 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 Joseph Buschynski, P.E. Bibbo Associates 589 Route 82 Croton Falls, NY 10519 Dear Mr. Buschynski: 15ze -4rtm ber Ang.-,4 20, 2004 Re: Proposed SSTS Renewal— Crawford North Shore Road, (T) Putnam Valley TM# 51.4-59 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. The last expansion trench is less than 10 feet from the top of slope. Also, layout does not �.txiatch uvhat was measured-in the -field on 5/- 7104. Please- Verify,,k et� Or, tk�e- layout -- - _......_ shown on current plans actually fits. 2/ Please provide plans for the separate one story garage. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP/km rA..1410LfNARi 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 Faz (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 8, 2004 Joseph Buschynski, PE Bibbo Associates PO Box 403 589 Route 22 Croton Falls, New York 10509 Dear Mr. Buschynski: ROBERT J. BONDI County Executive Re: Waiver Determination — Crawford North Shore Road, (T) Putnam Valley TM# 51.4-59 The Putnam County Health Department reviewed the waiver request for the above regarded project on September 7, 2004. The following determination has been made:. X The Waiver request was approved. _..__......,.._ _..__0' - "The Waivefrequest Was doridifionally'appr6ved. Howevei; the revisions) noted below . must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. ❑ The Waiver request was not voted on. Explanation noted below. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Sincerely, �oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj REMOrD iJP .. - >�;�:�"; :.fl�� =•.cpl :.fix : �.., .�0. - _ /�..., k.,., ..� �-� -. , . ..� --, - -- :�.-�: /_ \4 / / •/ / a ILT 630 \\ CLFANO /2' -3'F a,. i • / SAND MAX • • 620 1.5' -3' ROB �J ��•�TER SAND GRAS UO I ING / / / / / / / TO PROVIDE QT R SIDE / / MAX GRADE / / / /• // // / /i� / 610 / ;231 • i rLEAN01YT DEPTI FINIE ,% / ' / //' /' / r /' / '� '' PT 600 / i i -' i BIBBO ASSOCIATES LLP 589 Route 22 — Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277 -8210 WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter (URU TIE n @[� C[T ° e lNc@i1'IJv TCT er. 0 DATE - JOB NO. ATTENTION O RE: M,:..... . _ �..._. . `�• .o jP ❑ Attached ❑ Under separate cover via the following items: • Prints ❑ Plans ❑ Samples ❑ Specifications • Change order ❑ COPIES DATE NO. DESCRIPTION `�• .o jP I THESE ARE TRANSMITTED as checked below: -- - •• •• -•- - - -- E}- For�approval - ❑ Approved -as subr itted ❑" Resub "hut "" copses for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notlf us at once. K< I 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 September 3, 2004 Joseph Buschynski, PE Bibbo Associates 589 Route 22 Croton Falls, NY 10519 Dear Mr. Buschynski: ROBERT J. BONDI County Executive Re: Proposed SSTS Renewal — Crawford North Shore Road, (T) Putnam Valley TM# 51. -1 -59 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. - The - Following - i±enl § -do not meet current code a) Natural grade over the expansion area is greater than 15 %. b) Proposed SSTS is less than 50 feet from open drainage. Due to the above, the application is denied. However, it is your right to request a waiver. 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:km Sincerely, oseph S. Paravati, Jr. Assistant Public Health Engineering PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH LETTER OF AUTHORIZATION RE: Property of Located at A( owl _`i T/V ,,r" t1,w1111&tg Tax Map # Subdivision of ,Sr/ Block / Lot 15—? G Subdivision Lot # (101� Filed Map # 77 9 Date Filed / - 7- 178 Gentlemen: This letter is to authorizes a duly licensed Professional Engineer _� or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems :: - ..:....: in conformity :with .the. provisions of Article.44S -- and/or -1.47 of the--Education I:aw, 'the Public Healt Law, and the Putnam County Sanitary Code. v b Very dly y s, Countersigned: P.E., R.A., # QS" z - L- Mailing Address,,5 8 ,/� &� X .Z /©O -G:,r �3z colw7 ,,,710S* State.' X/ Zip Telephone: 9/¢— .2 77— S`80S Mailing Address: fO4 c5g 7` e23) �_r77 1�y1: ' State %� -y ZipJDQ /© Telephone: 2 1,2 Form LA -97 SENDING COMMON DATE SEP -2 -2004 THU 15:01 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919142778210 PAGES : 1/1 START TIME : SEP -02 15:00 ELAPSED TIME : 00'45" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... ono ' aavHO xdw , 3MAOHd 01 %VHD 9 CNV8 eoHrs•� I oze --- - IxM Id aL aNVS / d.6`z� i 1` trf4i�gm , , 1�1 i8 fo* 1 611360 ASSOCIATES LLP 589 Route 22 — Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277.8210 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ OIEVVcEa oIF C a H@NOCITITRI� DATE - 7 _O / 'OB NO. ATTENTION RE; �' Os dg e . sc /f 6' r G ❑ For your use ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION For-approval ❑'Approved as sutiml`�t ed ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ss s ,- ZZ' 121,a 04Y For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US THESE ARE TRANSMITTED as checked below: —� - -- -07 For-approval ❑'Approved as sutiml`�t ed ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: 02_1'6�r If enclosures are not as noted, kindly notify at once. Illy r � � w � (1) '� ��;� � � � � � I'�: (I� � � � � ...� � •� I I l i �� I III �i � i'� �� C(1jNSt1[tf ib*N` P7 EE* A � T F- Q~s1E TREATMENT SYSTEM PEST# Located at Town or Village R,1 %zaa07 as /lg..�e Troc�� �� s�a� Subdivision name ��,� ��� Subd. Lot # Tax Map Block / Lot J�'? Date Subdivision Approved act, o2R, /��� Renewal Revision Owner/Applicant Name , Pp ����������� C,6962, 6%0- Date of Previous Approval Mailing Address ,mac; S%¢ 3 �5�: , /��'tr� e v��l . � Zip O Amount of Fee Enclosed Building Type Lot Areallo. of Bedrooms Design Flow GPD /UP® Fill Section Only &,' Depth/.-C--,3 Volume e,:> Selgau°ate� Seweirag7ee System te C rm �to consist of 1,5 O gallon septic tank and ,tg ' Other Requirements: To be constructed by 0, D Address Water SUPPRd: Public Supply From Address i - - ._ - ddres ,_.: .. _.Pn��te S.upply..Drilled.by�. _ _..A.. s__ 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: Lzo. P.E. ./ Address .° �.SS�c s- ��� �.i� 3sc 72 R.A. Date !7-191-01 License # e2. 'y- Z f- APPROV]EIID 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 pernR. Approved or dis e o omestic sanitary se ge only. By: Title: Date: Lo li d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH. • DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSUREACE.SEWAGE - TRRATMENT SYSTEM " Address y_,r,`I' �/O Located at (Street) jL)orfLi 6f/ e- Tax Map � Block / Lot' s"9 indicate nearest cross street) Municipality Drainage Basin Z__4A e_- �,�Cciw9�g SOIL PERCOI _217- Date of Pre - soaking ,5 - jL-off )N TEST DATA Date of Percolation Test. Hole No. Run No. Time Start - Stop Ela se Time �1YIiR.) Dep th to Water 1N'rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 7 4 5 2 J3c� X.2a . _ . _ 1:4 .... _18:...._.x.! 4 5 1 2 3. 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation 'rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min /inch, ,5'2 min for 31-60 min/inch) All data to be submitted for review. Depth measurements to .'be made from top of hole. Form DD -97 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 Name:.����� Address: „��v,�S�sbcs_ , Z- Signature: Design Professional's Seal OF NIA ,��1✓ �. BUSCh,� �O OA 055g2h v 4ORESS60NP` TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.01 s.s' 6.0' 6.5' 7—t,, 7.0' -/ -7.5' 8.0' 8.5' 9.5' 10.0' 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 Name:.����� Address: „��v,�S�sbcs_ , Z- Signature: Design Professional's Seal OF NIA ,��1✓ �. BUSCh,� �O OA 055g2h v 4ORESS60NP` V1 /V5 /4VU4 IV.' V4 rnn U40 444 dd.V4 rULne.h1Uo �ulloi.�U.lii... �ye.e•�rvv FROM :FAIRWAY_TESTING FAX NO. :16459420995 Jan. 05 2004 09:36RM P3 -- GRAIN SIZE DISTRIBUTIM TEST DATA Client: Polhemus Construction Company, Inc. Projmct: Self Evaluation Project Number: Sample Data Source: Proposed septic material Sample No.: 01- 123103 Slay. or Depth: Sample Length .(in. /.cm.); Location: Septic Fill from Crawford Description: Proposed septic fill from Crawford _ Date: 12 -31 -03 Natural 0isture: Liquid Limit: Plastic Limit: USCS Class_:' Testing Remarks: Fractional components Gravel/Sand based on #4 Sand /Pines based on #200 COBBLRS = qs GPAVEL 40.4 $ SAND 52.7 SINES = 6.9 D85= 20.58 D60= 4.88 D50= 2..61 D30= 0.82 D15= 0.29 Dlo= 0.16 Cc= 0.6566 Cu= 29.9.167 __. F'AISMY TESTING CO. , INC. 01/05/04 -MON 10:53 [TX /RX NO 77211 Ia002 Mechanical Analysis Data. Slave Size, nm Percent fin, ar 2 inch 50.800 100,0 1,5 inch ,18 .100 100.0 1 inch 25.400 90.0 3/4 inch 19.050 83.3 1/2 inch 1.2.700 75.6 3/8 inch 9.525 70,4 1/4 inch 6.350 64.0 # 4 4.750 59.6 # 10 2.000 45.5 # 40 0.425 19.7 # 1.00 0.150 9.5 # 200 0.075 6.9 Fractional components Gravel/Sand based on #4 Sand /Pines based on #200 COBBLRS = qs GPAVEL 40.4 $ SAND 52.7 SINES = 6.9 D85= 20.58 D60= 4.88 D50= 2..61 D30= 0.82 D15= 0.29 Dlo= 0.16 Cc= 0.6566 Cu= 29.9.167 __. F'AISMY TESTING CO. , INC. 01/05/04 -MON 10:53 [TX /RX NO 77211 Ia002 •Y S p i 7 i J J 1 Q (D 1") Q) v m Q N In m C h in Q) (1) N V tlt N CD a-1 6 z Y. Q It u n 7 V 7 A 7 ]0 L7 x ? x � 1 N A W Q 3 a o C ti .. O� O LL .e u .i rE O h O ri PJ ti ti O z sc x H 0 z 0 O O 0 LORETTA MOLINARI Public Health Director May 10, 2004 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 . Early .Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Joseph Buschynski, PE Bibbo Associates 589 Route 22 PO Box 403 Croton Falls, New York 10519 Re: Field Inspection — Crawford North Shore Road, (T) Putnam Valley TM# 51. -1 -59 Dear Mr. Buschynski: ROBERT J. BONDI County Executive A site inspection was made for the above referenced project on May 7, 2004. The following comments must be corrected in the field. 1. Fill pad for primary and expansion areas is not complete. apipears the length (top -to bottom) of the- primary systerri-is correct,-how eiver, since the pad wasn't completed, a determination can't be made as to what the actual length is. The area between the two fill pads needs to be completed. 3. The width (side to side) of the primary fill pad is short by 20 -30 feet. 4. The width (side to side) of the expansion fill pad is short by 30 -50 feet. 5. In order to confirm depth, deep holes in each pad need to be dug. 6. Fill material looks marginal. Please provide a sieve analysis for both fill pads. 7. It appears the impervious layer for the primary, fill pad is not an impervious material. 8. There are two culvert pipes for the driveway that are too close to the proposed S STS. One is near the primary fill pad and the other is near the expansion fill pad. These culverts need to be removed. 9. There is a tree in the expansion area impervious layer that needs to be removed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, e 4.e Joseph S. Paravati, Jr. Assistant Public Health Engineer r o � � �- fr�,es �}t�_ e� � fist - 9 �- 05/05/04 WED 08:27 TEL 914 277 8210 BIBBO ASSOCIATES LLP 4 PCHD —77 COUNTY DEPARTMENT OF EMALTH DIVISION -OF ENYMONMENTAL SALTJI SERVICES ATTENTION • 0 JOSEPH .. 13 GENE REQUEST FOR FINAL INSPECTION All information must be My completed prior to any inspections being made. PCHD Construction Permit 4 0 For: Fill x Trenches Located: (T) (V). t1a Ile Owner /Applicant Nam6:,7a4ro, ror�,yor CAe;k4--' TM •r/ Block I Lot S-1? Formerly: Subdivision Name:ZA*-4.;7 c;► Subdivision Lot ff --� o Is systern fill. completed? — � e .r. Date: 00 ye C+ewn r-ri AA.F 10+'09 V. VJ A Is system constructed as per plans? e,7 Is well drilled? �eg Is well locatod as p lans? Coe Are, erosion control measures in tdace? 4e �X -7 =- UUM: - Date: I certify that the system(s), as'listed, at the above premises * has been constructed and I have inspected and verified their r completioa. in accordance with the issued PCHI) Construction Permit and approved plans and the Standards, kidesand Regulations of the Putnam 'County Department of Health. LUZDate: Certified RA besign, Professional Address: 01-AAI X Z Comments: Form PIR-99 MAY-5-2004 TEL OF Q001 04/05/2004 21:02 2127778261 q I i old J v 0' i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please pain[ or type .. ., - .._'_PCI D °Permif #. . �,Q ✓= a, (o.�� l..a::;.« . ,.� Well Location: Street Address: Town/Village Tax Grid # Map S-/ Block / Lot(s)6-91 Well Owner: Name: Address: axis- ,r,.f&h��� O �3 c57` Use of Well: :/ Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _Sj']pt gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling __Ll New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No v/ Is well located in a realty subdivision? ...................................... ............................... Yes ✓ No Name of subdivision 3 Lot No. e Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: — Applicant-.Signature:. _�"z 01 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 dril Pr cerli fied by Putnam County. Date of Issue to/J01 Permit Issuin Offici : , Date of Expiration I I tQ1 o 03 Title: Permit is Non- Transferrable White copy - HD file; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WP -97 PUTNAM COUNTY DLi AItt JV MUE --.[' Ok DIVISION OF ENVIRONMENTAL HEALTH SERVICES :.�.: _ :_...... :_...:.... APPLICATION 'OR PLANS OF PLANS F.OR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant:pf , /v / 2. Name of project: 3. Location TN: 4. Design Professional: V ; ��o �s $R7C LG� 5. Address: 6. Drainage Basin: Za4- 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 J� Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... i[j,¢ 10. .,Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials;- ordinaances? ._.:_.:. ........... ............................... 13. If so, have plans been submitted to such authorities? ..::.... .................:............. ,(J� 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ............... surface water g roundwater 16. If surface water discharge, what is the stream class designation? ..................... fir¢ 17. Waters index number (surface) ....................... 18. Is project located near a public water supply system? ....... ............................... iya 19. If yes, name of water supply Distance to water supply 20. Is project'site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 22. Date test holes observed� 23. Name of Health Inspector/-:z' - 24. Project design flow (gallons per day) ...... ......... : �,�. -. .�!' ���.�r� • .......... DOD - 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... Fomi PC -97 1 � 27. Is any portion of this project located within a designated Town or State wetland ?_,Vz2___ 28. Wetlands ID Number ........................................................... ............................... 29'. Is Wetlands "Permit required? .::......................... .... .................... .............. p Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 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/No 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? . ............................... G.S 36. Tax Map ID Number .......................... ............................... Map Block_ Lot 3`7 37. Approved. plans are to be returned to ..... Applicant t/ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC_ Watershedshajl. - i. »be -sent to- the-Departnient; and-need-not be sentih duplicate to-the DEP, althoughthm 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.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 applicRomust be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this-J., may be grounds for the rejection of any submission. I hereby affarin, wader penalty of perjury; that infortnation provided on this forur to the best of nay, knowledge and belief.' False statements made herein are punishable a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITTLES: Mailing Address: ..................................... �% �c �, J�� 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATAHEET = SUBSURFACE-SEWAGE TREATMENT SYSTEM ` Owner Jo4101- jlw scti t /cry rr/ Address Located at (Street /";'e' Tax Map.. / Block Lot ,S'S (indicate nearest cross street) Municipality A 7�ggl y, Drainage Basin g SOIL PERCOLATION TEST DATA - ,Ee;04,f/S1ait) IJW?F Date of Pre - soaking S'— Date of Percolation Test. z Hole No. Run No. Time Start - Stop Ela se Time. 6Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 3 '� -2� 02l 3 f 7 s J Z.- 7 3 -os- ; �7 4 / / =32 y . 5 2 . 3 NOTES: A : Tests to be repeated at same depth until appro*imately equal percolation rates are outainea at eacn ,percolation test hole. (i.e. s' 1 min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be ut•.�mitt ed;for review. ti? kF' a �2 Depth measurements to be made from top of hole. Form DD -97 • fr, .l TEST PIT DATA DESCRIPTION OF SOILS ENC0UNTERED IN TEST HOLES DEPTH HOLE NO. _S HOLE N0._ /� HOLE NO. G.L. _%o�JSo. Ta�so 0.5' . 1.0 2.0' - -J __:....:..'__ X9:0'.._..._......_.: , .� - -- : _ .� - '._... .:_. _ . � •_�-:_. _ :..._:..- .....:_::..._ ..�.. - • - : . - _� ._ �-- . -.:.__ .._: 9.5' 10.0'._ =a Indicate level at which groundwater is encountered ` ..•rte � Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date -� -q Design Professional Name: \7— m4 Address:, J .BUSS, �- Signature: �$sO��• 0559Z� DesDesign Pu'ofessaona➢ s F� Professional's Seal '90FESSIO P PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTALHEALTH SERVICES i ESIGN•DATA- -&HEET SD13S` I3RFACE� `SEWAGKIREA`TkkNt'SY'5T' 1Vi - :: :N Owner � Lir, �.ftiS�ti _r�ti��q�/ Addressl� Located at (Street) /j',b,,fl,SGi�5�rh �yjyye Tax Map S"/ Block �_ Lot'. S� (indicate nearest cross street) Municipality 21— //y Drainage Basin SOIL PERCOLATION TEST DATA •: jJ/%�d� C%i�c g Date of Pre - soaking /2-,2 - f ¢ Date of Percolation Test.' .102 - Z -�¢ Hole No. Run No. Time Start - Stop Ela se Time (pMin.) De th to Water rom Ground Surface (Inches) , Start Stop Water Level Drop In Indies Percolation Rate` . Min/Inch 3 7/g 7, 9 5 ; 3 4 x;03 /Z: 3 ,3O 1z Y %0- ep 5 1 2 . 4 NOTES:., - l' .-Tests to be repeated at same depth until approximately equal percolation rates are obtained at each :,percolation test hole. (i.e. s 1 min for 1 -30 min /inch, s 2 min for 31 -60 min /inch) All data to be bbinitted for review. 'Fs , "i 1). ",(h measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' _ 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5.' 6.0'. 6.5' 7.0' 8.0' 8.5' 9.0' . 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLIES HOLE NO. - HOLE N0. • HOLE NO. a6Y 5217' I ' J r r r 7 r AV O L'vc/, -5 Lf L,- Z= e looe t �--- - r -' a rn i --k3 I Indicate level at which groundwater is encountered e5�¢ - Indicate level at which mottling is observed — Indicate level to which water level. rises after being encountered Deep hole observations made by: �A�� „� r�,- _ Date 1,,,2 -2 } 14 Design Professional Name: Address: G, fJ- Signature: r C �ysFOA 05592b DeDesign Professional's Seal Ao • 06S�o�� 14.16-4 (2187) -Text 12 PROJECT I.D. NUMBER 617.21 SEAR u Appendix C State Environmental Quality Review' ,.�.- , ;,SH0RT - ENV1R0NMENT -AJ 4SSESSM'ENY O t '" For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. NT ISPONSORi/ PROJECT AME �' 41e G� 17,Ve,. 3. PROJECT LOCATION: fe �1c:P,�s Municipality • County 4. PRECISE LOCATION (Street address and road Intersections, prominlint landmarks, etc.. or provide map) s,/ /UO�1 S�JO.°'ci sGll�/r °vH 141 ���� S�,G✓o,0 Lo7`'``G a7�T�� Tv�, .� . �os7`� 7�� 5. IS PROPOSED ACTION: J { New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initiallyd acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 2Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ,Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? YSI Yes. ❑ No It yes, list agency(s) and ppermlt/approvals ✓ ✓ ✓N 11. DOES ANY ASPECT OF THE ACTIO HAVE A CURRENTLY VALID PERMIT OR APPROVAL? RrYJes ❑ No If yes, list name and permit/approval /agency /� GfOS /f�j �`f�G�• (/? / -/ /7?!�G' � `�/Gic,7C°�i �G-/ � �G� 7 /J J (v 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor ame: G%/ .. C , ) Date: tz Signature: 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 ll— ENVIRONMENTAL ASSESSMENT (To be completed by F,gency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration Ray . 4 eavperseded .by.another- lnvolvod•agency ..... .. .,... t_. .. > ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or. groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 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 C5. Growth, subsequent development, or related activities likely to be induced,by the proposed action? Explain briefly. i"n `? <C° C6. Long term, short term, cumulative, or other effects not Identified In C1-05? 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 ❑ 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, important 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. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL E4F and/or prepare a positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency " Signature of Preparer (if different from responsible officer) Date 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL' HEALTH. SERVICES,. LETTER OF AUTHORIZATION RE: I'roperly of �d�i� �, �s�Grr,✓ 7�d.��� u°�v�SGih /�%i/'f�Ia9 Gi'�d✓7�o��✓ Located at 7% ,�Aor e AU TNT /e Tax Map # ,S—/ Block / Lot S Subdivision of /G 2 Subdivision Lot # Filed Map # Date Filed /7Z9_e Gentlemen: This letter is to authorize i �,��►SSpci�J��s, -G.P a duly licensed Professional Engineer ,/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems inconformity with the provisions of Article 145 and/or_:147 of the Education Lawr.thc Public I ualth " "Law; grid the Putnam County Sanitary Code. Countersigned: P.E.,JA-A-, # _ Mailing Address S ,21 Ilan le 22 �a Z6 cloto )Ia� 115 State * Ar Zip 16�25_1i Telephone: 71 f-- A 7 7 — Seas' Mailing Address: State 1U, Zip Telephone: Form LA -97 • -- if w • PUTNAAL I COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIItON-N EN'TAL HEALTH ViDTVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT --.STRFET LOCATION:,x GR(Z,)SRDATE: 2 7 O/ Z TAX IvLaP =: (CO iED)_ ()C RPORATE RESOLUTION (� SHORT EAF � PL 'THREE SETS (j SE PLANS -TWO SETS U ARL�:`iCE REQUEST SUBDMSION LE GAL SUBDIVISION UBDTVISION APPROVAL CHECKED PERC RATE 1_ FILL REQUIRED DEPTH C (-JC AN DRAIN REQUIRED GENERAL (� C TED L\ NYC WATERSHED (___) ANS SUBNI TTED TO DEP UU EGATED TO PCHD (__) DEP APPROVAL, IF REQ'D p �- �AXP�VR, P TEST HOLES OBSERVED TNE S TO BE WISSED - PPROVAL SSDS ADJ, LOTS (� VETLANDS (fOWN/DECPER,'YITTREQ'D ?) . (� ON DDS PLANS & PERMIT SAME (� 1969 NEIGHBOR NOTIFICATION U TER BI/ZBA (___) 100 YR FLOOD ELEVATION W/I200' IL TESTLtiG-LOTS >10 YEARS OLD- - >EWAGE SYSTEM PLAN - (NORTH ARROW) ;SDS HYDRAULIC PROFILE JRAVTTY FLOW 2ONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS t' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT POTII (G /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS Z Imo, PE/RA; NAME, ADDRESS, PHONE9 TB OF DRAWING/REVISION DATUM REFERENCE 4OCATION OF WATERCOURSES, PONDS LAKBS,WETLANDS WTIHIN 200' OF P.L. PROPOSED FINISH FLOORAND . BASEb1ENT ELEVATIONS )WELLS & SSDS'S W/IN 200' OF SSTS )PROPERTY METES & BOUNDS Y- (REQUIRED DETAILS ON PLANS CONT'Dl H SE SEWER- W' FT. 4 "0'; TYPE PIPE CAST IRON NO BENDS; M,- X BENDS 45° W /CLEANOUT RENEWALS (- __)SITE NOTE (NO CHANGE) FILL SYSTEMS U 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( L SPECS! FILL NOTES 1 -5 ( ML PROFILE & DIMENSIONS L L\ EXPANSION AREA . FILL GREATER TH.4V 2 FEET LAY BARRIER. v g"CERTIFICATION NOTE vOTLON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS EPARATION DISTANCE FROM TOE OF SLOPE E (_ ,( TT ENCH PROVIDED ?O 60FT MAX. LEL TO CONTOURS 00° EXPANSION PROVIDED ( ETAIIJDUST FREE CRUSHED STONE OR WASHED GRAVEL ( JGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS UU10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 020' TO FOUNDATION WALLS �100' TO WELL, 200' IN DLOD,150' TO PITS 1 0' TO STREAM, WATERCOURSE, LASE (inc. eipan) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER �E TO WATER LINE (pits - 20') E�(j('220(600'1500'RESERVOR ' EiTER�NIITTENT DRAINAGE COURSE' ETC. ^ 150' GALLEY SYSTEMS . 7L-�w'MIN TO LEDGE OUTCROP SEPTIC TANK FROM FOUNDATION; 50' TO WELL WELL D1tiIENSIONS TO PROPERTY LINES ( OCATION OF SERVICE CONNECTION `LLN 15' TO PROPERTY LINE SLOPE U(___)SLOPE IN SSTS AREA 920 1/6) U( jREGRADED TO 15 %, IF REQUIRED pOSE/PU-lvIP SYSTEMS U( PUMP NOTES (�( DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED U DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) U( PIT AND D -BOX SHOWN & DETAILED U(�1 DAY STORAGE ABOVE ALARM C�/�/l�/ CURTAIN DRAI`i I �DPIPES. S' BOTH SIDES_IIF.'�• 15' NIIN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<1% C_ 20 hIN to CD DISCHARGE /100' with 182 cons day discharge (_�j( _J10' NILY to NON - PERFORATED PIPE �; � ..... COININIENM: P - -- — - (REVSHEET) 131660 ASSOCIATES LLP 589 Route 22 CROTON FALLS, NEW YORK 10519 277 -5805 FAX (914) ,2177.821 9 0 TO /ll�L�i �L�/9 /y /i°�� •<lG�/ WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ GATE _ _al JOB NO. ,;, RE: Z., 2A xo� the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION rit% , G J rii �/ /�O�/ a iv' � O c°6• 3 e, V/ S.5'1T.5 Z5 Z-2 - THESE•ARE'TRANSMITTED"a's checked below:- [/For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for cort, ctions ❑ Return �1 corrected prints • For review and comment C] /�eG' ���� L�' �r ,z 7 /?' y 2,27 ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS �-/!A SA - ���'i -�r �/7"��J� G -.�ree/ G�P�°SS CG/'/ e- / /�HCGI �Bh�✓`liEf`Y/G!°� /G;i.,s �r7�i k id• :��5iSTS �S�iD��-� 7 i o�: D 4.7 G: 4j, /% �j, lr% d'LiG��7i• 7`O'6'i yg S' /lgy���fG�.1' Se`ipe�ai a�-s �Oi-D' T' ' �G. . er /701 ,Pe�c� 7 Zeek, �l�ti SIGNED: BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N.. Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 August 27, 2001 Early Intervention (845)278-6014 Fax(845)278-6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Joseph Buschynski, PE Bibbo Associates 589 Route 22 Croton Falls, New York 10519 Re: Crawford, Lot # 6 Trading Post Realty Subdivision TM# 51 -1 -59, (T) Putnam Valley Dear Mr. Buschynski: 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. D cuments pplication CP -97 - Construction Permit (SSTS) /2.The property is located on North Shore Road. Please note in "Located .... North. _ Shore =Road; -not North - Shore.-and sunken Mine Road. Application for fill section only. Lineal footage of trench shall not be listed. A lication WP -97 The property is located on North Shore Road. Please note in "Located @ ............ North Shore Road, not North Shore and Sunken Mine Road. —97 - Letter of Authorization. Complete filed map number. Complete date filed. P n Please add additional ground water monitoring stand pipes at elevation 622 and 622.5. rovide note stating "groundwater monitoring pipes to be 5' -0" either side of curtain rain. Provide note "curtain drain minimum 15' -0" from SSTS. Tax map number as listed 51 -1 -56 is incorrect. _�.�;,:;� -, ��._ ._ . De s ^ ... v rrw ... -:v.� c _ rr . - - -. .......r... r�.un.,...�aa sr - >c ..... o- , .. .. a ._,. v > r.•.:w ...0 o .....r. . � — Provide note on groundwater monitoring stand pipe detail stating `.`provide 5' -0." either side of curtain. 2. Provide note. referencing direction of flow on cleanout detail. es , 1. Please verify /clarify note # 9 "Fill Notes." P ile 1. Show groundwater monitoring pipes on profile - 5' -0" either side. Tre la : t. an to include fill certification statement. Comments listed above shall also be reflected on "trench plan" if applicable. 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, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc: CP -97, WP -97, LA -97 �_. .- .... _.... __.Elan _o .. ___ s__. _r _.......:_ , ._._ ___...:._,...__.._ _..... ., _.......• _ . _.. �.__.... __ _.__ �._..a _.� .:.. �_ - _:.,+_.__�.._...� PUT NAM COUNTY DEPARTMENT OF HEAILLT DIVISION OF ENVIRONMC NTAL HEALTH SERVICES _ ... > - &�ET'�'1CR. ®JF -AUTH - 0RIZ,"ATION- ..—. RE: Property of jOfh A 4,J 7�6i- _ V_I x7sasi lr'lc��_ lax'/ Located at 1()er 1_7% TN loe,, l/ q Tax. Map # s-/ Block l Lot 3-7_ Subdivision of i� e_ Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize p" h�a XS.SCellkl Z- /—_ 110- a duly licensed Professional Engineer s/ 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 treatment 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 Sanita ry Code.: ... -� ....,� . __ .. Very truly Countersigned: Si Si P.E.,Jk-C, # el S�y.� `f _ (owner of Pr city) Mailing Address 3U7 State 1r Zip ZG�5 -1% Telephone: I/ f ` ,1- 7 7 — J'70,3_ Mailing Address; State /U, 2 Zip 16� Telephone: �2-1,2 ` 25_c3 — q,3 e96- ' corm LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location :, St�reet Addr ss: �IjownNillage:, _:. . Tax Grid # _ Ma Block / Lots .S— - % 7` rr �/ e� P Ste/ Lot( s) Well Owner: Name: Address. Use of Well: m/. Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought s gpm # People Served Est. of Daily Usage 04''Oal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling t/ New. Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type c/ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? Yes No ..................................... ............................... Name of subdivision T-1-aWn4 10 o.S7`oti 7`�i� � � Lot No. Water Well Contractor: Tom, 2 . Address: Is Public Water Supply available to site? Yes No Name of Public Water Supply: Town/Village Distance to property from.nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: Lze�� 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:. l.) 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1 -r v 11.n Al l C U UNTY DEPARTMENT OF HEALTH DIVIM T OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM Located at Z L,& Va,,e- ro-, a Ar , Town or Village , LZ��Ay :y %G�l ..- Subdivision name f/,� ke_ Subd. Lot # � Tax Map Block / Lot Date Subdivision Approved Renewal Revision' Owner /Applicant Name J0191.4 SfS�•i CMw 41W Date of Previous Approval Mailing Address , J:P J-7, , /1%v ; �%y� -/�, ��,,�• Zip Amount of Fee Enclosed Building Type i Lot Area425 -No. of Bedrooms S_ Design Flow GPDeeVL> . Fi11 Section Only _ Z Depth /.�i`c� Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of . 1S0749 gallon septic tank and �v�G G,�'• l/4 J2- -_ .. J r_/ .Zi /.._ Other Requirements: To be constructed by �-,,�7,,0, Address Water Su_ - 1- : Public Supply From Address or: a/ Private Supply Drilled.by �%, 0, ,0, 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.A. Date _,Za/ O/ License # f- APPROVEID FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BIBBO ASSOCIATES LLP 589 Route 22 CROTON FALLS, NEW YORK 10519 a - - -- .._.(.214)..277. - 5805... _. 'FAX (914)..277 -8210 TO WE ARE SENDING YOU O Attached O Shop drawings O Copy of letter g1VI M OU , `Ul `� n LIV�UVIIIJI, ",:ll�l /;\ GATE 3 a / DATE JOTS NO. ATfEN\ 0 Ee e.,-7 r s �- RE: 2- -A.7, J Gw Nero, O Under separate cover via the following items: O Prints O Plans O Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 2- -A.7, / OGif G �jC, &IJ; ' THESE ARE TRANSMITTED as checked below: MITor approval O For your use O As requested ❑ For review and comment O FORBIDS DUE REMARKS O Approved as submitted O Approved as noted O Returned for corr - ctions O Resubmit copies for approval O Submit copies for distribution ❑ Return corrected prints ' O 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: r MC H AIE L A. GIEY ER 2QD Wiest 2 ®tla Street, New ZYork, New �'oIIk__10'0 L,]I. -42A3. ..,.:.,..,. . 212 -691 -4722 Voice M[Geyer50 @aol.com 212 - 691 -0564 Fax 10 March 7.006 Iry Sevelowitz, Putnam Valley 265 Oscawana Putnam Valley; Re: Crawffi 196 Nc Putnaff. Our Re Dear Inspector Thank you for taking tim Qf your edule to meet with us at the site. It should considerably expedite the r ouolu pen issues holding up issuance of a Certificate of Occupancy for our clients. Based on our discussion, we understand that issuance of a Certificate of Occupancy is contingent on the receipt of the following: - Underwriters Laboratories approval of the electrical installation; - Health Department approval of the well and the septic tank; - Approval of the driveway by the Town Highway Superintendent; - A revised plan of the basement level showing the as-built condition, stamped and signed for filing and approval; _ Construction details of the retaining wall south of the hY , stamped and signed for filing and approval by the Town Engineer/Planner Final approval will require these formal sign -offs as wel entio o several matters of less consequence. The enclosed Memorandum records ' detai vario Re a discussed. Please inform me if we have missed any requirements. Sincerely, Michael A. Geyer Enclosures cc: S. Crawford J. Paravotti A R C IH[ I[ T IE C T Ir ... a M`1.1111i[Y111 L A. `1y11I111L'J1Lll 20 .. . . .... ... .. .. _.- .. W.. est 20th Street. York.. ..— - - 212- 691 -4722 Voice MGeyer50 @aol.coin 212 - 691 -0564 Fax MEMORANDUM To: Iry Put Date: 711 Project: Cr, IN Put Ou REQUIRE I. EXTERIOR A. South Retaining wan A Town ordinance requires formal filings and Town Engineer approval of retaining walls that exceed four feet in height. Construction details of the high retaining wall south of the house must be filed for approval. We will file for approval stamped and signed drawings prepared by a structural engineer. B. Driveway The eastern leg of the driveway must not drain to the neighboring parcel to the east. Before - committing to: a solution of the roblem however we must-ca the location and b. 'ed , _ .. P _ .� . ,. _ .... _ _........ - __.._.._... depth of utility lines that run along the west side of the drivewa . o that end, we have requested that Joe Buschynski of Bibbo Associates reviewtl"gem. A resolution of the drainage will be forthcoming. Recent discussions have raised the possibility that p required. Enclosed is a copy of the Site Data Not s development within the subdivision. The only re which contain paving requirements for the a ension reference to paving of driveways. U. INTERIOR IMPROVEMENTS A. Basement Kitchen / (, the subdivision is it varid�s quirements for ving is otes No. 8 and 9, Shore Road. We can find no Currently, approved constru h n ,lans shoNv an unfinished basement. A new plan must be filed showing the new storage cab' iie (the forr kitchen), laundry room and bathroom. We will record these improve ts, e a plan for approval, stamp and sign it and file it with the Building Department along with a new application form. In a previous discussion, Mr. Paravotti at the Health Department indicated that additional Health Department approvals would not be necessary if the area in the basement that is currently a kitchen ceased being a kitchen. By copy of this Memorandum we are seeking his confirmation that this is correct. q � Issuance of a Certificate of Occupancy will be contingent upon removal of the electrical junction box where the range was located, and removal of the 'shwasher and the junction box at that location as well. Sheetrock must be patched over loc 1 s where the junction boxes were located. B. Boiler Room The sheetrock partitions that form the boiler ro er a gara m t be firestopped up to the ceiling slab. The discharge pipes for the blow out val on th tw boilers and the hot water heater must be extended to discharge just above the lab. C. Stairwell from the Ground 1F➢ o to the o d or An outrigger handrail must m ed ong the ' side of the sheetrock bulkheads that flank the stair run. Installation ' re quired o o ide of the stair. D. Fireplace Statewide energy consery on odes uire glass doors on the fireplace. E. Carbon Monoxide >(Detecto It must be confirmed that the smoke detectors installed in the house are multi- purpose smoke and carbon monoxide detectors. cc: S. Crawford J. Paravotti Al R C H I T IE C T s Tad and Susan Crawford.., v. 10Bast23 Street New- .York,, NY- 1001,0 Friday, February 17, 2006 Mr. Joseph Paravotti Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Health Services 1 Geneva Road Brewster, New York 10509 Re: Residence of Tad and Susan Crawford 196 North Shore Road, Putnam Valley, NY 10579 Dear Mr. Paravotti: Thank you for calling today. I appreciate your retrieving our file from the archives and reviewing it yesterday. As we discussed, the Department of Health approval already covers the finished basement space. K I appreciate your calling Iry Sevelowitz, `Code Enforcement Officer for the Town of Putnam Valley Building Department, and I understand that from your conversation with Irv, that he said we do not have to apply to the Putnam County Department of Health for approval for additional living space because that was covered in the architectural drawings you signed. Thank you for your assistance. Si' cerely; Susan Crawford cc: Iry Sevelowitz DATE: Friday, February 17, 2006 FAX TO: Mr. Iry Sevelowitz Building Department Town of Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, NY 10579 FROM: Tad and Susan Crawford 10 East 23 Street New..York-, Pry 10010 212 - 420 -0400 RE: 196 North Shore Road, Putnam Valley, NY 10579 Irv, I'm faxing you a copy of my letter to Joe Paravotti of the Putnam County Department of Health. I'll call you lo confirm that no paper work or further action is needed at this time from the Board of Health. ....Jos- �ph.Paravotti, -APHE 0, . :f. b _ ..._ ... _ .._ _ .... _.. _ Tad and Susan Crawford,,....' 10 East 23 Street New York, NY 100.10. Friday, February 17, 2006 Mr. Joseph Paravotti Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Health Services 1 Geneva Road Brewster, New York 10509 Re: Residence of Tad and Susan Crawford 196 North Shore Road, Putnam Valley, NY 10579 Dear Mr. Paravotti: You'll receive a letter that I mailed to you before I faxed it to Irv. After he read the copy, he talked to my husband and the attached letter to Iry is what I believe they agreed to. May I bring a copy of the architectural drawings in question and have you stamp them for approval for the Building Deparent i utnain Valley? tm Si cerely,,�- usan Crawfo d Cr ._ 6 _ ....._.Tad.Crawford_- -; :....... 10 East 23rd Street New York, NY 10010 February 17, 2006 Mr. Iry Sevelowitz Building Department Town of Putnam Valley Town Hall 265 Oscawana Lake Road Putnam Valley, NY 10579 Dear Irv: We appreciated your help today with respect to the Board of Health approval for the additional living space in our home at 196 North Shore Road in Putnam Valley. Based on our conversation, we will ask the Board of Health to put their stamp on the set of plans showing the finished basement and to provide you with a letter indicating their approval with respect to these plans. Sincerely, T- ad Crawford' - cc: - Joe Paravotti February 17, 2006 To: Iv Sevelowitz, 845 -526 -2377 From: Susan Crawford Re: Board of Health Approval, 196 North Short Road, Putnam Valley, NY 10579 Because Frank Dushin is still in rehab, and I'm finding it difficult to understand the process, we've asked another architect to take this over for us. Michael Geyer, Architect, has all the information and will be calling you and Joe Paravotti on Monday to help expedite the approval for a finished basement. I told Mike that even though the December 2002 drawings indicate a basement kitchen, that we do not want a working kitchen and have already removed the cook top and oven as you indicated last June. His number is 212- 691 -4722. I will be out of town until next Thursday, but you can reach me anytime at 917 - 825 -4580. Thanks for all your help. cc: Michael Geyer �. ; _.._ ....... BIBBO ASSOCIATES, L.L.P. Consulting Engineers — Planners October 7, 2004 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATTN: Joseph Paravati, Jr. RE: Crawford SSTS Renewal (T) Putnam Valley Dear Mr. Paravati: John P. McNamara, P.E. Joseph J. Buschynski, P.E. Timothy S. Allen, P.E. Leonard J. Bibbo P.E. Robert A. B. Howe, B.S. Enclosed in the above matter are three (3) prints of the SSTS Fill Plan and one (1) print of the Trench Plan dated revised October 7, 2004. In accordance with your letter of September 20, 2004, we offer the following: 1. We have clarified the plan to show the top of slope in the expansion area. The ., spot elevations have been corrected to read 609.5. Separation between the last trench and the top of slope is ten (10) feet. The reason for the difference in trench length between our field measurements and the current plan is likely due to the fact that the plan shows actual as -built topography of the fill pad. The plan shows the layout of trenches along the grade of existing and proposed contours. The field measurements were made by approximating the orientation of trenches to level contours. 2. It is our understanding that the plans for the garage were delivered to you under separate cover. Please call if you have any questions. JJB /bs Enclosures Very truly yours, Joseph J. Buschynski, P.E. Planning ® Site Design - Environmental 589 Route 22 - P.O. Box 403 - Croton Falls, NY 10519 - (914) 277 -5805 - (914) 277 -8210 Fax LORETTA M01INAPJ ROBERT J. BONDI P.Nic Health Duro Loeary F-Wtw DEYAWITVIENT OF HEALTH I Geneva Road, Bnwatcr, Ncw York 10309 - Envlroii a ftl 11-kh (845) 278 - 6110 Fa. (865) 278 .7921 Nwdng S--kw (US)276. 6558 WIC (845)278.6678 "Pmt(945)27a.6083 tars Iatrrrmtioo/Prochwi (86,)278.6014, 1"(64.5)273 -6641 " December 10, 2004 Joe Buschynski, PE Bibbo Associates 293 Route 100, Suite 203 Mill Pond Olrtoea Somcm,NowYork 1053'i Rc: Fuld Inspection - Crawford North Shore Road, ('I) Putnam Valley 'IW 51 -1.59 Dcar Mr. Buschynski: A site inspection was made for the abo a refcrenced'projucl on Dccerliber 9. 2(K)4. 'fhu following eonunents must be con ctcd in the liuld. 1. What is the purpose of the two HDPE risors in the clay barrier? 2 Please provide manufacturer's specs on the septic talk and confirm size. 3. The cast iron pipe needs to be inspected when installed. Please be advised that it appears that 450 [ants may he needed In The pipe, which would require a cleanout for each bend. _ 4. . The route for the SDR35 pipe: t,ctwcen the tan): and ilia rust junction box appar rd to ' .. �. - "_..... • • ._ -.- - .."....- .go through or under die retaining wall by the house: Please confirm route and provide how pipe was protected in or under the wall. r: 5. The rover on junction box if : pis cracked and should be replaced. s, 6. The pipes in junction hoxes S and 9 need to be trimmed back. ' 7. All culverts remaining ruc..d to be plugged an both ends or removed. o If you havo any furthw quastiros. please c, ;react mn at (645) 278 -6130 ext. 2157, J.. � .l'IIICCIYIy, I (Joseph S. Paravati. Jr. i Assistunt Public Health Engineer JSP:cj "'QdZJ.TYdSNK2iJ JNaKnDOa JMDaH d0 af)Vd WaId NO : sIUM �rss : aaow t,SZ,00 : swis assdvra 9£ :t,T OT -Dda : awls S VIS T/T : SaWd OTZ8LLZt6T6T6 : dNOHd I TZ6L- 8LZ -5t,8 'Id,L HlgVaH dO 1NZK1HVdda AINIIOD WVN,Lnd dNVN L£:VT IUd VOOZ- OT -Dda aiva NOIZNUN00 91�IMS run AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONM1ENTAL HEALTH SERVICES FINAL-SITE INSPECTION Street Location r✓ 5 0/r-. 900-d Town TM # 4 1. Date:.` X101 Inspected by: ,']sr' Owner r z( Permit # lov 01 Subdivision Lot Sewage System Area XTWO , ATf% 1 ^ ^"'^`,V"Tr"" 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 ..................................... I............ d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course /wetlands ...........:........... IA� Sewa e S stem a. Septic tank size - 1,000 .... ..... 1,250 ......... othe '. 1.1. b. 'Septic tank'installed level ......... ........ /.. c. 10' minimum from foundation.... .....................`--' ...� d. Distribution Box I /.. 1. All outlets at s eleva ,ofi n� - wateNe ....... :.......... 2. Protected-b'elow frost .................. ............................... 3 .;nimum 2 ft.Original soil between box & trenches 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 1116 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations...... ..... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ..........:.........: 9. Depth of gravel in trench 12" minimum ....... : ........... 10. Pipe ends capped ......................... ............................... g. Puma or Dosed Systems 1. 'Size of pump chambers .- °'�. f ............... 2. Overflow tank. .............. . ....................... 3. Alarm, visual/a dio ........:........:.. .........................:..... 4. Purap�easily accessible, manhole to grade ................. .First box baffled ....:..................... ............................... . 6.- Cycle witnessed by H.D.estimated flow /cycle........... III. House(Buildina a. house located per approved plans Number of bedrooms ............... .............................. IV. Well ... k Well located as per approved plans .......:..................... b. Distance from STS area measured(. c. Casing. M' above grade ................ .............:................. d. Surface drainage around well acceptable ........................ V. Overall Workmanship . a. Boxes properly grouted .................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ................................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12102 Z'Mia LI Vv l l ytrl.LV1M1,4 13 C-(<' i., c�rf' Cry s� aK 2 y0�` (YeVC. �P n4 ti�vJZ �Ju �.v'S Srtr C e v c'r�jc Ovtr 6h I y TN 6 r r > h " Form I !h r.' SITE INSPECTION FOR FILL PAID Date: l7 0 Inspected by: -S P Fill pad located per the approved plan • 1 �ltncv„ �Gcn�l'Uek� �� /Jc� wo� cv�,' Fill Pad Len n- Required Le _ �c b'� AD 6 Lino Fill Pad ' dth 3w. 00 Required h�' _//-- 9PCP 57i,� Fill Pad Depth Required De th Run -of -Bank Fill Quality Slope from Top to Toe k, !;k b Impervious La Y er Installed j65566 L03 Gu 5 a,.zi-` f2{ .rS,,�cvdu Ct �fv � y»- �.c�Y ✓� vCc+A'S ,� �s. v>•F+Z -..7 C.vd(' Erosion Control Installed ' -k( Sieve Test Results (if applicable) Additional Continents: Reserved for Field Sketch if Applicable9�' U � 3 TRANS. PAD iE�wr OO GAL I ;CoNc ;TANK M LAN HIC SCALE IN FEET ) :h = 30 ft N PUTNAM COUNTY DEPAF I DIVISION OF ENVIRONME iLE RULES AND COUNTY HMLT Toff M-/ MENT OF HEALTH fAL HEALTH SERICES. Sw`10 -'p CONFORMANCE WITH EGULATIONS OF THE ilglo S-1 DATE INSET MAP SCALE I " =300' OFFSET DIMENSIONS ITEM C D T -1 15' 19' ITEM A B clo-6 89' 32' J -7 43' 29' J-8 51' 31' J -9 58' 36' J -10 68' 43' J -11 76' S0' J -12 85' 58' J -13 99' 70' J -14 1070 78' J -15 114' 86' J -16 119' 93' TE -17 18' 48' TE -18 26' 49' ITEM A B TE -19 34' 48' TE -20 42' 49' TE -21 49' 52' TE -22 58' 56' TE -23 70' 61' TE -24 78' 68' TE -25 83' 74' TE -26 9v 82' TE -27 67' 26' TE -28 78' 36' TE -29 84' 44' TE -30 97' 57' TE -31 105' 66' TE -32 113' 75' TE -33 130' 91' TE -34 138' 99' TE -35 148' 109' TE -36 151' 115' ITEM E F WELL 106' 82' HOUSE LOCATION AND PROPERTY BOUNDARIES FROM SURVEY PREPARED BY:BUNNEY ASSOCIATES LAND SURVEYORS SHEET: 51 BLOCK:1 LOT: 59 RS #6 FIELD REQUIRED: 556 FT. 24 IN. WIDE TRENCH FIELD INSTALLED: 576 FT 24 IN. WIDE TRENCH SYSTEM INSTALLED BY: CHARLES POLHEMUS GARRISON, NY. k�