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HomeMy WebLinkAbout2532DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.19 -1 -13 BOX 22 02532 .� .� r�. 16 m li J6 UL 02532 PUgiTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CLN�4TRn CT— ICI :YN`PE-%Mi'T..:FOR`SENV'*AG _Y IMEi^i.Y:13'Y13 iVf PERMIT # Located at IA11` 17-e 1#kl- If 6 To r Village J'ac `kRdf6n+✓���� Subdivision name A" . tir Subd. Lot # Date Subdivision Approved 4 1EA:1- Owner /Ap=plicant Name /a �Gr .4 It fdA) Mailing Address Amount of Fee Enclosed Tax Map.ss //`! Block / Lot Renewal Revision Date of Previous Approval N Zip /b r ::,, Building Type 01141-f !'x'11 `y Lot Area 40,W No. of Bedrooms 0 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Zb 1),0 _ gallon septic tank and Other Requirements: To be constructed by I 01% Address Water SuipDjV: Public Supply From Address - -or: �!� Private Supply Drilled by 7 jV 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. A Signed: P.E. A--' Address 1'y�� ��� -i•-,` �/ i���/,✓'.� R.A. Date ` Gy License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary y the Public Health Director. Any revision or alteration of the approved plan requires anew pe t. A rove o is of domestic sanitary sewage only. By: Title: � Date: l 3 © f White copy - HD File; Yellow copy-- Buil mg Inspector; Pink co - Owner; Orange copy - Design rr fessio al Form CP -97 f-4iiV-4%�n 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL .please printer type PCHD. permit. # %� �✓/ Well Location: Street Address: o illage Tax Grid # . `rffl {G 4/,7 M -I � /�� Map f Block Lot(s) Well Owner: Mme: Address: ` ' Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary - Industrial Institutional Standby Amount of Use Yield Sought i gpm rued Est. of Daily Usage 3a gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _ew Supply (new dwelling) Deepen Existing Well Detailed Reason S- W 4/p ®✓ ,r r sc,/� for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No !� Is well located in a realty subdivision? ............ ............................... .................... Yes {/ No �� Name of subdivision '!rope l/ o '0.rf.'a 4- � CGS Lot No. Water Well Contractor: B Address: Is Public Water Supply available to site? .................................. ............................... Yes No.,,,'-, Name of Public Water Supply.: )v/4r _ Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to a pr ided on separate sheet/plan. Date: e / Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such . well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Z ° Permit Issuin Official: &n Date of Expiratio Z � O 3 Title: o Permit is Non- Transfe>< ble Sf,� �v White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner: Orange copy - W 11 driller Form WP -97 CONSULTING ENGINEERS 0 Daniel J. Donahue, P.E. 200 Breckenridge Road _At!khqr.4c, N.Y. 10541 914,628.7576 TO p�F�' LEEMEM T)IFUMMSEDUML DATE NO. NO. PC S— — . WE ARE SENDING YOU LED Attached ❑ Under separate cover via ---the. following items: . .%. ❑ Shop drawings ❑ Prints . ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION S— (Of THESE ARE TRANSMITTED as, checked .below: c:&' For approval ❑ Approved as submitted D For your use ❑ Approved as noted As requested ❑ Returned for corrections ❑ For review and comment C) C3 Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints COPY TO-- SIGNED: It soclosurts are not as noted, kindly notify us st once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES g�p� r�g�g rg�$ D q� _fir r� �v qg� p p, A 7�� p��r� ^ ..- CTijtF S 3 RLTC- -�70N S ;aiRryl -! g'. FO.. SE.-V� AGE -TPi E12TM1 —F- � & - S PERMIT # J'0 Located at L41 /-/' 7 r Re 4A . own r Village 00t)Tn/ - 7 LG Subdivision name's ,� `��f'P�©s •�a;�u d. Lot # A &III&r Date Subdivision Approved Lmf 361 Qi S Owner /Applicant Name PA-f1? IG 1:l % 69 r,16A# 14 U Tax Map T1 � Block / Renewal Revision Date of Previous Approval Mailing Address 6.4 / d rt C & r S, (r: , Al, Zip Amount of Fee Enclosed i `1` t'-- 1 Design Flow GPD Building Type ;->� /� � Lot Area � No. of Bedrooms Fill Section Only � Depth —'---"Volume 1--- PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 01)a& gallon septic tank and Other Requirements: To be constructed by '7- Address Water Supply: Public Supply From Address or:_ Private Supply Drilled by � l� Address . _.... _........._._...._.- _. _.... _ ... .. _.. . - - .... I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date !� Address d'',-f, 4cl A-I &A ec �� License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified hen considered a ss y the Public Health Director. Any revision or alteration of the approved plan requires a new p Appr ed f i h g of domestic sanitary sewage only. By: Title: ��. Date: J(, j White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr essio al Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL :. __;..n[ease print o . type .:.. _ Peru? li #_.. V - _ PCHD P- Permit. Location: Street Address: (Z2wnDMlage Tax Grid # Lf,-14rlf /fig 110i) MaP.� // JBlock / Lots Well Owner: e: Address: / c 9A A q o /!t &4)tr % r1 Lam- lj i� � � �' i r /y'� �G �� • se of Well: - Residential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # e Est. of Daily Usage _36,0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason vp- ,yt for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No di Is well located in a realty subdivision? ...................................... ............................... Yes /--I' No Name of subdivision S //" f / W AW 6X e-,4 fig, 0 dr -' I Lot No. Water Well Contractor: f]ETp Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /V!f d Town/Village Distance to property from nearest water main: Afe Proposed[ well location & sources of contamination to b vide on arate sheet/plan. Date:r Applicant. Signature: :. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided. by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well 'l4certi d b y Putnam County. Date of Issue Permit Issuing fficial: Date of Expiration Z2% © Title: Permit its Non -Tra sferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Adam Steibling RE: SSTS Permit & Well Permit Property afMontagnino Whitehill.Road Putnam Valley Dear Mr. Steibling: Enclosed herewith please find the following: . 1. Form PC -1 2. SSTS application 3. Well permit application _ 4. Design data sheet 5. Letter of authorization 6. Fee in the amount of $300.00 7. Short EAF _.. ,8...Three copies of construction plans 9. Two sets of house.plans. Comments: I am in the process of sending out the. neighborhood notification; however to expedite the process, I would appreciate if you would review the submittal. Thank You. . Daniel I Donahue, P.E. I Site • Sanitary o Environmental PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENMRONNIENTAL HEALTH INDIVIDUAL, WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION OF O PERI � �ITT 11 �, .Ah1E t4NER: A! N r N.►- c. _.�. _t r, ... . -_... VZEt4 .. 2N at RE ED BY: R L GR, AS, SRDATE: TAX MAP..: (CONFIRMED) Y DOCUMENTS Y - (REQUIRED DETAILS ON PLANS CONT' ERIMIT APPLICATION HOUSE SEWER- W' FT. 44% TYPE PIPE CAST IRON U YELL PERMIIIT OR PWS LETTER ()NO BENDS; MAX BENDS 45° W /CLEANOUT ' PC -97 RENEWALS LE .TER OF AUTHORIZATION (__)(JSITE NOTE (NO CHANGE) (� _,40tSIGN, DATA SHEET (DDS) FILL SYSTEMS U COR] ?ORATE RESOLUTION (_j 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (_)SHORT EAF (� FILL SPECS; FILL NOTES 1 -5 (�(UPLAriS -THREE SETS _ g �L U FILL PROFILE & DIMENSIONS (_HOUSE PLANS -TWO SETS (_) FILL Lei EXPANSION AREA U —)VARIANCE REQUEST WIA Ems' L FILL GREATER TEA N2 FEET SUBDIVISION U CLAY BARRIER UULEGAL SUBDIVISION (�( FILL CERTIFICATION NOTE (-J( )SUBDIVISION APPROV CHECKED U DEPTH GAUGES P RC RATE 10-11 U VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (_J(LL REQUIRED DEPTH (__)(SEPARATION DISTANCE FROM TOE OF SLOPE UU N CURTA DRAIN REQUIRED. TRENCH ? GENERAL e q 3 kL, RENCH PRO VIDED 60FT NIAX. 3 U� ATED V; NYC WATERSHED ALLEL TO CONTOURS ZP NS SUBJIfITED TO DEP PARALLEL TO PROVIDED �al? E GATED TO P.CHD L ? - ET.�.IL/DUST FREE CRUSHED STONE OR WASHED GRAVE] APPROVAL, ff REQ'D (X GEOTEXTIIrE COVER TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS jLeT-APPROVAL CS TO BE WITNESSED (0/°r 0,: TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL SSDS ADJ, LOTS ?6; TO FOUNDATION WALLS �An()DATA. ETLANDS (TOWN/DEC PERMIT REQ'D ?) 00' TO WELL, 200' IN DLOD,150' TO PITS ON DDS PLANS & PERMIT SAME 00' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) YIEWAGE 1969 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TER BUZBA �0' TO WATERLINE (pits -20') R FLOOD ELEVATION W/I200'50' INTERMffTENT DRAINAGE COURSE - 'iESTLr GLOTS >l0 YEARS OLD ( 200','�,00'..RESERVOIR; ET C: - 1.50'-GA LEY SYSTEMS' :RED DETAILS -ON FLkN: .._ . SYSTEM PLAN - (NORTH ARROW) —)1 TO LEDGE OUTCROP SEPTIC TANK SSDS :HYDRAULIC PROFILE CZ10'FROM FOUNDATION; 50' TO WELL GRAVTTY FLOW WELL X--JCONSTRUCTION NOTES 1 -15 (�/� DIMENSIONS TO PROPERTY LINES D SIGN DATA: PERC & DEEP RESULTS (_}( LOCATION OF SERVICE CONNECTION ' COi (TOURS EXISTING & PROPOSED . ID; 15' TO PROPERTY LINE DRIVEWAY & SLOPES, CUT SLOPE (.ZFOOTING /GUTTER/C'URTAIN DRAINS ° (USDA SOIL TYPE BOUNDARIES SLOPE IN SSTS AREA (S20 /°) TITLE, BLOCK; OWNERS NAME ADDRESS LU(_j, GRADED TO 15 %, IF REQUIRED 1 #, PE/RA; NAME, ADDRESS, PHONE# DOSElPUMP SYSTEMS ATE OF DRAWING/REVISION U( PUMP NOTES ATUSI REFERENCE . ( —)( DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS (-U DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (�AKE;S,WETLANDS WITHIN 200' OF P.L. L--)( PIT AND D -BOX SHOWN & DETAILED ROPOSED FINISH FLOOR AND U( 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN BASE WENT ELEVATIONS U STANDPIPES, 5' BOTH SIDES DETAIL WELLS & SSDS'S W/IN 200' OF SSTS ( ) 15' L'vlhN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<I% ( PROPERTY METES &BOUNDS U 20' bIIN to CD DISCHARGE /100' with 182 cons day discharge U( 10' MII i to NON - PERFORATED PIPE COMMENTS: (REVSHEET) LI` ?AAM BRtM IL 1bLRV ~ LCPZr rA MOLOdAX RA, tYl,tt.ul. %MM Ate* aps w► AMPOW AD& AkdhA D&Wkr DEFARTMWr OF MALTH t 004" RVA mmoso New Yolk to m ATTg riox: /'"mm snmuhG o cocoa In AS to11swoom lwWw a ma 6e hft ampkUd p► to my Whoddho llMGW tR OR F9 I.- ®� Iwo PL J. AD'S Iddpo/C PRO" d; . _ k ";O r!G I'Z i to PVW lMST! To": SUMVNIOK- 4=9 dd g" Left: n8 NO -0 dr t► SM widdo do Oolpw bomb of iron Smuk or N* Coiw Nmerq*v. 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It a ►VIi«Q hu bas dteWOMW to be bdoih d bmd as tee Am MOM@ and dwo nbwgmm item des ittOcs- NYCM L rapeied a wfttw do am to" a wW of aR oak ampe.aft at/M SeoiOt � b ra- wWvai� ruse eslt pis Witt► NYCDI►. FOR cM,X!'r ca 0161 h 17,31 OCR (47 O P UTNAM COUNTY DEPARTMENT OF HIEALTHC _.. --GF EN- OM NT - ALTH��ER 11 4 S� ._ , ......_.....: . LETTER DE AUTHORIZATION RE: Property of, o AJ %�GN IA/ p Located at A) #1 e / //G (9v 1r0,j' /�'I �/fjTi j /rax Map # . / Block % . Lot Subdivision of Subdivision Lot # Filed Map # Date Filed -X Gentlemen; This letter is to authorize D R ,4%e L J , a duly licensed Professional Engineer --X- or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health aw "and =the Putnam County- Sanitary. Code: Very truly yours, Countersigned: d Signed: .I,�� P.E., R.A., # _ �7 L%� (owner of properly) Mailing Address /c✓ wiling Address: /4, d o� State Zip z5 Telephone:, � �/�� �� �' `)- j 7Z' _ State CO j_ . ,.-e A_q Zip / Q st-_ Telephone: 11 y- Form LA -97 14. 16-4 (Utli) - - ict; 1� ' PROJECT I.D NUMBER 617.21 SEQR Appendix C State Environmental Quality Review. SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by .Applicant or Project sponsor)' 1'. APPLICANT /SPON OR 2 PROJECT NAME eS 3 PROJECT LOCATION Municipality �G/J �/�G� County )00r/ /y/M — -- - -- - 4. PRECISE LOCATION (SKKSlreel address and road intersections, prominent landmarks, etc , or provide map) 5 IS PROPOSED ACTION. l! ,Kew Expansion ❑Modification /altera(ion 6. DESCRIBE PROJECT BRIEFLY: %G !i PX d r- q P NG G 7. AMOUNT OF LAND AFFECTED. Initially _ r acres Ultimately Qr .i'' acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? UYes LJ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0;ffe- sidenlial ❑ Industrial ❑Commercial ❑ Agriculture O Park/Forest /Open space ❑ Other Describe: ^t0.- boES ACTON-tNVOtVE -A- PERMIT APPROVAL,, OR-FUNDING,-NOW OR UL•TIMATEtY -FROM ANY. OTHER:•GO! ERKIMENTAL- AGENCY iFEDERAL:-._. STATE OR LOCAL)? es ❑ No If yes, list agency(s) and permit /approvals ;P1404 /'V f/0 's'e r'004 11. DOES ANY ASPECT OF THE ACT' ^N HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ki No If yes, list agency name and permitiapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes P No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: _ �L Ff Date: - -!� — 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 - DIVISION OF JN N ME, NT AI.,..: EA ITT H - S E.11INTIT CES... _ r CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM ,PCHD CONSTRUCTION PERMIT � Located a�/�`J�%wn Name f' Tax Map , % % y Block Lot Formerly Pi!5�420 17L6 ALO-f Subdivision Name :SAC Subd. Lot # 1 Mailing Address /Ckl 49if ' 15-1 d - Zip /dam Date Construction Permit Issued by PCHD ��� 7 Separate Sewerage System built by / :Z2::K /% Addressi�l�a� /��% •� -��i Consisting of & Z) b Gallon Septic Tank and 3.2 /C C) /gz- 02. Other Requirements: '6?®kR0— Water Sunn ➢v: Public Supply From Address or: Private Supply Drilled by h. W�7'` r &A, Address ® Building Ty pe . -_ %.< �! _ .L_ .- ??!as erosion cor�tru been conipieted-r Number of Bedrooms 3 Has garbage grinder been installed? A4J 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 o Putnam Qounty Department of Health. Date: Certified by P.E. R.A. Address .An'- 41y" A a) d-,- � j 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 approval are ubject t modification or change when, in the judgment of the Public Health Director, such revocat' ific t' cha nge i fsary. U id By: '' Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location.... Street Address-..:.- :- . _ _._ __ ..:.,.__.:....Tov ✓: f��i; e: ax �rriu z; _ .... Ma pa B lock Lot (s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondlary Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment e Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade _�S•> Diameter '�'� in. Weight per foot '.; Ib/ft. Materials: ti Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout ^ Bentonite Other Drive shoe: A Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield %G 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 analyses` are avai- Iable; . please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface , d' S G; V If yield was tested at different depths during drilling, list: Feet Gallons Per.Minute Pump /Storage Tank Information Pump Type Capaci'�%�� Depth Model Voltage L.� G HP Tank Type lLAY SITc' Volume Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature))'�' NUTI:: Exact location of well with distances to at least two permanenvianamarks to be proviaea on a separate sneevpian. Well Driller's Namet'�'`i.- /1�a"_ Address: Signature: _ I , '' _ Date: 2, '' /. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 I? . w Public Health Director "LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Eariroomental health (914)218-6130 Fax (914) 278-7921 Nursing Services (914)279-6558 WIC (914)279-6678 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Preschool (914) 278-6082 Fax(914)278-6649 OWNERS NAME: TAX MAP NUMBER: r. l E911 ADDRESS: jV %L)�I 'T� 12 4J TOWN: Le I-A) /2-fil AUTHORIZED TOWN OFFICIAL: ���y _ z- "( e— r�.. (Signature) DATE: I % ,;� 0-6) � The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned -by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR - + ATMENT SYSTEM PERMIT # '0 Located at _ , /�i � - ���- �� � Town Village �alhg,, f'4 //-,F% Subdivision name 4e40P Subd. Lot # Tax Map Block Lot 16 Date Subdivision Approved Renewal Revision;_ Owner /Applicant Name Date of Previous Approval Z4 ,3G 1J Z— r Mailing Address 40 d2"­'-14= P el ilO— IY--Z7 Zip `d �f `°/ Amount of Fee Enclosed `�oZ 112j Building Type Lot Area 11 iTo. of Bedrooms � Design Flow GPD �D y Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of %,0,0 gallon septic tank and Other Requirements: To be constructed by �� o Address Wate lac Public Supply From Address . orc...,.. Ptivatte-Su .1 Driiied b :_ :.., _ .....- Aaare s I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate jU treatment system described above will be constructed as shown on the approved amendment thereto and in hccordance with the standards, rules and regulations of the Putnam County Department .of Health, and that on completion 4hereof 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. 4' Signed: P.E. R.A. Date 2 If Address d"p...e /?L% / f,(/��� License #. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidere necessary by the Public,Health Director. Any revision or alteration of the approved plan requires a new per '. prov r discharge of domestic sanitary sewa nly. By: C�� Title: Date: 3u-/ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 t o L, I. 11 f` 1 "i OF I t'► n N� 1Yt I! 1 r11 M&%"Nw N.Y. 10541 To G i� WE ARQ SENDING YOU C Aft&49 C Undw upbraft caw vie .._..,_ ^. t4ia id o%" lams: 4 W" ®"W#Wa4 c poor. ®�ae�a o sA paee o St Ia�ow� O coo!► of w4w O Cho" ordov O THEff AMIC TRANSMITM as 064W balm: Anwowd. in-. .. ...- Ci is X0111 YN CJ Alo9reeis0 04 no C SNSIIIR /par dliBN0lRiei! - - ._.:.... .. _- °° C As C Rltuvnsd Asp awatim O 1114Y�1 osreratllS prints D for WWo MW W1 IW* O FOR Big$ clig 19� 0 PAINTS RE IRNt® AMU LOAN TO US REMARKS a - r f r ,_ y tv FJIti to r r n t C7 owi�l 1. Do�rwr. f'�t.. Sao >R..r 6. �ww-- . WE ARE $11*01NO You C AMtdW C UfdW 810 111 aw► vb ..—_..ft bus" am ci sw srrwmw o P*ft o pays o 1"Oft o $"Ok~r c1 a" M 1r11o► O Cl~ «da z 'aJ"4u TNtEE A11Z, TAA11AMtT7't0 !� t *�MrM rslsw: ow "PRO O Aprrwd N udrAigrd Now fw app "i u� fire V. Aw"w".. ".m" - ......_ .. 0 Om" !rr ON limbo i iC A! r�u+rrlrA C Arlur++r0 M er+lortNsr O Aitw��wrwNM I�+*1r ` _. = _ . - • -- .. _._...__ .._ c ow foomw rM rr m"WA la Q /op 8101) Dug Ism_ p PRINTS RE omm Aft'iQ LOAN TO us 11[llAMts. YYri ro. �r..�•a.r M FPM we «w M am& 60am as"* 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 January 26, 2004 Daniel Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 Re: Proposed SSTS: Relo Homes White Hill Road, Lot #14 (T) Putnam Valley, TM# 51.14 -1 -13 Dear Mr. Donahue: ROBERT J. BONDI County . Executive Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: -'i — R �r�t `ori �i�al desigi7 wnz SSTS pl n.. -. .._ ....... _ _..... _.. __ .... .. . 2. Existing contours are to be shown on the revised plan. 3. Minimum distance between two trenches is 6 feet. Plan scales to 4 feet in sections. 4. See attached drawing. Area exists to install 692 feet of fields. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn attach. Ve my yo , Robert Morris, P.E. Senior Public Health Engineer ., P OR pz, 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 16, 2003 Dan Donahue, PE 120 Breckenridge Road Mahopac, New York 10541 Re Dear Mr. Donahue: ROBERT J. BONDI County Executive V Construction Compliance - DMS Homes 10 White Hill Road, (T) Putnam Valley TM# 51.19 -1 -13 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� = Accc�rdir� to the subii�iLted as buih pilans',' it driveway is es`s'than 10 feet from`the constructed SSTS. All trenches must be 10 feet from the driveway surface.- — - 2. The following as -built measurements do not match by scale: Cll, C12, C13, C14, C15, D14. 3. From an inspection by this Department on September 16, 2003, a cleanout for a 45° bend needed to be provided and the pitch on the cast iron pipe was not at 1/4" per foot. These items need to be reinspected before compliance is issued. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, oseph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj ORE P'FA MOLINAtRI - 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 OFFICIAL NOTICE OF PERMIT SUSPENSION CERTIFIED RETURN RECEIPT REQUESTED DlVS Homes, Inc. 125' Dahlia Drive Ma*ac, NY 10541 Re: Suspension of Permit: PV -5 -01 10 White Hill Road (T) Putnam Valley, TM# 51.19 -1 -13 Dear Sir: ROBERT J. BONDI _.... . . County Executive December 31, 2003 Please be advised that the permit PV -5 -01 for the above regarded project has been suspended by this Department for the reasons noted below: .1. Septic system was not constructed according to approved plans.-_ Revised.:pl:�ns_riust be -_ subrri ted -by Dan Donahue, P.E. Plans must meet all current Putnam County Sanitary Code. The submission includes a fee of $200 and 3 sets of revised plans. The suspension of the permit will remain in effect until these issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit all work: shall cease upon written notice served upon any person connected with or working in said system. Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext 2157. JSP:tn cc: Dan Donahue, P.E. Iry Sevelowitz (T) Putnam Valley BI M. Budzinski, P.E. ;Ve tru ly yours, ph S. Paravati, Jr. Assistant Public Health Engineer - . YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, K|.Y.�_10598 P714} 245-�u00- Albert H. Padovani, DirOttor LAB #: 32.309022 CLIENT #: 57081 NON STAT PROC PAGE 1 ---------- Q --------------------- — ---- ---------- m ------------- m ----------------- DMS HOMES INC. 129 DAHLIA DRIVE MAHOPAC, NY 10541 DATE/TIME TAKEN: 11/05/03 12:16 DATE/TIME REC'D: 11/05/03 01:55 REPORT DATE: 11/12/03 PHONE: (914)-906-1742 SAMPLING SITE: 10 WHITE HILL RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : 8ARDEN HOSE PRESERVATIVES: NONE COL'D BY: VINNY CRECCO TEMPERATURE..: < 4C NOTES ...: CDLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/05/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 11/05/03 LEAD (INS) <1 ppb 0-15 ppb 9101 11/05/03 NITRATE NITROG 1.85 MG/L 0 - 10 9139 11/05/03 NITRITE NITROG <0.01 MG/L N/A 9146 11/05/03 IRON (Fe) 0.142 MG/L 0-0.3 mg/l 2037 11/05/03 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2017 1110003 SODIUM (Na) 10.2 MG/L N/A 11/05/03 p H 6 6 UNITS . 6.5-8.5 9043 11/05/03 HARDNESS,TOTAL 194 MG/L N/A 11/05/03 ALKALINITY (AS 126 MG/L N/A 11/05/03 TURBIDITY (TUR 1.9 NT ' �' 0-5 NTU-',`' COMMENTS: � BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A ! SATISFACTORY SANITARY QUALITY ACCORDINE�:����E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS � TESTED AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive "e/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. 4a No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, 1 maximum of 270 mg/L of Sodium > YML ENVIRONMENTAL SERVICES 321 Kear Gtreet Yorktown Heights, N.Y. 10598 ' . ' (9i4`)�^2��5-28O0 Albert H. Padovani, Director LAB 04 32.309022 CLIENT On 57081 NON STAT PROC PAGE DNS HOMES INC. DATE/TIME TAKEN: 11/05/03 12:16 - 129 DAHLIA DRIVE DATE/TIME REC'D: 11/05/03 O1:55 MAHOPAC, NY 10541 REPORT DATE: 11/12/03 PHONE: (914)-906-1742 SAMPLING SITE: 10 WHITE HILL RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : gARDEN HOSE PRESERVATIVES: NONE COL'D BY: VINNY CRECCO TEMPERATURE..: < 4C NOTES ... : COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. - pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN M8/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 30O MILL�8R��M' ' R[]T�y�-�` r-~'----- ----~�l�A��-W���R: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) iUBMITTED BY: Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT DIVISION Y 1' GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM I iii 5 lliml e s 14 Owner or Purchaser of Building ®/f S /�o ly e s [ , Building Constructed by /0 pIlle y`/l Q8 cj Location - Street Building Type S-1 , /y / 13 Tax Map Block Lot TownNillage Subdivision Name Subdivision Lot # �y 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 // Day / 7 Year 2 oU 3 General Contractor (Owner) - Signature d ifs 11017&5 1. Corporation Name (if corporation) Address: -1 9 O:,? / /,,? A j'o e, �'�, V!6 P , State Ale �v Ko,e 14 Zip fOx,�/ Signati Title: Corporation Name (if corporation) Address:--]__L�bc,wc )J (4 lard 4 Liaw Zip i : ---'it / Form GS -97 PD, DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120. Breckenridge. Road Mahopac, N.Y. 10541 845- 628 -7576 December 4, 2003 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Joseph Pavarotti RE: SSTS Certification Property Formerly of Montagnino White Hill Road Putnam Valley Dear Mr. Pavarotti: Enclosed please find: 1. Certification of Construction Compliance 2. Well Log and Bacti Results 3. Guarantee and two copies 4. Three copies of the as built plan 5. Filing fee of $200.00 6. E911 Verification Letter Your pr?iqpfattention would be appreciated. Sincerel Daniel . Donahue, P.E. Site • Sanitary • Environmental ibm"M COUNTY MIMON OF E MMOMMAL ffi.ALTH SRR VICMS ArrElFiON )POSEM ® GVa , $MMgQR UNAL IN4PEMM For: bill All f nfarmWm must be fully oampleted prior 10 any Tmoba Ll,ocsbed: r_i�T1d�.i _dr'�6r�Ltc ►visdw Nsme: � ....... _..... ,... .� ... Spa Viw tot # h system fin oompleted7 t- syacan coatplete? Date: 1 - Is Is well drilled? r._. Af J Date: is, well located as pet plans? _. At* Pi= Ica* t$ffi ow e listiod, at tho above premises has bay oo at:woted�d I brave is pec d and vj;e " their comply ion 'in a&)r&m with the issued FMD -C=6idoi Permit rind v4pl •+ .t ° Standgds, it dwand ftWadons of the Putnam Cowty Deparament of Des* Professi(Aw Address: ra* � ".�.a; r� Lie. # Co$: 'S 1 , SEP -13 -2003 SAT 17:53 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 IWI tl �■ I��VPG Wl Vi�YYI1P� G) 1 SEP -13 -2003 SAT 17:53 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONST- RUCTION- PER�`lIT- FOR - SEWAGE- TR1, ATMENT S'Y'STEM . PERMIT # Located at: � 1-1144 /Town r Village /1, Ad 'Ile //.pc, Subdivision name we ,d. Lot # Tax Map ,jBlock Lot Date Subdivision Approved 4 Renewal KKevision Owner /Applicant Name Date of Previous Approval Mailing Address ..2 -' y &Llw ,oe/dlo-- Zip Amount of Fee Enclosed °— Building Type D Y G 4,0 ,A7v/6r Lot Area No. of Bedrooms %.? Design Flow GPD ez;?) Fill Section Only Depth Volume Separate Sewerage System to consist of /t0 od gallon septic tank and Other Requirements: To be constructed by Address Water SunDIV: Public Supply From Address .. _ .._ . on _ jam_ Private Supply Drilled by - Address. - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage 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 "(lertificate 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. J � Signed: _v P.E. R.A. Daattet �-- Address ^, . p %�rc� =, �. ,�: 4/f.e Aoe License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approve for discharge of domestic sanitary s wage only. By: Title: Date: ,-3D -0 Z. White copy •- HD Fi ; Y llo copy - Building Inspector; Pink copy - ner, ange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ Please -print ciravpF .. P1r11L Pen- I Well Location: Street Address: 0 illage Tax Grid # Map f �/, /JPBlock Lots) Aa Well Owner: Name: Address: Ak-0 `.4,? 01 /) y G-/ 'e - g Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought i3° gpm rived Est. of Daily Usage J 'V gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling "ew Supply (new dwelling) Deepen Existing Well Detailed Reason I L ox z for Drilling Well Type Willed Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ................ ............................... ............. Yes_ No Name of subdivision /.�!'i �;,j Lot No. A/ Water Well Contractor: 'fir Address: Is Public Water Supply available to site? .................................. ............................... Yes Nom Name of Public Water Supply: / Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provid on separate sheet/plan. 11, oj, Date: /14//z///Z-Applicant Signature: �I PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. A n Date of Issue /0 �-� D C — Date of Expiratio Permit is lion- Transferrable Perini Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Located at 1✓4, -le. N;` // 44o ;9V 'Veki r Tax Map # S-�/ i Block / Lot Subdivision of'/ -0 e- Subdivision Lot # /y Filed Map # G) Date Filed % J_ Gentlemen: This letter is to authorize P r G V- 2'1,�r a duly licensed Professional Engineer _ ji or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health La�,v, slid the Putnam County Sanitary Code.. Countersigned: P.E., R..A., # Mailing Address ��' , Ytr�:,�,r All 2 1�� State Telephone: Very truly yours, Signed: R e /a //O /y es 14 C . (Owner of Property) Mailing Address: /al 9' 04-� /.q Q,Q I've State Ne,. rAl Zip /Ox'g/ Telephone: 11T ? Form LA -97 PUTNA.M[ COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO. PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: c represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: +Q e/6 /10 /V e s 2-4 Having offices at: /a 9 V gX h"9 Drj ^v +e Whose Officers Are: President - Name: o CR e c c o i. Address: 14 ' g:2sX109 4-,v e /`9��%qc *e A, }e146 Vice President - Name: Address: Secretary -Name: Address:_.:-- Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. WILLIAM VILLANOVA Notary public, state of New York No. 01V14101112 Qualified in Putnam County Commission Expires March 30,.E Sworn to before me this 9' day of 0 r--T (month) goo (Year) Notary Public Form CA -97 Signed: Title: Corporate Seal • PJ6DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS _ Road.. - .. _. Mahopac, N.Y. 10541 845- 628 -7576 October 16, 2002 .Putnam County Department of Health Geneva Road :Brewster N.Y. 10509 .Att: Mr. Joseph Pavarotti Dear Mr. Pavarotti: Enclosed please find: �rITF�M� I RE: SSTS Permit & Well Permit Property Formerly of Montagnino White hill Road Putnam Valley 1. Application for a permit to construct a SSTS 2. Application for a well permit 3. -Letter of authorization 4. Corporate Affidavit 5. Three sets of plans ('omments: This application is for a name change on the permit'that is necessary. in order ... to cbtahi -a building permit-ir. Putnam v alley:._ By: Daniel J. Donahue, P.E. Site - Sanitary - Environmental 0 0, t> & fl IL C f • i %J il\A111 \.V V1\ 1 1 LL' 1 til\11V1L 1\ 1 VK 11L' tiLlit DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: /9� eN-re ',./ .04 2. Name of project: sl6yc e fR "14 Y IpG r 3. Locaticok: 4. Design Professional:hgAi /c-G J. Doww4vr 5. Address: /a).o 6. Drainage Basin: to-g- .) 7. Typ_e of Project: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is thus project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ......................: ............................... Type I Exempt Type II Unlisted y 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... N/.¢- . 10. Has DEIS been completed and found acceptable by Lead Agency? ............... All'-f 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... - 11-1f-so; have -plai s been -submitted to such" authorities'? ` ..:.....:.:.: :..::.. :....:.: _. �s A0 ..... _ 14. Has :preliminary approval been granted by such authorities? Date granted: N 15. Type: of Sewage Treatment System Discharge ................. surface water Ygroundwater 16. If surface water discharge, what is the stream class designation? .................... N 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ...... ........... /V10 21. Name of sewage system / Distance to sewage system 22. Date: test holes observed < 6U 23. Name of Health Inspector 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... IVO 26. Has SPDES Application been submitted to local DEC office? ......................... N. le Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? A/a 28. Wetlands ID Number ................................:.......................... ............................... � 29. Is Wetlands Permit required? . ............................:................. ............................... N e) Has application' been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... iglu 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 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes& DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... E.!' 34. Are community water and/or sewer facilities planned to be developed. within 15 years in or adjacent to project site? ................................. ............................... A O 35. Are any sewage treatment areas in excess of 15 %slope? . ............................... /Va 36. Tax Map ID Number ..... Map Block 37. Approved plans are to be returned to ..... Applicant _( Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may-require DEP - approval of the SSTS_prior to final approval- by *.he Department..: Projects mittiin' -be watershed may.als6_ 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 .1 .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on' this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & ®FFICL4L TITLES: Mailing Address: ..: "......... .................. T� s PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH . SERVICES bEkGN DATA SHEET - SUBSURFACE TREATMENT SYSTEM ­ Owner Address Itle &4 Located at (Street) 14-1111 4­11'eo'r Tax Map f//f Block Lot �indjcate nearest cross street) Munic Watershed -4a"4 'e�r "0; -A/e -v'2-q SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test ".a Qa NOTES;: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 ar ......... ............. . ......... 2 J-3 d- 4 3 p 3r, 14 4­5 `l 3 o a� �� 4 Y-1- 3 2 3 Xj- 3 _/0 /0 4 5 2 3 4 T 5 NOTES;: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES 2 _ N HOLE. ._DEPT - HQI -E.NQ NO.:� HOLE NO. ^ . 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' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered A/f/W 0 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: f2 ,&ao Date Design Professional Name y/ -`rr- Address: lot- Signature: Design Professional's Seal ' �'o.49A PUTNAAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN'fAL I�EAI�7 I , EItV CE5 . __._ INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A..GE ERAL INFORMATION - Name of ]Project ® N:-tAcft o.t a (T)M Site Location 0 etr -- �w 4_n� . County Building construction begun q Extent Is pryrty within NYC Watershed ? ................. a Yes SECTION B. TOPOGRAPHY (Please check all appropriate b xes) 1. Hilly- Rolling-_ __ __ - -- _. steep, slope - - -_ ____ . __Gentle - slope -- — Flat- - --- 2. F� Evidence of wetlands Low area subject to flooding 0 Bodies of water 0 Drainage ditches Rock outcrops 3. Property lines or comers evident ............:.......... ............................... 0 Yes E] No 4.- -Dowatei courges ek on or adjoin the property. Yes o . - - -- .............. ........ 5. Will these affect the design of the sewage system facilities ?............ 0 Yes No . -- --- -6. - --Do watershed regulations applym-this -development ?: ............ Yes No -- - - - - -7 � —Will extensive grading be necessary ?. :: :..- :� ::: : ::::::::: :: :. Yes No 8. Will extensive frll:.be.necessary for- SS:'S ?... .. .............. . . .. ...... - Yes - .. -... _... .... - ... 0 ._. .... _... 9. Do filled areas exist within � the SSTS area? ........ ............................... Yes No If yes, what is the condition of the fill? -- - -- -= - -- - -- - - -- _. . SECTION C. SOIL OBSERVATIONS _ _ .. __ ------------- - - - - -- -- - - 10. - -A eatance of Soil:- d vel . Hard an e - - _ Lam`... _ Loam a Clay.: -� P 11. Observed fr om: Borings Batik *c Backhoe excavations k CL 12.. Soil borings /excavations observed by L on F� 13. Depth to groundwater on f l 14. Depth to mottling V on t( 15: Are test holes representative of primary & reserve areas ...... ............................... E2 ` es F__J No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION ID (on back) Form ST -1 4 0; SECTION D. DRAINAGE Yes 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F-1 E?r< . Yes '�gNg, 19. Will groundxyater or surface drainage require special consideration ..... ...... F 20. Will gullies', ditches, etc., be filled and watercourses be relocated? .......................... F_1 Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ............................................................... F__j Yes No I*ection data 22. Do a�dj acent-wells-and/or. sewage. systems exist ?::: ................................................. Y 23. Additional comments 01 24. Site observer/inspector and title �.N ite(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # - Lot # ---Hole �-­­ -Lot * Depth towater -----Depth to -water 4--(,Q)& -- Depthtowater mottling.... Depth to mottling Depth.to. mdttl ilfg Depth to rock/imp,_ to rock/imp. Depth to rock/imp. G.L. G.L. .7 0.5 ---------- 1.0 10 .0 .0, -3.0 t_7 7- :3.0 3.0 f .......... 4.0 .5.0 7 5.0 5.0 6.0- 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Dater Inspected by: Street Location !,��� .���. /( Owner TM # /. , t - 13 Subdivision Lot # 1. Sewage System Area YEAS .NO I COMMENTS a. STS area located as per approved plans .......................... . b.. Fill section - date of placement 3:1 barrier Lgth. Width. Avg.Dpt , c. Natural soil not stripped ........................... d. Stone, brush, etc., greater than 15' from STS area.....f e. 100' fi "Om water course / wetlands .............................. �... . II. Sewa e System a. Septic tank size - 1,000 ......... 1, 250 ......... other ...:............ b. 'Septic'tank installed level ............ ............................... c. 10' minimum from foundation ....................... ............... d. Distribution Box 1. All outlets at vation -water tested......... /- 2. P� Blow frost .................. ............................... °---�. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set ......................................... 6. Tr-ens: (We 7 1. Length required Length installed , 7 2. Distance to watercourse measured Ft ....... F%�� 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1116 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundation_ s.......... 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. Pum or Dosed vstems_: ;::- . _ .._ .. ...7j.. Size of pump chambe ................ 2. Overflow tank. " ................. 3. Alarm, vis audio........:. .............. 4. Pum ily accessible, manhole to grade ................. 5. st box baffied ................. ......... ............................... Cycle witnessed by H.D.estimated flow /cycle........... a. house located per approved plans .. ............................... b. Number of bedrooms ................... ............................... s IV. Well Well located as. per approved plans . ......:........................ b. Distance from STS area measured IEn ' - ft........... c. Casing 18" 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 water :o r g. Footing drains discharge away from STS area .............. h. Surface water protection adequate :: ......:........................ i. Erosion control provided .............. Rev. 12/02 3l � Fill pad located per the approved plan Fill Pad Length Required Length Fill Pad Width Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable � a vvru Y> 3G vux �Y 24.19' f /P 24,12' 19 ` I 1 /2%01IY 'rl -vdv1E 17Wt;Ll.. 25,91' A 434' r� °d9c } JU ILL to �X Z t' �✓ Si'� b 'A 15 E17G - .,.OF PAVEMENt. V1MIIV NIL. ROAD NM: 17' 5117E YAW5 ANO 26' MAR YAW A5 MR VARIANCE GR/N?EV ON OCTC?3ER 24, 2002 FOR TAX MA' NO. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL. SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK ST Al DEPARTMENT OF HEALTH 5U RVF,Y OFF f'R0i'[;i2'fY rwrAan FOR t2M5 NG'MrS, IN BEING "n NO. 1-1 A5 %iO N ON SECTION ONE LAC); 05CAWAW A0U!5 FILE12 . ANLIARYO, 1951 A5 MAP NO, 567A 5"I ATE IN TOWN Crr rUtNf VAI,IXY rU1NAM CO., N.Y. 5CA E. ; I" - 30' - ; MaMMIZ 30, 2002 COpYRI W B 2005 RODMKi H0eP iENDOW -F , ALL 06ii5 RE5ERVED SSTS TIE - INS (MEASURED BY TAPE,; MAY 7, 200'* H5E Lt MR CON5TRXTION NOV. 5, 2005 FINN. LPI7ATF UNIT A B C D LENGTH OF TRENCH SEPTIC TANK 16 45 Property of DMS HOMES WMTW HILL ROAD TM# JUNC.BOX 51.19 -1 -13 PUTNAM VALLEY J. 001V, L DANIEL J. DONAHUE, P.E. 1 50 65 120 BRECKENRIDGE ROAD .2 58 70 628-7576 3 64 74 4 69 78 5 69 76 6 69 74 7 116 123 45 8 111 120 41 9 102 113 40 10 82 94 24 11 70 94 22 ASBUILT PLAN SEWAGE TREATMENT SYSTEM Property of DMS HOMES WMTW HILL ROAD TM# �r :3SIO,V( FL 51.19 -1 -13 PUTNAM VALLEY J. 001V, L DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120 BRECKENRIDGE ROAD a * MAHOPAC, N.Y. 10541 628-7576 tv, { ° MAHOPAC, N.Y. 10541 I` a; 0 oa-' 00 9-� ®n VV /3� n I�1 STOR`f I i DwSu -IN4 13 F. ly 1� 1 v 1 o) °°G ¢p °w - O VFocF_ �� PAVana� +r V1� /} ITF I }► GL IZO A P THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED SUBSTANTIALLY AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED PT ACCORDANCE WITH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH SSTS TIE - INS (MEASURED BY TAPE) UNIT A B LENGTH OF TRENCH SEPTIC TANK 16 45 Junc. Box 1 62 74 2 72 78 3 71 Q 4 74 71 �.7 5 76 70 6 78 90 15 7 94.5 102 24 _.1.10.. =.IIS 9 110 113 y 10 111 114 40 i 25 �IyIUO 4r 50 i o) °°G ¢p °w - O VFocF_ �� PAVana� +r V1� /} ITF I }► GL IZO A P THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED SUBSTANTIALLY AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED PT ACCORDANCE WITH ALL STANDARDS, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH SSTS TIE - INS (MEASURED BY TAPE) UNIT A B LENGTH OF TRENCH SEPTIC TANK 16 45 Junc. Box 1 62 74 2 72 78 3 71 73 4 74 71 5 76 70 6 78 90 15 7 94.5 102 24 _.1.10.. =.IIS 9 110 113 40 10 111 114 40 it 50 22 50 12 44 22 50 13 44 43 30 14 45 48 30 15 45 55 20 Putnam County Department Of .icy _h . Division of Environmental Health Ser�iaas Appr d as noted for conformance with ap is le and Fe/�lations of the Y, Yll� ate Slg-ature &Title ASBUILT PLAN WAGE TREATMENT SYSTEM Property of DMS HOMES Wlif %V HILL I.OA17.... 51.19-1-13 PUTNAM VALLEY DANIEL J. DONAHUE, P.E. ,ONSULTING ENGINEERS 20 BRECKENRIDGE ROAD MAHOPAC, N.Y.10541 628-7576 MAHOPAC, N.Y. 10541 DATE: DECEMBER 4, 2003 \ \` �QT 22 OT9 \ tetde 97.2T }�• ej \g•O � { 1.n•a \ era r•e •�t .na II rea h 11 N0T09'40 "W "� 96.85' �URvF —'Y F PROPER • PREPARED FOR SITUATE \N THE TOWN OF PUTNAM VLI, =�Y PUTNAM COUNTY NEW YORK SCALE \ "s 30' AREA 0.4331 ACRES or 10,066 S.F. NOTES; I. Ali wrt \t \cotVOne ore vQ\\d for ihls map gndl'- only Vt sq\d map and ..pies bag, the \mpres�ed' sea of LTne surveyor whose elgnQIure oppeQrs hereon, 2. Altarotlon of this docul+tenl, except by o 1loensed land sur- veyor,ls Ille9Q1 Qnd 1n v \o \Qflon of Seet\on T2O9, Subd\vls\on 2 of the New l'orla Stote ad— 116r, Law, }. Thle map nerd ceplas tttereoT are ..milled to the Qbove named wnrre,tltle QQMpQny and lending trot \tutlon(s) shown hereon and to those PQrtles only, 4. Let I- q,_Sogtlon 1, N es shown on mop entit\ed '= SECTION ONE LAKE'OSCAWANA ACREW' tiled In tho Putnam County Clerk's off \qa, t11ed In the month oT J— 0, 1 51 as map no. 36TA 5. D COPYRIGHT RICHARD H. 60RR, P.L,S, 1998 6. Laaatlosi of ;undsrground'Improvament• and /brencrolxhmenfe hereen,lt any axlN, era het eerf7tlad. 1,RICMARD H: GORR,1he surveyor who mods Ittls msp,hsuby a r1Tyy -• - - - that Ins o•arvs.Y Shc•m1' Tar—n -Q. uti(rlpl itaH' &'i:yns 'a'.. -r'H1y +D.9Xr 0- '- •' end thet IN. ntap wvs iavmpletes Dy me pn JuIY u11,1DSlo.and trial this survey hs• .been prepared In — aa,danoe with the enlat\ng Cods vt Pra01 \me for I qnd Surveys advotsd by the New `fork Slots As. •oe1ot10n eT Prot ee •le ns4 Fend 3,arvaver •. Goss \b\.. lccotlor?a of nousa. ...._ . - 1� - -�-• = `14 ! -U00 �;�,�,•� ..rte • ��_-,�. R \CH PRO H. GO R, P.L.S.,N ,Y .S:LIC...40613 , ROUTE aa, P.O.DOX SIG, MAMOP AC,N: .,106x1 t i � ^- -5.5.0.6 f . a- c 1BAq N . Po enlbla 10 �gtlon o1 S.S.p.�.. - - ( not o Protasslonal • a�v N _ tnQlnu •.- a Qi 3 LOT c o [ a LOT 14 LOT 15 W ttoi;aR a •• lunp , Posslbie IQOatlon of ho::,:, N0T09'40 "W "� 96.85' �URvF —'Y F PROPER • PREPARED FOR SITUATE \N THE TOWN OF PUTNAM VLI, =�Y PUTNAM COUNTY NEW YORK SCALE \ "s 30' AREA 0.4331 ACRES or 10,066 S.F. NOTES; I. Ali wrt \t \cotVOne ore vQ\\d for ihls map gndl'- only Vt sq\d map and ..pies bag, the \mpres�ed' sea of LTne surveyor whose elgnQIure oppeQrs hereon, 2. Altarotlon of this docul+tenl, except by o 1loensed land sur- veyor,ls Ille9Q1 Qnd 1n v \o \Qflon of Seet\on T2O9, Subd\vls\on 2 of the New l'orla Stote ad— 116r, Law, }. Thle map nerd ceplas tttereoT are ..milled to the Qbove named wnrre,tltle QQMpQny and lending trot \tutlon(s) shown hereon and to those PQrtles only, 4. Let I- q,_Sogtlon 1, N es shown on mop entit\ed '= SECTION ONE LAKE'OSCAWANA ACREW' tiled In tho Putnam County Clerk's off \qa, t11ed In the month oT J— 0, 1 51 as map no. 36TA 5. D COPYRIGHT RICHARD H. 60RR, P.L,S, 1998 6. Laaatlosi of ;undsrground'Improvament• and /brencrolxhmenfe hereen,lt any axlN, era het eerf7tlad. 1,RICMARD H: GORR,1he surveyor who mods Ittls msp,hsuby a r1Tyy -• - - - that Ins o•arvs.Y Shc•m1' Tar—n -Q. uti(rlpl itaH' &'i:yns 'a'.. -r'H1y +D.9Xr 0- '- •' end thet IN. ntap wvs iavmpletes Dy me pn JuIY u11,1DSlo.and trial this survey hs• .been prepared In — aa,danoe with the enlat\ng Cods vt Pra01 \me for I qnd Surveys advotsd by the New `fork Slots As. •oe1ot10n eT Prot ee •le ns4 Fend 3,arvaver •. Goss \b\.. lccotlor?a of nousa. ...._ . - 1� - -�-• = `14 ! -U00 �;�,�,•� ..rte • ��_-,�. R \CH PRO H. GO R, P.L.S.,N ,Y .S:LIC...40613 , ROUTE aa, P.O.DOX SIG, MAMOP AC,N: .,106x1 t i � ^- -5.5.0.6 /1 . Po enlbla 10 �gtlon o1 S.S.p.�.. - - ( not o Protasslonal i y _ tnQlnu •.- a W " l 0 1r y N ... Z ea oa rna N0T09'40 "W "� 96.85' �URvF —'Y F PROPER • PREPARED FOR SITUATE \N THE TOWN OF PUTNAM VLI, =�Y PUTNAM COUNTY NEW YORK SCALE \ "s 30' AREA 0.4331 ACRES or 10,066 S.F. NOTES; I. Ali wrt \t \cotVOne ore vQ\\d for ihls map gndl'- only Vt sq\d map and ..pies bag, the \mpres�ed' sea of LTne surveyor whose elgnQIure oppeQrs hereon, 2. Altarotlon of this docul+tenl, except by o 1loensed land sur- veyor,ls Ille9Q1 Qnd 1n v \o \Qflon of Seet\on T2O9, Subd\vls\on 2 of the New l'orla Stote ad— 116r, Law, }. Thle map nerd ceplas tttereoT are ..milled to the Qbove named wnrre,tltle QQMpQny and lending trot \tutlon(s) shown hereon and to those PQrtles only, 4. Let I- q,_Sogtlon 1, N es shown on mop entit\ed '= SECTION ONE LAKE'OSCAWANA ACREW' tiled In tho Putnam County Clerk's off \qa, t11ed In the month oT J— 0, 1 51 as map no. 36TA 5. D COPYRIGHT RICHARD H. 60RR, P.L,S, 1998 6. Laaatlosi of ;undsrground'Improvament• and /brencrolxhmenfe hereen,lt any axlN, era het eerf7tlad. 1,RICMARD H: GORR,1he surveyor who mods Ittls msp,hsuby a r1Tyy -• - - - that Ins o•arvs.Y Shc•m1' Tar—n -Q. uti(rlpl itaH' &'i:yns 'a'.. -r'H1y +D.9Xr 0- '- •' end thet IN. ntap wvs iavmpletes Dy me pn JuIY u11,1DSlo.and trial this survey hs• .been prepared In — aa,danoe with the enlat\ng Cods vt Pra01 \me for I qnd Surveys advotsd by the New `fork Slots As. •oe1ot10n eT Prot ee •le ns4 Fend 3,arvaver •. Goss \b\.. lccotlor?a of nousa. ...._ . - 1� - -�-• = `14 ! -U00 �;�,�,•� ..rte • ��_-,�. R \CH PRO H. GO R, P.L.S.,N ,Y .S:LIC...40613 , ROUTE aa, P.O.DOX SIG, MAMOP AC,N: .,106x1 t i ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. M this card to the back of.the mailplece or on the front if space permts. _.._ . . 1. Art1ple Addressed to: A. Receive by (PI a Print leanly) B. Date of Delivery 3. Se ice Type ertified Mail ❑ Express Mail Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee).: O Yes 2. Article Number (Cop from service label) Gj t (Cop P C. Signature D. I iliNve re ss different fro m item If YES, enter delivery addre ss below: ❑ Agent _._ ❑,Addressee 1? "El" Yes •. _.._ ❑ No DUG f )a rte© PS Form 381,1, July 19991 Domestic Return Receipt • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: L lVe - A. Received by (Please Print Clearly) 10259' • V _ ....'_� . �.. a •1111 � � .. _ D. Is delivery address d' from Rem 1? 11 Yes If YES, enter delivery ad ress below: ❑ No 3. Service Type Z "ertified Mail 11 Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra-Fee) ice /abed PS Form 3811, July 1999 Domestic Return Receipt ON DELIVERY ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of them ' or on the front if space permits. 1�F'/ l^� 1. Article Addressed to: � /if A q 2001 A. Received by 102595.00 -M -0952 Clearly) B.�ats of gelivery 13 Addre ❑�l'es 2. Article Number (Copy from serv 13 Agent delivery address different from Rem 1? ❑Yes `4 f YES, enter delivery address below: ❑ No CO � 3. ,S�ervi /ce Type r�� /"/- r��� Ir�l'Gertified Mail ❑Express Mail / / ❑ Registered ❑Return Receipt for Merchandise 2. le Number (Co y rom service ?S Form 3811, July 1999 L-1 Insured Mail r-1 C.O.D. 4. Restricted Delivery? ()tra Fee) ❑ yes Domestic Return Receipt 102595 -00 -M -0952 't in --'e your name and address .on the reverses that we can return the card to you ❑ Agen tack this card to the back of the mailpiece, X dies e� R,;;t fpcnt f space permits; tli nt from dem 1 -? Yes v » Gcle Addressed to ue� add•esc,k, ^low 0 No t 4 AA, 3 Tim 7j M3.� Registered : ©`Return Rece¢pt {or MercHantlise =; 4 ❑Insured Mail c0 C trD 4 it xn Id Fee ❑Yes, RestnctedDeli�ery ?�(E�xi��Hp) -3- t �cle Number (C y from service label) E w 102595 00 M 0952 rlQrin 381 ��, July19�99 i {� �nestoRatrnieelpt'..x- y-y�zt.�'