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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -17 BOX 22 I INNS I.. IN J ON . . T rm � �. - 1t '' IN 02576 LIS UTNAM COUNTY DEPARTMENT OF HEALTH .. -: _ ....:.:.:;I. - ION OF.ENVIRONMENT'AL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # V- 17- _ DS_ l i$_ Located at CAS C,a w Town or Village Pv+ Ift w rn Owner /Applicant Name- [ i m j ce, dV Tax, Map s Z Block Z Lot 1 ' Formerly_ Subdivision Name Subd. Lot # Mailing Address 115 d SC/FW1'w HF►GNTS R eav , Pwrw#m rhtz.Fq 4 All Zip 14519 Date Construction Permit Issued by PCHD h 11S OScawgn�� HE��Mis Rp• Separate Sewerage System built by _ TiM HF*D!i Address Pu?W* " rgtgg, All Consisting of /•S-" Gallon Septic Tank and S__00 L : 1C 01 41 " Or ;Pr_ rj�✓a 4d _ l&A L �f " ti Iry vim. i + -e . c,1.r..e s . Other Requirements: Water Sun Public Supply From Address 00- 15z 13R&f -Ck S _r, or: _Private Supply Drilled by I/dRIY1QR(/4Npi=a4 Address Pu'+n►n+n V64 Ny _.._._.. -- $uildingT pe .�i�.�i_ _ LU�I : 4ZZ S. Has -erosion- 1 S - _- Number of Bedrooms "57 Has garbage grinder been i4staHed2' do NEW Y�R I certify that the system(s), as listed, serving the above premises ere .Ons cte,,d ess - ti y as shown on the as- built plans (copies of which are attached), in accordanc the V P c, nstrCc io Permit and approved plans and the standards rules and re Y" p regulations o Dep �t p�f He Ai' LU , Date: Certified by u (, ,� E. X R.A. esi Prpfegs�onal) s'Fp . 62980 Address L_ Jo �•v� �� ��� �1vcl. 'Ze 11 �clEkS&1S brv201 � 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 r change is necessary. B d Title: Date: 313 i 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 . Q1.. IL ..,. .. Y WELL COMPLETION REPORT Well Location Street Address: pp Town/Village: j Ar�l Tax Map # Map c5 c� Block Lot(s) 7 DL ®R Well Owner: Name: Address: h� 10L Le Use of Well: 1- Primary 2- Secondary _�2esidential _Public Supply Air cond /h` at pump _Irrigation Business Farm Test/m6nitoring —Other(specify) Industrial Institutional Standby Drilling Equipment U40tary _Cable percussion _Compressed air percussion Other(specify) Well Type pp Screened Open end casing _ Open hole in bedrock _Other Casing Details Total Length f[t.� e f SS Length below gradt. Diameter � in. Weight per foot /�CIb /ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: 1d6ement grout Benton' ite Other Drive shoe: Yes '_ No Liner: Yes --t.,,No Screen Details Diameter in Slot Size Length ft Dept to Screen ft Develo ped? First I I—Yes No Second I lHours Well Yield Test _Bailed _Pumped _ Compressed Air- Hours "7P- lYield gpm Depth DatpcA Measure from land surface-static (specily, fil 36 During yield test S0 Depth of compleied well in ft. 1 �ZSo Well Log If more detailed information......... - descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land5urface r� �_ -..., . - ...., . ._ �_ .pp ta If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type taCapacity Depth 6 y Model A0 _ Voltage Tank Type Volume of De Well Completetl � �� � i?ump'ttrstaller 1Nel[,Driler�PC Certificate# �pYSQ "� z zNY State #:� f PC Certificate #� 4 _ NY "State #�,�- '����� Date of Rep rte Well riper Na & Ac�dres� x# 'fixk` F £ '.' - .,E6 '.e, •, o.,ry !m�''AF.. I/^`",�il ', w«. T. •^ -°r/' 1�:xS' .. R....iR4'.ttf x!. .. it .,'&, ..Lr n.'. S. ". X`. 1 :.'rT .XK, %5:`7u]'k .d Pumpl staller Name �,Atltlress R yx t �v _ r' �_ wy_ Weld Driller sign ture) :. ec x ,: x p mp Installer nature) $ �' . xa, .v . —AMA Ukau V1 Vi wGn VVIUi URACH KVb U1 dl Mdbt lwu runnanent ianamarKS to oe pro�yiaea on a separate sneevplan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 .'j ' I\. BRUCE ... R. FOLBY . . NN/o h(sglfh Drector' ' LORM7A MOLINARIR,N.,. M.S.N.. _ ..... ._.. _. . __.._ _...._ ltaaoc /iue PaW AraliA Director' Diredor of patient Services DEPARTMENT OF IEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (843) 279.6130 Fax (843) 278 - 7921 Nursing Serviees (843) 278 - 6558 WIC (843) 278 - 6678 Fax (843) 278.6085 Early fntervention/Pregehool (845) 278.6014 Fax (845) 278.6648 9911 ADDRESS VERIFICA'T'ION FORM OWNERS NAME: Timothy heady TAX MAP NUMBER: Section: 52.0, Block: 2, Lot: 17 1::911 ADDRESS: I IS Oscawans Heights Road TOWN: Putnam Valley ALMORtZED TOWN OFFICIAL: DATE: 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 Certifcatc of Construction Compliance. (8911 VCrfim) r r� YML ENVIRONMENTAL SERVICES 321 Kear Street. Yorktown Heights, N.Y. 10598 (914) 245 -2800 filbert H. Padovani, Director LAB #: 1.801115 CLIENT #: 60595 NON STAT PROC PAGE: 1 of 1 N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N ------ N N N N N N N N N N N N N N N N N N N- N N N N N N N N N N N HEADY, TIMOTHY DATE /TIME TAKEN: 03/05/08 09:00 115 OSCAWANA HEIGHTS RD DATE /TIME RECD: 03/05/08 11:20 PUTNAM VALLEY, NY 10579 REPORT DATE: 03 /12/08 PHONE: (914) -490 -3629 SAMPLING SITE: 115 OSCAWANA HEIGHTS RD, PUTNAM VALLEY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COL'D BY: TIMOTHY HEADY TEMPERATURE..: < 4C NOTES...: COLIFORM METH: N/A ------------ --------------- NNNNN ----- NNNNNNNNNNNNNNNNNNNNNNNNNNNN DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/11/08 IRON (Fe) <0.060 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 03/11/08 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /1 SM 18 -20 3111B COMMENTS: Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. 3UBM I TTED BY: _ _ _ __ dov _ Albert Pa ani, M.T (ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.. HEALTH :SE.R'VICES v,.. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �. S2_ 2- l Owner or Purchas r of Buildina Tax Map Block Lot d Building Constru ed by TownNillage 1 ,5�0Sc c L"t. -a r, t rf o.&J Location - Street Subdivision Name Buildin? 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 ser`'ing 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- buildina:utilizing .the. - - -µ _ : '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 Dav Year Signature: Title: IgLvAel" Gen al C'ont ctor (Owner) - Signature Corporation Name (if corporation) Address: .115 0661~4 f' a4l ftYs RD, P. V. Corporation Name (if corporation) Address: SAME State N y Zip Z05 State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM l� d SL 2- } - Owner or Purchas r of Building Tax Map Block Lot Buildina Construe ed by Town/Villaae G► Location - Street =— Building Type Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system sen-ing 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 re'6 Dav ,$' Year ?00�( Gene Cont ctor (Owner) - Signature Corporation Name (if corporation) Address: RQ, P.V, State y Zip 1"O S72 Signature: Title: Corporation Name (if corporation) Address: AwrAf_ State Zip Form GS -97 Jan 31 2008 5:46PM HP LASERJET FAX P.1 YML ENVIRONMENTAL SERVICES 321 Kear Street .a. _, : •..,-... •:...,...�_... - r. .. , .......p , .... _ . _ .. - :.., or -b'own •TrIe�ht -. 1 5 9 8.: (914) 245 -2800 Albert H. PAdovani, Director .LAB #: 1.800326 CLIENT #: 60595 NON STAT PROC PAGE: 1 of 2 HEADY, TIMOTHY DATE /TIME TAKEN: 01/23/08 08:00 115 OSCAWANA HEIGHTS RD DATE /TIME RECD: 01/23/08 09:10 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/31/08 PHONE: (914)- 490 -3629 SAMPLING -SITE: 115 OSCAWANA HEIGHTS.RD,PG'TNAM VALLEY,NY SAMPLE TYPE..: POTABLE. : KITCHEN TAP PRESERVATIVES: NONE COLD BY: TIMOTHY HEADY TEMPERATURE..: < 4C NOTES—.: COLIFORM METH: MF ., ��-. ....-------------- ------------ -- -------- -------_ ------------------------ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PL's NAM CNTY PROFILE 01/23/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222E 01/29/08 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 31131 01/246/08 NITRATE NITROG 0.42 MG /L 0 - 10 SM18- 204500N01- 01/246/08 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 204500NO; 01/30/08 IRON (Fe) 0.510 MG. /L 0 -0.3 mg /1 SM 18 -20 3111E 01/30/08 MANGANESE (Mn) 0.022 MO /L. 0 -0.3 mg /l SM 18 -20 3111E 01/31/0$ SODIUM (Na) 5.82 MG /L N/A SM 18 -20 3111E 01/2:3./08 pH 7,1 UNITS 6.5 -8.5 SM18 -20 4500HI 01/23/08 HARDNESS,TOTAL 86.0 MG /L N/A SM 18 -20 2340( 01/29/08 ALKALINITY (AS 54.0 MG /L., N/A SM 18 -20 23201 01/29/08 TURBIDITY (TUR 3..8 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: FAX TO 845 -526 -7042 COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER (WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS Ti3STED, AT THE TIME OF COLLECTION. Pb /Cu L19AD limits for public schools are.8et at 15 ppb. EPA ,Lead & Copper Rule for Public Sy8tems requires that no more than 10t of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment- must be undertaken to reduce the waters corrosive Potential. Fe /Mn Ii` both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Jan 31 2008 5:46PM HP, ,LHSERJET FAX ..2 YML.ENVIRONMENTAL SERVICES NO 321 Kear Street___ 4.. Yorktbwi Heights, 'N:Y: 10538` ,(914) 245 -2800 Albert H. Padovani, Director LAB #: 1.800326 CLIENT #: 60595 NON STAT PROC PAGE: 2 Of 2 MM------- ..-- -- ----- N ------ _ wrKw. ----- ----- --- wow. ---- ----- --- ---.v HEADY, TIMOTHY DATE /TIME TAKEN: 01/23/08 08:00 115 OSCAWANA HEIGHTS RD DATE /TIME REC D: 01 /23/08 09:10 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/31/08 PHONE: (914)- 490 -3629 SAMPLING SITE: 115 OSCAWANA HEIGHTS RD,PUTNAM VALLEY,NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: TIMOTHY HEADY TEMPERATURE,,: < 4C NOTES. -.. COLI-ORM METH: MF .� - - - _- ,.- ---- -- - -,-- ---- -- . -,.- -- --------------------------------------- DAT13 FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Na No Limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -1 -A. 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.3.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM CF-THE CALCIUM & MAGNESIUM __._.CONCENTRATION, BOTH EXPRESSED AS CALCILN CARBONATE, IN MG/L. -THE _ HARDNESS MAY `�RANGE FROM 0 TO HUNDREDS OF' MG /L, 'DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /.L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER:'140 -300 MG /L (1 grain /gallon = 17.2 MG /L) SUBMITTED BY: Albert H V Padovax►a , M'. T . (ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WeII PeI mt EXI Dd b `. .. .::.k z, x:R. WELL COMPLETION REPORT Well Location Street Address: f /� , I 1 r �CCLQ -qkC 14t Town/Village: / P ,, 7,ci�vt /ley Tax Map # a � -) Map Sa Block Lot(s) 'GPS " x Well Owner: Name: Q Address: YeCL G(. /! �5� CC �`/ 'lei / \ G{ �'i 1 N1 ✓'� //e' Use of Well: 1- Primary 2- Secondary Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Mary _Cable percussion _Compressed air percussion —Other(specify) Well Type _Screened "Open end casing _ Open hole in bedrock _Other Casing Details Total Length S ft� Length below gra ft. Diameter 6 in. Weight per foot / 1b /ft Materials: ✓Steel Plastic Other Joints: Welded '"' Threaded Other Seal: dement grout Bentonite Other Drive shoe: Yes _✓Wo Liner: _Yes t--"No Screen Details -- - - Diameter in Slot Size Length ft Dept to Screen ft Develo ed? First _Yes No Hours Second Well Yield Test _Bailed = Pumped _ Compressed Air Hours -74 Yield / 1 , gpm Depth Date Measure froml;nd surface-static (spec fy ft) .i u During yield test ft Depth of completed well In Well Log If more detailed Information— - : escnp�id -is 6F - sieve analyse; are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface k Ty r - s; _. _ .. �. A . If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information i Q / Pump TypeS_t, W--� Capacity Depth J Model `, 0&e f Voltage HP '7 Tank Type LLAJ X A Volume Date Well'Completed` ��atit� ,. 1lVell Driller PCCertiflcate # nNYState #D Date of Report r ip Fumpl sta°Iler'PrCrtificate #" !k "NYState " # °l� /�/ i/ /� . Well Driller0N<<& AtldrTess x : ` g r eR Y Xj(f [i ump l "nstaller ame 8rAtltlress _ s " x fi �� �d: .i ,� .g `l 910--- jWy'j_k +$.p "Za' arc M&* a. .F'vR d i ¢ x5. -f � .4+ LW��� 'a. 9 W I nller (s(�n ture)r ', nil r (si.gnature1; nstalle '° $ ^,:..I. •,'.. �y � 4 %.' " � I , e i 'x .. m #.». �r :: NO i t: txacvcocation of well witn aistances to at least two permanent landmarksAo be�rovided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -9T Rev. 3/06 SHERLiTA AMLER, MD, MS, FAAP Commissioner of Health ORETTA M0LINARI,.RNfMSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York.] 0509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT .D. BONDI County Executive Director of Environmental Health March 27, 2008 Re: Construction Compliance — Heady 115 Oscawana Heights Rd. (T) Putnam Valley, TM# 52 -2 -17 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 well has to be located from the house corners. 2. The well completion report has not been completed (depth data and pump /storage tank information). 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. JSP /kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer 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 RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200,2 John Walsh Boulevard, Peekskill, New York 10566 Tel.:,.91.4- 736 -3664 a. Fax: 9.14- 736 - 3693:• -. _ :. February 6, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brev✓ster, New York 10509 Re: Tim Heady Certificate of Construction Compliance 5 Bedroom Residence 115 Oscawana Heights Road Town of Putnam Valley, New York 10579 Section: 52.00, Block: 2, Lot: 17 Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project 1. One (1) Letter of Authorization authorizing Cronin Engineering P.E., P.C. 2. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. 3. Three (3) Copies..of a .two -(2) year.guacanteeslgned by the Owner °4: Four (4) -Well Completion' Reports signed by Norman Anderson (The Well Driller) 5. One (1) Copy of Satisfactory Results of a Water Analysis by a NYSDOH Approved Laboratory. 6. One (1) E911 Address Verification Form 7. Four (4) Certificates of Construction Compliance 8. Four (4) Sets of "As- Built' Plans signed and sealed by the Design Professional of this office. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, 7— James W. Teed Project Engineer cc: Tim Heady=er File- Paravati Heady -0scawana Heightsftflad4SSTSAs13ft- Trans- JT- 20080206.doc SHERLITA AMLER, MD, MS, FAAP Commissioner of Health "�'LORET'TA "M'OLINARI;-RN',�'NiSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health February 13, 2008 Re: Construction Compliance - Heady 115 Oscawana Heights Road, (T) Putnam Valley TM # 52 -2 -17 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 well has not been located from two fixed points. 2. The well completion report has not been completed (depth data and pump /storage tank information sections). 3. The maximum containmanent level for iron and iron plus manganese has been exceeded. 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. JSP /kly Very truly yours, IzZt � J Paravati, Jr. Assistant Public Health Engineer 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L0RE'ITA -.M0 INAR% RN, MSN . ..:.., ..._.. Associate Commissioner of Health October 1, 2007 .DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Patrick Bell Cronin Engineering Tht. Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Bell: ROBERT I BONDI County Executive 1-°ROBERT-MORRIS, PE - Director of Environmental Health Re: Field Inspection — Heady 115 Oscawana Heights Road (T) Putnam Valley, TM # 52 -2 -17 The above referenced separate sewage treatment system,can be backfilled. The following continents must be corrected in the field. 1. Remove large rock from SSTS area prior to backfilling. 2.. Call_ when ready for bedroom count and well inspection. If you have any further questions, please contact me at (845) 278 -6130. JD:ens Sincerely, Joseph Digit Environmental 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 '07 -10 -01 09:07 FROM- PUTNAM COUNTY DEPARTMENT OF HEALTH DlAgSYON OF ENVIRONMENTAL HEALTH SERVICES ATTENTION d GENE RF. 1 TEST FOR FINAL IN FC TI N For:. Fill All information must be fully completed prior to any Trenches inspections being made. T-568 P002/002 F -453 W41 PC14D Construction Permit # 1%' l� Located: 01r=4 wo tie-, f moo. �rj (V) t,•>�iw W, v Owner /Applicant Name: fwr 4-C TM 5 Block _ Lot Formerly: ~' Subdivision Name: Subdivision Lot # Is system fill completed? VV 10 Date: Is system complete? Ve Date: d Is system constructed as per plans? ILLS Is well drilled? \)-e 5 Date: Is well located as per plans ?� S Are erosion Control measures in place? P S N I certify that the system(s), as listed, at the above premises has and verified their completion in accordance with the approd!ed_ plans. and - --the - Standards, and Re ti s e ...._.. , - -. . - Health I have inspected N,pn Permit and �I =11, - � , .. W . Date: 0 7 Certified by: ` RA Desi silo 4 "ROFESS�. Address: b t4N 1+ v - 06',2 j perry tla-/ /Uy % Comments: E e � yc �c.�.Q -�_ Q c� v�-� -� w ,-y1 / 4 / Form FIR -99 0' ` f' IC? 1 1 � PUTNAM COUNTY DEPARTMENT OF HEALTH ' 61'/t- V o DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: %� ///07 Inspected by: Street Location 11 -0SGOW-A1A lkl ►Y tcol Owner Tom .._.z _ _ ... -J_�t� . `A:l::�:. - � ...........:.: . .. ..:Permit #.. . ; :. �' - 12 ry. TM # 2 r7 Subdivision Lot .# --- 1. Sewage System Area a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................:. . ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands . ............................... IL Sewage System � n a. Septic tank size - 1,000 .......... 1,250 ......... omer.... ........ b. ' Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... .......... ...................... d. Distribution Bog 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction. Bog : proper set .......... ............................... 6. renc es / �� 1. Length required 0 ® Length installed — 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size o:F gravel 3/4 - 11/2" 'diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ........................ ............................... PUS Pu or -Dosed Systems - 1. Size . pump chamber ................ ......................:........ 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:..........: ..............................: 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a.. House located per approved plans ... ....................:.......... b. Number of bedrooms ....................... ............................... IV. Well Well located as Fier approved plans . ......:........................ b. Distance from STS area measured . . ft ........... c. Casing lid" 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. 12/02 r PERMIT. FOR SEWAGE TREATMENT SYSTEM Located at 0-,:;e— AW o9YV4 #V7tC7ff4 A�d AD Town or Village &riV A-M VAC t Ck/ Subdivision name Date Subdivision Approved Subd. Lot # -- Tax Map ,SZ Block 7 Lot / -:;�- Renewal — Revision Owner /Applicant Name L (W-r- oDd A -LovI Date of Previous Approval Mailing Address i-E R--�o ;J0 L`o4J e0 pj) 19dT �lA,M LJ4f Lam_ N )( Zip Amount of Fee Enclosed :14�0v c,r 6 Building Type &( t,f mec Lot AreaZd,69 No. of Bedrooms Design Flow GPD� e- e S Fill Section Only Depth 0— 12-11 Volume :t 3 ;-v 6 U. '/J PCHID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage —System to consist of IS-" gallon septic tank and 3M F Other Requirements: To be constructed by -1—o Fe DF7 9.41AI" Address Water Supply: Public Supply From Address or: _ Private'Supply Drilled by- O� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will placesgyoodoperating condition any part of said sewage treatment system during the period of two (2) years immediately ayvm thhdate.othe issuance of the approval of the Certificate of Construction Compliance of the original system or re kiis thEe eto a Signe P.E. Vey_ R.A. y D. 196rKSk I B C- A Y License # / 016.1; Date 1 (� Dj g 1112- _ APPROVED �2���ONS� ,..n "'ION :`'phis approval expires two years from the date issued unless construction of the sewage treatment sy 'emtaen completed and inspected by the PCHD and is revocable for cause or maybe 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. By- 4 Title: 41451, Date: W ite opy - 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 APPLICATION TO CONSTRUCT A WATER WELL please print or type I5�11�ermlt # Well Location: Street Address: Town/Village Tax Grid # e 4w 4,V,4 476 Hi3 e j). PuIWPw t/ Map S-2- Block 2 Lot(s) 1'4 Well Owner: Name: Address: Cap �k�N 4t-C�w l2a�� %7��v'feta'v Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served sT Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason N/ -1 a,.4L Y V09- /V u?-/ f24 S 1 A 0J ( 6_ for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. -- Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No �--- Name of Public Water Supply: V- Town/Village .k Distance to property from nearest water main: ,ev f ff Proposed well location & sources of contamination to be rovi on separate sheet/plan. Date: CI ._= - Applicant Sinahure: F2 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 7 i q Permit Issuing Official Date of Expiration � Title: - Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 JUNC77ON BOX (F SOIL TESr H E (TYP) (SEE D£TAlL) (SEE SOIL DA T SHEET) 12° Ad OF BA U 2 L. F, -4"0 SOLID R38 (341 CU YD RED o v PVC PIPE FROM C710N , F \ I, BOX TO PERFOR D � \ w T TRENCH PIPE . ot V,V)V,70Nx (TYP) (SEE DE -MIL) to i J i i f �° OPOSED EROSION c n AREApi W A. 2 L.F. -4 -0 SOLID SDR �� i jo PIP£. FROM 'dYl C77OIV. t ��tP , i i " = w � i i i _ �� 100.t' EX�ANSlQN . ro OX TO PE RF TED i 00 i ti 56✓� i� i �� � � - r 410 PERFORA i 09A VEL ME CAPP M. F. —4 SOLID S35 PVC' f m m Q v W TH 22' NOS AS AWN (22' ;u r MAXIMUM D, 45 REIJUj z { _ . 740 ID Ti - J ...... err. _ . ... �� R � Y, —� 15 GALLON . 40 i�ITH DUAL: C n U (' tiao Wit• (S£E' DETAIL m m . 1 S ;A N r.A A ` ' O�/18/2006 11:06 13147363693 ---``-`------'-~' � ' CR0NIN ENGINEERING 1 ' ' � / � w PAGE 03 07/18/2006 11:06 9147363693 CRONIN ENGINEERING 1 PAGE 04 CS q 1 RA �44- � ` o a g � 1 � X on of �w e 1 I ® ing JUL -18 -2006 TIDE 08:02 TEL:845- 278 -7921 NAMP:PIITNAM rnliNTv nPPOPTMMOT nr* A A RONIN ENGINEERING, P.E., P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 649,17 ay, . (914)736 3fi9:: • .:.;::, -T _.:. ;., - w,.... July 1.8, 2006 Joseph Paravati, Assistant Public Health Engineer Putnam County Dept. of Health 'I Geneva Road Brewster NY 10509 Re; Well & SS TS Construction — TTLV Oscawana Heights Road, Town of Putnam Valley Dear Mr. Paravati: Please find enclosed three copies of the revised Subsurface Sewage Treatment System plan for the above referenced property. Revisions have been completed based on your memo dated July 17, 2006. Please call me at the above number if you have any questions, or require additional information. Thank you for your time and assistance in this matter. p c Ily s itt , t hn L. Cronin, roject Engineer SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Keith Staudohar Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Staudohar: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health July 17, 2006 Re: Proposed SSTS — TTLV Corp. Oscawana Heights Road, (T) Putnam Valley TM# 52. -2 -17 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Please show all 100' wetland buffers on both sheets. _ ......::_ s 1p -syem lw 2 Please-- exparision� -area i,i ay 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. JSP/kly Very truly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer 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 9HRRUTA AMLEIL MD, MS, FAAP Ccwmluio1wr alHedlh I.ORRTTA MOLINARL RN, MSN Amwmr Commtnhurrr o/Hrdrh DEPARTMENT OF HEALTH 1 Bence a Road, Brewster. New York 10509 RORRRTJ. BONDI co.o & a w ROBERT MORRIS, PR Ogeuor ol�r.,n..7erd HmlU� i July 17, 2006 Keith Staudolurr Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. •rccksldll. NY 10566 Re: Ptnpofed SSTS — TTLV Corp. .. i : • y _ OscewwA Heights Rood, M Putrwm Valley TM# 52,247 Tear Mr. Staudohar. Phis office has received and reviewed the most recent set of plans for the above-mentioned project. We wnuhi Pike to offer the following comments for your review and consideration. 1. Please show all 100' wslland buffers on both sheets. Plesse show the oxpansion area in the same way as the primary system is shown. This office will continue its review upon consideration of flie above - mentioned comments. I Please feel free to contact the at cat 2157 if any quesNots arise. �J Very truly yrnm� \ L /Joseph S. Patavati..Tx. Assistant Public Health Engineer JSP /kly Lnvtmmem'altlaM ("5)27"13e Fax(00)278-Ml Wstw 98p1} xeelea (845)225,5106 Fw (W) !2515418 NunhMAcrvi=(845)2M4S58 Fa (MS)2704eM WC(943)278.6670 Nw't40liar Care Fa (845)2704085 Fs A)• IntwembwV%vw% .1(MS) 2786011 Fu (W) 278!648 SENDING MU MA B DATE JUL -17 -2006 MON 13:15 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE : 919147363693 PAGES 1�1 START TIME : JUL -17 13:14 ELAPSED TIME : 00'33" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 9HRRUTA AMLEIL MD, MS, FAAP Ccwmluio1wr alHedlh I.ORRTTA MOLINARL RN, MSN Amwmr Commtnhurrr o/Hrdrh DEPARTMENT OF HEALTH 1 Bence a Road, Brewster. New York 10509 RORRRTJ. BONDI co.o & a w ROBERT MORRIS, PR Ogeuor ol�r.,n..7erd HmlU� i July 17, 2006 Keith Staudolurr Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. •rccksldll. NY 10566 Re: Ptnpofed SSTS — TTLV Corp. .. i : • y _ OscewwA Heights Rood, M Putrwm Valley TM# 52,247 Tear Mr. Staudohar. Phis office has received and reviewed the most recent set of plans for the above-mentioned project. We wnuhi Pike to offer the following comments for your review and consideration. 1. Please show all 100' wslland buffers on both sheets. Plesse show the oxpansion area in the same way as the primary system is shown. This office will continue its review upon consideration of flie above - mentioned comments. I Please feel free to contact the at cat 2157 if any quesNots arise. �J Very truly yrnm� \ L /Joseph S. Patavati..Tx. Assistant Public Health Engineer JSP /kly Lnvtmmem'altlaM ("5)27"13e Fax(00)278-Ml Wstw 98p1} xeelea (845)225,5106 Fw (W) !2515418 NunhMAcrvi=(845)2M4S58 Fa (MS)2704eM WC(943)278.6670 Nw't40liar Care Fa (845)2704085 Fs A)• IntwembwV%vw% .1(MS) 2786011 Fu (W) 278!648 June 6, 2006 TTLV CORPORATION SITE DEVELOPMENT PLAN WETLANDS PERMIT NEGATIVE DECLARATION OF SIGNIBICANCE OSCAWANA HEIGHTS ROAD ��TM. 62 x2_v17�'�� FILE: 52./100511006 WHEREAS, the applicant is proposing the construction of a single-family residence on approximately 20.69 ( +/-) acres of land located on Oscawana Heights Road in the Low - Density Residential (R-3) Zoning District; and WHEREAS, the Planning Board granted Sketch Plan Approval on November 14, 2005; and WHEREAS, the Town of Putnam Valley regulates wetlands that are equal to or greater than 1/2 acres in size, vernal pools, waterbodies, streams, and intermittent streams and WHE A$, the-18 (+/-).acre wetland located on the westerly side of the proposed driveway is not a vernal pool-aiid i4 t exefwre r���t regull►l cad _th,E Tcs�un of-Putnam- Valley;; and ........ . .... . WHEREAS, the applicant is proposing to cross an intermittent stream along Oscawana Heights Road &ad is proposing disturbance within 100-feet of a Town regulated wetland (located in the northeasterly portion of the site) and a Wetlands Permit is required from the Planning Board; and WHEREAS, the Putnam Valley Highway Department is requiring the applicant to remove rock outcroppuzg along Osca.wana Heights Road to achieve the proper sight distance; and WHEREAS, the rock removal and grading associated with this project shall not extend onto adjoining properties; and WHEREAS, the Code Enforcement Officer has determined that a Minor Grading Permit i.; required; and 'age 1 of 5 TOWN N Off' PIJTNAM VALLEY BILLY L CROWDER JOHN ZARCONE, JR. - Chairman PLANNING BOARD Secretary MICHAft RAIMO16Y;' IY. "� .,.:._, :. ..,: 255 Oacawanl Leke Road : ,. RICHARD TULL'Y Vice Chairmen Putnam Valley, NY 10579 -2004 EUGENE YETTER ,Ill: ($43)526 -3740; Fax: (845)526-3307 TOM CARANO THE CHAZEN COMPANIES -mail 1P-,.m is m my ev. (Jkd Hoc) Town Planner FOLCWTTI & ASSOCIATES LAURA LUSSIER Town Engineer Clerk June 6, 2006 TTLV CORPORATION SITE DEVELOPMENT PLAN WETLANDS PERMIT NEGATIVE DECLARATION OF SIGNIBICANCE OSCAWANA HEIGHTS ROAD ��TM. 62 x2_v17�'�� FILE: 52./100511006 WHEREAS, the applicant is proposing the construction of a single-family residence on approximately 20.69 ( +/-) acres of land located on Oscawana Heights Road in the Low - Density Residential (R-3) Zoning District; and WHEREAS, the Planning Board granted Sketch Plan Approval on November 14, 2005; and WHEREAS, the Town of Putnam Valley regulates wetlands that are equal to or greater than 1/2 acres in size, vernal pools, waterbodies, streams, and intermittent streams and WHE A$, the-18 (+/-).acre wetland located on the westerly side of the proposed driveway is not a vernal pool-aiid i4 t exefwre r���t regull►l cad _th,E Tcs�un of-Putnam- Valley;; and ........ . .... . WHEREAS, the applicant is proposing to cross an intermittent stream along Oscawana Heights Road &ad is proposing disturbance within 100-feet of a Town regulated wetland (located in the northeasterly portion of the site) and a Wetlands Permit is required from the Planning Board; and WHEREAS, the Putnam Valley Highway Department is requiring the applicant to remove rock outcroppuzg along Osca.wana Heights Road to achieve the proper sight distance; and WHEREAS, the rock removal and grading associated with this project shall not extend onto adjoining properties; and WHEREAS, the Code Enforcement Officer has determined that a Minor Grading Permit i.; required; and 'age 1 of 5 WHEREAS, the applicant has confirmed that blasting will not be required to remove on-site rock and rock required to be removed within the Town right-of-way; and Chapter 144 Erosion and Code; and tlxe: Planning Board has reviewed - the proposed actiou`in - aimorclance �vftli "Freshwater Wetlands, Watercourses and Waterbodies," Chapter 155 "Soil Sediment Control," and Chapter 165 "Zoning" of the Putnam Valley Town WHEREAS, the applicant has submitted a Short Environmental Assessment Forza (EAF), last revised January 20, 2006; and WIHERFAS, the proposed action has been determined to be an Unlisted Action under the State Environmental Quality Review Act (SEQRA); and WHEREAS, the Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c) and determined that the proposed action_ will not have a significant adverse impact on the environment; and WHEREAS, the Planning Board has considered-all reasonably related long-term, short - term, direct, indirect, and cumulative environmental effects associated with the proposed action including other simultaneous or subsequent actions. NOW THEREFORE 13E IT RESOLVED THAT, the public hearing for the Site Development Plan and Wetlands Permit is hereby closed; and BE IT FURTHER RESOLVED THAT, the attached Negative Declaration of Significance is hereby issued; and BE IT FURTHER RESOLVED THAT, the Site Development Plan (Sheet's- 1 thrc,ugh .t) titled "Site Development Plan for TTLV Corporation," prepared by Cronin Engineering, P:E., P.C., revised May .19. 2006, is hereby approved subject . to the below-listed conditions;....: BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid for a period of 18 months after the Site Development Plan has been signed by the Chairman and may be extended once, at the request of the applicant, by the Planning Board for a period not to exceed six months; and BE IT FURTHER RESOLVED THAT, the Wetlands .Perm -it is hereby approved subject to the below -listed conditions and the signing of the Site Development Plan and shall be. valid for a period of three years from the signing of the Site Development Plan. All work associated with the Wetland Permit shall be conducted in strict compliance with the approved Site Development Plan and shall be completed within six months following the initiation of construction; and Page 2 Df 5 13E IT FURTHER RESOLVED THAT, in accordance with Chapter 144, the Planning Board, Wetlands Inspector and Code Enforcement Officer shall have the right to inspect the ro ect from-time-to p J time,..�n BE IT FURTHER RESOLVED THAT, the Wetlands Permit shall automatically expire upon completion of work; and BE IT ]FURTHER RESOLVED THAT, the below listed conditions must be completed within 6 months of the date of this resolution. Should the below -listed conditions not be completed within the allotted time frame, this resolution shall become null and void unless an extension is requested by the applicant (in writing) within said 6 month period and g =anted by the Planning Board. General conditions to be satisfied prior to the signing of the Site Davelor�ment. Plan. I. Submission of all applicable fees and escrow. 2. Construction MonitorMg Escrow in the amount of $1,500 shall be submitted to the Planning Board Clerk. S. The Planning Board Chairman shall sign the Slzort EA-F, last revised January 20, 2006. 4. The applicant shall satisfactorily address any comments from the To•wr. Engineer, Town Planner, and Town Wetlands Inspector. Prior to the signing of the Site Development Plan by the Chairman, final reports from the Town Engineer, Town Planner, and Town Wetlands Inspector addressing resolution compliance shall be submitted to the Planning Board. 5. An Erosion and Sediment Control Bond, or ether collateral acceptable to the Planning ;Board and in form acceptable to Planning Board Counsel, shall be submitted to the Planning Board Clerk in the amount of $4,620. The applicant shall provide an action plan for the security indicating, to the satisfaction of .planning Board Counsel, when the Town has the.right to utilize the surety and to take the necessary corrective measures. 6. An engineeringlinspection fee equal to 5% of the cost of the Erosion and Sediment _:.: Control :Bon .. shall -be aaz.; tcd �to the Planning Ecar�i Clark: 7. A wetland bond, or other form of collateral acceptable to the Plan, rung Board and in form satisfactory to Planning Board Counsel, in the amount of $1,503 shall be required to be submitted by the wetland permit holder to the Town of Putnam Valley prior to the commencement of any site construction. The bond shall be released when the Town of Putnam Valley Wetland Inspector confirms that there has not been any negative impacts to the jurisdictional wetland or wetland buffer and all conditions of the wetlar.c, permit have been met. S. An additional $750.00 shall be placed in escrow for future site inspections by the Town Wetland Inspector. All funds that are not utilized shall be returned to the applicant. 9. Eight original copies of the Site Development Plan, signed by a Licensed Professional Engineer and the owner of the property, shall be submitted for the Chairman's signature. Page 3 off' S =ditions of Wetlands Permit ........ .. 3i): TnrB 'vtliicls ' permit iali` be prominently displayed at the project site during construction. I L The piping that is to be installed under the proposed driveway shall be an open bottom arch of adequate size and material construction to the approval of the Town Engineer, The piping shall be installed during a low flow period of the intermittent water course. A plan to divert the stream water during the pipe installation shall be submitted to the Town Engineer for approval. 12. Limits of disturbance shall be marked in the field by orange construction fencing prior to the commencement of construction. 13.A pre-construction meeting with the Town Wetland Inspector and other Town representatives as deemed appropriate shall be held at the site prior to the commencement of any work other than installation of the limits of disturbance and temporary erosion and sediment controls. The Town Wetland Inspector must be contacted at least 72 hours prior the meeting at 914-962-7733 to arrange an appointment. 14, All. erosion controls must be maintained during the construction period. The road is to be maintained free of mud, dust and debris during construction. MAR temporarily disturbed areas located within the wetland or wetland buffer shall be immediately seeded and mulched with a seed mix approved by the Town Wetland Inspector, 1.6. The amount of impervious material located in the wetland and wetland buffer shalt be quantified (square feet). A wetland or buffer enhancement shall be installed at no less than a 14 area mitigation ratio an area determined in the field by the Town Wetland Inspector. 17. The Town Wetland Inspector shall inspect the site at the end of construction but prior to the issuance of a certificate of occupancy to insure compliance with the wetland permit. 18.At least two business days prior to the commencement of the work, the applicant shall' apply to the Code Enforcement Officer for a permit to commence work, pursuant to Chapter -155, Soil Erosion and Sedimentation Control, of the Code of the Town of ]Putnam Valley. M Prior to the issuance of a Building Permit, a site inspection shall be conducted with the applicant, contractor, Highway Department, Building Department, Wetlands Inspector, and Town Engineer. 20. Prior to the issuance of a Certificate of Occupancy, a final site inspection shall be conducted with the applicant, contractor, Building Department, Highway Department. Wetlands Inspector, Town Engineer, and Town Planner. 21.11rior to the issuance of a Certificate of Occupancy, an as•built survey demonsttatin6 compliance with the approved Plan shall be submitted to the Planning Board, Town 1agineer, Town Planner, Wetlands Inspector, and Code Enforcement Officer. Fare 4 of 5 22. Prior to the issuance of a Certificate of Occupancy, the Building Department shall confirm with the Planning Board Clerk that all escrow accounts have been paid in full. Motion: Eu.eene T. Yetter,, Jr. Second: Migbael Haimondi. Jr. Yea Nay Abstention Absent Tom Carano X Eugene T. Yetter, Jr. h Richard Tully X John Zarcone, Jr. K Michael Raimondi, Jr. x r Chairman Billy L. Crowder X ChairmA Billy L. Crowder The Planning Board Clerk hereby confirms that conditions 1-9, identified above, have been sati8 ied and that the Site Development Plan has been signed by the Chairman of the Planning Board. Confirmed BY: Date: Page 5 of 5 NEGATIVE DECLARATION Notice of Determination of Non-Significance Date: Juue 5, 2006 This notice is issued pursuant to Fart 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Conservation Law. The Town of Putnam Valley Planning Board has determined that the proposed action described below will not have a significant environmental impact and. a Draft Environmental Impact Statement will not be prepared. Name of Action: Proposed Single-Family Residence for TTLV Corporation SEQRA Statue= ,_ Type 1 X Unlisted Conditioned Negative Declaration: Yes .I No Description of Action: The applicant is proposing the construction of a single- family residence on approximately 20.69 ( + /-) acres of land located on Osca.wana Heights Road in the Low-Density Residential (R-3) Zoning District. In accordance with §165-46 of•the Putnam Valley. Zonin_g_,CoAe.,::t4e_-:_ construction of the proposed residence requires Planning Board approval. In addition, the applicant is proposing to cross an intermittent stream along; Oscawana Heights Road and is proposing disturbance within 100-feet of a Town regulated wetland (located in the northeasterly portion of the site); a Wetlands Permit is required from the Planning Board. Location: Oscawana Heights Road, Putnam Valley, New York Reasons Supporting This Determination: The Planning Board has compared the proposed action with the Criteria for Determining Significance in 6 NYCRR 617.7 (c), specifically 1. The proposed action will not result ire a substantial adverse change in the existing air quality, ground or surface water quality or quantity, traffic or noise levels,' a substantial increase in solid waste production; or a Page 1 of 3 :...: :... Y.... substantial., ,inc a- ot u ` 1m ib ri i eac zvg or - drainage problems. 2. The proposed action will not result in the removal or destruction of large quantities of vegetation or fauna, substantial interference with the movement of any resident or migratory fish or wildlife species, impact a significant habitat area, result in substantial adverse impacts on a threatened or endangered species of animal or plant, or the habitat of such species; and will not result in other significant adverse impacts to natural resources. 3. The proposed action will not result in the impairment. of the environmental characteristics of a Critical Environmental Area as designated pursuant to 6 NYCRR Part 617.14(g). 4.. The proposed action will not result in a material conflict with the Town's officially approved or adopted plans or goals. 5. The proposed action will not result in the impairment of the character or quality of important historical, archaeological, architectural, aesthetic resources, or the existing character of the community or neighborhood. 6. The proposed action will not result in a major change in the use of either the quantity or type of energy. 7. The proposed action will not create a hazard to human health. 8. The proposed action will not create a substantial change. in t_ e., use, or _. iiensity of use, of land including agricultural, open space or recreational resources, or in its capacity to support existing uses. 9. The proposed action will not encourage or attract a large number of people to a place or place for more than a few days, compared to the number of people who would come to such place absent the action. 1O.The proposed action will not create a material demand for other actions that would result in one of the above consequences. 11. The proposed action will not result in changes in two or more elements of the environment, no one of which has a significant impact on the environment, but when coa sidered together result in a substantial adverse impact on the environment. 14. When analyzed with two or more related actions, the proposed action will Page 2 of 3 �er =A° 3igfiifidant impact- oti tY1e'eriviraiiiziP'tit`�ri��i cumulatively, will not meet one or more of the criteria under '6 NYCRR 617.7(c). 13.The Planning Board has considered reasonably related long-term, short - term, direct, indirect and cumulative impacts, including other simultaneous or subsequent actions. For further information contact: Laura Lussier, Planning Board Clerk 265 Oscawana Lake Road Putnam Valley, New York 10679 This notice is being filed with: Putnam Valley Planning Board 265 Osca3wana Lake Road Putnam `alley, New York 10579 Page 3 of 3 SHERLITA AMLER, MD, MS,.FAAP_.. Commiss oner of hlealth s � -' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Sir or Madam: County Executive September 20, 2005 RE: Application to Construct a Subsurface Sewage Treatment System TTLV Corp. Oscawana Heights Road (T) Putnam Valley;sTM� #'S2 2 17 4rA f r Y The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on August 5, 2005 is. incomplete. .. -- 1? e tie=DepaimenC may-, ar =be: a inf©r.- PAiorr 4s- required-before' commence its review. The SSTS plan submitted are approvable, however the permit cannot be issued until a wetland permit or a letter from the Town of Putnam Valley is submitted stating that a wetland permit is not required. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:kly �i9jly your "tiV )M-7 obert Morris, P. E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 .__ . .. SHERLITA AMLER, MD,_MS, FAAP ... . Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health a.� r ROBERT J., BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 20, 2005 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 RE: Application to Construct a Subsurface Sewage Treatment System TTLV Corp. Oscawana Heights Road (T) Putnam Valley, TM # 52 -2 -17 Dear Sir or Madam: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on August 5, 2005 is incomplete. :__.....::._:._.,... _ please..b.e.. advised. th-, t . the; following. required before .the Department-may ; -:- commence its review. 0 The SSTS plan submitted are approvable, however the permit cannot be issued until a wetland permit or a letter from the Town of Putnam Valley is submitted stating that a wetland permit is not required. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:kly r V l-y^ y /our Morris, P. E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY .& SUBSURFACE SEWAGE TREATMENT SYSTEMS - _ _... _ _...- W SHEET FOR: CONIITRUI `i'IO1 TLR' P. NAME OF OWNER: �/° STREET LOCATION: v �7 VIEWED BY: SRDATE: TAX MAP #: (CONFIRMED) Y N DO 5 �Y,� (REQUIRED DETAILS ON PLANS CONT'D) �P RMIT APPLICATION �JIUHOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON 1 LL PERMIT OR PWS LETTER UUNO BENDS; MAX BENDS 45° W /CLEANOUT . OF AUTHORIZATION DATA SHEET (DDS) (ATE RESOLUTION SHORT EAF PLANS -THREE SETS ((___)HOUSE PLANS - TWO SETS (_)L__)VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE (� t FILL REQUIRED DEPTH (_) CURTAIN DRAIN REQUIRED GENERAL d,kDFP CATED IN NYC WATERSHED ANS SUBMITTED TO DEP LEGATED TO PCHD APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED Le PPRCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) 'DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA• . ) 1-00-YR: 'FhGOI1 E'L-E VA I`ION W /1 200' ( )( )SOIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) 'HYDRAULIC PROFILE VITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED U WAY & SLOPES, CUT (� FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS M #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION . DATUM REFERENCE '��11LOCATION OF WATERCOURSES, PONDS y�LAKES,WETLANDS WITHIN 200' OF P.L. (� PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS C� WELL & UU EROSION CONTROL FOR HOUSE , SSTS, EROSION CONTROL NOTE ;OMMENTS: . REVSHEET)09 /01100 RENEWALS SITE NOTE (NO CHANGE) FILL SYSTEMS - 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (_) ILL SPECS/ FILL NOTES 1 -5 (_() ILL PROFILE & DIMENSIONS (� ILL IN EXPANSION AREA FLLL GREATER MIV 2 FEET CLAY BARRIER U FILL CERTIFICATION NOTE DEPTH GAUGES (� ; VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS �) SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH U LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS, 100% EXPANSION PROVIDED �) DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTME COVER SEPA- RATION DISTANCES ON PLAN - FROM SSTS 6' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS j 0' TO STREAM, WATERCOURSE, LAKE (inc. espan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 1 � -- (�50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS Ij (__)10' MIN TO LEDGE OUTCROP { SEPTIC TANK (_)(_)10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE =SLOPE IN SSTS AREA (S20 %) REGRADED TO 15 %, IF REQUIRED DOSEMUMP SYSTEMS PUMP NOTES C_ DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (_, DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) IT AND D -BOX SHOWN & DETAILED (�1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN ANDPIPES, 5' BOTH SIDES, DETAIL �) 15' MIN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % - <1% 0' MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ' / T-(- VA C0ePV4AT767eJ Located at M )(C, �0- p T/V PvT -Py.4m �% ( ax Map # j Z Block Lot 1-7- Subdivision of Subdivision Lot # Gentlemen: Filed Map # Date Filed This ler:er is to authorize �,,,j o7-N- y L. (* R 0ev i,y _J= 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 145 and/or 147 of the Education Law, the Public Health - Law,:and the:Putu_gm,County Sanitary.Code 0--.7h P.E., Mailing State _ o,11 y Zip /ar6 6 Telephone: b-1, 4J :73 G — -U 6 Y Very of i,i) Mailing Address: ex 0 c-"I - cT ,4-►M L) 4c- t- Ei State Al -w "/v/R <_ Zip /vS - -6-f Telephone: i /yJ y ' qL y� Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT,. - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAiM COUNTY HEALTH DEPARTiNT To: Public Health Director In the matter of application for: 6 77ZvcT70 a r SS W&TEK. 5- ,PP6`� Jv9v�E i✓1a� oc.�_ represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: `T--F(- V Cc #I-)P c) A /4 770 v-) Having offices at: %%� T� % c o '`> pc) >4 � . ' ��-t yy� t4l, 6 j Whose Officers Are: President - Name: -J'i m oTvl L - C 12 o r,j I 1T Address: Z 'jo +4__j L,) .,I-Cs H -9 & v1). P is k I t_ (_ -,V Y ),Z5W,6 Vice President - Name: yvo4 Address: Secretary -Name: iwl a g c v c k - J d'4/Iil a,Ll S. r 3o L �� 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. Sio-ne Title: P Sworn to before me this 3 day of "u6r_(mon KEITH STAUDOHAR Notary Public, State of New York No. 4999872 Qualified in DutcheQt County Commission Expires December 1,,®al,_ Corporate Seal Form CA -97 CNI `, I ION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Permit # t lo? .+�3� , WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # Map `5 � Block � Lot(s) J 7 'GPS s • Well Owner: Name: Address: i � a D h� 4 Uw ! l,� Use of Well: 1- Primary 2- Secondary _-viftesidential _Public Supply Air cond /h at pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment 140tary _Cable percussion Compressed air percussion Other(specify) Well Type Screened ►Open end casing _ Open hole in bedrock _Other Casing Details Total Length -t4g"_ft.� Length below grade t. Diameter � in. Weight per foot lb/ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: y*6ement grout Bentonite Other Drive shoe: Yes No Liner: _Yes __I,.No Screen Details Diameter in Slot Size Length (ft) Dept to Screen ft Developed? First _Yes No Hours Second Well Yield Test - Bailed _Pumped _ Compressed Air Hours ")I- Yield gpm Depth Datpra Measure from land surface-static (specify 3 During yield test (ft) Ly so Depth of complete we 1 n . s0 Well Log If more detailed InfOrl118t1vn .. descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface o If yield was tested at different depths during drilling list: Feet er Minute Pump /Storage Tank Information Pump Type S,-j,;&e,s,�(Capacity Depths) Model /o -. Voltage ) a a I Tank TypeChid V01ume c.l Date Well Completetl 1Nell Driller PC Certlflcate # p NY State # Date of Rep rt ° ! x /+� �G Pump,lnstaller PC Certificate; #.. NY State Well tiller Na 8;Address :. :_ WeIFDr�llec,(sign ture) :. c. ., -:.. .. .. .. .. ., -. .gin., Pump l staller Name max, p P mp Installer nature) r NOTE: Exact Location of well with distances to at least two ermanent landmarks to be pro ded on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT WSTtht' 1. Name and address of applicant: V:- A�y► (/ogc-tC/ . X1 /os-67 2. Name of project: 3. Location TN: hv:LLm-ro yygv --cul/ 4. Design Professional: '7 ,,m o-n+ y t. C Po ou ivu-_E�5 . Address: 2- To+i -" w v) c 6. Drainage Basin: P"#_ t c L t-lp &LbW Rav o k K t L, AD5 -64 T. Type )f 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) ........................ ...6........................... Type I Exempt Type II Unlisted 1/ 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... id/—P 10. Has DEIS been completed and found acceptable by Lead Agency? ............... Al liq 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances _ . ...... . ......... ................... .............................. 13. If so, have plans been submitted to such authorities NO 14. Has preliminary approval been granted by such authorities? Date granted: A-1114 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If suriFace water discharge, what is the stream class designatiott? .................... ✓v lft 17. Waters index number (surface) ................................ ............................... l 18. Is project located near a public water supply system? ....... ............................... /W 19. If yes, name of water supply /I/& Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ ft/d 21. Name of sewage system IV A4 Distance to sewage system N1i`1 22. Date test holes observed for .23.. Name of Health Inspector J, A- CkV'4 -rg 24. Project design flow (gallons per day) ............. ............ ............................... / o—e-D 25. Is State Pollutant Discharge Elimination System' ( SPDES) Permit required ?... tip 26. Has SPDES Application been submitted to local DEC office? ......................... /UM Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? �&5. _ 28. Wetlands ID Number ........... ............................... { ................ .. ... .Al A 29. Is Wetlands Permit required? ...... �� ..... ........ S Has application been made to Town or Local DEC office? ............................... Na 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /yo 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 LVO 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 0111 DESCRIBE: 33. Is there a local master plan on file with the T, own or Village? ,E 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? . ............................... 11119 36. Tax Map ID Number .............. Map S-2 Block Lot / - 37. .Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications_ for review. and approval,of a new SSTS to be located - within the NYC: Watershed - shall. — be'selit to the Departiiieht, and need nofbe sent-in duplicate to'fhe DEP, afthough the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. Falser" ade herein are punishable as a Class A misdemeanor pursuant to Sect * nal Law.. V SIGNATURES & OFFICiAL TITLES: So XA /. Mailing AddreS ..................... ........... v D. r� 9-6 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE.TREATMENT SYSTEM Owner -�-7"G ���,� P� Q�TI v�.l Address jAgl a yy 4-1ac. L g (,V A01Tb Located at (Street) O�.c,Iv,*v4 XF/C 19S t iyicc d pew Tax Map SZ Block Lot / 91 (indicate nearest cross street) Municipality (T) P-1014,H Drainage Basin PertsKrLC. } 6 cc-ow SOIL PERCOLATION TEST DATA Date of Pre- soaking G /A /v r— Date of Percolation Test C / -As' Hole No„ Run No. Time Start - Stop Ela se Time (pI in.) Depth to Water From Ground— Surface (Inches) Start Stop Water Level Drop In Incites Percolation Rate Min/Inch 1 �A 16 I zS Ib N ,y" 3 2 1:,30 I:� cj e" .�, 3 3 3 % q5-1 ITT- I 2 16 " �i 7'' 3 if ,, is , 5 2 1 2:3() Z: 3b " it 2 - If - _ 3 7 : s� �Z : s� 1s'' 11g 1. 3 2 4 3:60 3 :0 1511 /j, 3 3 5 3 3. 1 2 3 4 5' NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootamea 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 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 HOLES DEPTH HOLE N0. HOLE NO. 2 HOLE NO. . G.L. So i c. oPSoi� Togo tc. 1.0 LL *V.- �•N �2ot�+n/. � IC uwN 1.5' SAW D y UOPM C,firi Dv Cdr A>v� y t.� AM 2.0' 2.5' 3.0' �,�dvav S�wD pj Indicate level at which groundwater is encountered �t/n,�G�lrro wry E� Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations m"kyr,- f oAJ) Date 0 Design Professional „ e Q�I — (0120 /V1.4) 3?' Address: € �01<xs_�� a �. S i mature: ]Design Profesoonal's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESI.GN.UA7CA_ET- _SLJ$SDR'AE SE�VAG TAIi;TI' SYSTEM Owner _—J--T-Z, V C vk?-04 d-no Address t- fo2,_-MN 1�io G�w )2 f►--t> ,/e s- 64 Located at (Street) 09c , -}rva9 i1QtZ f-st Tax Map ..5-Z Block Z Lot /: (indicate nearest cross street) wn C o Pte` Municipality (-t) (v- nWAyvk . Drainage Basin PC-r— -5r-ILL SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test Bole No. Run No. Time Start - Stop Elappse Time (1lin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Dro In InZes Percolation Rate Nfin/Inch 1 2 3 .4 5 1 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately, equal percolation rates are obtained at each percolation test hole. (i.e. 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. 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.01 4.51 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.51 9.01 9.5' 10.01 TEST PIT DATA DESCRIPTION OF SOILS �O �ENCI RINTERED IN TEST HOLES HOLE NO.. oPSo ice. td AM F-601viv I At Ec HOLE NO. HOLE NO. Indicate level at which groundwater is encountered A/,,,v Indicate level at which mottling is observed NM7 Indicate level to which water level rises after being encountered /y/W Deep hole observations mad e$JV11V r1Ve-7kVrrX),AJ4 -Date I I,?, Ir, 11-1 Design Professional pa'--r- � JT A ,vt- tWw4:(,_f9, Address: Avo Ci:;_ IN Signature: Design Professional's Seal 2 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED. ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Proiect sponsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: Jane Morfock Well and SSTS Construction 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) South side of Oscawana Heights Road, approximately 1600 ft. west of the intersection with Wiccoppe Road 5. PROPOSED ACTION IS: ❑New ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and a water service connection for the construction of a single family house 7. AMOUNT OF LAND AFFECTED: Initially 20.6986 acres Ultimately 20.6986 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ■❑Yes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? QResidential ❑Industrial ❑Commercial ❑Agricultural ❑Park /Forest/Open space 00ther Describe: Surrounding lands are zoned singled family residential - 1.0:•DOF-S AC7-9PJ INVG VE- A•PERMIz•APPZOVAL-,,O- R-FUND -ING NIOW-OR °ULTiiVATELY "FRONT ANY 0THER7,3-o'VERrWiV NTAL AGENCY (FEDERAL, STATE OR LOCAL)? 0■ Yes ❑No If yes, list agency(s) name and permit/approvals Town of Putnam Valley- Building Permit, Putnam Co. Health Dept. - SS TS & Well Permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ❑■ No If yes, list agency(s) name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes NNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor na 7 e: Cronin En�i P. E. P. C. /Patrick Bell date: August 2. 2005 /neeriin�g Ol/ ✓vl / w' Signature: • If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER 1 PART II- ENVIRONMENTAL ASSESSMENT (To be completed A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR PART 617.4? if yes, coordinate the review process 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 may be superseded by another involved agency. Dyes ❑No CI C.I. IJGL` DAuirui�lf i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1L%tIT1AL'W- DIVWUAL /COMMERCkL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project (T)m u _ J y/ County ,Site Location: �SG�L �✓L"h ll3' Building construction begun f y Extent t Is property within NYC Watershed ? ................. Yes No SECTION :B. TOPOGRAPHY (Please check all appropriate boxes) 1. U - R`Jly- . 0 Rolling /[79--Steep slope ,Gentle slope a Flat, 2. hdence of wetlands a Low area subjitct to flooding Bodies of water. Eapraiaage ditches CM Rock outcrops 3. Property 'lines or comers evident ..... ............................... .................. Yes No 4. . 'Do water courses exist on or adjoin the property? ............................ ; Yes a No 5. Will these affect the design of the sewage system facilities ?............ Yes No 6. Do watershed regulations apply in this development ? ....................... =Yes No 7 Will extensive grading be necessary? ............................... ,................ Q Yes No 8. Will extensive fill be necessary. for SS'TS ?.................. o�. - - - -- - - -- - ...................... 9. Do filled areas exist within the SSTS area? ........ ................. ........ ...:.... =Yes . o If yes, what is the condition of the fill? • SECTION C. SOIL OBSERVATIONS 10. Appearance of soil:,(S�Sand Q Gravel "am a Clay =Hardpan Mixture 11. Observed- from: 0 Borings Q Bank cut Bac a excavations s/excavations observed g y 4 �rrrn� F on 12. Soil borbi b � ��� 13. Depth'to groundwater /V J on' .14. Depth to mottling on 15. Are test boles representative of primary &reserve areas..., ................................... No Yes 16... Soil percolation tests made by h a % on 17. Soil percolation tests witnessed by l� on . SECTION I) (on back) Form ST-1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes TN 19. Will groundwater or surface drainage require special consideiation? ...................... F-l"Yes 20. Will gullies, ditches, etc.-, be filled and watercourses be relocated? ............................ F7'Yes 15allo, SECTION E. REMARKS. 21. If a common water supply is proposed; has an inspection bee. e of the existing or proposed' source and facilities? ................... .......... Y6 =No 7411 Inspection data 22. Do adjacent wells and/or sewage systems exist? ............................................... ..... Yes No 23. Additional comments 24. - Site observer/inspector and title P kpoc 25. Date(s)-of observation(s)inspection(s) TEST PIT PROFILES -Hole #.L Lot # Hole# - 1ot# Depth'..to water- AJlk Depth to water A -6 t6 mottling mottling Depth to rock/imp. Depth to rock/imp. G.L. G.L. 1.0 2.0- Hole # '3 Lot # D . ep% to. water- AJ Depth to mottling AJ Depth to rock/imp. G.L. 0.5 0.5 1.0. 1.0 96 2.0 C 2'.0 S, 3.0* 3.Q 3.0 4.0- 3� 4.0 4.0- 5.0 S.O. 5-0 .6.9 6.1 60.0 .0 7.0 .0 .0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 #k 0 AUI BRUCE R. FOLEY _- .:.•::..Publ is -.,HeRlth,: l)dxecmr..�:_ •.::- rz -s -:_: - .,.._. _.:,;..:�r- ._,..:... LORETTA MOLINARI R.N., M.S.N. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REQUEST FOR FIELD TESTNG DoE ATTENTION: i G ❑ GENE REED All information below must be fullx completed prior to any scheduling. DATE: Z oS ENGINEER OR FIRM: ORW I N &N( ?lttiEE R /4 PHONE fur: ix -f4 `� REASON: DEEPS: t� PERCS: ❑ PUMP TEST: ❑ ROAD /STREET: Q5CAW,9P1 #4 &/F jj r j 2& o TO`VN: l� T'N A r✓! �/At t �''/ TAY �L�P #: S� . I SUBDIIJISION: /�/�f� r LOT 'M: AIM OWNER: TTL U CDRPoA A -9/1/ 1`ZYCDEP CRITERIA FOR JOINT REVIEW AND WlTNTSSiNG OF SOIL TESTING YES NO ❑ 13 / Proposed SSTS within the drainage basin of Nest Branch or Bo_yds Corner Resen-oirs. ❑ .- i� :. Proposed SSTS- within 500.._feet.of a- reserv�Qir-resi t r'oir sierra ar contrel -lake • Q-"' Proposed SSTS within 200 feet of a watercourse or a DEC wetland. • IV' Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. • is"" Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes. to any of the questions. NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: � TIME: CONIMENTS: 14 -- (FIELDTE:3T) I;QIiET'IA: A ©I- INARI- - ..<_,;.�. Puhlic 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 January 24, 2005 Cronin Engineering Mr. Keith- Staudohar The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re:. , Field Testing — TTLV Corp. Oscawana Heights Road; (T) Putnam Valley, T.M. #52 -2 -17 Dear Mr. Staudohar: 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. • The map provided does not meet the requirements to schedule field testing. All proposed lots, with driveway, house location, SSTS area, well location etc ... need to be shown. All points from the field testing, memo dated January 26, 2004, must also be provided. Field testing for the proposed subdivision will not be scheduled until all requirements are satisfied. 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, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cw 01 GRONIN ENGINEERING P.E. P.C. THE LINDY BUILDING, SUITE 200 2 JOHN WALSH BOULEVARD, PEEKSKILL_NY 10566 (PH) 914736 -3664 00 914736 -3693 M Joe Paravati Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 From: Maith Staudohar Res Adomo, TTLV Corp. at Oscawana ke Road, TTLV Corp. at Eastern Road, Town of Putnam Valley c= sent ovemight mail Date: January 19, 2005March 15, 2004 Adomo• Enclosed is. the request for pump test and the fire underWriters certificate. The request for final inspection will be faxed to you in the morning when Ken is back from vacation. TTLV Corp. Oscawana Lake Road: Enclosed is the request for field testing and a copy of the topographic map. The wetlands were . flagged by the Town Wetland Inspector and survey located. TTLV Corso. Eastem Road: — _. Enclosed is the request for field testing. I believe Kenny submitted the site plan previously. As discussed, we are meeting on Friday January 21 at 10:30 am. IGndiy review the information and plEsse call should you have any questions. Thanks. pcdtr-paravafi-adorrw 011805.doc • Page 1 of 2 DRAIN 4DERS %00' APPROXIMA TE L OCA 77C WA TER SERWCE TO RE VIL T SUBSURFACE SEWAGE TREA TMENT PLAN CONSTRUCTION PERMIT # PV -12 -05 . ..... .. _ .... - --- ' ...... M OF BDRMS ' GPDIBDRM iI 5 (MAX) 1 200 GPD PUTNAM COUNT SUBSURFACE SEWAGE TREATMENT SYSTEM DESIGN BASED ON A 5 BEDROOM RESIDENCE AND 1 TO 7 MINUTE PER INCH DROP SOIL AND CONSISTS OF A 1500 GALLON CONCRETE SEPTIC TANK. AND i y / 1 \ TO 7 MINUTES URVEYING, P.C., SATED THROUGH JUNE )F A PROTION OF THE: A COUNTY CLERICS SSTS SEPERATION DISTANCES DESCRIPTION A B C SEPTIC TANK CENTER 24.5' 27.0' JUNCTION BOX # 1 67.3'. 35.5' JUNCTION BOX #.2 71.0' 41.5' JUNCTION BOX # 3 75.0' 47.2' '- JUNCTION BOX # 4 79.4' 52.8' JUNCTION BOX # 5 i 83.8' 58.8' TRENCH 1 38.6' 79.5' 4. TRENCH 2 p. 45.0' 81.8' TRENCH 3 52.0' 85.8' t• TRENCH 4 58.6' 88.4' i . TRENCH 5 117.0' 51.0' i TRENCH 6 118.0'. 53.5' TRENCH 7 119.9' 57.0' . TRENCH 8 122.0' 61.0' TRENCH 9 125.7 66.1' A WELL SEPERATION DISTA' DESCRIPTION i 9< WELL