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Home My WebLink About2579DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -23 BOX 22 02579 .. a 1161 �. 1 r , 1 L 'T 1 L r 1 , 1� f j� '� ' alt- 02579 0 PUTNAM COUNTY DEPARTMENT OF HEALTH Vl-$ION,.OF-ENVIRONMENTAL,HEALTH.SERVI( ( .TE OF CONSTRUCTIO MPLIANCE OR SEWAGE TREATMENT SYSTEM 1UCTION PERMIT # �VV- Located at 0 `JC Av-ApJ A KCi GINS eon Town or Village A 4 1: L- f:-- Owner /Applicant Name �tR (A ac R P, LL, Tax Map Block 2 Lot Z 3 Formerly Subdivision Name C)Sc4v.qANA �Joc5 -r Subd. Lot # ok Mailing Address (a2 QSCAW kJ/-1 1- ru bfi_0 OctA � fV-,t-,AA V A(C f Zip Date Consb-uction Permit Issued by PCHD tyy A- Separate Sewerage 3 sv tem built by M�1�lify 1%�5 QUC � Address j2� I�D�Ir�� ST Consisting of 1250 Gallon Septic Tank and A 4 1: L- f:-- I4 e1SG)C_ f 7WAJ '-t-1 ,NC 1 V4 j-�,� -c . 7`�0�✓ (3G K S Other Requirements: Water Supply: Public Supply From Address or: K -Private Supply Drilled by J)OXm+fJ Auol - S0A) Address /SZ f9 A A&r,:_9 S7" 10 - - Building Type - -s Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? A/0 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 regulatio a Putn County Department of Health. Date: ( Z IT c 1 ° 4 Certified by P.E. R.A. (Design Professional) Address 103 {�Err�/ L`si2. )u%AI LCr fLD C'T C�(o77So License #� '� 3 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: Title: Date: o O Whi copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 I'll) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Lo &-ti on Sireet A dress: ow illa e:' Tax Grid # Map SZ Block z Lot(s) Well Owner: N e: Addre Use of Well: 1- primary 2- secondary Y Residential Pubig Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment k Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing _ Open hole in bedrock Other Casing Details Total length 6�40 ft. Length below grade 8, Iff." Diameter &I " in. Weight per foot /4/5 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded Z�,' Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: kYes No Liner _ Yes 7`No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Lompressed Air Hours Yield 5� gpm Depth Data Measure from land surface- static (specify ft) o During yield test(ft) - -�- Depth of completed well in feet 5 0 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface _W G 5'0 0 " If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type► apacity 5` Depth -AIV Model �S / Voltage 2 3O # HP Tank Type a� Z Volume l/8' Date Well Completed U Putnam County Certification No. Date of Report Well Driller (signature) Ntp E: t=ct tocatton or well wttn atstances to at least two permanent lanumarxs to be provtden on a separate sheetiplan. Well Driller's Name -- Signature: Address: /52- r //� Date: // 2 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 C BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278.6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: - &L) /cE e;zR i Y! �Gtri TAB: MAP NUMBER: i Z, - L — E91:1 ADDRESS : d4 L k TOWN: �v 7-W lf"t" l AUTHORIZED TOWN OFFICIAL: DATE: 1 9117 X 494 .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. (E911 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM &Lvx/ C6 ;&g - 2 - Z3 Owner or Purchaser of Building Tax Map Block Lot W/q/ lwyd a -& Building Constructed by Location - .Street 1 Z-:,5 / I & A V Building Type &77V4 Town/Village f�5c- A�- �I/� -n1 t/tl�F.OS Subdivision Name .4- 9 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and. hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. : Month _It, Day Z t Year SO GenerAContrac'tor (Ow"Aer) - Signature Corporation Name (if corporation) Address: 12 wt f VT- State p zip OSL 7 °/ Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 ` ` YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown ts Heigh N.Y. 10598 .�,� Albert H. Padovani, Director LAB #: 32.40:3090 CLIENT #: 58005 NON STAT PROC PAGE: l ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ HALL, MAURICE DATE/TIME TAKEN: 11/09/04 12:15P 62 OSCAWANNA HEIGHTS RD DATE/TIME REC'D: 11/09/04 12:45P PUTNAM VALLEY, NY 10579 REPORT DATE: 11/16/04 PHONE: (646)-234-2801 SAMPLING SITE: SAME ' SAMPLE TYPE..: POTABLE KITCHEN TAP_ �' �' _ .RESERVATIVES: NONE COL'D-BY: MAURICE HALL.. TEMPERATURE..: < 4C NOTES...: - COLIFORM METH: MF ' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ` PUTNAM CNTY PROFILE ' 11/09/04 MF T. COLIFORM ABSENT /100 ML ABSENT - 1008 11/09/04 LEAD' (IMS) <1 ppb 0-15 ppb 9101 11/09/04 NITRATE NITROG 1.38 MG /L 0 - 10 9139 11 /09 /04 NITRITE NITROG <0 MG/L' N/A 9l46 11/09104 IRON (F&)' - G L � ' 0-O.3 mg/} 2037 11/09/04 MANGANESE (Mn) 6" 8 M8/L 0-0.3 mg/1 2037 ' 11/09/04 SODIUM (Na)--' ' 4-69 MG/L N/A 11. /09/04 pH ` 6.5 UNITS 6.5-8,5 9043 11/09/04 HARDNESS,TOTAL 56.0 MG/_ N/A 11/09/04 ALKALINITY (AS G/L N/A _ 11/09/04 TURBIDITY (TUR TU 0-5 N T U COMMENTS: BACT' THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN��f8-�'HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p/ EPA Lead & Copper ' '`than 10% of their than 15 ppb and a treatment must be potential. -iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution poi'nts have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. ' Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium diet,the water should contain no more than 20 mg/' of'_Sodi ` r! or those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is . suggested. YML ENVIRONMENTAL SERVICES ;fir 1 Kear Street ( 914) b45-286 Albert H. Pacolani., Director LAB 0: 32.408090 CLIENT #i 58005 NON STAT PROC; PAGE: E NNNNNNN NNNNNNNNNN NNNNNNNNNN N NNIV- - ---- -- --- HALL, MAUR I CE: DATE /TIME TAKE Ni a 1.1: /09 /04 12 w 1.5 68 OSCAWANNA HEIGHTS RD DATE /TIME REC ' D ° 11/09/04 1 is 433 PUTNAM VALLEY; NY 10579 REPORT DATE: s 11/16/04 PHONE: v (646)-284-2801 SAMPLING SITE: SAME= SAMPLE TYPE .. 2 POTABLE. R KITCHEN TAP PRESERVATIVES: NONE:: COL' D BY.- MAUR I CE HALI... TEMP E RATURE , .:: <: 4C; NOTES ... a COL.. I FORM METH: MF IV NIV- ---NIV NiVNIVrvry NN NNNNry NIVry NNNIV NiV NiV IV IV lVN nIry IVNry NNrvIVrviVNry m—m NIVIVNNrviVrvn /NNNn - ---m-- -nine DATE: FLAB PROCEDURE RESULT NORMAL - RANGE METHOD 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 ME.TAL.. PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /I.... 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 c ABOVE: 300 MG /L. MODE:RAT RLY HARD WATER, r 70 -140 MG /I.... M.G /L - ; M :L LL -1 GI =tAM PER LITER FIARll WA1`ER � 14(y- 3(ata MC; %L (1 drain /gal fan - ill2 AW } SUBMITTED BY: Albert Hi Padovani., M.T. (ASCP) Director E::LAP# 10323 /ML ENVIRONMENTAL SERVICES 321 Kear Street -- Y�rktown Height N Y . - _ _ _ ~ Albert H. Padovani, Director LAB #: 1.500070 CLIENT #: 58005 NON STAT PROC PAGE: 1 HALL, MAURICE DATE/TIME TAKEN: 01/05/05 09,00 62 OSCAWANNA HEIGHTS RD DATE/TIME REC'D: 01/05/05 09:20 PUTNAM VALLEY, NY 10579 REPORT DATE: 01/06/05 PHONE: (646)-234-2801 SAMPLING SITE: SAME SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: MANNY VAZQUEZ TEMPERATURE—,_ . NOTES...: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 01/05/05 IRON (Fe) 0.131 MG/L 0-0.3 mg/L 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Director ELAP# 10323 .. _....1 , �',� ____ ice` /�5� j'�i�< J ��. cam, s �� ,a � i�ry �..5'�c.r�° s "� O JAIL -07-05 -FRI 0 :24 N -SAX: -PAGE I YML ENViROMMTAL SCEs 321 Keax Street YorktQwn Re fight , N..-V-. - 105,98. -t. ,_ _.. 014) 245 -280D Albert H. Padorrar;i, - Director l #; 1, 5t OD70 CULT 80,05 NM S'TAT PROC PAGE: ]. www ✓.,.wvr�rvw ..,y.n.,e.a. rr+YNwwww yti wwrw✓ yN.yy,+�.rariv.. ra. wwwwwµYMr ,,wwwrM-- -- MMwwwwwwnrw ✓ww ---- — HALL, W0RIfi;E DATE /TIME 'TAKEN: D- 1/05/05 09:00 -62 .0SCANANNA HEIC --HTS RD D&TE /TIME .REC I.D: - 01/05/D -5 -09,20 -PVIN M VALLRY> N`? 1,05 73 RE-PORT DATE: X01/0105 Pi ONR: 0540-234-28,01 -28fli SAMPLING' SITE: SAME SAMPLE TYPE..: POTABLE KITCHEN -TAP - PRESERVATIVES: NONE C-Z) D BY- MANVY VAZ1QUEZ TEMPERATURE . _ -COLIFORM -METH: -N/A hw Nwww Nv wwww .,ti.N.r .e a...s..nM.4+t.✓rv.-+r..www v.9F lVNH HTi JJ ii, k,1rwtiwww -------- ------------------------ DATE t-7AG PROCEDURE .RESULT .NORMAL - -RANGE - METHOD A1/05I.Q5 IRON dFe) 4.131 AdenYL 0 -0,3 mgyl 2.037 C014LVMMS : -Fe/Mn -If -both iron -and - marigan-ese are present, their total value combined shall not exceed -0.5 M-9/1. EURMITTV.1a BY-. - Albert H. Padovani, M,T, (ASCP) Director EZ+AF.# 1023 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 5, 2005 Steve Ferreira P.E. 103 Perry Dr. New Milford, CT 06776 Re: Construction Compliance - Hall 62 Oscawana Heights Rd (T) Putnam Valley, T.M. #52 -2 -23 Dear Mr. Ferreira: ROBERT J. BONDI County Executive 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. Iron is above the maximum contaminant level. 2.. The well needs to be located from two .fixed points. 3. Please provide a scale for the entire site portion of the plan. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, v� �G "Z oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cw PUTNAM COUNTY DEPARTMENT OF HEALTH / DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street - Location _ 0SC.* I I . own _��1,,�,, ✓� C��,c� TM# Sa - a -23 1. Sewage System Area Date: lc ok - Este Inspected by: 7-5 Owner /Vlcu.f Permit # - "7 - n Subdivision Lot 0scAw4-A4 u:rc.-,,s 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 ...... ............................... II. Sewaee System a. Septic tank size - 1,000 .......... 1, 250 .........other ................ b. ' Septic'tank installed level ................ ............................... C. 10' minimum from foundation ........:.....: ....................... d. Distribution Box �evafion-water �%� 1. All outlets at Tested ................. 2. P R Vielow frost ................:: ............................... mum 2 ft.Original soil between box & trenches e. Junction Box -properly set .......... ............................... 6. rZr encfiies 1. Length required � Length installed �l6� 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 he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Roora allowed for expansion, 100 % .................. .....:.. 8. Size of gravel 3/4 - 11/2" diameter clean .................:.. 9. Depth of gravel in trench 12" minimum .......:........... 10..Pipetgds s ca ed ....... .... ..................:............ : . g:... Pum or Doed Svsterns �j 1. Size of pump chamber ........ ...... ............................... 2. Overflow tank .......... ................. ............................... 3. Alarm, visual/ o ........:.......... . ............................... 4. Pump of ' accessible, manhole to grade ................. 5. elvrce ox baffled .......................... .....................:......... witnessed by H.D.estimated flow /cycle........... III. House/Builditig a. house located per approved plans ... ............................... b. Number of bedrooms ................. ............................... . IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured tmow ' - ft........... c. Casing. 18" above grade ................ .............:...............:. d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially baclfrlled ........... ............................... 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 waterco g. Footing; drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided .................. ............................... Rev. 12/02 trvcq . AT/Y /"�l11�TI�TT1►TT[� i Jed 1\ V %_ V1T11r1.L' 1\ 1 J ""w Zles D k' A A Ll orm _ jss `r Fill pa located er the approved plan ill Pad Length �D R / e /nth Pad Width RequiredWidth Fill Pad Depth r Required Depth � ' ran n e�� "Lw- -s 9 P Run -of -Bank Fill Quality (� Slope from Top to Toe /U,9:� Impervious Layer Installed A) Erosion Control Installed D `i Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable �� /C�� ? S` lam" £'- � G°'`` d `vv►,�2•c �`'✓ %'i�H ,.� . � t S !��-�. 2 12/09/2004 07:41 1026 7 PAGE 02/02 PUTNAM COUNTY DEPARTMENT OF BMALTH DIVISION of ENVIRONMENTAL HEALTH SERVICES �JOSEFH. .A� TENTION �GEr'E R,Ii VEST FOR EMA L. I N Sp1»CTION' For: till _ All iformation must be fully completed prior to any Trenches inspections being made. PC:HD Construction Permit # Located: (T) (V) VTw ✓� D'►v�nerlApplicant Name: IMAW.4. C_rf TM �,, Bloc)ti 2. Lot Formerly: Aw,ti Subdivision Name: Subdivision hot # Is system fill completed? 'k Date: 1114 r-- Is system complete? K ' Date: fi to o Is system constructed as per plans? Ms- Is well drilled? 3 _ Date: 9 a Is -well located as per plans? Lot: Air. erosion control mea='cs in place? _ I oertifj oWthe system(s), as'.listed, atthcabovc premiSeshns been co><astructed and I have inspected and vexifed their .completion in accotdarice .with the issued PCHD Construction Permit and approved plans and the Stasidaxds, Rules and Regulalions of. the Putnam. County Mpa=ent of Data: C6rtificd by: PE FA Design Frof ssional Form FM -99 DEC -9 -2004 THI I 0R: 4.7 TFI : R4S- ?7R -79 ?1 NAMF: PI ITNAM 0711 INTY nFPARTMENT nF P. 2 C NSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV U 3 Located at Q r9--r =ft He,) 1-,,i4 —Ij 0010 �. Subdivision name 0.5c. V A,4 hk- Subd. Lot # Date Subdivision Approved -I Owner /Applicant Name Mfiy,&1 cc Rau- Mailing Address -'Z�1 Amount of Fee EnclosedE i ►A k 0 Town or Village PV77V4-04 1// Tax Map Block - Lot Renewal Revision Date of Previous Approval Zip t �' ,-5 Building Type �S to - Lot Area i () '��-�'No. of Bedrooms -4- Design Flow GPD 5 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of [7- 5""cl gallon septic tank and 2-1 r Q F /+/�i/J %' �'�✓lV e^iC. i /�� r-� J'S �i k +� J` Other Requirements: j (LL. Pt" i 0'7 -W4t EQ To be constructed by VA S- 6)04--2- Address Water Supply: Public Supply From Address - '6W vor:-,-- -'Private Su PP 1 Drilled b Y £, a4K n-Al vo� -a Address /� r - S� � .. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments em 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 th`e owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. .l1 R.A. Date // 2 License # 02 � a3 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 't. Approved for discharge of domestic sanitary sewage only. By: 1// Title: g-P 9 Date: O W it opy - HD File; Yellow copy - Building nspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Of ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _I/�;.i /7 Address 0 s c,9 -uy4oA km gentD Located at (Street) Tax Map > Z Block 2 Lot (in ate nearest cr ss street) Municipality iv � ' s Watershed ,,, ►� 50 11 SOIL PERCOLATION TEST DATA Date of Pre - soaking i //� L �� Date of Percolation Test i �.? o'�' NOTES: 1. Tests to be repeated at same depth until approximately equal pe }colation 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 1L2 a 7 it 3 S 4 5 =21�� .2.s -- 4 5 1 2 3 4 5 FSSI P� NOTES: 1. Tests to be repeated at same depth until approximately equal pe }colation 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 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. DEPTH' :. :.:..; HOLE NO. HOLE NO: _ . _ HOLE NO. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' Q -- 5.0' 5.5' N rn`: 6.0' 6.5' a 7.0' 7.5' 8.0' 8.5' 9.0' . 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which. water .level rises after being encountered Deep hole observations.rrt�de °_rA, Design Professioi al:Nari e`: R ; Address: Signature: Design Prof'essional's Seal Date S)F Engineenig tirvices .. Stephen J.. Ferreira, P.E. .'..:.103 Perry Drive... .. .. _...._..._ __ .. .. . New Milford, Connecticut 06776 (860) 350-2499 November 24, 2004 Joe Paravati Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: SSDS Construction Permit Maurice Hall Sects B1k :Z Lot: 23 Oscawana Heghts Road Putnam Valley, NY Dear Mr. Paravati: Please find the three copies of the trench plans for the above mentioned project. The information enclosed is provided based on our recent conversations and our field inspections. Please feel free to contact me if there are any further questions or information required. p n lly Yours, t e Feu 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 November 5, 2004 Stephen J. Ferreira 103 Perry Dr. New Milford, CT 06776 ROBERT J. BONDI County Executive Re: Field Inspection — Hall Oscawana Heights Road, (T) Putnam Valley, TM # 52 -2 -23 Dear Mr. Ferreira: A site inspection was made for the.above referenced project on November 4, 2004. The following comments r? iust.be.corrected in the field: 1. It appears that the fill depth is short and that the fill over the SSTS area is not entirely run of bank fill. 2. The swale on the far side of the system needs to be shown on the trench plan. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, J eph S. Paravati, Jr. Assistant Public Health Engineer JSP:km 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 October 28, 2004 Steve Ferriera, PE 103 Perry Drive New Milford, Ct. 06776 Dear Mr. Ferriera: ROBERT J. BONDI County Executive Re:. Field Inspection — Hall Oscawana Heights Road, (T) Putnam Valley TM# 52 -2 -23 �,OA A site inspection was made for the above referenced project on October 28, 2004. The following comments must be corrected in the field. 64. It appears that the fill pad width is shorter than what was shown on the approved plan. Since the trenches are to be laid out diagonally in the fill pad, it is hard to make accurate measurements of the length and width. Please stake out the actual trench layout in the fill pad so that a better determination of the length and width can be made. The end and sides of the fill pad need to be completed (10 feet of fill pasta the trench ends including 2 feet of impervious material and impervious side slopes at 1 foot vertical to 3 feet horizontal. GV_ P-e &A=Il<<le.d -3-�/ There are some trees that need t o. The toe of slope needs to be 10 feet from all ledgerock. 5 Please provide deep holes in several 1pcations to confirm., depth of fill. �r � �%� � ►`i 4�1�k;,�I l�w�'�r°��,( �;,,�� ` 'L lee a S �.h y If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. S� r/-^ Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH _ INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE REkTMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: e`' STREET LOCATION: (i5«W6' REVIEWED.BY: RM, GR, SRDATE: f 0 3 TAX MAP #: (CONFmivm) Y /N DOCUMENTS ,,/( * . )PERMIT APPLICATION ( )I/ .)WELL PERMIT OR PWS LETTER PC 97 U _)LETTER OF AUTHORIZATION U—)DESIGN DATA SHEET (DDS) SHORTEAF (_}P LANS-THREE SETS (�L_JfiOUSE PLANS - TWO SETS U . VARIANCE REQUEST SUBDIVISION LVJZ LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED • � RATE _ �O _ i REQUIRED ? DEPTH TAIN DRAIN REQUIRED GENERAL UULOCATED IN NYC WA UUPLANS SUB 0 DEP ��/�' (_)( =)D TO PCHD EP APPROVAL, IF REQ'D (� EP TEST HOLES OBSERVED C_) PERCS TO BE WITNESSED U APPROVAL SSDS ADJ, LOTS (Z-)WETLANDS (TOWN/DEC PERMIT REQ'D ?) ((,)DATA ON DDS PLANS & PERMIT SAME CZCJPRE 1969 NEIGHBOR NOT.IFICATION_. (___)(_L:�200 YR. FLOOD'ELEVATION W/I 200' (_) OIL TESTING LOTS>10 YEARS OLD REQUIRED DETAILS ON PLANS ( l�_ _ )SEWAGE SYSTEM PLAN - (NORTH ARROW) ( 1F )SSDS HYDRAULIC PROFILE RAVTTY FLOW INSTRUCTION MOTES 1 -15 Z.SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED AY & SLOPES, CUT ING/GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES Y /1V (REQUIRED DETAILS ON PLANS CONT'D) (`' (__)SOUSE SEWER -1 /." FT 4 "0', TYPE PIPE CAST IRON s (��BEL S _M2CXBENWR 6 - -mC E g _=k e b �c3 r RENEWALS �,� -'� ,.' ,�4 ::�-= --$-•� ^SILL SYSTE1tiIS =s y,�,iy� Jore�s (�(_)TTTLE BLOCK; OWNERS NAME ADDRESS PE/RA; NAME, ADDRESS, PHONE# ✓ ATE OF DRAWING/REVISION LOCATION OF WATERCOURSES, PONDS �LAKES ,WETLANDS WITHIN 200' OF P.L. (�PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS , ( S�J or�r c�a; }(EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE WDUNTS: DL`t /QEft L+.n \nn ins ,nn Lam(` FILL PROFILE & DIMENSIONS ()FILL IN EXPANSION AREA FILL GREATER THAN2 FEET C CLAY BARRIER DFILL CERTIFICATION NOTE EPTH GAUGES (___)`L. ON PLAN FOR R.O B., UIJCLASSIFIED & IMPERVIOUS �- - . -_ (�? SEPARATION DISTANCE FROMTOE ORtSE // (�(_-_)LF TRENCH PROVIDED_ 60FT MAX. C ,LJPARALLEL'TO CONTOURS C_w_-) 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL (__)GEOTEXTILE COVER �_ =EPARATION DISTANCES ON PLAN - FROMISS S o F (." -1T 1117d1,`T!1 TJ L 71TliVl7 W A V T?A>Df L� tTDTi'Ti Q ![!ADS (1T. N . Lop! TO FOUNDATION WALLS 00' TO WELL, 200' IN DLOD,150' TQ PITS 00' TO STREAM, WATERCOURSE, LAKE (inc._ezpa.n).. �0' TO CATCH BASLN, 35' STORMDRAIN; PIPED WATER ,0' TO WATERLINE (pits -20') i0' INTERM rrENT DRAINAGE COURSE ;00' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS 10' MIN TO LEDGE QUTCROP SEPTIC'IiANK ZC_x0*'FROM FOUNDATION; 50' TO WELL WELL (� NSIONS TQROP -ERTY LES x` ' :CA�1TO..OF SERViCECT O (ZJC_)M[IN 15' TO PROPERTY LINE � � SLOPE Ul___,)S PE IN SSTS AREA I s (520%) L_t_ RADED TO 15 %, IF REQUIRED DOSEIFUMP S STEM f f� (�(>PUMP NOTES . / v�' " (— jL,JDOSE 75% OF PIPE OSE VOLUME NOTED (�UDETAIL FO CK.MAIN, (PIPE TYPE, ETC.) (--)(—)P D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM ]� CURTAIN D / UUSTANDPIPES, 5' BOTH SID AIL (_,(_J15' MIN to CDS ° , - 4 %,15'-3%,35'-1'/'6, 100 % -<I% (-_)L—)20' MIN t LSCHARGE/100' with 182 cons day discharge (� to NON - PERFORATED PIPE (Nact) r Stepl:ien J. Ferreira, P.E. _ 103 1?erry Drive _ _ _.�...._. New Milford, Connecticut 06776 (860) 350 -2499 Joseph Paravati Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: SSDS Construction Permit Sect: 5Z Blk:. Z Lot: 0 Oscawana Heights Road Putnam Valley, New York Dear Mr. Paravati: Please find enclosed: 1 2. 3. 4... 6. 7. 8. 9. 10. 11. N, deaf M r3 E 2� Zoo Z (1) Plot plan, (1) seperate sewage disposal system plan and (3) copies of fill pad plans. Two sets of Modular Home plans. Construction permit application. -Letter of Authorization. = Application for approval of plans. Application to construct a water well with source contamination map. Soil Data Sheet. Short environmental assessment form. Property Survey. $300.00 Certified Check. List of property owners notified in accordance with the required neighbor notification. The information enclosed is provided based on our field inspections. Please feel free to contact me if there are any further questions or information required. Sincerely Yours, Stephen J. Ferreira FROM :WFENGINEERING FAX NO. :860 -350 -2499 Oct. 18 2002 07:09PM P3 PUTNAM COUNTY DEPARTMENT OF HEALTH DWISION OF ENVIRONMENTAL HEALTH SERVICES LETT R 07 AUTHORIZATION RE: ' Property of N o m e A) ri P k Located at T/V gee i% Tax Map # Block Lot Subdivision of okr ✓Au * G✓deloS`! Subdivision Lot # q Filed Map # Iz y6 Date Filed 11817 Gentlemen: This letter is to authorize a duly licensed Professional Engineer W _ 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 mfr behalf in connection with this mattex aced to supervise the construction of said wastewater treament and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: ry /Signed: P.E., R.A., # (owner of Property) Mailing Address 163 moiling Address: State Zip d%77& /State Telephone: Telephone 9- 54r,// j V.34 Form LA-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DI'V'ISION OF ENVIRONMENTAL HEALTH SERVICES 'APPLICATION- FOR AiPkROVAI; OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 44111 cle 11411L 2. Name of project: O4-i -t- 3. Location TN: PV W.4W. 4 t1,4LaJ 4. Design Professional: STe -PI4eJ FLEA -614 5. Address: 1P3 rA54e`l Die 6. Drainage Basin: q vp s`0 ry 2yQ P— C j o ( '7'7 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A10 10. Has DEIS been completed and found acceptable by Lead Agency? ............... cvw 11. Name of Lead Agency =- 12:. I$.this:.project man area :under the:control of- ioeal- planning, z6hing,'dr other - officials:, ordinances? ......................................................... ............................... IIVv 13. If so, have plans been submitted to such authorities? ........................................ - 14. Has preliminary approval been granted by such authorities? Date granted: . 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .......... ..... ....... J. 17. Waters :index number (surface) ................................:.......... ........:...............:....:. 18. Is project located near a public water supply system? ....... ............................... o • 19. If yes, ;name of water supply — Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system -- Distance to sewage system -- 22. Date test holes observed � & 0 -Ii 23. Name of Health Inspector Tf f- P "A Vf+: i 24. Project design flow (gallons per day) Hco 25. Is State; Pollutant Discharge Elimination System (SPDES) Permit required ?.:. AAD 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? 4,0 28. Wetlands ID Number ...................... ............................... -- _ Is Wetlands Permif required? Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes 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? ............................... Yeso,. , DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ........................... ..... 35. Are any sewage treatment areas in excess of 13% slope? ............. 36. Tax Iviap ID Number ......................................................... Map Sz Block 2 Lot Z 3 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: epaitrnent, and need riot be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the-watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed, by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 1 hereby affirm, 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 10.45 of the ,Penal aw. SIGNATURES & OFFICUL TITLES. Z7 6S sCll I 1 330 ZO Mailing Address: .......................... �,,:�'`' , %4)` j,' < fL. ., C77 7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM 4 20 w S7 7-18M Owner, �1119101' 1,441— Address eAK Located at (Street) Tax Map Block 2- Lot '23 (indicate nearest cross street) oe Watershed 4/'4v_r"a 121V-61Z Municipality. mr—AI19�oi 4�* SOIL PERCOLATION TEST DATA Date of Pre-soaking z2- Date of Percolation Test S: ........... X ....... U 'A .. Start .. . . ... ... ..... . T ....... Stait. ifi. ... ............ .............. % p.51 216 . ...... ........ 2 3 .......... z 4 n' 75 5 2 1 !qv— 27 A 9' 3 4 5 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 I min for 1-30 min/inch, -.q 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 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES DEPTH HOLE NO. HOLE NO. 2- HOLE NO G.L. —rcve So Lc- 0.5' 1.0'. 1.5' 2.0'owlRJ 2.5' 1.oA 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' 9.5' 10.0' —roe S o L t. -rte Sot (� Indicate level at which groundwater is encountered 'OV0 �� Indicate level at which mottling is observed /yoIf- Indicate level to which water level rises after being encountered �ca� Deep hole observations made by: Date na- Design Professional Name: Srg r4 Address: /o3 t- c egg bet! r/,c Signature: Design Professional's Seal �Ld.joining Owner Notification: Date: 12/4/02 yyo i i 2 14.25 AC. CAL. J f 34.38 AC. CAI 1 412 =w 1740'23 so �sasa 9 w 7 1 •s a try r� x �w 287 . . P. yE�G y S� ROc2 ' 2`4rry °oo ,�26 ° �1e ".�` 32 tV Nw v 70.2 , ?i4 3.00 AG _ .2 A x'1820 28 '� 1ytA a _ 4 m °'9S °120, .,. .2 � �, �1 -- ,� a44 - _ . - - ia� - `` 27 _x:66 . - -'` ®R ,r 2 1 • AC. '8 AC. 2.8 0 S �c}� a 2.11 s' g" 2.03 AC Zoo. '! °`c� - ° ` AC. 6 e 2.27 8 > � zoo A� oil 240fs) tae o AC. �t o z •.711 { A7 up 22282 2 .� g 43 b etors 1 � �a • Oq'NN. � �A 30.71 AC. CAL. b f 1^ ate^ 21.2 A I..- j0if°) b a� 8.86 AC. o' 21.1 �9 � oti1 '' /• bg1 cA o�Q e,,,,2 . t d e�' 25.85 AC. a 117 09.14 ties' '�$ 20 'fit 403.88 wN Q P/O 62 -1 -3 3.2 I, --- - - 6.61 AC. P/0 6: _ ------ - - - - -- E678000 \ \I 'U S..Postal Service 10 Certified Fee O O CERTIFIED MAIILT,., RECEIPT (Endorsement Required) O Restricted Delivery Fee rl (Endorsement Required) rl (Domestic Mail Only; No Insurance Coverage Provide] d)-: provided) Return Recle p t Fee (Endorsement Required) r(Do5mestic ru Total Postage & Fees $ Fgr delLVgf)r Information vlsitoyr;websl_te �t wyyw,up nt To M t f ---- _ i1 pE IVo RECEIPT ru Total Postage & Fees $ M Certified Fee C31 Certified Fee O O Return Reciept Fee O (Endorsement Required) O Restricted Delivery Fee rl (Endorsement Required) rl (Endorsement Required) (1J Total Postage & Fees g He?' \ `ii'Fl.` 4 -12' ,•i V71 .O . M p x x NJ P5 Form 3800, June 2002 See Reverse for'Instructions. U.S. Postal ServiceTM r CERTIFIED MAILT. RECEIPT j(Domestic Mail Only, No Insurance Coverage Provided) .!1 cc Su li. a vn_ .. �I Ln Postage M 0 Certified Fee C3 O Return Reciept Fee Return Reciept Fee (Endorsement Required) O Restricted Delivery Fee r q (Endorsement Required) Restricted Delivery Fee M ru Total Postage & Fees 11.1 M Sent o __ [`- WMe4 APL 0., or PO Box No. 114 o > C AT, - PoslrnarK 7 m C� c0 Ln Postage 1 $ M 0 Certified Fee 0 O C3 Return Reciept Fee (Endorsement Required) 0 (Endorsement Required) rl O Restricted Delivery Fee M rl (Endorsement Required) Return Recle p t Fee (Endorsement Required) r(Do5mestic ru Total Postage & Fees $ ru ':! Q nt To M t f ---- _ i1 pE IVo -C,-77 LIN7,1 i. t:Ii; I. 'PostmZ._ nr' r Here �- 'r i^ orPO Box No. ' 7d Flo Y' y1G%'�%f = t—AWI A/X/, M . I M cc � I Ln Postage 1 $ M C3 Certified Fee 0 Return Reciept Fee —� (Endorsement Required) 0 Restricted Delivery Fee rl (Endorsement Required) ' ' : ; ,•, M f1J Total Postage & Fees w1PO =or PS Form 3800, June 2002 See Reverse for Instructions Cal —� . . ; :, �r 1 Here Postage , $ %. ; r w1PO =or PS Form 3800, June 2002 See Reverse for Instructions Cal . . ; :, Ln Postage , $ %. ; r ' ' : ; ,•, M Certified Fee ,ti 1 Return Recle p t Fee (Endorsement Required) r(Do5mestic Postal ServiceTM Restricted Delivery Fee ':! ri Endorsement Required) RTIFIED � MAILT. RECEIPT ru Total Postage & Fees $ 11.1 C3 C3 Sent To �` Mail Only; No Insurance -!o.,.,_ City, State, ZIP+4 ME I Ye ti>L 7'r✓w'✓ �i� Coverage Provided) Cal . . ; :, Ln Postage , $ %. ; r ' ' : ; ,•, M Certified Fee ,ti 1 Return Recle p t Fee (Endorsement Required) .. ,�;; , ",: ,Here 1 :'• . M Restricted Delivery Fee ':! ri Endorsement Required) � t ru Total Postage & Fees $ 11.1 C3 C3 Sent To �` 3`freet, hpE' N•' o: j _________________________ _ _ ____ 4 _____•-•- or PO No /s ox 212 •- ......___._._.._.._..._..... -!o.,.,_ City, State, ZIP+4 ME I Ye ti>L 7'r✓w'✓ �i� /�- lul o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f V _ j - 03 Located at 0�CAWA-rJA- t4e4&l -CM P—OACD Subdivision. name W_S' Subd. Lot # Town or VillageicfAM Tax Map 5�-- Block Z Lot 0.k Date Subdivision Approved 4-15---07 0% Renewal Revision Owner /Applicant Name Mtn U (L1GI�-7 14,4 I-. Date of Previous Approval Mailing Address �r� e� �S 216` s "7 -�T dV'Ew Yew N f Zip 1603 Amount of ]Fee Enclosed 10 Building Type Lot Area 10' No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth 1=r Volume 0- PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 790 gallon septic tank and q q `-P >'�.. ->'- OF7 Other Requirements: . f� O 0' &L To be constructed by Address Water Sup 1: Public Supply From _. ... Address e /u ewn-�' N o a-6J- A dress.. or: _ Pnvate Supply Drilled by° 1� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate s iee treatment system described above will be constructed as shown on the approved amendment thereto and in accordance vvith 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 guilder 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. X- R.A. Date /z1/X1/-1'0z- Address _ /p:? C7- C *776 License # C76 �3 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 neAcopy :. Approved for discharge of domestic sanitary sewage only. By; ;L Title: el-r Date: a .1 y o HD File; Yello w copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES T Q CONSTRUCT A WATER WEL_L.. _" please print or type' _.. ,..� .,.«....� _ .. _..._,. - PCHD Permit Well Location: Street Address: Town/Village Tax Grid # • QS,g-W/l / /%/4VO 4 ax�� 1 /,-n • Map ,SZ Block Z-- Lot(s) 22 Well Owner: Name: Address: 5'�?V wES'T' Z 1 ,;,M S-1' MA-041 fo rcle, Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served 4 Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling . New Supply (new dwelling) Deepen Existing Well Detailed Reason S'1,�(sc. lc;gm I Hcwc 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. F Water Well Contractor: 1014 -AJ1b00fRJeA1 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village - Distance to property from nearest water main: �-- Proposed well location & sources of contamination o be provided on separate sheet/plan. l _ - Date:.::._ _�' a7- _ _ Appliirabt 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. A Date of Issue o ' Permit Iss •ng Official: Date of Expiration o Title: Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 le DINING ROOM 9'- 8" x 113' -0" LIVINI 15' -5 ": KITCHEN 1,1'-I"x 11'-0" BROCKTON I FOYER lll�,]P,Ampwr AILEA i3'-0" R.1111) ito()NI /,// 1, - o" x FAWLY BOORI 18' -5 "x 17' -5" I.p.IRSrr FLOOR q7'-0"'x 48'-0" 4BIt. 120' Sq. lPt,. �T .,PUTNAM COUNTY DEIART,',112' OF HEALTI-i HOUSE T-f-•ANS APPROVIED F0.2 BED1111130M CIOUNT ONLY, T -,;23 ALL SUB51,01IT'll—" yr JONS RESE HOUSE TO Tl PL-&m Phu ST EEP SUBI:1*11'1"1'E!D TO PCDOH FOR APPROVA-L Z�e 0 G'N-9T!fPfE & TITLE -74 Oil , 1 Dr4l. I BROCKTON SECOND FLpOn I 27' - 6" x 48' - 0" 41311, 1320 Sq. Ft. i PROJECT I.D. NUMBER 617.20 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 Proreet Sponsor)- 1. APPLICANT (SPONSOR 2. PROJECT NAME hVt 3. PROJECT LOCATION: Municipality hj/f'l / Count 4. PRECISE LOCATION (Street address and road inters%tions, prominent landmarks, etc., or provide map) OSc�i�vflti�9 her i3 l��o_'� �va,��i1 S�D,E� T9AS7 PR's T.. 5. IS P POSED ACTION: ew ❑ Expansion ❑ Modification /alteratlon 6. DESCRIBE PROJECT BRIEFLY: $i�t/Gc,� ,��i -tif/L� �'- d'l��Il� .�'aoj vl�v!9L �•�- tEL-t` l),-s j2o s ff s� .r 7. AMOUNT OF LAND AFFECTED: r ' Zr J Initially acres Ultimately acres S. V(YP l ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? S ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? KJ Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesUOpen space ❑ Other Oesuibe: 10. DOES.ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAQ? imYes ❑ No If yes,-list agency(s) and permit /approvals .- _ i3W4bui; for_4 '<<!� �osS1QU9 U_V_7' +V 114r_�11`' c 11. DOES ANY AUCT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes I No I CERTIFY THAT THE INFORMATI N PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name: , Date: (( �� P — �%rFiYo • Cf� '_'" '" � Signature: - " If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A DOES ACTION EX ED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? It yes, coordinate the review process and use the FULL EAF. 1:1 Yes No B. WILL ACTIO RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative •declaratIon may be supersedeoy another involved agency. ❑ Yes 49wo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels; existing traffic patterns, solid waste production or disposal, potential for /erosion, drainage or flooding problems? Explain briefly: � V,9 C2. Aesthetic agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 1P y)4— C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: /q/0 C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. A/10 ilt C6. Long term, short term, cumulative, or other effects not identified in C1•C5? Explain briefly. C7. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes o E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes 10 If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probablllty of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been ideniffied and adequately addressed. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. , . Check this box if you have determined, based on the information and analysis.above and any supporting documentatlon, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide ort attachments as necessary, the reasons supporting this determination: S Name or Lead Agency �SsrS� -h� Name eT sponsi�icer in Wd Agency Title of Responsible Otlicer - r.er m le Agenry 5 RV o p r rent from responsible officer °-- to an'1��144 i [• '.i °: T it'i..d UCB R FOLEY V Hi!alth Dowtcv DEPAR-TNHNT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLD AIU XN., M.S.N. .4seaclate Public Heaft D1regWr Dbwtw Q(PadrW Servkm Eavlroamental Health (845)378;,6130 Fux (845) 279.7921 Narslog Swvkas {845) Z78 - 6558 WIC(845)279-6679 I'ax.(845)278.6085 Early col (845) - 60114 Vax (MS) 278 - fiM48 a Jaau,aty 16, 2003 �` D �Cep#�ett J. P'a,1'B 103 Perry Drive Nzmf ivlii8 I %.L. E1b'176 Re: Proposed SSTS - Hall Q=WA%W IIdghW R04 .M Putm m'V'alley TM# 52 -2 -23 Des:( Mr. Ferreira: This office has =t ivcd. and rovinw(W the fmosl recent sat of p"- far tha above; mentioned praject. We would like to offcr*v following comments foryotiur review tend oansideration. /A. Vill .'i)esi¢R 1. The top of the fill pad needs to be 10 feet past the start and end of all trenches before regrading at 1:3 to ws 2. The toe of fill needs to be 10 feet off the property line and 10 feet off the driveway. The dill notes par Appundiu c in Bulletin ST 19 neul to be provided.. _ B. OV mill Maiin A datum reference needs to be provided. f .2. The label for the 4 inch cast iron pipe needs to nnclnde "(c7�. 2% minimum or 1 /4" per foot" in the plan view. ✓/ The tniidinum d stanarbutrweun trmdies is 6 focC on air. ✓ 4. There appear to be two 45" bends in the pipe between the septic tank and the &rst luntctioa box. If this is the case, :CIMOUts Med to .be. provided at each bead and,& ckAnout detail should be added to the.plan. f5. The well needs at least one dimension to a property line. The water . service. connectim imds to be shown. ,/ A second set of floor plans needs to be provided. ✓F) Please contho me con=ning bedroom► (cunt. ILere is a_ possibility. that the floor plans as shown contains 5 bedroo r (L 4 N S Tins offlou will continue its review upon consideration of the above mentioud conimemCS. Please feel free to contact me at cad. .2157 if any .questionearise. �Vr^4 D f fbi F,4J. "k) ��. ln/w•� r�i ur S 1�,� ✓Ld � 3 vtzy U-dy yc;=, slrl $f 3., PA. A,66 Joseph S. paravati, Jr. Assistant Public 1;Iealth Engimvr JSP: cj A60,Fi;;., h�.�, �, "• iu l� q,,r �� s�.�,�aL �1 ,,,/ r yW �Jll.•'l �WJ�L`S ,rv"''f (1�. , Wre VI/ 11M lJ�ja a' Z ZiZ :d 6 T0£LbT6T6;01 T26L- 8L2-Sb8 i8bc[34 AlNnoo WtlNind :wo8-i 9T :9T 2002- 6T -Ndf SENDING CONFUNTION DATE : JAN -19 -2003 SUN 16:17 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE : 919147341029 PAGES : 2/2 START TIME : JAN -19 16:15 ELAPSED TIME : 0013911 MODE : ECM RESULTS : OK - sa aopyo.epp magnoa amid `afilo3W uoAdaaa!Mo! 1 palanbaa n paipsu v puodaa smW -- (pow ao— 9olpupqD -c . .09pd '011 6r 07 -K� h -) `o=ut .a800aoYlT /WOE paamaafp ov sv(saa mob rog aopefwojm mod aqd V MBJO wwwdaa A-03 —'Rua •�r.LLwvrrxd 'S 'f asoS :100,53 VV-. .a :qt • awa•aitfilU bl amgamfcW ro�wya na -att foal mn�vn N4 • feos ;au (sw)ve ae»•a�fseal aad afsY•au(iW a+w+�f abMq i fmc•aut aD�r Kfi -aut<W m� � Wsol 40A obi 'ZowaH• PM RWPD t i bIrmaR d0 .LN8NLLwaaa ""s P-pvr p + 0-w �'w "M NK-d ate• ' -4-ttl ww MR;v '[11D'Y1 •!L8 T1N6II'I4K tl.1.fi1H07 .l3IO.i 11 9'.lAll9 ' 1 BRUCE R. '.FOLEY LORETTA MOLINARI R.N., M.S.N. - "x Associate PuGlfe - Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road • Brewster, New York 10509 Environmental Health (845) 278.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 • Fax (845) 278.6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6649 Date: ' 17ji%3 tt , To- _ S +e.0Lyi T, krre,it'e4 . -9Y J6• From: :7"oseph ' S. Po zaia:�* -Tr. Putnam County Department of Health _..For your information For your review As discussed Notes,Messages Fax #: l 9l q- 73N -to aq No. Pages (Including cover sheet) . N Please respond ` Attached as requested Please call In the event of transmission/reception difficulties, please contact this office at (845):Z78-6130 ext.- 61157 BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278: 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 January 16, 2003 Stephen T Ferreira, PE 103 Perry Drive New Milford, Ct. 06776 Re: Proposed SSTS - Hall Oscawana Heights Road, (1) Putnam Valley TM# 52 -2 -23 Dear Mr. Ferreira: 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. A. Fill Design 1. The top of the fill pad needs to be 10 feet past the start and end of all trenches before regrading at 1:3 takes place. 2. The toe of fill needs to be 10 feet off the property line and 10 feet offthe.driveway. 3. The fill notes per Appendix c in Bulletin ST -19 need to be provided. B'. Overall Design 1. A datum reference needs to be provided. 2. The label for the 4 inch cast iron pipe needs to include "@ 2% minimum or 1/4" per foot" in the plan view. 3. The minimum distance betrween trenches is 6 feet on center. 4. There appear to be two 45° bends in the pipe between the septic tank and the first junction box. If this is the case, cleanouts need to be provided at each bend and a cleanout detail should be added to the plan. 5. The well needs at least one dimension to a property line. 6. The water service connection needs to be shown. 7. A second set of floor plans needs to be provided. 8. Please contact me concerning bedroom count. There is a possibility that the floor plans as shown contains 5 bedrooms. 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:cj 10/21/2004 11:06 1026 PAGE 01/01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRON1V>CI;NTA L HEALTH SERVICES A-rrE NTI ON kJOSEPH F-E GENE REQUEST FOR FINAL WSPECM for: kill All izdormation must be fully completed prior: to any Tregches impections being made. PCHD Construction Permit 4 Located: 0G t_ CT) ( Pi9lN -c �i/�LL Owner /Applicaat Nan oe: WI _ -.CM _ Block -Z- Lott �3 Formerly. ^ ,%A. "Itua Subdivision Name: Subdivision Lot 9 1 Is systm fill completed? SAS bate: %y Is system complete? Date: Is system constructed as per plans? Is well drilled? Y165 Date: Is well located as per plans? Y's Are erosion. w trot vacasures in place? I ccsrrify that the syste (s), ms listed at the above premises has beezt constt'ucted and I have inspected art.d veri.hed their completion in accotdance with the issued PCHD Construction Permit and approved plans and the- Standards, .Rules and Regulations of the Putnam County Department of Health. i h Date: l0/p, PA Certified by: -�- _ PE � RA Resign P fessional Address: 4 W- c�..� 047z,6 Lie. # CJ %% Comments: a For -i FIR -99 BERUNNllu' UT, riz No. 40507,;; CONK. Reg. No. 8000 6 N.Y. 10541 AF,,�A - io.�58 Aces 4.94 30 i 0 i AS- B UAL T PLAN GRAPHIC SCALE 60 120 15 30 I I 8 19 N 0 O M C N ti O P MM� "1 Ft N LOCATIONS A- B 1 40 67 2 72r W-911 3 74' -5" 99 4 74► 98' -6" 5 751-4" j 941 6 76-61' 93f-3" 7 78-- 92-4 8 81f i-9" 903r -6" 9 851 95' 10 881-611 96 O'DAMLITO QOATV 120 ( IN FEET ) I inch = 30 fL MR. ------T-O--f LOCATIONS A B 11 117 1461-611 12 116' 143f 13 115f-6" 140'-611 14 116' 1381-911 15 117-3" 137-6 It 16 118 136f-9 If -tl 7 1211 138' 18 124' 1391 127" 14067- PREP 1.