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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 52. -2 -28 BOX 22 02583 r no ,� ���.�� ' r- 16 02583 PUTNAM COUNTY DEPARTMENT OF HEALTH .:.:- ���D€VdSIO�T QF-£N`�R�NME�V�=�i-I14LT� SERVIC�S:- .:.._ CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S MENT SYSTEM PCHD CONSTRUCTION PERMIT # P V- 9 - `1 82 Located at oScAUANA HEM GH TJ' R bAD Co;�or Village 'Pu ?r►Arn VAI-LLr 7 wne Applicant Name:'J4 c o u6 t i iJ e L; d r- i F1.0 Tax Map 52 Block 2 Lot 2 8 Formerly Subdivision Name oS c AW n N A W abo s Subd. Lot # Mailing Address 2S E VE R G 12Ce,'J R0. F u 1 NA rl 11K► t C C Y- /0, Y Zip 16.S- 7 Date Construction Permit Issued by PCHD 1hA 25 1119 / q cHES'T� A Pz- 19 c C' Separate Sewerage System built by vT.JA rvi Coo T-Ra c Ti ijC Address 44eC 44e PEA K,rWI L z, /J' Y. /off Consisting of ) 2 Sa Gallon Septic Tank and T - if id ,O�`/�Fa /2 ?�o /OV c 14711,06 1/J 1q -' 4-glg ✓C L TRcp c- -j Other Requirements: Water Supply: Public Supply From Address 4 0ouTNAn, Av�NV� or: ✓ Private Supply Drilled by r HEAL 1� 40r3.l hl-) C. Address STEWSrCR, P, Y . F3uilding Type S` i �i 6 �� Fia r'? i Y iL� -.r 4 Has erosion control been completed Number of Bedrooms T Has I certify that the system(s), as listed, serving the built plans (copies of which are attached) in acm plans and the standards, rules and regula ' 6n 9� Date: / t ?- 7 - 00 Certified by Address installed? /J 6 ted essentially as shown on the as- Construction Permit and approved .nt of Health. f\f' P.E. R.A. License # 06 iiy 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 odi tion o ecessary. By. Title: Date: f 3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 NE %N Acc090 it M NORTHEAST LABORATORY OF DANBURY LASS 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 a 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: MS. JACQUELINE LYNFIELD DATE SAMPLE COLLECTED: 9/13/2000 & 6/1/2001 25 EVERGREEN ROAD TIME COLLECTED: 4:30 P.M. & 3:00 P.M. PUTNAM VALLEY, N.Y. 10579 COLLECTED BY: J. LYNFIELD DATE RECEIVED @ LAB: 9/14/2000 & 6/1/2001 TESTED BY: LAB #11471 LAB 1D.# NY -158 & NY -56 REPORT DATE: 6/4/2001 SAMPLE SITE: 82.OSCAWANAHEIG11TS-ROAD, PUTNAM VALLEY, N.Y. SAMPLE POINT: SPIGOT AT IN-HOUSE TANK & KITCHEN SINK SOURCE: WELL TREATMENT: NONE MAXEM M CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 Ind SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent }6 /1/2001 0 - EPA 110:2 15 Odor ND _ _ : 3 Units .. • pH 7.18 - EPA 150.1 No designated limits • Turbidity- 6/1/2001 0.53 NTUs EPA 180.1 5 NTUs CHEMISTRY: . • - Nitrite Nitrogen 0.028 mg/L as N EPA 354.1 1.0 mg/L :. • Nitrate Nitrogen - 0,23 mg/L as N „ _. ': _ SM 4500D' 10'm • Alkalinity 104.0 mg/L SM 2320B No defined limits • Hardness 74.0 mg/L EPA 130.2 No defined limits • Iron- 6/1/2001 0.062 mg/L EPA 236.1 0.30 mg/L • Manganese 0.193 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 18.9 mg/L - EPA 273.1 20.0 mg/L** • Lead <0.901 mg/L. EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level . "Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 9/14/2000 & 6/1/2001 Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 -654 -1230 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _... - - - _ _..... ... . - - - - _ _WELL COMPLETION.REP Well Location Street Address: 82 0scawana Heights Road Town/Village: Putnam Valley Tax Grid # Map 52 Block 2 Lot(s) 28 Well Owner: Name: Address: Putnam Docks Inc., 25 Evergreen Road, Putnam Valley, NY 10579 Use of Well: 1- primary 27secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade 41 ft. Diameter - 6 in. Weight per foot 119 lb /ft. Materials: X Steel Plastic Other Joints: - _ Welded X Threaded _ Other Seal: X 'Cement grout . Bentonite Other Dfive shoe: X Yes No .. L'iner: -Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface - static (specify ft) 20' During yield test(ft) 465' Depth of completed well in feet 505' Well Log If more detailed information descriptions or sieve anal" analyses Y are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 15 Drillinc in overpurden 15 H' , 15 42 - Drilling in`rock se 42 505 Drillinc in rock aranite �j��c:rrtzz: If yield was tested at different depths during drilling, list: Feet Gallons Per Minute ump /Storage Tank Information Pump Type,` '''Capacity I s KljjU 10 Depth '2 Model (�` -S' Voltage 'Z add HP Tank Type' & *r V e5 AA PA t weik Date Well Completed 12/9/99 Putnam County Certification No. 002 Date of Report. 5/30/01 AlcoLu T. Beal Jr. NOTE: Exact location of well wim aistances to at Least two permanent ianumarxs w vc P1 VV Uu a boYai aWr 0IMVL /PIMA. Well Driller's Na Address: 4 Putnarmke Bamu tz, NY 111x A Signature: l_ Date: 5/30/01 Ma colm T. Be 1, Jr. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 I a� � DIVISION OFINVIRONMENTAL HEAL'T'H SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM WY?%J1'iELa / S Prf ?-o Owner or Purchaser of Building Tax ift Block Lot PoTNpcM DbGI-- S LN Gf Building Constructed by � -- Location - Street V4 o o D f * t4& lie- f-7PCri i U-f Building Type -- Town/Village bSc�v�. n1� WOODS, Subdivision Name ,1; Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, constmetion 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 Deparhtent of Heald 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 rate erly is cau prop redley. the #ll i or_negli ent act, of the pccupant of the building till ng the system. The undersigned ftuther 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. Irk' R Signature: 1J��� - Contractor (Owner) - Signature P LATtJ Acr't u o Gk- 5 1 N C, , ?LATPAIA C©07i?- #,-c -r Corporation Name (if corporation) Corporation Name (if corporation) Address; 'Z W 01-6- ye- 'e-�tJ (z-t� Address- 101 C. H e -> M f- P L— State ?V7 tiA-t,N VAc.LIe'*-f 1J j Zip I'O5--+n . State L - .F eG,-'S L1 LL _Zip I d Form GS -97 82 Oscawana Heights Road M Putnam Valley, New York 10579 Tel 845 528 0068 / Fax 845 528 2010 Memo . L J TO: Putnam County Dept. of Environmental Health Attention: Adam Steibeling From: Jacqueline Lynfield Architect BY HAND Date: 06/11/01 Subject: Certificate of Construction Compliance TM# 52.-2-28 Re: 82 Oscawana Heights Road, Putnam Valley In response to your letter dated May 22 to Tim Cronin's office, please find attached the following: GS -97: Three (3) copies of Guarantee of Subsurface Sewage Treatment System signed in the appropriate places by the appropriate people. The new water test -date 6/1 /01- original enclosed WC -97: The revised well report — dated 5/30/01 - with the data on pump filled out; white, yellow and pink form copies attached. In an effort to expedite this final review process, I am hand delivering these. Ken Murphy will hand- deliver the drawing to you tomorrow._ This should satisfy your requirements of your letter dated May - 22-for. We"wouid greatly appreciate an expeditious- response: Please remember to return a copy of the water test. Thank you for your assistance in this matter. 0 1 *40 " 'MW /01 " q • Page 1 FrM JACQUELINE LYNFIELD ARCHITECTS FAX NO_: 8455282010 Mg. 30 2001 02:20PM P1 To, Putnam County Environmental Health Dept. Froar. Jacqueline Lynfield Dates 05130101 ftibjeft Certificate of Construction Compliance TM# 52.-2-28 Re.. -82 Ovemana Heights Rood, Putnam Valley Adam Stiebeling 1. am in receipt of your letter dated Z? tqT .IrR.Croninsofte As per your request, we are putting together the paper work to complete this application in an expeditious manner. However, with regards to PCHD Form GS-97, there are two signatures an this form already: 1. the GC, Putnam Docks Inc. located at 25 Evergreen Road Putnam Valley NY signed by David Santo the Prasident 2. the other Is the septic system contractor — Richle Becarelli — Putnam Contracting located at 19 Chester Pl. This is not a corporation so he just signed in the line. Would you find this acceptable? If not I will need a dean form, and perhaps you can tell me who is supposed to sign where, or if you just want the GC* to sign again above the Title line? Thank you very much for your expeditious response. Cc: 'Ken Murphy 0 Page 1 FROM : JACQUELINE LYNFIELD ARCHITECTS FAx No, : 8455282010 May. 30 2001 02:20PM P2 V'5/30/20-31 l b: B6 9147:'10693 : RUNIN ENGj NE.'_Rit j 1 N4'. J♦ BRUCE R FOLEY LORETTA MOLINAW R.N., M.S.N" Pxblio X�oldk Dfi,eaor Auwwm Prr & & d1h DbVCW Dkmw or Pass' Strvmu DEPART Wr OF HEALTH I deWV& Road Brewster, Now York 10509 RAx"VXneow Red* (iai)M . 6130 Fa (MS?276.7931 Harriq ler (A�$)MS-b3lb WIC (M271-667E PiKJOS S -6041 4�1 May 22, 2001 SsAy levee•+ *5)2--s-4014 tr (84$)228-6108 F=(843)=-W$ Timothy Cronin, PE The Lindy Building, Suite 200 2 ,,'oho Walsh Blvd, Peeksld'AL IK IOS66 Re: Application of Certificate of Construction Compliance - Lynfxekl, .Dscewarta Heights Road TM# 52 -2 -28, (T) Putnam valley. Dgar Mr. Cronin: - „ �Q eve This office has determined that the above referenced Certificate of Construction. COMP11i e ' U application, received by the Dcpartmeat ou'\Uy 10.2001 is incomplete. Please be advised th the followmg information is ragw ed before the Department may commence its review. PCM Form CC -97 - Certification of Construction Compliance • E -911 Number to be listed at "Located at. r PCHD Form GS -97 Guaramtee of Separate Sewage Treatment Syste ' • Sigaeture required an form. PCHD Foray NYC -97 - Well Completion Report {ei► ... _.- .:...:.. Clrigtu document urr ;_ " Cerrecrstreet address required. • Pumglstorage trait iafotztlatiorz requiued-eo b� ��zrfpletcd:� -� -: '_ ._ _::.:. - -_ -,.. - _. • Comments ass noted on water quality analysis states: J L • "All toolding times (were not) Imet." J �,p N t !Q'j•�W. • -Results of samples analyses beyond holding times." Retesting and submission of results as required. - cow)_?- ai'Gt'i This office will continue its review upon receipt of the above mentioned comments. Please fat free to contact this Oka if z y questions arise. very tally uts, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc, PC HD Applications - CC -97 (1), GS -97 (3) Copy of our AndYste (1) r a FROM : JACQUELINE LYNFIELD ARCHITECTS FAX NO..: 8455282010 65/30I?�al 12:53 914r36359� CRONIN ENGaaINEFRiNG 1 T, s- 0,11. N May. 30 2001 02:21PM P3 HAVE �� >.. -- Thu `v s w kcep cs.mdu@iw: t ' the a of hbk . hh ctw ogtbe Pmam Cody Dqutuw ofd a to why or m tt ad= - - Otte qsm to opmft way mna by f® wiM or w*igm Est c(dw c=upw of to ' tatiWBs the luavoreft 1Wk� 7 .d RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914)'73&366t-wPg)x "(9-'4)736 -3693 - .< June 12, 2001 Adam B. Stiebeling, Assistant Public Health Engineer Putnam County:Department of Health Division of Environmental Services 1 Geneva Road. Brewster, N.Y. 10509 Re: SSTS Construction Compliance Jacqueline Lynfield P.C. D. H Permit #PV -9 -99 82 Oscawana Heights Road Town of Putnam Valley Dear Mr. Stiebeling: Please find enclosed the revised certification of don structiori coiiiph;jnce necessary'for-firial'" '- ..... --- . approval for the above referenced project: The revised guarantee, well completion report and water analysis will be submitted when it has been obtained from owner Jacqueline Lynfied, Kindly review the document enclosed. Should you have any questions or require additional information please contact me at the above number. Thank you for your time and assistance in this matter. Respectfully submitted, enneth M. Murphy Project Designer FROM J CQUELINE LYNFIELD ARCHITECTS 1: FAX NO. : 8455282010 Jun. 01 2001 12:48PM P1 Bruce Foley I am in receipt of a letter from Adam Stiebeling dated May 22 to 'Tim Cronin's office. As per his request, we are putting together the paper work to complete this application in an expeditious manner. However, with regards to PCHD Form GS-97, there are two (2) signatures on this form already: 1. the GC, Putnam Docks Inc. located at 25 Evergreen Road Putnam Valley PAY signed by David Santo the President. 2 : the other is the septic system contractor_- Richie- l3ecanelli —.,Putnam Contracting located at 19 Chester PI. This is not a corpo lion so he'ust igri& in the line ic says corpo fatioei narne� Needless to say, Adam has asked us to resubmit this form with the signatures in the right place. We are in the process of taking care of this. I bring this to your attention because I do not think that the average `man/wromarnon -the- street" can figure out where they are supposed to sign, not to mention a septic contractor. Perhaps you should redesign this form as follows: There should be a line down the middle, clearly separating the two columns. At the top of the left column it should say "Ovvned= Info (Fill in belowr and above the right column it should say "Sepdc Contractog, info ( Fill in below)" or "person responsible for subsurface Sewage Treatment System" ftNarme (Please print)" then "signature°° and date, and then below that the Address with room for city and state. I am taking this time to write this, because I do Believe this would clarify it for the rest of the world. Thank. you I& your consideration. s 0 Page 1 FROM : JACQUELINE LYNFIELD ARCHITECTS FAX NO. : 8455282010 Jun. 01 2001 12:48PM P2 0b/38/2b07 10: b5 W14 :'3b �b9 -PUNiN LNi1NLr -Pi"j 1 rrtu= rat -Tr) � LeAi 1 0 U BRUCE B. FOLEY LORETTA 14OLINARI R.N., M.S.N. POIN MOM Dbntror Auwi= PWk lba(rb Dmfor Dowsw of Pamw some DEPARTMENT OF HEALTH 1 0eneva Road Brewster, New York 10509 Rodm mw Rai* (US)47a -6130 fnt{N5)27$-M1 NmsY� leery (US) 2T1.64Sa ' RC (VS) 271.4674. r-a (t o rn - sou y' 1 May 22, 2001 UM hWvn*u (atS) 271- 6014 le+eeeeeel ta11226. 6101. FOX WP 274 -b61a LLrr Timothy Cronin, PE The Lindy Building, Suite 200 2 John Walsh Blvd. Peelceldli, NVY 1066 Dear Mr. Cronin: �y ly.'A \'V Re: Application of Certificate of Constr'actioiiZ Compliance - Lyaiield, Occawans. Heights Road TM# 52 -2 -29, (T) Putnam Valley This office has determined that the above referenced Cadftagte of Construction CompiAnc aptislication, received by the Department on May 10, 2001 is incomplete. Please be advised the following formation is required before the Department may commence its review. �Zg,o US,- FCHb Form CC -97 - Certiftcation of Construction Compliance • E -911 Number to be listed. at "Located at..." �r r PCHD Form GS -97 - Guarantee of Sepatrate Sewage Treatment System '.7►' • Signature required on form. • PCHD Form WC- - Well Completion Report Crigipal document required. _ �._ :........_.... Correct street address tcquim. • Putnplstbialge taatk informauian-raquiu+ed to be comp et . ,. _ _ . _ ,. - . . • Comments as noted on water quality analysis states: ++ • "Ali holding times (were not) met." � 1 ��• /(�t?�(�. - " Results of smmples analyses beyond holding titnee " Retesting and submission of results are required. .�•� my This office will continue its r VWW upon receipt of the above mentioned conunetus. Please feel free to contact this office if sky questions arise. Very truly urs, Adw B. Stiebeiing Assistant Public Health Engineer ABS: cj enc. PCFM Applications - CC -97 (1). G5 -97 (3) Copy of water Analysis (1) FROM : JACQUELINE LYNFIELD ARCHITECTS FAX NO. : 8455282010 Jun. 01 2001 12:50PM P4 1.:: u':TS�.� �. �-- aa[. �sr: �a. a.-- �r-.-.= Y. �.: .�_.w•c.Z'-.at•v.- .+a'_sru:+�.c .r.�L :�.'r - «.. - ^-r.. . r�. A.T C. .W- ._.- T.aaa�.-r+ 'auc .. _.. -. �a rt +..wew-_.. r.oe �.��. T. .ereM Svner/Gee�e I ConUp for info_ fFW P jmon_res000eiblefgr in belay 1jubs Sewage Treatment System Info ( Fill In below Nerve (Please prim Sig Ure da d: Title Corporation Name ( it corporatiwn Address cityst. --.. Corporation Name (if corporation) Address city and state. zap FROM JACQUELINE LYNFIELD ARCHITECTS FAX NO. 8455282010 Jun. 01 2001 12:49PM P3 05�3012U01 11:53 914736369= CRONIN ENGINErRiNG 1 PAGE 02 FMAM COiJN'I'Y DEP'AR' • DIVISION OF INi MONMENTAL gEAL1`8 sER 4=bs GUARAME OF SVB UMACR 81WAGZ TREATMENT �'�tatNE�t� E �7�11ptlLp� j�/kv1 D SZ. " � wTt, Owwar Pwdww of Bttilding TOE b* Nook Lot (4,T,Nj'j .fig S IN(;,.._....._.. BundinCbr A-Z_ 4CAt)A& 1&144M AP Location • sum yVw FK Whiz BWWn$ mm Taa�� W WoorDS su�ai+�omNs,Du $WxUvisioa Lot / I repnaw tha I am wholly and compkWy responsible for tha Iocem wadmaoa*p, tt>mnd, 00MVuedan sod drainage of dw sa wap teemed system s ir4 *d ahwA4 § eeibed "aty, sod *Xis bu been cmauated as shovm on tbw app roved plu or Vproved amendmern dwewo sod its acoordsace wilh the abudaa* rAa aadtepkli= of ** Put = Cavity Datwtmem of He and heseby Swum to to the oww, his smasoa, heir or assign& to phce in pW aperseml coadidw aay pare of sstd system eeostrucoed by me which wh to opum ft s paw of two yew S+ fouawins the date of gpravel d dl °'C.ertifeaste of C cmpiiwe for the wwap wammial snits, at say fepgn made by tae m such systeft aJCeept when t#ts hdm+s to 1,0 we pmp»atly is cad by dw wM aewgUlm-= of the ocgVw of** building udiiring dw aysttem. - - Tht undersigaad iinther ag m to t as mclwi" *e dew=balw of the Pubiic. Hub Diaeota of the Putt CouM Deputy of Health as to w1ucr oe act tho'baum dtlk s*6b to overdo was cmud by the wmfbi or oeg ro act of the orapaas of dw buadft vWizing the s. Yew s Carporibn Name tit' �porstion) Addtw; Ls state LW P-afA k M W zip 1 saya-7 Tide: Naa c�ro� AM. swe L,r ti�t,C t`1N�zip Fam aw May 22, 2001 -- ----------- LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 " �o 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) 228 - 6108 Fax (845) 278 - 6648 Timothy Cronin, PE The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Application of Certificate of Construction Compliance- Lynfield, Oscawana Heights. Road TM# 52 -2 -28, (T) Putnam Valley - I . Dear Mr. Cronin: - - This office has-determined that the above referenced Certificate of Construction Compliance- - application, received by the Department on May 10, 2001 is incomplete. Please be advised that e following information is required before the Department may commence its review. PCHD Form CC -97 - Certification of Construction Compliance • E -911 Number to be listed at "Located at..." PCHD Form GS -97 - Guarantee of Separate Sewage Treatment System Signature required on form. PCHD For`m'WC -97 -Nell Complelioii Report • Original document required. • Correct street address required. • Pump /storage tank information required to be completed: - - - -- - - - - -- - . • Comments as noted on water quality analysis states: • "All holding ti es (were not) met. "Results 6' f samples analyses beyond holding times." Retesting and submission of results are required: This office will continue its review upon receipt of.the above mentioned comments. Please feel free to contact this office if any questions arise. Very truly ours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc. PCHD Applications - CC -97 (1), GS -97 (3) Copy of Water Analysis (1) _ _ — , A , l,i,jc 1 11 LL\ 1' OF HEALTH DIVISION OF ENVIRONMENTAL HEALTR SERVICES FINAL SITE INSPECTION Date:,. Q C Inspected by: Street Loca•' t�,�. �-, Owner Y At A� t�ti Town . - .. - P'errriit ,- yUN-1 f 2 —Z— 2 Q> Subdivision Lot', 1. Sewage System Area rYE CO1• NL ENTS a. STS area located as per approved plans ..........................: b. Fill section - date of placement 3:1 ban- ier Lgt'n. Width Av?.Dp�n c. \atural soil not stripped ................... ............................... IL d. Stone, brush,.etc., greater than 15' from STS area ......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System C. a. '.ptic tan- size -1,000 ... 1,25 other ................ �� 5--� -- ... b. Septic tart's installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtu'o Box outlet"" at same elevation -mater tested ................. 3 Minimum 2: t.Ori inal soil between c x & tehc Junction o. - ............................. TrLengt requirede e italled 2. Distance to � =ratereourse measured Ft.......... 3. Installed according to plan .................e ..................... I 4. Slope of trench acceptable 1/16 -1/32" /foot ............. j 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. I 7. Room allowed for expansion, 100% ......................... I 8. Size of gravel 3/4 - 1 %2" diameter clean .................... 1 9. Depn of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ........................:...... ( _ _.. g. :.. Fum D SS stems pup mer .... ... - _.. ....•'tie o mc 2. Overflow tanl< ................... ....... ............................ . . ._. 3. Alarm, visual / audio .................... ............................... I 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle v,itnessed by H.D.estimated floc =/cycle........... III. HouseBuildin,7 a. house located per approved plans... ........ .. ...................... b. Number of bedrooms ..................... ............................... IV. Well i/ell located as per approved plans ............. ............. b. Distance from STS area measured 45'� ft........... c. Casino 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... oe 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... .10000 - i. Erosion control provided ................. ............................... P, v. 1191 "— NE O T HEAS T - ®-r ` 5A14BUR.Y..:....�.._.:._: 39 MILL PLAIN ROAD - DANBuRY, CT 06811 CT Cert: PH -0404 LA$$ (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY MPORT REPORT TO: MS. JACQUELINE LYNFIELD DATE SAMPLE COLLECTED: 9/13/2000 & 10/29/2000 25 EVERGREEN ROAD TRAE COLLECTED: 4:30 P.M. PUTNAM VALLEY, N.Y. 10579 COLLECTED BY: J. LYNFIELD DATE RECEIVED @ LAB: 9/14/2000 & 10/29/2000 TESTED BY: LAB #11471 REPORT DATE: 11/1/2000 SAMPLE SITE: 82 OSCAWANAHEIGHTS ROAD, PUTNAM VALLEY, N.Y. SAMPLE - POINT: SPIGOT AT IN -HOUSE TANK SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED AWTHUM CONTAMINANT RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: ® Color (Apparent) (10/30/2000) 1 - EPA 110.2, .:` . 15 ® Odor ND - - 3 Units e pH 7.18 - EPA 150.1 No designated limits • Turbidity (10/30/2000) 0.69 NTUs EPA 180.1 5 NTUs CHEMISTRY: e Nitrite Nitrogen 0.028 mg/L as N EPA 354.1 1.0 mg/L. • Nitrate Nitrogen 0.23 mg/L as N SM 4500D 10 mg/L e Alkalinity -_- -104.0 mg/L .. SM 2320B No defined limits- • Hardness 74.0 _ . mg/L `_t A'130:2__ ._. , __,._._. -.. .- .-- "No- deiiiiedlimits - • Iron (10/30/2000) 0.180 mg/L EPA 236.1 0.30 mg/L • Manganese 0.193 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 18.9 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** . ml= milliliter mg/L--milligrams per Liter. ND =none detected MC)rMw mum Contaminant Level x "Notification Level * "Action Level COMMENTS: -All holding times (were noo met. - Results of samples analyzed beyond hold times (48hrs for color & 28days for Metals) could be invalid. SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 9/14/2000 & 10/29/2000 �. fijA ion . Labor o 'Mredt6r •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 BRUCE R FOLEY Public Health Director r LOREttAi"1vMUINARI R.N., M.S.N. Associate Public Health Director Director . of Patient Services DEPARTNENT . OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-:6130 Fax (9.14) 278.7921 Nursing Services (914) 278 - 6558 WIC (914) 278 : 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: -:Y� c A u CL tic L` ti F) e 1-10 TAX MAP NUMBER: MAP: S 2 Tit°_ .a C K. 2 f' o T 29 E911 ADDRESS: $2 OSCA VAMNA LIE) GA TS 12d qD TOWN: AUTHORIZED TOWN OF (Signature) / DATE: / 0 2 0 The .Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) 10 Fwv�� fm'i � fuu"`a^µ' H+s ' p'.�„' �`auc'1 N� 30s.afl ob ve 14 Yi 7 4D 01 POO* IMU16 raw* met 44- 10 Fwv�� fm'i � fuu"`a^µ' H+s ' p'.�„' �`auc'1 N� MAY -15 -00 .$NON 11:10 JACQUELINE.LYNFIELD ARCH 91452800.$$ P -02 PUI'NAM COUNTY DEPARTMENT OF A1LTH DIVISION OF ENVIRONMENTAL HEAL T SERVICES WELL Well Location Street Address: Town/Village: Tax Grid # S& 0scawana Heights Putnam Valleys Map 151Z Block S- Lot(s) 26 Well Owner: Name: Address: Use of Well: _x Residential Public Supply �estlmonitoring t cond/heat pump Irrigation I- rimy P r3' Business Farm Other(specify) i 2- secondary Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed it percussion Other (specify) Well Type Screened Open end casing X Open hol in bedrock Other Total length 42 It. Materials: � S I 'Plastic _ Other lded X Threaded _ Other Casing Details Length below grade _ 41 ft. Joints: _ W grout Bentonite Other Diameter 6 in. Seal: X Cemerif Weight per foot 19 lb /fL Drive shoe: X Y s No Liner: Yes X No Diameter (in) Slot Size Len (ft) Depth to Screen (ft) Developed? First __ Yes No Screen Detaft Second Hours Well 'Yield Test _ Bailed x Pumped X Compressed Air Hours _y_- Yield __5_ gpm Depth Data Wasure from tan s sec -s is (specs wring yield test() Depth of completed well in feet 20' 465' 505° Well Log De tb From S; face Water Well Formation it. ft. If more detailed Bearlog Wsmeter(in) Description Land Surface 15. ilk "ft I clay and boldexy, information - --- = - _ : -: -- 15 -millixW, -Hit._ rock at 15 ! dcscr,.iptions or _ 15 42 Drills ._ ..0 _..r.o,c.k . set c.a. slr , u sieve analyses 42 505 Drillinal in rock ciran to are available, I I Please attach. U If yield was tested Feet Gallons Per Minute Pump /Storage 7 anit informatton at different depths Pum Type Capacity during drilling, De p Model list: Volge HP Tani] Type Volume Me Well to'Inple'tu, loam unty MrIFICatlon T40. E5/10/00 Report W r t�,(stg e) 12/9/99 002 a� NO EE Exact location o well with istances t least two perntdmarks be prove ed on a,separate she p Well Daillei'sN; P 3 Ad Tess: Put -v,a�, A Rr+p�^, war 1 Signature: Daft: 5/10/00 White copy: HD File; Yellow copy - Building Inspector, Pink copy - Owi er; Orange copy - Well driller Form WC -9? BRUCE -R.� P0LSE-Y,:._,., -::� :. Public Health Director LORE:TA MOLFNARI AN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 . Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)278-6678 -Fax (914) 278-6085 FILE May 22, 2000 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Re: Lynfield, Oscawpa Heights Road TM# 52 -2 -28, Lot #5 Town of Putnam Valley Dear Mr. Cronin: This office has conducted a final site inspection of the SSTS and water supply system as requested on Friday, May 19, 2000. I offer the following comments for your review and consideration, correction required. Concrete spillage at the septic tank baffles to be removed. _. Start.of rFnch to begin two_(2.). fePt�froln.rlrap box Two foot separation to be solid pipe. moved and replaced. G La (g,00- dad16� Perforation pipe to be re p ® � � ;n, osion control measures to be installed immediately. This is a violation of Putnam County Sanitary Health Code and approved plans. 3. 0nch piping to be cut flush inside drop boxes. 5. 1 trees within 10'0 ". of system to be removed. Trenches within 10'.0" will not be credited for lineal footage. System end(s) are within 10'0" of driveway. Remove all components of system within 10'0" of driveway. 7 Inspection measurements of system result in a total of 380.0 LF of trench. • System requires a minimum of 400'.0" as shown on approved plan dated May 28, 1999. • These measurements include all trench(s) currently installed. 8. Please submit a "revised" plan of corrective actions for review (to be constructed) to completed SSTS. It is the opinion of this office that a thorough inspection of the above stated SSTS was not conducted prior to submission of (FIR -99). A request for final inspection to this office. t, It is the responsibility of the design professional to verify and "certify that the systems) as�listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health." Please contact this office upon completion of the above to schedule a subsequent inspection. 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. ABS:cj Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH "i DIVISION OF ENVIRONMENTAL HEALTH SERVICES i Y ATTENTION ADAM GE RMUEST FOR FINAL INSPECTION For: Fill ' All information must be fully completed prior to any Trenches ✓ inspections being made., . PCHD Construction Permit # V" `� Located: OicnimpiQ Hi m4iT-s' 20 igo Om IOU T.JAA Ltc- Y Owner/Applicant,, lVa'S� u�[ �,uE LYEFIEC!� TM 52 Block Lot 28 ' Formerly:.. - -- . ...Subdivision Name: OScfIJJArrp �o6tW- Subdivision Lot # Is system fill completed' -Nft- Is Is system complete? `� E i� Date:"W4V l S, Zao d Is system constructed as per plans? Is well drilled? YKJ Date: Is well located as per glans? ` e-r Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department. of Health Ti i, crr# Y L. cNu ilAJO Date: IN Y 00 6 Certified by:. CYO-414 6€ WI AIC&-P I A JC pE ,� RA fig' L I AfO ZZ b Cl Design Professional ,Z 170 f(N WIQI r�r ;TGVa Address: f,c2c K.f K I L (_, N. y_ !6 SC Lic. # 6 Z S 8 d Form FIR-99 _" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION P.V/ CONSTRUCTION PERMIT FOR SEWAGE TRE TMENT SYSTEM PERMIT # - 9 q Located at OS CtgVGANn 14G1GD-1T9 9oAD own rVillage 'faTNAr-1 I%ZLE- `s' Subdivision name QScAvjAtjq yj ooaxSubd. Lot # Tax Map J? S?- Block 1__ Lot 9 Date Subdivision Approved -T3tJ e 9, 19 $ '-? Renewal Revision Owner /Applicant Name -SAD C qyc L 1 nS C Ly,j F Date of Previous Approval Mailing Address Z S EV E iz GT2 E61J 'R p - Pu TO i9 r i Vrg LL e ke of , y, Zip i o s 7 �( Amount of Fee Enclosed .93o0 Building Type 910C LE' rAA t L 4 Lot Area ?,CfAc No. of Bedrooms _�4_ Design Flow GPD Z-00 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED ti Separate Sewerage System to consist of 12- 5-0 gallon septic tank and /�i3(I (r, F. pcRF pyC Pj rc 1a.j Zq,, 6kr4WCZ %'iZ;t/)ej_j Other Requirements: C H a-44--PTt- PL ►q e. c To be constructed by ?u -'NA rh Ca" M A c.,r t eo 6 Address L19 Kt: P6 t K S is I L L. N. 10 S'7'1' .. Water Supply: Public Supply, From- Address or: Private Supply Drilled by Mo l kn Atj t1NDe RLS0/j 1/i C_ Address P u ; N 4 N VA L, L C y, I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furn i ' *— his successors, heirs or assigns by the builder, that said builder will, place in good operating condition '` `gyp Rev treatment system during the period of two (2) years immediately following the date of the issuan , eApproval; ificate of Construction Compliance of the original system or any repairs thereto.;' Signed: -_ as' �E. / y R.*. Date �°'l �—`� Address 200 � d A /� ' �` 16 License # 0 "`IQFE�5�v '*. APPROVED FOR CONS'T'RUCTION: This app � two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Ap roved fo dis ar of domestic sanitary sewa Wly. By Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro ssion 1 Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - - - please print or type - PCHD Permit #� Well Location: Street Address: o illage Tax Grid # S�JaL OT -116S- OSCAWAIJ10- HC1 t ?u T JAr+t Map .5-Z, Block?_ Lot(s)2q Well Owner: Name: E i 10 C Address: Z 5 6711 €°R G ` LE Av 1Z G A b L,%N Fl EL D 1°'0 T'tJ A r11 Vr4LLE-Z' N, , i o S7 3 Use of Well: t 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 gpm # People Served Est. of Daily Usages 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling >r New Supply (new dwelling) Deepen Existing Well Detailed Reason Wg Lcn_ S u i' pL Y I =o°iL- n1 W J. E S 1 D cr1 e 6- for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No A- Is well located in a realty subdivision? ...................................... ............................... Yes_,�r No Name of subdivision oG CAW A1-J 4 W b O D S Fl LC z 2:3-6, Lot No. Water Well Contractor: pigTLnAr> 6tJbEnSo,*-J Ad - G�?Z ST Fu i NAA VnL. Is Public Water Supply available to site? ............................. Name of Public Water Supply: r. 4, �F, N °R ... Yes No A- ���'�I'own'll e ` , J \ Distance to property from nearest water main: Proposed well location & sources of contamin 'on to pr vide s.i-�rate plan. Date: 4'' Applicant Sigoaturc;_ 29$0 v �KUF SS�OC", PERMIT TO CONSTRUCT A LL 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 51 Z 5 1 Permit Issuing cial: vt Date of Expiration 5 Z ®71— Title: e Permit is Non - Transferra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .... � .....,. ,_: , .., ..,., _:....... - •.F'IJ-ICtiT�OwT-FOR,APPR ®VAIJ OF PLANS:FOR" .. - ........,.... -.- . A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: —1-19 c q y E t- ► .--) c Lys D V4 L OF Y, /11 Y 10577 2. Name of project: S S D S 3. LocatiorOT V: Pv i �A M V8 LLC Y T19C L lAC,le &,Lo c 4. Design Professional:TiMoTHY L, cRoiJird .Ir 5. Address: Su k ri t a 0 2 �'o%9h% '�.1x1l.CN rILLJ�, 6. Drainage Basin: 05c4M4.04 t4KE- 11)1y- 10S6,6- 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 1� Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10-10 10. Has DEIS been completed and found acceptable by Lead Agency? ............... AJ . r4 11. Name of Lead Agency .12._ Is -this project:in an area.under the control of local planning,- zoning,_or.other v: offrdials,- ordinances? :........... .......... V6 13. If so, have plans been submitted to such authorities? ........ ............................... /40 14. Has preliminary approval been granted by such authorities ?AJ 4 Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water �� groundwater 16. If surface water discharge, what is the stream class designation? .................... A- 17. Waters index number (surface) ........................................... ............................... "i I t+ 18. Is project located near a public water supply system? ....... ............................... do 19. If yes; name of water supply N (14 Distance to water supply N 20. Is project site near a public sewage collection or treatment system? ................ 00 21. Name of sewage system..' �A Distance to sewage system 22. Date test holes observed' q 99 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 800 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... mb 26. Has SPDES Application been submitted to local DEC office? ......................... r' Form PC -97 2� 27. Is any portion of this project located within a designated Town or State wetland? /J O 28. Wetlands. ID Number. . _. _ .._.. ...... ..........: ....................::......:.. 29. Is Wetlands Permit required? .....................................:....... ............................... rJ d Has application been made to Town or Local DEC office? .............:................. — 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /J O 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, ti 0 landfilling, sludge application or industrial activity. ................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town .or Village? .......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years..in or adjacent to project site? :............:.................. ............................... tJ U 35. Are any sewage treatment areas in. excess of 15% slope? . ............................... /00 36. Tax Map ID Number ...............::,...S UOLo -F Map SZ Block Z Lot Z 9 37. Approved plans are to be returned.to ..... Applicant _ Design Professional _:NOTE: All applications for review and a yorc���al:ofa rie�y;S.STS..to be locafed within the:NYC �?�late:sbed �hul =- = :. _ _ _ _p_ be sent to -the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects ofa project, such as stonnwater plans or the creation of ti 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. 0 oc_ I hereby affirm, under penalty of perjury, that information provid irk\ `` . f6�• �R t to the best of my knowledge and belief.. Fa atements made re re hdb a Class A misdemeanor pursuant to S Lion 110.45pflhe Pen ' w SIGNATURES & OFFICIAL TITLES: 1 Y" 1 O TH V `L . C110 N J s az9so V; Mailing Address •THE- t iN p y 9W c A ids r 40 1 o �o Z –XO H N W M L. S 01 EL VZ cc I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1JESIGN DATA S14�:ET SUBSURFACE SEWAGE TREATMENT SYSTEM 2 S v L�TZ d'iL� tr-1 -iLa r� ►, Owner'Si4equec iris 44zrj T 1 ELb Address f'u rjJA rh VA LLE t d- y. 10S-_?') Located at (Street)oscAWA, -3A f16'16Kr1 1LoA o Tax Map SZ Block Z Lot Z 8 (indicate nearest cross street) S V IrL®? 4*- S` Municipality PoT-rinYti Vogl ZL& Y Drainage Basin O-S c q WA r.1 Lr4 KL✓ SOIL PERCOLATION TEST DATA Date of Pre - soaking &F il- Zoe 19 14 j ) 9 g 7 Date of Percolation Test A "PA 1 L 21, 19 9 t Hole No. Run No. Time Start - Stop Ela se Time �1Vlin.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch 1 X29 103s 9 0 3 3 2 )03� 3 4 �J�s L° >S s 5 jo_ g 3 y-z 9. 2 i o :� .�0 3 16 ss )) °S �� S 4 110,1- ) 0 o Z -7 5 1130 11 s� 2 l 7 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, _< 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- iiOu NO. 1j 1 HOLE NO. D 2- HOLE NO. D 3 G.L. -r-0 ps 10 1 t- `%pS61c. 'TpSoI 0.5' Lo w► Lor,4vti Lo4dh 1.0' 1.5' 2.0' Sx1,,,)h Ar A G%AV €(- 2.5' 3.0' 9,9/4 AtJo 6&AVgL -�rtIACC -e a r- c c04 Y 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered 00 Nc Indicate level at which mottling is observed ,Jo.�Jc Indicate level to which water level rises after being encountered �PI�i� Deep hole observations made by:Ti MOTHY L,. e izoiji --j JT- Date 11-20-99 AND ) 9 7 Design Professional Name: -7 ► mo IrtV L, c?Za,,;,J rs.t--a Address: r t-w aY 13(.6 6, Su i l-C 7,00 2, Al W4, r9 Signature: / / / ", "I p tc - Design Professional's Seal WeIr C'r0 (G LO' 62980 � �� �'ROFESS1�NPv I �It y -Ic P Lf < 7 -------------------------------------- 115- 1 r��l ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES kAnAm ❑ GENE REQUEST FOR FINAL INSPECTION For: FBI All information must be fully completed prior to any Trenches ✓ inspections being made:. . P61HD Construction Permit # !PV_ 1 19 i T 190 0 "-6 y 12cated:,bSCdPR^J4 HOCH -f JeO OV). f V TA)A Vt7 Owner/Appficantgjame-:-A:5' c,4V;Ejjuc LVAIFICCp TM S_ Z_ Block Z Lot Formerly: Subdivision Name:, Subdivision Lot # Is system fill completed.? Date At _— Is system complete? Date: -�71VWY I 250 4 Is system construct9d as per plans? Yc-r Is well drilled? YE-J Date.- Is well located as per plans? Are erosion control measures in place? I certify that the. system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit mit and approved plans and the Standards, Rules and Regulations of the Putnam County Department, of Health. �irtojwv I, ci&wl'uo Dater y j 00 0 Certified by: C AJ CAVIIJEfN I AJCPE � RA Y Design Professional Address: PEE KS K I L L, AJ /d4r, �K Lic. # Form FIR 99 09mments*..- Form FIR 99 04/05/99 MON 23:03 FAX 914 736 3693 CRONIN ENGINEERING PE PC r PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OIP ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION -_:S;g CQ u E- L G1J Lr LytJ F 14 L D (it,) Co N T-t'4 e-r) RE: Property of Located at O�G�}'GUf?'� f� ��• Ov'?kj—, t.)A Y-%% VAL1LCY Tax Map # �Z • Block y Lot 28 Subdivision of ?147/VA-�'( Subdivision Lot �l Filed Map � '0213(,o, Date Filed 2001 Gentlemen: TiMoT� `� L.. e'2oiv iN � This letter is to authorize (61_d1Aj11V FN & /NC FP_l/1G Pk a duly licensed Professional Engineer k_ or Registered Architect to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, an `sign all necessary papers on my behalf in connection with this matter and to supervise the_o rlgl�?Whi f said wastewater -treatment .and/or.water supply systems,'-.- L1 confoiffiity with the p -fig" l "cl 45. and/or 147 of the Education Law, the Public Health Law e Putnam.-Co fie. r `Very truly yours, C ntersioned: �ZJ�u 62980 �P �'/ Signed: P:E., *: # Or.2 80 KvFESS�� ( vnerofProperry) 'Tk 1;F L1^30 Y Xu1 Lb 1^3 6 Z� Elie i�1 Mailing Address Sul rt: 2o6 Mailing Address: PEC KSKJ L L State Pg w yonK Zip.. / 6 S-,K-,6 Telephone: 01. Y) 73 d – 3 6C f K State Zip /06 --7 Telephone: qN ✓ Z 000L Form LA -97 14-164 41071 —TM 12 ' SEOR C also Enwironmemal Oualky Ra1INw SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ISPONSOR 1 2. PROJECT NAME C UEL1tJt5 Iii= 1�Z.4J S W+4Gcs DISPoSt�l. S`iSTgr'-I 3. PROJECT LOCATION: municipality 'Too J oF- `Pvri -)A ALLOY county PV -t t-3 01 1. PRECISE LOCATION (Street address and road Intersections, prominent Iandmeratr, etc., or provide neap) A)02-r k1 SIDS Or— 0SC.A1n?#4hJ1q 14611GHTS �p140 0. IS PROPOSED ACTION: ❑ New ❑ Expansion ❑ Modlflcatlo dalterstlon e. DESCRIBE PROJECT BRIEFLY: C rN 5 7 •Z V GT 12f /� 01= %} Sit 6' L SCE. A G'Lc D 1 S P o S A L S Y S -rc t-4 #I/j& b'111 LL t_b W -EcL 0rS q 2.,C r+C 1Z6 P191ZC &C OF LlqOb 7. AMOUNT OF LAND AFFECTED: Initially Z- « acres uttimate4y Z 6 acres s. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? {y Yes ❑ No If No, describe briefly _. Y.: _ ..WH 16.10RESENT LAND USE IN VICINITY OF PROJECT? . r to Raldentld ❑ Industrial i Commerelal ®AOrkultun~ rt u PiikJForisUOpin ipico ^� OtMi__. z Describe: jq�T01 n1 i N G L. 9/0I _S 6RE- ZatJ Q 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU? Yes O No N yes, no 206 rw) (8) and Pw dthipProvala . SEWA6 DIS.1>0-09 L. A1'JD WArCr�- SQpr'.( — PU T -"JAr%' co O`) Y pEpAi2T►"4t-i-iri' 01= hEgL� -aUIL611%)6' P 2rhV7'- PUrtJiqr-% V142Ze-Y 11. DOES ANY T OF THE ACTIOII HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? [3 Va it yea, Ica haled WW v«nwwoaow 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERM1T1APPROVAL REQUIRE MOOIPICATION? ❑ Y« 1 MTIFY THAT THE INFORMATION PROVIDED ADM 18 TRUE TO THE BEST OF MY KNOWLEDGE Applksnthportao► n�Ilts C-VotJ I tj 45� 6 r Tt I NC p t. '� L S l 5 Date. eve sloeal�tr� rd If tM aatlon Is In the Coastal Area, and you are a stalls apancy, oomplets the Coastal Assessment Form before proceeding with this asssssmant OVER PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. prOES ACT1ON`EX ANY -TY0T I Tk4 IN 6 NYCRR, PART ({17.12? It yes, 0owdinste the 906- WOO& tend U00 tie FULL EAF. ❑yes ❑NO _ S. WnLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED IN UNUSTED ACTIONS IN a NYCRR, PART 617.67 If No, i npitiw'd et�ation may be superseded by arwww Involved asenci ❑ Yn ❑ No C. COULD ACTION RESULT IN AW AOVERSE`EFFECTS ASSOCIATED WITH THE FOLLOWING; (Answers may be handwritten, It legible) C1. Existing air qualMy, awfacs or groundwater gwllty or quantity, robe levels. existing traffic pattanw, solid waste production or disposal, Potential for erosion, draNyge or flooding Problem? Explain brbfry: C2. Aesthetic, agHwkwal, weltasological, historic, or other natural or cultwal raeowoee; or conownity or neighborhood character? Explain brleMrr. C3. vegetation or fauna, fish, elMiffish or wildlife species, sofficant ha Mats, or Moistened or andengered sowAss? Explain brlefty: Ct. A ooarmuntty's existing plans or goals as officially ~ad, or a change M uM Or Intettelty Of use Of lard Of other natural neoutm? Explain bristly, CS. Growth, subsequent development. or related Wivltln Ilkely to be induced by the pr tip caed action? Explain briefly. CS. Long tens, elnOR term, cumutattve, or otter effects not identified in C1-05? Explain briefly. C7. Other Impacts (Including changes In use of anther gmtlty or type of wwo? Esplaln Wielly. D. 18 THERE, OR IS THERE LIKELY TO 9E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL_ IMPACTS? ❑ Yes ❑ No K Yet, apfatn bristly TART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agsncy) . IMPRUCTtON& For each towns effect Identified above, determine whether n is substantW, larp, Important a otherwise sgnitkent. Each sffect should be assessed In connection with Its (a) setting PAL ~ or wriJ); (b) pfobsMilty oVooeurring; (c) duntknr p Irrom Minty; (a) gsographie scope; and M magnituds. If necessary, add attachments .or reference supporting materials. Ensure go explanations contain wffictatt detail to stow that all reMwrtt sdrrene Impwb Aaw been Identified and adequately. addressed. ❑ Check this box if you haw identified one or mots potentially large or significant adverse Impacts which MAY occur. Than proceed directly to the FULL EAF andkw prepare a pceithro declaration. ❑ Check this box If you hays determined, based on the information and analysis above and any supporting documentation, that fete proposed action WILL NOT result to any significant adverse environmental Impacts AND provide on attearnents u necessary, the reasons supporting this determination: 19ft of Lad Agency or YW idr EM ;Z—M� TOM of Rijoit"k Officer ere roar a — V1 r+ O CD 24' -7" >y N i I � `° z LoJ � I N re = c a f 3T -0" IF4 02 0 } t — V1 r+ O CD 24' -7" >y N i I � `° z LoJ � I N re = c a 15'-103/8' 111-111/2* C 00 16 -0" N_ I I I I. O IF4 02 0 b O C, W C CD . 0--k Q., CD N r.l W 15'-103/8' 111-111/2* C 00 16 -0" N_ I I I I. O 02 0 b O C, W C CD . 0--k Q., CD N r.l W CD Q+ W N 0 O CD O C iy I 15'-103/8' 111-111/2* C 00 16 -0" N_ I I I I. a !i i O N )F HEALTH HOUSE PLANS APPROVED FOR EDROOMS Jacequeline Lynfield Arch. 25 Evergreen Road Putnam Valley, NY 10579`. NY914- 5280068 CT=- 6981961 ` Signature & Title r. , Date b O ►'� N r.l W W N ° C I a !i i O N )F HEALTH HOUSE PLANS APPROVED FOR EDROOMS Jacequeline Lynfield Arch. 25 Evergreen Road Putnam Valley, NY 10579`. NY914- 5280068 CT=- 6981961 ` Signature & Title r. , Date aignaTxe 4 Titls CONSTRUCTION NOTI✓ A co�'Y 01= THE HOUSE t�L,�NS SUBMITTED TO THE BU I LD I NO I N5FEoTO.R 1; AHEN F I L I NCG FORA. .,� BUILDING PERMIT , MUST BE SUBM I TTT—_D TO THE PUTNAM COUNTY HEALTH DI= P,�RTM�NT TO' 1VRI FY THE BEDROOM COUNT. ' s 1 1 'i ",C4 1,-f AE Y ,04,4.4-J S-dR3(D1lVfS4 (DIV PLAT KNOWN. -A S osc. /-\ r,/ �' R E *CC'v E 0 3L EP�V'rp.p �H S t TUA TE IN P+ TO YVIV (D F P V DA/A dW VA L L E Y J, 87 ABR -3 P VftNAdW COUNJ NEW YOP 6� 'tions alt iz,c.6*,ck R.qo-c,rne- zurwe4or rmaAetrue, mzor, I o C-e�- %ca, 1985 0� O%ojt the Sorvec,5 sl^%04A>1% V4.reo;r% WO-S C-O"N?\ b43 Ls A reap SCALEDec esl Ae'- 4,/ 1472 anck tkor-k6 e mop w c4clftrte \.eok 0 c se �nos �ecr�, LA gurus . a - IN I 0�'l —e Tre 0 od� LIB occorC6,ce We le.:K tJ%n yo ?W t J16% of NEjV St a.0 �Ft eo\ 0 tVA 9- Ve..>yd r -3. r ce- f led OL C4_ L Ct MAP ltcV15E0 0 i�srr -S ti. Y. 's x C. 0 0. V�Gk T(V ap: 4 12,EV13C 0 -J(AIVJ A.44 P RqV,t,,-L) M-40, R-rvl 5 --b 'JULY (f rt: A At' ft� VIS e-6 AuGu VIIS kN blic �: a: ilm ve�;.; r Rave .(Zeci-loo'Ter 4L /4 .4 p sA 4 1p 't �io- Wd Ire, /w, Nr OW 00 1 e3o 300 200 > 3 Cf O'l 7 5o -7 / 5 5 30o ion :2 ?o a: ilm 1 egp .y $ a IAJ Pi 5 v a o(p IL a ( � p•:: B�\ \ � i� ene g 0 5 P � +r4i .Z 46 (oO QG'' '3- _ 6 l )5 M�• j CV (� \ �.. • ,,. ,oa'w`' a °ti•�b?; ' oa- gyp. Loo c oA Qp { (v • ao .d � �� LoT.Z j u w61�"' / qo�J^ � ",-.h •• . 6 � � 1 a. = 2. r BJ Ac/ • r 0 1 /.OT w �a o ati � id• ",y � . ' erI �•J6•Yi =S2 � � , JJ h / t k! / / LOT 5 AREA—fI4871 SF (266 A6WS) A 00 rr C" 2aoo, 4 M65.14'W EXS72NG *ELL EA757ING tWA WATER SERVICE ROOF LEADER & F0077NO DRAIN (7-rP) 46 4' .VNC170M 80-Y (TYP) 14L.F. - 4 0 CAST IRON PIPE 1250 GALLON CONCRETE 5,EP770 IWO SDR38 PVC I *j7L.F-4'0 WTH SENDS AS SHOW 405L F. - 4 10 PDW PVC PhRE IN 24' GRAVEL 7PENa4 (ENDS ARE CAPPED) 100% EXPANSION AREA CV Lu OLD FOUNDATION 14 41 Z p- EVAN A - - - - - - 65CAr yt) tlrly. WET AREA paw A of Ill 77PP-,d 7-A,.4.X-A/7- qY.qTFA4 PUTNAM COUNTY DEPARTMENT OF HEALTH .:� . DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM ^`-SECTIO\' A. GENERAL INFORMATION Name of Project O County S- Site Location Aljk*cA: 11�frGs. Building construction begun Extent Is property within \TYC Watershed ? ................. F7 Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. F--� Hilly Q Rolling F--J Steep slope Gentle slope F-� Flat 2. F--J Evidence of wetlands Low area subject to flooding a Bodies of water Drainage ditches ff Rock outcrops 3. Property lines or comers evident ....................... ............................... 4. Do water courses exist on or adjoin the property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... 7 . Will extensive grading be necessary? ................. ............................... 8. Will extensive fill be necessary for SSTS? ......... ............................... aYes aYes Yes Yes 0 Yes aYes 9. Do filled areas exist within the SSTS area ? ................:.:::.:9 If yes, what is the condition of the fill? No No No No PNoN.:. SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand ravel Loam F--J Clay F-� Hardpan Mixture 11. Observed from: a Borings .E] Bank c t ackhoe excavations 12. Soil borings /excavations observed by on -� 13. Depth to groundwater Unm-cf. on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas .... ............................... Yes � No 16. Soil percolation tests made b o� r; on rS Y 17. Soil percolation tests witnessed by _ SECTION D (on back) C( on Form ST -1 (v ( 2 4 �2. SECTION D. DRAINAGE .18. "- Will'pr-oposed grading materially alter the natural drainage in this or adjacent areas? Yes ^ 19. Will groundwater or surface drainage require special consideration? ...........::........ F--] Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ?......... .. ............... F. -1 Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities ?............ ........................................ F--J Yes No Inspection data 2_. Do adjacent wells and/or sewage systems exist......... �es � No � � Q y � ............ 23. Additional comments -zoo 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole 4 _ _Lot Hole 9 Z- Lot Hole Lot 4 Depth to water t*40tie, Depth to water Depth to water Depth to mottling KwL Depth to mottling Depth to mottling De th to rock/im . _ Depth to. r ockhm -] ,`L De th=to rock/un ` G.L. G.L. 0.5 &::) //-IV 0.5 0 (0 1-A3 1.0 2.0 3.0 4.0 5 2L 6.0 7.0 .-_ 8.0 9.0 1.0 . G.L. 0.5 1.0 rr r 2.0 " ZfL 2.0 3.0 3.0 4.0t 4.0 7.0 8.0 L 6OC-0 9.0 5.0 6.0 7.0 8.0 9.0 10.0 10.0 10.0 06/13/2001 13:28 9147363693 CRONIN ENGINEERING 1 PAGE 01 RONIN ENGINEERING U., P.C. lindr Building. Suite 200, E john Walsh Blvd., Peck"l, New York 10566 el. (el4)7965864•Fax. (914)736-3693 JUNE 15, 2001 ADAM S. STIEBELING PUBLIC HEALTH ENGINEER PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL SERVICES L GENEVA ROAD BREWSTER, N.Y. 10509 RE: SSTs Commumav CoMPL/ANcE JJAcom /NE L YWIELD P. C. D. H. PERMIT #PV - -9 -99 82 Osc a wANA HopmTs RoAO Torlw of Punum VALLEY DEAR MR. STIESELING: THIS LETTER IS TO INFORM. YOU THAT JACQUELINE LYNFIELD WILL PERSONALLY BE PICKING UP. THE CONSTRUCTION COPLIANCE WHEN THE PUTNAM COUNTY HEALTH DEPARTMENT HAS ISSUED FINAL APPROVAL FOR THE ABOVE REFERENCED PROJECT. PLEASE CONTACT ME AT THE ABOVE NUMBER WHEN FINAL APPROVAL HAS BEEN ISSUED SO I CAN INFORM MS. LYNFIELD. IF YOU REQUIRE ADDITIONAL INFORMATION OR HAVE QUESTIONS PLEASE DO NOT HESITATE TO CALL: ME. RESPECTFULLY SUBMITTED, Kellnetb M. Murphy Project Designer }