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Home My WebLink About2609DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52.-2-53.12 NO 02609 �I . 16 el , 6 UL 02609 PUTNAM COUNTY DEPARTMENT OF HEALTH _.IVI .ION .OF ENVIRONMENI�I,E ALT I CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION .PERMIT # P. V. -1 8 - 01A T �, a Located at 155 Wiccopee Road TownorVNIW Putnam Valley Owner /Applicant Name Eric Leisengang Tax Map 52 . Block 2 Lot53. 12 Formerly p0n.ald Leisengang Subdivision Name Leisengang Subd. Lot # 2 Mailing Address 155 Wiccopee Road, Putnam Val l Py., NY ZiPi 0 S:79 Date Construction Permit Issued by PCHD 7 / 2 3 / 01 17 Pondview DriveNY Separate Sewerage System built byBVA Construction Address Hopewell Junction, �a533 Consisting of 12 5 0 Gallon Septic Tank and 375 LF of Leaching Tran nh ag Other Requirements: Water Supply: Public Supply From Address 152 Barger Street or: X Private. Supply Drilled byN�rman Anriar, Address Putnam Valley, NY 10579 _......._� - B.uilding.Typra')t e Fami:ly..Residenice.. -Has e'ro'sion con rof- be�n•completed? Number of Bedrooms 3 Has garbage grinder been installed? - no F , I certify that the system(s), as listed, serving the above premi were constructed essentially as shown on the as- built plans (copies of which are attached), in rdance with issued PC Co ction Permit and approved plans and the standards, rules and regulati ns of a Pu ty De ent f Health. Date: 6/6/02 Certified by P.E. R.A. x sign Profe nal) Address 2 Muscoot Road North Ma ac 1 0541 Lic e # 11056 Any person occupying premises served "/above system(s) shall promptly 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 revocavion, modificatigot or change is necessary. By: Title: Date: White copy - HD Fil ; Yel py - Building Inspector; Pink copy - er; Or4 copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Welll:ocaton - Street Address: �� 3� aMap ax Grid # Block Lo(s) Well Owner: Name- Address: Al L �-� Use of Well: 1- primary 2- secondary 7',I- Residential 6hblic Supply A' cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment 7,"- Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened `'" Open end casing Open hole in bedrock _ Other Casing Details Total length a-ft. Length below grade Diameter `7 in. Weight per`foot �lb /ft. Materials: _ 77 Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: ,� Yes No Liner _ Yes ?<4o Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours7t Yield �gpm Depth Data Measure from land surface- static (specify ft) –3 a r During yield test(ft) Depth of completed well in feet 3 40 r Well Log If more detailed information descriptions or saeye analyses.,—* are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 3.,6 960 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typ q,,C Capacity Depth 3 ®d Model .0 Voltage A3 D HP ,� it `6P Pa i Tank Type4& X46 Volume aft Date We I Completed Putnam County Certification No. Date of Report W Driller (signature) rTE: h(Ract location of well with distances to at least two permaKent landmarks to be provided on a separate sheet/plan. Well Driller's Name7i�e � — 4Z—, Address: N -ffl Signature: Date: S 1r3 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WC -97 5 YML ENVIRONMENTAL SERVICES 321 Kear Street Y - o,r'=k=t, o w= n Hei ' 'ht ,_ (014 245�28�W.7 Albert H. Padovani, Director LAB #: 32.203940 CLIENT #: 55578 STAT PROC PACE 1 LEISBVGANG, ERIC DATE/TIME TAKEN: 06/01/02 11:00A 155 WICCOPEE RD DATE/TIME REC'D: 06/01/02 12:35P PUTNAM VALLEY, NY 10579 REPORT DATEt 06/05/02 PHONE: (845)-526-2061 SAMPLING SITE: 155 WICCOPEE RD : PUTNAM VALLEY COL'D BY: ERIC LEISENGANG NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTYPROFILE 06/01/02 MF T. COLIFORM ABSENT /100 ML ABSENT 06/01/02 LEAD (IMS) <1 ppb 0-15 ppb 06/01/02 NITRATE NITROG 0.22 MG/L 0 - 10 06/01/02 I N/A ^� �~ 0-0.3 mg/l T7;7ll/t2 MAN@ANESE (Mn) <0,010 MG/L 0-0.3 mg/l 06/01/02 SODIUM (Na) 7.93 MG/L N/A 06/01/02 pH 7.6 UNITS 6.5-8.5 06/01/02 HARDNESS,TOTAL 84.0 MG/L N/A 06/01/02 ALKALINITY (AS 58.0 MG/L N/A .. 06/01/02- -TURBIDITY (TUR '1.2'NTU.' - - 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE NOT) OF A SATISFACTORY SANITARY dUALITY ACCORDI 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. 4blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD-value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and monganese 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 restricted diet',the water should contain no more than 20 mg/L of Sodium. For those on a moderately-restricted diet, a maximum of 270 mg/L of Sodium is suggested. 1008 9101 9139 9146 2037 2037 9043 YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 Albert H. Padovani, Director LAB #; 32.203?40 CLIENT #4 55578 STAT PROC PAGE 2 LEISENGANG, ERIC DATE/TINE TAKEN: 06/01/02 14400A 155 WICCOPEE RD DATE/TIME REC'D: 06/01/02 12:351-:' PUTNAM VALLEY, NY 10579 REPORT DATE: 06/05/02 PHONE: (845)-526-2061 SAMPLING SITE: 155 WICCOPEE RD : PUTNAM VALLEY COL`D BY: ERIC LEISEN8ANG NOTES...: KITCHEN TAP ~~~~~~~~~~~~~~~~°~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IrlPUR|HN| AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. ' SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L ' ~ - MODERATELY^HARD ER:��7(�� MG/L ' MG/L.= MILLlGRAM�PER LITER',''�`��= - ' - _',^ . '� _�. _-�-_ M ' - --'^-_'_ --- _._ - -'�_-~.�_ �._ _,'_--_ -'-_'-----'_ SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 1O598 7(91/4-) 245.-E!8{�) Albert H. Padowani, Director LAB #: 32.204B29 CLIENT #: 55578 NON STAT PROC I PAGE I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~�~~~~~ LEISENGANG, ERIC DATE/TIME TAKEN: 07/05/02 11:00 155 WICCOPEE RD DATE/TIME REC'D: 07/05/02 12:10 PUTNAM VALLEY, NY 1{}579 REPORT DATE: 07/06/02 PHONE: (845)-526-2061 SAMPLING SITE: 155WICC8pEE ROAD KITCHEN TAP SAMPLE TYPE..: POTABLE : PUTNAM yALLY, NY PRESERVATIVES: NONE C8L'D BY: ERIC LEISENGANG TEMPER#TURE�.: NOTES ... : COLIFORM METH: N/A ��----------- --- -------° ------��.�� DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 07/05/02 IRON (Fe) <0.06 MG/L 0-0.3 mg/l 2037 COMMENTS: PICK UP REPORT COMMENTSx Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: kka. - AEbert H. Padovani, M.T.(ASCP) Director EL.AP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH 1 - GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Eric Leisenganq 52. - 2 - 53.12 Owner or Purchaser of Building Tax Map Block Lot Eric Leisengang Building Constructed by 155 Wiccopee Road Location - Street One .Family Residence Building Type Putnam Valley TownNillage Leisenganq Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system 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. j Dated: Month 06 Day 0 6 ar 02 Signature: r `� Eric Leisencfan Title: n,'ne,- General Contractor (Owner) - Sign re Corporation Name (if corporation) Address: 155 Wiccopeg Road, Putnam Valley BVA Cons.i-ruction Corporation Name( if corporation ) e33 ioe Address: Ho ewl i Suncc 4 State NY Zip 1 0579 State NY Zipl 2533 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Eric Leisen Located at 155 Wiccopee Road TRi Putnam Valley Tax Map # 52 _ Block 2 Lot 53.1 2 Subdivision of Leisengan Subdivision Lot # 2 Gentlemen: FiledMap#2667-A Date Filed 7/9/.01 This letter is to authorize Joel Greenberg a duly licensed Professional Engineer or Registered Architect x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the co of said wastewater tretment and /or water supply systems in conformity with - the -provi ' 45 and /or 147 of the Education I.aw,. the Public H_ ealth Law, and the Putnam C a itary G Countersigned: P.E:, R.A., # 1 1 0 5 6 Mailing Address 2 Muscoot Road North State NY Zip 10541 Very tru Signed: Mailing Address:15:iGGepee Road Putnam Valley State NY Zip 1 01;79 Telephone: 845-628-6613 Telephone: 845 -5261 Form LA -97 AS BUILT PREPAED BY ROBERT BAXTER, P.C., N.Y. STATE LICENSED o C4 w —) LAND SURVEYOR NO. 49434 DATED MAY 30, 2002. N 0 loti j� �, tee! SA0 I THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM HAS BEEN a a o S ` CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT I EXPECT THE i SYSTEM BEFORE IT WAS COVERED OVER. THE SYSTEM WAS N w CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND 0 0 REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH. Z � AS- �ul�.-r LocgTlor•.a5 , G ITEM 1 ai ` ` 2 317 47 > W dC01edy \ ` , ` `�tiyO 5 55 3y) �b' �� \� •� 7 6 o F F J Q o 0 75 31 �00/ r p�j Q1 IG 75 9 V ,6z d` `3 r FT � \ I 701 g 0 -A Ib ROZ 9 iyY U Vl os r -o t 4 `` 15 94 132 4 ° J ti' °s V� �� N 1 X41- i; O�� \� • 1 1q 80 5 W t Y CC6 `, �8 78 48 IVELI r / �♦ ^G : u Liuiiu l:vutIcY Leyat• 6wnu ' vi �.-� F' 1vision of Environmental Health uSery Q kDDroved as noted for conformance vitb�� 4- `'\•y i 1— iDDlloable Hulea and Hegolatioae of the J` 1 a0 v 'utnam Coen Health Department.. Ei �I W LLA IIZZ LL1 �o. •CAGY * � we i -r?'m9 Q Q o W Z Y ! \ d G L T is Eb r PUTNArI COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES 6, FINAL SITE MPECTION Date: �L•0/SA1 4AAZ4 y f � � Owner Town 1/,rjLL Ey Permit # PLI— /0 -- 01 TM r 5,--2 — 9 — 57s , j Subdivision Lot # a 1. SeNvage Svstein Area a. STS area located as per approved plans ........................... b. Fill section = date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tan. size -1,000 .......1,25 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......................................... d. Distribution Bo . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renc es Length required 3715- Length installed :37.5-- 2. Distance to watercourse measured-f- I oo Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100%... :..................... 8. Size of gravel 3/4 -1 %:" diameter clean .................... _ . g..._Depth -of gravel ..............•... 10. Pipe ends capped .................................. :.................... g. PUmD or Dosed Svste s Size ot pump chamber ................ ............................... 2. Overflow tank ........................................ :................... 3. Alarm; visuaUaudio .................... ............................... - 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........... ........ ........................:...... 6. Cycle witnessed by H.D.est'unated flow /cycle.......:... III. House/Buildin a. house located per approved plans...'3**.... ; ...- ............ b Number of bedrooms. ... ' IV Well - a -Well located °as per approved NO COMMENTS IE_LI �of 9ra�:'iry cw/,v -b- "Distance from STS area measured LjOo ft.........:. c. Casing 18" above grade ............:..... ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. *Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing--drains-discharge away-from STS area ..... _,... _- 4. 04/12/2002 10:43 8456282807 JOEL GREENBERG PAGE 02 PUTNArix COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEUTH SERVICES ATT MON 11 ADAM ® GENE. U4 M TFMFF NA _MS ECTM For: Fill All information must be fully completed prior to any Trenches x inspections being made. PCHD Construction Permit # U -18 - 01 Located: WICCOPPEE ROAD (T) (V) PUTNAM VALLEY Owner /Applicant Name: ERIC LEZSENGANG TNI 52 Block 2 Lot , 53.2 FQrj�e1ly: DONALD LEISENGANG SubdMsionName: NANCY & DONALD LEISENGANG Subdivision Lot A Is system fill completed? N/A Date: Is system Complete? YES r}at e: 4/8/2002 Is system constructed as per plans? YES Is well drilled? - _ NO Date Is well located as per plans? N/A Are erosion control ineasures in place? YES I certify that the system(s), as listed, at the above premises has A. c0 ed and I have inspected and verified their completion in accordance with the i e PC 116 C nst,rucction Permit and approved plans and the Standards, Ru1esxwHMgu1afions f tl e P unity Department of A Date: 4.1 9 1.19 0 n 7 Certified PE RA X Address: 2 MUSCOOT ROAD NORTH .MAHO AG, .Y. Lie. # 11056 Comments: FormFIR 99 n1 1-k 1^" m M" nr-r1 lf7TMCF IT PIC 2 '� ... �.. ,., .. � ��1i ,4if.LtYs- R..r.�lJia�Cv,E.• .�.., r_ . .n,.. ,�- ._.+ �. ..m.. icu�. . Public Health Director April 17, 2002 _-Fr _� -,...� _,_ <. =•:�ORE�'FA � ��10�Il�Ti�R%- �ItT:; .:�,p u:lv`:'. r ,... Associate Public 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 Fix(845)278-6648 Preschool (845)228-5912 Fax(845)228-6113 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Re: Field Inspection - Leisengang Wiccopee Road, (T) Putnam Valley Lot # 2, TM# 52 -2 -53.2 Dear Mr. Greenberg: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Silt fence has not been installed. All silt fence must be properly installed per the approved plan prior to the start of any construction. :.:..3..._ .,2. ..- The well needs to be inspected upon - completion. - - -- - If you have any hither questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide Public Health Director April 17, 2002 R:IN - ii+i:SX. Associate Public 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Joel Greenberg, RA 2 Muscoot North, RFD #2 Mahopac, New York 10541 Re: Field Inspection - Leisengang Wiccopee Road, (T) Putnam Valley Lot # 2, TM# 52 -2 -53.2 Dear Mr. Greenberg: The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: 1. Silt fence has not been installed. -A fQrmai.notice of hearing may be issued if the violation is.not corrected within 5 days. It is truly hope drthat the aliove violations are corrected'withouf having fo take legafaction. GDR:cj Very truly yours, - 01 � Gene D. Reed Environmental Health Engineering Aide SENDING CONFIRMATION DATE : APR -18 -2002 THU 20:16 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96282807 PAGES : 0/2 START TIME : APR -18 20:15 ELAPSED TIME : 00,001, MODE : ECM RESULTS : NO ANSWER FIRST PAGE OF RECENT DOCUMENT FAILED TO SEND FULLY... Mute R FOLSY - LORMA MOLINAM R.N, M.B.N. Pa6176 H.dth D&rte A—daft 3AMla H- M Dtrm- ,ftwf of J-.&W &mw DEPARTMENT OF IMALTH 1 Gonave Road Bsewe . New York 10509 T.TIM Aw Ho7152 (940271.030 RN(14S)272 -7911 Metdge 6c.Am (24!)772 _6SSt ws"41)271. 6671 P- (647)172.6HS L1131mnaNm (645)376.6014 PQ( "n 271 -6MM Fv ("5)122.5911 f- (10=.6113 April 17, 7002 Joel Greenberg, RA 2 Mus000t Nortb. RFD 92 Mahopao, New Yol1t 10541 Re: Field Inspection - Lcisangang Wiccopee Road, M Putnam Valley Los k 2, TMA 52-2 -53.2 Den 3& Grecriberg: The above refereacod separate sewage treatment system on be backfilled. The following comments must be ourroetod in the field. 1. Silt fhnco has not been installed All silt fhnco must be properly installed per the approved plan prior to the start of any construction. 2. The well needs to be inspected upon completion If you have any farther questions, please contact me at (84S) 278 -6130 on. 2261. VQyuwyyours, Gene D. Reed GDR:cj Environmental Health Engineering Aide BRUCE-- li. -- FOLEY Public Health Director May 5, 2002 Associate Public 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. Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Joel Greenberg, RA RFD #2, 2 Muscoot North Mahopac, New York 10541 Re: Field Inspection - Leisengang Wiccopee Road, (T) Putnam Valley Dear Mr. Greenberg: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. �... _.... _ -- Nwfurther comments. _..:.. _: ..._ . .._. _ .. _,.. _....._ ._ If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE : MAY -6 -2002 MON 00:44 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96282807 PAGES : 1�1 START TIME : MAY -06 00:44 ELAPSED TIME : 00, 191, MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... - a BRUCE R. FOLEY LDRL+ITA MOLWARI R.N., bLS.N. AWL HmM DfrftW A.—I= Nuk Ilad1A Dasd c, Dhr f pm. S.W.. DEPARTMENT OF HEALTH 1 Own Road Br"t'. New Yolk 10509 9-1m. td 9eaaa (a6n276 -6120 Fw(a6n27a -7921 IImIIaa aaHea Mn2A•633a WIC (013)276.6671 F4(W)M.6063 ROY I—d" 0"nm -6016 is•(313)271.6612 Frelara a1n22a -3911 t4ap13)221.6117 May 5, 2002 Joel Graabcrg, RA RFD #2, 2 Muscoot North Mahopac,'iew York 10541 Roe Field Inspection - Leimgpmg %iceopeo Road. m Putnam Valley Dear Mr. GtamberX The above referenced separate aewapc treatment system can be backf led. The following comments must be corrected in the field. No Anther comments. If you have any further q=dons, pleaso contact mo at (945) 27 8-6130 ext. 2261. Very »y Yom, 6 Gm D. Reed GDR cj Erl*o=ertal Health Engineering Aide J13�uJ PUTNAM COUNTY DEPARTMENT OF HEALTH rT- .x1.i:. y. ?ti* DIVISI ®N OF ENVIRONMENTAL HEALTH SERVICES .. ♦.. .. z.. .. .i11 �f .C::.e�. ^.xn.G'..'..^ f.'vl. -M � .-ur -. v.• aw f.r tr .t .'. ... .. 'h At�.lwwt..� .... .. .e I'�}� -if .T.. .t,. Ia As y,� CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #. Located at WICCOPEE ROAD Town or Village PUTNAM VAr.r.Fy Subdivision name LEI SENGANG Subd. Lot # 2 Date Subdivision Approved 5 / 21 / 01 Owner /Applicant Name DONALD LEISENGANG Tax Map 5 2 Block 2 Lot P/ 0 53.1L Renewal Revision Date of Previous Approval Mailing Address 157 WICCOPEE ROAD, PUTNAM XXXE VAr...v NY Zip 1 nr,vA Amount of Fee Enclosed �$ -3 o o _ n o Building Type RESIDENCE Lot Area _ 5.0 3 3No. of Bedrooms -_ Design Flow GPD 6 Q 0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage Systeni to consist of 1.250) gallon septic tank and ^�� r.F QF:. LEACHING FIELDS' Other Requirements: To be constructed by NOT SELECTED Address - - _Water Su�nly: Public Supply From Address or: * ** Private Supply Drilled by NOT SELECTED Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and, regulatio tiaa he Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compli . ce" isfa ctory to the Public Health Director will be submitted to the Department, and a written guarantee will_ be mished t e owner, his successors,:.heirs or assigns by the builder, that said builder will place in good operAjrig conditi any part 1. said sewage treatment system during the period of two (2) years immediately following the da4 oA the iss i ce of the ap roval of the Certif Cate of Construction Compliance of the original system or any re airs thereto. __ I t � Signed: Address P.E. R.A. * ** Date 7/2/01 v n a T License # 1 10 5 6 APPROVE FOIX CO STRUCTION: This a�proval expires -two years from the date issued unless construction of the sewage trea en ystvfn has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necess y the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. Appr ved o d ch of domestic sanitary sews a only. By: Title: Date: Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design P ofessional Form CP -97 _# f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Pei mlt # — i = 0 Well Location: Street Address: Town/Village Tax Grid # WICCOPEE ROAD PUTNAM VALLEY Map 52 Block 2 Lot(s) 53. Well Owner: Name: Address: DONALD LEISENGANG 157 WICCOPEE ROAD PUTNAM Use of Well: k** 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 5 gpm # People Served _A_ Est. of Daily Usage 1 n 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ** New Supply (new dwelling) Deepen Existing Well Detailed Reason NEW DWELLING 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 DONALD LEISENGANG Lot No. 2 Water Well Contractor: Address. Is Public Water Supply available to site? ................................ ............................... Yes No*** Name of Public Water Supply: N/A To illage N/A Distance to property from nearest water main: N/A Proposed well location & sources of contamina ion be rovid d one ate eet/plan. Date: 7/2-/01_ Applicant Signatures: PERMIT TO Oiab RU T A WATER WE L This permit to construct one water well as set 0 e, 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 Ovate well dril er certifie by tnan County. � Date of Issue 7 1 Z �5) of i I Date of Expiration 7 1 2 O Permit is Non- Transferrabl Permit Issuing Title: White copy - HD file; Yellow.copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUN'T'Y DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A:WASTEW.A''.REATMLI`1T SYSTEII� i P ... . 1. Name and address of applicant: MR. & MRS. DONALD LEISENGANG 157 WICCOPEE ROAD PUTNAM VALLEY, N.Y. 10579 2. Name of project: LEISENGANG SUBDIVISION 3. Location TN: PUTNAM VALLEY 4. Design Professional: JOEL GREENBERG, R.A. 5. Address: 2 MUSCOOT ROAD NORTH 6. Drainage Basin: 7. Tvne of Proiect: HUDSON RIVER Private/Residential Food Service Apartments Institutional Office Building x Realty Subdivision 8. Is this project subject to State Environmental Quality. Review Type Status (check one) ....................... ............................... 9. Is a Draft Environmental Impact Statement (DEIS) required? MAHOPAC, N.Y. 10541 _ Commercial _ Mobile Home Park _ Other (specify) (SEQR)? Type I Exempt _ Type II Unlisted x ........................ NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, : ordinances? :::::::.- :.:::::..::.................:.............:....... .................... .,:.:....::..._ 13. If so, have plans been submitted to such authorities? ........ ...............:............... YES 14. Has preliminary approval been granted by such authorities? YES Date granted: JAN. 2001 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ............................................ :............................. N/A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system N/A Distance to sewage systemN /A 22. Date test holes observed 12/7/00 23. Name of Health Inspector ADAM STIEBELING 24. Project design flow`(gallons per day) ................................. ............................... 800 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC. 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? YF.s 28. Wetlands ID Number ............................................. ............................... .......... N/A 29. Is Wetlands Permit required? .............................................. ............................... NO Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No N 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ............................ ........................ YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... No 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number .......................... ............................... Map 52 Block 2 Lot 53.1 37. Approved plans are to be returned to ..... Applicant x Design Professional °_-NN-TE �A.11 applieations:for review ,ao( apptpxal:of a.ne_w: -SST.S to-be:located_within the -NYC Watershed shall= = be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is twee to the. best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: 157 WICOOPEE ROAD PUMAM VALLEY, N.Y. 10579 � P 14.1" (21e7) —T*xt 12 PROJECT 1.0. NUMBER 617.21 S EO R Appendix C State. Environmetltal Qwtltyj%witar; _.._...:w.- SHOAT* E=NVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (TO be cornnleted by Aoolicant or Proiect snnnsorl 1. APPLICANT /SPONSOR 2. PROJECT NAME DONALD LEISENGANG DONALD LEISENGANG J. PROJECT LOCATION: Municipality TOWN OF PUTNAM VALLEY County PUTNAM 4. PRECISE LOCATION (Street address and road Intersections, promtn*nt landmarks. ilc.. or prdvtde map) WICCOPEE ROAD S. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification/alteration A. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 7. AMOUNT OF LAND AFFECTED: Initially 5.0334 acres ultimately 5.0 3 3 4 acre$ A. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ICRTe>a ❑ No If No, describe prbfly 9. WHAT IS PRESENT LANDf USE IN VICINITY OF PROJECT? 0 Resirentlal u Industrial ' [3 on C mwclal C1 Agriculture ❑ PsrlOor"VOpen space nn u Other Describe: _. - _ <...• - 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL_ STATE OR LOCAU? Ely" 0 No If In. list AgencN61 and ON Ivapprovels PUTNAM VALLEY BUILDING DEPARTMENT it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL7 ❑ Yes If ye} Itst oq%ney name and perhwapproval 1:. AS A RESULT OF rROPOSED ACTION WILL E)UST1NG PERMIT /APPROVAL REQUIRE MODIFICATION? Ely" ® No I COMFY TNT E INFORMATIO V ED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Date: 7/2/01 Ao011canUSpon rr1e: a .(PROJECT ARCHITECT) Signature: IV Iit e a Ion 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 Ito oe completea Dy Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617.12' It yea, coordinate the review iNoce" and use the FULL EAF ❑ Yes J No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN S NYCRR. PART 617.111? It No, a nagetive dectaratlon . stay too suporsaaeq by another Involved agbiii y: " ❑ Yes ❑ Nu C. COULD ACTION RESI.ILT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answo may be tusndwntteh, If leglblel Cl. Exiating air quality. aurfaCe or groundwater quality or quantity, nose* levels. exlett" traHto pettarvW solid waste production or disposal. potentiai for on soon, drainage or flooding p(oblems? Explain briefly: C2. Aeethalie, egro.ultural, archaeological, historic. or other natural or cultural resources: or community or nslgftborlsood Character. Explain briefly: CJ. Vegetation or fauna, fish, shellfish or wildlife siseciea, significant habitats, or thr®atoned or oftengumd specism? Explain briefly. C4. A community's existing plant or goals as officially adopted, or a change in use or intonaft of use of lend or Other natural resources? Explain briefly CS. Growth, subsequent development. or related actMties likely to 11x1 induced by the prop000d mabon? Explain oftfly. C6. Long term. short tarn, cumulative, or other effects not klentit" In CI-07 Explain brtefty. C7_. Other impacts (Including changes in use of eittwr quantity or type of .energy)? Explain bristly. Q. ='13i IERE OR IS THEE UKEi:Y T-b -i3 ; coKrRavEm TED'TO "PI YD` DIAL ADVERSE ERIVIRONtaiEPiTAL IMPACTS? ❑ Yes ❑ No If Yea, ettown waft PART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse @!fact id@ntlfled above, determine whether It is substantial. large, important or otherwise significant Each offset should be assessed in connection_ with Its (a) twtfing. (i.e. urban or rural): (b) probability of occurring; (c) duration: (d) irreversibllity; (e) geographic scope; and M magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relmnt advert Impacts have been identified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts which .MAT occur. Then proceed directly to the FULL EAF andlor prepare a positive declaration. ❑ Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant, adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: not or glee Name or Responsobit Uffocior in Load Agency 1pwturli of AvivorossbN Officer on L*84 Asencv Harm ol Lvad Agency Otte es>�1 Title of espons a officel renetwre 0 Isymarer III diff=t fror" r"ponsible off Iced PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner DONALD LEISENGANG Address 157 WICCOPEE ROAD PUTNAM VAbbEYFN.Yi,1U_-)19_— Located.at (Street) WICCOPEE ROAD Tax Map 52 Block 2 Lot 53.1 (indicate nearest cross street) Municipality TOWN OF PUTNAM VALLEY Watershed HUDSON RIVER LOT # 2 SOIL PERCOLATION TEST DATA Date of I Pre-soaking 12/11 /00 4 4fi8 loi Date of Percolation Test 12/12/00 2 8:47 9:17 30 23 25.25 2.25 30/2.25 =1 . 3 9: 8 9:48 30 23. 25.25 2.25 30/2.25=12. 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. :5 1 min for 1-30 • in/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 � 3 3 3 ..... . ... . .. D Depthl'd*aIer - W ... . . .... . ...... - E .::...From Ground - eve ' . !. . .. ' . Surface I In R Rate d I ......... . .... . ...... a S ...... .... n. . . .. 8:02 8 8:32 3 30 2 22 24.5 . .2.5 3 30/2.5=12 mi/2 /06 2 2 8 8:33 9 9:03 3 30 2 22 24.5 2 2.5 3 30/2.5=12 3 9 9:04 9 9:34 3 30 2 22 24.5 2 2.5- 3 30/2.5=12 4 5 8:04 4 8 8: 3 4 - -.30 2 23 .25..5 2..$- 3 30/2..5F-.l? 2 8 8:35 9 9:05 3 30 2 23 25.5 2 2.5 3 30/2.5=12 3 9 9:06 9 9:36 3 30 2 23 25.5 2 2.5 3 30/2.5=12 4 5 1 8 8:16 8 8:46 3 30 2 23 25.25 2 2.25 3 30/2.25 =1 . NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 • in/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 � 3 3 3 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES DEPTH.- HQLE.NO. . F M1 G.L. -$" TOPSOIL., ()-V TOPSOIL �� TOPSOIL u a f 0.51 81.' -3'Z FT.BROWN SANDY SILTY 28 "BROWN SANDY SILTY. X560 -BROWN SANDY SILTY 1.0 LOAM LOAM LOAM S2" -4'14 G2AY SONY QAYEL 2f3 ,� Y .3 VL G 2AY S 3140Y 1.5 � re L 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' Nof 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered 6 FT. Indicate level at which mottling is observed NONE Indicate level to which water level rises after being encountered 6 FT. Deep hole observations made by: ADAM STIEBELING Date 12/7/00 le/m/oo Design Professional Name: JOEL GREENBERG, R . A . Address: TWO MUSCOOT ROAD NORTH Signature al �(LaED qR 1 4,° 011016 0 OF t4F i a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of MR. & MRS. DONALD LEISENGANG Located at 157 WICCOPEE ROAD T/V PUTNAM VALLEY Tax Map # 52 Subdivision of Subdivision Lot # 2 Gentlemen: LEISENGANG Filed Map # Block 2 Lot 53.1 N/A Date Filed N/A This letter is to authorize JOEL GREENBERG, R.A. a duly licensed Professional Engineer or Registered Architect x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in - -- :conformity-with the provisions of Article, 145 and/or - 447- :ofAhe= Education -Law, the.P_- u_blic H_ ealth Law, and the Putna anita Co e. Countersign P.E., R.A , # 1 Mailing State NEW YORK P c. 0110 Zip 10541 Telephone: 845 628 -6613 Very truly yours, Signed: ��w ' (Owner of Property) Mailing Address: 157 WICCOPEE ROAD PUTNAM VALLEY State NEW YORK Telephone: 845 526 -2061 Zip. 10579 Form LA -97 R .000 Fvs q) eick :10 w lk X o -slmFvc--,TA Aza 0 HOUSE P \ Lie A. ly, (1) p p do 7 car ----------------- ------- 680 spring -10 000- 0000 ./N 5 .00 5 -0-9'24' guy Cable L 45. 00 70 —11e J, MGM m W0, Q $S. a ;0, a