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Home My WebLink About2611DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2- 53.112 BOX 22 02611 off Is if J E 9L . �� . �� Lj[ T� m ■ �I } M . Is � . ii.- ` 02611 PUTNAM COUNTY DEPARTMENT OF HEALTH ;: ; Y DIVISION OF ENVIRONMENTAL HEALTH SERVICES_; : ;:."t' i�arNT SF TION WELL COMPLETION REPORT Well Location Street Address: 61 /(:0. Q� Town/Village: ul"M V� l Tax Grid # p $ Map Block Well Owner: Name: Address: P66 11415en a>q Use of Well: 1- primary 2- secondary 1 Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion is Compressed air percussion Other (specify) Well Type Screened Open end casing )( Open hole in bedrock _ Other Casing Details Total length ft. Length below grade p ft. Diameter 7 in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _X Threaded _ Other Seal: a(, Cement grout _ Bentonite _ Other Drive shoe: _X Yes _ No Liner:_ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface - static (specify ft) -reed reed During yield test(ft) 130 om Depth of completed well in feet a2v� Well Log If more detailed information descriptions or sieve analyses _ .... . are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 6 t) If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity jo_6fTA Depth 310 Model 1607 Voltage oq3 0 HP 3 Tank Type, i Volume Date Well Comp eted /� 47 Putnam County Certification No. 00-7 Date of Re ort d b well Driller (signature) d NOT E act location of well with distances to at least two permanent an arks to be provide on a separa a ee p an. Well Driller's Name 6G(- /'I Cc 7�SOHS Addressll:%J � Sati Signature: Date: 149 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 t. ... -- TNAM COUNTY DEPARTMENT OF HEALTH '191, 9 HEALTH E CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS PCHD CONSTRUCTION PERMIT # PV__13- 04 Located at 151 Uf 1 CC®PEa KCAD Town or Village &77VAt,4 VQ4E u Owner /Applicant Name ROBERT LEISEd�1AN Tax Map 5Z Block Z Lot 53.117- Formerly Subdivision Name Li 1sj& eti7 Or Mailing Address CC Subd. Lot # 2— Zip Date Construction Permit Issued by PCHD M4 V 26 / Z ook Separate Sewerage System built by 3M i�H*QW/ICK Address SOFbSay kl , Pur vdm 0ftat Consisting of :1250 Gallon Septic Tank and 3?> Ls F. pF `%"o PER1=0/207-r9p pl c Ft W 7-.y" VKAVEL TketicH 11V 214 M1m 9�RRVA1 Other Requirements: Water Sunnly: Public Supply From dLA Address l-Q ®8 ROUTS 311 or: V Private Supply Drilled by 69T f4. � �` SbNS Address Y4T16 /ZSav 1 A/y s/+��iB.r1 t�� RES . Has erosion "control been com feted? Building Type p` Number of Bedrooms Has garbage N�A I certify that the system(s), as listed, serving the ab is I e stru , sentially as shown on the as- built plans (copies of which are attached), in ord e , a is :dGID C ns ction Permit and approved plans and the standards, rules and regulat' s o 0 e ealth. Date: N4Y ZOOS Certified b < � P.E. R.A. (Design ProfessiU Address 2. J01f Al (NOW bo AP, �! t�f i[.�' ` `" `J_ ,.License # ®rJ29 90 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, modificationX change is necessary. Title: ApAi Date: 5- ` Q copy - HD File; Yellow copy - `Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914.) 245 2$.0_0. Al�ert� Fi.''�Paclovani, Director' LAB #: 1.801675 CLIENT #: 60728 NON STAT PROC PAGE: 1 of 2 LEISENGANG, ROBERT DATE /TIME TAKEN: 04/08/08 09:30 151 WICCOPEE RD DATE /TIME REC'D: 04/08/08 10:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 04/15/08 PHONE: (845)- 721 -1120 SAMPLING SITE: SAME AS ABOVE SAMPLE TYPE..: POTABLE : BASEMENT TAP PRESERVATIVES: NONE COLD BY: ROBERT LEISENGANG TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/08/08 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 04/09/08 LEAD (IMS) 2.5 ppb 0 -15 ppb SM 18 -19 3113B 04/11/08 NITRATE NITROG 9.17 MG /L 0 - 10 SM18- 204500NO3 04/10/08 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 04/10/08 IRON (Fe) 0.355 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/10/08 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/10/08 SODIUM (Na) 54.1 MG /L N/A SM 18 -20 3111B 04/08/08 pH 7.6 UNITS 6.5 -8.5 SM18 -20 4500HB 04/08/08 HARDNESS,TOTAL 74.0 MG /L N/A SM 18 -20 2340C 04/08/08 ALKALINITY (AS 94.0 MG /L N/A SM 18 -20 2320B 04/14/08 TURBIDITY (TUR 3.8 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATER WAS),(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATERTSTANDARDS_,,_FOR.THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 LAB #: 1.802195 CLIENT #: 60728 STAT PROC I PAGE: 1 of 1 LEISENGANG, ROBERT DATE /TIME TAKEN: 05/08/08 10:00 151 WICCOPEE RD DATE /TIME REC'D: 05/08/08 10:45 PUTNAM VALLEY, NY 10579 REPORT DATE:. 05/09/08 PHONE: (845) -721 -1120 SAMPLING SITE: 151 WICCOPEE RD SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: DONALD LEISENGANG TEMPERATURE..: < 4C NOTES...: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 05/09/08 IRON (Fe) f0.060 MG /L 0- 0.3°mg /l SM 18 -20 3111E COMMENTS: PICK UP COMMENTS: Fe /Mn If bath iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. SUBMITTED BY: ______ v"______ rS�CP) _ Albert . Padovani, M.T.( Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 .(914) 2.4.5.12800_ : z.:<. r...:- :�._..:n- .....�.....�<a._�...a. _ r ..�. F�Albert M. Padovani, Director <..�. LAB #: 1.801675 CLIENT #: 60728 NON STAT PROC PAGE: 2 of 2 LEISENGANG, ROBERT DATE /TIME TAKEN: 04/08/08 09:30 151 WICCOPEE RD DATE /TIME RECD: 04/08/08 10:00 PUTNAM VALLEY, NY 10579 REPORT DATE: 04/15/08 PHONE: (845)- 721 -1120 SAMPLING SITE: SAME AS ABOVE SAMPLE TYPE..: POTABLE : BASEMENT TAP PRESERVATIVES: NONE COLD BY: ROBERT LEISENGANG TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ------------------------ - - -- -- ---------- --- -------------------- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. PH PH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF PH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF PH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L .-MODERATELY-HARD-WATER.: HARD-WATER: 70 -140 MG /L MG /L =--MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon =- 17.2-MG %L) SUBMITTED BY: Albert H. P dovani, M. .(ASC ) Director ELAP# 10323 '08 -04 -23 08:49 FROM- T -877 P003/004 F -439 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ROBERT LEISENGANG 92 2 53.1 Owner or Purchaser of Building Tax Map Block Lot ROBERT LEISENGANG Building Constructed by WICCOPEE ROAD Location - Street SINGLE FAMILY RESIDENCE Building Type TOWN OF PUTNAM VALLEY TownNillage LEISENGANG Subdivision Name 2 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 regWations ofthe Putna n County Department ofl Cealth, 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 ffirtlier agrees -to accept a`s conclusive the Aetertnination- cif the public Heilth Director of the Putnam County Department of Health as to whether or not the failure of the systelp to operate was caused by the willful or negligent act of the occupant of the bVildingAtilizipiAc system: Date on D. Year 05 i Signature: Title;�� bignarure I ( /^ 4 Corporation Name (if corporation) Co oration Name (if corporation) I Address. �� R41 Pi) &,a G,, /p ddress: State h1 �' zip State - Zip y Dorm 09.99 108 -04 -18 10:53 FROM- BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 T -871 P002/002 F -424 LORBTTA MOLINARI R.N., M.S.N. Amociate Public Health Dhwetor Director of Patient Services Environmental Hcaltb (843) 278.6130 Fax (843) 278 - 7921 Nursing Services (843) 278 - 6558 WIC (845) 278 ■ 6678 Fax (043) 278.6083 Early rntervention/Prelcbaol (845) 278 - 6014 Fax (84S) 278 - 6648 E911 ADDRESS VERIFICAxION FORM OWNERS NAME: Robert Leisengang TAX MAP - -1) - B911 ADDRESS:151 Wiceopee Road TOWN: Putnam Valley AUTHORUED TOWN OFFICIAL: DATE: The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911verftm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. WELL COMPLETION REPORT pWeIlOwner: on Street Address: ® Town/Village: G4//i 'qM QI Tax Grid # Map Block Lot(s) Name: Address: �b le 'en Use of Well: 1- primary 2- secondary / Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion i( Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length __�,Lft. Length below grade 'eft. Diameter 7 in. Weight per foot _ZTlb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _X Threaded _ Other Seal: X Cement grout _ Bentonite _ Other Drive shoe: Yes _ No Liner:_ Yes'Y No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _Pumped I Compressed Air Hours _6 Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) No Depth of completed well in feet J Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface � d j If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 6itt Capacity '0 6frn Depth 3 zy Model 1607 Voltage On HP -j– Tank Type Xtm ( Volume �! Date,+Well Completed 01-b-16 7 Putnam County Urtification No. 1 007 Date of Re ort /Oil Well Driller (signature) NOTF/ Efict location of well with distances to at least two permanent land/harks to be provided on a separate rettplan. Well Driller's Name Jam! bar' /'1 • P14al 7` Soros Address: , F &Arsbk Signature: Date: L White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ... LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT J. BONDI County.Executive ROBERT MORRIS, PE Director of Environmental Health May 7, 2008 Re: Construction Compliance — Leisengang 151 Wiccopee Road (T) Putnam Valley TM # 52- 2- 53.112 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The iron level is over the maximum contaminent level of 0.3 2. The chart title should be "as -built distances ". 3. The relocation dimension for the well should be column "C ", not column `B ". 4. The trench ends need to be located from two visible fixed points. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Very truly yours, r PC" 1 'Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Far (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Tel.: 914 - 736 -3664 o Fax: 914 - 736 -3693 May 1, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Robert Leisengang Certificate of Construction Compliance 3 Bedroom Residence 151 Wiccopee Road Town of Putnam Valley, New York 10579 Section: 52.00, Block. 2, Lot. 53.112 Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: 1. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. 2. Three (3) Copies of a two (2) year guarantee signed by the Owner & the Installer Wef!`Com° l6tidn_- F,1e0.:it� sionedby Milton Hyatt he Well D.rill6l` 4. One (1) Copy of Satisfactory Results of a Water Analysis by a NYSDOH Approved Laboratory. 5. One (1) E911 Address Verification Form 6. Four (4) Certificates of Construction Compliance 7. Four (4) Sets of "As- Built' Plans signed and sealed by the Design Professional. 8. One (1) Copy of As -Built Foundation Survey by Baxter Land Surveying. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, es W. Teed Project Engineer cc: Robert Leisengang- Owner File- Paravati - Leisengang- Wiccopee Road- SSTS -As- Built - Trans - JT- 20080501.doc SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Cronin Engineers ag The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 To Whom It May Concern: ROBERT J. BONDI County Executive ~ROBERT MORRIS, PE Director of Environmental Health April 22, 2008 Re: Field Inspection — Leisengang Wiccopee Road (T) Putnam Valley, TM # 52. -2 -53.1 The above referenced separate sewage treatment system can be backfilled. The following comments need to be corrected. in-the field. • Silt fence needs to be repaired /replaced and installed per the approved plan. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Very truly yours, V Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OFENVICRONMXNTAL: HEALTH -SERVICES FINAL SITE INSPECTION Date: N Inspected by Street Locatiori'�:-1,�lc�o p `iZoaa' s _ _� ILL ,Gvvner Town r JAM tkLLg X ZP6 rmit 3�o7 T1VI # �z ; — S3 . Subdivision Lot # .2 1. 'Sewasle System Area YES O: COAMENTS z,; as era roved plans ........................... p approved.: b.. Fill:section 'date of,placemen.t I o� 3:1 .bamer' Lgth. 'Width Avg':Dpth . .c.:Natural.soil not stripped...... d. Stone; brush, .etc. j ST eater <than:l5' from STS:area..:...:... . e. 1.00:-from.water course/ wetlands .:..... ..............................: IL Sewa�eS� stem 7k....la'o�r raw a :Sep tic' :tanksize 1,0.0D ...:. 1,250. ..... other �o�ra�c ao` b..Septic"tank iristalled1evel .......................... ..: ..:..... ' c. 10 nffi um fron ' foundation .......... ............................... d. Distf butionBox 1. Alh.outlets At.a'ame elevation- water tested :..:..... . 2. Protected below frost ..... ...............:.:..... :.:..... 3. M nimum 2 ft:Original soil between box & trenches . - e. .Junction Bog properlyaet ......:.... ............................... 6. 'trenches 1.:Length °required 3 -:; 3 Length installed s 2. Distanceao. watercourse measured 4- t c� oFt.:........ 3. Installed ,according,to plan ............... 4. `Slope of trench acceptable 1/16 1-/32" /foot :............ 5. .10 ft.. from:property line -.20 ft:- oundations.......... 6. Depth .of trench <30 inches. from, surface .................. 7. Room.allowed:_for expansion, 100 %0......... : ............... 8. Size of, gravel 3 /4 - l "A" diameter clean .................... 9.- Depth of: gravel. in 12" minimum ............:...... 10: Pipe ends , c appe d .:.:.::.:.................::.. g. Pump :or Dosed,-Systems 1. °Size .of pump chamber ................. .............................. 2.: Overfl ow :, tank .............. .................................................. 3: Alarm, :..:. ............................... 4 —Puimp easily:accessible, manhole..to grade ................. x baffled . ....................... ............................... 5. Firstbo 6.:C�� y..cle :witnessed by H:D..estimated flow /cycle........... HL buseBdl ins a. - Houseaocatedper .: approved :plans................. b Number of:bedrooms ..... ...... ......... 3/............ IV. Well vP - 2 Xzn ,�to�e� _f fo'' -to o-F 6a-;e_ Well. located as per approved plans . ......:........................ b. Distance from STS: area measured /z/ ft........... c. Casing. 18,E above grade ................ ............................... d. Surface: drainage around well . acceptable ....................... V. Overall W.orlananshin . a.. Boxes properly :grouted ............... b. . All .pipes:part ally backfilled ........... ............................... c. .All-:pipes'flush.with: inside: of box ... ............................... d. Backfill material contains _ stones <4" diameter............... e. Curtaindrain & standpipes installed according to plan.. f. Curtain:draiii outfall,protected &.dinto exist watercourse g. Footing drains discharge away from'STS area.. ............. h. Surface water protection adequate .... ............................... i. Erosion control provided ........:........ ............................... Rev. E102 Form 73 '08-04-18 14:01 FROM- LO PUTNAM COUNTY DXPA.RTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM GENE RFQY TBSTTOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. T-872 P001/001 F -426 PCHD Construction Permit # PV~` / 3 — o a S Located: 1C o V) purN r �/t&6;t4 Owner /Applicant Name: 15FdAeArt/A4U-t� .. �z . Block � Lot 5% 2 Formerly: Subdivision Name: �tAD 611Wiy�alod 4c ),roc. Subdivision Lot # Is system fill completed? Date: JOLA 3 , ZoW Is system complete? v6s Date: -APg1 f ioo9 Is system constructed as per plans? �✓� S�� Is well drilled? _ Date: MAge 2n�� Is well located as per plans? alia s6 Wmmc�� Are erosion control measures in place? v. s I certify that the and verifiYL.-' approved Health. 4, a above premises has been constructed and I have inspected _ a& rdance with the issued PCHD Construction Pernut and rcl u s. and Regulations of the Putnam County Department of �• � 629$0 f y by: Design Professional PE __ W� RA Address: Z JOKE f avL-aywa> xri E-;K it w. Lie. # ' 21790 Comments: 9GIAH7. 0150. - -- L K W L 'prod CALF - W W JW14 f1fir4 � iihn (iRiYK 'to J044�Cw� X �S` HDfr_ IJIT �?laA a PvrJ h%w% E44l; 1b Twc (Sim-3T rHS-c�i� FormFTR -99 1 XNE CG. Ct.15MM fl 2A )ZT- (X1601V**A wNON StNSAvawu P- SITE Vi /vT I U1111,31,4161 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # &1 -1 ; ,,g Located at WICCOPEE ROAD Subdivision name LEISENGANG Subd. Lot # 2 Date Subdivision Approved Owner /Applicant Name ROBERT LEISENGANG Town or Village PUTNAM VALLEY Tax Map 52 Block 2 Lot 53.1 Renewal Revision Date of Previous Approval Mailing Address 157 WICCOPEE ROAD. PUTNAM VALLEY. NEW YORK Amount of Fee Enclosed $400 Zip 10579 Building Type SINGLE FAMILY RES Lot Areas . 33 AC. No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 5 0 gallon septic tank and 333 L . F . OF 4" DIA. PERFORATED PVC IN 24" TRENCH FILLED WITH 3/4" TO 1 -1/2" WASHED GRAVEL. Other Requirements: 24" BANKRUN To be constructed by TO BE DETERMINED Address Water Supply: Public Supply From Address or_ Private Supply Drilled by TO BE DETERMINED Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Cons Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a writte aim 44,t rnished the owner, his successors, heirs or assigns by the builder, that said builder will place in go irtg i�in y part of said sewage treatment system during the period of two (2) years immediately followin a of the iss a approval of the Certificate of Construction Compliance of the original system or any repair . t_e ` , -;, ,Y / Signed: �- y P.E. R.A. X Date D 40 /03- Address THE LINDY B , �9W Ad;S BOULEVARD, PEEKSKILL, NY License # 062980 APPROVED FOR CONST This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit, Approved for discharge of domestic sanitary sewage only. By: t:/ °��' Title: r`T%" Date: If Whit opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1. APPLICATION TO ZONSTRUCT A WATER WELL., .. _ _ please print or type PCHD Permit # PV t _ - -1'7 f Well Location: Street Address: TownNillage Tax Grid # WICCOPEE ROAD PUTNAM VALLEY Map 52 Block 2 Lot(s) 53.1 Well Owner: Name: Address: ROBERT LEISENGANG 157 WICCOPEE ROAD, PUTNAM VALLEY, NY 10579 Use of Well: le 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 5 Est, of Daily Usage 40o al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _ New Supply (new dwelling) Deepen Existing Well Detailed Reason CONSTRUCTION OF NEW RESIDENCE for Drilling Well Type Drilled Driven Gravel Other Iswell site subject to flooding? .........................................:....... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes � No Name of subdivision LEISENGANG SUBDIVISION Lot No. 2 Water Well Contractor: TO BE DETERMINED Address: N/A Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: N/A TownNdlage N/A Distance to property from nearest water main: N/A Proposed well location & sources of contamination to be provided on separate sheet/plan. O Dae-:- APAIC 1?sr 'l- . Applicant Signature; p :✓+ � � - „ . Af PERKU TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED, FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well'has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. ,Q Date of Issue 5-//&/0'7 Permit issuing Official Date of Expiration S 1b n Title: s` G2 n. %yet,✓' Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LETTER OF TRANSMITTAL CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Joseph Paravoti Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: SSTS Plan for Robert Leisengang Tax Map Sec: 52 Block: 2 Lot: 53.1 Wiccopee Road, Putnam Valley THESE ARE TRANSMITTED as checked below: May 7, 2007 X FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY Dear Mr. Paravoti, In reference to the above mentioned project please find the following: 1.) Four revised copies of Subsurface Sewage Treatment System Plan 2.). Four. revised applications for a construction permit . 3.j • 1 revised'copy of application•for plan-approval 4.) 1 additional copy of an application to construct a water well The plans have been revised to reflect your comment letter dated May 7, 2007, which includes the following: Application has been revised to show only design criteria for a 3 bedroom residence 3!�Total LF of trenches now provided is 333LF for both the primary and 100% expansion Floor plan corrections have been pursuant of your conversations with our office via telephone on May 7, 2007. / roposed bedrooms is now shown on plans $. Corrections in pen have been changed to typed text Fill notes are now on plan All fill has been extended 10' past the trench ends Additional well permit has been provided Please revi at your earliest convenience. Thank you for your assistance in this matter. Respectfully gubmitted, ame eed olect Engineer SHERLITA AMLER, MD, MS, FAAP Commissioner. of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 7, 2007 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Proposed SSTS — Leisengang Wiccopee Road (T) Putnam Valley, TM# 52 -2 -53.1 Dear Mr. Teed: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Based on the approved subdivision, the maximum SSTS design is for 3 bedrooms. Howeve:, the application appears to be a mixture of design criteria for 3- bedroom and 4- bedroom. 2. The_floor.plans provided have a minimum of 4 potential bedrooms. .__...•- 3:_._..._.`I'he "tofaTLE trench-es'pr -oVided- aie- ,al'350r isle . -- Based- on-the- percolation amount is 3 feet less than the required amount for a 3 — bedroom design. 4. The amount of proposed bedrooms needs to be noted on the plans, preferably on the proposed house location. 5. The corrections in pen in the general notes should be revised to be computer generated. No corrections in pen will be acceptable on the plans. 6. The fill notes have not been provided. 7. All fill is to extend 10 feet past the trench ends. 8. One more well permit application is required (only 3 were submitted). This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. Very truly yours, L�/seph S. Paravati, Jr. Assistant Public Health Engineer JSP/kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 =6648 MEMORY TRANSMISSION REPORT TIME MAY -OT -2007 02:2909..: TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 777 DATE MAY -07 02:28PM TO 919147363693 DOCUMENT PAGES 001 START TIME MAY -07 02:28PM END TIME MAY -07 02:29PM SENT PAGES 001 STATUS OK FILE NUMBER 777 * ** SUCCESSFUL TX NOT ICE * ** SHERL(TA AM LER. MD, MS, FAAP Co,rsmfssloncr orHswfth LORETTA MOL�NARI� RIV. MSN AssoeimB Commtsslonsr ofJYeolrh E)EPARTMaNT OF "F=AL-rH 1 Geneva Moad, Brewster, New York 10509 May 7, 2007 RQ}BERT J_ $ONO( Coat�rry F}nocr,e/..e ROBERT MORRIS. PE 0/ sClor of Em+ /ronmBr+to! Hsalth James W- -reed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peek %]till, NY 10566 - _ - _ _. �. - P-e: Proposed SS-ZS — Leisengang Wiecopee Road (T) Putrlarn valley, TM# 52 -2 -53.1 Dear Mr. Teed: This of!nce has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Based on the approved subdivision, the maxirnum SSTS design is £or 3 bedrooms. However, the application appears to be a mixture of design criteria for 3- bedroom and 4- bedroom. 2. The floor plan% provided have a minimum of 4 potential bedrooms. 3. Zhe total LF trenches provided arc at 350 LF. Based on the percolation rate, this amount is 3 feet less than the required amount for a 3 — bedroom design. 4. The amount of proposed bedrooms needs to be noted on the plans, preferably on the proposed house location. 5. The corrections in pen in the general notes should be revised to be. computer generated. No corrections in pen will be acceptable on the plans. 6. The fill notes have not been provided. 7. All fill is to extend 10 £eet past the trench ends. S. One rnore well peranit application is required (only 3 were submitted. This office will continue its review upon consideration of the above - mentioned comments. please feel free to contact me at est. 2157 if any questions arise. Very truly yourss,,, S_ Paravati. Jr. Assistant Public Health 1= ngineer JSP/kly 6nviron,naaea{ Health (84$) 278 -6130 Fax (845) 278 -7921 W- Supply Section (845) 225 -5186 Fax (84S) 225 -5428 M-iag Services (845) 278 -6558 Fex (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Cary {ntervention /Preschool(943) 278 -6014 Fax(845)278 -6648 4 PUTNAIVI COUNTY DEFARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH ...... NT _ .;..:.... . l:. _... - ..;.. INDIVIDUAL WATER SUPPLY & SUBSURFA E SEWAGE TREATME SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT P'VI.( 3- `7 NAME OF OWNER: STREET LOCATION: REVIEWED.BY: RM, G J.�P SRDATE: £' TAX MAN: (CONFRUAI D) 53: 1 Y , N DOCUMENTS Y / N 1REOUIRED DETAILS ON PLANS CONT'Dl PERMIT OR PWS LETT�ER� ER OF AUTHORIZATION W DATA SHEET (DDS) ORATE RESOLUTION T RAF - U PLANS -THREE SETS OUSE PLANS - TWO SETS VARIANCE REQUEST SUBDIVISION ()(„LEGAL SUBDIVISION �SUBDTYISION PROVAL CHECKED �PERCRATE�G' i �L REQUIRED DEPTH (___)(CURTAIN DRAIN REQUIRED GENERAL L}(OCATED.IN NYC WATX19.SHED UUPLANS SUB1�11TTE_ - r If - 1T- tVTTir!A Ir Drq:m �Z?—XPPROVAL, IF REQ'D . . (DEEP TEST HOLES OBSERVED )(�PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWNIDEC PERMIT REQ'D ?) DATA ON DDS- PLANS & PERMIT SAME - 1(;,;,��PRE 1969 NEiGESOR NOTI1vTCA.TION„ • _�•._. ,..._ -.. .. �., :'.c� ETTER. BU7.BA . • . t ' .)�OO YE: FLOOD ELEVATION W1I 200' !mil( /1SOIL TESTII�IG LOTS >IO YEARS OLD EWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE GRAVITY FLOW :ONSTRtCTION NOTES 1 -15 IESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING/GUTTER/CURTAIN DRAINS _- „)USDA SOIL TYPE BOUNDARIES (_)TITLE BLACK; OWNERS NAME ADDRESS / TM#, PE/RA; NAME, ADDRESS, PHONE# --')C JDATE OF DRAWINGMEVISION DATUM REFERENCE . LOCATION OF WATERCOURSES, PONDS S,WETLANDS WITHIN 200' OF P.L. %,) ROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS A SSDS'S WAN 200' OF SSTS ROPERTY METES & BOUNDS =)c--)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE )AZIEENTS: C �HOUSE SEWER - W FT. 4 "0'; TYPE PIPE. CAST IRON (U/ (_ __-)NO BENDS; MAX BENDS 4T W /CLEANOUT RENEWALS (--- )L-JSTTEkcIT*#10 CHANGE) FILL SYSTEMS k�j�10' HORIZONTAL';-P,AST TRENCH SLOPES 3:1 TO GRADE ' FILI, SPECS /FILL NOTES 1- �� L PROFILE &DIMENSIONS /.r 6 7 'L-j(_) CLAY BARMA (�(_)FILL'CERTIFICA UUDEPTE[ GAUGES 1 -0"1” FOR R.O.B., tNCLASSOUD & EMPERVIOUS ARATION DISTANCE FROMTOE OF SLOPE 60FT MAX. )DETAOIJU ST FREE CRUSHED'STONE OR WASHED GRAVEL �(,�GEOTEXTILE COVER , SEPARATION DISTANCES ON PLAN , FROfM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. x)20' TO FOUNDATION WALLS . 1100' TO WELL, 200' IN DLOD,150' TQ PITS Zi, 100'.TO STREAM,WATERCOURSE,.L&EL.(ine- ezpam). 50'•TO,CATCH- BASIN, 3S''STORNIDRAl-N , PMV WATER — 10' TO WATER LINE (pits - 20') 50'• IN`ITjtMITTENT DRAINAGE COURSE 9(___)200's00' RESERVOIp, ETC. 150' GALLEY SYSTEMS C—j(--)l0'MIN TO LEDGE.OUTCROP SEPTIC TANK (--/x—)10' FROM FOUNDATION; 50' TO WELL WELL ( e/J(�DIMENSIONS TO PROPERTY LINES (4j�(_)LOCATION OF SERVICE CONNECTION (�,)(�MIN 15' TO'PROPERTY LINE SLOPE U(=,SLOPE IN SSTS AREAL t- (a (S20 %) U(•)REGRADED TO 15 %, IF REQUIRED. ` (_J(-)P.UMP NOTES N /l'}- (--)(_,DOSE 75% OF PX• E'VOLUME/DOSE VOLUME NOTED U(�DETA,IL YORTORCE '.M&W, (PIPE TYPE, ETC.) L,)(_)P D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM UUSTANDPIPES, 5' BO ES, DETAIL L:—)L—J15' MIN to %, 20' -4 %, 25' -3 %, 35' -l' %,100 % -<1% (-J(_)20' CD DLSCE ARGE/100' with 182 cons day discharge L—J to NON - PERFORATED PIPE ., ......, .._ -- _ NT PEPARTM]EN�':. ®F_IIE.�LTFi _ IIIVISION OF ENVIRONMENTAL HEALTH SERVICES _ LETTER OF AUTHORIZATION RE: Property of ROBERT LEISENGANG Located at WICCOPEE ROAD TN PUTNAM VALLEY Tax Map # Subdivision of LEISENGANG 52.00 Block 2 Lot 53.1 Subdivision Lot # 2 Filed Map # � C Date Filed 0q1 ZoOr� Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in co tf6 ity- witlr tfrne- provisioiis -- ofArtic16145-6A&er-- 14T.0 .- CheEducati6n'14W Pftlic.,Health. Law, and the Putnam C9 it Code. JY Ebb ypR/f Countersigned: ` P.E R-A , # - a Mailing Addres `'S 62980 The Lindy �ler,, 2 John Walsh B' kskill State Ne w York Zip 10566 Very truly yours, Signed: ; (owner of Property) Mailing Address: 157 Wiccopee Road Putnam Valley State New York Zip 10579 Telephone: (914) 736 -3664 Telephone: (914) 526 -2061 Form LA -97 1 2. 4. 6. 7. PUTNAM COUNTY DEPARTMENT OF HEALTH . -DMI SION- OF�EN``IRONM—EN-TA�i HEALTH- SURVICES . APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM Name and address of applicant: ROBERT LEISENGANG 157 WICCOPEE ROAD PUTNAM VALLEY, NY 10579 Name of Project: LEISENGANG SSTS Design Professional: TIMOTHY L. CRONIN III Drainage Basin: PEEKSKILL HOLLOW BROOK Tvve Project: 3. Location: TQV: PUTNAM VALLEY 5. Address: 2 JOHN WALSH BOULEVARD PEEKSKILL, NY 10566 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) ? .............. Yes/No YES Type Status (check one) ...................................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No NO 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No N/A 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances ? ........................... . :.:..:..- .....,. :.:....................... ...Yes/No. 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No N/A 14. Has preliminary approval been granted by such authorities? N/A Date granted: N/A 15. Type of sewage treatment system discharge ........................ surface water 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? ................ :............... Yes/No NO 19. 20. 21. 22. 24. 25. 26. If yes, name of water supply Distance to water supply N/A Is project site near a public sewage collection or treatment system? .......... Yes/No NO Name of sewage system N/A Distance to sewage system _ 04/06/2006 MIKE LUKE Date test holes observed 12/19/2006 23. Name of Health Inspector JOE DIGIT N/A Project design flow (gallons per day) ............. 600 GPD Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No NO Has SPDES Application been submitted to local DEC office? Yes/No N/A Rev. 11/02 Form PC -97 Pg. I of 2 4: N 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No YES 28. Wetlands ID number .................................................................. ............................... NSA 29. Is Wetlands Permit required? LOCAL PERMIT ONLY Yes/No YES Has application been made to Town or Local DEC ........................... Yes/No YES 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No 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 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 NO DESCRIBE: BASED ON VISUAL OBSERVATIONS ONLY 33. YES Is there a local master plan on file with the Town or Village? .........................Yes/No 34. Are community water and /or sewer facilities planned to be developed within ' 15 years in or adjacent to project site? .................................. .........................Yes/No NO 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No NO 36. Tax Map ID Number .............. ............................... Map 52 . Block 2 Lot 53.1 ' -- 37. Approved plans are to be returned to .............. ... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent. to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by 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 1 the application must be accompanied by a Letter of Authorization (Form LA -97). Failuregp1p'lv1i; provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that infor ao ro 'ti this r is true to the best of my knowledge and belief. False statements ma er �' re pu ' 5as a A misdemeanor pursuant to Section 210.45 of the Penal L. ;; ',i. ILU SIGNATURES & OFFICIAL TITLES: ' TIMOTHY L. CRONI Z! SNP Mailing Address: 2 JOHN WALSH BOULE - PEEKSKILL, NEW YORK 10566 Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LFRI' ACE "gRWAGSt4RE -A`IMEN- 9SVST-- -EM- ") W ICf o0d;' 00" P UPAJ M Owner I I SeKC 4i j (A Address t S Located at (Street) (S% yji66oPt� -L- rZoAD Tax Map 57i Block Z Lot 5-b, I (indicate nearest cross street) . . Municipality �T� FLIE64AM `1 A-L,LI'U Watershed GI---- �� SOIL PERCOLATION TEST DATA Date of Pre - soaking 04- ZO .O(, Date of Percolation Test e� 4- ZI - 06 Hole No. Run No. Time Start - Stop Elapse Time (IViin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Alin /Inch 121 j 1 t.o 3'4 'Lq- I _ 2') I 3 7-1 t, I 2 3q_ci 3 a -loZg 30 20 - z.3 I 3 I to 4 p''8_105e 3o I tiv - Z 3 3 I to 5 611'+— 2 4 BAH_ 51 I Z I Zv -7- I 3 5 P3 1 9sa -�S4 1 —Z�t I I 3 2� k 2 9 54 - 101,4 3 ►d��f, lDt9 1� ZI -z`+ I I 5 4 5 NOTES: 1. Tests to be repeated at same depth until approximate[y equal percolation rates are obtained at each percolation test hole. (i.e. :- 1 min for 1 -30 minhnch, <_ 2 min for 31 -60 min inch). All data to he submitted for revIe W. 2. Depth measurements to be made from top of hole. TEST PIT DATA l DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES OLE NO ?f: HOLE NO. NO G.L. LL i L 0.5' 1.0' 1.5' wN 1i_ 2a G tea^^ 2.0' 2.5' 3.0' a„_. P.I. _ 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 1 w ki0k C 6)Ut 8.0' t .�► -cun . 4;,�a -nom c� S . 5 8.5' 9.0' 9.5' 10.0' IT- Indicate level at which groundwater is encountered 5tg: '.4011 Indicate level at which mottling is observed blowt% o8�zr'1Zvu)D Indicate level to which water level rises after being encountered SGT pp-)�vc Deep hole observations made by: GAO — c- Gov eN6. Date o4r- p b •0& obt'N r+1�1 Design Professional Name: t�ao't t_ 1.t2®1�W Address: L 0 5b� EW l Signature: U Cam` W Desib �-P, fes al s S 0 617.20 SEAR Appendix C State Environmental Quality Review SHORI° ii'- ENVIRr`DiVMENTAL-ASSESSMENT FORK. _::..:. For UNLISTED ACTIONS Only PART I- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) I, APPLICANT /SPONSOR 2. PROJECT NAME Robert Leisengang Single Family Residence Construction 3, PROJECT LOCATION: Municipality: Town of Putnam Valley County: Putnam County 4. PRE61SE LOCATION (Street address and road intersection , prominent landmarks, etc., or provide map) Wiccopee Road, Tax Map: Sec. 52.00 Block 2 Lot 53.1 Sub/ot 2 North Side of Wiccopee Road 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construct New Single Family Residence 7. AMOUNT OF LAND AFFECTED: Initially 5.33 acres Ultimately 5.33 acres (5.33 acres is size of parcel) 8, WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? S Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: .._.V..DQES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY FEDERAL, STATE OR LOCAL? - • - - -- - --- -- - - =- = = -. -- = _.. -.__ J Yes ❑ No If yes, list agency(s) and permit/approvals Surrounding lands are zoned single family residential 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑ No If yes, list agency name and permit/approval PCDH- Realty Subdivision approval Town of Putnam Valley- Subdivision approval, Building Permits, Wetland Permits, Development Plan Approval, Driveway Permit 12, AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes §No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor e: Cronin n ineerin P.E. P.C. /James W. Teed Date: An'FIt, Signature If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II - ENVIRONMENTAL ASSESSMENT (To be completed by Agency) LGE G it✓N€XC €EJ= ANY.7Y'PF:!:;THRF.S Ql l3.!Hs6:�lY R1 , PA?R 617 127,,, 4,., coordinate the review process and use the FULL EAF. -✓` ` ` -` -" B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617,67 If No. a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal. potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources: or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish. shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4, A Community's existing plans or goals. as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly, C5. Growth, Subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D.-WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CASUED THE °STABLISHM[ti�T'OF-A CRIT?CgL ENVI.RO!�IMENTAL A,REA;(CEA) ?.C] Yes [1 Np • Y if Yes, explain briefly - _.M1 _:.....w�..._.., .... _... . E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? M Vo M Nln If Vnc c nl.in hrinflu PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑Check this box if you have determined, based on the information and analysis above and any supporting 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: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer) .-I- ' Fe,b 27 07 .02:07P Planning Board (845) 52.6 -3307 p.1 TOWN OF PUTNAM VALLEY • MICHEAI, RADVIONDI... ..._.. < ..,....:.......,.._:, _ .. _. , , - ,_ ,.. HN =•Z ARC ONEi.IRs.• za. . Chairman PLANNING BOARD Secretary EUGENE YETTER, JR. 265 Oscawana Lake Road RICHARD TULLY Vice Chairman Putnam Valley, NY 10579 -2004 BILLY CROWDER CORNERSTONE ASSOCIATES (845)526 -3740; Fax: (845)526- 3307 -- TOM CARANO Town Wetlands Inspector (Ad Hoc) THE CHAZEN COMPANIES E -mail llussier@aputnamvalley.com LAURA LUSSIER Town Planner Clerk FOLCHETTI & ASSOCIATES, LLC Town Engineer February 26, 2007 LEISENGANG, DONALD AND NANCY FINAL SUBDIVISION APPROVAL SITE DEVELOPMENT PLAN APPROVAL WETLANDS PERMIT MAJOR GRADING PERMIT - WICCOPEE ROAD TM: 52.-2-53.11 FILE: 52./1005/1003 & 1004 . WHEREAS, the applicant is proposing a 2 -Lot subdivision on 56.7 ( + /-) acres of land located on Wiccopee Road in the Conservation (CD) Zoning District; and WHEREAS, the subject site is located within the Ground and Surface Water Protection (WP) Overlay District, the Hillside Management (HM) Overlay District, and the Wetland and Watercourse (W) Overlay District; and WHEREAS, the proposed 2-lot subdivision will only result in the construction of 6-he -single= " family residence; and WHEREAS, a habitat assessment has been conducted for the presence of both the Timber Rattlesnake and Wild Hydrangea by the Town Wetlands Inspector (see report conducted by Bruce Barber, dated July 17, 2006). The assessment concluded that no evidence of wild hydrangea was observed and conditions do not seem suitable to support said species. However, there is suitable habitat for the Timber Rattlesnake on Lot 1 and a conservation easement will be placed on certain areas to protect this habitat; and WHEREAS, the applicant is proposing to conserve approximately 34% of the parcel (19.5 acres) by establishing a permanent conservation easement on Lot 1, where the habitat described above is primarily located; and WHEREAS, the subject parcel is located in an Agricultural District and an Agricultural Data Statement has been submitted by the applicant and ' Fe,b 27 07 02:07p Planning Hoard (845) 526 -3307 p.2 � WHEREAS . -the. Code_.Enforcement Officer has determined that a Major Grading Permit is required; and WHEREAS, in accordance with Section 165-16 of the Zoning Code, a Site Development Plan is required; and WHEREAS, a wetlands permit is required from the Planning Board for disturbance within 100 - feet of a Town regulated wetland; and WHEREAS, the Planning Board has reviewed the proposed action in accordance with Chapter 56 "Subdivision Regulations" and Chapter 155 "Soil Erosion and Sediment Control," and Chapter 165 "Zoning" of the Putnam Valley Town Code; and WHEREAS, the application and project plans were approved on October 3, 2006 by the Putnam County Department of Planning under Sections 239-n and 239.-m of General Municipal Law; and WHEREAS, a public hearing on the Preliminary Plat, Site Development Plan, Wetlands Permit, and Major Grading Permit was opened and closed on November 13,-2006; and WHEREAS, a Negative Declaration. and Conditional Preliminary Subdivision Approval was granted on November 13, 2006; and WHEREAS, the applicant has submitted a Final Plat and Site Development Plan in accordance with the Planning Board's November 13, 2006 resolution; and WHEREAS, on February 12, 2007, the Planning Board determined that since the project plans have not substantially changed, a final public hearing is not necessary. • NOW,_'THERKFORE;'BE.IT- RESOLVED -THAT; -the Planning-Boa-rd' Hereby approves tfie-Final Subdivision Plat (Sheet SP1.0) titled "Subdivision and Development Approval Plan for Donald for Nancy Leisengang," prepared by Baxter Land Surveying, P.C., last revised January 11, 2007, subject to the below-listed conditions; and BE IT FURTHER RESOLVED THAT, the. Planning Board hereby approves the Site Development Plan (Sheets SP1.0, SP1.1, UD2.1) titled "Subdivision and Development Approval Plan. for Donald for Nancy Leisengang;" prepared by Cronin Engineering, P.E., P.C., last revised January 11, 2007, subject to the below-listed conditions; and BE IT FURTHER RESOLVED THAT, the Site Development Plan is valid for a period of 18 months after said Plan has been signed by the Chairman and may be extended once, at the request of the applicant, by the Planning Board for a period not to exceed six months; and BE IT FURTHER RESOLVED THAT, the Wetlands Permit is hereby approved subject to the below-listed conditions and the signing of the Site Development Plan and shall be valid for a period of three years from the signing of the Site Development Plan. All work associated with the Wetland Permit shall be conducted in strict compliance with the approved Site Development Plan and shall be completed within six months following the initiation of construction; and a Feb 27 07 02:07p Planning Hoard (845) 526 -3307 p.3 "f'P`FURTHER "'RRSfiiI. Ei'r i1 AAT; =thy s; etl i dsF..P -, rat::shal1z?;utQi3?4 ti C,lly ,e_xpire- upon. -. - -- - completion of work; and - r BE IT FURTHER RESOLVED THAT, a Major Grading Permit is herby issued subject to the signing of the Site Development Plan by the Chairman; and BE IT FURTHER RESOLVED THAT, the Major Grading Permit shall expire six months after the signing of the Site Development Plan by the Chairman; and BE IT FURTHER RESOLVED THAT, the below-listed conditions must be completed within 180 days of the date of this resolution. Should the below-listed conditions not be completed within the allotted time flame, this resolution shall become null and void unless a 90-day extension is requested by the applicant in writing, prior to said 180 days, and granted by the Planning Board: Conditions to be satisfied prior to the signing of the Subdivision and Site Development Plan: 1. Submission of all applicable fees and escrow. 2. Construction Monitoring Escrow in the amount of $2,500 shall be submitted to the Planning Board Clerk. 3. A recreation fee in the amount of $5,000 (certified or bank check) shall be submitted to the Planning Board Clerk. 4. The applicant must satisfactorily address any outstanding comments provided by the Town Planner. 5. The Town Planner shall prepare a final report identifying resolution conformance. 6. All legal documentation associated with the conservation easement shall be provided to the Planning Board and shall be prepared to the satisfaction of Planning Board Counsel. _ 7. Maintenance requirements and schedule for on-site stormwater facilities, prepared to the - "�;atisfactioii Hof the--Town- engineer;- shall- spj :6&c:.oa thePjap§ and .annual written_xeports . prepared by a Certified Professional in Erasion and Sediment Control (CPESC) or professional engineer, certifying satisfactory and timely compliance, shall be submitted to the Town. A deed declaration, satisfactory to Planning Board Counsel, imposing this obligation on the current and future owner(s), shall be recorded. 8. Sight distances shall be illustrated on the Plan. 9. The names and addresses of the abutting property owners shall be provided on the Plan. 10. The final subdivision plat to be signed by the Planning Board Chairman shall be produced on Mylax. The Planning Board Chairman shall only sign the final plat when the plat has been previously signed by a New York State Licensed Professional Engineer, New York State Licensed Land Surveyor, the owner of the land, and the Putnam County Department of Health. The applicant shall also produce eight original copies of the final plat and .Site Development Plan, complete with signatures, to the Planning Board for the Chairman's signature. Feb 27 07 02:08p Planning Board _ _Conditions of the Wetlands Permit (845) 526 -3307 p.4 11. The Applicant shall allow periodic inspections by the Town and its consultants before, -` during, and after construction. 12. The Town Wetland Inspector shall inspect the site at the end of construction but prior to the issuance of a certificate of occupancy to insure compliance with the Wetland Permit. 13. This Wetlands Permit shall be prominently displayed at the project site during construction. Additional requirements to be satisfied subseg,.uent to the signing of the subdivision and site development plan: 14. At least two business days prior to the commencement of the work, the applicant shall apply .to the Code Enforcement Officer for a permit to commence work, pursuant to Chapter 155, Soil Erosion and Sedimentation Control, of the Code of the Town of Putnam Valley. 15. Prior to the issuance of a Building Permit, a site inspection shall be conducted with the applicant, contractor, Building Department, Highway Department, Town Engineer, Town Planner, and Town Wetlands Inspector. 16. Prior to the issuance of a Certificate of Occupancy, a final site inspection shall be conducted with the applicant, contractor, Building Department, Highway Department, Town Engineer, Town Planner, and Town Wetlands Inspector. 17. Prior to the issuance of a Certificate of Occupancy, an as-built survey demonstrating compliance with the approved Site Development Plan shall be submitted to the Planning Board, Town Engineer, Town Planner, Town Wetlands. Inspector, and Code Enforcement Officer. 18. Prior to the issuance of a Certificate of Occupancy, the Building Department shall confirm with the Planning Board Clerk that all consultant fees have been paid in full. Motion: Eugene T. Yetter, Jr. Second: Billy L. Crowder Tom Carano Eugene T. Yetter, Jr. Richard Tully John Zarcone, Jr. Billy L. Crowder Chairman Michael Raimondi BY: h an Michael Raimondi r` Yea Nay Abstention Absent X X X X X X ' -Feb 27 07 02:08p Planning Board (845) 526-3307 p.5 The Planning Board, Clerk hereby confirms that conditions 1-10, identified above, have been ';'s; "a n---. 'i&diVisidif` A. A- S -it ez De wlo m e nttn :14 s.R,Xep�4,signed by,the Chairman of the Planning Board. Confirmed BY: Date: U PUTNAM COUNTY-DEPARTMENT OF HEALTH. '+ -DST ION OF = EN!WRO =. - ENTAL - HEAl.4T ,SERVICES , ....-. CPXSTRUCTION P RMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # LoCated at WICCOPEE ROAD Town or Village PUTNAM VALLEY Subdivision name LEISENGANG Subd. LOt # 2 Tax Map 52 Block 2 Lot 53.1 Date Subdivision Approved AML, 15 Zoo`V Renewal Revision Owner/Applicant Name ROBERT LEISENGANG Date of Previous Approval Mailing Address 157 WICCOPEE. ROAD. PUTNAM VALLEY. NEW YORK Zip 10579 Amount of Fee Enclosed $400 Building Type SINGLE FAMILY "s Lot Area 5.33 AC. No. of Bedrooms ',4 �_� Desi Flow GP zoo Fill Section Only Depth Volume Separate Sewerage Sys to consist of 1250 gallon septic tank and 3 3 3 L . F . 4" DIA. PERFORATED PVC IN 24" TRENCH FILLED WITH 3/4 ". TO 1 -1/2" WASHED GRAVEL: Other Requirements: 24" BANKRUN To be constructed by To BE DETERMINED Address wMer Serdnly: - _Public Supply from - - - Address. Private Supply Drilled by' To BE DETERMINED Address ' I represent that I am wholly and completely responsible for the design and location. of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Departmdnk,,_1 n guarantee will be furnished the owner, his successors; heirs or assigns by the builder, that said buildell g6d' crating condition any part of said sewage treatment system during the period of two (2) years im I Id C4 of the issuance of the approval of the Certificate of Construction Compliance of the original P.E. R.A. X -DateArgiL 141 20 'fi ` , 2 JOHN. WALSH BOULEVARD, PEEKSKILL, NY 062980 LINDY BU � License # APPRO _ „'.N TRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or maybe amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Grange copy - Design Professional Form CP -97 IME-1R 1111� F TRANSMITTAL CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: SSTS Plan for Robert Leisengang Tax Map Sec: 52 Block: 2 Lot: 53.1 Wiccopee Road, Putnam Valley THESE ARE TRANSMITTED as checked below: April 16, 2007 X FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY Dear Mr. Paravati, In reference to the above mentioned project please find the following: 1.) Three copies Construction Permit Application 2.) Letter of Authorization (1 Original) 3.) Application for Approval of Plans for a Wastewater Treatment System 4.) Short Environmental Assessment Form 5.) Design Data Sheet 6.) Four copies of Subsurface Sewage Treatment System Plan 7.) 2 sets of house plans 8.) Three copies Well Permit ApplicaY n 9.) Check for the Application Fee ' 10.) Planning Board Approval Notice which includes Wetlands Permit Please review at your earliest convenience. Thank you for your assistance in this matter. J s W. Teed Project Engineer t4' )4' .1 P��pE�.NGANG. N �F LEISE SIB NCY A'". NA 7 —A � I' AS•BUILT JUNCTION BOX (TYPICAL INSTALLATION) t36 L.F. OF 4 "0 HDPE ASTM FB10 PIPE 22.5' BEND AS BUILT SEPC TANK „ (1250 GALLON COTINCRETE) 45" BEND CLEANOUT d*0 SDR -35 PVC PIPE j / APPROXIMATE WELL TANK i WELIXTROL MODEL WX262 A CR TS 5 PRO PSI APPROXIMATE WATER SERVICE / / AS -BUILT WELL LOCATION i / i i DIRT DRIVE _ _: -------- -- 9i ih 10D% EXPANSION irch -.-.. . .-.. 24" MIN. BANKRUN FILL t7. 1 IMPERVIOUS CLAY BOUNDARY ---'--- -_--- = ao�m.•_ girth _ _ - 40.E J ,,,rrr•••�� ALL TRENCH ENDS 16" ARE CAPPED �"�' PRIMARY S.S.T.S. AREA 33:a . . 333 L.F. OF 4 "0 16' h 14 ; Z" PERFORATED PVC PIPE g D Twin 4 IN 24" GRAVEL TRENCHI 4,P WI FILTER FABRIC 12:5' y ABSORPTION TRENCH (TYPICAL INSTALLATION) a phis -� c 14 "0 HDPE FOOTING DRAINI E l` WETLAND DELINE AS FLAGG I STEVE COLEMI MAY7 op tl 1 1� l i i i.